Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis.

PubMed

Rommens, Pol Maria; Wagner, Daniel; Hofmann, Alex

2017-01-01

The incidence of fragility fractures of the pelvis is increasing quickly. The characteristics of these fractures are different from pelvic ring disruptions in adults. Fragility fractures of the pelvis are the consequence of a low-energy trauma which occurs in a patient with an important decrease of bone mineral density. Due to a consistent pattern of alteration of bone mass distribution in the sacrum, other fracture morphologies occur than in younger adults. The leading symptom is immobilizing pain in the lower back, in the buttocks, in the inguinal region and/or at the pubic symphysis. Conventional radiographs and CT will show the presence and localization of the fractures in the anterior and posterior pelvic ring. A new, comprehensive classification system distinguishes four categories of instability. This first criterion is most important, because it also gives hints for the preferred type of treatment. The second criterion, leading to the subtypes in the four categories, is the localization of the instability in the posterior pelvic ring. This criterion points the way towards the type of the surgical procedure to be used. When a surgical treatment is chosen, the procedure should be as minimal invasive as possible. Different techniques for percutaneous or less invasive fixation of the posterior pelvic ring have been developed. Their advantages and limitations are presented: sacroplasty, iliosacral screw osteosynthesis, cement augmentation, transiliac internal fixation, trans-sacral osteosynthesis, lumbopelvic fixation. Fractures of the anterior pelvic ring also need special attention. Retrograde transpubic screw fixation is recommended for pubic rami fractures. Fractures of the pubic body and instabilities of the pubic symphysis need bridging plate osteosynthesis. We do not recommend anterior pelvic external fixation in elderly because of the risk of pin track infection and pin loosening. Celsius.

Large sliding inguino-scrotal hernia of the urinary bladder

PubMed Central

Wang, Ping; Huang, Yonggang; Ye, Jing; Gao, Guodong; Zhang, Fangjie; Wu, Hao

2018-01-01

Abstract Rationale: Sliding inguinal hernias of the urinary bladder are protrusions of the bladder through the internal inguinal ring, most of which are insignificant and diagnosed intra-operatively. Large inguino-scrotal bladder hernias commonly present with lower urinary tract symptoms and may cause severe complications, including bladder incarceration or necrosis, bladder hemorrhage, obstructive or neurogenic bladder dysfunction, and even renal failure. Patient concerns: We describe and discuss the clinical findings and management of a 59-year-old man who complained of a decrease in scrotal size after voiding and 2-stage voiding requiring pressure to the scrotum. Diagnoses: The patient was diagnosed preoperatively as massive, bilateral, inguinoscrotal hernias, and a large, left-sided, sliding bladder hernia. Interventions: The patient underwent a timely open re-peritoneal inguinal herniorrhaphy using a mesh. Outcomes: The surgical outcomes were good, and no surgical site infection, chronic postoperative inguinal pain or recurrence were recorded during the follow-up. Lessons: Better knowledge of this rare condition of large inguino-scrotal sliding bladder hernia could help in making a correct diagnosis preoperatively and provide proper surgical management timely, so as to reduce delay in treatment and avoid potential complications. PMID:29595706

Evaluation of the Contralateral Inguinal Ring in Clinically Unilateral Inguinal Hernia: A Systematic Review and Meta-analysis

PubMed Central

Kokorowski, Paul J; Wang, Hsin-Hsiao Scott; Routh, Jonathan C; Hubert, Katherine C; Nelson, Caleb P

2013-01-01

Purpose The management of the contralateral inguinal canal in children with clinical unilateral inguinal hernia is controversial. Our objective was to systematically review the literature regarding management of the contralateral inguinal canal. Methods We searched MEDLINE, EMBASE, and Cochrane databases (1940–2011) using ‘hernia’ and ‘inguinal’ and either ‘pediatric,’ ‘infant,’ or ‘child,’ to identify studies of pediatric (age≤21 yrs) patients with inguinal hernia. Among clinical unilateral hernia patients, we assessed the number of cases with contralateral patent processus (CPP) and incidence of subsequent clinical metachronous contralateral hernia (MCH). We evaluated three strategies for contralateral management: expectant management, laparoscopic evaluation or pre-operative ultrasound. Pooled estimates of MCH or CPP were generated with random effects by study when heterogeneity was found (I2>50%, or Cochrane’s Q p≥0.10). Results We identified 2,477 non-duplicated studies, 129 of which met our inclusion criteria and had sufficient information for quantitative analysis. The pooled incidence of MCH after open unilateral repair was 7.3% (95% CI 6.5%–8.1%). Laparoscopic examination identified CPP in 30% (95% CI 26%–34%). Lower age was associated with higher incidence of CPP (p<0.01). The incidence of MCH after a negative laparoscopic evaluation was 0.9% (95% CI 0.5%–1.3%). Significant heterogeneity was found in studies and pooled estimates should be interpreted with caution. Conclusions The literature suggests that laparoscopically identified CPP is a poor indicator of future contralateral hernia. Almost a third of patients will have a CPP, while less than one in 10 will develop MCH when managed expectantly. Performing contralateral hernia repair in patients with CPP results in overtreatment in roughly 2 out of 3 patients. PMID:23963735

Two-trocar needlescopic approach to incarcerated inguinal hernia in children.

PubMed

Shalaby, Rafik; Shams, Abdul Moniem; Mohamed, Soliman; el-Leathy, Mohamed; Ibrahem, Medhat; Alsaed, Gamal

2007-07-01

Many studies described the safety and effectiveness of laparoscopy in the treatment of inguinal hernia in children. Needlescopic techniques have been recently used in repairing inguinal hernias, which made this type of surgery more cosmetic and less invasive. However, few reports have described its role in the treatment of incarcerated inguinal hernia. The aim of this study was to assess the feasibility and outcome of needlescopy in the treatment of incarcerated inguinal hernia in children. A total of 250 children, comprising 190 boys and 60 girls, who presented with incarcerated inguinal hernia were analyzed. Their ages ranged from 6 months to 6 years (mean age, 2 years). In 170 (68%) cases, manual reduction was successful. One hundred of these patients were subjected to definitive surgery in the same day, whereas the remaining 70 patients were subjected to needlescopy 1 to 3 days later. In 80 (32%) cases, external manual reduction was unsuccessful. These children were subjected to urgent needlescopic reduction and herniorrhaphy. The incarcerated herniae were easily reduced and the contents thoroughly inspected under direct vision. Then the hernia was repaired in the same setting. In all patients, there was no need to convert the procedure to an open approach. Immediate needlescopic herniorrhaphy in the same session was added without significant increase in operative time. The mean operative time is 10 minutes. There were no intraoperative complications. The study showed that needlescopic approach to incarcerated inguinal hernia in children is feasible, safe, easy, and preferable to the open surgery. In addition to reduction of incarcerated hernial contents under direct vision, it allows definitive treatment of hernial defect at the same time without significant increase in operative time and hospital stay.

Complete response in a patient with gynecological hidradenocarcinoma treated with exclusive external beam radiotherapy and brachytherapy: a case report.

PubMed

Giannelli, Flavio; Chiola, Ilaria; Belgioia, Liliana; Garelli, Stefania; Pastorino, Alice; Marcenaro, Michela; Mammoliti, Serafina; Costantini, Sergio; Bizzarri, Nicolò; Vellone, Valerio; Barra, Salvina; Corvò, Renzo

2017-12-01

Hidradenocarcinoma (HC) is a very rare disease. This case report illustrates a successful treatment of a 60-year-old woman with vulvo-vaginal localization of hidradenocarcinoma treated with external beam radiotherapy delivered by helical tomotherapy with a simultaneous integrated boost (SIB), followed by brachytherapy. External beam radiotherapy dose prescription was 50.4 Gy in 28 fractions, five fractions per week to whole pelvis (planning target volume 1 - PTV1), 60.2 Gy in 28 fractions to SIB1 (fundus of uterus and right inguinal node), and 58.8 Gy in 28 fractions to SIB2 (lower/middle third of vagina, paraurethral region and right inguinal lymph nodes). Brachytherapy dose prescription was 28 Gy in 4 fractions for cervix, fundus of uterus and upper third of vagina (HR-CTV1), and 22 Gy in 4 fractions to middle third of vagina and paraurethral region (HR-CTV2). D 90 for whole treatment was 91.9 Gy and 86.0 Gy for HR-CTV1 and HR-CTV2, respectively. Patient remained 12-months disease-free without treatment related side effects.

Minimal access surgery of pediatric inguinal hernias: a review.

PubMed

Saranga Bharathi, Ramanathan; Arora, Manu; Baskaran, Vasudevan

2008-08-01

Inguinal hernia is a common problem among children, and herniotomy has been its standard of care. Laparoscopy, which gained a toehold initially in the management of pediatric inguinal hernia (PIH), has managed to steer world opinion against routine contralateral groin exploration by precise detection of contralateral patencies. Besides detection, its ability to repair simultaneously all forms of inguinal hernias (indirect, direct, combined, recurrent, and incarcerated) together with contralateral patencies has cemented its role as a viable alternative to conventional repair. Numerous minimally invasive techniques for addressing PIH have mushroomed in the past two decades. These techniques vary considerably in their approaches to the internal ring (intraperitoneal, extraperitoneal), use of ports (three, two, one), endoscopic instruments (two, one, or none), sutures (absorbable, nonabsorbable), and techniques of knotting (intracorporeal, extracorporeal). In addition to the surgeons' experience and the merits/limitations of individual techniques, it is the nature of the defect that should govern the choice of technique. The emerging techniques show a trend toward increasing use of extracorporeal knotting and diminishing use of working ports and endoscopic instruments. These favor wider adoption of minimal access surgery in addressing PIH by surgeons, irrespective of their laparoscopic skills and experience. Growing experience, wider adoption, decreasing complications, and increasing advantages favor emergence of minimal access surgery as the gold standard for the treatment of PIH in the future. This article comprehensively reviews the laparoscopic techniques of addressing PIH.

Bilateral cryptorchidism in a dog with persistent cranial testis suspensory ligaments and inverted gubernacula: report of a case with implications for understanding normal and aberrant testis descent.

PubMed Central

Kersten, W; Molenaar, G J; Emmen, J M; van der Schoot, P

1996-01-01

The genital system of a dog with bilateral intra-abdominal testes is described. External virilisation was normal except for an empty scrotum. Internally there was a prostate of normal macroscopic and histological appearances and, bilaterally, a fully developed male genital tract. Testicular vasculature was normal. Cranial to each testis, there was a strong ligament lying at the free edge of the gonadal/genital mesentery and running between the cranial tip of the testis/epididymis and the area craniolateral of the ipsilateral kidney. It was impossible to push the testes into the inguinal canal because of this strong ligament. Caudal to each testis, there was an elongated whitish structure between the caudal pole of the epididymis and the area of the internal inguinal ring. On closer inspection this structure appeared to be the inverted and elongated processus vaginalis sac. There was a minor ligament at the free border of the inguinal fold of the genital mesentery between the tip of this inverted processus vaginalis and the adjacent junction of the cauda epididymidis and vas deferens. The findings suggest that persistence of the fetal cranial gonadal suspensory ligaments could have been the major aetiological factor in this case of cryptorchidism. Their persistence could have prevented caudal outgrowth of the processus vaginalis with its consequent development into an intra-abdominal papilla-like structure. Inappropriate persistence of the cranial suspensory ligaments in male rodents, pig, and cattle has been associated with insufficient exposure of their primordia to androgen during fetal life. It is uncertain whether a similar deficiency could underlie persistence of these structures in the present specimen. The findings add further weight to the hypothesis that regression of the cranial gonadal suspensory ligament in males is a key event in the process of testis descent. The human homologue of this ligament deserves more attention in the analysis and treatment of human cryptorchidism. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 PMID:8771408

Evaluation of Infrared Thermometry in Cynomolgus Macaques (Macaca fascicularis).

PubMed

Laffins, Michael M; Mellal, Nacera; Almlie, Cynthia L; Regalia, Douglas E

2017-01-01

Recording an accurate body temperature is important to assess an animal's health status. We compared temperature data from sedated cynomolgus macaques (Macaca fascicularis) to evaluate differences between rectal, infrared (inguinal and chest), and implanted telemetry techniques with the objective of demonstrating the diagnostic equivalence of the infrared device with other approaches. Infrared thermometer readings are instantaneous and require no contact with the animal. Body temperature data were obtained from 205 (137 male, 68 female) cynomolgus macaques under ketamine (10 mg/kg IM) sedation over a 3-mo period during scheduled physical examinations. Infrared measurements were taken 5 cm from the chest and inguinal areas. We evaluated 10 (9 functional devices) sedated cynomolgus macaques (5 male, 5 female) implanted with telemetry units in a muscular pouch between the internal and external abdominal oblique muscles. We determined that the mean body temperature acquired by using telemetry did not differ from either the mean of inguinal and chest infrared measurements but did differ from the mean of temperature obtained rectally. In addition, the mean rectal temperature differed from the mean of the inguinal reading but not the mean of the chest temperature. The results confirm our hypothesis that the infrared thermometer can be used to replace standard rectal thermometry.

Complete Expulsion of Testicular Prosthesis via the Scrotum: A Case-Based Review of the Preventive Surgical Strategies

PubMed Central

Deb, A.; Jay Mathias, Suresh; Fraser Saxby, Mark; Fernando, Herman

2015-01-01

Testicular prostheses are regularly used in urological surgery and are important for postoperative psychological well-being in many patients undergoing orchiectomy. One of the recognised complications of this procedure is graft extrusion, which can result in significant morbidity for patients and require operative reintervention. Whilst most cases of extrusion involve upward graft migration to the external inguinal ring or direct displacement through the scrotal skin, we present an unusual case of complete expulsion of testicular implant three weeks postoperatively through a previously healthy scrotum. During surgical insertion of testicular prostheses, the urological surgeon must carefully consider the different surgical strategies at each step of the operation to prevent future extrusion of the graft. A stepwise review of the preventive surgical strategies to reduce the risk of graft extrusion encompasses the choice of optimal surgical incision, the technique of dissection to create the receiving anatomical pouch, the method of fixation of the implant within the receiving hemiscrotum, and the adoption of good postoperative care measures in line with the principles of sound scrotal surgery. PMID:26137344

Complete response in a patient with gynecological hidradenocarcinoma treated with exclusive external beam radiotherapy and brachytherapy: a case report

PubMed Central

Giannelli, Flavio; Chiola, Ilaria; Garelli, Stefania; Pastorino, Alice; Marcenaro, Michela; Mammoliti, Serafina; Costantini, Sergio; Bizzarri, Nicolò; Vellone, Valerio; Barra, Salvina; Corvò, Renzo

2017-01-01

Hidradenocarcinoma (HC) is a very rare disease. This case report illustrates a successful treatment of a 60-year-old woman with vulvo-vaginal localization of hidradenocarcinoma treated with external beam radiotherapy delivered by helical tomotherapy with a simultaneous integrated boost (SIB), followed by brachytherapy. External beam radiotherapy dose prescription was 50.4 Gy in 28 fractions, five fractions per week to whole pelvis (planning target volume 1 – PTV1), 60.2 Gy in 28 fractions to SIB1 (fundus of uterus and right inguinal node), and 58.8 Gy in 28 fractions to SIB2 (lower/middle third of vagina, paraurethral region and right inguinal lymph nodes). Brachytherapy dose prescription was 28 Gy in 4 fractions for cervix, fundus of uterus and upper third of vagina (HR-CTV1), and 22 Gy in 4 fractions to middle third of vagina and paraurethral region (HR-CTV2). D90 for whole treatment was 91.9 Gy and 86.0 Gy for HR-CTV1 and HR-CTV2, respectively. Patient remained 12-months disease-free without treatment related side effects. PMID:29441103

Evaluation of Infrared Thermometry in Cynomolgus Macaques (Macaca fascicularis)

PubMed Central

Laffins, Michael M; Mellal, Nacera; Almlie, Cynthia L; Regalia, Douglas E

2017-01-01

Recording an accurate body temperature is important to assess an animal's health status. We compared temperature data from sedated cynomolgus macaques (Macaca fascicularis) to evaluate differences between rectal, infrared (inguinal and chest), and implanted telemetry techniques with the objective of demonstrating the diagnostic equivalence of the infrared device with other approaches. Infrared thermometer readings are instantaneous and require no contact with the animal. Body temperature data were obtained from 205 (137 male, 68 female) cynomolgus macaques under ketamine (10 mg/kg IM) sedation over a 3-mo period during scheduled physical examinations. Infrared measurements were taken 5 cm from the chest and inguinal areas. We evaluated 10 (9 functional devices) sedated cynomolgus macaques (5 male, 5 female) implanted with telemetry units in a muscular pouch between the internal and external abdominal oblique muscles. We determined that the mean body temperature acquired by using telemetry did not differ from either the mean of inguinal and chest infrared measurements but did differ from the mean of temperature obtained rectally. In addition, the mean rectal temperature differed from the mean of the inguinal reading but not the mean of the chest temperature. The results confirm our hypothesis that the infrared thermometer can be used to replace standard rectal thermometry. PMID:28905720

Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX.

PubMed

Reichel, Lee M; MacCormick, Lauren M; Dugarte, Anthony J; Rizkala, Amir R; Graves, Sara C; Cole, Peter A

2018-02-01

Anterior external fixation for pelvic ring fractures has shown to effectively improve stability and reduce mortality. However, these fixators can be associated with substantial morbidity such as pin tract infection, premature loss of fixation, and decreased quality of life in patients. Recently, two new methods of subcutaneous anterior pelvic internal fixation have been developed; the INFIX and the Pelvic Bridge. These methods have the purported advantages of lower wound complications, less surgical site pain, and improved quality of life. We sought to investigate the measured distances to critical anatomic structures, as well as the qualitative and topographic differences notable during implantation of both devices in the same cadaveric specimen. The Pelvic Bridge and INFIX were implanted in eleven fresh cadavers. Distances were then measured to: the superficial inguinal ring, round ligament, spermatic cord, lateral femoral cutaneous nerve (LFCN), femoral nerve, femoral artery, and femoral vein. Observations regarding implantation and topography were also recorded. The INFIX had greater measured distances from all structures except for the LFCN, in which its proximity placed this structure at risk. Neither device appears to put other critical structures at risk in the supine position. Significant implantation and topographic differences exist between the devices. The INFIX application lacked "safety margins" concerning the LFCN in 10/11 (90.9%) specimens, while Pelvic Bridge placement lacked "safety margins" with regard to the right superficial ring (1/11, 9%) and the right spermatic cord (1/11, 9%). Both the Pelvic Bridge and INFIX lie at safe distances from most critical pelvic structures in the supine position, though INFIX application places the LFCN at risk. Copyright © 2017 Elsevier Ltd. All rights reserved.

External-beam irradiation of carcinoma of the penis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sagerman, R.H.; Yu, W.S.; Chung, C.T.

1984-07-01

Twenty-four patients with biopsy-proved squamous-cell carcinoma of the penis underwent external-beam radiation therapy between 1966 and 1980. Fifteen were treated for the primary tumor and 9 for metastatic inguinal lymphadenopathy; no patient received prophylactic nodal irradiation. Seven out of 9 tumors in stage I, 2/3 in stage II, and 1/3 in stage IV were controlled for three years. Control of fixed, inoperable groin nodes was poor, and none of these patients survived beyond 1 1/2 years.

A feasibility of single-incision laparoscopic percutaneous extraperitoneal closure for treatment of incarcerated inguinal hernia in children: our preliminary outcome and review of the literature.

PubMed

Murase, Naruhiko; Uchida, Hiroo; Seki, Takashi; Hiramatsu, Kiyoshi

2016-02-01

The purpose of this study is to examine the feasibility of single-incision laparoscopic percutaneous extraperitoneal closure (LPEC) for incarcerated inguinal hernia (IIH) repair. 6 single-incision LPEC procedures were performed for IIH repair and 60 procedures were performed for reducible inguinal hernia (RIH) in the same period of time in one hospital. The laparoscope and one pair of grasping forceps were placed through the same umbilical incision. In IIH repair, the herniated organ was gently pulled using the grasping forceps with external manual pressure. If it was difficult to reduce the herniated organ with one pair of forceps, another pair of forceps were inserted through a multi-channel port without extending the umbilical incidion. Using the LPEC needle, the hernia orifice was closed extraperitoneally. We performed a retrospective analysis to compare the outcomes of single-incision LPEC for IIH repair or reducible inguinal hernia. All procedures were completed by single-incision without open conversion. A multi-channel port with another pair of forceps was needed in three cases. The operation time and the length of stay were significantly longer with IIH repair than with RIH repair. There were no major complications and there was no evidence of early recurrence in any patient. In conclusion, single-incision LPEC with a multi-channel port is feasible and safe for IIH repair.

Efficacy of laparoscopically assisted high ligation of patent processus vaginalis in children.

PubMed

Ahmed, H; Youssef, M K; Salem, E A; Fawzi, A M; Desoky, E A E; Eliwa, A M; Sakr, A M N; Shahin, A M S

2016-02-01

Laparoscopic hernia repairs have been proven to be efficient and safe for children, despite the slightly higher recurrence rate compared with the classic surgical repair. They have the advantage of easy and precise identification of the type of defect and its correction, both in ipsilateral and contralateral sides. The objectives of this study were to evaluate the efficacy, safety and outcome of the laparoscopically assisted piecemeal high ligation of a patent processus vaginalis (PPV) in children. A total of 40 children were enrolled into this prospective study; they were aged ≥ 6 months and had an inguinal hernia. The peritoneal cavity, including the contralateral side, was inspected for the possibility of bilateral hernias using a 3-mm 30° telescope. Another 3-mm port was introduced through the same infra-umbilical incision. The hernia was manually reduced or with the aid of a working infra-umbilical grasper. A prolene or vicryl 2/0 or 3/0 suture on a curved semicircle round-bodied taper-ended 25-30 mm needle was introduced through a very small inguinal skin-crease incision. It was passed through the abdominal wall layers to the peritoneum and was manipulated by the laparoscopic grasper to pick up the peritoneum in piecemeal all around the internal ring. The needle was then pushed to the outside near to the entrance site, thus forming a semicircle around the internal ring. The suture was then tied and the knot was subcutaneously buried. The primary outcome of the procedure was the incidence of intraoperative diagnosis and surgical repair of contralateral hernias in pre-operatively diagnosed unilateral cases. The secondary outcomes were defined as the incidence of complications and hernia recurrence. The exploratory laparoscopy found contralateral patent processus vaginalis (CPPV) with a detection rate of 28.1%. Chan et al., Esposito et al., Toufique et al. and Niyogi et al. reported similar figures for laparoscopic contralateral hernia detection rates of 28%, 39%, 39.7% and 29.2%, respectively. The limitations of this study were the small sample size, plus the risk factors and clinical significance for CPPV. Laparascopically assisted piecemeal closure of the internal inguinal ring in children is a safe and effective procedure. It helps in detecting a contralateral hernia without prolonging the operative time. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Laparoscopic repair of indirect inguinal hernia in children: does partial resection of the sac make any impact on outcome?

PubMed

Borkar, Nitinkumar B; Pant, Nitin; Ratan, Simmi; Aggarwal, Satish K

2012-04-01

To test the hypothesis that during laparoscopic hernia repair, partial resection of the distal sac along with suture ligation of the neck is better than simple transection and ligation. The following two techniques of laparoscopic hernia repair were compared: Group I, circumferential incision of peritoneum at the deep ring and partial resection of the distal sac and suture ligation at the neck; versus Group II, circumferential incision of the peritoneum at the deep ring and suture ligation at the neck. Twenty-five cases of inguinal hernia were randomly selected in each group between the age group of 6 months to 12 years. The outcome measures were recurrence, intra- or postoperative complications, and time taken for surgery. There were no recurrences in either group. Other parameters for comparison were also not statistically different between the two groups. There was no conversion. Although partial resection of the sac has been an essential step in open hernia repair over five decades, its value has been questioned by our study, because omitting this step during laparoscopic repair has not adversely affected the outcomes. Partial resection of the sac is not a necessary component of hernia repair. It is a technical necessity of the open approach. Therefore, omitting this step in laparoscopic repair does not adversely affect the outcome.

Squamous Cell Carcinoma of the Anal Canal: Patterns and Predictors of Failure and Implications for Intensity-Modulated Radiation Treatment Planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wright, Jean L., E-mail: jwright3@med.miami.ed; Patil, Sujata M.; Temple, Larissa K.F.

2010-11-15

Purpose: Intensity-modulated radiation treatment (IMRT) is increasingly used in the treatment of squamous cell carcinoma of the anal canal (SCCAC). Prevention of locoregional failure (LRF) using IMRT requires appropriate clinical target volume (CTV) definition. To better define the CTV for IMRT, we evaluated patterns and predictors of LRF in SCCAC patients given conventional radiation treatment. Methods and Materials: We reviewed records of 180 SCCAC patients treated with conventional radiation with or without chemotherapy at our institution between January 1990 and March 2007. All patients received radiation; the median primary tumor dose was 45 Gy. A total of 173 patients alsomore » received mitomycin-based chemotherapy. Results: Median follow-up was 40 months. Actuarial 3-year colostomy-free survival was 89% and overall survival (OS) 88%. Actuarial 3-year LRF was 23%. A total of 45 patients had LRF, with 35 (78%) occurring locally in the primary site (25 local only, 10 local and regional); however, 20 (44%) had regional components of failure within the pelvis or inguinal nodes (10 regional only, 10 local and regional). Cumulative sites of LRF (patients may have one or more site of failure) were as follows: primary, 35; inguinal, 8; external perianal, 5; common iliac, 4; presacral, 3; distal rectum, 2; external iliac, 2; and internal iliac, 2. All patients with common iliac failure had cT3 or N+ disease. Conclusions: The observed patterns of failure support inclusion of the inguinal and all pelvic nodal groups in the CTV for IMRT. In patients with advanced tumor or nodal stage, common iliac nodes should also be included in the CTV.« less

Correction of aortic insufficiency with an external adjustable prosthetic aortic ring.

PubMed

Gogbashian, Andrew; Ghanta, Ravi K; Umakanthan, Ramanan; Rangaraj, Aravind T; Laurence, Rita G; Fox, John A; Cohn, Lawrence H; Chen, Frederick Y

2007-09-01

Less invasive, valve-sparing options are needed for patients with aortic insufficiency (AI). We sought to evaluate the feasibility of reducing AI with an external adjustable aortic ring in an ovine model. To create AI, five sheep underwent patch plasty enlargement of the aortic annulus and root by placement of a 10 x 15 mm pericardial patch between the right and noncoronary cusps. An adjustable external ring composed of a nylon band was fabricated and placed around the aortic root. Aortic flow, aortic pressure, and left ventricular pressures were measured with the ring loose (off) and tightened (on). Mean regurgitant orifice area decreased by 86%, from 0.07 +/- 0.03 cm2 (ring loose, off) to 0.01 +/- 0.00 cm2 (ring tightened, on) [p < 0.01]. The regurgitant fraction decreased from 18 +/- 4% to 2 +/- 1% [p < 0.01]. The ring did not significantly affect stroke volume and aortic pressure. An ovine model of aortic root dilatation resulting in acute AI has been developed. In this model, application of an external, adjustable constricting aortic ring eliminated AI. An aortic ring may be a useful adjunct in reducing AI secondary to annular dilatation.

External front instabilities induced by a shocked particle ring.

PubMed

Rodriguez, V; Saurel, R; Jourdan, G; Houas, L

2014-10-01

The dispersion of a cylindrical particle ring by a blast or shock wave induces the formation of coherent structures which take the form of particle jets. A blast wave, issuing from the discharge of a planar shock wave at the exit of a conventional shock tube, is generated in the center of a granular medium ring initially confined inside a Hele-Shaw cell. With the present experimental setup, under impulsive acceleration, a solid particle-jet formation is observed in a quasi-two-dimensional configuration. The aim of the present investigation is to observe in detail the formation of very thin perturbations created around the external surface of the dispersed particle layer. By means of fast flow visualization with an appropriate recording window, we focus solely on the first instants during which the external particle ring becomes unstable. We find that the critical area of the destabilization of the external ring surface is constant regardless of the acceleration of the initial layer. Moreover, we observe in detail the external front perturbation wavelength, rendered dimensionless by the initial ring perimeter, and follow its evolution with the initial particle layer acceleration. We report this quantity to be constant regardless of the evolution of the initial particle layer acceleration. Finally, we can reasonably assert that external front perturbations depend solely on the material of the particles.

Intracorporeal robot-assisted microsurgical vasovasostomy for the treatment of bilateral vasal obstruction occurring following bilateral inguinal hernia repairs with mesh placement.

PubMed

Trost, Landon; Parekattil, Sijo; Wang, Julie; Hellstrom, Wayne J G

2014-04-01

Various surgical approaches have been described to manage iatrogenic inguinal vasal obstruction, including open microscopic, laparoscopic and robot-assisted techniques. The open and laparoscopic approaches are often limited in cases of extensive inguinal obstruction or inadequate intra-abdominal vasal length. The robotic approach offers novel opportunities to the operating surgeon, including performing microsurgical anastomoses in traditionally challenging locations. To our knowledge we describe the first intracorporeal robot-assisted, microsurgical vasovasostomy for iatrogenic vasal obstruction not amenable to standard microscopic repair. Bilateral intracorporeal robot-assisted microsurgical vasovasostomy was performed. The proximal vasa were transected and obstruction of the distal segments was confirmed. After docking the robot the intracorporeal regions of the vasa were transected at the internal ring. The proximal vasal segments were passed intracorporeally and approximated with 5-zero polypropylene sutures. A standard 2-layer anastomosis was performed intracorporeally using 10-zero/9-zero sutures. Total operative time was 278 minutes. No intraoperative or postoperative complications were noted. Semen analysis 8 weeks after the procedure demonstrated a total volume of 5.4 cc, 8.4 × 10(6) sperm per ml, 45.4 × 10(6) total sperm and 16% motility, consistent with a successful result. To our knowledge this represents the first reported case of intracorporeal outpatient vasovasostomy. These results demonstrate the feasibility of the procedure and highlight unique aspects of the robotic approach, which may offer advantages over the traditional microscope in select cases. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

The Experience of Soviet Medicine in the Great Patriotic War 1941-1945,

DTIC Science & Technology

1980-02-06

mainly during shock/counterblow of brain against the contradictory/opposite walls of skull. Subliminal stimulations cause system resFonse of IX-X nerve...the same effect was cbtained during the stimulation of external auditory passage and muccsa of ncse. Vith sharp pressure to the region of the inguinal...zone of stimulation are invclved the centers cf tespcral region in combination with vestibular, auditory or gustatory aura. At the same time the

Stabilizing windings for tilting and shifting modes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jardin, S.C.; Christensen, U.R.

1982-02-26

This invention provides simple, inexpensive, independent and passive, conducting loops for stabilizing a plasma ring having externally produced equilibrium fields on opposite sides of the plasma ring and internal plasma currents that interact to tilt and/or shift the plasma ring relative to the externally produced equilibrium field so as to produce unstable tilting and/or shifting modes in the plasma ring. More particularly this invention provides first and second passive conducting loops for containing first and second induced currents in first and second directions corresponding to the amplitude and directions of the unstable tilting and/or shifting modes in the plasma ring.more » To this end, the induced currents provide additional magnetic fields for producing restoring forces and/or restoring torques for counteracting the tilting and/or shifting modes when the conducting loops are held fixed in stationary positions relative to the externally produced equilibrium fields on opposite sides of the plasma ring.« less

Strangulated inguinal hernia in adult males in Kumasi.

PubMed

Ohene-Yeboah, M; Dally, C K

2014-06-01

The complications of untreated inguinal hernias are common surgical emergencies in adult Ghanaian men. To describe the epidemiology of strangulated inguinal hernia in adult males in Kumasi. From the hospital records the age and sex of all male adult patients treated for strangulated inguinal hernia were recorded at the Komfo Anokye Teaching Hospital(KATH), the University Hospital (UH), the Seventh Day Adventist Hospital (SDAH) and the Kumasi South Hospital (KSH) for the period January 2007 to December 2011 inclusive. The total number of inguinal hernia repairs from all four facilities was also recorded. The annual incidence of strangulated inguinal hernia and the hernia repair rates were estimated using the 2010 population data. Five-hundred and ninety-two cases of strangulated inguinal hernia were treated over the five years. The incidence of strangulated inguinal hernia was 0.26%. A total of 2243 inguinal hernia repairs were performed and 26.4 % of these repairs were for strangulation. The total number of inguinal hernia repairs averaged 77.3 repairs per 100 000 adult males per year and the elective repair rate was low at 0.9%. There is the need to increase the levels of elective repair of inguinal hernia in Kumasi.

Biomechanical Comparison of External Fixation and Compression Screws for Transverse Tarsal Joint Arthrodesis.

PubMed

Latt, L Daniel; Glisson, Richard R; Adams, Samuel B; Schuh, Reinhard; Narron, John A; Easley, Mark E

2015-10-01

Transverse tarsal joint arthrodesis is commonly performed in the operative treatment of hindfoot arthritis and acquired flatfoot deformity. While fixation is typically achieved using screws, failure to obtain and maintain joint compression sometimes occurs, potentially leading to nonunion. External fixation is an alternate method of achieving arthrodesis site compression and has the advantage of allowing postoperative compression adjustment when necessary. However, its performance relative to standard screw fixation has not been quantified in this application. We hypothesized that external fixation could provide transverse tarsal joint compression exceeding that possible with screw fixation. Transverse tarsal joint fixation was performed sequentially, first with a circular external fixator and then with compression screws, on 9 fresh-frozen cadaveric legs. The external fixator was attached in abutting rings fixed to the tibia and the hindfoot and a third anterior ring parallel to the hindfoot ring using transverse wires and half-pins in the tibial diaphysis, calcaneus, and metatarsals. Screw fixation comprised two 4.3 mm headless compression screws traversing the talonavicular joint and 1 across the calcaneocuboid joint. Compressive forces generated during incremental fixator foot ring displacement to 20 mm and incremental screw tightening were measured using a custom-fabricated instrumented miniature external fixator spanning the transverse tarsal joint. The maximum compressive force generated by the external fixator averaged 186% of that produced by the screws (range, 104%-391%). Fixator compression surpassed that obtainable with screws at 12 mm of ring displacement and decreased when the tibial ring was detached. No correlation was found between bone density and the compressive force achievable by either fusion method. The compression across the transverse tarsal joint that can be obtained with a circular external fixator including a tibial ring exceeds that which can be obtained with 3 headless compression screws. Screw and external fixator performance did not correlate with bone mineral density. This study supports the use of external fixation as an alternative method of generating compression to help stimulate fusion across the transverse tarsal joints. The findings provide biomechanical evidence to support the use of external fixation as a viable option in transverse tarsal joint fusion cases in which screw fixation has failed or is anticipated to be inadequate due to suboptimal bone quality. © The Author(s) 2015.

A Prospective Randomized Trial to Assess Fixation Strategies for Severe Open Tibia Fractures: Modern Ring External Fixators Versus Internal Fixation (FIXIT Study).

PubMed

OʼToole, Robert V; Gary, Joshua L; Reider, Lisa; Bosse, Michael J; Gordon, Wade T; Hutson, James; Quinnan, Stephen M; Castillo, Renan C; Scharfstein, Daniel O; MacKenzie, Ellen J

2017-04-01

The treatment of high-energy open tibia fractures is challenging in both the military and civilian environments. Treatment with modern ring external fixation may reduce complications common in these patients. However, no study has rigorously compared outcomes of modern ring external fixation with commonly used internal fixation approaches. The FIXIT study is a prospective, multicenter randomized trial comparing 1-year outcomes after treatment of severe open tibial shaft fractures with modern external ring fixation versus internal fixation among men and women of ages 18-64. The primary outcome is rehospitalization for major limb complications. Secondary outcomes include infection, fracture healing, limb function, and patient-reported outcomes including physical function and pain. One-year treatment costs and patient satisfaction will be compared between the 2 groups, and the percentage of Gustilo IIIB fractures that can be salvaged without soft tissue flap among patients receiving external fixation will be estimated.

Giant iliopectineal bursitis presenting as neuropathy and severe edema of the lower limb: case illustration and review of the literature.

