Spinning dangerously in the 'top end'.
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Biomedical subjects
E Moisidis
Publications and source records attributed to E Moisidis.
An unusual cause of right iliac fossa pain.
There are many causes of right iliac fossa pain. Arriving at the correct diagnosis is easier if an accurate history and examination is complemented with sensitive diagnostic evaluation. Though testicular pathology in an undescended testis may mimic other conditions (e.g., appendicitis), these patients may have symptoms from intra-abdominal pathology which is completely unrelated to their long standing testicular maldescent.
Abdominal Pain↗
Improving the reinforcement of parastomal tissues with Marlex mesh: laboratory study identifying solutions to stomal aperture distortion.
PURPOSE: Parastomal hernia formation commonly complicates permanent stomas and represents a significant and frequently recurrent management problem, regardless of the method of repair. Prosthetic material reinforcement of parastomal tissues offers the best results. However, problems with unravelling of mesh fibers along cut margins leading to aperture enlargement and hernia recurrence may occur. Raised intra-abdominal pressure in the early postoperative period before incorporation of the mesh into surrounding tissues may result in hernia formation if the aperture size in the mesh increases. METHODS: Assessment of the physical properties of Marlex mesh was performed in a materials testing laboratory, using standardized tests to simulate the stresses imposed on in situ mesh. RESULTS: Holes cut in Marlex mesh were found to enlarge and distort at loads simulating intra-abdominal pressure changes. Reinforcement with a polypropylene pursestring suture was found to stabilize the periaperture mesh fibers and maintain the original area throughout tensions at least double maximal intra-abdominal pressures. Distensibility of intact sheets of mesh was found to vary by up to 100 percent, depending on the direction of the applied tension, and thus, mesh orientation in hernia repair has major implications. CONCLUSION: We propose that if mesh is used to reinforce abdominal wall tissues and is cut or fashioned to size, then the cut margins must be reinforced if the intended dimensions and functional integrity of the mesh are to be maintained.
Abdomen↗
Initial experience of Integra in the treatment of post-burn anterior cervical neck contracture.
Bilaminate bioartificial skin substitutes such as Integra have been described as a temporary substitute for autograft in acute burns. The aim of this study was to assess their role in the treatment of hypertrophic scarring and anterior neck contracture in the reconstructive phase of burns surgery. Five patients underwent Integra grafting over a 12-month period, with one patient having the procedure performed on two separate occasions. One patient had a combination of hypertrophic scarring of the face and neck contracture, and two patients suffered from recurrent folliculitis in hypertrophic scars in the bearded area of the neck. Mean hospital stay was 24 days (range, 19-30 days). Mean follow-up was 48 months (range, 43-54 months). In all cases of neck contracture a superior cosmetic result was achieved. Recurrence of contracture of greater than 50% occurred within the follow-up period in all cases. Ineffective immobilisation of the graft and overgranulation were identified as contributing to contracture recurrence. Based on our initial experience bilaminate artificial skin substitutes offer an improved cosmetic result in cases of neck contracture and hypertrophic scarring, particularly in the bearded area of the neck. Recurrence of neck contracture remains a problem despite improved techniques of immobilisation. Long-term follow-up will be necessary to assess the applications of this technique fully.
Adult↗
Re-operation for failed anti-reflux surgery.
BACKGROUND: Between 1993 and 1995, 315 anti-reflux procedures were undertaken on our service. A previous antireflux procedure had been performed in 31 patients referred (10%). Previous surgery was, in the main (80%), a Nissen fundoplication. METHODS: Pre-operative investigations in all patients were manometry, 24h pH monitoring, oesophagoscopy and barium radiology. On this basis the causes of failure of the previous surgery were established as hiatal failure in 20 (65%), unrecognized oesophageal dysmotility in three (10%) and fundoplication failure (slipped and disrupted) in eight (25%). Contrary to standard recommendations for re-operation most re-operative surgery was performed transabdominally (94%). Complications occurred in 16%. RESULTS: Review was undertaken at a mean of 21 months following surgery, and 91% of patients reported a good to excellent symptomatic outcome. CONCLUSIONS: Transabdominal re-operative anti-reflux surgery has an acceptable complication rate and a surprisingly good symptomatic outcome in the medium term.
Adult↗