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Biomedical subjects

A Pans

Publications and source records attributed to A Pans.

18 recordsLinked to original sources
PubMed2003

Joint mobility in adult patients with groin hernias.

The basic mechanisms of hernia formation remain mostly unknown, but several studies suggest that a connective-tissue pathology, affecting mainly the collagen metabolism, could play a role in the genesis of groin hernias. It would be interesting to know if this pathology can express some clinical signs other than the hernia. Our study focused on the joint mobility and the diagnostic criteria for benign joint hypermobility syndrome. Sixty male adult patients with inguinal hernias and 62 control subjects without hernias, age-matched, were compared, taking into account anamnestic criteria (family history of groin hernia, joint sprain, joint dislocation, skin striae, major arthralgia) and joint mobility. This was assessed by using Beighton criteria and measuring the range of movement of five joints (extension of the fifth finger, thumb, wrist, elbow, and knee). The frequency of the positive anamnestic criteria was not statistically different between the two groups. Nevertheless, a family history of groin hernia was observed in 25% of the hernia patients, against 16% in the control subjects ( P=0.23). The mean Beighton score was 0.30 in the hernia patients and 0.29 in the control population. The movement range of the five examined joints was similar in the two groups. In conclusion, patients with a groin hernia presented neither joint hypermobility nor clinical evidence of a benign joint hypermobility syndrome. Although abnormal collagen metabolism is likely implicated in hernia formation, this pathology does not seem to have clinical repercussion on joint mobility.

Adult↗
PubMed2001

Biochemical study of collagen in adult groin hernias.

BACKGROUND: Previous works have suggested that a defect in collagen fiber structure may play a role in inguinal hernia formation. These studies focused mainly on the rectus sheath or the skin, while only few reports dealt with the transversalis fascia. According to these findings and to our previous biomechanical and histological studies suggesting that a connective tissue pathology could play a role in the genesis of groin hernias, we performed a biochemical investigation of the collagen in the transversalis fascia and rectus sheath. MATERIALS AND METHODS: The samples were collected from 40 adult patients with uni- or bilateral hernias and from 20 control subjects without hernia (autopsies and organ donors). A constant area of tissue was taken by using a calibrator. The wet and dry weights per 100 mm(2) were determined and the total collagen concentration as well as its sequential extractibility in NaCl, acetic acid, and pepsin was measured. The ratios of alpha(1)/alpha(2) chains (I) and of type I/III collagen were assessed by polyacrylamide gel electrophoresis. RESULTS: Samples collected in the control and patient sheaths showed an increased wet weight per 100 mm(2) in the patients. The wet and dry weights per unit area were increased in the patient fascias. The collagen concentration was increased in the indirect hernias. The fascias from the direct hernias (DH) presented a significantly increased collagen extractibility after pepsin digestion (5.6%), when compared to the control fascias (2.6%). The extractibility was 3.4% in the nonherniated (NH) sides. The qualitative study (ratios alpha(1)/alpha(2) (I) and I/III collagen) showed no difference between the fascia groups. CONCLUSIONS: The significant increase of collagen extractibility with pepsin in the DH fascias and at a lesser degree in the NH fascias suggests that molecular alterations of collagen could be involved in the genesis of groin hernias. This connective tissue pathology would express preferentially its effects in the inguinal region, since we have observed no major difference between the rectus sheaths of controls and those of patients.

Adult↗
PubMed1999

[Gangrene of the round liver ligament: an unrecognized pathology].

The necrosis of the ligamentum teres hepatis is a very rare and unrecognized pathology. Two cases only were reported in the literature. The presence of generalized or epigastric peritoneal signs, simulates acute cholecystitis or perforated pyloric ulcer. The diagnosis could be suggested by ultrasonography and CT scan of the abdomen revealing a hyperechogenic and hypodense focal lesion at the junction of the segments III and IV of the liver, associated with inflammatory signs and/or collection along the ligamentum teres. The etiology of this necrosis remains unclear, although in this case report, a ligament infection with E. Coli, Enterococcus and Klebsiella pneumoniae was observed. However, the primum movens of the infection is unknown. The proposed treatment is resection of the ligament from umbilicus up to the liver, associated with systemic antibiotherapy, because of the possible risk of propagation of the infection to the portal vein.

