Repair of High-Risk Incisional Hernias and Traumatic Abdominal Wall Defects with Porcine Mesh

2011 ◽  
Vol 77 (2) ◽  
pp. 144-150 ◽  
Author(s):  
Matthew C. Byrnes ◽  
Eric Irwin ◽  
Dana Carlson ◽  
Amy Campeau ◽  
Jonathon C. Gipson ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Medical Records ◽  
Average Duration ◽  
Early Recurrence ◽  
Biologic Mesh ◽  
Fascial Closure ◽  
Abdominal Wall Defects ◽  
Technical Failures ◽  
Ventral Hernias

Complex ventral hernias represent a significant challenge to surgeons. We hypothesized that a wide underlay technique in combination with a novel biologic mesh would result in repair with a low recurrence rate. Medical records of patients undergoing ventral herniorrhaphy with Xen-Matrix biologic mesh were evaluated. All patients were evaluated for hernia recurrence both immediately and after 2 to 3 years. There were 57 patients included in the study. The overall recurrence rate was 7.2 per cent; however, all recurrences were early and were likely technical failures. The average duration of follow-up was 30.6 months with no further recurrences after the early technical failures. The average number of previous recurrences was 1.5. Fascial closure was obtained over the mesh in 84 per cent of patients, with component separation being necessary in 36 per cent of patients. Lack of fascial reapproximation over the mesh was associated with early recurrence (0 vs 55%, P < 0.0001). Complex ventral hernias can be repaired with a low recurrence rate. Our technique in combination with the XenMatrix biologic mesh provides for durable repair. Whenever possible, the fascia should be closed above the underlay mesh, because this technique provides a more durable repair than using the mesh as a “fascial bridge.”

scholarly journals RECURRENCE RATE OF HELICOBACTER PYLORI IN PATIENTS WITH PEPTIC ULCER FIVE YEARS OR MORE AFTER SUCCESSFUL ERADICATION

2016 ◽  
Vol 53 (3) ◽  
pp. 152-155 ◽  
Author(s):  
Yuri Costa Farago FERNANDES ◽  
Gabriel da Rocha BONATTO ◽  
Mauro Willeman BONATTO
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Recurrence Rate ◽  
Early Recurrence ◽  
Peptic Ulcers ◽  
Ulcer Disease ◽  
Gastroduodenal Mucosa ◽  
H Pylori

ABSTRACT Background Infection with Helicobacter pylori is highly prevalent worldwide, especially in developing countries. Its presence in the gastroduodenal mucosa is related with development of peptic ulcer and other illnesses. The eradication of H. pylori improves mucosal histology in patients with peptic ulcers. Objective This study was aimed to verify if H. pylori recurrence occurs five years or more after confirmed eradication in patients with peptic ulcer. Moreover, we sought to determine the recurrence rate. Methods Retrospective and longitudinal, this study was based on a sample of 201 patients from western Paraná, Brazil. The patients were diagnosed with peptic ulcer disease, in the period of 1990-2000, and followed for five years or more after successful H. pylori eradication. Patients with early recurrence - prior to five years after eradication - were excluded from the sample. Results During an average follow-up of 8 years, 180 patients (89.55%) remained negative, and 21 (10.45%) became positive for H. pylori infection. New ulcers appeared in two-thirds of the patients with H. pylori recurrence. Conclusion The recurrence of H. pylori in patients with peptic ulcer can occur in the long-term - even if the infection had been successfully eradicated and the patients had remained free of recurrence in the first years of follow-up.

Bilateral inferior petrosal sinus sampling: experience in 327 patients

2016 ◽  
Vol 9 (2) ◽  
pp. 196-199 ◽  
Author(s):  
Amy Deipolyi ◽  
Alexander Bailin ◽  
Joshua A Hirsch ◽  
T Gregory Walker ◽  
Rahmi Oklu
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Inferior Petrosal Sinus ◽  
Technical Success ◽  
Cushing Disease ◽  
Inferior Petrosal Sinus Sampling ◽  
Technical Success Rate ◽  
Technical Failures ◽  
Groin Hematoma