PubMed

Iwata, Takahiro; Nozawa, Satoshi; Ohashi, Minoru; Sakai, Hiroshi; Shimizu, Katsuji

2013-05-01

We report a 61-year-old woman with rheumatoid arthritis (RA: Steinblocker stage III, class 3) who developed severe swelling and neuropathy of the right lower limb caused by an iliopectineal bursa associated with destruction of the hip joint. Physical examination revealed an inguinal mass and groin pain. X-ray examination indicated destruction of the hip joint. Contrast-enhanced computed tomography showed the bursa connected with the hip joint and a markedly compressed external iliac vein among the inguinal ligament, pubis, and bursa. The patient underwent partial synovial resection and total hip arthroplasty for recovery of hip function, and this led to successful resolution of the symptoms and bursa. We present the characteristic images from this case and review all previously reported cases of RA iliopsoas bursitis causing leg swelling or neuropathy, and summarize the background. Since this lesion may cause various symptoms, clinical awareness that iliopsoas bursitis may present with unique clinical symptoms may aid correct diagnosis.

CT and US findings of ovarian torsion within an incarcerated inguinal hernia.

PubMed

Hyun, Park Mee; Jung, Ah Young; Lee, Yul; Yang, Ik; Yang, Dae Hyun; Hwang, Ji-Young

2015-02-01

Inguinal hernia is relatively common in children. Although inguinal hernia is not frequently encountered in girls in comparison to boys, there are occasional cases of uterine or ovarian herniation in female indirect inguinal hernia. Incarcerated ovary in hernia sac has the risk of torsion and strangulation. We present an 8-year-old girl with painful mass in her left groin. With computed tomography (CT) and ultrasonography (US), we made the diagnosis of ovarian strangulation within an incarcerated inguinal hernia. Since ultrasound is primarily used for evaluation of groin mass, CT findings of an incarcerated inguinal hernia is rarely reported.

Technical considerations to minimize complications of inguinal lymph node dissection

PubMed Central

Gupta, Manik K.; Patel, Amar P.

2017-01-01

Penile cancer is a rare malignancy with a high propensity for regional dissemination. Current guidelines recommend inguinal lymphadenectomy in patients with penile cancer for palpable inguinal lymph nodes or in certain cases of nonpalpable inguinal lymph nodes. For many years, this procedure was performed with a traditional open approach and carried significant morbidity due to severe lymphedema, flap necrosis, wound infections, and seroma formation. The evolution of inguinal lymphadenectomy surgery for patients with penile cancer to a more minimally invasive approach has greatly reduced the morbidity of the procedure. Complications of inguinal lymphadenectomy can be minimized with modifications in surgical approach with the use of endoscopic, robotic, and various reconstructive methods. This review focuses on various intraoperative techniques to reduce morbidity in inguinal lymphadenectomies for penile cancer. PMID:29184778

[Subperitoneal inguinal hernioplasty by anterior approach, using a memory-ring patch. Preliminary results].

PubMed

Pélissier, E-P; Ngo, P

2006-12-01

Incidence of chronic pain is lower following laparoscopic hernioplasty than open surgery, probably due to the location of the patch in the preperitoneal space. But since laparoscopy is more demanding, the rates of complications and recurrences are higher. The aim of this study was to evaluate the results of a procedure consisting of placement of a patch, endowed with some memory of shape, provided by a thin peripheral memory ring, in the preperitoneal space, by inguinal incision, through the hernia orifice, under spinal or local anesthesia. The study was carried out in two stages. The first study consisted of evaluating the results of a prosthesis made of a polypropylene mesh endowed with a memory-ring made of a PDS cord (Ethicon SAS, 92787 Issy-les-Moulineaux). The second study evaluated the results of the Polysoft patch manufactured by Bard C degrees (Bard France, 78960 Voisins-le-Bretonneux), according to this concept. The first study involved 129 hernias operated on 126 patients of mean age 60 years (27-84). There were 3 (2.3%) benign complications. With a median follow-up of 24.5 months (12-42), 124 hernias (96%) were evaluated. There were 2 recurrences (1.6%) and 7 cases (5.6%) of chronic pain. The second series involved 150 hernias operated on 139 patients of mean age 60 years (21-94). Four (2.7%) benign complications occurred. The median length of surgery was 36 min (20-60), the median postoperative hospital stay was 1 day (0-5), the median time to return to normal activity was 3 days (0-8) and the median time off work was 18 days (1(30). The patients took paracetamol for 3 days (0-10) and the total units number was 8 (0-28). These results suggest that the method, easily reproducible, provides a low rate of complications and recurrences, as well as a low level of postoperative and chronic pain. They are worth being confirmed by a randomised comparison to the laparoscopic and Lichtenstein techniques.

Validation of newly developed physical laparoscopy simulator in transabdominal preperitoneal (TAPP) inguinal hernia repair.

PubMed

Nishihara, Yuichi; Isobe, Yoh; Kitagawa, Yuko

2017-12-01

A realistic simulator for transabdominal preperitoneal (TAPP) inguinal hernia repair would enhance surgeons' training experience before they enter the operating theater. The purpose of this study was to create a novel physical simulator for TAPP inguinal hernia repair and obtain surgeons' opinions regarding its efficacy. Our novel TAPP inguinal hernia repair simulator consists of a physical laparoscopy simulator and a handmade organ replica model. The physical laparoscopy simulator was created by three-dimensional (3D) printing technology, and it represents the trunk of the human body and the bendability of the abdominal wall under pneumoperitoneal pressure. The organ replica model was manually created by assembling materials. The TAPP inguinal hernia repair simulator allows for the performance of all procedures required in TAPP inguinal hernia repair. Fifteen general surgeons performed TAPP inguinal hernia repair using our simulator. Their opinions were scored on a 5-point Likert scale. All participants strongly agreed that the 3D-printed physical simulator and organ replica model were highly useful for TAPP inguinal hernia repair training (median, 5 points) and TAPP inguinal hernia repair education (median, 5 points). They felt that the simulator would be effective for TAPP inguinal hernia repair training before entering the operating theater. All surgeons considered that this simulator should be introduced in the residency curriculum. We successfully created a physical simulator for TAPP inguinal hernia repair training using 3D printing technology and a handmade organ replica model created with inexpensive, readily accessible materials. Preoperative TAPP inguinal hernia repair training using this simulator and organ replica model may be of benefit in the training of all surgeons. All general surgeons involved in the present study felt that this simulator and organ replica model should be used in their residency curriculum.

[Modern approaches for the choice of open-access method of plastic surgery for recurrent inguinal hernia].

PubMed

Belianskiĭ, L S; Todurov, I M; Pustovit, A A; Kucheruk, V V

2010-03-01

Retrospective analysis of the treatment results concerning 272 patients, who have suffered recurrent inguinal hernia and were operated on in the clinic for the period of 1999-2009 yrs, was done. The need for preperitoneal plasty of inguinal canal performance for recurrent inguinal hernia, using extrainguinial access to hernia defect, was noted. This procedure lowers therisk of iatrogenic injury occurrence of anatomic structures of inguinal canal.

Simplified flangeless unisex waveguide coupler assembly

DOEpatents

Michelangelo, Dimartino; Moeller, Charles P.

1993-01-01

A unisex coupler assembly is disclosed capable of providing a leak tight coupling for waveguides with axial alignment of the waveguides and rotational capability. The sealing means of the coupler assembly are not exposed to RF energy, and the coupler assembly does not require the provision of external flanges on the waveguides. In a preferred embodiment, O ring seals are not used and the coupler assembly is, therefore, bakeable at a temperature up to about 150.degree. C. The coupler assembly comprises a split collar which clamps around the waveguides and a second collar which fastens to the split collar. The split collar contains an inner annular groove. Each of the waveguides is provided with an external annular groove which receives a retaining ring. The split collar is clamped around one of the waveguides with the inner annular groove of the split collar engaging the retaining ring carried in the external annular groove in the waveguide. The second collar is then slipped over the second waveguide behind the annular groove and retaining ring therein and the second collar is coaxially secured by fastening means to the split collar to draw the respective waveguides together by coaxial force exerted by the second collar against the retaining ring on the second waveguide. A sealing ring is placed against an external sealing surface at a reduced external diameter end formed on one waveguide to sealingly engage a corresponding sealing surface on the other waveguide as the waveguides are urged toward each other.

Simplified flangeless unisex waveguide coupler assembly

DOEpatents

Michelangelo, D.; Moeller, C.P.

1993-05-04

A unisex coupler assembly is disclosed capable of providing a leak tight coupling for waveguides with axial alignment of the waveguides and rotational capability. The sealing means of the coupler assembly are not exposed to RF energy, and the coupler assembly does not require the provision of external flanges on the waveguides. In a preferred embodiment, O ring seals are not used and the coupler assembly is, therefore, bakeable at a temperature up to about 150 C. The coupler assembly comprises a split collar which clamps around the waveguides and a second collar which fastens to the split collar. The split collar contains an inner annular groove. Each of the waveguides is provided with an external annular groove which receives a retaining ring. The split collar is clamped around one of the waveguides with the inner annular groove of the split collar engaging the retaining ring carried in the external annular groove in the waveguide. The second collar is then slipped over the second waveguide behind the annular groove and retaining ring therein and the second collar is coaxially secured by fastening means to the split collar to draw the respective waveguides together by coaxial force exerted by the second collar against the retaining ring on the second waveguide. A sealing ring is placed against an external sealing surface at a reduced external diameter end formed on one waveguide to sealingly engage a corresponding sealing surface on the other waveguide as the waveguides are urged toward each other.

Simplified flangeless unisex waveguide coupler assembly

DOE Office of Scientific and Technical Information (OSTI.GOV)

Michelangelo, D.; Moeller, C.P.

1993-05-04

A unisex coupler assembly is disclosed capable of providing a leak tight coupling for waveguides with axial alignment of the waveguides and rotational capability. The sealing means of the coupler assembly are not exposed to RF energy, and the coupler assembly does not require the provision of external flanges on the waveguides. In a preferred embodiment, O ring seals are not used and the coupler assembly is, therefore, bakeable at a temperature up to about 150 C. The coupler assembly comprises a split collar which clamps around the waveguides and a second collar which fastens to the split collar. Themore » split collar contains an inner annular groove. Each of the waveguides is provided with an external annular groove which receives a retaining ring. The split collar is clamped around one of the waveguides with the inner annular groove of the split collar engaging the retaining ring carried in the external annular groove in the waveguide. The second collar is then slipped over the second waveguide behind the annular groove and retaining ring therein and the second collar is coaxially secured by fastening means to the split collar to draw the respective waveguides together by coaxial force exerted by the second collar against the retaining ring on the second waveguide. A sealing ring is placed against an external sealing surface at a reduced external diameter end formed on one waveguide to sealingly engage a corresponding sealing surface on the other waveguide as the waveguides are urged toward each other.« less

Prophylactic inguinal-femoral irradiation as an alternative to primary lymphadenectomy in treatment of vulvar carcinoma.

PubMed

Hallak, Sorana; Ladi, Luz; Sorbe, Bengt

2007-11-01

In a complete geographic series of 294 cases of primary vulvar carcinomas prophylactic inguinal-femoral irradiation was used as a standard postoperative therapy. Inguinal lymph node dissection was performed in only 27 cases (9%) and was not part of the standard surgery. The histology was squamous cell carcinoma in 269 cases (92%). The primary surgery was total vulvectomy, partial vulvectomy, or local resection of the tumor. The main type of radiotherapy was adjuvant inguinal irradiation. Two separate, symmetrical and rectangular inguinal fields were irradiated with combined photon and electron beams. In the complete series 127 recurrences (43%) were recorded. Local (24%) and regional recurrences (19%) were most frequent. Type of surgery was not associated with the risk of tumor recurrence. The 5-year overall survival rate was 53% and the relapse-free survival (RFS) rate was 55%. Tumor grade was significantly (P=0.007) associated with the RFS. The inguinal RFS rate was 75% both for patients treated with adjuvant inguinal irradiation without lymphadenectomy and patients treated with primary lymph adenectomy +/- inguinal irradiation. Postoperative complications were recorded in 22%. Postoperative complications occurred most frequently in the subgroup undergoing inguinal lymphadenectomy. Chronic lymph edemas were the most serious late tissue reactions.

Colonic carcinoma presenting as strangulated inguinal hernia: report of two cases and review of the literature.

PubMed

Slater, R; Amatya, U; Shorthouse, A J

2008-09-01

Inguinal hernia and colonic carcinoma are common surgical conditions, yet carcinoma of the colon occurring within an inguinal hernia sac is rare. Of 25 reported cases, only one was a perforated sigmoid colon carcinoma in an inguinal hernia. We report two cases of sigmoid colon carcinoma, one of which had locally perforated. Each presented within a strangulated inguinal hernia. Oncologically correct surgery in these patients presents a technical challenge.

Stabilization of ring dark solitons in Bose-Einstein condensates

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Wenlong; Kevrekidis, P. G.; Carretero-González, R.

Earlier work has shown that ring dark solitons in two-dimensional Bose-Einstein condensates are generically unstable. In this work, we propose a way of stabilizing the ring dark soliton via a radial Gaussian external potential. We investigate the existence and stability of the ring dark soliton upon variations of the chemical potential and also of the strength of the radial potential. Numerical results show that the ring dark soliton can be stabilized in a suitable interval of external potential strengths and chemical potentials. Furthermore, we also explore different proposed particle pictures considering the ring as a moving particle and find, wheremore » appropriate, results in very good qualitative and also reasonable quantitative agreement with the numerical findings.« less

Stabilization of ring dark solitons in Bose-Einstein condensates

DOE PAGES

Wang, Wenlong; Kevrekidis, P. G.; Carretero-González, R.; ...

2015-09-14

Earlier work has shown that ring dark solitons in two-dimensional Bose-Einstein condensates are generically unstable. In this work, we propose a way of stabilizing the ring dark soliton via a radial Gaussian external potential. We investigate the existence and stability of the ring dark soliton upon variations of the chemical potential and also of the strength of the radial potential. Numerical results show that the ring dark soliton can be stabilized in a suitable interval of external potential strengths and chemical potentials. Furthermore, we also explore different proposed particle pictures considering the ring as a moving particle and find, wheremore » appropriate, results in very good qualitative and also reasonable quantitative agreement with the numerical findings.« less

Structural analysis of the space shuttle solid rocket booster/external tank attach ring

NASA Technical Reports Server (NTRS)

Dorsey, John T.

1988-01-01

An External Tank (ET) attach ring is used in the Space Shuttle System to transfer lateral loads between the ET and the Solid Rocket Booster (SRB). Following the Challenger (51-L) accident, the flight performance of the ET attach ring was reviewed, and negative margins of safety and failed bolts in the attach ring were subsequently identified. The analyses described in this report were performed in order to understand the existing ET attach ring structural response to motor case internal pressurization as well as to aid in an ET attach ring redesign effort undertaken by NASA LaRC. The finite element model as well as the results from linear and nonlinear static structural analyses are described.

ROBOTIC ASSISTED SINGLE SITE FOR BILATERAL INGUINAL HERNIA REPAIR.

PubMed

Bosi, Henrique Rasia; Guimarães, José Ricardo; Cavazzola, Leandro Totti

2016-01-01

The inguinal hernia is one of the most frequent surgical diseases, being frequent procedure and surgeon´s everyday practice. To present technical details in making hernioplasty using robotic equipment on bilateral inguinal hernia repair with single port and preliminary results with the method. The bilateral inguinal hernia repair was performed by using the Single-Site(c) Da Vinci Surgical Access Platform to the abdominal cavity and the placement of clamps. This technique proved to be effective for inguinal hernia and have more aesthetic result when compared to other techniques. Inguinal hernia repair robot-assisted with single-trocar is feasible and effective. However, still has higher costs needing surgical team special training. A hérnia inguinal é uma das doenças cirúrgicas mais frequentes, tornando-a procedimento frequente e do cotidiano do cirurgião. Apresentar detalhes da técnica da hernioplastia inguinal bilateral robótica por single-site e resultados preliminares com o método. Foi realizada hernioplastia inguinal bilateral assistida por robô, utilizando-se da Vinci Single-Site(c) Surgical Platform para acesso a cavidade abdominal e colocação das pinças. Esta técnica demonstrou-se efetiva para correção da hérnia inguinal, além de apresentar melhor resultado estético quando comparado às outras técnicas. A hernioplastia inguinal assistida por robô com trocarte único é viável e eficaz. Contudo, ainda apresenta custos mais elevados e necessidade de treinamento especial por parte da equipe cirúrgica.

Numerical Simulations of Silverpit Crater Collapse

NASA Technical Reports Server (NTRS)

Collins, G. S.; Ivanov, B. A.; Turtle, E. P.; Melosh, H. J.

2003-01-01

The Silverpit crater is a recently discovered, 60-65 Myr old complex crater, which lies buried beneath the North Sea, about 150 km east of Britain. High-resolution images of Silverpit's subsurface structure, provided by three-dimensional seismic reflection data, reveal an inner-crater morphology similar to that expected for a 5-8 km diameter terrestrial crater. The crater walls show evidence of terrace-style slumping and there is a distinct central uplift, which may have produced a central peak in the pristine crater morphology. However, Silverpit is not a typical 5-km diameter terrestrial crater, because it exhibits multiple, concentric rings outside the main cavity. External concentric rings are normally associated with much larger impact structures, for example Chicxulub on Earth, or Orientale on the Moon. Furthermore, external rings associated with large impacts on the terrestrial planets and moons are widely-spaced, predominantly inwardly-facing, asymmetric scarps. However, the seismic data show that the external rings at Silverpit represent closely-spaced, concentric faultbound graben, with both inwardly and outwardly facing fault-scarps. This type of multi-ring structure directly analogous to the Valhalla-type multi-ring basins found on the icy satellites. Thus, the presence and style of the multiple rings at Silverpit is surprising given both the size of the crater and its planetary setting. A further curiosity of the Silverpit structure is that the external concentric rings appear to be extensional features on the West side of the crater and compressional features on the East side. The crater also lies in a local depression, thought to be created by postimpact movement of a salt layer buried beneath the crater.

A randomised study of ilio-inguinal nerve blocks following inguinal hernia repair: a stopped randomised controlled trial.

PubMed

Walker, Stuart; Orlikowski, Chris

2008-02-01

Local anaesthetic use for post-operative pain control is widely used following open inguinal hernia repair but this is not without risk. The aim of this study was to compare ilio-inguinal nerve block and wound irrigation in patients undergoing open inguinal hernia repair under general anaesthetic in a randomised, double blind, placebo controlled trial. Adult patients admitted for unilateral primary open mesh repair of an inguinal hernia were recruited. The patients received a standard general anaesthetic. Prior to skin incision, an ilio-inguinal injection was performed by the anaesthetist with either ropivicaine or normal saline. Prior to closure of the wound, the wound was irrigated with either ropivicaine or normal saline. Post-operatively, all patients received fentynal patient controlled analgesia and regular oral analgesia. Pain scores and visual analogue scores were recorded until discharge. Patients were then contacted by telephone at 24h, 48h, 2weeks and 4weeks post-operatively and asked a standard series of questions, mainly related to post-operative pain. After 12 patients had been recruited the trial was stopped as 5 of the 8 patients who received an ilio-inguinal nerve block suffered a neurological complication. Ilio-inguinal nerve block with ropivicaine should be avoided.

Ring-resonator-integrated tunable external cavity laser employing EAM and SOA.

PubMed

Yoon, Ki-Hong; Kwon, O-Kyun; Kim, Ki Soo; Choi, Byung-Seok; Oh, Su Hwan; Kim, Hyun Su; Sim, Jae-Sik; Kim, Chul Soo

2011-12-05

We propose and demonstrate a tunable external cavity laser (ECL) composed of a polymer Bragg reflector (PBR) and integrated gain chip with gain, a ring resonator, an electro-absorption modulator (EAM), and a semiconductor optical amplifier (SOA). The cavity of the laser is composed of the PBR, gain, and ring resonator. The ring resonator reflects the predetermined wavelengths into the gain region and transmits the output signal into integrated devices such as the EAM and SOA. The output wavelength of the tunable laser is discretely tuned in steps of about 0.8 nm through the thermal-optic effect of the PBR and predetermined mode spacing of the ring resonator.

Prevalence of Inguinal Hernia in Adult Men in the Ashanti Region of Ghana.

PubMed

Ohene-Yeboah, Michael; Beard, Jessica H; Frimpong-Twumasi, Benjamin; Koranteng, Adofo; Mensah, Samuel

2016-04-01

Inguinal hernia is thought to be common in rural Ghana, though no recent data exist on hernia prevalence in the country. This information is needed to guide policy and increase access to safe hernia repair in Ghana and other low-resource settings. Adult men randomly selected from the Barekese sub-district of Ashanti Region, Ghana were examined by surgeons for the presence of inguinal hernia. Men with hernia completed a survey on demographics, knowledge of the disease, and barriers to surgical treatment. A total of 803 participants were examined, while 105 participants completed the survey. The prevalence of inguinal hernia was 10.8 % (95 % CI 8.0, 13.6 %), and 2.2 % (95 % CI 0, 5.4 %) of participants had scars indicative of previous repair, making the overall prevalence of treated and untreated inguinal hernia 13.0 % (95 % CI 10.2, 15.7 %). Prevalence of inguinal hernia increased with age; 35.4 % (95 % CI 23.6, 47.2 %) of men aged 65 and older had inguinal hernia. Untreated inguinal hernia was associated with lower socio-economic status. Of those with inguinal hernia, 52.4 % did not know the cause of hernia. The most common reason cited for failing to seek medical care was cost (48.2 %). Although inguinal hernia is common among adult men living in rural Ghana, surgical repair rates are low. We propose a multi-faceted public health campaign aimed at increasing access to safe hernia repair in Ghana. This approach includes a training program of non-surgeons in inguinal hernia repair headed by the Ghana Hernia Society and could be adapted for use in other low-resource settings.

Buckling tests of two 4.6-meter-diameter, magnesium ring-stiffened conical shells loaded under external pressure

NASA Technical Reports Server (NTRS)

Anderson, J. K.; DAVIS R. C.

1973-01-01

Two ring-stiffened magnesium conical shells with a 120 deg apex angle and a 4.6-meter diameter were loaded to failure by a uniform external pressure. The cones differed from one another only in the number of internal stiffening rings. Test specimen details, test procedure, and test results are discussed. Both buckling and prebuckling data are compared with appropriate theoretical predictions. Measured strains in skin and rings agreed well with theoretical predictions. Extensive imperfection measurements were made and reported on both cones in the as fabricated condition.

Ring resonator based narrow-linewidth semiconductor lasers

NASA Technical Reports Server (NTRS)

Ksendzov, Alexander (Inventor)

2005-01-01

The present invention is a method and apparatus for using ring resonators to produce narrow linewidth hybrid semiconductor lasers. According to one embodiment of the present invention, the narrow linewidths are produced by combining the semiconductor gain chip with a narrow pass band external feedback element. The semi conductor laser is produced using a ring resonator which, combined with a Bragg grating, acts as the external feedback element. According to another embodiment of the present invention, the proposed integrated optics ring resonator is based on plasma enhanced chemical vapor deposition (PECVD) SiO.sub.2 /SiON/SiO.sub.2 waveguide technology.

FIBER AND INTEGRATED OPTICS: Integrated optical passive ring resonator for optical gyroscopes

NASA Astrophysics Data System (ADS)

Baĭborodin, Yu V.; Dyadin, S. S.; Lyadenko, A. F.; Mashchenko, A. I.; Ul'yanov, I. A.; Fatin, Yu L.

1992-02-01

A passive ring resonator based on channel waveguides, formed in a K8 glass substrate by diffusion ion exchange in molten potassium nitrate, was made and investigated. The waveguide structure of the resonator included a ring waveguide as well as two Y-type couplers, whose symmetric arms were coupled to the ring waveguide, whereas homogeneous arms were coupled to an external laser and a photodetector. The coupling of the external devices to the channel waveguides was implemented by prisms and butt (end face) contacts. The transfer function of the ring resonator was determined experimentally in order to illustrate its resonant properties and sharpness. Estimates were obtained of the ultimate sensitivity of an optical gyroscope utilizing a ring resonator with the properties described above and ways of improving this sensitivity were analyzed.

External Coulomb-Friction Damping For Hydrostatic Bearings

NASA Technical Reports Server (NTRS)

Buckmann, Paul S.

1992-01-01

External friction device damps vibrations of shaft and hydrostatic ring bearing in which it turns. Does not rely on wear-prone facing surfaces. Hydrostatic bearing ring clamped in radially flexing support by side plates clamped against radial surfaces by spring-loaded bolts. Plates provide friction against radial motions of shaft.

Resonance of scroll rings with periodic external fields in excitable media

NASA Astrophysics Data System (ADS)

Pan, De-Bei; Li, Qi-Hao; Zhang, Hong

2018-06-01

By direct numerical simulations of a chemical reaction-diffusion system coupled to a periodic external AC electric field with frequency equal to double frequency of the scroll wave rotation, we find that scroll rings resonate with the electric field and exhibit various dynamical behaviors, for example, their reversals, collapses, or growths, depending both on the initial phase of AC electric fields and on the initial phase of scroll rings. A kinematical model characterizing the drift velocity of the scroll rings along their radial directions as well as that of the scroll rings along their symmetry axes is proposed, which can effectively account for the numerical observations and predict the behaviors of the scroll rings. Besides, the existence of the equilibrium state of a scroll ring under the AC electric fields is predicted by the kinematical model and the predictions agree well with the simulations.

Internal versus external fixation of the anterior component in unstable fractures of the pelvic ring: pooled results from a systematic review.

PubMed

Wardle, B; Eslick, G D; Sunner, P

2016-10-01

Improving reduction of the pelvic ring improves long-term functional outcomes for patients. It has been demonstrated that posterior internal fixation is necessary to adequately control fractures to the posterior ring and there is evidence that supplementing this with fixation of the anterior ring improves stability. It is accepted that internal fixation provides greater stability than external fixation of the anterior ring but long-term differences in radiographic and functional outcomes have not yet been quantified. A search of electronic databases, reference lists and review articles from 1989 to 2015 yielded 18 studies (n = 884) that met our inclusion criteria. We included studies that discussed pelvic ring injuries in adults, reported functional or radiological outcomes or complications by anterior ring intervention and exceeded 14 patients. We excluded biomechanical and cadaver studies. Internal fixation of the anterior pelvic ring had better functional and radiographic outcomes. Residual displacement of >10 mm was less common with internal fixation (ER 0.12, 95 % CI 0.06-0.24) than external fixation (ER 0.31, 95 % CI 0.11-0.62). Unsatisfactory outcomes also occurred at a lower rate (ER 0.09, 95 % CI 0.03-0.22) compared to external fixation (ER 0.32, 95 % CI 0.18-0.50). Losses of reduction (ER 0.02, 95 % CI 0.01-0.04 versus ER 0.07, 95 % CI 0.02-0.21), malunions (ER 0.03, 95 % CI 0.01-0.08 versus ER 0.07, 95 % CI 0.02-0.21) and delayed/non-unions (ER 0.02, 95 % CI 0.01-0.05 versus ER 0.04, 95 % CI 0.02-0.07). Internal fixation of the anterior pelvic ring as supplementary fixation for unstable injuries to the pelvic ring appears to result in better radiographic and functional outcomes as well as fewer complications. However, data that separated outcomes and complications in relation to interventions of the anterior pelvic ring were limited. More studies looking specifically at outcomes in relation to the type of anterior ring intervention are needed.

The etiology of indirect inguinal hernia in adults: congenital or acquired?

PubMed

Jiang, Z P; Yang, B; Wen, L Q; Zhang, Y C; Lai, D M; Li, Y R; Chen, S

2015-10-01

During hernioplasty focal thickened tissue containing smooth muscle is found at the neck of the hernia sac in most patients with indirect inguinal hernia. These thickenings may be related to the processus vaginalis and reveal the etiology of indirect inguinal hernia. The study included 50 male adults with indirect inguinal hernia and 50 male adults with direct inguinal hernia, all of them were initial cases. Hernioplasty and excision of the hernia sac were performed, meanwhile anatomical features of the hernia sac and the spermatic cord were recorded, then followed by histological investigation of the hernia sacs. Focal thickenings were observed at the neck of the hernia sac in 88 % of adults with indirect inguinal hernia. Dense adhesion between the hernia sac and the spermatic cord was found where the thickening located. Histological examination identified smooth muscle cells in 57 % of the thickened tissues. No similar findings were observed in patients with direct inguinal hernia. The focal thickening which contains smooth muscle tissue may be remnant of the processus vaginalis after its obliteration. In other word, the presence of the thickening means that fusion of the processus vaginalis has previously taken place. Thus, most indirect inguinal hernias in adults may represent acquired diseases.

Rotary high power transfer apparatus

NASA Technical Reports Server (NTRS)

Jacobson, Peter E. (Inventor); Porter, Ryan S. (Inventor)

1987-01-01

An apparatus for reducing terminal-to-terminal circuit resistance and enhancing heat transfer in a rotary power transfer apparatus of the roll ring type comprising a connecting thimble for attaching an external power cable to a cone shaped terminal which is attached to a tab integral to an outer ring. An inner ring having a spherical recess mates with the spherical end of a tie connector. A cone shaped terminal is fitted to a second connecting thimble for attaching a second external power cable.

Numerical Simulations of Silverpit Crater Collapse

NASA Technical Reports Server (NTRS)

Collins, G. S.; Turtle, E. P.; Melosh, H. J.

2003-01-01

The Silverpit crater is a recently discovered, 60-65 Myr old complex crater, which lies buried beneath the North Sea, about 150 km east of Britain. High-resolution images of Silverpit's subsurface structure, provided by three-dimensional seismic reflection data, reveal an inner-crater morphology similar to that expected for a 5-8 km diameter terrestrial crater. The crater walls show evidence of terracestyle slumping and there is a distinct central uplift, which may have produced a central peak in the pristine crater morphology. However, Silverpit is not a typical 5-km diameter terrestrial crater, because it exhibits multiple, concentric rings outside the main cavity. External concentric rings are normally associated with much larger impact structures, for example Chicxulub on Earth, or Orientale on the Moon. Furthermore, external rings associated with large impacts on the terrestrial planets and moons are widely-spaced, predominantly inwardly-facing, asymmetric scarps. However, the seismic data show that the external rings at Silverpit represent closely-spaced, concentric fault-bound graben, with both inwardly and outwardly facing faults-carps. This type of multi-ring structure is directly analogous to the Valhalla-type multi-ring basins found on the icy satellites. Thus, the presence and style of the multiple rings at Silverpit is surprising given both the size of the crater and its planetary setting.

Method and apparatus for the formation of a spheromak plasma

DOEpatents

Jardin, Stephen C.; Yamada, Masaaki; Furth, Harold P.; Okabayashi, Mitcheo

1984-01-01

An inductive method and apparatus for forming detached spheromak plasma using a thin-walled metal toroidal ring, with external current leads and internal poloidal and toroidal field coils located inside a vacuum chamber filled with low density hydrogen gas and an external axial field generating coil. The presence of a current in the poloidal field coils, and an externally generated axial field sets up the initial poloidal field configuration in which the field is strongest toward the major axis of the toroid. The internal toroidal-field-generating coil is then pulsed on, ionizing the gas and inducing poloidal current and toroidal magnetic field into the plasma region in the sleeve exterior to and adjacent to the ring and causing the plasma to expand away from the ring and toward the major axis. Next the current in the poloidal field coils in the ring is reversed. This induces toroidal current into the plasma and causes the poloidal magnetic field lines to reconnect. The reconnection continues until substantially all of the plasma is formed in a separated spheromak configuration held in equilibrium by the initial external field.

Polled Intersex Syndrome with urethral atresia in a goat.

PubMed

Yokota, Shinichi; Matsuu, Aya; Morita, Takehito; Tsuka, Takeshi; Hishinuma, Mitsugu; Minami, Saburo; Hikasa, Yoshiaki

2011-10-01

A 5-day-old hornless goat was referred with dysuria since birth. The scrotum was absent, and a small penis-like structure was seen below the perineal raphe. On the laparotomy, the testicles were found near the inguinal ring- and attached to a uterus-like structure. On histological analysis, the uterus-like structure was blind-end. Germ cells were absent in the testis. The karyotype of this goat was 60, XX and the SRY gene was absent. The goat was homozygous for a DNA deletion responsible for the Polled Intersex Syndrome (PIS). To the authors' knowledge, this is the first report as the clinical case of the PIS-/- goat with urethral atresia.

Closeup view of an External Tank (ET) Attach Ring undergoing ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Close-up view of an External Tank (ET) Attach Ring undergoing preparations in the Processing Building of the Rotation Processing and Surge Facility at Kennedy Space Center. After preparations are complete the ET Attach Ring will be mated to the top of the Aft Motor Segment. The most prominent features in this view are the ET/Solid Rocket Booster Struts in the center and left in the view and the Aft Integrated Electronics Assembly located on the right side if the ring in this view. - Space Transportation System, Solid Rocket Boosters, Lyndon B. Johnson Space Center, 2101 NASA Parkway, Houston, Harris County, TX

Predictors of inguinal hernia after radical prostatectomy.

PubMed

Rabbani, Farhang; Yunis, Luis Herran; Touijer, Karim; Brady, Mary S

2011-02-01

To determine the significant independent predictors of inguinal hernia development after radical prostatectomy (RP) so that prophylactic measures can be undertaken in those at increased risk. Although inguinal hernia is a recognized complication after RP, the risk factors have not been well elucidated. From January 1999 to June 2007, 4592 consecutive patients underwent open retropubic RP or laparoscopic RP without previous radiotherapy. The median follow-up was 36.9 months (interquartile range 20.3, 60.6). Comorbidities were recorded, as well as the occurrence of inguinal hernia, wound infection, and bladder neck contracture. Cox proportional hazards analysis was performed for the predictors of inguinal hernia after RP on multivariate analysis. Inguinal hernia developed after RP in 68 men (1.5%) men at a median follow-up of 7.9 months (interquartile range 4.3, 18.1). The laterality was bilateral in 7, right in 27, left in 24, and not documented in 10 patients. The significant independent predictors of inguinal hernia included age (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.01-1.09, P = .016), body mass index (HR 0.91, 95% CI 0.85-0.98, P = .011), history of inguinal hernia repair (HR 3.9, 95% CI 1.8-8.2, P <.001), and bladder neck contracture (HR 2.8, 95% CI 1.3-5.9, P = .007) but not the RP approach (HR 1.08, 95% CI 0.60-1.96, P = .80 for laparoscopic RP vs retropubic RP). The results of our study have indicated that older patients, thinner patients, those with previous inguinal hernia repair, and those developing bladder neck contracture are at increased risk of developing an inguinal hernia. These factors might identify a subset for whom evaluation for subclinical hernia might allow prophylactic inguinal hernia repair at RP. Copyright © 2011 Elsevier Inc. All rights reserved.

Inguinal Hernia in Athletes: Role of Dynamic Ultrasound.

PubMed

Vasileff, William Kelton; Nekhline, Mikhail; Kolowich, Patricia A; Talpos, Gary B; Eyler, Willam R; van Holsbeeck, Marnix

Inguinal hernia is a commonly encountered cause of pain in athletes. Because of the anatomic complexity, lack of standard imaging, and the dynamic condition, there is no unified opinion explaining its underlying pathology. Athletes with persistent groin pain would have a high prevalence of inguinal hernia with dynamic ultrasound, and herniorrhaphy would successfully return athletes to activity. Case-control study. Level 3. Forty-seven amateur and professional athletes with sports-related groin pain who underwent ultrasound were selected based on history and examination. Patients with prior groin surgery or hip pathology were excluded. Clinical and surgical documentation were correlated with imaging. The study group was compared with 41 age-matched asymptomatic athletes. Ultrasound was positive for hernia with movement of bowel, bladder, or omental tissue anterior to the inferior epigastric vessels during Valsalva maneuver. The 47-patient symptomatic study group included 41 patients with direct inguinal hernias, 1 with indirect inguinal hernia, and 5 with negative ultrasound. Of 42 patients with hernia, 39 significantly improved with herniorrhaphy, 2 failed to improve after surgery and were diagnosed with adductor longus tears, and 1 improved with physical therapy. Five patients with negative ultrasound underwent magnetic resonance imaging and were diagnosed with hip labral tear or osteitis pubis. The 41-patient asymptomatic control group included 3 patients with direct inguinal hernias, 2 with indirect inguinal hernias, and 3 with femoral hernias. Inguinal hernias are a major component of groin pain in athletes. Prevalence of direct inguinal hernia in symptomatic athletes was greater than that for controls ( P < 0.001). Surgery was successful in returning these athletes to sport: 39 of 42 (93%) athletes with groin pain and inguinal hernia became asymptomatic. Persistent groin pain in the athlete may relate to inguinal hernia, which can be diagnosed with dynamic ultrasound imaging. Herniorrhaphy is successful at returning athletes to sports activity.

Adenocarcinoma arising at a colostomy site with inguinal lymph node metastasis: report of a case.