Abdomen, Acute↗
PubMed1999

[New prospects in the etiology of groin hernias].

AIM OF THE STUDY: To explore new etiological hypotheses of groin hernias, using a biomechanical and histochemical study of the transversalis fascia and of the rectus sheath. PATIENTS AND METHODS: The samples were collected from 63 patients with uni- or bilateral hernias and from 30 control subjects without hernia. The biomechanical properties were assessed using a computerized-suction device (Cutometer). Sections were stained with hematoxylin and eosin, Masson-trichrome and double-stained with sirius red and orcein. RESULTS: There was no major biomechanical and histological difference between the control and patient aponeuroses. The patient fasciae from the non-herniated sides presented an increased extensibility and elasticity, as compared with the control fasciae. Those fasciae also showed a collagen framework with disorganized areas and an increased number of isolated fibers. CONCLUSION: The transversalis fascia from the nonherniated side appears to be a pathological fascia. Therefore, a connective tissue pathology seems to be involved in the genesis of groin hernias, with a preferential manifestation in the inguinal region which affects mainly the collagen fibers.

Age Factors↗
PubMed1998

Long-term results of polyglactin mesh for the prevention of incisional hernias in obese patients.

The aim of this study was to compare prospectively the incidence of incisional hernia in two groups of patients operated on for morbid obesity, with or without intraperitoneal polyglactin mesh. From October 1990 to September 1993, a total of 288 patients were randomly assigned to the two groups. There were 144 patients in the mesh group and 144 in the no-mesh group. Altogether 240 patients (83%) were reviewed personally, 45 (16%) were interviewed by phone (n = 39) or mail (n = 6), and 3 (1%) were inaccessible for follow-up since discharge from the hospital. The mean follow-up period was 29.8 months (range 0-67 months). A total of 33 incisional hernias were observed in the mesh group and 41 in the no-mesh group. There was no significant difference in the distribution of herniation time between the two groups (p = 0.43). The two main predictive factors of herniation were age and weight. In conclusion, the use of an intraperitoneal polyglactin mesh does not prevent postoperative incisional hernias in obese patients.

Adult↗
PubMed1997

Adult groin hernias: new insight into their biomechanical characteristics.

The biomechanical properties of the transversalis fascia and rectus abdominis aponeurosis were assessed in adult groin hernias, using a computerized-suction device (Cutometer) equipped with a 2-mm probe. Evaluations were made ex vivo on fresh samples collected from 63 patients with unilateral or bilateral hernias and 30 control subjects without hernias. Under 50 and 200 mbar suctions, there was no statistical difference between the overall mechanical properties of control and patient aponeuroses. For both 50 and 200 mbar suctions, the maximum distension (MD) and the biological elasticity (BE) of fasciae from direct hernias were significantly increased, compared with control fasciae. In the same comparison, the MD-50 and -200 and the BE-50 of patient fasciae from the non-herniated sides were also significantly increased. It is concluded that the presently reported biomechanical alterations seem to be the cause and not the consequence of the hernias. These data suggest that a functional connective tissue pathology probably plays a role in the genesis of groin hernias.

Adult↗
PubMed1997

Striae distensae of pregnancy. An in vivo biomechanical evaluation.

BACKGROUND AND OBJECTIVE: Striae distensae of pregnancy is a common finding. There is currently a lack of information about the rheological characteristics of such lesions. The purpose of this study was to compare the mechanical properties of striae distensae before and after delivery. PATIENTS AND METHODS: A total of 79 primigravid entered the study. Rheological properties of skin were evaluated in vivo using a Cutometer equipped with a 2-mm probe. RESULTS: Mechanical properties of striae distensae developing during pregnancy resembled those of the surrounding skin. By contrast, significant differences were yielded during post-partum. Extensibility of striae distensae was increased although parameters of elasticity remained normal. CONCLUSIONS: Rheological properties of striae distensae of pregnancy vary in time. This might reflect the changes in hormones and in the mechanical stresses normally setting the skin under tension.

Adult↗
PubMed1997

Use of a preperitoneal prosthesis for strangulated groin hernia.