ObjectiveTo describe findings and outcomes of 331 bilateral inferior petrosal sinus sampling (BIPSS) procedures performed in 327 patients evaluated for Cushing disease (CD).Materials and methodsThe radiology department's electronic database was searched to identify all BIPSS procedures (1990–2013). Electronic medical records were used to identify demographics, laboratory, procedural, surgical and pathologic findings.ResultsA total of 331 BIPSS procedures were performed in 327 patients (254 F, 73 M), mean age 41 (range 7–81) years. The overall technical success rate was 88% for bilateral cannulation, though nearly two-thirds of the technical failures had unilateral sampling that diagnosed CD. Of the 331 BIPSS procedures, 40 were performed without, and 291 with stimulation by Acthrel or desmopressin. Sensitivity was 89–94% for unstimulated BIPSS, 96% for stimulated BIPSS, and 77% for MRI. BIPSS lateralization was accurate in about half of patients, compared with 75% accuracy for MRI. Mean inferior petrosal sinus (IPS):peripheral adrenocorticotropic hormone ratio was 17.3 (SE 1.8) at baseline, and 99.2 (SE 14.8) at 3 min, with decreasing values over time. All patients with follow-up after surgical resection for centralizing BIPSS were reported to be cured, with cortisol levels significantly decreased from 19 to 4 μg/dL (p<0.0001). Complications from BIPSS were rare, including groin hematoma (2.5%), but no thromboembolic complications were seen.ConclusionsBIPSS remains the ‘gold standard’ for diagnosing CD. Stimulation with Acthrel or desmopressin is key to increasing specificity. When only one IPS can be successfully cannulated, results may still be diagnostic. BIPSS findings cannot be used to accurately lateralize lesions within the pituitary.

scholarly journals Three Years’ Experience of Management of Different Types of Rhinosporidiosis in Rural Part of Western West Bengal

2015 ◽  
Vol 23 (3) ◽  
pp. 92-98
Author(s):  
Debdulal Chakraborty ◽  
Chiranjib Das ◽  
Rajesh Hansda
Keyword(s):  
Recurrence Rate ◽  
West Bengal ◽  
Tertiary Care ◽  
Surgical Excision ◽  
Complete Removal ◽  
Early Recurrence ◽  
Care Hospital ◽  
Different Types ◽  
Very High

Introduction: The incidence of different types of rhinosporidiosis is very high in the rural western part of West Bengal.  The treatment of choice is surgical excision and cauterization of the base. The recurrence rate is very high. Aims and objectives: The objectives of this study were to assess the distribution of rhinosporidiosis according to age, sex, presenting features, site of origin, recurrence rate and compare them with literature; and describe the surgical technique to reduce recurrence of the disease. Materials and methods: This prospective case study was done in the department of Otorhinolaryngology in a tertiary care hospital in the western part of West Bengal from April 2012 to March 2015. Wide local excision of rhinosporidiosis along with electrocautery of the base was done. We took the help of endoscope and microscope whenever needed. Regular follow up with endoscope was done in postoperative period. Results: Out of total 112 patients 62 were male and 50 were female. Commonest age group affected was 2nd decade. There was no recurrence in patients undergoing operation for the first time. Recurrence was noted in nasopharynx of 3 patients undergoing revision surgery. Conclusion: Complete removal of rhinosporidiosis from the base is the basic criterion to reduce recurrence. It is possible by using meticulous technique along with the guidance of endoscope or microscope whenever needed. Regular postoperative follow up with endoscope is must to detect and treat early recurrence. 

scholarly journals Congenital Abdominal Wall Defects: Staged closure by Dual Mesh

2015 ◽  
Vol 5 (1) ◽  
pp. 2
Author(s):  
Kirsten Risby ◽  
Marianne Skytte Jakobsen ◽  
Niels Qvist
Keyword(s):  
Abdominal Wall ◽  
Fascial Closure ◽  
Abdominal Wall Defects ◽  
Post Discharge ◽  
Safe Alternative ◽  
A Minor ◽  
Primary Fascial Closure ◽  
Abdominal Compartment ◽  
Congenital Abdominal Wall Defects

Objective: To evaluate the clinical utility of GORE® DUALMESH (GDM) in the staged closure of large congenital abdominal wall defects.Materials and Methods: Data of patients with congenital abdominal wall defects managed with GDM was analyzed for outcome regarding complete fascial closure; mesh related complications; and post-discharge gastrointestinal surgery.Results: GDM was placed in 34 (gastroschisis=27, omphalocele=7) patients during the study period. Complete closure of the fascia was obtained in one patient with omphalocele and in 22 patients with gastroschisis. Mesh related surgical complications were seen in five (15%) children: four had detachment of the mesh and one patient developed abdominal compartment syndrome. Mesh related clinical infection was observed in five children. In hospital mortality occurred in four cases (2 gastroschisis and 2 omphalocele) and was not procedure-related. Of the 30 children discharged, 28 (82%) were still alive. At follow-up, three patients (10%) were operated for a minor ventral hernia and 4 children were operated (laparotomy and adhesionolysis) for adhesive intestinal obstruction.Conclusion: Staged closure with GDM is a safe alternative when primary fascial closure is difficult.

