Comparative Experimental Evaluation of the Effectiveness of Composition and PTFE Prostheses in Plastic Hiatal Hernia

The purpose of this study was to determine the optimal synthetic material for prosthetic hiatal hernia. Materials and methods. Experimental study was carried out in 24 adult rabbits of different sexes. In the ex-periment prosthetic hernioplasty hiatal hernia was simulated. The animals were divided into two groups: 12 hernioplasty with implantation of a monofilament macroporous lightweight composite prosthesis (50% polypropylene, 50% monocryl) and 12 hernioplasty with implantation of a microporous prosthesis from polytetrafluoroethylene PTFE. Comparative analysis of reparative processes in the implantation of endoprosthesis was carried out in the 7th, 30th, 90th and 180th postoperative day. Results. Intra-operative complications in the groups didn’t registered. In the postoperative period after implanta-tion of the composite prosthesis in all periods, the complication wasn’t identified. There are the complications in 3 cases (25%) of the use of PTFE prosthesis in the late postoperative. One patient was found to displacement of the implant on 90th day of the experiment, and 2 observations - cigar-shaped deformation of the prosthesis on the 90th and 180th days of the postoperative period. Feature of the morphological picture in the implantation of the prosthesis PTFE was a large amount of thick convoluted collagen fibers, not germinating implant. The implant is made of composite material, was surrounded by a thin, soft fiber, uniform layer of mature connective tissue with an orderly arrangement of collagen fibers sprouting prosthesis. Conclusion. It was established that the most suitable implant for plastic hiatal hernia is a composite prosthesis as firmly fixed to the diaphragm germinating its connective tissue and has no tendency to shift. The implantation of PTFE prosthesis has a more favorable course of the wound process, however, the implant doesn´t invade connective tissue and is encapsulated with the formation of rough scar.

Popliteal Aneurysms as a Cause for Arterial Insufficiency

Summary Clinical manifestations, possibilities for accurate diagnosis of popliteal aneurysms, and operative approaches applied depending on their location are presented, as well as results from treatment over a four-year period. Popliteal artery aneurysms accounted for 5.63% of all 266 cases of acute arterial insufficiency. The mean age of the patients was 68.8 years, and the male:female ratio – 4:1. In five patients (33.33%), the localization of aneurysm was unilateral. In 80% of the cases with bilateral popliteal aneurysms, the aneurysms were combined with aneurysms of other locations. The surgical technique applied was posterior approach with resection of the aneurysm and interposition of a polytetrafluoroethylene (PTFE) prosthesis. The early patency rate of the reconstructed segment was 100%. Late patency rate of the reconstructed segment was 90.9%. Despite the better late results in femoropopliteal reconstruction, we think that a posterior approach with prosthesis implantation is better because it saves the great saphenous vein. The presence of multiple aneurysms in the patients studied (80%) determined the low survival at 5 and 10 years, which makes it comparable to the results from applying the two surgical methods.

An animal model for the evaluation of graft thrombosis in the acute phase on carbon-lined PTFE prosthesis

Fortyfive carbon-lined (CL) and 45 standard (ST) 4 mm internal diameter polytetra-fluoroethylene (PTFE) grafts were implanted as aortic interposition in 90 rabbits. A pilot study of 20 animals: 10 CL and 10 ST grafts were used to develop microsurgical techniques, then 60 grafts were placed in 60 New Zealand rabbits with lower morbidity. The two hours graft patency (Doppler and angiographic studies) showed better patency rate in CL group (93% versus 80%). In 10 animals, platelet accumulation was investigated in vivo using gammacamera imaging after injection of autologous platelets labeled with Indium111. In vitro, radioactivity counting of the explanted midgraft sections at 2 hours revealed 6 times greater activity in ST grafts (6.60 ± 1.98 x 103platelets/mm2 versus 0.82 ± 0.25 x 103 platelets/mm2; p<0.05). Light microscopy found platelet and fibrin deposition (PFD) in nearly all ST grafts whereas PFD were found in only 13% of the CL grafts corresponding to those thrombosed (chi2: 61.117, p<0.001). Carbon-lining decreases platelet accumulation on PTFE grafts in the acute phase of a new experimental model.