PubMed

Iwamoto, Masayoshi; Kawada, Kenji; Hida, Koya; Hasegawa, Suguru; Sakai, Yoshiharu

2015-02-01

Inguinal lymph node metastasis from adenocarcinoma arising at a colostomy site is extremely rare, and the significance of surgical resection for metastatic inguinal lymph nodes has not been established. An 82-year-old woman who had undergone abdominoperineal resection 27 years earlier was admitted to our hospital complaining of bleeding from a colostomy. Physical examination revealed that a tumor at the colostomy site directly invaded into the peristomal skin, and that a left inguinal lymph node was firm and swollen. Positron emission tomography/computed tomography scan demonstrated accumulation of (18)F-fluorodeoxy glucose into both the colostomy tumor and the left swollen inguinal lymph node, while there was no evidence of metastasis to liver or lungs. She underwent open left hemicolectomy with wide local resection of the colostomy, and dissection of left inguinal lymph nodes. Histological diagnosis was a moderately differentiated adenocarcinoma that directly invaded into the surrounding skin and metastasized to the left inguinal lymph node. The patient has been followed up for >5 years without any sign of recurrence. In general, inguinal lymph node metastasis from colorectal cancers is regarded as a systemic disease with a poor prognosis, and so systemic chemotherapy and radiotherapy, but not surgical lymph node dissection, are recommended. Considering the lymphatic drainage route in the present case, inguinal lymph node metastasis does not represent a systemic disease but rather a sentinel nodal metastasis from adenocarcinoma at a colostomy site. Surgical dissection of metastatic inguinal lymph nodes should be considered to enable a favorable prognosis in the absence of distant metastasis to other organs. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Early-onset inguinal hernia as risk factor for schizophrenia or related psychosis: a nationwide register-based cohort study.

PubMed

Melkersson, Kristina; Wernroth, Mona-Lisa

2017-10-01

In an earlier interview study, we found that more men with familial schizophrenia had undergone inguinal hernia operation, than men with sporadic schizophrenia. However, there are no other studies published specifically on inguinal hernia and schizophrenia. Therefore, the aim of this study was to carry out a Swedish register-based cohort study on the association between inguinal hernia and schizophrenia or related psychosis. Data from the Total Population- and Medical Birth-Registers were used to create a cohort of all individuals born in Sweden 1987-1999 (n=1 406 168). The cohort individuals were linked with the In- and Out-patient Registers and followed from birth to 2015 to identify onset of schizophrenia, schizoaffective disorder and inguinal hernia. Cox proportional hazards regression models were used to assess the association between inguinal hernia before age 13 and risk of developing schizophrenia or schizoaffective disorder during a follow-up from age 13. Inguinal hernia before age 13 was identified in 21 095 individuals, and during the follow-up in total 1314 individuals developed schizophrenia or schizoaffective disorder. The risk of schizophrenia or schizoaffective disorder was higher among individuals with inguinal hernia before age 13, than among individuals without such a diagnosis, especially among the men [adjusted hazard ratio (95% confidence interval); all: 1.44 (1.01-2.06), p=0.0452, men: 1.46 (1.01-2.12), p=0.0460, women: 0.56 (0.14-2.27), p=0.4173]. This study shows that early-onset inguinal hernia is associated with increased risk of developing schizophrenia or schizoaffective disorder, especially in men. Such an association may point to a common biological basis for the development of inguinal hernia and schizophrenia or related psychosis.

[A case of a geriatric patient with stage IV anal canal cancer showing complete response to chemoradiation therapy].

PubMed

Kuroda, Masatoshi; Hirai, Ryuji; Ikeda, Eiji; Tsuji, Hisashi; Takagi, Shoji; Yamano, Toshihisa; Yoshitomi, Seiji

2012-11-01

We present a case in which chemoradiation therapy was effective in a geriatric patient with Stage IV anal canal cancer. The patient is an 81-year-old woman who complained of proctorrhagia and anal pain. She was referred to us by her family doctor who suspected rectal cancer. Tumors as large as 6.5 cm in diameter mainly on the right side of the rectum as well as 2 palpable enlarged lymph nodes on the right inguinal area, were found during the initial physical examination. Squamous cell carcinoma was elevated to 16 ng/mL. A CT scan revealed that irregularly shaped masses as large as 7 cm in diameter were externally exposed on the right side of the rectum along with enlarged lymph nodes on the right inguinal area and metastasis at S7 lesion in the liver. Squamous cell carcinoma was diagnosed from biopsy results. Due to her age, the chemotherapy regimen was S-1+CDDP with radiation therapy and 4-port irradiation (50.4 Gy) of the primary tumor, interior of the pelvis, and inguinal lymph nodes. Partial response was observed upon completion of treatment, and complete response was obtained after 6 months. She is currently an outpatient taking S-1: 60 mg/day orally. There is no indication of cancer recurrence after 1 year and 3 months, and she continues to visit an outpatient clinic for regular follow-ups. These results demonstrate the effectiveness of chemoradiation therapy for geriatric patients with Stage IV anal canal cancer.

Hospital costs associated with laparoscopic and open inguinal herniorrhaphy.

PubMed

Spencer Netto, Fernando; Quereshy, Fayez; Camilotti, Bruna G; Pitzul, Kristen; Kwong, Josephine; Jackson, Timothy; Penner, Todd; Okrainec, Allan

2014-01-01

The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy. A prospectively maintained database was used to identify patients who underwent elective inguinal herniorrhaphy from April 2009 to March 2011. A retrospective review of electronic patient records was performed along with a standardized case-costing analysis using data from the Ontario Case Costing Initiative. The main outcomes were operating room (OR) and total hospital costs. Two hundred eleven patients underwent elective unilateral inguinal herniorrhaphy (117 open and 94 laparoscopic), and 33 patients underwent elective bilateral inguinal herniorrhaphy (9 open and 24 laparoscopic). OR and total hospital costs for open unilateral inguinal hernia repair were significantly lower than for the laparoscopic approach (median total cost, $3207.15 vs $3723.66; P < .001). OR and total hospital costs for repair of elective bilateral inguinal hernias were similar between the open and laparoscopic approaches (median total cost, $4574.02 vs $4662.89; P = .827). In the setting of a Canadian academic hospital, when considering the repair of an elective unilateral inguinal hernia, the OR and total hospital costs of open surgery were significantly lower than for the laparoscopic techniques. There was no statistical difference between OR and total hospital costs when comparing open surgery and laparoscopic techniques for the repair of bilateral inguinal hernias. Given the perioperative benefits of laparoscopy, further studies incorporating hernia-specific outcomes are necessary to determine the cost-effectiveness of each approach and to define the optimal treatment strategy.

Management of Inguinal Involvement of Peritoneal Surface Malignancies by Cytoreduction and HIPEC with Inguinal Perfusion.

PubMed

Shachar, Yair; Adileh, Mohamed; Keidar, Assaf; Eid, Luminita; Hubert, Ayalah; Temper, Mark; Azam, Salah; Beny, Alex; Grednader, Tal; Khalaileh, Abed; Yuval, Jonathan B; Stojadinovic, Alexander; Avital, Itzhak; Nissan, Aviram

2015-01-01

Achieving complete cytoreduction of peritoneal surface malignancies (PSM) can be challenging. In most cases, delivery of heated intra-peritoneal chemotherapy (HIPEC) is straightforward. However, using the closed technique in some cases may be technically challenging; for example, in patients requiring abdominal closure using a large synthetic mesh. In cases where groin hernias are present, it is imperative to resect the hernia sac, since it may contain tumor deposits. In cases with major inguinal involvement where disease may spread out of the hernia sac or in cases where a hernia repair was performed while disease is present, inguinal perfusion should be considered. To describe our experience with combined intra-peritoneal and inguinal perfusion of HIPEC following cytoreductive surgery. This is a retrospective review of all patients who underwent cytoreductive surgery (CRS) and HIPEC at our institution. A prospectively maintained database containing data of patients treated by CRS and HIPEC (n=122) was reviewed. All patients with macroscopic inguinal involvement by PSM with complete cytoreduction perfused by HIPEC were included. We identified five cases who underwent CRS and combined intraperitoneal and inguinal perfusion after resection of large inguinal tumor deposits (n=4) or after a recent hernia repair with hernial sac involvement by mucinous adenocarcinoma (n=1). All five patients were successfully perfused using an additional outflow catheter placed in the groin. In cases of inguinal involvement by PSM, complete cytoreduction should be achieved and perfusion of the involved groin considered as it is feasible and safe.

External electric field effect on the binding energy of a hydrogenic donor impurity in InGaAsP/InP concentric double quantum rings

NASA Astrophysics Data System (ADS)

Hu, Min; Wang, Hailong; Gong, Qian; Wang, Shumin

2018-04-01

Within the framework of effective-mass envelope-function theory, the ground state binding energy of a hydrogenic donor impurity is calculated in the InGaAsP/InP concentric double quantum rings (CDQRs) using the plane wave method. The effects of geometry, impurity position, external electric field and alloy composition on binding energy are considered. It is shown that the peak value of the binding energy appears in two rings with large gap as the donor impurity moves along the radial direction. The binding energy reaches the peak value at the center of ring height when the donor impurity moves along the axial direction. The binding energy shows nonlinear variation with the increase of ring height. With the external electric field applied along the z-axis, the binding energy of the donor impurity located at zi ≥ 0 decreases while that located at zi < 0 increases. In addition, the binding energy decreases with increasing Ga composition, but increases with the increasing As composition.

Biosensing based on magnetically induced self-assembly of particles in magnetic colloids.

PubMed

Yang, Ye; Morimoto, Yoshitaka; Takamura, Tsukasa; Sandhu, Adarsh

2012-03-01

Superparamagnetic beads and nonmagnetic beads of different sizes were assembled to form a "ring-structure" in a magnetorheological (MR) fluid solution by the application of external magnetic fields. For superparamagnetic beads and non-magnetic beads functionalized with probe and target molecules, respectively, the ring-structure was maintained even after removing the external magnetic field due to biomolecular bonding. Several experiments are described, including the formation process of ring-structures with and without molecular interactions, the accelerating effect of external magnetic fields, and the effect of biotin concentration on the structures of the rings. We define the small nonmagnetic particles as "petals" because the whole structure looks like a flower. The number of remnant ring petals was a function of the concentration of target molecules in the concentration range of 0.0768 ng/ml-3.8419 ng/ml which makes this protocol a promising method for biosensing. Not only was the formation process rapid, but the resulting two-dimensional colloidal system also offers a simple method for reducing reagent consumption and waste generation.

Outpatient repair for inguinal hernia in elderly patients: still a challenge?

PubMed

Palumbo, Piergaspare; Amatucci, Chiara; Perotti, Bruno; Zullino, Antonio; Dezzi, Claudia; Illuminati, Giulio; Vietri, Francesco

2014-01-01

Elective inguinal hernia repair as a day case is a safe and suitable procedure, with well-recognized feasibility. The increasing number of elderly patients requiring inguinal hernia repair leads clinicians to admit a growing number of outpatients. The aim of the current study was to analyze the outcomes (feasibility and safety) of day case treatment in elderly patients. Eighty patients >80 years of age and 80 patients ≤55 years of age underwent elective inguinal hernia repairs under local anesthesia. There were no mortalities or major complications in the elderly undergoing inguinal herniorraphies as outpatients, and only one unanticipated admission occurred in the younger age group. Elective inguinal hernia repair in the elderly has a good outcome, and age alone should not be a drawback to day case treatment. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Laparoscopic repair of hernia in children: Comparison between ligation and nonligation of sac.

PubMed

Pant, Nitin; Aggarwal, Satish Kumar; Ratan, Simmi K

2014-04-01

The essence of the current techniques of laparoscopic hernia repair in children is suture ligation of the neck of the hernia sac at the deep ring with or without its transection. Some studies show that during open hernia repair, after transection at the neck it can be left unsutured without any consequence. This study was aimed to see if the same holds true for laparoscopic hernia repair. Sixty patients (52 boys and eight girls, 12-144 months) with indirect inguinal hernia were randomized for laparoscopic repair either by transection of the sac alone (Group I) or transection plus suture ligation of sac at the neck (Group II). Outcome was assessed in terms of time taken for surgery, recurrence, and other complications. Thirty-eight hernia units in 28 patients were repaired by transection alone (Group I) and 34 hernia units in 29 patients were repaired by transection and suture ligation (Group II). Three patients were found to have no hernia on laparoscopy. Recurrence rate and other complications were not significantly different in the two groups. All recurrences occurred in hernias with ring size more than 10 mm. Laparoscopic repair of hernia by circumferential incision of the peritoneum at the deep ring is as effective as incision plus ligation of the sac.

Comparison of Single-Port Percutaneous Extraperitoneal Repair and Three-Port Mini-Laparoscopic Repair for Pediatric Inguinal Hernia.

PubMed

Korkmaz, Mevlit; Güvenç, B Haluk

2018-03-01

Laparoscopy has been widely used in surgical practice in pediatric age, and many techniques for laparoscopic hernia repair have been described till now. In this study, we compared two laparoscopic techniques performed by two surgeons; each surgeon practicing only one of the two techniques. A retrospective analysis was performed on the surgical charts, enrolling 71 patients with uncomplicated inguinal hernia. Patients were divided into two groups according to the type of surgery: (Group A, 24 patients aged 2 months-8 years) laparoscopic percutaneous internal ring suturing technique and (Group B, 47 patients aged 35 days-12 years) three-port mini-laparoscopic technique. The hernia sac was ligated at the level of internal ring, using nonabsorbable 4/0-3/0 suture. Any unexpected contralateral opening was repaired in the same manner for both groups. Follow-up period was 4 months-2 years and 9 months-8 years, respectively. Operative time and complications were analyzed. Operation time (19.58 ± 7.06 minutes versus 35.87 ± 10.34 minutes, P < .001) was shorter in the percutaneous repair group. However, when subdivided by unilateral and bilateral presentation, only unilateral operative time was shorter compared to three-port group. There were no recurrences in Group A, while two recurrences occurred in Group B during the learning curve period. A contralateral opening accompanied the presenting unilateral hernia in 3 cases for Group A and 16 for Group B. One patient had to be converted open resulting from epigastric vessel injury, and postop hydrocele formation was seen in another in Group A. No intraoperative complications were seen in Group B. The overall experience shows that laparoscopic repair is a reliable approach regardless of the chosen technique. Percutaneous repair seems to be a less invasive method with shorter operative time, but it is not free of complications according to this series.

Management of Inguinal Involvement of Peritoneal Surface Malignancies by Cytoreduction and HIPEC with Inguinal Perfusion

PubMed Central

Shachar, Yair; Adileh, Mohamed; Keidar, Assaf; Eid, Luminita; Hubert, Ayalah; Temper, Mark; Azam, Salah; Beny, Alex; Grednader, Tal; Khalaileh, Abed; Yuval, Jonathan B.; Stojadinovic, Alexander; Avital, Itzhak; Nissan, Aviram

2015-01-01

Background: Achieving complete cytoreduction of peritoneal surface malignancies (PSM) can be challenging. In most cases, delivery of heated intra-peritoneal chemotherapy (HIPEC) is straightforward. However, using the closed technique in some cases may be technically challenging; for example, in patients requiring abdominal closure using a large synthetic mesh. In cases where groin hernias are present, it is imperative to resect the hernia sac, since it may contain tumor deposits. In cases with major inguinal involvement where disease may spread out of the hernia sac or in cases where a hernia repair was performed while disease is present, inguinal perfusion should be considered. Aim: To describe our experience with combined intra-peritoneal and inguinal perfusion of HIPEC following cytoreductive surgery. Patients and Methods: This is a retrospective review of all patients who underwent cytoreductive surgery (CRS) and HIPEC at our institution. A prospectively maintained database containing data of patients treated by CRS and HIPEC (n=122) was reviewed. All patients with macroscopic inguinal involvement by PSM with complete cytoreduction perfused by HIPEC were included. Results: We identified five cases who underwent CRS and combined intraperitoneal and inguinal perfusion after resection of large inguinal tumor deposits (n=4) or after a recent hernia repair with hernial sac involvement by mucinous adenocarcinoma (n=1). All five patients were successfully perfused using an additional outflow catheter placed in the groin. Discussion: In cases of inguinal involvement by PSM, complete cytoreduction should be achieved and perfusion of the involved groin considered as it is feasible and safe. PMID:25663941

Paratesticular Liposarcoma: A Radiologic Pathologic Correlation

PubMed Central

Pergel, Ahmet; Yucel, Ahmet Fikret; Aydin, Ibrahim; Sahin, Dursun Ali; Gucer, Hasan; Kocakusak, Ahmet

2011-01-01

Spermatic cord liposarcoma is an uncommon paratesticular tumor. Patients usually present with a painless scrotal or inguinal mass, mimicking inguinal hernia. Clinical examination suggested an inguinal hernia. Computed tomography demonstrated a fat-containing mass in the right inguinal region. The mass was surgically removed, along with the right testis and spermatic cord. Histopathological examination revealed a well-differentiated liposarcoma. No evidence of recurrence or metastases has been noted during the two-year follow-up with postoperative adjuvant therapy. PMID:22267992

Paratesticular liposarcoma: a radiologic pathologic correlation.

PubMed

Pergel, Ahmet; Yucel, Ahmet Fikret; Aydin, Ibrahim; Sahin, Dursun Ali; Gucer, Hasan; Kocakusak, Ahmet

2011-01-01

Spermatic cord liposarcoma is an uncommon paratesticular tumor. Patients usually present with a painless scrotal or inguinal mass, mimicking inguinal hernia. Clinical examination suggested an inguinal hernia. Computed tomography demonstrated a fat-containing mass in the right inguinal region. The mass was surgically removed, along with the right testis and spermatic cord. Histopathological examination revealed a well-differentiated liposarcoma. No evidence of recurrence or metastases has been noted during the two-year follow-up with postoperative adjuvant therapy.

Testicular transposition in children undergoing brachytherapy for bladder and/or prostate rhabdomyosarcoma.

PubMed

de Lambert, Guenolee; Chargari, Cyrus; Minard-Colin, Véronique; Haie-Meder, Christine; Guérin, Florent; Martelli, Hélène

2018-04-13

Fertility preservation is a major goal in treatment of children with cancer. We describe a new technique of testicular transposition (TT) in patients treated with pulse-dose-rate (PDR) brachytherapy as part of the multimodal conservative treatment of bladder neck and/or prostate rhabdomyosarcoma (BP RMS). Medical records of consecutive patients treated between September 2016 and August 2017 were studied. These patients underwent a TT performed during BP RMS surgery by the same suprapubic incision. The external oblique aponeurosis was not incised. The spermatic cord was mobilized up to the external inguinal ring, and the gubernaculum attachments were severed from the scrotum. The testis was then flipped over with care taken to avoid injury of the vessels or the vas, wrapped in a silicone material and sutured under the abdominal skin with a transfixing stitch facing the anterior superior iliac spine. At the end of brachytherapy, the testis was relocated in the scrotum and during the same general anesthesia, plastic tubes and stents were removed. Surgical outcome and dosimetric parameters were examined. Eight patients were identified. Median age was 24 months (range 11-80 months). All had embryonal BP RMS and received chemotherapy according to RMS 2005 protocol prior to local treatment. All patients underwent conservative surgery followed by brachytherapy (60 Gy) and had testicular transposition of one testis. None had surgical complications. After converting doses to biologically equivalent doses in 2-Gy fractions (EQD2), the dose delivered to 75% of the transposed testis was 1.5 GyEQD2 (1-3 GyEQD2), versus 5.4 GyEQD2 (3.9-9.4 Gy EQD2) for the untransposed testis (p < 0.001). Testicular transposition is feasible in order to potentially preserve fertility and future quality of life in children undergoing brachytherapy for BP RMS. Level IV Treatment Study: Case Study with no Comparison Group. Copyright © 2018 Elsevier Inc. All rights reserved.

Depot-dependent effects of adipose tissue explants on co-cultured hepatocytes.

PubMed

Du, Zhen-Yu; Ma, Tao; Lock, Erik-Jan; Hao, Qin; Kristiansen, Karsten; Frøyland, Livar; Madsen, Lise

2011-01-01

We have developed an in vitro hepatocyte-adipose tissue explant (ATE) co-culture model enabling examination of the effect of visceral and subcutaneous adipose tissues on primary rat hepatocytes. Initial analyses of inflammatory marker genes were performed in fractionated epididymal or inguinal adipose tissues. Expressions of inflammation related genes (IL-6, TNF-α, COX-2) were higher in the inguinal than the epididymal ATE. Similarly, expressions of marker genes of macrophage and monocyte (MPEG-1, CD68, F4/80, CD64) were higher in the stromal vascular fraction (SVF) isolated from inguinal ATE than that from epididymal ATE. However, expressions of lipolysis related genes (ATGL, HSL, perilipin-1) were higher in the epididymal adipocytes than inguinal adipocytes. Moreover, secretion of IL-6 and PGE(2) was higher from inguinal ATEs than from epididymal ATEs. There was a trend that the total levels of IL-6, TNF-α and PGE(2) in the media from inguinal ATEs co-cultured with primary rat hepatocytes were higher than that in the media from epididymal ATEs co-cultured with hepatocytes, although the significant difference was only seen in PGE(2). Lipolysis, measured as glycerol release, was similar in the ATEs isolated from inguinal and epididymal adipose tissues when cultured alone, but the glycerol release was higher in the ATEs isolated from epididymal than from inguinal adipose tissue when co-cultured with hepatocytes. Compared to epididymal ATEs, the ATEs from inguinal adipose tissue elicited a stronger cytotoxic response and higher level of insulin resistance in the co-cultured hepatocytes. In conclusion, our results reveal depot-dependent effects of ATEs on co-cultured primary hepatocytes, which in part may be related to a more pronounced infiltration of stromal vascular cells (SVCs), particularly macrophages, in inguinal adipose tissue resulting in stronger responses in terms of hepatotoxicity and insulin-resistance.

Ring Attractor Dynamics Emerge from a Spiking Model of the Entire Protocerebral Bridge.

PubMed

Kakaria, Kyobi S; de Bivort, Benjamin L

2017-01-01

Animal navigation is accomplished by a combination of landmark-following and dead reckoning based on estimates of self motion. Both of these approaches require the encoding of heading information, which can be represented as an allocentric or egocentric azimuthal angle. Recently, Ca 2+ correlates of landmark position and heading direction, in egocentric coordinates, were observed in the ellipsoid body (EB), a ring-shaped processing unit in the fly central complex (CX; Seelig and Jayaraman, 2015). These correlates displayed key dynamics of so-called ring attractors, namely: (1) responsiveness to the position of external stimuli; (2) persistence in the absence of external stimuli; (3) locking onto a single external stimulus when presented with two competitors; (4) stochastically switching between competitors with low probability; and (5) sliding or jumping between positions when an external stimulus moves. We hypothesized that ring attractor-like activity in the EB arises from reciprocal neuronal connections to a related structure, the protocerebral bridge (PB). Using recent light-microscopy resolution catalogs of neuronal cell types in the PB (Lin et al., 2013; Wolff et al., 2015), we determined a connectivity matrix for the PB-EB circuit. When activity in this network was simulated using a leaky-integrate-and-fire model, we observed patterns of activity that closely resemble the reported Ca 2+ phenomena. All qualitative ring attractor behaviors were recapitulated in our model, allowing us to predict failure modes of the putative PB-EB ring attractor and the circuit dynamics phenotypes of thermogenetic or optogenetic manipulations. Ring attractor dynamics emerged under a wide variety of parameter configurations, even including non-spiking leaky-integrator implementations. This suggests that the ring-attractor computation is a robust output of this circuit, apparently arising from its high-level network properties (topological configuration, local excitation and long-range inhibition) rather than fine-scale biological detail.

Spontaneous thrombosis of congenital extrahepatic portosystemic shunt (Abernethy malformation) simulating inguinal hernia incarceration.

PubMed

Afzal, Samara; Nair, Amit; Grainger, Jennie; Latif, Sherif; Rehman, Atiq-ur

2010-08-01

Tender lumps in the inguinal region are often explored emergently to treat suspected hernial strangulation. We discuss the case of an adult male who presented acutely with a tender inguinal swelling and raised inflammatory markers and was therefore deemed as requiring surgical exploration. However preoperative abdominal computerized tomography (CT) revealed an extensive thrombosing congenital venous malformation of portosystemic origin with extension into the symptomatic inguinal canal. A potentially lethal exsanguination from surgery was thus avoided.

On a suspected ring external to the visible rings of Saturn

NASA Technical Reports Server (NTRS)

Feibelman, W. A.; Beebe, R. F.; Smith, B. A.; Cook, A. F., II

1974-01-01

The reexamination of a photograph of Saturn taken on 15 November 1966 when the earth was nearly in the ring plane is investigated which indicates that ring material does exist outside the visible rings, extending to more than 6 Saturnian radii. The observed brightness in blue light was estimated per linear arc second, implying a normal optical thickness, for ice-covered particles.

Testicular Ischemia Caused by Incarcerated Inguinal Hernia in Infants: Incidence, Conservative treatment procedure, and Follow-up.

PubMed

Ozdamar, Mustafa Yasar; Karakus, Osman Zeki

2017-07-02

Testicular ischemia and necrosis, especially in the infant age, may result from incarcerated inguinal hernia. Duration of ischemia is a significant factor for the affected testicle. We aimed to present a case series on the conservative management in the testicular ischemia caused by incarcerated inguinal hernia. Inguinal hernia repairs performed in between March 2009 and December 2014 were investigated retrospectively. Patients' characteristics, hernia side, incarceration, testicular ischemia and complications were recorded. Color Doppler ultrasonography was performed in the incarcerated inguinal hernia patients preoperatively and was repeated on 3 and 7 days and then at 1, 3 and 6 months postoperatively. The testicle sizes, volumes, and arterial flow patterns of them were recorded at the same time. Total 785 inguinal hernias were treated in 738 male patients, ranging from 18 days to 16 years. From all male patients, 44 (5.9%) had the IIH. There were 16 (36.3%) irreducible hernias in 44 incarcerated hernia patients. Of these 16, testicular ischemia was determined in 9 (56.2%) infants with the irreducible incarcerated hernia. Orchidopexyprocedure was performed in these patients. Testicular atrophy was occurred in two patients (22.2%). In the others, testicular volumes and perfusions were normal during follow-up (mean 8.3 ± 2.2 months). Testicular ischemia resulting from incarcerated inguinal hernia may be treated conservatively without orchiectomy for the ischemic testicle and testicular ischemia may be followed with color Doppler ultrasound for atleast 6 months. The inguinal hernia repair in infants should be subject to urgent surgery rather than elective surgery. So, the testicular ischemia in infants with the inguinal hernia will be an avoidable complication.

Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis

PubMed Central

Wang, Jun; Xia, Shu-Jie; Liu, Zhi-Hong; Tao, Le; Ge, Ji-Fu; Xu, Chen-Min; Qiu, Jian-Xin

2015-01-01

Conventional meta-analyses have shown inconsistent results for the efficacy of various treatments of varicoceles. Therefore, we performed a multiple-treatment meta-analysis to assess the effectiveness and safety of 10 methods of varicocelectomy and embolization/sclerotherapy. We systematically reviewed 35 randomized controlled trials and observational studies, from 1966 to August 5, 2013, which compared any of the following treatments for varococeles: laparoscopic, retroperitoneal, open inguinal and subinguinal varicocelectomy, microsurgical subinguinal and inguinal varicocelectomy, percutaneous venous embolization, Tauber antegrade sclerotherapy, retrograde sclerotherapy and expectant therapy (no treatment). Inguinal and subinguinal microsurgery, open inguinal, laparoscopic varicocelectomy showed a significant advantage over expectant therapy in terms of pregnancy rates (odds ratio (OR): 3.48, 2.68, 2.92 and 2.90, respectively). Compared with retroperitoneal open surgery, inguinal microsurgery showed an improvement of sperm density (mean difference (MD): 10.60, 95% confidence interval (CI): 1.92–19.60) and sperm motility (MD: 9.09, 95% CI: 4.88–13.30). Subinguinal and inguinal microsurgery outperformed retroperitoneal open surgery in terms of recurrence (OR: 0.05, 0.06 respectively). Tauber antegrade sclerotherapy and subinguinal microsurgery were associated with the lowest risk of hydrocele formation. The odds of overall complication, compared with retroperitoneal open varicocelectomy, were lowest for inguinal microsurgery (OR = 0.07, 95% CI: 0.02–0.19), followed by subinguinal microsurgery (OR = 0.09, 95% CI: 0.02–0.19). Inguinal and subinguinal micro-varicocelectomy had the highest pregnancy rates, significant increases in sperm parameters, with low odds of complication. These results warrant additional properly conducted randomized controlled clinical studies with larger sample sizes. PMID:25248652

Single-Incision Laparoscopic Repair of Spigelian Hernia

PubMed Central

Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne J.

2015-01-01

Introduction: Spigelian hernias represent only 1% to 2% of all abdominal wall hernias. The treatment, however, remains controversial but depends on institutional expertise. This case series reports the first experience with single-incision laparoscopic totally extraperitoneal (SILTEP) repair of Spigelian hernias with telescopic extraperitoneal dissection in combination with inguinal hernia repair. Methods: From February 2013 to April 2014, all patients referred with inguinal or Spigelian hernias, without histories of extraperitoneal intervention, underwent SILTEP repair with telescopic extraperitoneal dissection. A single-port device, 5.5 mm/52 cm/30° angled laparoscope, and conventional straight dissecting instruments were used for all cases. Extraperitoneal dissection was performed under direct vision with preservation of preperitoneal fascia overlying retroperitoneal nerves. Inguinal herniorrhaphy was performed with lightweight mesh that covered low-lying Spigelian defects. High-lying Spigelian defects were repaired with additional mesh. Results: There were 131 patients with 186 (92 direct) inguinal hernias and 7 patients with 8 Spigelian hernias (6 incidental, including 1 bilateral and 2 preoperatively diagnosed), with a mean age of 51.3 years and a mean body mass index of 25.1 kg/m2. An additional piece of mesh was used for 3 hernias. All Spigelian hernias were associated with direct inguinal hernias, and 8 combined inguinal and Spigelian hernias were successfully repaired with SILTEP repair with telescopic extraperitoneal dissection as day cases. There were no clinical recurrences during a mean follow-up period of 6 months (range, 1–15 months). Conclusions: Combined Spigelian and inguinal hernias can be successfully treated with SILTEP herniorrhaphy with telescopic extraperitoneal dissection. The high incidence of Spigelian hernias associated with direct inguinal hernias suggests a high index of suspicion for Spigelian hernias during laparoscopic inguinal herniorrhaphy. PMID:25722629

[The quality of patient care under the German DRG system using as example the inguinal hernia repair].

PubMed

Rudroff, C; Schweins, M; Heiss, M M

2008-02-01

The DRG system in Germany was introduced to improve and at the same time simplify the reimbursement of costs in German hospitals. Cost effectiveness and economic efficiency were the declared goals. Structural changes and increased competition among different hospitals were the consequences. The effect on the qualitiy of patient care has been discussed with some concern. Furthermore, doubts have been expressed about the correct representation of the various diagnoses and treatments in the coding system and the financial revenue. Inguinal hernia repair serves as an example to illustrate some common problems with the reimbursement in the DRG system. Virtual patients were grouped using a "Web Grouper" and analysed using the cost accounting from the G-DRG-Browser of the InEK. Additionally, the reimbursement for ambulant hernia repair was estimated. The DRG coding did not differentiate the various operative procedures for inguinal hernia repair. They all generated the same revenues. For example, the increased costs for bilateral inguinal hernia repair are not represented in the payment. Furthermore, no difference is made between primary and recurrent inguinal hernia. In the case of a short-term hospital stay, part of the revenue is retained. In the case of ambulatory treatment of inguinal hernia, the reimbursement is by far not a real compensation for the actual costs. The ideal patient in the DRG system suffers from a primary inguinal hernia, undergoes an open hernia repair without mesh, and remains for 2-3 days in hospital. Minimally invasive procedures, repair of bilateral inguinal hernia and ambulant operation are by far less profitable--if at all. The current revenues for inguinal hernia repair require improvement and adjustment to reality in order to accomplish the goals which the DRG system in Germany aims at.

Conversion to Stoppa Procedure in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair

PubMed Central

Dirican, Abuzer; Ozgor, Dincer; Gonultas, Fatih; Isik, Burak

2012-01-01

Background and Objectives: Conversion to open surgery is an important problem, especially during the learning curve of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. Methods: Here, we discuss conversion to the Stoppa procedure during laparoscopic TEP inguinal hernia repair. Outcomes of patients who underwent conversion to an open approach during laparoscopic TEP inguinal hernia repair between September 2004 and May 2010 were evaluated. Results: In total, 259 consecutive patients with 281 inguinal hernias underwent laparoscopic TEP inguinal hernia repair. Thirty-one hernia repairs (11%) were converted to open conventional surgical procedures. Twenty-eight of 31 laparoscopic TEP hernia repairs were converted to modified Stoppa procedures, because of technical difficulties. Three of these patients underwent Lichtenstein hernia repairs, because they had undergone previous surgeries. Conclusion: Stoppa is an easy and successful procedure used to solve problems during TEP hernia repair. The Lichtenstein procedure may be a suitable option in patients who have undergone previous operations, such as a radical prostatectomy. PMID:23477173

Comparison of Positron Emission Tomography Scanning and Sentinel Node Biopsy in the Detection of Inguinal Node Metastases in Patients With Anal Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mistrangelo, Massimiliano, E-mail: mistrangelo@katamail.co; Centre of Minimally Invasive Surgery, University of Turin; Pelosi, Ettore

2010-05-01

Background: Inguinal lymph node metastases in patients with anal cancer are an independent prognostic factor for local failure and overall mortality. Inguinal lymph node status can be adequately assessed with sentinel node biopsy, and the radiotherapy strategy can subsequently be changed. We compared this technique vs. dedicated 18F-fluorodeoxyglucose positron emission tomography (PET) to determine which was the better tool for staging inguinal lymph nodes. Methods and Materials: In our department, 27 patients (9 men and 18 women) underwent both inguinal sentinel node biopsy and PET-CT. PET-CT was performed before treatment and then at 1 and 3 months after treatment. Results:more » PET-CT scans detected no inguinal metastases in 20 of 27 patients and metastases in the remaining 7. Histologic analysis of the sentinel lymph node detected metastases in only three patients (four PET-CT false positives). HIV status was not found to influence the results. None of the patients negative at sentinel node biopsy developed metastases during the follow-up period. PET-CT had a sensitivity of 100%, with a negative predictive value of 100%. Owing to the high number of false positives, PET-CT specificity was 83%, and positive predictive value was 43%. Conclusions: In this series of patients with anal cancer, inguinal sentinel node biopsy was superior to PET-CT for staging inguinal lymph nodes.« less

Optical feedback in dfb quantum cascade laser for mid-infrared cavity ring-down spectroscopy

NASA Astrophysics Data System (ADS)

Terabayashi, Ryohei; Sonnenschein, Volker; Tomita, Hideki; Hayashi, Noriyoshi; Kato, Shusuke; Jin, Lei; Yamanaka, Masahito; Nishizawa, Norihiko; Sato, Atsushi; Nozawa, Kohei; Hashizume, Kenta; Oh-hara, Toshinari; Iguchi, Tetsuo

2017-11-01

A simple external optical feedback system has been applied to a distributed feedback quantum cascade laser (DFB QCL) for cavity ring-down spectroscopy (CRDS) and a clear effect of feedback was observed. A long external feedback path length of up to 4m can decrease the QCL linewidth to around 50kHz, which is of the order of the transmission linewidth of our high finesse ring-down cavity. The power spectral density of the transmission signal from high finesse cavity reveals that the noise at frequencies above 20kHz is reduced dramatically.

A Literature Review on the Role of Totally Extraperitoneal Repairs for Groin Pain in Athletes

PubMed Central

Siddiqui, Muhammad R. S.; Kovzel, Makysym; Brennan, Stephen; Priest, Oliver H.; Preston, Shaun R.; Soon, Yuen

2012-01-01

A literature review was made on the role of totally extraperitoneal (TEP) hernia repairs for groin pain in athletes. Electronic databases were searched for literature published from January 1993 to November 2011. There were 10 articles incorporating 196 patients included in this review. Thirty percent of patients were reported to have direct inguinal hernias, 22% had indirect inguinal hernias, and 41% had dilated internal rings. Of note, 30% of cases had no macroscopic abnormality. Four studies reported on an early follow-up ranging between 3 and 6 weeks. Only minimal or mild symptoms were reported. Up to 33% of patients had impaired ability to perform at peak levels. Up to 53% of patients had persistence of symptoms at the early follow-up. Total follow-up time ranged from 3 to 80 months, and most patients were active (90%–100%). At long-term follow-up, 3% to 10% were unable to play, and 5% were reported as being unable to train. Two studies from the same center reported on TEP surgery for osteitis pubis, and most patients returned to sporting activity after 4 to 8 weeks. TEP repair is a good operative intervention in athletes with chronic groin pain not relieved by conservative measures. Athletes recover quickly and return to sport early. PMID:23294074

Division and dynamic morphology of plastids.