BACKGROUND: Prostheses are widely used in the elective treatment of adult groin hernias. Their use for strangulated hernias remains controversial because of the potential risk of sepsis. METHODS: Thirty-five patients with a strangulated groin hernia were treated by insertion of a prosthetic mesh via a midline preperitoneal approach. Nine patients needed an intestinal resection for irreversible necrosis without peritonitis, and an appendicectomy was carried out in three others. RESULTS: There were two postoperative wound infections, neither in patients who had an intestinal resection. No mesh had to be removed. The recurrence rate was one of 35 after mean follow-up of 4.2 years. CONCLUSION: A strangulated groin hernia can be repaired safely with prosthetic mesh. When an intestinal resection is carried out with sufficient care to minimize infective complications, the use of mesh is not contraindicated.

Adult↗
PubMed1995

The impact of renal revascularisation on renal dysfunction.

AIM: To determine the value of kidney revascularisation in patients with impaired renal function and correctable renal artery stenosis, the authors reviewed their surgical experience from 1978 to 1990. PATIENTS AND METHODS: The study population included 23 patients with ischaemic nephropathy whose preoperative baseline creatinine level exceeded 20 mg/l (range 21-65 mg/l). This represents 20% of all patients operated on for renal artery disease during the same time interval. Preoperative risk profile, operative mortality, impact on hypertension and on renal function, and late survival were analysed. Renal function response to kidney revascularisation was defined as favourable (20% or more reduction of serum creatinine), moderate (stabilised serum creatinine values) or bad (further deterioration of renal function). All patients had atherosclerotic renal artery disease, involving a solitary kidney in five, both kidneys in 15 and one of the two kidneys in three patients. Hypertension was present in 74%. Revascularisation was unilateral in 10, bilateral in nine and associated with controlateral nephrectomy in four patients. RESULTS: Four patients died postoperatively (three myocardial infarctions, one stroke). Four patients needed postoperative short-term dialysis. After operation, renal function improved in 13, stabilised in six and deteriorated in four patients (of whom two died). Follow-up among the survivors averaged 46 months. The mean serum creatinine value at last follow-up visit was 26.2 mg/l, a decrease of 7.7 mg/l compared to preoperative values (p < 0.05). Overall, 69% of azotemic patients submitted to renal revascularisation manifested a favourable response (45% improved and 24% stabilised). Three patients required long-term dialysis. The 5-year survival rate was 48%. CONCLUSION: These data suggest that kidney revascularisation in patients with ischaemic nephropathy can restore or stabilise renal function, preventing evolution and end-stage renal disease and dialysis dependency.

Chronic Disease↗
PubMed1992

A comparison of intraperitoneal prostheses for the repair of abdominal muscular wall defects in rats.

We compared the tissue response to the intraperitoneal implantation of three different prostheses (Gore-Tex, Mersilène, Vicryl-Mersilène) used to repair abdominal wall defects in rats. Vicryl-Mersilène is a new experimental prosthesis made of Dacron (Mersilène) coated with absorbable polyglactin (Vicryl). The least amount of adhesions to omentum and gut was found with Mersilène. Gore-Tex was responsible for the accumulation of neutrophils rather than macrophages mostly collected in close contact with Mersilène and Vicryl-Mersilène. Fibrosis, evaluated by histology and computerized morphometry, was mostly found with Vicryl-Mersilène. This should allow a better incorporation of Mersilène and a tighter anchorage to the abdominal wall, after Vicryl resorption.

Abdominal Muscles↗
PubMed1992

[Acquired diverticulosis of the small bowel].

The authors report about their surgical experience? On the basis of one case of pneumascos and one case of gastrointestinal hemorrhage with collapse, for which no origin was found preoperatively and which was attributed to the presence of diverticula in the small bowel. The analysis of the literature shows that this rare condition (0.1% of the population) is mainly expressed as acute complications: diverticulitis, perforation, hemorrhage, obstruction. The treatment is surgical as a rule, but it can be medical if the condition is included in the scope of a malabsorption syndrome.

Aged↗
PubMedDate not supplied

Tensile properties of relaxed excised skin exhibiting striae distensae.