Evaluation of factors related to late recurrence (later than 10 years after the primary treatment) in early breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11557-e11557
Author(s):  
Reiki Nishimura ◽  
Tomofumi Osako ◽  
Yasuyuki Nishiyama ◽  
Rumiko Tashima ◽  
Masahiro Nakano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Recurrence Rate ◽  
Early Breast Cancer ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Primary Treatment ◽  
Lymph Node Status ◽  
Ki 67

e11557 Background: Breast cancer is associated with a relatively good prognosis and heterogeneity. Prognostic factors examined to date are related to early recurrence while those related to late recurrence and their countermeasures remain unclear. Therefore, we examined the factors related to late recurrence, later than 10 years after primary treatment, in early breast cancer. Methods: From 1980 to August 2012, 4774 patients who underwent primary treatment, including operation and estrogen and progesterone receptors (ER and PgR) measurement, were enrolled in this study. The patients were divided into two groups, those with a follow-up period within 10 years, and those (1323 patients) without any recurrence at 10 years but who continued follow-up examinations. Recurrence occurred in 711 patients within 10 years and occurred in 51 patients from ≥10 years. The items examined were tumor size, lymph node status, and biological markers such as ER, PgR, Ki-67 values, p53 and human epidermal growth factor receptor 2 (HER2) expressions. Results: The overall 10-year cumulative disease-free survival (DFS) rate was 79.5%, and the recurrence rate at ≥10 years was 5.8% (some cases had recurrence 20 years later). A multivariate analysis revealed that the factors related to late recurrence were positive nodes and PgR positive. This result differed from that for early recurrence, where the DFS rate was low in patients with ER/PgR negative, high Ki-67 index values and p53 overexpression. Conclusions: The PgR positivity and lymph node metastasis significantly correlated with late recurrence (later than 10 years after primary treatment) in early breast cancer. Therefore, it is important to evaluate appropriate measures such as treatment period and treatment regimen for hormone-sensitive (ER and/or PgR positive) patients. In addition, how to inform patients about the recurrence rate and recurrence time from the initial treatment, and the Informed Consent regarding the follow-up period and surveillance plan must be examined.

Prediction of early relapse in patients with operable breast cancer by detection of occult bone marrow micrometastases.

1991 ◽  
Vol 9 (10) ◽  
pp. 1749-1756 ◽  
Author(s):  
R J Cote ◽  
P P Rosen ◽  
M L Lesser ◽  
L J Old ◽  
M P Osborne
Keyword(s):  
Bone Marrow ◽  
Recurrence Rate ◽  
Early Recurrence ◽  
Tumor Burden ◽  
Treatment Programs ◽  
Axillary Lymph ◽  
Bone Marrow Micrometastases ◽  
Long Term Follow Up

We used monoclonal antibodies to identify occult micrometastases in the bone marrow of 49 patients with operable (stage I and II) breast carcinoma. Follow-up (mean, 29 months; median, 30 months) revealed that 12 patients recurred. The presence of bone marrow micrometastases (BMM) was significantly associated with early recurrence (P less than .04). The estimated 2-year recurrence rate for patients with no BMM detected (BMM-) was 3%; in patients with BMM, the 2-year recurrence rate was 33%. When BMM and axillary lymph node (LN) status were combined, groups of patients at low risk (LN-, BMM-; 2-year recurrence rate, 0%) and high risk (LN+, BMM+; 2-year recurrence rate, 42%) for early recurrence were identified. Bone marrow tumor burden was related to early recurrence. Among patients with BMM, those who did not recur had on average fewer extrinsic cells in their marrow than those who recurred (15 v 43 cells, respectively). Multivariate analysis comparing BMM, LN+ versus LN-, and tumor size (less than or equal to 2 cm v greater than 2 cm) revealed no factor independently associated with early recurrence. Peripheral tumor burden of BMM (0 or less than 10 extrinsic cells v greater than or equal to 10 extrinsic cells) was the only independent predictor of early recurrence (P less than .003). In conjunction with conventional prognostic factors, particularly axillary LN status, evaluation for BMM might be used to stratify patients for adjuvant treatment programs. Because this pilot study involved few patients with short-term follow-up, the results should be interpreted with caution. The examination of bone marrow for micrometastases remains an experimental procedure; the clinical usefulness of the test will be established through larger studies with long-term follow-up.

scholarly journals Recurrence of hyperparathyroidism; a long-term follow-up after surgery for primary hyperparathyroidism