PubMed

Osteryoung, Katherine W; Pyke, Kevin A

2014-01-01

Plastid division is fundamental to the biology of plant cells. Division by binary fission entails the coordinated assembly and constriction of four concentric rings, two internal and two external to the organelle. The internal FtsZ ring and external dynamin-like ARC5/DRP5B ring are connected across the two envelopes by the membrane proteins ARC6, PARC6, PDV1, and PDV2. Assembly-stimulated GTPase activity drives constriction of the FtsZ and ARC5/DRP5B rings, which together with the plastid-dividing rings pull and squeeze the envelope membranes until the two daughter plastids are formed, with the final separation requiring additional proteins. The positioning of the division machinery is controlled by the chloroplast Min system, which confines FtsZ-ring formation to the plastid midpoint. The dynamic morphology of plastids, especially nongreen plastids, is also considered here, particularly in relation to the production of stromules and plastid-derived vesicles and their possible roles in cellular communication and plastid functionality.

Bubonic lymphogranuloma venereum with multidrug treatment failure.

PubMed

Vall-Mayans, Martí; Isaksson, Jenny; Caballero, Estrella; Sallés, Beatriz; Herrmann, Björn

2014-03-01

A patient with proctitis and inguinal buboes diagnosed with lymphogranuloma venereum (LGV) was treated with doxycycline 21 days, azithromycin 20 days and moxifloxacin for a further 12 days because of progressive worsening of inguinal symptoms. Despite extensive antibiotic treatment, the inguinal LGV lesions persisted; however, the patient recovered spontaneously after three months.

Sportsman’s hernia? An ambiguous term

PubMed Central

Dimitrakopoulou, Alexandra; Schilders, Ernest

2016-01-01

Groin pain is common in athletes. Yet, there is disagreement on aetiology, pathomechanics and terminology. A plethora of terms have been employed to explain inguinal-related groin pain in athletes. Recently, at the British Hernia Society in Manchester 2012, a consensus was reached to use the term inguinal disruption based on the pathophysiology while lately the Doha agreement in 2014 defined it as inguinal-related groin pain, a clinically based taxonomy. This review article emphasizes the anatomy, pathogenesis, standard clinical assessment and imaging, and highlights the treatment options for inguinal disruption. PMID:27026822

Sportsman's hernia? An ambiguous term.

PubMed

Dimitrakopoulou, Alexandra; Schilders, Ernest

2016-04-01

Groin pain is common in athletes. Yet, there is disagreement on aetiology, pathomechanics and terminology. A plethora of terms have been employed to explain inguinal-related groin pain in athletes. Recently, at the British Hernia Society in Manchester 2012, a consensus was reached to use the term inguinal disruption based on the pathophysiology while lately the Doha agreement in 2014 defined it as inguinal-related groin pain, a clinically based taxonomy. This review article emphasizes the anatomy, pathogenesis, standard clinical assessment and imaging, and highlights the treatment options for inguinal disruption.

An early observation on the anatomy of the inguinal canal and the etiology of inguinal hernias by Petrus Camper in the 18th century.

PubMed

IJpma, Frank F A; van de Graaf, Robert C; van Geldere, Dick; van Gulik, Thomas M

2009-06-01

The famous Dutch medical doctor Petrus Camper (1722-1789) was appointed professor of anatomy and surgery at the University of Franeker, Amsterdam, and Groningen. As Praelector Anatomiae of the Amsterdam Guild of Surgeons, he gave public anatomy lessons in the Anatomy theatre in Amsterdam. During the mid 18th century he performed dissections on corpses of children and adults to investigate the anatomy and etiology of inguinal hernias. The concept that a hernia was caused by "a rupture of the peritoneum" was common at that time. Camper concluded that this was incorrect and provided a clear description of the etiology of hernias in children and adults. For the treatment of inguinal hernias, he designed a truss based on the geometrical proportions of the pelvis. This "truss of Camper" was much used and internationally renowned. His anatomical studies and perfect, self-drawn illustrations contributed to a better understanding of the anatomy of the inguinal canal, on the national as well as international level. Camper's "Icones Herniarum" is his most widely known work on inguinal hernias and included a series of outstanding anatomical illustrations. Petrus Camper should be considered one of the pioneers in the field of inguinal hernias.

Complete resection of locally advanced ovarian carcinoma fixed to the pelvic sidewall and involving external and internal iliac vessels.

PubMed

Nishikimi, Kyoko; Tate, Shinichi; Matsuoka, Ayumu; Shozu, Makio

2017-08-01

Locally advanced ovarian carcinomas may be fixed to the pelvic sidewall, and although these often involve the internal iliac vessels, they rarely involve the external iliac vessels. Such tumors are mostly considered inoperable. We present a surgical technique for complete resection of locally advanced ovarian carcinoma fixed to the pelvic sidewall and involving external and internal iliac vessels. A 69-year-old woman presented with ovarian carcinoma fixed to the right pelvic sidewall, which involved the right external and internal iliac arteries and veins and the right lower ureter, rectum, and vagina. We cut the external iliac artery and vein at the bifurcation and at the inguinal ligament to resect the external artery and vein. Then, we reconstructed the arterial and venous supplies of the right external artery and vein with grafts. After creating a wide space immediately inside of the sacral plexus to allow the tumor fixed to pelvic sidewall with the internal iliac vessels to move medially, we performed total internal iliac vessel resection. We achieved complete en bloc tumor resection with the right external and internal artery and vein, right ureter, vagina, and rectum adhering to the tumor. There were no intra- or postoperative complications, such as bleeding, graft occlusion, infection, or limb edema. Exfoliation from the sacral plexus and total resection with external and internal iliac vessels enables complete resection of the tumor fixed to the pelvic sidewall. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of flow restoration on mussel growth in a Wild and Scenic North American River

PubMed Central

2013-01-01

Background Freshwater mussels remain among the most imperiled species in North America due primarily to habitat loss or degradation. Understanding how mussels respond to habitat changes can improve conservation efforts. Mussels deposit rings in their shell in which age and growth information can be read, and thus used to evaluate how mussels respond to changes in habitat. However, discrepancies between methodological approaches to obtain life history information from growth rings has led to considerable uncertainty regarding the life history characteristics of many mussel species. In this study we compared two processing methods, internal and external ring examination, to obtain age and growth information of two populations of mussels in the St. Croix River, MN, and evaluated how mussel growth responded to changes in the operation of a hydroelectric dam. Results External ring counts consistently underestimated internal ring counts by 4 years. Despite this difference, internal and external growth patterns were consistent. In 2000, the hydroelectric dam switched from operating on a peaking schedule to run-of-the-river/partial peaking. Growth patterns between an upstream and downstream site of the dam were similar both before and after the change in operation. At the downstream site, however, older mussels had higher growth rates after the change in operation than the same sized mussels collected before the change. Conclusions Because growth patterns between internal and external processing methods were consistent, we suggest that external processing is an effective method to obtain growth information despite providing inaccurate age information. External processing is advantageous over internal processing due to its non-destructive nature. Applying this information to analyze the influence of the operation change in the hydroelectric dam, we suggest that changing to run-of-the-river/partial peaking operation has benefited the growth of older mussels below the dam. PMID:23452382

Mesh Displacement After Bilateral Inguinal Hernia Repair With No Fixation

PubMed Central

Rocha, Gabriela Moreira; Campos, Antonio Carlos Ligocki; Paulin, João Augusto Nocera; Coelho, Julio Cesar Uili

2017-01-01

Background and Objectives: About 20% of patients with inguinal hernia present bilateral hernias in the diagnosis. In these cases, laparoscopic procedure is considered gold standard approach. Mesh fixation is considered important step toward avoiding recurrence. However, because of cost and risk of pain, real need for mesh fixation has been debated. For bilateral inguinal hernias, there are few specific data about non fixation and mesh displacement. We assessed mesh movement in patients who had undergone laparoscopic bilateral inguinal hernia repair without mesh fixation and compared the results with those obtained in patients with unilateral hernia. Methods: From January 2012 through May 2014, 20 consecutive patients with bilateral inguinal hernia underwent TEP repair with no mesh fixation. Results were compared with 50 consecutive patients with unilateral inguinal hernia surgically repaired with similar technique. Mesh was marked with 3 clips. Mesh movements were measured by comparing initial radiography performed at the end of surgery, with a second radiographic scan performed 30 days later. Results: Mean movements of all 3 clips in bilateral nonfixation (NF) group were 0.15–0.4 cm compared with 0.1–0.3 cm in unilateral NF group. Overall displacement of bilateral and unilateral NF groups did not show significant difference. Mean overall displacement was 1.9 cm versus 1.8 cm in the bilateral and unilateral NF groups, respectively (P = .78). Conclusions: TEP with no mesh fixation is safe in bilateral inguinal repairs. Early mesh displacement is minimal. This technique can be safely used in most patients with inguinal hernia. PMID:28904521

[Infantile Amyand's hernia presenting as acute scrotum].

PubMed

Armas Alvarez, A L; Taboada Santomil, P; Pradillos Serna, J M; Rivera Chávez, L L; Estévez Martínez, E; Méndez Gallart, R; Rodríguez Barca, P; López Carreira, M L; Bautista Casasnovas, A; Varela Cives, R

2010-10-01

Amyand's hernia is a condition of exceptional presentation in children and is defined by the presence of inflamed appendix inside a inguinal hernia. It may manifest clinically as acute scrotum, inguinal lymphadenitis or strangulated hernia. The treatment is surgical and although several approaches are described, appendectomy with herniotomy by inguinal approach is considered of choice.

[Surgical treatment of recurrent inguinal hernia].

PubMed

Orokhovskiĭ, V I; Papazov, F K; Vasilćhenko, V G; Mezhakov, S V; Shvanits, Sh

1993-01-01

The experience with surgical treatment of 89 patients with recurrent inguinal hernia is presented. A method for hernioplasty with the use of the pyramidal muscle transferred for covering the inguinal space is described. In 37 patients, no hernia recurrence and injury to the femoral vessels were revealed. This was indicative of the effectiveness of the method suggested.

Pitfalls in the diagnosis and management of inguinal lymphogranuloma venereum: important lessons from a case series.

PubMed

Oud, Emerentiana Veronica; de Vrieze, Nynke Hesselina Neeltje; de Meij, Arjan; de Vries, Henry John C

2014-06-01

Current lymphogranuloma venereum (LGV) guidelines mainly focus on anorectal infections. Inguinal LGV infections have been rare in the current epidemic among men who have sex with men (MSM), but might require a different approach not yet recommended in current guidelines for the treatment and diagnosis of LGV. We describe 4 inguinal LGV cases. Three MSM developed inguinal LGV infection several weeks after a previous consultation, of which two had received azithromycin after being notified for LGV. Three failed the recommended 21 days doxycycline treatment. These inguinal LGV cases highlight 3 pitfalls in the current standard management of LGV: (1) Urethral chlamydia infections in MSM can be caused by LGV biovars that in contrast to non-LGV biovars require prolonged antibiotic therapy. (2) The recommended one gram azithromycin contact treatment seems insufficient to prevent established infections. (3) Inguinal LGV may require prolonged courses of doxycycline, exceeding the currently advised 21 days regimen. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

How to deal with penile carcinoma inguinal metastases invading femoral vessels.

PubMed

Fodor, Marius; Petrut, Bogdan; Fodor, Lucian

2017-01-01

Penile cancer accounts for 1-10% of men neoplastic diseases and 30-60% of patients have inguinal metastases at the time of diagnosis. Inguinal metastases of penile cancer with femoral vessel involvement could lead to vascular fistula and hemorrhagic shock. We present 3 consecutive patients with inguinal metastases of penile cancer complicated by infection and hemorrhage from femoral vessels invaded by the tumor. Simultaneous extra-anatomical axillo-femoral bypass graft, wide excision of tumor and groin defect reconstruction was used to achieve "tumor-free" oncologic aim and to save the lower limb. We consider the extra-anatomic axillo-femoral bypass associated with wide inguinal tumor excision and defect covering a feasible surgical solution for improving the life quality and extend life expectancy in patients with lymph node metastasis of penile cancer complicated by necrosis, infection and femoral vessel involvement.

Depilatory laser: a potential causative factor for inguinal hyperhidrosis: report of three cases.

PubMed

Obeid, Grace; Helou, Josiane; Maatouk, Ismael; Moutran, Roy; Tomb, Roland

2013-10-01

Hyperhidrosis has recently been described as a novel adverse effect of laser-assisted hair removal in the axillary area. Inguinal Hyperhidrosis (IH) is a localized and, typically, a primary form of hyperhidrosis affecting the groin area in individuals before age 25. IH has been reported in the literature after traumas and as a dysfunction of the central sympathetic nervous system. To the best of our knowledge, IH has never been reported as secondary to laser-assisted hair removal. Herein, we report three cases of IH following depilatory laser of the inguinal zone. Three female patients with no relevant medical history presented with the complaint of excessive sweating in the inguinal area after undergoing full bikini depilatory laser sessions. Although never described before, depilatory laser seems to trigger the occurrence of hyperhidrosis in the inguinal zone.

Crucial steps in the evolution of the preperitoneal approaches to the groin: an historical review.

PubMed

Read, R C

2011-02-01

Preperitoneal approaches to the repair of primary, bilateral, recurrent, inguinal, and femoral herniae, the most common abdominal protrusions, now dominate techniques of repair. The purpose of this review is to outline crucial steps which have led to this result. Abernethy (Surgical cases and remarks. Of the operation for the aneurysm. Cadell and Davies (Strand), London, pp. 149-176, 1797) introduced an operation to treat aneurysms of the external iliac artery, which was endorsed by Cooper (The anatomy and surgical treatment of abdominal hernia. Longman and Co, London, 1804). Bogros (Essai sur l'anatomie chirurgical de la region iliac et description d'un nouveau procede pour faire la ligature des arteries epigastric et iliaque externe. Th. Paris, no. 153. A Paris, de l'imprimerie de Didot le Jeune, imprimeur de la Faculte de Medicine, rue des Macons, Sorbonne no. 13, 1823) described his preperitoneal space which continues into the suprapubic space of Retzius. Annandale (Edinb Med J 21:1087-1091, 1876) initiated anterior preperitoneal repair. Cheatle (Br Med J 2:68-69, 1920, Br Med J 2:1025-1026, 1921) demonstrated the median posterior preperitoneal approach, resurrected by Henry (Lancet 1:531-533, 1936). McEvedy (Ann R Coll Surg Engl 7:484-496, 1950) modified the Cheatle-Henry procedure by using a unilateral oblique incision in the rectus sheath and underlying transversalis fascia with medial retraction of the rectus muscle. Estrin et al. (Surg Gynecol Obstet 116:547-550, 1963) reinforced this repair with prostheses attached to Cooper's ligament, thereby, eliminating tension. Anterior prosthetic preperitoneal repair was introduced by Usher et al. (Am Surg 24:969-974, 1958) using polyethylene and, later, polypropylene meshes which were not slit, since the spermatic cord was lateralized. Stoppa et al., beginning in 1965, performed giant prosthetic reinforcement of the visceral sac, covering Fruchaud's myopectineal orifice preperitoneally with extensive overlap. They used a posterior approach to avoid scarring in recurrent cases and to allow the exposure of large, bilateral, inguinal, and femoral sacs (Rev Med Picardie 1:46-46, 1972). Wantz (Surg Gynecol Obstet, 169:408-417, 1989) proposed a unilateral version. Gilbert (Am J Surg 163:331-335, 1992) described the anterior preperitoneal sutureless repair of groin herniation. He employed a two-layered prosthesis, the upper resting on the transversalis fascia, the lower in the space of Bogros. They were connected by a plug passed through the internal inguinal ring. Kugel (Am J Surg 178:298-302, 1999) described his anterior preperitoneal prosthetic repair of groin herniation through an abdominal gridiron incision. Laparoscopic repair of groin protrusions began in 1982 (Ger; Ann R Coll Surg Engl 64:342-344, 1982). In 1992, Arregui et al. (Surg Laparosc Endosc 2:53-58, 1992) and Dion and Morin (Can J Surg 35:209-212, 1992) reported on their transabdominal preperitoneal (TAPP) approach. To avoid intraperitoneal complications, Dulucq (Cahiers Chir 79:15-16, 1991) recommended a totally extraperitoneal (TEP) approach. These techniques incur fewer recurrences than open techniques and diminish postoperative pain. However, the operating time is longer, they are more expensive, and special skills are needed. In addition, general anesthesia is required. Thus, late in the 18th century, surgeons began incising the groin to treat aneurysms there. This experience led to the discovery of the preperitoneal space of Bogros, which, in the 1870 s, was employed for the anterior repair of groin herniation. The posterior preperitoneal approach became established in the 1920s-1960s, along with the use of prostheses. Laparoscopy was applied near the end of the century.

Successful implantation of physiologically functional bioengineered mouse internal anal sphincter.

PubMed

Raghavan, Shreya; Miyasaka, Eiichi A; Hashish, Mohamed; Somara, Sita; Gilmont, Robert R; Teitelbaum, Daniel H; Bitar, Khalil N

2010-08-01

We have previously developed bioengineered three-dimensional internal anal sphincter (IAS) rings from circular smooth muscle cells isolated from rabbit and human IAS. We provide proof of concept that bioengineered mouse IAS rings are neovascularized upon implantation into mice of the same strain and maintain concentric smooth muscle alignment, phenotype, and IAS functionality. Rings were bioengineered by using smooth muscle cells from the IAS of C57BL/6J mice. Bioengineered mouse IAS rings were implanted subcutaneously on the dorsum of C57BL/6J mice along with a microosmotic pump delivering fibroblast growth factor-2. The mice remained healthy during the period of implantation, showing no external signs of rejection. Mice were killed 28 days postsurgery and implanted IAS rings were harvested. IAS rings showed muscle attachment, neovascularization, healthy color, and no external signs of infection or inflammation. Assessment of force generation on harvested IAS rings showed the following: 1) spontaneous basal tone was generated in the absence of external stimulation; 2) basal tone was relaxed by vasoactive intestinal peptide, nitric oxide donor, and nifedipine; 3) acetylcholine and phorbol dibutyrate elicited rapid-rising, dose-dependent, sustained contractions repeatedly over 30 min without signs of muscle fatigue; and 4) magnitudes of potassium chloride-induced contractions were 100% of peak maximal agonist-induced contractions. Our preliminary results confirm the proof of concept that bioengineered rings are neovascularized upon implantation. Harvested rings maintain smooth muscle alignment and phenotype. Our physiological studies confirm that implanted rings maintain 1) overall IAS physiology and develop basal tone, 2) integrity of membrane ionic characteristics, and 3) integrity of membrane associated intracellular signaling transduction pathways for contraction and relaxation by responding to cholinergic, nitrergic, and VIP-ergic stimulation. IAS smooth muscle tissue could thus be bioengineered for the purpose of implantation to serve as a potential graft therapy for dysfunctional internal anal sphincter in fecal incontinence.

Current trends in laparoscopic groin hernia repair: A review

PubMed Central

Pahwa, Harvinder Singh; Kumar, Awanish; Agarwal, Prerit; Agarwal, Akshay Anand

2015-01-01

Hernia is a common problem of the modern world with its incidence more in developing countries. Inguinal hernia is the most common groin hernia repaired worldwide. With advancement in technology operative techniques of repair have also evolved. A PubMed and COCHRANE database search was accomplished in this regard to establish the current status of laparoscopic inguinal hernia repair in view of recent published literature. Published literature support that laparoscopic hernia repair is best suited for recurrent and bilateral inguinal hernia although it may be offered for primary inguinal hernia if expertise is available. PMID:26380826

Complex inguinal hernia repairs.

PubMed

Beitler, J C; Gomes, S M; Coelho, A C J; Manso, J E F

2009-02-01

Complex inguinal hernia treatment is a challenge for general surgeons. The gold standard for the repair of inguinal hernias is the Lichtenstein repair (anterior approach). However, when multiple recurrent hernias or giant hernias are present, it is necessary to choose different approaches because the incidence of poor results increases. There are many preperitoneal approaches described in the literature. For example: (a) open procedure-Nyhus and Stoppa (b) laparoscopic technique-transabdominal pre-peritoneal (TAPP) and totally extraperitoneal (TEP). In this study, we show how we repair complicated cases using open access in huge unilateral or bilateral, recurrent, or multiple recurrent inguinal hernias. The present study includes the period from November 1993 through December 2007. One hundred and eighty-eight patients, divided into 121 with unilateral hernias and 67 with bilateral hernias, totaling 255 inguinal hernia repairs, were treated by the Nyhus or Stoppa preperitoneal approach, depending on whether they were unilateral or bilateral. We used progressive preoperative pneumoperitoneum for oversize inguinal hernias in all patients. Orchiectomy was necessary on only two occasions. Despite the repair complexity involved, we had only two known recurrences. The mortality was zero and the morbidity was acceptable. We conclude that an accurate open preperitoneal approach using mesh prosthesis for complex inguinal hernias is safe, with very low recurrent rates and low morbidity. Progressive preoperative pneumoperitoneum for giant hernias was shown to be an important factor in accomplishing good intraoperative and immediate postoperative results.

Simultaneous laparoscopic prosthetic mesh inguinal herniorrhaphy during transperitoneal laparoscopic radical prostatectomy.

PubMed

Allaf, Mohamad E; Hsu, Thomas H; Sullivan, Wendy; Su, Li-Ming

2003-12-01

Concurrent repair of inguinal hernias during open radical retropubic prostatectomy is well described and commonly practiced. With the advent of the laparoscopic approach to radical prostatectomy, the possibility of concurrent laparoscopic hernia repair merits investigation. We present a case of simultaneous prosthetic mesh onlay hernia repair for bilateral inguinal hernias during laparoscopic transperitoneal radical prostatectomy.

High submuscular placement of urologic prosthetic balloons and reservoirs via transscrotal approach.

PubMed

Morey, Allen F; Cefalu, Christopher A; Hudak, Steven J

2013-02-01

Traditional placement of inflatable penile prosthesis (IPP) reservoirs and/or artificial urinary sphincter (AUS) balloons into the space of Retzius may be challenging following major pelvic surgery. The aim of this study is to report our 1-year experience using a novel technique for high balloon/reservoir placement beneath the rectus abdominus muscle, thus completely obviating deep pelvic dissection during prosthetic urologic surgery. A retrospective review of all patients who underwent IPP and/or AUS placement between June 2011 and June 2012 was performed. All had AUS balloons and/or IPP reservoirs placed in a submuscular location by bluntly tunneling through the external inguinal ring into a potential space between the transversalis fascia and the rectus abdominus muscle using a long, angled, lung grasping clamp. Patient demographics, perioperative outcomes, and initial follow-up patient-reported outcomes were reviewed. During the study period, 120 submuscular balloons/reservoirs were inserted in 107 consecutive patients who underwent placement of an IPP (61 patients), AUS (33 patients), or both (13 patients). Among our 48 most recent patients, 41 (85%) reported they were totally unable to feel their balloon/reservoir, and all but two patients reported no bother from the submuscular balloon/reservoir placement. Of the 120 total submuscular balloons and reservoirs, surgical time and outcomes of the prosthetic procedures appeared similar to those placed using traditional methods; two reservoirs required revision surgery for repositioning. High submuscular placement of genitourinary prosthetic balloons and reservoirs via a transscrotal approach is both safely and effective, while avoiding deep retropubic dissection. © 2012 International Society for Sexual Medicine.

Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: A comparative study.

PubMed

de Araújo, Felipe Brandão Corrêa; Starling, Eduardo Simão; Maricevich, Marco; Tobias-Machado, Marcos

2014-10-01

To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique. TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven. Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon. All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014). Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042). There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement. EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven.

Analgesia and sedation practices for incarcerated inguinal hernias in children.

PubMed

Al-Ansari, Khalid; Sulowski, Christopher; Ratnapalan, Savithiri

2008-10-01

In this study, the use of medications for analgesia and/or sedation for incarcerated inguinal hernia reductions in the emergency department was analyzed. A retrospective chart review was conducted for all patients presenting to a pediatric emergency department with incarcerated inguinal hernia from 2002 to 2005. A total of 99 children presented with incarcerated hernias during the study period. The median age was 11 months. Forty-four percent of children received medication for the procedure, of them 75% received parenteral and 25% oral or intranasal medications. Forty-five percent of children who received medication went through at least 1 hernia reduction attempt initially without medications. More than half the children with incarcerated inguinal hernias did not receive any medication for pain and/or sedation prior to hernia reduction. Guidelines for medication use for children with incarcerated inguinal hernias need to be developed.

How to deal with penile carcinoma inguinal metastases invading femoral vessels

PubMed Central

FODOR, MARIUS; PETRUT, BOGDAN; FODOR, LUCIAN

2017-01-01

Penile cancer accounts for 1–10% of men neoplastic diseases and 30–60% of patients have inguinal metastases at the time of diagnosis. Inguinal metastases of penile cancer with femoral vessel involvement could lead to vascular fistula and hemorrhagic shock. We present 3 consecutive patients with inguinal metastases of penile cancer complicated by infection and hemorrhage from femoral vessels invaded by the tumor. Simultaneous extra-anatomical axillo-femoral bypass graft, wide excision of tumor and groin defect reconstruction was used to achieve “tumor-free” oncologic aim and to save the lower limb. We consider the extra-anatomic axillo-femoral bypass associated with wide inguinal tumor excision and defect covering a feasible surgical solution for improving the life quality and extend life expectancy in patients with lymph node metastasis of penile cancer complicated by necrosis, infection and femoral vessel involvement. PMID:29151798

Laparoscopic inguinal hernioplasty after robot-assisted laparoscopic radical prostatectomy.

PubMed

Sakon, M; Sekino, Y; Okada, M; Seki, H; Munakata, Y

2017-10-01

To evaluate the efficacy and safety of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in patients who have undergone robot-assisted laparoscopic radical prostatectomy (RALP). From July 2014 to December 2016, TAPP inguinal hernia repair was conducted in 40 consecutive patients who had previously undergone RALP. Their data were retrospectively analyzed as an uncontrolled case series. The mean operation time in patients who had previously undergone RALP was 99.5 ± 38.0 min. The intraoperative blood loss volume was small, and the duration of hospitalization was 2.0 ± 0.5 days. No intraoperative complications or major postoperative complications occurred. During the average 11.2-month follow-up period, no patients who had previously undergone prostatectomy developed recurrence. Laparoscopic TAPP inguinal hernia repair after RALP was safe and effective. TAPP inguinal hernia repair may be a valuable alternative to open hernioplasty.

[Study of collagen and elastic fibers of connective tissue in patients with and without primary inguinal hernia].

PubMed

Bórquez, Pablo; Garrido, Luis; Manterola, Carlos; Peña, Patricio; Schlageter, Carol; Orellana, Juan José; Ulloa, Hugo; Peña, Juan Luis

2003-11-01

There are few studies looking for collagen matrix defects in patients with inguinal bernia. To study the skin connective tissue in patients with and without inguinal bernia. Skin from the surgical wound was obtained from 23 patients with and 23 patients without inguinal bernia. The samples were processed for conventional light microscopy. Collagen fibers were stained with Van Giesson and elastic fibers with Weigert stain. Patients without hernia had compact collagen tracts homogeneously distributed towards the deep dermis. In contrast, patients with hernia had zones in the dermis with thinner and disaggregated collagen tracts. Connective tissue had a lax aspect in these patients. Collagen fiber density was 52% lower in patients with hernia, compared to subjects without hernia. No differences in elastic fiber density or distribution was observed between groups. Patients with inguinal bernia have alterations in skin collagen fiber quality and density.

Antibiotic prophylaxis in open inguinal hernia repair: a literature review and summary of current knowledge

PubMed Central

Makarewicz, Wojciech; Ropel, Jerzy; Bobowicz, Maciej; Kąkol, Michał; Śmietański, Maciej

2016-01-01

More than 1 million inguinal hernia repairs are performed in Europe and the US annually. Although antibiotic prophylaxis is not required in clean, elective procedures, the routine use of implants (90% of inguinal hernia repairs are performed with mesh) makes the topic controversial. The European Hernia Society does not recommend routine antibiotic prophylaxis for elective inguinal hernia repairs. However, the latest randomized controlled trial, published by Mazaki et al., indicates that the use of prophylaxis is effective for the prevention of surgical site infection. Unnecessary prophylaxis contributes to the development of bacterial resistance and significantly increases healthcare costs. This review documents clinical trials on inguinal hernia repairs with mesh and summarizes the current knowledge. It also tries to solve certain problems, namely: what constitutes a real risk factor, late-onset infection, and how the “surgical environment” impacts on the need to use antibiotic prophylaxis. PMID:27829934

Characteristics of chiral plasma plumes generated in the absence of external magnetic field

NASA Astrophysics Data System (ADS)

Nie, LanLan; Liu, FengWu; Zhou, XinCai; Lu, XinPei; Xian, YuBin

2018-05-01

A chiral plasma plume has recently been generated inside a dielectric tube without the use of an external magnetic field. In this paper, we seek to further study the key properties of such a chiral plume to improve our understanding of how this interesting structure is generated and controlled. The chiral plume is generated by externally mounting a stainless steel helical coil or a ring onto the dielectric tube. By changing the pitch of the helical coil, the pitch of the plasma plume can be controlled, with the shape of the plume following the shape of the helical coil. The addition of the helical coil significantly expands the range of parameters under which the chiral plasma plume appears. When the frequency of the applied voltage increases, additional stable discharge channels appear between the adjacent helices. The addition of two helical coils results in the formation of two chiral plasma plumes, which follow the shape of the helical coils. When a metal ring is placed on the outside of the tube, there is no chiral plasma plume between the high voltage electrode and the ring; however, a chiral plasma plume appears on the right side of the ring if the distance between the ring and the high voltage electrode is small. These findings suggest that the chiral plasma can be effectively modulated and guided using an externally mounted helical coil, which acts as the floating/actual ground to reduce the impedance of the discharge and as such contributes to the emergence of the chiral plasma plume behavior.

A Low-Cost Teaching Model of Inguinal Canal: A Useful Method to Teach Surgical Concepts in Hernia Repair

ERIC Educational Resources Information Center

Ansaloni, Luca; Catena, Fausto; Coccolini, Frederico; Ceresoli, Marco; Pinna, Antonio Daniele

2014-01-01

Objectives: Inguinal canal anatomy and hernia repair is difficult for medical students and surgical residents to comprehend. Methods: Using low-cost material, a 3-dimensional inexpensive model of the inguinal canal was created to allow students to learn anatomical details and landmarks and to perform their own simulated hernia repair. In order to…

Testicular atrophy secondary to a large long standing incarcerated inguinal hernia.

PubMed

Salemis, Nikolaos S; Nisotakis, Konstantinos

2011-07-01

Testicular atrophy is a rare but distressing complication of inguinal hernia repair. Apart from the postsurgical etiology, ischemic orchitis and subsequent testicular atrophy may occur secondary to compression of the testicular vessels by chronically incarcerated hernias. We present a rare case of testicular atrophy secondary to a large long standing incarcerated inguinal hernia of 2-decade duration in a 79-year-old man. Testicular atrophy should be always considered in long standing incarcerated inguinal hernias and patients should be adequately informed of this possibility during the preoperative work-up. Preoperative scrotal ultrasonography can be used to determine testicular status in this specific group of patients.

Testicular atrophy secondary to a large long standing incarcerated inguinal hernia

PubMed Central

Salemis, Nikolaos S.; Nisotakis, Konstantinos

2011-01-01

Testicular atrophy is a rare but distressing complication of inguinal hernia repair. Apart from the postsurgical etiology, ischemic orchitis and subsequent testicular atrophy may occur secondary to compression of the testicular vessels by chronically incarcerated hernias. We present a rare case of testicular atrophy secondary to a large long standing incarcerated inguinal hernia of 2-decade duration in a 79-year-old man. Testicular atrophy should be always considered in long standing incarcerated inguinal hernias and patients should be adequately informed of this possibility during the preoperative work-up. Preoperative scrotal ultrasonography can be used to determine testicular status in this specific group of patients. PMID:24765329

[Inguinal impalement. Report of two cases].

PubMed

Baeza-Herrera, Carlos; Medellín-Sierra, Ulises Darío; Domínguez-Pérez, Salomón T; Atzín-Fuentes, José Luis; García-Cabello, Luis Manuel

2008-01-01

Traumatic inguinal lesions in children are relatively unusual and those caused by impalement are less common. The purpose of this paper is to demonstrate the clinical course of two similar cases. A 13-year-old male and a 7-year-old female are presented in this report. During an accidental fall, they sustained an inguinal wound. In the emergency room, a wooden stake and a metallic bar were seen in the inguinal region. The surgical procedure shows absence of vascular, neurological, visceral and testicular damage. Both wounds caused by foreign bodies were subcutaneous and removed without complications. These types of accidents are uncommon and the absence of damage is the most relevant issue.

Testicular Torsion in the Left Inguinal Canal in a Patient with Inguinal Hernia: A Difficult Case to Diagnose

PubMed Central

Erdoğan, Alihan; Günay, Emel Ceylan; Gündoğdu, Gökhan; Avlan, Dincer

2011-01-01

A 8 month old boy suffering from inconsolable cry and tenderness presented to our hospital. Ten hours had passed from the onset of his symptoms. Physical examination showed a tender mass on the left groin. Patient was evaluated with Doppler ultrasound and Technetium-99m pertechnetate testicular scintigraphy Differential diagnosis of torsion and inflammatory disease could not be made by adjunctive tests. The patient underwent surgery based on clinical findings and necrotic inguinal left gonad was shown. In this study, we discussed the scintigraphic pattern in a patient with torsion in undescended inguinal testicle Conflict of interest:None declared. PMID:23486731

Acute testicular ischemia caused by incarcerated inguinal hernia.

PubMed

Orth, Robert C; Towbin, Alexander J

2012-02-01

Acute testicular ischemia caused by an incarcerated inguinal hernia usually affects infants. There are few reports of diagnosis using US, and the effect of long-standing reducible hernias on testicular growth in infants and children is unknown. The objectives of this study were to determine the incidence of testicular ischemia secondary to an incarcerated inguinal hernia at scrotal sonography and to determine the effect on testicular size at diagnosis. A hospital database was used to locate scrotal sonography examinations documenting an inguinal hernia, and images were reviewed for signs of testicular ischemia. Testicular volumes were compared using the Wilcoxon signed rank test. A total of 147 patients were identified with an inguinal hernia (age 1 day to 23 years, average 6 years). Ten patients (6.8%) had associated testicular ischemia (age 3 weeks to 6 months, average 9 weeks) and showed a statistically significant increase in ipsilateral testicular size compared to the contralateral testicle (P = 0.012). Patients without testicular ischemia did not show a significant difference in testicular size, regardless of patient age. An incarcerated inguinal hernia should be considered as a cause of acute testicular ischemia in infants younger than 6 months of age.

Cellular Angiofibroma Presenting as an Inguinal Subcutaneous Mass: a Case Report and Review of the Literature.

PubMed

Schiebel, Frank; Cassim, R

2016-01-01

Cellular angiofibroma is a rare benign mesenchymal tumor that occurs in the inguinal and vulvovaginal region. We report a case of the tumor occurring in the right inguinal region of a 64 old male and a review of the current literature. A 64 year old male veteran was referred to our general surgery service with an incidentally discovered right inguinal mass on a computerized tomography scan. The scan was performed to follow a history of prostate cancer that had been treated with brachytherapy. Magnetic resonance imaging of the lesion helped confirm that the mass did not represent a hernia or an undescended testicle. Surgical resection revealed encapsulated, yellowish, pink tissue measuring 6.5 x 5 x 3.5 cm. Microscopically, the sections showed densely fibrous to loose and focally fibromyxoid background of oval to spindle-shaped cells with a few scattered plasma cells and mast cells. Based upon the clinical, histologic, and immunohistochemical findings, the lesion was classified as a cellular angiofibroma. Cellular angiofibroma of the inguinal region is a rare benign encapsulated tumor.It should be considered in the differential diagnosis of a male with an inguinal mass proven not to be a hernia or undescended testicle.