Tensile properties of skin determine some important physical attributes of skin. They may be conveniently assessed using recent technologies. The aim of the study was to compare ex vivo the tensile properties of normal looking skin and striae distensae. The Cutometer was used with 2 and 4 mm diameter probes. Skin distensibility values were dependent on the suction force and area of the skin tested. Conversely, tensile ratios yielding elasticity parameters were not affected by the same variables. Although tensile properties of excised normal skin resembled those previously reported in vivo, striae distensae showed markedly different properties in vivo and ex vivo. The ex vivo and in vivo evaluations of the tensile properties and functions of skin are complementary particularly when the connective tissue is abnormal.

Adult↗
PubMedDate not supplied

[Transsection of the cervical trachea secondary to a closed injury. Apropos of a case].

The successful surgical management of a case of complete blunt traumatic transection of the cervical trachea is reported. The management of this rare pathology is a real challenge for the surgeon with regard to early recognition of the lesion and proper therapeutic strategy. Except in case of respiratory distress and/or major laryngotracheal lesions, where urgent tracheotomy is recommended, diagnostic fiberoptic bronchoscopy should be performed to assess the lesions. Guided intubation can also be contemplated. It seems however more prudent to explore the trachea surgically under mask or IV (Ketalar) anesthesia with maintenance of spontaneous breathing. During this exploration intubation can be guided by the surgeon and general anesthesia be initiated. In cases of complete transection, end-to-end anastomosis using absorbable sutures, avoidance of protective tracheotomy and postoperative low-dose steroids seems to be the treatment of choice to avoid stenotic sequelae. If a postoperative stenosis occurs, it should be treated by laser before contemplating surgical correction.

Adult↗
PubMedDate not supplied

[Surgical treatment of incarcerated inguino-crural hernia with interposition of a preperitoneal prosthesis].

For the last four years, 17 inguinal and femoral strangulated hernias have been treated at our institution by a median subumbilical incision. In all cases, a prosthesis has been placed by preperitoneal approach. An intestinal resection for irreversible necrosis has been performed in five patients. This procedure gives good control of the herniated organs, allows easy intestinal resection and good management of unforeseeable situations. The surgical exploration of the other hernial orifices and, if needed, their simultaneous treatment can be performed. Intestinal resection does not represent, in our opinion, an absolute contra-indication to the implantation of a prosthesis. In our study, the morbidity does not seem to be increased.

Adult↗
PubMedDate not supplied

[Gallbladder volvulus].

We report two new cases of gallbladder volvulus. This rare condition principally affects elderly patients but is due to a congenital malformation related to the presence of a long mesocyst. Various factors such as kyphoscoliosis, multiparity and peristalsis of neighbouring organs favorise the occurrence of volvulus, the role of lithiasis is debatable. The diagnosis may be suggested on ultrasound but is most often confirmed at laparotomy. Diagnosis should be made rapidly in order to avoid progression towards a potentially fatal secondary peritonitis. Certain clinical elements such as the presence of a "floating mass" on palpation may suggest the diagnosis.

Aged↗
PubMedDate not supplied

Use of an absorbable polyglactin mesh for the prevention of incisional hernias.

Nowadays, incisional hernias are still one of the more common complications of abdominal surgical procedures. A population, at high risk of developing an incisional hernia, has been chosen for this study, namely patients suffering from morbid obesity. The aim of the study was to compare prospectively the incidence of incisional hernias in 2 groups of patients operated upon for morbid obesity (Vertical Silicone Ring Gastroplasty) with or without intraperitoneal polyglactin mesh. Patients were randomly assigned in the 2 groups. For this preliminary study, 112 patients operated upon before 01/04/1992 were selected; the mean follow-up period was 28.3 months (S.D.:5.7); 81 patients have been reviewed personally, 31 interviewed by phone call or mail. The 2 groups of patients were not significantly different as regarding age, sex, weight, body mass index, diabetes and wound infection. Sixteen incisional hernias were observed in the group with mesh and 17 in the group without mesh. According to these preliminary results, there is no argument for recommending the use of the polyglactin mesh in the prevention of postoperative incisional hernias, in obese patients.

Adult↗