2003 ◽  
pp. 413-421 ◽  
Author(s):  
G Hedback ◽  
A Oden
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Creatinine ◽  
Recurrence Rate ◽  
Medical Records ◽  
Elevated Serum ◽  
Large Patient Series ◽  
Large Patient ◽  
Patient Series

OBJECTIVE: In general it is thought that recurrence of primary hyperparathyroidism is a rare event. To our knowledge, however, only one large patient series has been reported with a mean of more than 7 years of follow-up. The aim of the present study was to determine the long-term recurrence rate in 785 out of 886 patients operated on for primary hyperparathyroidism and followed-up for a mean of 10.03 years after surgery. DESIGN: Medical records were scrutinised. The patients who were still alive answered a questionnaire and had laboratory tests. METHODS: Follow-up data concerning the state of health, medical treatment, other diagnoses, renal function, and serum calcium and creatinine levels were found in the medical records of 203 patients, and were registered at the start of investigation of 582 patients. Intact parathyroid hormone values were determined in 252 patients. Recurrence rate and 95% confidence interval (C.I.) were calculated. RESULTS: Recurrence rate of hyperparathyroidism with constant or intermittent hypercalcaemia (n=39) was 4.97% (95% C.I.=3.45-6.74%) during a mean of 10 years of follow-up. Nine out of 39 had elevated serum creatinine levels. Recurrence rate of hyperparathyroidism with normal serum creatinine levels, including patients with normocalcaemia, intermittent hypercalcaemia, and constant hypercalcaemia was estimated to be 7-8% during a mean of 10 years of follow-up. CONCLUSIONS: Recurrence rate was determined with reasonable precision in this large patient series, and recurrence of hyperparathyroidism cannot be considered to be extremely rare, but it may occur more than 20 years after treatment in both single and multiple gland disease.

scholarly journals Peritoneal flap mesh hernioplasty: A reliable option for difficulty in closure of complex ventral hernia: A case report

2020 ◽  
Vol 13 (2) ◽  
pp. 188-191
Author(s):  
Bhawani Khanal ◽  
Sunit Agrawal ◽  
Suresh Sah ◽  
Roshan Gurung ◽  
Rakesh Kumar Gupta
Keyword(s):  
Case Report ◽  
Ventral Hernia ◽  
Early Recurrence ◽  
Primary Defect ◽  
Complex Ventral Hernia ◽  
Peritoneal Flap ◽  
Ventral Hernias ◽  
Mesh Hernioplasty ◽  
Abdominal Compartment

Peritoneal flap mesh hernioplasty is a technique to deal with complex ventral hernias in which primary closure of the defect is not attainable. We are here presenting a case report of a 50-year-old gentleman with huge complex ventral hernia with loss of domain. The patient also had overlying ulcerated and blackish colored skin. Botulinum toxin was infiltrated into the muscles of anterior abdominal wall and was followed by peritoneal flap mesh hernioplasty after one month. The final outcome was complete closure of the midline with a healthy skin with no evidence of abdominal compartment syndrome. There was no evidence of early recurrence on follow up. Owing to the favorable outcome in this case, suitability of peritoneal flap mesh hernioplasty technique in treatment of complex ventral hernia could be explored further where closure of the primary defect is difficult.  

J 5 — A Data Processing System for Medical Information

1967 ◽  
Vol 06 (01) ◽  
pp. 1-6
Author(s):  
P. Hall ◽  
Ch. Mellner ◽  
T. Danielsson
Keyword(s):  
Medical Records ◽  
Medical Information ◽  
Health Care Systems ◽  
Processing System ◽  
Linear Pattern ◽  
Flexible Form ◽  
Care Systems ◽  
Pattern Recognition Analysis ◽  
Numeric Information

A system for medical information has been developed. The system is a general and flexible one which without reprogramming or new programs can accept any alphabetic and/or numeric information. Coded concepts and natural language can be read, stored, decoded and written out. Medical records or parts of records (diagnosis, operations, therapy, laboratory tests, symptoms etc.) can be retrieved and selected. The system can process simple statistics but even make linear pattern recognition analysis.The system described has been used for in-patients, outpatients and individuals in health examinations.The use of computers in hospitals, health examinations or health care systems is a problem of storing information in a general and flexible form. This problem has been solved, and now it is possible to add new routines like booking and follow-up-systems.

Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

2013 ◽  
Vol 154 (33) ◽  
pp. 1291-1296 ◽  
Author(s):  
László Romics Jr. ◽  
Sophie Barrett ◽  
Sheila Stallard ◽  
Eva Weiler-Mithoff
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Breast Conservation ◽  
Malignant Lesion ◽  
Surgical Techniques ◽  
Incomplete Resection ◽  
Immediate Reconstruction ◽  
Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

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