Cross-sectional study to identify staphylococcal species isolated from teat and inguinal skin of different-aged dairy heifers.

PubMed

Adkins, P R F; Dufour, S; Spain, J N; Calcutt, M J; Reilly, T J; Stewart, G C; Middleton, J R

2018-04-01

The purpose of this study was to describe the prevalence and distribution of staphylococcal species on the teat and inguinal skin of dairy heifers across the various stages of the heifer life cycle. The cross-sectional study included 106 Holstein heifers with an age range of 0 d to 27 mo that were selected from 11 different groups, based on housing type and age, on a single dairy operation. A composite swabbing sample including all 4 teats and a second composite sample including both inguinal regions of each heifer were collected using gas-sterilized electrostatic dusters (Swiffers; Procter and Gamble, Cincinnati, OH). Swabbing samples were mixed with 10 mL of sterile saline, agitated, and cultured on mannitol salt agar plates. At 24 h, plates were read and up to 10 staphylococcal colonies were saved for further analysis. Staphylococcal isolates were speciated using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or PCR amplification and partial sequencing of rpoB or tuf. The prevalence of staphylococci was compared between the inguinal and teat regions using the chi-squared or Fisher's exact test, as applicable. Logistic regression models were used to investigate the relationship between a heifer's age (treated as a quantitative continuous variable) and the probability of isolating a given staphylococcal species from a given body site (inguinal region or teats). Overall, the most common species identified were Staphylococcus haemolyticus followed by Staphylococcus chromogenes, Staphylococcus xylosus, Staphylococcus devriesei, and Staphylococcus sciuri. Staphylococcus aureus was more prevalent on the teat than in the inguinal region, whereas Staphylococcus arlettae was more prevalent in the inguinal region than on the teat. All other staphylococcal species were as likely to be found on the teat skin as the inguinal region skin. Isolation from the inguinal and teat skin was associated with age for Staphylococcus agnetis, S. chromogenes, S. devriesei, Staphylococcus equorum, S. haemolyticus, Staphylococcus lentus, S. sciuri, Staphylococcus vitulinus, and S. xylosus. The probability of finding S. chromogenes and S. agnetis on the teat and inguinal region increased with age, whereas the probability of S. devriesei and S. haemolyticus decreased with age. This study provides further insight into the ecology of staphylococcal species involved in heifer mastitis. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Effect of ring-shaped SiO2 current blocking layer thickness on the external quantum efficiency of high power light-emitting diodes

NASA Astrophysics Data System (ADS)

Zhou, Shengjun; Liu, Mengling; Hu, Hongpo; Gao, Yilin; Liu, Xingtong

2017-12-01

A ring-shaped SiO2 CBL underneath the p-electrode was employed to enhance current spreading of GaN-based light-emitting diodes (LEDs). Effects of ring-shaped SiO2 current blocking layer (CBL) thickness on optical and electrical characteristics of high power LEDs were investigated. A 190-nm-thick ring-shaped SiO2 CBL with inclined sidewalls was obtained using a combination of a thermally reflowed photoresist technique and an inductively coupled plasma (ICP) etching process, allowing for the deposition of conformal indium tin oxide (ITO) transparent conductive layer on sidewalls of ring-shaped SiO2 CBL. It was indicated that the external quantum efficiency (EQE) of high power LEDs increased with increasing thickness of ring-shaped SiO2 CBL. The EQE of high power LED with 190-nm-thick ring-shaped SiO2 CBL was 12.7% higher than that of high power LED without SiO2 CBL. Simulations performed with commercial SimuLED software package showed that the ring-shaped SiO2 CBL could significantly alleviate current crowding around p-electrode, resulting in enhanced current spreading over the entire high power LED structure.

Redesign of solid rocket booster/external tank attachment ring for the space transportation system

NASA Technical Reports Server (NTRS)

Mccomb, Harvey G., Jr. (Compiler)

1987-01-01

An improved design concept is presented for the Space Shuttle solid rocket booster (SRB)/external tank (ET) attachment ring structural component. This component picks up three struts which attach the aft end of each SRB to the ET. The concept is a partial ring with carefully tapered ends to distribute fastener loads safely into the SRB. Extensive design studies and analyses were performed to arrive at the concept. Experiments on structural elements were performed to determine material strength and stiffness characteristics. Materials and fabrication studies were conducted to determine acceptable tolerances for the design concept. An overview is provided of the work along with conclusions and major recommendations.

FIBER AND INTEGRATED OPTICS. OTHER TOPICS IN QUANTUM ELECTRONICS: Fiber-optic interferometers: control of spectral composition of the radiation and formation of high-intensity optical pulses

NASA Astrophysics Data System (ADS)

Bulushev, A. G.; Dianov, Evgenii M.; Kuznetsov, A. V.; Okhotnikov, O. G.; Paramonov, Vladimir M.; Tsarev, Vladimir A.

1990-05-01

A study was made of the use of single-mode fiber ring interferometers in narrowing the emission lines of semiconductor lasers and increasing the optical radiation power. Efficient coupling of radiation, emitted by a multifrequency injection laser with an external resonator, into a fiber ring interferometer was achieved both under cw and mode-locking conditions. Matching of the optical lengths of the external resonator and the fiber interferometer made it possible to determine the mode width for this laser. A method for generation of optical pulses in a fiber ring interferometer from cw frequency modulated radiation was developed.

Diagnosis and successful surgical treatment of an unusual inguinal liposarcoma in a pet ferret (Mustela putorius furo)

PubMed Central

Gardhouse, Sara; Eshar, David; Fromstein, Jordan; Smith, Dale A.

2013-01-01

A 4 1/2-year-old female spayed ferret (Mustela putorius furo) was presented for a rapidly growing mass in the inguinal region. Following a complete clinical evaluation, the unusual mass was surgically removed and the histopathological diagnosis was an inguinal liposarcoma. No post-operative complications were observed over a 14-month follow-up period. PMID:24155472

Penile carcinoma presenting as inguinal bubo, masquerading as a venereal disease.

PubMed

Gupta, Vishal; Rai, Ajay; Mutha, Shreyans; Firdaus Ali, Mohammad; Sharma, Vinod K

2016-03-01

We report a case of penile carcinoma presenting as an inguinal bubo in a young man. The associated painful genital ulcer and history of high-risk sexual behaviour raised a strong suspicion of a sexually transmitted infection. We review the literature for similar cases, highlight the similarities with venereal disease and discuss the differential diagnosis of inguinal bubo. © The Author(s) 2016.

Ring stability of underground toroidal tanks

NASA Astrophysics Data System (ADS)

Lubis, Asnawi; Su'udi, Ahmad

2017-06-01

The design of pressure vessels subjected to internal pressure is governed by its strength, while the design of pressure vessels subjected to external pressure is governed by its stability, which is for circular cross-section is called the ring stability. This paper presented the results of finite element study of ring stability of circular toroidal tank without stiffener under external pressure. The tank was placed underground and external pressure load from soil was simulated as pressure at the top of the vessel along 30° circumferentially. One might ask the reason for choosing toroidal rather than cylindrical tank. Preliminary finite element studies showed that toroidal shells can withstand higher external pressure than cylindrical shells. In this study, the volume of the tank was fixed for 15,000 litters. The buckling external pressure (pL) was calculated for radius ratio (R/r) of 2, 3, and 4. The corresponding cross-section radiuses were 724.3 mm, 632.7 mm, and 574.9 mm, respectively. The selected element type was SHELL 281 from the ANSYS element library. To obtain the buckling load, the arc-length method was used in the nonlinear analysis. Both material and geometric nonlinearities were activated during the analysis. The conclusion of this study is that short-radius and thin-walled toroidal shell produces higher buckling load.

The effect of external mean flow on sound transmission through double-walled cylindrical shells lined with poroelastic material

NASA Astrophysics Data System (ADS)

Zhou, Jie; Bhaskar, Atul; Zhang, Xin

2014-03-01

Sound transmission through a system of double shells, lined with poroelastic material in the presence of external mean flow, is studied. The porous material is modeled as an equivalent fluid because shear wave contributions are known to be insignificant. This is achieved by accounting for the energetically most dominant wave types in the calculations. The transmission characteristics of the sandwich construction are presented for different incidence angles and Mach numbers over a wide frequency range. It is noted that the transmission loss exhibits three dips on the frequency axis as opposed to flat panels where there are only two such frequencies—results are discussed in the light of these observations. Flow is shown to decrease the transmission loss below the ring frequency, but increase this above the ring frequency due to the negative stiffness and the damping effect added by the flow. In the absence of external mean flow, porous material provides superior insulation for most part of the frequency band of interest. However, in the presence of external flow, this is true only below the ring frequency—above this frequency, the presence of air gap in sandwich constructions is the dominant factor that determines the acoustic performance. In the absence of external flow, an air gap always improves sound insulation.

Inguinal pain syndrome. The influence of intraoperative local administration of 0.5% bupivacaine on postoperative pain control following Lichtenstein hernioplasty. A prospective case-control study.

PubMed

Cybułka, Bartosz

2017-04-30

With current technological advancement and availability of synthetic materials used in inguinal hernia repair, a recurrence after first intervention is not a common and important adverse event. On the other hand, however, some patients complain about chronic pain of the operated site after surgeries using a polypropylene mesh. Many patients are constrained to a prolonged use of analgesics and increased frequency of control visits, which may eventually result in loss of trust in the operator. Every surgical intervention is associated with the risk of immediate or delayed complications. Genitofemoral neuralgia is associated with dysfunction of peripheral nerves passing through the inguinal canal or the surrounding tissue and it is a chronic, troublesome and undesired complication of an inguinal hernia repair. The possibility of minimizing chronic inguinal pain by proper management during herniorraphy should be considered in all cases of an inguinal canal reconstruction. The aim of the study was to investigate whether an intraoperative injection of 0.5% bupivacaine into the operated site (preemptive analgesia) has an influence on the postoperative pain assessed on the day of operation as well as the 1st and 2nd postoperative day after Lichtenstein hernioplasty of an inguinal, scrotal or recurrent hernia. In the studied population, we attempted to identify risk factors affecting pain level after surgical repair of an inguinal, scrotal or recurrent hernia. During the period between December 2015 and May 2016, 133 patients with preoperative diagnosis of an inguinal (81.95%, n=109), scrotal (13.53%, n=18) or recurrent hernia (4.51%, n=6) underwent an elective intervention and were randomly allocated to the group, which intraoperatively received 20 mL of 0.5% bupivacaine locally in selected anatomical points of the inguinal canal. In the group with preoperative diagnosis of an inguinal hernia, this intervention was applied in 56.88% of cases (n=62). In the case of scrotal or recurrent hernia, a similar intervention was applied in 41.67% (n=10) of patients. During the hospital stay, pain was assessed four times a day using the NRS numeric scale. All patients received preoperative antibiotic prophylaxis, and, during observation, analgesics and low-molecular-weight heparin were used. In the studied group, risk factor were identified, which affect the pain level associated with surgical treatment of an inguinal hernia. Mean pain level score according to the NRS scale (0-10) for an inguinal hernia was 4.17 on day 0 (standard deviation 2.22; minimum 0; maximum 10). On day 1 - 2.86 (standard deviation 1.86; minimum 0; maximum 8). On day 2 - 0.84 (standard deviation 1.21; minimum 0; maximum 5). The values of those parameters for a scrotal and recurrent hernia were as follows: on day 0 - 3.67 (standard deviation 1.76; minimum 0; maximum 7). On day 1 - 3.79 (standard deviation 1.67; minimum 0; maximum 7). On day 2 - 2.25 (standard deviation 1.54; minimum 0; maximum 4). Intraoperative application of 20 mL 0.5% bupivacaine did not reduce the postoperative pain on the postoperative day 0, 1, 2. Among independent risk factors exacerbating pain, the following variables were identified: local complications of the operated site including edema, ecchymosis and hematoma of the inguinal region. More frequent dressing changes were directly correlated with an increased pain sensation. Postoperative urethral catheterization due to urinary retention was associated with an increased pain immediately after surgery. In the case of intraoperative diagnosis of concurrent direct and indirect hernia (so-called pantaloon hernia), less intense pain was observed on postoperative day 0. Other parameters such as age, sex, duration of operation, duration of hospitalization and wound drainage did not influence the pain sensation. Local injection of an analgesic into the operated site was not associated with the reduction of pain assessed on postoperative day 0, 1 and 2 after an isolated inguinal, scrotal or recurrent hernia repair. Pathologies of the operated site such as edema, ecchymosis or hematoma were associated with an increased pain sensations on observation. Also, postoperative urinary retention and urethral catheterization increased the pain sensation after an inguinal hernia repair. A lack of wound complications significantly decreased the pain sensation during the immediate postoperative period after hernia repair.

[Hernia surgery in urology: part 1: inguinal, femoral and umbilical hernias - fundamentals of clinical diagnostics and treatment].

PubMed

Franz, T; Schwalenberg, T; Dietrich, A; Müller, J; Stolzenburg, J-U

2013-05-01

Hernias are a common occurrence with correspondingly huge clinical and economic impacts on the healthcare system. The most common forms of hernia which need to be diagnosed and treated in routine urological work are inguinal and umbilical hernias. With the objective of reconstructing and stabilizing the inguinal canal there are the possibilities of open and minimally invasive surgery and both methods can be performed with suture or mesh repair. Indications for surgery of umbilical hernias are infrequent although this is possible with little effort under local anesthesia. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostics and therapy of inguinal, femoral and umbilical hernias.

Spontaneous decoherence of coupled harmonic oscillators confined in a ring

NASA Astrophysics Data System (ADS)

Gong, ZhiRui; Zhang, ZhenWei; Xu, DaZhi; Zhao, Nan; Sun, ChangPu

2018-04-01

We study the spontaneous decoherence of coupled harmonic oscillators confined in a ring container, where the nearest-neighbor harmonic potentials are taken into consideration. Without any external symmetry-breaking field or surrounding environment, the quantum superposition state prepared in the relative degrees of freedom gradually loses its quantum coherence spontaneously. This spontaneous decoherence is interpreted by the gauge couplings between the center-of-mass and the relative degrees of freedoms, which actually originate from the symmetries of the ring geometry and the corresponding nontrivial boundary conditions. In particular, such spontaneous decoherence does not occur at all at the thermodynamic limit because the nontrivial boundary conditions become the trivial Born-von Karman boundary conditions when the perimeter of the ring container tends to infinity. Our investigation shows that a thermal macroscopic object with certain symmetries has a chance for its quantum properties to degrade even without applying an external symmetry-breaking field or surrounding environment.

"Laparoscopic excision of a large ovarian cyst herniating into the inguinal canal: a rare presentation".

PubMed

Machado, Norman Oneil; Machado, Lovina S M; Al Ghafri, Wadha

2011-08-01

Inguinal hernia repair is one of the most common operation in surgical practice. Despite its common occurrence, hernia often poses a surgical dilemma even for a skilled surgeon. The unexpected hernial content constitutes one of these cases. Although the often-reported, unusual contents of a hernia sac include ovary, fallopian tube, vermiform appendix, Meckel diverticulum, and urinary bladder, the herniation of a large ovarian cyst into the inguinal canal has been hardly reported. Majority of the ovarian cysts are asymptomatic or present with vague lower abdominal pain, whereas the presentation of a large ovarian cyst as an inguinolabial swelling as in our patient is extremely rare. We present here one of the few reported cases of a laparoscopic excision of a large ovarian cyst herniating into the inguinal canal and discuss the pathogenesis of an ovarian cyst as hernial content, the advantages and concerns of a laparoscopic approach in resecting large ovarian cysts, and simultaneous management of the inguinal hernia.

Pelviscrotal vasovasostomy: refining and troubleshooting.

PubMed

Shaeer, Osama K Z; Shaeer, Kamal Z

2005-11-01

Obstruction of the vas deferens in the inguinal canal may occur as a sequel of inguinal surgery. The condition is occurs in 26.7% of cases following childhood herniotomy. Open surgery in the inguinal region for anastomosing the remnants of the vas is difficult and associated with high morbidity. We have previously reported an alternative based on anastomosing the pelvic vas deferens (harvested laparoscopically) to the scrotal vas deferens and bypassing the inguinal vas. This technique, termed Shaeer pelviscrotal vasovasostomy, is easier to perform with much less morbidity. In this study we present the results of performing the procedure bilaterally at the same session as well as technique troubleshooting. A total of 25 patients with azoospermia due to inguinal obstruction of the vas deferens underwent unilateral (15) or bilateral (10) surgery. Patients were followed for 1 year. Of the 25 patients 17 (68%) had a sperm concentration of between 11.88 and 17 million per ml. Some patients who remained azoospermic underwent reoperation and the obstacles to a successful anastomosis were analyzed and resolved. Shaeer vasovasostomy is a practical approach to inguinal obstruction of the vas deferens. It enables a reliable anastomosis, simultaneous bilateral repair and lower morbidity in terms of wound healing and hernia as well as a shorter convalescence.

The role of surgical expertise with regard to chronic postoperative inguinal pain (CPIP) after Lichtenstein correction of inguinal hernia: a systematic review.

PubMed

Lange, J F M; Meyer, V M; Voropai, D A; Keus, E; Wijsmuller, A R; Ploeg, R J; Pierie, J P E N

2016-06-01

The aim of this study was to evaluate whether a relation exists between surgical expertise and incidence of chronic postoperative inguinal pain (CPIP) after inguinal hernia repair using the Lichtenstein procedure . CPIP after inguinal hernia repair remains a major clinical problem despite many efforts to address this problem. Recently, case volume and specialisation have been found correlated to significant improvement of outcomes in other fields of surgery; to date these important factors have not been reviewed extensively enough in the context of inguinal hernia surgery. A systematic literature review was performed to identify randomised controlled trials reporting on the incidence of CPIP after the Lichtenstein procedure and including the expertise of the surgeon. Surgical expertise was subdivided into expert and non-expert. In a total of 16 studies 3086 Lichtenstein procedures were included. In the expert group the incidence of CPIP varied between 6.9 and 11.7 % versus an incidence of 18.1 and 39.4 % in the non-expert group. Due to the heterogeneity between groups no statistical significance could be demonstrated. The results of this evaluation suggest that an association between surgical expertise and CPIP is highly likely warranting further analysis in a prospectively designed study.

Amyand's hernia: A case report and review of the literature.

PubMed

Shaban, Youssef; Elkbuli, Adel; McKenney, Mark; Boneva, Dessy

2018-05-07

An Amyand hernia is a rare disease where the appendix is found within an inguinal hernia sac. This rare entity is named after the French born English surgeon, Dr. Claudius Amyand. Inguinal hernias are one of the most common surgeries that a general surgeon performs with more than 20 million inguinal hernia repairs performed yearly worldwide. The incidence of finding an appendix within the hernia sac is rare, occurring in less than 1% of inguinal hernia patients and when complications arise such as inflammation, perforation, or abscess formation it becomes exceptionally rare with an incidence of about 0.1%. A 59-year-old male with a history of a previously reducible right inguinal hernia presented to the Emergency Department with acute abdominal pain, right groin mass. Computed tomography (CT) confirmed a right incarcerated inguinal hernia with herniated loops of bowel within the right inguinal region. Patient was subsequently treated with an appendectomy and tension free hernia repair with mesh with a successful outcome. The current generally accepted treatment algorithm for Amyand's hernia is essentially contingent on the appendix's condition within the hernia sac. Controversy exists regarding the application of mesh in type 2 Amyand's hernia. More research is needed to provide surgeons with evidence-based standardized approaches for dealing with this unique situation. This case report reviews a rare entity known as an Amyand's hernia that presented as an incarcerated hernia that was diagnosed intraoperatively with an inflamed appendix, recognized as a type 2 Amyand's hernia. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Type V Collagen is Persistently Altered after Inguinal Hernia Repair.

PubMed

Lorentzen, L; Henriksen, N A; Juhl, P; Mortensen, J H; Ågren, M S; Karsdal, M A; Jorgensen, L N

2018-04-01

Hernia formation is associated with alterations of collagen metabolism. Collagen synthesis and degradation cause a systemic release of products, which are measurable in serum. Recently, we reported changes in type V and IV collagen metabolisms in patients with inguinal and incisional hernia. The aim of this study was to determine if the altered collagen metabolism was persistent after hernia repair. Patients who had undergone repairs for inguinal hernia (n = 11) or for incisional hernia (n = 17) were included in this study. Patients who had undergone elective cholecystectomy served as controls (n = 10). Whole venous blood was collected 35-55 months after operation. Biomarkers for type V collagen synthesis (Pro-C5) and degradation (C5M) and those for type IV collagen synthesis (P4NP) and degradation (C4M2) were measured by a solid-phase competitive assay. The turnover of type V collagen (Pro-C5/C5M) was slightly higher postoperatively when compared to preoperatively in the inguinal hernia group (P = 0.034). In addition, the results revealed a postoperatively lower type V collagen turnover level in the inguinal hernia group compared to controls (P = 0.012). In the incisional hernia group, the type V collagen turnover was higher after hernia repair (P = 0.004) and the postoperative turnover level was not different from the control group (P = 0.973). Patients with an inguinal hernia demonstrated a systemic and persistent type V collagen turnover alteration. This imbalance of the collagen metabolism may be involved in the development of inguinal hernias.

Feasibility of robotic inguinal hernia repair, a single-institution experience.

PubMed

Escobar Dominguez, Jose E; Ramos, Michael Gonzalez; Seetharamaiah, Rupa; Donkor, Charan; Rabaza, Jorge; Gonzalez, Anthony

2016-09-01

With the growth of the discipline of laparoscopic surgery, technology has been further developed to facilitate the performance of minimally invasive hernia repair. Most of the published literature regarding robotic inguinal hernia repair has been performed by urologists who have dealt with this entity in a concomitant way during radical prostatectomies. General surgeons, who perform the vast majority of inguinal herniorrhaphies worldwide, have yet to describe the role of robotic inguinal hernia repair. Here, we describe our initial experience and create the foundation for future research questions regarding robotic inguinal hernia repair. A retrospective chart review was performed in 78 patients who underwent robotic transabdominal preperitoneal TAPP inguinal hernia repair with a prosthetic mesh using the da Vinci platform (Intuitive Surgical Inc). Data collected included patient demographics, past medical history, previous surgeries, details related to the surgical procedure, perioperative outcomes and complications. A total of 123 hernias were repaired. Forty-five patients had bilateral robotic inguinal herniorrhaphies, and the mean age was 55.1 years (SD 15.1), with a mean BMI of 27.6 (SD 6.1). There were 71 male and 7 female patients. Surgical complications included hematoma in three patients (3.9 %), two seromas (2.6 %) and one superficial surgical site infection at a trocar site (1.3 %), which resolved with oral antibiotics. Chronic postoperative complications (>30 days post-surgery) included the persistence of hematomas in two patients (2.6 %). Same day discharge was achieved in 60 patients (76.9 %) with a mean length of stay of 8 h (SD 2.65). Neither mortality nor conversion to open surgery occurred. Our early experience has demonstrated that the robotic transabdominal preperitoneal (TAPP) inguinal hernia repair is a safe and versatile approach that allows the general surgeon to perform this procedure in more complex cases such as those involving incarcerated and/or recurrent hernias.

Anterior transversalis fascia approach versus preperitoneal space approach for inguinal hernia repair in residents in northern China: study protocol for a prospective, multicentre, randomised, controlled trial

PubMed Central

Fan, Qing; Zhang, De-wei; Yang, Da-ye; Li, Hong-wu; Wei, Shi-bo; Yang, Liang; Yang, Fu-quan; Zhang, Shao-jun; Wu, Yao-qiang; An, Wei-de; Dai, Zhong-shu; Jiang, Hui-yong; Wang, Fu-rong; Qiao, Shi-feng; Li, Hang-yu

2017-01-01

Introduction Many surgical techniques have been used to repair abdominal wall defects in the inguinal region based on the anatomic characteristics of this region and can be categorised as ‘tension’ repair or ‘tension-free’ repair. Tension-free repair is the preferred technique for inguinal hernia repair. Tension-free repair of inguinal hernia can be performed through either the anterior transversalis fascia approach or the preperitoneal space approach. There are few large sample, randomised controlled trials investigating the curative effects of the anterior transversalis fascia approach versus the preperitoneal space approach for inguinal hernia repair in patients in northern China. Methods and analysis This will be a prospective, large sample, multicentre, randomised, controlled trial. Registration date is 1 December 2016. Actual study start date is 6 February 2017. Estimated study completion date is June 2020. A cohort of over 720 patients with inguinal hernias will be recruited from nine institutions in Liaoning Province, China. Patient randomisation will be stratified by centre to undergo inguinal hernia repair via the anterior transversalis fascia approach or the preperitoneal approach. Primary and secondary outcome assessments will be performed at baseline (prior to surgery), predischarge and at postoperative 1 week, 1 month, 3 months, 1 year and 2 years. The primary outcome is the incidence of postoperative chronic inguinal pain. The secondary outcome is postoperative complications (including rates of wound infection, haematoma, seroma and hernia recurrence). Ethics and dissemination This trial will be conducted in accordance with the Declaration of Helsinki and supervised by the institutional review board of the Fourth Affiliated Hospital of China Medical University (approval number 2015–027). All patients will receive information about the trial in verbal and written forms and will give informed consent before enrolment. The results will be published in peer-reviewed journals or disseminated through conference presentations. Trial registration number NCT02984917; preresults. PMID:28860228

Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair : Laparoscopic approach for inguinodynia.

PubMed

Ramshaw, Bruce; Vetrano, Vincent; Jagadish, Mayuri; Forman, Brandie; Heidel, Eric; Mancini, Matthew

2017-12-01

Traditional methods of clinical research may not be adequate to improve the value of care for patients with complex medical problems such as chronic pain after inguinal hernia repair. This problem is very complex with many potential factors contributing to the development of this complication. We have implemented a clinical quality improvement (CQI) effort in an attempt to better measure and improve outcomes for patients suffering with chronic groin pain (inguinodynia) after inguinal hernia repair. Between April 2011 and June 2016, there were 93 patients who underwent 94 operations in an attempt to relieve pain (1 patient had two separate unilateral procedures). Patients who had prior laparoscopic inguinal hernia repair (26) had their procedure completed laparoscopically. Patients who had open inguinal hernia repair (68) had a combination of a laparoscopic and open procedure in an attempt to relieve pain. Initiatives to attempt to improve measurement and outcomes during this period included the administration of pre-operative bilateral transversus abdominis plane and intra-operative inguinal nerve blocks using long-acting local anesthetic as a part of a multimodal regimen, the introduction of a low pressure pneumoperitoneum system, and the expansion of a pre-operative questionnaire to assess emotional health pre-operatively. The results included the assessment of how much improvement was achieved after recovery from the operation. Forty-five patients (48%) reported significant improvement, 39 patients (41%) reported moderate improvement, and 10 patients (11%) reported little or no improvement. There were 3 (3%) complications, 13 (11%) hernia recurrences, and 15 patients (13%) developed a new pain in the inguinal region after the initial pain had resolved. The principles of CQI can be applied to a group of patients suffering from chronic pain after inguinal hernia repair. Based on these results additional process improvement ideas will be implemented in an attempt to improve outcomes.

Anal Canal Cancer: Management of Inguinal Nodes and Benefit of Prophylactic Inguinal Irradiation (CORS-03 Study)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ortholan, Cecile, E-mail: c.ortholan@wanadoo.fr; Princess Grace Hospital; Resbeut, Michel

2012-04-01

Purpose: To evaluate the benefit of prophylactic inguinal irradiation (PII) in anal canal squamous cell carcinoma (ASCC). Methods and Materials: This retrospective study analyzed the outcome of 208 patients presenting with ASCC treated between 2000 and 2004 in four cancer centers of the south of France. Results: The population study included 35 T1, 86 T2, 59 T3, 20 T4, and 8 T stage unknown patients. Twenty-seven patients presented with macroscopic inguinal node involvement. Of the 181 patients with uninvolved nodes at presentation, 75 received a PII to a total dose of 45-50 Gy (PII group) and 106 did not receivemore » PII (no PII group). Compared with the no PII group, patients in the PII group were younger (60% vs. 41% of patients age <68 years, p = 0.01) and had larger tumor (T3-4 = 46% vs. 27% p = 0.01). The other characteristics were well balanced between the two groups. Median follow-up was 61 months. Fourteen patients in the no PII group vs. 1 patient in the PII group developed inguinal recurrence. The 5-year cumulative rate of inguinal recurrence (CRIR) was 2% and 16% in PII and no PII group respectively (p = 0.006). In the no PII group, the 5-year CRIR was 12% and 30% for T1-T2 and T3-T4 respectively (p = 0.02). Overall survival, disease-specific survival, and disease-free survival were similar between the two groups. In the PII group, no Grade >2 toxicity of the lower extremity was observed. Conclusion: PII with a dose of 45 Gy is safe and highly efficient to prevent inguinal recurrence and should be recommended for all T3-4 tumors. For early-stage tumors, PII should also be discussed, because the 5-year inguinal recurrence risk remains substantial when omitting PII (about 10%).« less

Spherical Particle in Nematic Liquid Crystal Under an External Field: The Saturn Ring Regime

NASA Astrophysics Data System (ADS)

Alama, Stan; Bronsard, Lia; Lamy, Xavier

2018-03-01

We consider a nematic liquid crystal occupying the exterior region in R^3 outside of a spherical particle, with radial strong anchoring. Within the context of the Landau-de Gennes theory, we study minimizers subject to an external field, modeled by an additional term which favors nematic alignment parallel to the field. When the external field is high enough, we obtain a scaling law for the energy. The energy scale corresponds to minimizers concentrating their energy in a boundary layer around the particle, with quadrupolar symmetry. This suggests the presence of a Saturn ring defect around the particle, rather than a dipolar director field typical of a point defect.

Perforated appendix and periappendicular abscess within an inguinal hernia.

PubMed

Salemis, N S; Nisotakis, K; Nazos, K; Stavrinou, P; Tsohataridis, E

2006-12-01

We report an extremely rare case of complicated Amyand's hernia. A 61-year-old male patient was admitted with clinical signs of incarcerated right inguinal hernia and localised tenderness in the right iliac fossa. He underwent emergency surgery and the operative findings included perforated appendix and periappendicular abscess within a right inguinal hernia sac. Appendectomy and Shouldice's herniorrhaphy without prosthetic mesh placement were performed. Histology revealed the presence of a villous adenoma near the base of the appendix. We point out that although Amyand's hernia is a very rare clinical entity, it should always be considered in the differential diagnosis in cases with clinical signs of incarcerated right inguinal hernia, especially when there are no pathological findings on the abdominal X-rays.

VEIL Surgical Steps.

PubMed

Raghunath, S K; Nagaraja, H; Srivatsa, N

2017-03-01

Inguinal lymphadenectomy remains the standard of care for metastatic nodal disease in cases of penile, urethral, vulval and vaginal cancers. Outcomes, including cure rates and overall and progression-free survivals, have progressively improved in these diseases with extending criteria to offer inguinal lymph node dissection for patients 'at-risk' for metastasis or loco-regional recurrence. Hence, despite declining incidence of advanced stages of these cancers, many patients will still need to undergo lymphadenectomy for optimal oncological outcomes. Inguinal node dissection is a morbid procedure with operative morbidity noted in almost two third of the patients. Video endoscopic inguinal lymphadenectomy (VEIL) was described and currently practiced with proven equivalent oncological outcomes. We describe our technique of VEIL using laparoscopic and robotic access as well as various new surgical strategies.

Hodgkin's lymphoma presents as an inguinal abscess: a case report and literature review

PubMed Central

Telfah, Muwaffaq Mezeil

2012-01-01

Lymphadenitis with suppuration is a rare presentation of Hodgkin's lymphoma with few cases reported in the literature. We report two cases of Hodgkin's lymphoma in two male members of the same family. They presented initially with clinical features suggesting infective inguinal lymphadenitis and then the picture was indistinguishable from inguinal abscess. The diagnosis was made after drainage of the pus and excision of the involved lymph node. The histopathology of the excised lymph node showed Hodgkin's lymphoma—nodular sclerosis for both brothers. After careful staging of both patients, the disease found to be localised to the inguinal group of lymph nodes. The patients referred to the haematologist for chemotherapy and they recovered after treatment. PMID:23001092

Unreliability of modified inguinal lymphadenectomy for clinical staging of penile carcinoma.

PubMed

Lopes, A; Rossi, B M; Fonseca, F P; Morini, S

1996-05-15

In 1988, Catalona proposed a modified bilateral inguinal lymphadenectomy for staging of lymph node metastasis from penile carcinoma. All three patients with penile carcinoma submitted to this procedure and without histologically confirmed metastases were free of disease within a mean follow-up time of 14.6 months. In a prospective study, the authors evaluated thirteen patients staged by the TNM system and submitted to modified bilateral inguinal lymphadenectomy. None of the patients had histologic metastases in the medial quadrant lymph nodes. Two of these patients developed regional lymph node metastases within 13.2 months (mean follow-up time). Catalona's procedure was not reliable. We therefore recommend standard inguinal lymphadenectomy as the minimal treatment for patients with infiltrating carcinoma of the penis.

Spectrum of MRI findings in clinical athletic pubalgia.

PubMed

Zajick, Donald C; Zoga, Adam C; Omar, Imran M; Meyers, William C

2008-03-01

Athletic pubalgia is a frequently encountered syndrome for clinicians who treat active patients participating in a wide variety of athletic endeavors worldwide. Pathologies associated with this clinical scenario span anatomically from the pubic symphysis to the hip and include a myriad of poorly understood and incompletely described musculoskeletal entities, many of which are centered about the pubic symphysis and its tendinous attachments. In this article, we discuss the relevant anatomy and pathophysiology for the most frequently encountered of these disorders, using magnetic resonance (MR) images as a guide. We describe an MR imaging protocol tailored to clinical athletic pubalgia. We then review reproducible MRI patterns of pathology about the pubic symphysis, the rectus abdominis/adductor aponeurosis and the inguinal ring, as well as a group of clinically confounding entities remote from the symphysis but visible by MRI.

Laparoscopic inguinal hernia repair by the hook method in emergency setting in children presenting with incarcerated inguinal hernia.

PubMed

Chan, Kin Wai Edwin; Lee, Kim Hung; Tam, Yuk Him; Sihoe, Jennifer Dart Yin; Cheung, Sing Tak; Mou, Jennifer Wai Cheung

2011-10-01

The development of laparoscopic hernia repair has provided an alternative approach to the management of incarcerated inguinal hernia in children. Different laparoscopic techniques for hernia repair have been described. However, we hereby review the role of laparoscopic hernia repair using the hook method in the emergency setting for incarcerated inguinal hernias in children. A retrospective review was conducted of all children who presented with incarcerated inguinal hernia and underwent laparoscopic hernia repair using the hook method in emergency setting between 2004 and 2010. There were a total of 15 boys and 1 girl with a mean age of 30 ± 36 months (range, 4 months to 12 years). The hernia was successfully reduced after sedation in 7 children and after general anesthesia in 4 children. In 5 children, the hernia was reduced by a combined manual and laparoscopic-assisted approach. Emergency laparoscopic inguinal hernia repair using the hook method was performed after reduction of the hernia. The presence of preperitoneal fluid secondary to recent incarceration facilitated the dissection of the preperitoneal space by the hernia hook. All children underwent successful reduction and hernia repair. The median operative time was 37 minutes. There was no postoperative complication. The median hospital stay was 3 days. At a median follow-up of 40 months, there was no recurrence of the hernia or testicular atrophy. Emergency laparoscopic inguinal hernia repair by the hook method is safe and feasible. Easier preperitoneal dissection was experienced, and repair of the contralateral patent processus vaginalis can be performed in the same setting. Copyright © 2011 Elsevier Inc. All rights reserved.

Assessing the impact of short-term surgical education on practice: a retrospective study of the introduction of mesh for inguinal hernia repair in sub-Saharan Africa.

PubMed

Wang, Y T; Meheš, M M; Naseem, H-R; Ibrahim, M; Butt, M A; Ahmed, N; Wahab Bin Adam, M A; Issah, A-W; Mohammed, I; Goldstein, S D; Cartwright, K; Abdullah, F

2014-08-01

Inguinal hernia repair is the most common general surgery operation performed globally. However, the adoption of tension-free hernia repair with mesh has been limited in low-income settings, largely due to a lack of technical training and resources. The present study evaluates the impact of a 2-day training course instructing use of polypropylene mesh for inguinal hernia repair on the practice patterns of sub-Saharan African physicians. A surgical training course on tension-free mesh repair of hernias was provided to 16 physicians working in rural Ghanaian and Liberian hospitals. Three physicians were requested to prospectively record all their inguinal hernia surgeries, performed with or without mesh, during the 14-month period following the training. Demographic variables, diagnoses, and complications were collected by an independent data collector for mesh and non-mesh procedures. Surgery with mesh increased significantly following intervention, from near negligible levels prior to the training to 8.1 % of all inguinal hernia repairs afterwards. Mesh repair accounted for 90.8 % of recurrent hernia repairs and 2.9 % of primary hernia repairs after training. Overall complication rates between mesh and non-mesh procedures were not significantly different (p = 0.20). Three physicians who participated in an intensive education course were routinely using mesh for inguinal hernia repair 14 months after the training. This represents a significant change in practice pattern. Complication rates between patients who underwent inguinal hernia repairs with and without mesh were comparable. The present study provides evidence that short-term surgical training initiatives can have a substantial impact on local healthcare practice in resource-limited settings.

