Biomedical subjects

A Willms

Publications and source records attributed to A Willms.

5 recordsLinked to original sources

PubMed2006

Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair.

Endoscopic hernia repair methods have become increasingly popular over the past 15 years. The postulated main advantages of the endoscopic technique are less postoperative pain, early recovery and lower recurrence rates. Fixation of the endoscopic mesh seems to be necessary to minimize the risk of recurrence. Stapling has been implicated to cause chronic inguinal pain syndromes. We performed a retrospective study on male patients who were endoscopically operated on primary inguinal hernias. Our aim was to clarify whether mesh fixation using a fibrin sealant is as safe and reliable as conventional stapling. Additionally, we compared the prevalence of chronic inguinal pain. A standardized population of 133 male patients (mean age 55.9 years) with 186 (80 unilateral; 53 bilateral) consecutive primary laparoscopic total extraperitoneal inguinal hernia repairs was assigned to two groups, depending on whether stapling or a fibrin sealant had been used for mesh fixation. A retrospective case control study was performed to conduct statistical analysis based on the following parameters: recurrence, complications, chronic inguinal pain, foreign body sensation and numbness. Hernia repairs numbering 173 (staples n=87; fibrin n=86) were followed up for a mean duration of 23.7 (11-47) months. The prevalence of chronic inguinal pain was significantly (P=0.002; Fisher exact test) higher in the stapled group-20.7% than in the fibrin sealant group with a prevalence of 4.7%. In terms of recurrence rate, complications and foreign body sensation, fewer patients were affected in the fibrin group than in the reference population, although the differences were not statistically significant. There were no major complications in either of the groups. The mean postoperative stay in hospital was 1.4 days. Fibrin sealing is as effective as stapling in providing secure mesh fixation. The fibrin group displayed a statistically significant lower prevalence of chronic pain syndromes. Mesh sealing provides adequate fixation and reduces the risk of chronic inguinal pain as a complication of the intervention.

Case-Control Studies↗

PubMed2006

[Management of recurrent inguinal hernia after previous mesh repair: a challenge].

INTRODUCTION: Since the use of prosthetic mesh for the surgical repair of inguinal hernias has become increasingly popular, mesh material introduced during a previous operation is being detected in a growing number of patients undergoing surgery for recurrent hernia. This applies to at least 10% of recurrences. Needed is a therapeutic algorithm for the surgical management of recurrent hernias after previous mesh repair. MATERIAL AND METHODS: A total of 672 recurrent hernia repairs performed in hospitals in the German cities Aachen and Koblenz were analysed in order to review clinical practice. In 92 patients (13.7%) who underwent surgery for recurrent hernia, mesh had been used in the previous hernia repairs. Attention was focused on the location of the recurrence in relation to the site of mesh implantation and on the advantages and disadvantages of the various surgical procedures for repairing recurrent hernias. Re-examination was performed with a mean follow-up of 3 years. RESULTS: Surgeons mostly decided during operation which procedure to use. A transinguinal approach was preferred for patients presenting with recurrent hernia and pain, and mesh material introduced during a previous operation was then explanted. In the case of multiple recurrences, a minimal direct suture repair was used for small defects or a preperitoneal approach for inserting a new, large mesh. The majority of recurrences were medial or suprapubic, especially those occurring after a Lichtenstein repair. After re-examining 87 of 92 patients, nine recurrences (10.3%) were found. Mesh-free suturing methods were affected most frequently. Moderate complaints were reported by 39.1%, and 4.6% suffered from medical chronic pain. CONCLUSION: The surgical management of recurrent hernias after previous mesh repair is a particular challenge for surgeons. We introduce a therapeutic algorithm for recurrent hernia surgery after previous mesh implantation based on analysis of clinical practice.

Adult↗

PubMed2006

[Laparoscopy for abdominal trauma].

With increasing experience in minimally invasive surgery, laparoscopy's role in abdominal trauma can be defined exactly. Main exclusion criteria are hemodynamic instability and increased intracranial pressure. A literature review of 1996 to 2006 reveals perforating injury mainly of the left thoracoadominal area as the most important indication for laparoscopy . Its goal is to determine intraperitoneal lesions and integrity of the abdominal wall and diaphragm. Minor injuries of the parenchymatous organs and diaphragm can be successfully repaired laparoscopically. In blunt abdominal trauma, laparoscopy is used as a complementary diagnostic device in case ultrasound and multislice CT show unclear findings and the patient's clinical status requires invasive measures. The clear weakness of laparoscopy in abdominal trauma is its inability to identify reliably hollow viscus perforation and retroperitoneal injury. In this, sensitivity is only 25%. In case of proven lesions of the gastrointestinal tract, conversion to laparotomy is to be considered. Despite the reports on laparoscopic treatment, open repair of hollow organ injuries is still to be recommended.

Abdominal Injuries↗

PubMed1997

Bifurcation, bursting, and spike frequency adaptation.

Many neural systems display adaptive properties that occur on time scales that are slower than the time scales associated with repetitive firing of action potentials or bursting oscillations. Spike frequency adaptation is the name given to processes that reduce the frequency of rhythmic tonic firing of action potentials, sometimes leading to the termination of spiking and the cell becoming quiescent. This article examines these processes mathematically, within the context of singularly perturbed dynamical systems. We place emphasis on the lengths of successive interspike intervals during adaptation. Two different bifurcation mechanisms in singularly perturbed systems that correspond to the termination of firing are distinguished by the rate at which interspike intervals slow near the termination of firing. We compare theoretical predictions to measurement of spike frequency adaptation in a model of the LP cell of the lobster stomatogastric ganglion.

Action Potentials↗

PubMed1989

Automated Feulgen staining with a temperature-controlled staining machine.

A Shandon Varistain 24-3 staining machine was modified in order to run automated DNA Feulgen staining. Initial studies showed a strict dependence of the staining intensity (integrated optical density [IOD]) on the temperature of the DNA hydrolysis in 4 N HCl: a difference of 0.5 degrees C around the optimum hydrolysis temperature of 27.5 degrees C resulted in IOD differences of up to 7.8% in epithelial cells and up to 12.0% in lymphocytes. A temperature-controlled stainless steel cuvette, covered with a 4 N HCl-resistant material, was developed and integrated into the machine. Temperature measurements were performed at different positions in the cuvette and on glass slides with copper-constantan electrodes fixed on them; no temperature gradient could be detected within the cuvette. The adjusted temperature of 27.5 degrees C remained constant over 24 hours. The coefficient of variation (CV) of the staining intensity in lymphocytes between different areas on the same slide and between different slides of the same staining cycle was less than 0.6%. The CV between different staining cycles was 5.9%. This system for automated Feulgen staining thus gives reproducible and reliable results and may be introduced into routine diagnostic procedures.

Coloring Agents↗