Current practices of laparoscopic inguinal hernia repair: a population-based analysis.

PubMed

Trevisonno, M; Kaneva, P; Watanabe, Y; Fried, G M; Feldman, L S; Andalib, A; Vassiliou, M C

2015-10-01

The selection of a laparoscopic approach for inguinal hernias varies among surgeons. It is unclear what is being done in actual practice. The purpose of this study was to report practice patterns for treatment of inguinal hernias among Quebec surgeons, and to identify factors that may be associated with the choice of operative approach. We studied a population-based cohort of patients who underwent an inguinal hernia repair between 2007 and 2011 in Quebec, Canada. A generalized linear model was used to identify predictors associated with the selection of a laparoscopic approach. 49,657 inguinal hernias were repaired by 478 surgeons. Laparoscopic inguinal hernia repair (LIHR) was used in 8 % of all cases. LIHR was used to repair 28 % of bilateral hernias, 10 % of recurrent hernias, 6 % of unilateral hernias, and 4 % of incarcerated hernias. 268 (56 %) surgeons did not perform any laparoscopic repairs, and 11 (2 %) surgeons performed more than 100 repairs. These 11 surgeons performed 61 % of all laparoscopic cases. Patient factors significantly associated with having LIHR included younger age, fewer comorbidities, bilateral hernias, and recurrent hernias. An open approach is favored for all clinical scenarios, even for situations where published guidelines recommend a laparoscopic approach. Surgeons remain divided on the best technique for inguinal hernia repair: while more than half never perform LIHR, the small proportion who perform many use the technique for a large proportion of their cases. There appears to be a gap between the best practices put forth in guidelines and what surgeons are doing in actual practice. Identification of barriers to the broader uptake of LIHR may help inform the design of educational programs to train those who have the desire to offer this technique for certain cases, and have the volume to overcome the learning curve.

OUTCOME OF LAPAROSCOPIC TOTALLY EXTRAPERITONEAL HERNIOPLASTY FOR INGUINAL HERNIA.

PubMed

Hanif, Hammad; Memon, Sohail Ahmed

2015-01-01

Hernioplasty for Inguinal hernia is one of the commonest operations performed in general surgical wards. More recently, interest has waxed and waned regarding the minimally invasive approach to hernioplasty. This study was carried out to assess the management outcome of minimally invasive hernioplasty (Totally extra-peritoneal approach) as the treatment of choice for uncomplicated (incomplete and reducible) inguinal hernia. In this quasi experimental study patients aged between 14-83 years who were otherwise fit and willing for total extra-peritoneal laparoscopic repair were recruited prospectively over a 10 month period. Thirty-seven such patients were operated and followed up in the hernia clinics. Six cases were later excluded for lack of proper follow-up. The typical patient was middle-aged male with right-sided inguinal hernia. Mean operating time was 53.3 minutes. No conversion was undertaken; however, there was one case of small bowel injury that went unrecognized on-table but necessitated subsequent laparotomy. Overall morbidity was 13.5%. Mean length of hospitalization was 2.89 days. Mean duration to normal routine life was 9.25 days. Overall, 70.9% of patients expressed satisfaction with the surgery. Totally extra-peritoneal mesh repair is a new and safe technique for hernioplasty with acceptable rates of morbidity and it is procedure of choice for recurrent and bilateral inguinal hernias and also used as alternate to open hernioplasty for uncomplicated (incomplete and reducible) inguinal herma.

A meta-analysis of the efficacy of prophylactic alpha-blockade for the prevention of urinary retention following primary unilateral inguinal hernia repair.

PubMed

Clancy, C; Coffey, J C; O'Riordain, M G; Burke, J P

2017-03-14

Urinary retention following inguinal hernia surgery is common and is believed to be associated with adrenergic over-stimulation of the smooth muscle in the bladder neck and prostate. The efficacy of prophylactic alpha-blockade in the prevention of urinary retention following elective inguinal hernia repair in males is unknown. A comprehensive literature search was performed adhering to PRISMA guidelines. Each study was reviewed and data were extracted. Random-effects models were used to combine data. Five randomized studies describing 456 patients were identified. General or spinal anaesthetic were used. Prophylactic alpha-blockade decreases the risk of urinary retention requiring catheterisation following elective unilateral inguinal hernia repair compared to control groups (OR:0.179, 95% CI:0.043-0.747, p:0.018). Rates of urinary retention between treatment and control groups are reduced by 20.6%. No serious complications relating to alpha blockade occurred. Prophylactic alpha-blockade reduces urinary retention following elective inguinal hernia surgery under general or spinal anaesthetic. Urinary retention is common following inguinal hernia surgery. It is believed to be associated with adrenergic over-stimulation of the smooth muscle in the bladder neck and prostate. Prophylactic alpha-blockade reduces the rates of urinary retention by 20.6% in adult males undergoing general or spinal anaesthetic with minimal associated side effects. Copyright © 2017. Published by Elsevier Inc.

A prospective randomized study comparing laparoscopic transabdominal preperitoneal (TAPP) versus Lichtenstein repair for bilateral inguinal hernias.

PubMed

Ielpo, Benedetto; Duran, Hipolito; Diaz, Eduardo; Fabra, Isabel; Caruso, Riccardo; Malavé, Luis; Ferri, Valentina; Lazzaro, Sara; Kalivaci, Denis; Quijano, Yolanda; Vicente, Emilio

2017-07-19

In literature, only a few studies have prospectively compared the results of laparoscopic with open inguinal hernia repair yet none have compared bilateral inguinal hernia repair. The aim of this study is to compare the open Lichtenstein repair (OLR) with laparoscopic trans-abdominal preperitoneal (TAPP) repair in patients undergoing surgery for bilateral inguinal hernia. Patients were prospectively randomized between March 2013 and March 2015. Outcome parameters included hospital stay, operation time, postoperative complications, immediate postoperative pain and chronic pain, recurrence and quality of life. Sixty-one patients underwent TAPP repair and 73 underwent OLR. TAPP procedure had less early post-operative pain up to 7 days from surgery (p = 0.003), a shorter length of hospital stay (p = 0.001), less postoperative complications (p = 0.012) and less chronic pain (0.04) when compared with the OLR approach. TAPP procedure for bilateral inguinal hernia effectively reduces early postoperative pain, hospital stay and postoperative complications. Copyright © 2017 Elsevier Inc. All rights reserved.

The iliopubic tract: an important anatomical landmark in surgery

PubMed Central

TEOH, LAURENCE S. G.; HINGSTON, GUY; AL-ALI, SAAD; DAWSON, BRENDA; WINDSOR, JOHN A.

1999-01-01

A band of fascial thickening, termed the iliopubic tract, lies on the posterior aspect of the inguinal region and has been described in the surgical literature as playing an important role during herniorraphy. This study was undertaken to examine the gross and microscopic anatomy of the iliopubic tract in 12 cadavers. The results confirmed that the iliopubic tract can be readily identified as a thickening of the transversalis fascia running deep and parallel to the inguinal ligament. It attaches to the superomedial part of the pubic bone medially, but laterally its fibres fan out within the fascia transversalis and fascia iliaca without bony attachment to the iliac spines. In contrast to the inguinal ligament, the histological analysis of the iliopubic tract shows a high elastin to collagen ratio. The functional signficance of this structure merits further study, but there is no doubt that it is important in many approaches to inguinal herniorraphy. For this reason it is considered that the iliopubic tract deserves greater emphasis in the anatomy teaching of the inguinal region. PMID:10227675

Persistent Mullerian duct syndrome with transverse testicular ectopia and seminoma.

PubMed

Alp, Bilal Fırat; Demirer, Zafer; Gürağaç, Ali; Babacan, Oğuzhan; Sarı, Erkan; Sarı, Sebahattin; Yavan, Ibrahim

2014-08-01

Persistent Mullerian duct syndrome (PMDS) is a rare form of the 46 XY disorders of sexual differentiation, characterized by the presence of a uterus and fallopian tubes due to the failure of Mullerian duct regression in genotypically normal males. More than 150 cases have been recorded, most of them in adults. In most cases, the PMDS is discovered during surgery for inguinal hernia or cryptorchidism, or by the presence of transverse testicular ectopia (TTE). The presence of PMDS with TTE is even more uncommon. In TTE, both testes descend through the same inguinal canal into the same scrotal sac. Patients with TTE present with symptoms of unilateral cryptorchidism and a contralateral inguinal hernia. For patients with inguinal hernia and cryptorchidism associated with TTE, PMDS should be kept in mind, and radiologic evaluation such as ultrasonography or magnetic resonance imaging of the genitourinary system and karyotyping are recommended. Whereas radiologic evaluation could be helpful in the diagnosis of TTE, it cannot diagnose the malignancy itself. The case explained in this report will offer urologists additional useful treatment strategies for patients with inguinal hernia and cryptorchidism.

Electronics box having internal circuit cards interconnected to external connectors sans motherboard

NASA Technical Reports Server (NTRS)

Hockett, John E. (Inventor)

2005-01-01

An electronics chassis box includes a pair of opposing sidewalls, a pair of opposing end walls, a bottom surface, a top cover, and ring connectors assemblies mounted in selective ones of the walls of the electronic box. Boss members extend from the bottom surface at different heights upon which circuit cards are mounted in spatial relationship to each other. A flex interconnect substantially reduces and generally eliminates the need of a motherboard by interconnecting the circuit cards to one another and to external connectors mounted within the ring connector assemblies.

Contemporary Role of Radiotherapy in the Management of Primary Penile Tumors and Metastatic Disease.

PubMed

Crook, Juanita

2016-11-01

Squamous cell cancer of the penis is a radiocurable malignancy all too often managed solely by partial or total penectomy. Effective management of the primary tumor while preserving penile morphology and function is a priority. External radiotherapy and brachytherapy have a role to play in the definitive management of the primary tumor. Surgical nodal staging remains a cornerstone of management because it is the strongest predictor of survival, and inguinal status determines pelvic management. Postoperative radiotherapy of the regional nodes for high-risk pathology is indicated. Chemoradiotherapy should be considered as neoadjuvant treatment for unresectable nodes or as definitive management. Copyright © 2016 Elsevier Inc. All rights reserved.

FDG PET/CT Findings in Primary Diffuse Large B-cell Lymphoma, Leg Type.

PubMed

Ni, Chiayi; Lewis, Michael; Berenji, Gholam

2016-01-01

A 64-year-old man presented with complaints of worsening left foot pain and swelling. MRI showed a soft tissue mass overlying the dorsolateral aspect of the left foot. Following a 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), the left foot mass was biopsied and pathology indicated a diagnosis of primary diffuse large B-cell lymphoma, leg type (PDLBCL, LT). Review of the PET/CT images demonstrated hypermetabolic activity associated with the left foot mass, multiple subcutaneous nodules/nodes, sclerotic osseous lesions in the lower extremities, and left external iliac/left inguinal lymphadenopathy. At the moment, the patient is undergoing chemotherapy.

Referred pain and cutaneous responses from deep tissue electrical pain stimulation in the groin.

PubMed

Aasvang, E K; Werner, M U; Kehlet, H

2015-08-01

Persistent postherniotomy pain is located around the scar and external inguinal ring and is often described as deep rather than cutaneous, with frequent complaints of pain in adjacent areas. Whether this pain is due to local pathology or referred/projected pain is unknown, hindering mechanism-based treatment. Deep tissue electrical pain stimulation by needle electrodes in the right groin (rectus muscle, ilioinguinal/iliohypogastric nerve and perispermatic cord) was combined with assessment of referred/projected pain and the cutaneous heat pain threshold (HPT) at three prespecified areas (both groins and the lower right arm) in 19 healthy subjects. The assessment was repeated 10 days later to assess the reproducibility of individual responses. Deep electrical stimulation elicited pain at the stimulation site in all subjects, and in 15 subjects, pain from areas outside the stimulation area was reported, with 90-100% having the same response on both days, depending on the location. Deep pain stimulation significantly increased the cutaneous HPT (P<0.014). Individual HPT responses before and during deep electrical pain stimulation were significantly correlated (ρ>0.474, P≤0.040) at the two test days for the majority of test areas. Our results corroborate a systematic relationship between deep pain and changes in cutaneous nociception. The individual referred/projected pain patterns and cutaneous responses are variable, but reproducible, supporting individual differences in anatomy and sensory processing. Future studies investigating the responses to deep tissue electrical stimulation in persistent postherniotomy pain patients may advance our understanding of underlying pathophysiological mechanisms and strategies for treatment and prevention. ClinicalTrials.gov (NCT01701427). © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Comparison of outcomes for single-incision laparoscopic inguinal herniorrhaphy and traditional three-port laparoscopic herniorrhaphy at a single institution.

PubMed

Buckley, F Paul; Vassaur, Hannah; Monsivais, Sharon; Sharp, Nicole E; Jupiter, Daniel; Watson, Rob; Eckford, John

2014-01-01

Evidence in the literature regarding the potential of single-incision laparoscopic (SILS) inguinal herniorrhaphy currently is limited. A retrospective comparison of SILS and traditional multiport laparoscopic (MP) inguinal hernia repair was conducted to assess the safety and feasibility of the minimally invasive laparoscopic technique. All laparoscopic inguinal hernia repairs performed by three surgeons at a single institution during 4 years were reviewed. Statistical evaluation included descriptive analysis of demographics including age, gender, body mass index (BMI), and hernia location (uni- or bilateral), in addition to bivariate and multivariate analyses of surgical technique and outcomes including operative times, conversions, and complications. The study compared 129 patients who underwent SILS inguinal hernia repair and 76 patients who underwent MP inguinal hernia repair. The cases included 190 men (92.68 %) with a mean age of 55.36 ± 18.01 years (range, 8-86 years) and a mean BMI of 26.49 ± 4.33 kg/m(2) (range, 17.3-41.7 kg/m(2)). These variables did not differ significantly between the SILS and MP cohorts. The average operative times for the SILS and MP unilateral cases were respectively 57.51 and 66.96 min. For the bilateral cases, the average operative times were 81.07 min for SILS and 81.38 min for MP. A multivariate analysis using surgical approach, BMI, case complexity, and laterality as the covariates demonstrated noninferiority of the SILS technique in terms of operative time (p = 0.031). No conversions from SILS to MP occurred, and the rates of conversion to open procedure did not differ significantly between the cohorts (p = 1.00, Fisher's exact test), nor did the complication rates (p = 0.65, χ (2)). As shown by the findings, SILS inguinal herniorrhaphy is a safe and feasible alternative to traditional MP inguinal hernia repair and can be performed successfully with similar operative times, conversion rates, and complication rates. Prospective trials are essential to confirm equivalence in these areas and to detect differences in patient-centered outcomes.

Genome-wide association study using deregressed breeding values for cryptorchidism and scrotal/inguinal hernia in two pig lines.

PubMed

Sevillano, Claudia A; Lopes, Marcos S; Harlizius, Barbara; Hanenberg, Egiel H A T; Knol, Egbert F; Bastiaansen, John W M

2015-03-21

Cryptorchidism and scrotal/inguinal hernia are the most frequent congenital defects in pigs. Identification of genomic regions that control these congenital defects is of great interest to breeding programs, both from an animal welfare point of view as well as for economic reasons. The aim of this genome-wide association study (GWAS) was to identify single nucleotide polymorphisms (SNPs) that are strongly associated with these congenital defects. Genotypes were available for 2570 Large White (LW) and 2272 Landrace (LR) pigs. Breeding values were estimated based on 1 359 765 purebred and crossbred male offspring, using a binary trait animal model. Estimated breeding values were deregressed (DEBV) and taken as the response variable in the GWAS. Heritability estimates were equal to 0.26 ± 0.02 for cryptorchidism and to 0.31 ± 0.01 for scrotal/inguinal hernia. Seven and 31 distinct QTL regions were associated with cryptorchidism in the LW and LR datasets, respectively. The top SNP per region explained between 0.96% and 1.10% and between 0.48% and 2.77% of the total variance of cryptorchidism incidence in the LW and LR populations, respectively. Five distinct QTL regions associated with scrotal/inguinal hernia were detected in both LW and LR datasets. The top SNP per region explained between 1.22% and 1.60% and between 1.15% and 1.46% of the total variance of scrotal/inguinal hernia incidence in the LW and LR populations, respectively. For each trait, we identified one overlapping region between the LW and LR datasets, i.e. a region on SSC8 (Sus scrofa chromosome) between 65 and 73 Mb for cryptorchidism and a region on SSC13 between 34 and 37 Mb for scrotal/inguinal hernia. The use of DEBV in combination with a binary trait model was a powerful approach to detect regions associated with difficult traits such as cryptorchidism and scrotal/inguinal hernia that have a low incidence and for which affected animals are generally not available for genotyping. Several novel QTL regions were detected for cryptorchidism and scrotal/inguinal hernia, and for several previously known QTL regions, the confidence interval was narrowed down.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Voskoboynikov, O., E-mail: vam@faculty.nctu.edu.tw

We theoretically investigate suppression and recovery of the Aharonov-Bohm oscillations of the diamagnetic response of electrons (holes) confined in self-assembled In{sub c}Ga{sub 1−c}As/GaAs semiconductor reflection asymmetrical quantum rings. Based on the mapping method and gauge-origin-independent definition for the magnetic vector potential we simulate the energies and wave functions of the electron (hole) under external magnetic and electric fields. We examine the transformation of the ground state wave function of the electron (hole) in reflection asymmetrical rings from localized in one of the potential valleys (dotlike shape of the wave function) to distributed over all volume of the ring (ringlike shape)more » under an appropriate lateral electric field. This transformation greatly recovers the electron (hole) diamagnetic coefficient and Aharonov-Bohm oscillations of the diamagnetic response of the ring. However, the recovering electric field for the first Aharonov-Bohm diamagnetic oscillation of the electron is a suppressing one for the hole (and vice versa). This can block the recovery of the optical Aharonow-Bohm effect in In{sub c}Ga{sub 1−c}As/GaAs asymmetrically wobbled rings. However, the recovery of the Aharonov-Bohm oscillations for the independent electron (hole) by the external electric field remains interesting and feasible objective for the asymmetric rings.« less

High-power 671  nm laser by second-harmonic generation with 93% efficiency in an external ring cavity.

PubMed

Cui, Xing-Yang; Shen, Qi; Yan, Mei-Chen; Zeng, Chao; Yuan, Tao; Zhang, Wen-Zhuo; Yao, Xing-Can; Peng, Cheng-Zhi; Jiang, Xiao; Chen, Yu-Ao; Pan, Jian-Wei

2018-04-15

Second-harmonic generation (SHG) is useful for obtaining single-frequency continuous-wave laser sources at various wavelengths for applications ranging from biology to fundamental physics. Using an external power-enhancement cavity is an effective approach to improve the frequency conversion efficiency. However, thermal effects limit the efficiency, particularly, in high-power operation. Therefore, reducing thermal effects is important when designing a cavity. This Letter reports the use of an external ring cavity for SHG, yielding a 5.2 W, 671 nm laser light with a conversion efficiency of 93.8±0.8% which, to the best of our knowledge, is a new record of conversion efficiency for an external ring cavity. It is achieved using a 10 mm length periodically poled potassium titanyl phosphate crystal and a 65 μm radius beam waist in the cavity so as to minimize thermal dephasing and thermal lensing. Furthermore, a method is developed to determine a conversion efficiency more accurately based on measuring the pump depletion using a photodiode detector and a maximum pump depletion up to 97% is recorded. In this method, the uncertainty is much less than that achieved in a common method by direct measuring with a power meter.

Temperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method.

PubMed

Lefrant, J-Y; Muller, L; de La Coussaye, J Emmanuel; Benbabaali, M; Lebris, C; Zeitoun, N; Mari, C; Saïssi, G; Ripart, J; Eledjam, J-J

2003-03-01

Comparisons of urinary bladder, oesophageal, rectal, axillary, and inguinal temperatures versus pulmonary artery temperature. Prospective cohort study. Intensive Care Unit of a University-Hospital. Forty-two intensive care patients requiring a pulmonary artery catheter (PAC). Patients requiring PAC and without oesophageal, urinary bladder, and/or rectal disease or recent surgery were included in the study. Temperature was simultaneously monitored with PAC, urinary, oesophageal, and rectal electronic thermometers and with axillary and inguinal gallium-in-glass thermometers. Comparisons used a Bland and Altman method. The pulmonary arterial temperature ranged from 33.7 degrees C to 40.2 degrees C. Urinary bladder temperature was assessed in the last 22 patients. A total of 529 temperature measurement comparisons were carried out (252 comparisons of esophageal, rectal, inguinal, axillary, and pulmonary artery temperature measurements in the first 20 patients, and 277 comparisons with overall methods in the last patients). Nine to 18 temperature measurement comparisons were carried out per patient (median = 13). The mean differences between pulmonary artery temperatures and those of the different methods studied were: oesophageal (0.11+/-0.30 degrees C), rectal (-0.07+/-0.40 degrees C), axillary (0.27+/-0.45 degrees C), inguinal (0.17+/-0.48 degrees C), urinary bladder (-0.21+/-0.20 degrees C). In critically ill patients, urinary bladder and oesophageal electronic thermometers are more reliable than the electronic rectal thermometer which is better than inguinal and axillary gallium-in-glass thermometers to measure core temperature.

Sandwich technique, peripheral nerve stimulation, peripheral field stimulation and hybrid stimulation for inguinal region and genital pain.

PubMed

Shaw, Andrew; Sharma, Mayur; Zibly, Zion; Ikeda, Daniel; Deogaonkar, Milind

2016-12-01

Ilioinguinal neuralgia (IG) and genitofemoral (GF) neuralgia following inguinal hernia repair is a chronic and debilitating neuropathic condition. Recently, peripheral nerve stimulation has become an effective and minimally invasive option for the treatment of refractory pain. Here we present a retrospective case series of six patients who underwent placement of peripheral nerve stimulation electrodes using various techniques for treatment of refractory post-intervention inguinal region pain. Six patients with post-intervention inguinal, femoral or GF neuropathic pain were evaluated for surgery. Either octopolar percutaneous electrodes or combination of paddle and percutaneous electrodes were implanted in the area of their pain. Pain visual analog scores (VAS), surgical complication rate, preoperative symptom duration, degree of pain relief, preoperative and postoperative work status, postoperative changes in medication usage, and overall degree of satisfaction with this therapy was assessed. All six patients had an average improvement of 62% in the immediate post-operative follow-up. Four patients underwent stimulation for IG, one for femoral neuralgia, and another for GF neuralgia. Peripheral nerve stimulation provided at least 50% pain relief in all the six patients with post-intervention inguinal region pain. 85% of patients indicated they were completely satisfied with the therapy overall. There was one treatment failure with an acceptable complication rate. Peripheral nerve or field stimulation for post-intervention inguinal region pain is a safe and effective treatment for this refractory and complex problem for patients who have exhausted other management options.

Memory characteristics of ring-shaped ceramic superconductors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Takeoka, A.; Hasunuma, M.; Sakaiya, S.

1989-03-01

For the practical application of ceramic superconductors, the authors investigated the residual magnetic field characteristics of ring-shaped ceramic superconductors in a Y-Ba-Cu-O system with high Tc. The residual magnetic field of a ring with asymmetric current paths, supplied by external currents, appeared when one of the branch currents was above the critical current. The residual magnetic field saturated when both brach currents exceeded the critical current of the ring and showed hysteresis-like characteristics. The saturated magnetic field is subject to the critical current of the ring. A superconducting ring with asymmetric current paths suggests a simple and quite new persistent-currentmore » type memory device.« less

Type II GaSb quantum ring solar cells under concentrated sunlight.

PubMed

Tsai, Che-Pin; Hsu, Shun-Chieh; Lin, Shih-Yen; Chang, Ching-Wen; Tu, Li-Wei; Chen, Kun-Cheng; Lay, Tsong-Sheng; Lin, Chien-chung

2014-03-10

A type II GaSb quantum ring solar cell is fabricated and measured under the concentrated sunlight. The external quantum efficiency confirms the extended absorption from the quantum rings at long wavelength coinciding with the photoluminescence results. The short-circuit current of the quantum ring devices is 5.1% to 9.9% more than the GaAs reference's under various concentrations. While the quantum ring solar cell does not exceed its GaAs counterpart in efficiency under one-sun, the recovery of the open-circuit voltages at higher concentration helps to reverse the situation. A slightly higher efficiency (10.31% vs. 10.29%) is reported for the quantum ring device against the GaAs one.

Robotic Inguinal Hernia Repair: Technique and Early Experience.

PubMed

Arcerito, Massimo; Changchien, Eric; Bernal, Oscar; Konkoly-Thege, Adam; Moon, John

2016-10-01

Laparoscopic inguinal hernia repair has been shown to have multiple advantages compared with open repair such as less postoperative pain and earlier resume of daily activities with a comparable recurrence rate. We speculate robotic inguinal hernia repair may yield equivalent benefits, while providing the surgeon added dexterity. One hundred consecutive robotic inguinal hernia repairs with mesh were performed with a mean age of 56 years (25-96). Fifty-six unilateral hernias and 22 bilateral hernias were repaired amongst 62 males and 16 females. Polypropylene mesh was used for reconstruction. All but, two patients were completed robotically. Mean operative time was 52 minutes per hernia repair (45-67). Five patients were admitted overnight based on their advanced age. Regular diet was resumed immediately. Postoperative pain was minimal and regular activity was achieved after an average of four days. One patient recurred after three months in our earlier experience and he was repaired robotically. Mean follow-up time was 12 months. These data, compared with laparoscopic approach, suggest similar recurrence rates and postoperative pain. We believe comparative studies with laparoscopic approach need to be performed to assess the role robotic surgery has in the treatment of inguinal hernia repair.

Laparoscopic preperitoneal repair of recurrent inguinal hernias.

PubMed

Sayad, P; Ferzli, G

1999-04-01

Repair of recurrent inguinal hernias using the conventional open technique has been associated with high rates of recurrence and complications. Stoppa has reported a low recurrence rate using the open preperitoneal approach. Evolution of laparoscopic techniques has allowed the reproduction of the open preperitoneal repair via an endoscopic totally extraperitoneal (TEP) approach. This study reviewed all the recurrent inguinal hernias repaired laparoscopically and evaluated the complication and recurrence rate. A total of 512 inguinal hernias were treated laparoscopically using the TEP approach. Of these, 75 were recurrent. The ages of the 61 men ranged from 36 to 65 years. There were 41 direct and 34 indirect hernias. Fourteen were bilateral. None of the repairs was converted to an open procedure. The operating time ranged from 20 to 145 min (median 42 min). All patients were discharged home on the same day. There were no deaths. The complications consisted of two instances of urinary retention and one groin collection. Patient follow-up ranged from 6 to 72 (median 40) months, and there have been no recurrences to date. The TEP repair for recurrent inguinal hernias can produce results comparable to the open preperitoneal technique with low morbidity and recurrence rates.

The feasibility of laparoscopic extraperitoneal hernia repair under local anesthesia.

PubMed

Ferzli, G; Sayad, P; Vasisht, B

1999-06-01

Laparoscopic preperitoneal herniorrhaphy has the advantage of being a minimally invasive procedure with a recurrence rate comparable to open preperitoneal repair. However, surgeons have been reluctant to adopt this procedure because it requires general anesthesia. In this report, we describe the technique used in the laparoscopic repair of inguinal hernias under local anesthesia using the preperitoneal approach. We also report our results with 10 inguinal hernias repaired using the same technique. Ten patients underwent their primary inguinal hernia repairs under local anesthesia. None were converted to general anesthesia. Four patients received a small amount of intravenous sedation. Three patients had bilateral hernias. There were five direct and eight indirect hernias. The average operative time was 47 min. The average lidocaine usage was 28 cc. All patients were discharged within a few hours of the surgery. There were no complications. Follow-up has ranged from 1 to 6 months. There has been no recurrences to date. The extraperitoneal laparoscopic repair of inguinal hernia is feasible under local anesthesia. This technique adds a new treatment option in the management of bilateral inguinal hernias, particularly in the population where general anesthesia is contraindicated or even for patients who are reluctant to receive general or epidural anesthesia.

Effect of external electric and magnetic field on propagation of atmospheric pressure plasma jet

NASA Astrophysics Data System (ADS)

Zhu, Ping; Meng, Zhaozhong; Hu, Haixin; Ouyang, Jiting

2017-10-01

The behaviors of atmospheric pressure plasma jet produced by a coplanar dielectric barrier discharge (CDBD) in helium in external electrostatic and magnetic field are investigated experimentally. Time-resolved ICCD images of jet in electric field, magnetic field, and floating metal ring are recorded, respectively. The results show that the jet dynamics is affected significantly by a metal ring, an electric, and/or a magnetic field. In a transverse electric field, the jet shows behavior of deflection, broadening, and shortening according to the structure of electric field. In a transverse magnetic field, the jet deflects to up or down depending on the magnetic direction. The jet can be slowed down or obstructed by a floating metal ring on the jet path, but will still pass through the tube at higher applied voltages of DBD, without significant change in jet length or shape out of the tube compared with that without metal ring. A positive DC voltage on the metal ring helps to improve the jet length, but a negative voltage will reduce the length or completely stop the jet. The electric field to sustain the jet in helium is estimated to be about 24 ± 15 kV/cm from this experiment.

Circumcision-incision orchidopexy: A novel technique for palpable, low inguinal undescended testis.

PubMed

Chua, Michael E; Silangcruz, Jan Michael A; Gomez, Odina; Dy, Jun S; Morales, Marcelino L

2017-11-01

Given that both orchidopexy and circumcision are commonly done in a single operative setting, we adopted a technique of combined orchidopexy and circumcision using a single circumcision incision. We applied this new technique to boys with palpable, low inguinal cryptorchidism. Here we describe a case series of 7 boys who underwent concurrent orchidopexy via the circumcision site. We present this novel technique and discuss our preliminary outcomes, including the anatomic basis and feasibility. The technique appears to be an alternative for concurrent circumcision and cryptorchid cases with palpable, low inguinal testes.

Rotational fluxons of Bose-Einstein condensates in coplanar double-ring traps

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brand, J.; Institute of Natural Sciences, Massey University; Haigh, T. J.

Rotational analogs to magnetic fluxons in conventional Josephson junctions are predicted to emerge in the ground state of rotating tunnel-coupled annular Bose-Einstein condensates (BECs). Such topological condensate-phase structures can be manipulated by external potentials. We determine conditions for observing macroscopic quantum tunneling of a fluxon. Rotational fluxons in double-ring BECs can be created, manipulated, and controlled by external potentials in different ways than is possible in the solid-state system, thus rendering them a promising candidate system for studying and utilizing quantum properties of collective many-particle degrees of freedom.

Self-injection-locking linewidth narrowing in a semiconductor laser coupled to an external fiber-optic ring resonator

NASA Astrophysics Data System (ADS)

Korobko, Dmitry A.; Zolotovskii, Igor O.; Panajotov, Krassimir; Spirin, Vasily V.; Fotiadi, Andrei A.

2017-12-01

We develop a theoretical framework for modeling of semiconductor laser coupled to an external fiber-optic ring resonator. The developed approach has shown good qualitative agreement between theoretical predictions and experimental results for particular configuration of a self-injection locked DFB laser delivering narrow-band radiation. The model is capable of describing the main features of the experimentally measured laser outputs such as laser line narrowing, spectral shape of generated radiation, mode-hoping instabilities and makes possible exploring the key physical mechanisms responsible for the laser operation stability.

Tunable ring laser with internal injection seeding and an optically-driven photonic crystal reflector.

PubMed

Zheng, Jie; Ge, Chun; Wagner, Clark J; Lu, Meng; Cunningham, Brian T; Hewitt, J Darby; Eden, J Gary

2012-06-18

Continuous tuning over a 1.6 THz region in the near-infrared (842.5-848.6 nm) has been achieved with a hybrid ring/external cavity laser having a single, optically-driven grating reflector and gain provided by an injection-seeded semiconductor amplifier. Driven at 532 nm and incorporating a photonic crystal with an azobenzene overlayer, the reflector has a peak reflectivity of ~80% and tunes at the rate of 0.024 nm per mW of incident green power. In a departure from conventional ring or external cavity lasers, the frequency selectivity for this system is provided by the passband of the tunable photonic crystal reflector and line narrowing in a high gain amplifier. Sub - 0.1 nm linewidths and amplifier extraction efficiencies above 97% are observed with the reflector tuned to 842.5 nm.

Surgical management of inguinal hernias at Bugando Medical Centre in northwestern Tanzania: our experiences in a resource-limited setting.

PubMed

Mabula, Joseph B; Chalya, Phillipo L

2012-10-25

Inguinal hernia repair remains the commonest operation performed by general surgeons all over the world. There is paucity of published data on surgical management of inguinal hernias in our environment. This study is intended to describe our own experiences in the surgical management of inguinal hernias and compare our results with that reported in literature. A descriptive prospective study was conducted at Bugando Medical Centre in northwestern Tanzania. Ethical approval to conduct the study was obtained from relevant authorities before the commencement of the study. Statistical data analysis was done using SPSS software version 17.0. A total of 452 patients with inguinal hernias were enrolled in the study. The median age of patients was 36 years (range 3 months to 78 years). Males outnumbered females by a ratio of 36.7:1. This gender deference was statistically significant (P=0.003). Most patients (44.7%) presented late (more than five years of onset of hernia). Inguinoscrotal hernia (66.8%) was the commonest presentation. At presentation, 208 (46.0%) patients had reducible hernia, 110 (24.3%) had irreducible hernia, 84 (18.6%) and 50(11.1%) patients had obstructed and strangulated hernias respectively. The majority of patients (53.1%) had right sided inguinal hernia with a right-to-left ratio of 2.1: 1. Ninety-two (20.4%) patients had bilateral inguinal hernias. 296 (65.5%) patients had indirect hernia, 102 (22.6%) had direct hernia and 54 (11.9%) had both indirect and direct types (pantaloon hernia). All patients in this study underwent open herniorrhaphy. The majority of patients (61.5%) underwent elective herniorrhaphy under spinal anaesthesia (69.2%). Local anaesthesia was used in only 1.1% of cases. Bowel resection was required in 15.9% of patients. Modified Bassini's repair (79.9%) was the most common technique of posterior wall repair of the inguinal canal. Lichtenstein mesh repair was used in only one (0.2%) patient. Complication rate was 12.4% and it was significantly higher in emergency herniorrhaphy than in elective herniorrhaphy (P=0.002). The median length of hospital stay was 8 days and it was significantly longer in patients with advanced age, delayed admission, concomitant medical illness, high ASA class, the need for bowel resection and in those with surgical repair performed under general anesthesia (P<0.001). Mortality rate was 9.7%. Longer duration of symptoms, late hospitalization, coexisting disease, high ASA class, delayed operation, the need for bowel resection and presence of complications were found to be predictors of mortality (P<0.001). Inguinal hernias continue to be a source of morbidity and mortality in our centre. Early presentation and elective repair of inguinal hernias is pivotal in order to eliminate the morbidity and mortality associated with this very common problem.

Liquid-injection for preperitoneal dissection of transabdominal preperitoneal (TAPP) inguinal [corrected] hernia repair.

PubMed

Mizota, Tomoko; Watanabe, Yusuke; Madani, Amin; Takemoto, Norihiro; Yamada, Hidehisa; Poudel, Saseem; Miyasaka, Yuji; Kurashima, Yo

2015-03-01

The creation of an adequate peritoneal flap during laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair, while avoiding injuring surrounding structures can be technically challenging. Liquid infiltration of the preperitoneal space can help facilitate dissection and avoid inadvertent injuries. We describe a novel technique for TAPP inguinal hernia repair using liquid-injection for preperitoneal [corrected] dissection and report our initial experience. TAPP inguinal hernia repair using a liquid-injection technique during preperitoneal dissection was performed by a single surgical resident without prior TAPP repair experience from July 2013 to January 2014. After trocar placement, 60 mL of 0.3 % lidocaine with 1:300,000 dilution of epinephrine was injected percutaneously using a blunt needle under laparoscopic visualization into the preperitoneal space to assist with the dissection and parietalization of the vas deferens, spermatic vessels, and epigastric vessels. The initial peritoneal incision is performed at the lateral side of the inguinal canal, followed by blunt dissection of the preperitoneal space. Eleven patients (median age: 69; 8 male) with a total of 12 inguinal hernias underwent a TAPP repair using a liquid-injection preperitoneal dissection technique. Ten patients had unilateral hernias (4 indirect, 6 direct), and one patient had bilateral direct hernias. The median operative time, median injection time, and median dissection time were 116, 3.5, and 42 min, respectively. Estimated blood loss was less than 10 mL for all cases. No intraoperative injuries, conversions to open repair, or 30-day postoperative complications occurred. There were no hernia recurrences after a median follow-up of 143 days. Our preliminary experience suggests that liquid-injection to assist preperitoneal dissection during TAPP inguinal hernia repair appears to be safe and feasible. This novel method facilitates the dissection of spermatic cord structures, and can be used to minimize trauma to surrounding structures, especially when performed by trainees with limited operative experience.

Combined Partial Penectomy With Bilateral Robotic Inguinal Lymphadenectomy Using Near-infrared Fluorescence Guidance.

PubMed

Sávio, Luís Felipe; Panizzutti Barboza, Marcelo; Alameddine, Mahmoud; Ahdoot, Michael; Alonzo, David; Ritch, Chad R

2018-03-01

To describe our novel technique for performing a combined partial penectomy and bilateral robotic inguinal lymphadenectomy using intraoperative near-infrared (NIR) fluorescence guidance with indocyanine green (ICG) and the DaVinci Firefly camera system. A 58-year-old man presented status post recent excisional biopsy of a 2-cm lesion on the left coronal aspect of the glans penis. Pathology revealed "invasive squamous cell carcinoma of the penis with multifocal positive margins." His examination was suspicious for cT2 primary and his inguinal nodes were cN0. He was counseled to undergo partial penectomy with possible combined vs staged bilateral robotic inguinal lymphadenectomy. Preoperative computed tomography scan was negative for pathologic lymphadenopathy. Before incision, 5 mL of ICG was injected subcutaneously beneath the tumor. Bilateral thigh pockets were then developed simultaneously and a right, then left robotic modified inguinal lymphadenectomy was performed using NIR fluorescence guidance via the DaVinci Firefly camera. A partial penectomy was then performed in the standard fashion. The combined procedure was performed successfully without complication. Total operative time was 379 minutes and total robotic console time was 95 minutes for the right and 58 minutes to the left. Estimated blood loss on the right and left were 15 and 25 mL, respectively. A total of 24 lymph nodes were retrieved. This video demonstrates a safe and feasible approach for combined partial penectomy and bilateral inguinal lymphadenectomy with NIR guidance using ICG and the DaVinci Firefly camera system. The combined robotic approach has minimal morbidity and avoids the need for a staged procedure. Furthermore, use of NIR guidance with ICG during robotic inguinal lymphadenectomy is feasible and may help identify sentinel lymph nodes and improve the quality of dissection. Further studies are needed to confirm the utility of NIR guidance for robotic sentinel lymph node dissection. Copyright © 2017 Elsevier Inc. All rights reserved.

The potential of mild testicular heating as a safe, effective and reversible contraceptive method for men.

PubMed

Mieusset, R; Bujan, L

1994-08-01

A preliminary assessment of the contraceptive efficacy of a daily mild increase (1-2 degrees C) in testicular temperature during waking hours is reported in nine couples using two techniques of non-surgical fixation of the testes close to the inguinal canal. With technique 1, immobilization was achieved by passing the penis and the empty scrotum through a hole made in close-fitting underwear; there was one pregnancy, from a man who stopped the heating after 7 weeks, for 42 cycles of exposure in three couples. With technique 2, immobilization was achieved by adding a ring of soft material surrounding the hole in the underwear; there was no pregnancy for 117 cycles of exposure in six couples. Reversibility and safety were assessed. These preliminary results suggest that a daily mild increase in testicular temperature could be a potential contraceptive method for men.

Evidence supporting laparoscopic hernia repair in children.

PubMed

Jessula, Samuel; Davies, Dafydd A

2018-06-01

Pediatric inguinal hernias are a commonly performed surgical procedure. Currently, they can be approached via open or laparoscopic surgery. We summarize the current evidence for laparoscopic inguinal hernia repairs in children. Laparoscopic and open inguinal hernia repair in children are associated with similar operative times for unilateral hernia, as well as similar cosmesis, complication rates and recurrence rates. Bilateral hernia repair has been shown to be faster through a laparoscopic approach. The laparoscopic approach is associated with decreased pain scores and earlier recovery, although only in the initial postoperative period. Laparoscopy allows for easy evaluation of the patency of contralateral processus vaginalis, although the clinical significance of and need for repair of an identified defect is unclear. Laparoscopic surgery for pediatric inguinal hernias offers some advantages over open repair with most outcomes being equal. It should be considered a safe alternative to open repair to children and their caregivers.

Measurement of Basal and Forskolin-stimulated Lipolysis in Inguinal Adipose Fat Pads.

PubMed

Baskaran, Padmamalini; Thyagarajan, Baskaran

2017-07-21

Lipolysis is a process by which the lipid stored as triglycerides in adipose tissues are hydrolyzed into glycerol and fatty acids. This article describes the method for the measurement of basal and forskolin (FSK)-stimulated lipolysis in the inguinal fat pads isolated from wild type mice fed either normal chow diet (NCD), high fat diet (HFD) or a high fat diet containing 0.01% of capsaicin (CAP; transient receptor potential vanilloid subfamily 1 (TRPV1) agonist) for 32 weeks. The method described here for performing ex vivo lipolysis is adopted from Schweiger et al. 1 We present a detailed protocol for measuring glycerol levels by UV-Visible (UV/VIS) spectrophotometry. The method described here can be used to successfully isolate inguinal fat pads for lipolysis measurements to obtain consistent results. The protocol described for inguinal fat pads can readily be extended to measure lipolysis in other tissues.

[Incidence and influencing factors of distal external iliac lymph node metastasis in early cervical cancer].

PubMed

Yin, Yueju; Sheng, Xiugui; Li, Xinglan; Li, Dapeng; Han, Xiaoyun; Zhang, Xiaoling; Zhang, Tingting

2014-06-01

The distal external iliac lymph nodes are located along the external iliac artery between the deep circumflex iliac vein and the inguinal canal. Our study aimed to investigate the incidence of metastasis in distal external iliac lymph nodes and its association with clinicopathological factors in patients with early stage cervical cancer, and to determine the role of distal external iliac lymph nodes dissection in the surgery. Five hundred and twenty-four patients with early stage cervical cancer underwent radical hysterectomy and bilateral pelvic lymphadenectomy in the Shandong Province Cancer Hospital between June 1995 and December 2011, and their clinicopathological features were analyzed retrospectively. Of the 524 patients, 124 (23.7%) had pelvic lymph node metastasis. The metastasis rates were 16.2% (85 of 524 patients) in the obturator lymph nodes, 12.2% (64 of 524 patients) in the internal and external iliac lymph nodes, 2.9% (15 of 524 patients) in the common iliac lymph nodes, 2.1% (11 of 524 patients) in the distal external iliac lymph nodes, and 1.7% (9 of 524 patients) in the para-aortic nodes. The incidence of isolated positive distal external iliac lymph nodes was 0.2%. Univariate analysis showed that lymphovascular space invasion, pelvic lymph node metastases (excluding distal external iliac lymph nodes) were significantly associated with distal external iliac lymph node metastasis (P < 0.05). Logistic regression analysis showed that pelvic lymph node metastasis (excluding distal external iliac lymph nodes) was the independent risk factor for metastasis to distal external iliac lymph nodes. In early stage cervical cancer, distal external iliac lymph node metastasis is rare, especially in cases with stage IA or without pelvic lymph node metastasis. Less extensive pelvic lymphadenectomy may be considered in these patients in order to reduce operative complications and improve patients' quality of life. The deep circumflex iliac vein may be an appropriate landmark for the caudal limit of external iliac lymphadenectomy. However, if pelvic lymph node metastasis (excluding distal external iliac lymph nodes) is found by intraoperative rapid pathological diagnosis, systematic pelvic lymphadenectomy including removal of the distal external iliac lymph nodes should be performed in order to reduce the risk of distant metastasis.

Irreducible inguinal hernia in children: how serious is it?

PubMed

Houben, Christoph Heinrich; Chan, Kin Wai Edwin; Mou, Jennifer Wai Cheung; Tam, Yuk Huk; Lee, Kim Hung

2015-07-01

We evaluated the experience with irreducible inguinal hernias at our institution. We reviewed patients with an inguinal hernia operation at our institution between 1st January 2004 and 31st December 2013. Individuals with a failed manual reduction of an incarcerated hernia under sedation by the attending surgeon were included into the study group as irreducible hernia. Overall 2184 individuals (426 females) had an inguinal herniotomy with the following distribution: right 1116 (51.1%), left 795 (36.4%) and bilateral 273 (12.5%) cases. A laparoscopic herniotomy was done in 1882 (86.4%). 34 patients (3 females) - just 1.6% of the total - presented at a median age (corrected for gestation) of 12 months (range 2 weeks to 16 years) with an irreducible hernia, of which 24 individuals (70%) were right sided. A laparoscopic approach was attempted in 21 (62%), two required a conversion. The open technique was chosen in 13 (38%) individuals. The content of the hernia sac was distal small bowel in 21 (62%), omentum in four (12%) and an ovary in three (9%) cases. Four patients (12%) required laparoscopic assisted bowel resection and two partial omentectomy (6%). Two gonads (6%) were lost: one intraoperative necrotic ovary and one testis atrophied over time. There was no recurrent hernia. Irreducible inguinal hernias constitute 1.6% of the workload on inguinal hernia repair. The hernia sac contains in males most frequently small bowel and in females exclusively a prolapsed ovary. Significant comorbidity is present in 18%. Laparoscopic and open techniques complement each other in addressing the issue. Copyright © 2015 Elsevier Inc. All rights reserved.

Long-term outcome for open preperitoneal mesh repair of recurrent inguinal hernia.

PubMed

Yang, Bin; Jiang, Zhi-peng; Li, Ying-ru; Zong, Zhen; Chen, Shuang

2015-07-01

Recurrent inguinal hernia represents a major challenge for surgeons with high risks of re-recurrence and complications, especially when an anterior approach is adopted. The aim of this study was to evaluate the long-term results of the open preperitoneal mesh repair for recurrent inguinal hernia. We performed a prospective clinical study of 107 consecutive patients having recurrent inguinal hernias between April 2006 and November 2010. All patients were operated on using open preperitoneal mesh repair. The demographics, perioperative variables, complications and recurrences were evaluated with all patients. There were no major intraoperative complications. The average operative time was 42.1 min (range 28-83 min) for unilateral and 62.7 min (range 38-106 min) for bilateral hernias. The mean postoperative hospital stay was 1.6 days (range 1-9 days). The overall complication rate was 8.4%. There were two superficial wound infections, two groin seroma and three urinary retention. The mean follow-up time was 42.3 months (range 28-73 months), three patients developed hernia recurrence. No testicular, chronic pain or mesh-related complications were noted in these series. Open posterior preperitoneal mesh repair offers a viable option for recurrent inguinal hernias and achieves equally effective results to laparoscopic approaches with acceptable complication and recurrence rates. It is safer and easier to learn than laparoscopic repair and has become the preferred approach for treatment of the majority of recurrent inguinal hernias at our institution, especially useful for complex multirecurrent hernias and patients with cardiopulmonary insufficiency. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia: the first 1,000 patients.

PubMed

Lange, J F M; Lange, M M; Voropai, D A; van Tilburg, M W A; Pierie, J P E N; Ploeg, R J; Akkersdijk, W L

2014-08-01

After the introduction of mesh in inguinal hernia repair, the focus to improve surgical technique has changed from recurrence to chronic postoperative inguinal pain. At present, the most common surgical techniques are the Lichtenstein hernioplasty and total extraperitoneal procedure. Both techniques have their own specific disadvantages, with regard to potential nerve damage and the necessity of general anesthesia, respectively. The goal of this study was to evaluate the results of a new technique in which the inguinal nerves are not at risk, and in which general anesthesia is not needed: trans rectus sheath extraperitoneal procedure (TREPP). Between 2006 and 2010, a total of 1,000 patients were treated for inguinal hernia with TREPP. A questionnaire concerning pain, sensibility changes, patient satisfaction, and recurrence was sent to all patients. The questionnaire was completed by 932 patients. Almost 90% of patients had not experienced any pain since the surgical procedure; 8% of patients reported experiencing some pain, but less than preoperatively; and 2% of patients reported an increase in pain postoperatively. Recurrence occurred in 1 and 3% were unsure about this. Reduced sensibility of the scar, scrotum, and upper leg was reported by 12.4, 1.4, and 1.5%, respectively. Overall, 97.4% of patients were satisfied with the results of the surgical procedure. The time period in which TREPP was performed was not associated with any of the outcome measures. TREPP has proven to be a feasible new technique for inguinal hernia repair, with excellent results, justifying a randomized controlled trial in which TREPP should be compared with standard techniques.

Correction of craniosynostosis using modified spring-assisted surgery.

PubMed

Shen, Weimin; Cui, Jie; Chen, Jianbin; Zou, Jijun; Ji, Yi; Chen, Haini; Xiongzheng, Mu

2015-03-01

The use of springs in craniofacial surgery was originated at Sahlgrenska University Hospital in 1997 as a way of remodeling the cranial vault postoperatively. After a decade of development, spring technology has been improved to a greater extent. However, there still exist some problems, such as the poor consistency of steel wire stretches, the wrong position of steel wire, the problem of increasing the elasticity of springs, and so on. We have designed a spring device for external uses. This device is composed of 3 parts. The first part is the outside of the spring ring. This ring is the same as the internal spring, only a little bigger. The second part is a small U-shaped hook, which is made of titanium plates and linked to the skull portion. The U-shaped hook is approximately 1 cm long and 1 cm wide. The hang is approximately 1 cm long and 0.6 cm wide. The U-shaped level length is 1 cm, but the level width should be equal to or bigger than the thickness of the skull. The third part is a steel wire, which is placed at 1 end of hook. We first conduct a strip craniotomy, then put 2 hooks at the bone ends and, after that, fix hooks on the skull. Finally, we pull the steel wire of the hook end out of the scalp, connect it with the external spring, and draw out the external spring. We performed 24 craniofacial spring placement procedures for 12 patients with craniosynostosis. We used 6 springs for 3 patients who had anterior plagiocephaly, 12 springs for 6 patients who had scaphocephaly, and 3 springs for another patient who had metopic synostosis and holoprosencephaly. We also used 3 springs for 2 patients who had metopic synostosis. The 12 patients have not required further surgeries so far, and there were no major complications. Spring dislodgement had not caused any complication in early cases. We could easily change the position of the spring rings from outside the scalp, regularly correct the elasticity of the spring rings, and replace spring rings to increase the traction. The head shapes of the 12 children have been improved significantly to use external spring rings. This therapeutic modality in craniofacial surgery has allowed minimization of the extent of surgery without compromising clinical outcomes. The authors have shown that the use of external spring techniques is safe and, in selected situations, offer significant advantages over other methods of treatment. It makes up for a number of shortcomings of internal springs.

Medial Versus Traditional Approach to US-guided TAP Blocks for Open Inguinal Hernia Repair

ClinicalTrials.gov

2012-04-30

Abdominal Muscles/Ultrasonography; Adult; Ambulatory Surgical Procedures; Anesthetics, Local/Administration & Dosage; Ropivacaine/Administration & Dosage; Ropivacaine/Analogs & Derivatives; Hernia, Inguinal/Surgery; Humans; Nerve Block/Methods; Pain Measurement/Methods; Pain, Postoperative/Prevention & Control; Ultrasonography, Interventional

Semiconductor ring lasers subject to both on-chip filtered optical feedback and external conventional optical feedback

NASA Astrophysics Data System (ADS)

Khoder, Mulham; Van der Sande, Guy; Danckaert, Jan; Verschaffelt, Guy

2016-05-01

It is well known that the performance of semiconductor lasers is very sensitive to external optical feedback. This feedback can lead to changes in lasing characteristics and a variety of dynamical effects including chaos and coherence collapse. One way to avoid this external feedback is by using optical isolation, but these isolators and their packaging will increase the cost of the total system. Semiconductor ring lasers nowadays are promising sources in photonic integrated circuits because they do not require cleaved facets or mirrors to form a laser cavity. Recently, some of us proposed to combine semiconductor ring lasers with on chip filtered optical feedback to achieve tunable lasers. The feedback is realized by employing two arrayed waveguide gratings to split/recombine light into different wavelength channels. Semiconductor optical amplifier gates are used to control the feedback strength. In this work, we investigate how such lasers with filtered feedback are influenced by an external conventional optical feedback. The experimental results show intensity fluctuations in the time traces in both the clockwise and counterclockwise directions due to the conventional feedback. We quantify the strength of the conventional feedback induced dynamics be extracting the standard deviation of the intensity fluctuations in the time traces. By using filtered feedback, we can shift the onset of the conventional feedback induced dynamics to larger values of the feedback rate [ Khoder et al, IEEE Photon. Technol. Lett. DOI: 10.1109/LPT.2016.2522184]. The on-chip filtered optical feedback thus makes the semiconductor ring laser less senstive to the effect of (long) conventional optical feedback. We think these conclusions can be extended to other types of lasers.

Incarcerated Pediatric Hernias.

PubMed

Abdulhai, Sophia A; Glenn, Ian C; Ponsky, Todd A

2017-02-01

Indirect inguinal hernias are the most commonly incarcerated hernias in children, with a higher incidence in low birth weight and premature infants. Contralateral groin exploration to evaluate for a patent processus vaginalis or subclinical hernia is controversial, given that most never progress to clinical hernias. Most indirect inguinal hernias can be reduced nonoperatively. It is recommended to repair them in a timely fashion, even in premature infants. Laparoscopic repair of incarcerated inguinal hernia repair is considered a safe and effective alternative to conventional open herniorrhaphy. Other incarcerated pediatric hernias are extremely rare and may be managed effectively with laparoscopy. Copyright © 2016 Elsevier Inc. All rights reserved.

Laparoscopic repair of inguinal hernias.

PubMed

Carter, Jonathan; Duh, Quan-Yang

2011-07-01

For patients with recurrent inguinal hernia, or bilateral inguinal hernia, or for women, laparoscopic repair offers significant advantages over open techniques with regard to recurrence risk, pain, and recovery. For unilateral first-time hernias, either laparoscopic or open repair with mesh can offer excellent results. The major drawback of laparoscopy is that the technique requires a significant number of cases to master. For surgeons in group practice, it makes sense to have one surgeon in the group perform laparoscopic repairs so that experience can be concentrated. For others, the best technique remains the approach that the surgeon is most comfortable and experienced performing.

Embryologic and anatomic basis of inguinal herniorrhaphy.

PubMed

Skandalakis, J E; Colborn, G L; Androulakis, J A; Skandalakis, L J; Pemberton, L B

1993-08-01

The embryology and surgical anatomy of the inguinal area is presented with emphasis on embryologic and anatomic entities related to surgery. We have presented the factors, such as patent processus vaginalis and defective posterior wall of the inguinal canal, that may be responsible for the genesis of congenital inguinofemoral herniation. These, together with impaired collagen synthesis and trauma, are responsible for the formation of the acquired inguinofemoral hernia. Still, we do not have all the answers for an ideal repair. Despite the latest successes in repair, we, to paraphrase Ritsos, are awaiting the triumphant return of Theseus.

Simultaneous open preperitoneal repair of inguinal hernia with open prostatectomy for benign prostate hyperplasia.

PubMed

Johnson, O Kenneth

2015-01-01

Where surgical resources are slim, patients may suffer the obstructive symptoms of benign prostate hyperplasia until they present with frank urinary retention and they may have unattended inguinal hernia. The best strategy to take care of patients who have both problems at once has remained elusive. We report a small case series of 10 patients in whom open preperitoneal inguinal hernia repair was done together with suprapubic prostatectomy over a 10-year period in the district hospital. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Spermatic cord dedifferentiated liposarcoma presenting as a recurrent inguinal hernia.

PubMed

Crigger, Chad; Barnard, John; Zaslau, Stanley; Vos, Jeffrey A

2016-12-01

Paratesticular sarcomas are a rare entity and provide a unique clinical challenge due to their slow growing, often painless natural course. Adding to this challenge is the complex anatomy of the scrotum that allows these masses to mimic other conditions, including inguinal hernia, cysts, or fluid collections. We report such a case and our approach to an 83-year-old male with dedifferentiated liposarcoma of the spermatic cord with a history of inguinal hernia. In doing so, we highlight the need for thorough evaluation of scrotal masses and the management of these rare, though well-described, tumors.

Circumcision-incision orchidopexy: A novel technique for palpable, low inguinal undescended testis

PubMed Central

Silangcruz, Jan Michael A.; Gomez, Odina; Dy, Jun S.; Morales, Marcelino L.

2017-01-01

Given that both orchidopexy and circumcision are commonly done in a single operative setting, we adopted a technique of combined orchidopexy and circumcision using a single circumcision incision. We applied this new technique to boys with palpable, low inguinal cryptorchidism. Here we describe a case series of 7 boys who underwent concurrent orchidopexy via the circumcision site. We present this novel technique and discuss our preliminary outcomes, including the anatomic basis and feasibility. The technique appears to be an alternative for concurrent circumcision and cryptorchid cases with palpable, low inguinal testes. PMID:29124248

Human Papilloma Virus: Prevalence, distribution and predictive value to lymphatic metastasis in penile carcinoma.

PubMed

Fonseca, Aluizio Gonçalves da; Soares, Fernando Augusto; Burbano, Rommel Rodriguez; Silvestre, Rodrigo Vellasco; Pinto, Luis Otávio Amaral Duarte

2013-01-01

To evaluate the prevalence, distribution and association of HPV with histological pattern of worse prognosis of penile cancer, in order to evaluate its predictive value of inguinal metastasis, as well as evaluation of other previous reported prognostic factors. Tumor samples of 82 patients with penile carcinoma were tested in order to establish the prevalence and distribution of genotypic HPV using PCR. HPV status was correlated to histopathological factors and the presence of inguinal mestastasis. The influence of several histological characteristics was also correlated to inguinal disease-free survival. Follow-up varied from 1 to 71 months (median 22 months). HPV DNA was identified in 60.9% of sample, with higher prevalence of types 11 and 6 (64% and 32%, respectively). There was no significant correlation of the histological characteristics of worse prognosis of penile cancer with HPV status. Inguinal disease-free survival in 5 years did also not show HPV status influence (p = 0.45). The only independent pathologic factors of inguinal metastasis were: stage T ≥ T1b-T4 (p = 0.02), lymphovascular invasion (p = 0.04) and infiltrative invasion (p = 0.03). HPV status and distribution had shown no correlation with worse prognosis of histological aspects, or predictive value for lymphatic metastasis in penile carcinoma.

Postoperative nausea and vomiting (PONV) in outpatient repair of inguinal hernia.

PubMed

Palumbo, Piergaspare; Usai, Sofia; Amatucci, Chiara; Pulli, Valentina Taurisano; Illuminati, Giulio; Vietri, Francesco; Tellan, Guglielmo

2018-01-01

Nausea and vomiting are among the most frequent complications following anesthesia and surgery. Due to anesthesia seems to be primarily responsible for post operative nausea and vomiting (PONV) in Day Surgery facilities, the aim of the study is to evaluate how different methods of anesthesia could modify the onset of postoperative nausea and vomiting in a population of patients undergoing inguinal hernia repair. Ninehundredten patients, aged between 18 and 87 years, underwent open inguinal hernia repair. The PONV risk has been assessed according to Apfel Score. Local anesthetic infiltration, performed by the surgeon in any cases, has been supported by and analgo-sedation with Remifentanil in 740 patients; Fentanyl was used in 96 cases and the last 74 underwent deep sedation with Propofol . Among the 910 patients who underwent inguinal hernia repair, PONV occurred in 68 patients (7.5%). Among patients presenting PONV, 29 received Remifentanil, whereas 39 received Fentanyl. In the group of patients receiving Propofol, no one presented PONV. This difference is statistically significant (p < .01). Moreover, only 50 patients of the total sample received antiemetic prophylaxis, and amongst these, PONV occurred in 3 subjects. Compared to Remifentanil, Fentanyl has a major influence in causing PONV. Nonetheless, an appropriate antiemetic prophylaxis can significantly reduce this undesirable complication. Key words: Day Surgery, Fentanyl, Inguinal, Hernia repair, Nausea, Vomiting.

Electrosurgical operation of vulvar carcinoma with postoperative irradiation of inguinal lymph nodes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kucera, H.; Weghaupt, K.

1988-02-01

The results of treatment in the department of 607 patients with invasive squamous cell carcinoma of the vulva between 1952 and 1980 is described and analyzed. The absolute 5-year cure rate in these patients was 60.3%. Particular attention was given to lymph node status (TNM system) in the analysis of the last 141 patients treated. The absolute 5-year survival rate was 67% for the N0-N1 patients and 43% for the N2-N3 patients. Patients were treated uniformly by means of electrosurgical operation and postactinic irradiation of the inguinal lymph nodes. Operative lymphadenectomy was performed only in 5% of cases when themore » diameter of inguinal lymph nodes was greater than 2 cm. This simple surgical technique, in combination with irradiation of inguinal lymph nodes, gives excellent results and avoids the complications associated with inguinofemoral lymphadenectomy. Owing to its combination of electrosurgical operation of the vulva and irradiation of the inguinal regions as a standard procedure, the treatment involves extremely low strain on the patient and is almost free of complications. This seems to be particularly important as the results of our treatment are not less satisfactory than those of more aggressive procedures.« less

Use of a dynamic self-regulating prosthesis (P.A.D.) in inguinal hernia repair: our first experience in 214 patients.

PubMed

Ferranti, Fabrizio; Marzano, Marco; Quintiliani, Alberto

2009-01-01

Numerous techniques exist for inguinal hernia treatment. Currently, open mesh tension-free repair is regarded as the repair method of choice. In particular Lichtenstein repair is the most common procedure performed, although several articles have reported long-lasting postoperative pain and a higher recurrence rate than originally reported. This study describes the P.A.D. (Protesi Autoregolantesi Dinamica) prosthesis implantation technique and reports postoperative complications and long-term results. From June 2002 to May 2005 a total of 214 patients underwent P.A.D. prosthesis inguinal repair. All patients were male, with a mean age of 51 years. All hernias were treated via an open inguinal approach using the original technique described by Valenti, with slight modifications. A total of 171'patients (80%) were available to follow-up 3 years after surgery. Early postoperative complications occurred in 14 patients (8.4%). Four patients (12.1%), who had undergone regional anaesthesia, developed urinary retention. Wound infection occurred in 3 patients (1.4%). There were two direct recurrences (0.93%) whereas chronic postoperative inguinal pain was reported in 4.2% of patients. Within the limitations of a short follow-up, our results show that the P.A.D. prosthesis procedure is a reliable technique with a low recurrence rate and low postoperative morbidity.

First report of tomato spotted wilt virus causing potato tuber necrosis in Texas

USDA-ARS?s Scientific Manuscript database

In the summer of 2008, potato tubers (cv FL1867, FL2053, and FL1922) from commercial fields near Dalhart, Texas were observed with distinct external erumpent rings and severe internal discolorations including blotches, spots, and dry, cork-like tissue. The presence of rings suggested the possible i...

Adjustable expandable cryogenic piston and ring

DOEpatents

Mazur, Peter O.; Pallaver, Carl B.

1980-01-01

The operation of a reciprocating expansion engine for cryogenic refrigeration is improved by changing the pistons and rings so that the piston can be operated from outside the engine to vary the groove in which the piston ring is located. This causes the ring, which is of a flexible material, to be squeezed so that its contact with the wall is subject to external control. This control may be made manually or it may be made automatically in response to instruments that sense the amount of blow-by of the cryogenic fluid and adjust for an optimum blow-by.

Strain measurement in the wavy-ply region of an externally pressurized cross-ply composite ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gascoigne, H.E.; Abdallah, M.G.

1996-07-01

Ply-level strains are determined in the cross-section of an externally pressurized cross-ply (3:1 circumferential to axial fiber ratio) graphite-epoxy ring containing an isolated circumferential wavy region. A special test fixture was used which permitted measuring orthogonal displacement components in the wavy area using moire interferometry as the pressure was increased. Strain components were determined at selected locations in the wavy area up to approximately90% of failure pressure. The study shows: (1) large interlaminar shear strains, which are non-existent in the perfect ring, are present near the wave inflection points; (2) the wavy plies generate increased interlaminar normal compressive strains inmore » both circumferential and axial plies along a radial line coinciding with maximum wave amplitude; and (3) nonlinear strain response begins at approximately 60% of failure pressure.« less

Left-sided incarcerated Amyand's hernia with cecum and terminal ileum: a case report.

PubMed

Bekele, Kebebe; Markos, Desalegn

2017-01-01

Amyand's hernia, which is the presence of a normal or pathological appendix as a part of an inguinal hernia, is a rare clinical entity. We are reporting a very rare case of left-sided incarcerated Amyand's hernia with cecum and terminal ileum involvement. A 4-year-old male child with left inguinal swelling of 2-year duration presented to Goba Referral Hospital. Two days before the patient visited our hospital, the swelling had become irreducible and caused severe groin pain. He had abdominal cramps, bilious vomiting, and mild abdominal distention, but passed feces. With the diagnosis of left-sided incarcerated inguinal hernia, the patient was investigated and prepared for surgical management. During the operative procedure, we identified the presence of appendix, cecum, and terminal ileum in the scrotum as the herniated component. After the sack was dissected, since there was also appendicitis, an appendectomy was performed. Then, high ligation of sack was done after cecum and ileum were reduced. After 3 uneventful postoperative days in the hospital, the patient was discharged. The patient was followed-up for 6 months, and he did not develop any complications. Left-sided incarcerated Amyand's hernia with cecum and terminal ileum involvement is a rare clinical entity. Even though it is not common, appendicitis is one of the comorbidities that can be seen in patients with left-sided incarcerated Amyand's hernia with cecum and terminal ileum. Surgeons should have a high index of clinical suspicion and be aware of the potential involvement of appendix, cecum, and ileum as part of an incarcerated hernia during surgery, even in the left inguinal region. In this case, left-sided incarcerated inguinal hernia which involved inflamed appendix, cecum, and terminal ileum was successfully managed using an inguinal approach.

Inguinodynia in patients submitted to conventional inguinal hernioplasty.

PubMed

Dias, Bruno Garcia; Santos, Marcelo Protásio Dos; Chaves, Ana Barbara DE Jesus; Willis, Mariana; Gomes, Marcio Couto; Andrade, Fernandes Tavares; Melo, Valdinaldo Aragão DE; Santos, Paulo Vicente Dos

2017-01-01

to evaluate the incidence of chronic pain and its impact on the quality of life of patients submitted to inguinal hernioplasty using the Lichtenstein technique. this was a descriptive, cross-sectional study of patients operated under spinal anesthesia from February 2013 to February 2015 and who had already completed six postoperative months. We questioned patients about the presence of chronic inguinal pain and, if confirmed, invited them to a consultation in which we assessed the pain and its impact on quality of life. out of 158 patients submitted to the procedure, we identified 7.6% as having inguinodynia. Of these, there was an impact on the quality of life in 25%. the incidence of inguinodynia after hernioplasty with repercussion in quality of life was similar to the one of found in the world literature. avaliar a incidência de dor crônica e o seu impacto na qualidade de vida de pacientes submetidos à hernioplastia inguinal pela técnica de Lichtenstein. trata-se de estudo transversal descritivo, de pacientes operados de hérnia inguinal pela técnica de Lichtenstein sob anestesia raquidiana, no período de fevereiro de 2013 a fevereiro de 2015, e que já haviam completado seis meses de pós-operatório. Os pacientes foram questionados sobre a presença de dor inguinal crônica e, caso confirmada, convidados a uma consulta na qual foi feita análise da qualidade da dor e seu impacto na qualidade de vida. do total de 158 pacientes submetidos ao procedimento, 7,6% foram identificados como portadores de inguinodinia. Destes, houve impacto na qualidade de vida em 25%. observou-se incidência de inguinodinia pós-hernioplastia com repercussão na qualidade de vida semelhante à literatura mundial.

Prosthetic mesh hernioplasty during laparoscopic radical prostatectomy.

PubMed

Teber, Dogu; Erdogru, Tibet; Zukosky, Derek; Frede, Thomas; Rassweiler, Jens

2005-06-01

To evaluate the role of simultaneous laparoscopic mesh prosthetic hernioplasty during laparoscopic radical prostatectomy (LRP), because 5% to 10% of candidates for radical prostatectomy present with a detectable inguinal hernia at their preoperative physical examination. Moreover, data have suggested a greater incidence of inguinal hernia after open radical prostatectomy. During 1035 LRP procedures, 50 laparoscopic mesh prosthetic hernioplasty procedures were performed in 37 patients (3.6%) for 13 bilateral and 24 unilateral inguinal hernias. We compared the outcome of LRP with simultaneous laparoscopic inguinal hernioplasty (group 1) with that of 37 match-paired patients treated by LRP alone (group 2). Both groups were matched according to age, prostate-specific antigen level, prostate volume, pathologic stage, and Gleason score. Perioperative parameters (ie, operative time, analgesic requirements) and postoperative results were analyzed. The patient age was 64.1 +/- 6.4 years versus 62.8 +/- 4.9 years old and had a body mass of 26.5 +/- 3.0 versus 27.4 +/- 3.2 kg/m2 in groups 1 and 2 (with and without laparoscopic hernioplasty), respectively. The mean operating time (221.9 versus 191.2 minutes, P = 0.011) and the total amount of narcotic analgesic requirements (26.8 mg versus 17.5 mg, P = 0.026) was significantly increased in the patients who underwent simultaneous laparoscopic inguinal hernia mesh repair. No statistically significant difference was found in the complication rate (4% versus 2%), median catheter time (7 days), and positive surgical margins (21.8%). Simultaneous repair of inguinal hernia during LRP using prosthetic mesh is feasible without adverse effects on surgical and functional parameters. Neither the transperitoneal nor extraperitoneal approach is associated with an increase in complications or morbidity. However, an extraperitoneal access allows an easier repair without the refixation of the peritoneum.

Orchiectomy as a result of ischemic orchitis after laparoscopic inguinal hernia repair: case report of a rare complication.

PubMed

Moore, John B; Hasenboehler, Erik A

2007-11-07

Ischemic orchitis is an established complication after open inguinal hernia repair, but ischemic orchitis resulting in orchiectomy after the laparoscopic approach has not been reported. The patient was a thirty-three year-old man who presented with bilateral direct inguinal hernias, right larger than left. He was a thin, muscular male with a narrow pelvis who underwent bilateral extraperitoneal mesh laparoscopic inguinal hernia repair. The case was complicated by pneumoperitoneum which limited the visibility of the pelvic anatomy; however, the mesh was successfully deployed bilaterally. Cautery was used to resect the direct sac on the right. The patient was discharged the same day and doing well with minimal pain and swelling until the fourth day after surgery. That night he presented with sudden-onset pain and swelling of his right testicle and denied both trauma to the area and any sexual activity. Ultrasound of the testicle revealed no blood flow to the testicle which required exploration and subsequent orchiectomy. Ischemic orchitis typically presents 2-3 days after inguinal hernia surgery and can progress to infarction. This ischemic injury is likely due to thrombosis of the venous plexus, rather than iatrogenic arterial injury or inappropriate closure of the inguinal canal. Ultrasound/duplex scanning of the postoperative acute scrotum can help differentiate ischemic orchitis from infarction. Unfortunately, testicular torsion cannot be ruled out and scrotal exploration may be necessary. Although ischemic orchitis, atrophy, and orhiectomy are uncommon complications, all patients should be warned of these potential complications and operative consent should include these risks irrespective of the type of hernia or the surgical approach.

Laparoendoscopic single-site extraperitoneal inguinal hernia repair: initial experience in 10 patients.

PubMed

Do, Minh; Liatsikos, Evangelos; Beatty, John; Haefner, Tim; Dunn, Ian; Kallidonis, Panagiotis; Stolzenburg, Jens-Uwe

2011-06-01

Recent technical advances and a trend toward laparoscopic single incision surgery have led us to explore the feasibility of laparoendoscopic single-site (LESS) hernia repair. We present our technique and initial experience with LESS extraperitoneal inguinal hernia repair in 10 consecutive men with unilateral inguinal hernias. Age range was 43.7 (28-64) years. Mean body mass index was 28 (range 24-30). Six were left inguinal hernias. There were six indirect and four direct hernias. Three patients had undergone previous open appendectomy. Incarcerated or bilateral hernias were excluded from our initial series. All cases were performed by three surgeons who were experienced in conventional totally extraperitoneal laparoscopic hernia repair as well as experienced in LESS. A literature review of current single-port inguinal hernia repair data is also presented. The mean operative time was 53 minutes (range 45-65  min). The average length of skin incision was 2.8  cm (range 2.3-3.2  cm). No drain was necessary in any of the patients, while no recordable bleeding was observed. There were no intraoperative or immediate postoperative complications. Hospitalization period was 2 days for all patients. After a limited follow-up of 1 month, there have been no recurrences and no complaints of testicular pain. The results of the current series compare favorably with those found in a literature review. LESS extraperitoneal inguinal hernia repair is both feasible and safe, although more technically demanding than its conventional laparoscopic counterpart. Although the cosmetic result with the former approach may prove superior, there are standing questions regarding the complications and long-term outcome. Randomized and if possible blinded trials that compare conventional and single-incision laparoscopic hernia repair may help to distinguish the most advantageous technique.

A systematic review of the association between a single strenuous event and the development of an inguinal hernia: A medicolegal grey area.

PubMed

Patterson, Timothy; Currie, Peter; Spence, Robert; McNally, Sinead; Spence, Gary

2018-03-10

Inguinal hernia is a common surgical presentation. Evidence for its causation regarding occupational and recreational physical exposures is limited. The aim of this study is to conduct a systematic review objectively evaluating the evidence for a causal link between a single strenuous event and the development of an inguinal hernia. A systematic review was carried out in accordance with PRISMA guidelines. PubMed, Ovid Embase, SCOPUS, and Cochrane Library were searched. In addition, the ISRCTN register, ClinicalTrials.gov, ICTR Platform, and EU Clinical Trials Register were searched. Identified publications were collated and both reviewers independently reviewed their contents. 5508 records were identified, resulting in 5 studies being selected. These 5 studies were all case series. Of 957 patients identified, 1003 hernias were described, of which 983 were inguinal hernias which 255 (26%) were attributed by patients to a single strenuous event. Only two of these studies applied Smith's Criteria (causation of a hernia from a single strenuous event): officially reported, severe pain at the time of the event, no prior history of inguinal hernia, and the diagnosis was made by a doctor within 30 days (preferably 3 days). Only 2 of 54 patients (4%) met all four criteria and so could be considered as having an inguinal hernia relating to a single strenuous event. Many patients associate hernias to a single episode, however upon application of more stringent criteria such as Smith's, a much smaller proportion are deemed to be actually attributable to a single strenuous event. Copyright © 2018 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Cervical external immobilization devices: evaluation of magnetic resonance imaging issues at 3.0 Tesla.

PubMed

Diaz, Francis L; Tweardy, Lisa; Shellock, Frank G

2010-02-15

Laboratory investigation, ex vivo. Currently, no studies have addressed the magnetic resonance imaging (MRI) issues for cervical external immobilization devices at 3-Tesla. Under certain conditions significant heating may occur, resulting in patient burns. Furthermore, artifacts can be substantial and prevent the diagnostic use of MRI. Therefore, the objective of this investigation was to evaluate MRI issues for 4 different cervical external immobilization devices at 3-Tesla. Excessive heating and substantial artifacts are 2 potential complications associated with performing MRI at 3-Tesla in patients with cervical external immobilization devices. Using ex vivo testing techniques, MRI-related heating and artifacts were evaluated for 4 different cervical devices during MRI at 3-Tesla. Four cervical external immobilization devices (Generation 80, Resolve Ring and Superstructure, Resolve Ring and Jerome Vest/Jerome Superstructure, and the V1 Halo System; Ossur Americas, Aliso Viejo, CA) underwent MRI testing at 3-Tesla. All devices were made from nonmetallic or nonmagnetic materials. Heating was determined using a gelled-saline-filled skull phantom with fluoroptic thermometry probes attached to the skull pins. MRI was performed at 3-Tesla, using a high level of RF energy. Artifacts were assessed at 3-Tesla, using standard cervical imaging techniques. The Generation 80 and V1 Halo devices exhibited substantial temperature rises (11.6 degrees C and 8.5 degrees C, respectively), with "sparking" evident for the Generation 80 during the MRI procedure. Artifacts were problematic for these devices, as well. By comparison, the 2 Resolve Ring-based cervical external immobilization devices showed little or no heating (< or = 0.6 degrees C) and the artifacts were acceptable for diagnostic MRI examinations. The low degree of heating and minor artifacts associated with the Resolve-based cervical external immobilization devices indicated that these products are safe for patients undergoing MRI at 3-Tesla.

Late complication of open inguinal hernia repair: small bowel obstruction caused by intraperitoneal mesh migration.

PubMed

Ferrone, Roberto; Scarone, Pier Carlo; Natalini, Gianni

2003-09-01

We describe a case of small bowel obstruction due to prosthetic mesh migration. A 67-year-old male, who had undergone prosthetic repair of inguinal hernia 3 years before, was admitted for a mechanical small bowel obstruction. Laparotomy revealed the penultimate ileal loop choked by an adhesion drawing it towards a polypropylene mesh, firmly attached to the parietal peritoneum of the inguinal region. The intestinal loop was released; the mesh was embedded deep with continuous whip suture after folding the parietal peritoneum. The patient was dismissed on the 11th postoperative day surgically healed. The "tension-free" technique is undoubtedly the gold standard for hernia repair. However, it is not free of complications, mostly due to technical errors, of which the surgeon must be aware, both when he is responsible for correcting defects in the wall, as well as when he has to face an occlusion in a patient who has undergone plastic surgery for inguinal hernia.

Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report.

PubMed

St-Onge, Eric; MacIntyre, Ian G; Galea, Anthony M

2015-12-01

To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy.

Reduction en masse of inguinal hernia: a review of a rare and potential fatal complication following reduction of inguinal hernia.

PubMed

Yatawatta, Ashanga

2017-08-07

Reduction en masse is reduction of a hernial sac into the pre-peritoneal space with a loop of bowel remaining incarcerated at the neck of the sac, leading to early strangulation. This is a rare complication, usually encountered with inguinal hernias, with a false reassurance to the patient and the treating physician that complete reduction has been achieved. Unless early intervention is carried out, this condition will typically present with worsening pain and absence of an appreciable hernia bulge at the groin, and intestinal necrosis may be encountered on exploration. The outcome will depend on the severity of peritonitis/sepsis, and mortality remains high for late presentations. A case of early presentation of reduction en masse of an inguinal hernia is reported with a review of the existing literature. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Contralateral metachronous hernia following negative laparoscopic evaluation for contralateral patent processus vaginalis: a meta-analysis.

PubMed

Zhong, Hongji; Wang, Furan

2014-02-01

To conduct a meta-analysis of contralateral metachronous inguinal hernia (CMIH) that originated from negative laparoscopic evaluation for contralateral patent processus vaginalis (CPPV) in children who presented with a unilateral inguinal hernia and to determine the incidence of and factors associated with such a CMIH. A PubMed search was performed for all studies concerning laparoscopic repair or evaluation of inguinal hernia in children. The search strategy was as follows: (laparoscop* OR coelioscop* OR peritoneoscop* OR laparoendoscop* OR minilaparoscop*) AND ("inguinal hernia" OR "metachronous hernia") AND child*. Inclusion criteria included unilateral inguinal hernia in children, negative laparoscopic evaluation of CPPV, without history of contralateral inguinal surgery previously, and clearly reporting CMIH development or not. Editorials, letters, review articles, case reports, animal studies, and duplicate patient series were excluded. Twenty-three studies comprising 6091 children with negative CPPV fulfilled the inclusion criteria and were included in the final analysis, of whom 80 (1.31%) subsequently presented with a CMIH. Subgroup analysis showed that CMIH incidence was lower through an umbilical approach than via an inguinal one (0.85% versus 1.78%, P=.009). As for the transinguinal approach, there was a CMIH incidence of 0.78% and 2.05%, respectively, for laparoscopy with a small angle (30° and 70°), whereas there was no CMIH development for that with a large angle (110°, 120°, and flexible). A high pneumoperitoneum pressure (>10 mm Hg, >12 mm Hg, and >14 mm Hg) was usually associated with a slightly higher CMIH incidence than a low one (≤10 mm Hg, ≤12 mm Hg, and ≤14 mm Hg), all without significant difference. CMIH incidence was slightly lower for using a broad CPPV definition than for using a narrow one (0.64% versus 1.35%, P=.183). CMIH following negative laparoscopic evaluation for CPPV was a rare but possible phenomenon. Choosing the transumbilical approach, transinguinal laparoscopy with a large angle, low-pressure pneumoperitoneum, and broad CPPV definition would probably reduce the occurrence of such CMIHs.

Usage of a self-adhesive mesh in TAPP hernia repair: A prospective study based on Herniamed Register

PubMed Central

Klobusicky, Pavol; Feyerherd, Peter

2016-01-01

INTRODUCTION: Inguinal hernia repair is one of the most frequently performed surgical procedures worldwide in general surgery. The transabdominal laparoscopic (TAPP) approach in the therapy of inguinal hernia seems to be a suitable alternative to classical open inguinal hernia repair mainly in the hands of an experienced surgeon. TAPP repair offers the possibility of gentle dissection with implantation of the mesh and the possibility of non-invasive fixation of the implanted mesh. MATERIALS AND METHODS: Data analysis encompassed all patients who underwent inguinal hernia surgery at our Surgical Department within the period from July 1, 2012 to September 30, 2014 and who fulfilled the inclusion criteria. The standard surgical technique was used. Data were entered and subsequently analysed on the Herniamed platform. Herniamed is an Internet-based register in German and English, and includes all data of outpatient and hospitalised patients who underwent surgery for some type of hernia. All relevant patient data are collected via Internet. RESULTS: There were 241 patients enrolled in the group and there were 396 inguinal hernias repaired in total. Standard long-term follow-up after 12 months was evaluated in 205 patients (85.06%), and in the rest of the patients during the closing of the study, but at least 6 months after operation. The mean follow-up was at 19.69 months. At the 1-year assessment, mild discomfort was reported in the groin in 10 patients (4.88%) [1-3 on the visual analogue scale (VAS)]. Post-operative pain lasting over 12 months in the groin of moderate degree (4-6 VAS) was reported in two cases (0.97%). There was no recurrence and no chronic post-operative pain of severe degree reported. CONCLUSION: Our study demonstrates that laparoscopic inguinal hernia repair using the TAPP technique with the implantation of a self-fixation mesh is fast, effective, reliable and economically advantageous method in experienced hands and, according to our results, reduces the occurrence of post-herniorrhaphy inguinal pain (CPIP) and has a low recurrence rate. PMID:27279393

Laparoscopic inguinal herniorrhaphy in children: a three-center experience with 933 repairs.

PubMed

Schier, Felix; Montupet, Philippe; Esposito, Ciro

2002-03-01

Laparoscopic inguinal herniorrhaphy has been introduced recently as an alternative to conventional open repair in children. This study was undertaken to evaluate the safety, efficacy, and reproducibility of this minimally invasive approach. A total of 933 laparoscopic inguinal herniorrhaphies were performed on 666 children (597 boys and 69 girls), ranging in age from 3 weeks to 14 years (median, 3.2 years). A 5-mm laparoscope was placed through an umbilical incision, and two 2-mm or 3-mm needle drivers were inserted through the lateral abdominal wall. The neck of the sac was closed with a 4-0 monofilament suture. The needle was inserted directly through the abdominal wall, and removed together with the trocar. Only the umbilical fascia was closed with an absorbable suture. No skin sutures were applied. A total of 911 indirect inguinal hernia sacs were closed (337 right, 172 left, 402 bilateral) and 22 direct inguinal hernias were repaired (14 boys, 3 girls; 11 right, 3 left, 4 bilateral). The median operating time was 22 minutes (range, unilateral, 7 to 45 min; bilateral, 9 to 51 min). With experience, this time gradually decreased. There were no intraoperative complications. The contralateral asymptomatic processus was unexpectedly open on the left side in 137 of the boys (23%) and 10 of the girls (15%), and on the right side in 131 of the boys (22%) and 21 of the girls (32%). In 16% of the children, the final procedure was modified on the basis of the anatomic findings. No hernia was found in 13 children (1.9%). The recurrence rate was 3.4% (follow-up time ranged from 2 months to 7 years). Hydroceles were observed in 4 children, and a subtle change in testicular position and size was noted in one boy. Laparoscopic inguinal repair in children proved safe and reproducible, although the recurrence rate was slightly higher than with the open approach. However, laparoscopy allows easy and precise identification of the type of defect and its correction. In this series, the incidence of direct inguinal hernias was higher, and the incidence of a patent contralateral processus vaginalis was lower than previously reported. Copyright 2002 by W.B. Saunders Company.

Differences in gaze behaviour of expert and junior surgeons performing open inguinal hernia repair.

PubMed

Tien, Tony; Pucher, Philip H; Sodergren, Mikael H; Sriskandarajah, Kumuthan; Yang, Guang-Zhong; Darzi, Ara

2015-02-01

Various fields have used gaze behaviour to evaluate task proficiency. This may also apply to surgery for the assessment of technical skill, but has not previously been explored in live surgery. The aim was to assess differences in gaze behaviour between expert and junior surgeons during open inguinal hernia repair. Gaze behaviour of expert and junior surgeons (defined by operative experience) performing the operation was recorded using eye-tracking glasses (SMI Eye Tracking Glasses 2.0, SensoMotoric Instruments, Germany). Primary endpoints were fixation frequency (steady eye gaze rate) and dwell time (fixation and saccades duration) and were analysed for designated areas of interest in the subject's visual field. Secondary endpoints were maximum pupil size, pupil rate of change (change frequency in pupil size) and pupil entropy (predictability of pupil change). NASA TLX scale measured perceived workload. Recorded metrics were compared between groups for the entire procedure and for comparable procedural segments. Twenty-five cases were recorded, with 13 operations analysed, from 9 surgeons giving 630 min of data, recorded at 30 Hz. Experts demonstrated higher fixation frequency (median[IQR] 1.86 [0.3] vs 0.96 [0.3]; P = 0.006) and dwell time on the operative site during application of mesh (792 [159] vs 469 [109] s; P = 0.028), closure of the external oblique (1.79 [0.2] vs 1.20 [0.6]; P = 0.003) (625 [154] vs 448 [147] s; P = 0.032) and dwelled more on the sterile field during cutting of mesh (716 [173] vs 268 [297] s; P = 0.019). NASA TLX scores indicated experts found the procedure less mentally demanding than juniors (3 [2] vs 12 [5.2]; P = 0.038). No subjects reported problems with wearing of the device, or obstruction of view. Use of portable eye-tracking technology in open surgery is feasible, without impinging surgical performance. Differences in gaze behaviour during open inguinal hernia repair can be seen between expert and junior surgeons and may have uses for assessment of surgical skill.

An external-cavity quantum cascade laser operating near 5.2 µm combined with cavity ring-down spectroscopy for multi-component chemical sensing

NASA Astrophysics Data System (ADS)

Dutta Banik, Gourab; Maity, Abhijit; Som, Suman; Pal, Mithun; Pradhan, Manik

2018-04-01

We report on the performance of a widely tunable continuous wave mode-hop-free external-cavity quantum cascade laser operating at λ ~ 5.2 µm combined with cavity ring-down spectroscopy (CRDS) technique for high-resolution molecular spectroscopy. The CRDS system has been utilized for simultaneous and molecule-specific detection of several environmentally and bio-medically important trace molecular species such as nitric oxide, nitrous oxide, carbonyl sulphide and acetylene (C2H2) at ultra-low concentrations by probing numerous rotationally resolved ro-vibrational transitions in the mid-IR spectral region within a relatively small spectral range of ~0.035 cm-1. This continuous wave external-cavity quantum cascade laser-based multi-component CRDS sensor with high sensitivity and molecular specificity promises applications in environmental sensing as well as non-invasive medical diagnosis through human breath analysis.

Scanning gate microscopy of quantum rings: effects of an external magnetic field and of charged defects.

PubMed

Pala, M G; Baltazar, S; Martins, F; Hackens, B; Sellier, H; Ouisse, T; Bayot, V; Huant, S

2009-07-01

We study scanning gate microscopy (SGM) in open quantum rings obtained from buried semiconductor InGaAs/InAlAs heterostructures. By performing a theoretical analysis based on the Keldysh-Green function approach we interpret the radial fringes observed in experiments as the effect of randomly distributed charged defects. We associate SGM conductance images with the local density of states (LDOS) of the system. We show that such an association cannot be made with the current density distribution. By varying an external magnetic field we are able to reproduce recursive quasi-classical orbits in LDOS and conductance images, which bear the same periodicity as the Aharonov-Bohm effect.

Continuous wave room temperature external ring cavity quantum cascade laser

DOE Office of Scientific and Technical Information (OSTI.GOV)

Revin, D. G., E-mail: d.revin@sheffield.ac.uk; Hemingway, M.; Vaitiekus, D.

2015-06-29

An external ring cavity quantum cascade laser operating at ∼5.2 μm wavelength in a continuous-wave regime at the temperature of 15 °C is demonstrated. Out-coupled continuous-wave optical powers of up to 23 mW are observed for light of one propagation direction with an estimated total intra-cavity optical power flux in excess of 340 mW. The uni-directional regime characterized by the intensity ratio of more than 60 for the light propagating in the opposite directions was achieved. A single emission peak wavelength tuning range of 90 cm{sup −1} is realized by the incorporation of a diffraction grating into the cavity.

Tracheal ceramic rings for tracheomalacia: a review after 17 years.

PubMed

Göbel, Gyula; Karaiskaki, Niki; Gerlinger, Imre; Mann, Wolf J

2007-10-01

Despite different support techniques, the surgical management of tracheomalacia is still a challenging problem. Satisfactory results after internal stenting are above 80%, whereas, when performing external stenting using biocompatible ceramic rings, results are reported at over 90%. The purpose of this study was to examine the efficiency of surgical treatment in patients with segmentary tracheomalacia using external ceramic ring grafts. In this retrospective study, we collected data from 12 patients who underwent surgery during the last 17 years for symptomatic segmentary tracheomalacia by use of biocompatible aluminum-oxide ceramic rings. All except one patient had undergone previous tracheostomy, six had a history of long-term intubation, two had previous trauma, and two patients had previous cancer treatment including radiotherapy. One of the patients still had an existing tracheostoma, which was closed when a ceramic ring was implanted. Tracheal wall collapse with pseudoglottis formation or flattened anterior-posterior tracheal diameter was documented with fiberoscopy at rest, and both pre- and postoperative airway resistance measurements were performed in all 12 patients using a spirometer. After malacic segments were found to be expandable using rigid tracheoscopy while the patient was under general anesthesia, preparation of the trachea was performed using a midline vertical incision in the neck. Subsequently, the malacic trachea was expanded by placing and suturing proper-sized ceramic ring(s) around it. In all patients, surgical expansion of the malacic segment using ceramic rings was successfully carried out without major complications while inspiratory stridor was resolved. Airway resistance decreased significantly from an average of 0.62 to 0.385 kPascal. Although the results of applying internal tracheal stents are encouraging, complications such as stent migration, granulation tissue and fistula formation, and mucociliary transport arrest are possible. Biocompatible ceramic rings do not cause foreign body reactions, remain stabile, and, with a proper suturing technique, provide a suitable long-term solution.

Effect of interdiffusion and external magnetic field on electronic states and light absorption in Gaussian-shaped double quantum ring

NASA Astrophysics Data System (ADS)

Aziz-Aghchegala, V. L.; Mughnetsyan, V. N.; Kirakosyan, A. A.

2018-02-01

The effect of interdiffusion and magnetic field on confined states of electron and heavy hole as well as on interband absorption spectrum in a Ga1-xAlxAs/GaAs Gaussian-shaped double quantum ring are investigated. It is shown that both interdiffusion and magnetic field lead to the change of the charge carriers' quantum states arrangement by their energies. The oscillating behavior of the electron ground state energy as a function of magnetic field induction gradually disappears with the increase of diffusion parameter due to the enhanced tunneling of electron to the central region of the ring. For the heavy hole the ground state energy oscillations are not observable in the region of the values of magnetic field induction B = 0 - 10 T . For considered transitions both the magnetic field and the interdiffusion lead to a blue-shift of the absorption spectrum and to decreasing of the absorption intensity. The obtained results indicate on the opportunity of purposeful manipulation of energy states and absorption spectrum of a Gaussian-shaped double quantum ring by means of the post growth annealing and the external magnetic field.

Liposarcoma of the spermatic cord associated with scrotum lipoma: A case report and review of the literature.

PubMed

Yamamichi, Gaku; Nakata, Wataru; Yamamoto, Akinaru; Tsujimura, Go; Tsujimoto, Yuichi; Nin, Mikio; Tsujihata, Masao

2018-03-01

Liposarcoma of the spermatic cord is a rare disease and often mistakenly diagnosed as inguinal hernia, hydrocele, and lipoma. We report the case of a 58-year-old man who presented with persistent discomfort and swelling on the left inguinal region. He was diagnosed with left scrotum lipoma when he was 12 years old. He underwent high orchiectomy and wide resection of the inguinal tumor. Histopathological examination revealed a well-differentiated liposarcoma of the spermatic cord with negative resection margin and scrotum lipoma. To our knowledge, this is the first report of liposarcoma of the spermatic cord with scrotum lipoma in English literature.

Inguinal hernia repair in the Amsterdam region 1994-1996.

PubMed

Schoots, I G; van Dijkman, B; Butzelaar, R M; van Geldere, D; Simons, M P

2001-03-01

In the Netherlands, approximately 30,000 inguinal hernia repairs are performed yearly. At least 15% are for recurrence. New procedures are being introduced creating discussion on which technique is the best. Currently it is not possible to choose on evidence alone because of the long follow-up that is needed. In 1996 an inventory was taken of all inguinal hernia repairs that were performed in the Amsterdam region (9 hospitals). These results were compared with the results from a similar study performed in 1994. Major changes in treatment strategy were noted. The Bassini repair was replaced by Shouldice and Lichtenstein techniques. There was a significant increase in the use of prostheses for both primary and recurrent inguinal hernias. There was no significant decrease in the percentage of operations performed for recurrent hernia from 19.5% to 16.8%. However, there was a significant decrease in operations performed for early recurrences (5.1%-3.4%) (p = 0.05). These results suggest that the Shouldice and Lichtenstein repairs may be superior to the Bassini repair in terms of early hernia recurrence.

Laparoscopic Pediatric Inguinal Hernia Repair: Overview of "True Herniotomy" Technique and Review of Current Evidence.

PubMed

Feehan, Brendan P; Fromm, David S

2017-05-01

Inguinal hernia repair is one of the most commonly performed operations in the pediatric population. While the majority of pediatric surgeons routinely use laparoscopy in their practices, a relatively small number prefer a laparoscopic inguinal hernia repair over the traditional open repair. This article provides an overview of the three port laparoscopic technique for inguinal hernia repair, as well as a review of the current evidence with respect to visualization and identification of hernias, recurrence rates, operative times, complication rates, postoperative pain, and cosmesis. The laparoscopic repair presents a viable alternative to open repair and offers a number of benefits over the traditional approach. These include superior visualization of the relevant anatomy, ability to assess and repair a contralateral hernia, lower rates of metachronous hernia, shorter operative times in bilateral hernia, and the potential for lower complication rates and improved cosmesis. This is accomplished without increasing recurrence rates or postoperative pain. Further research comparing the different approaches, including standardization of techniques and large randomized controlled trials, will be needed to definitively determine which is superior. Copyright© South Dakota State Medical Association.

Transabdominal preperitoneal laparoscopic approach for incarcerated inguinal hernia repair

PubMed Central

Yang, Shuo; Zhang, Guangyong; Jin, Cuihong; Cao, Jinxin; Zhu, Yilin; Shen, Yingmo; Wang, Minggang

2016-01-01

Abstract To investigate the efficacy, key technical points, and complication management of the transabdominal preperitoneal (TAPP) approach for incarcerated inguinal hernia repair. Seventy-three patients with incarcerated inguinal hernias underwent TAPP surgery in our department between Jan 2010 and Dec 2015. A retrospective review was performed by analyzing the perioperative data from these patients. The operation was successfully completed in all 73 patients. Operation time was 54.0 ± 18.8 minutes (range, 35–100 minutes). Length of stay was 3.9 ± 1.1 days (range, 3–9 days). There was 1 case of incisional infection, 32 cases of seroma, and 3 cases of postoperative pain during follow-up. All patients recovered after the appropriate treatment. No recurrence or fistula was observed. The TAPP approach represents a safe and effective technique for incarcerated inguinal hernia repair because of its potential in assessment of hernia content and decreasing incisional infection rate. However, it requires experienced surgeons to ensure safety with special attention paid to the key technical points as well as complication management. PMID:28033260

Bilateral inguinal hernia repair: laparoscopic or open approach?

PubMed

Feliu, X; Clavería, R; Besora, P; Camps, J; Fernández-Sallent, E; Viñas, X; Abad, J M

2011-02-01

The aim of this study was to investigate outcomes in the treatment of bilateral inguinal hernia, comparing the laparoscopic totally extraperitoneal (TEP) and open tension-free mesh repair (LICHT) approaches. We performed a prospective controlled non randomized clinical study in 128 patients with bilateral inguinal hernia over a period of 3 years. LICHT was used in 106 cases (53 patients) while TEP was employed in 150 cases (75 patients). The main outcome measurements were: recurrence rate, operating time, hospital stay and postoperative complications. There were three recurrences (2.3%): two in the LICHT group (3.8%) and one (1.3%) in the TEP group P = NS. The TEP procedure was faster than LICHT repair (48.8 ± 10.8 vs. 70.4 ± 11.2 min) P < 0.01. Postoperative complications were more frequent in LICHT group (16%) than TEP group (5.3%) P < 0.01. Hospital stay was significantly shorter in the TEP group (0.6 ± 0.8 vs. 1.3 ± 1.2 days) P < 0.001. The TEP approach is an effective option for the treatment of bilateral inguinal hernia when performed by experienced surgeons.

Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report

PubMed Central

St-Onge, Eric; MacIntyre, Ian G.; Galea, Anthony M.

2015-01-01

Objective: To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. Clinical Features: A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. Intervention: The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. Discussion: This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. Summary: Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy. PMID:26816415

Irradiation of the inguinal lymph nodes in patients of differing body habitus: a comparison of techniques and resulting normal tissue complication probabilities.

PubMed

Brown, Paul D; Kline, Robert W; Petersen, Ivy A; Haddock, Michael G

2004-01-01

The treatment of the inguinal lymph nodes with radiotherapy is strongly influenced by the body habitus of the patient. The effect of 7 radiotherapy techniques on femoral head doses was studied. Three female patients of differing body habitus (ectomorph, mesomorph, endomorph) were selected. Radiation fields included the pelvis and contiguous inguinal regions and were representative of fields used in the treatment of cancers of the lower pelvis. Seven treatment techniques were compared. In the ectomorph and mesomorph, normal tissue complication probability (NTCP) for the femoral heads was lowest with use of anteroposterior (AP) and modified posteroanterior (PA) field with inguinal electron field supplements (technique 1). In the endomorph, NTCP was lowest with use of AP and modified PA field without electron field supplements (technique 2) or a 4-field approach (technique 6). Technique 1 for ectomorphs and mesomorphs and techniques 2 and 6 for endomorphs were optimal techniques for providing relatively homogeneous dose distributions within the target area while minimizing the dose to the femoral heads.

Granular cutaneous glands in the frog Physalaemus biligonigerus (Anura, Leptodactylidae): comparison between ordinary serous and 'inguinal' glands.

PubMed

Delfino, G; Brizzi, R; Alvarez, B B; Gentili, M

1999-12-01

Beside the ordinary granular (or serous) glands, the skin of the leptodactylid frog Physalaemus biligonigerus possesses peculiar clusters of large granular units, the 'inguinal' glands, located in the dorsolateral areas of the pelvic girdle. Both gland types store their specific products within the syncytial cytoplasm of the secretory unit. These secretory materials consist of spheroidal or ellipsoidal bodies (granules) with a repeating substructure. The subcellular features of the immature products of the ordinary serous and inguinal glands are identical. However, these products undergo divergent maturative processes, leading to fluidation on the one hand and condensation on the other. Secretory release into the small gland lumen was observed in both cases, involving merocrine mechanisms. On the basis of the analysis of cutaneous serous gland polymorphism in anurans, the inguinal units in P. biligonigerus do not appear to be an independent line. Rather, these large units belong to the ordinary serous type and represent a gland population specialized in the storage of remarkable amounts of product used in chemical defence of the skin.

The environmental influence on tropical cyclone precipitation

NASA Technical Reports Server (NTRS)

Rodgers, Edward B.; Baik, Jong-Jin; Pierce, Harold F.

1994-01-01

The intensity, spatial, and temporal changes in precipitation were examined in three North Atlantic hurricanes during 1989 (Dean, Gabrielle, and Hugo) using precipitation estimates made from Special Sensor Microwave/Imager (SSM/I) measurements. In addition, analyses from a barotropic hurricane forecast model and the European Centre for Medium-Range Weather Forecast model were used to examine the relationship between the evolution of the precipitation in these tropical cyclones and external forcing. The external forcing parameters examined were (1) mean climatological sea surface temperatures, (2) vertical wind shear, (3) environmental tropospheric water vapor flux, and (4) upper-tropospheric eddy relative angular momentum flux convergence. The analyses revealed that (1) the SSM/I precipitation estimates were able to delineate and monitor convective ring cycles similar to those observed with land-based and aircraft radar and in situ measurements; (2) tropical cyclone intensification was observed to occur when these convective rings propagated into the inner core of these systems (within 111 km of the center) and when the precipitation rates increased; (3) tropical cyclone weakening was observed to occur when these inner-core convective rings dissipated; (4) the inward propagation of the outer convective rings coincided with the dissipation of the inner convective rings when they came within 55 km of each other; (5) in regions with the combined warm sea surface temperatures (above 26 C) and low vertical wind shear (less than 5 m/s), convective rings outside the region of strong lower-tropospheric inertial stability could be initiated by strong surges of tropospheric moisture, while convective rings inside the region of strong lower-tropospheric inertial stability could be enhanced by upper-tropospheric eddy relative angular momentum flux convergence.

The Environmental Influence on Tropical Cyclone Precipitation.

NASA Astrophysics Data System (ADS)

Rodgers, Edward B.; Baik, Jong-Jin; Pierce, Harold F.

1994-05-01

The intensity, spatial, and temporal changes in precipitation were examined in three North Atlantic hurricanes during 1989 (Dean, Gabrielle, and Hugo) using precipitation estimates made from Special Sensor Microwave/Imager (SSM/I) measurements. In addition, analyses from a barotropic hurricane forecast model and the European Centre for Medium-Range Weather Forecast model were used to examine the relationship between the evolution of the precipitation in these tropical cyclones and external forcing. The external forcing parameters examined were 1) mean climatological sea surface temperatures, 2) vertical wind shear, 3) environmental tropospheric water vapor flux, and 4) upper-tropospheric eddy relative angular momentum flux convergence.The analyses revealed that 1) the SSM/I precipitation estimates were able to delineate and monitor convective ring cycles similar to those observed with land-based and aircraft radar and in situ measurements; 2) tropical cyclone intensification was observed to occur when these convective rings propagated into the inner core of these systems (within 111 km of the center) and when the precipitation rates increased; 3) tropical cyclone weakening was observed to occur when these inner-core convective rings dissipated; 4) the inward propagation of the outer convective rings coincided with the dissipation of the inner convective rings when they came within 55 km of each other; 5) in regions with the combined warm sea surface temperatures (above 26°C) and low vertical wind shear (less than 5 m s1), convective rings outside the region of strong lower-tropospheric inertial stability could be initiated by strong surges of tropospheric moisture, while convective rings inside the region of strong lower-tropospheric inertial stability could be enhanced by upper-tropospheric eddy relative angular momentum flux convergence.

Knee arthrodesis with the Sheffield external ring fixator: fusion in 6 of 10 consecutive patients.

PubMed

Ulstrup, Anton K; Folkmar, Klaus; Broeng, Leif

2007-06-01

Knee arthrodesis with external fixation (XF) is a possible salvage procedure for infected total knee arthroplasties (TKA). We report the outcome in 10 patients who underwent arthrodesis with the Sheffield Ring Fixator. The patients had primary arthrosis in 8 cases; 2 cases were due to rheumatoid arthritis and sclerodermia. The mean time between the primary TKA and arthrodesis was 6 (0.5-14) years. The average age at arthrodesis was 69 years. The average follow-up period was 10 months. Stable fusion was obtained in 6 patients after a mean XF time of 3.6 (2-4) months. 1 patient was referred to another hospital because of nonunion. This patient showed fusion with intramedullary nailing after 7 months. 3 nonunion patients required permanent bracing. 7 patients had pin tract infections. Infections healed in all patients. The Sheffield Ring Fixator gives an acceptable fusion rate for arthrodesis in the infected TKA, with limited complications.

Incarcerated inguinal hernia management in children: 'a comparison of the open and laparoscopic approach'.

PubMed

Mishra, Pankaj Kumar; Burnand, Katherine; Minocha, Ashish; Mathur, Azad B; Kulkarni, Milind S; Tsang, Thomas

2014-06-01

To compare the outcomes of management of incarcerated inguinal hernia by open versus laparoscopic approach. This is a retrospective analysis of incarcerated inguinal hernina in a paediatric surgery centre involving four consultants. Manual reduction was attempted in all and failure was managed by emergency surgery. The laparoscopy group had 27 patients. Four patients failed manual reduction and underwent emergency laparoscopic surgery. Three of them had small bowel strangulation which was reduced laparoscopically. The strangulated bowel was dusky in colour initially but changed to normal colour subsequently under vision. The fourth patient required appendectomy for strangulated appendix. One patient had concomitant repair of umbilical hernia and one patient had laparoscopic pyloromyotomy at the same time. One patient had testicular atrophy, one had hydrocoele and one had recurrence of hernia on the asymptomatic side. The open surgery group had 45 patients. Eleven patients had failed manual reduction requiring emergency surgery, of these two required resection and anastomosis of small intestine. One patient in this group had concomitant repair of undescended testis. There was no recurrence in this group, one had testicular atrophy and seven had metachronous hernia. Both open herniotomy and laparoscopic repair offer safe surgery with comparable outcomes for incarcerated inguinal hernia in children. Laparoscopic approach and hernioscopy at the time of open approach appear to show the advantage of repairing the contralateral patent processus vaginalis at the same time and avoiding metachronous inguinal hernia.

Inguinal hernia repair in women: is the laparoscopic approach superior?

PubMed

Ashfaq, A; McGhan, L J; Chapital, A B; Harold, K L; Johnson, D J

2014-06-01

Laparoscopic inguinal hernia repair is associated with reduced post-operative pain and earlier return to work in men. However, the role of laparoscopic hernia repair in women is not well reported. The aim of this study was to review the outcomes of the laparoscopic versus open repair of inguinal hernias in women and to discuss patients' considerations when choosing the approach. A retrospective chart review of all consecutive patients undergoing inguinal hernia repair from January 2005 to December 2009 at a single institution was conducted. Presentation characteristics and outcome measures including recurrence rates, post-operative pain and complications were compared in women undergoing laparoscopic versus open hernia repair. A total of 1,133 patients had an inguinal herniorrhaphy. Of these, 101 patients were female (9 %), with a total of 111 hernias. A laparoscopic approach was chosen in 44 % of patients. The majority of women (56 %) presented with groin pain as the primary symptom. Neither the mode of presentation nor the presenting symptoms significantly influenced the surgical approach. There were no statistically significant differences in hernia recurrence, post-operative neuralgia, seroma/hematoma formation or urinary retention between the two approaches (p < 0.05). A greater proportion of patients with bilateral hernias had a laparoscopic approach rather than an open technique (12 vs. 2 %, p = 0.042). Laparoscopic herniorrhaphy is as safe and efficacious as open repair in women, and should be considered when the diagnosis is in question, for management of bilateral hernias or when concomitant abdominal pathology is being addressed.

Postoperative urinary retention after inguinal hernia repair: a single institution experience.

PubMed

Blair, A B; Dwarakanath, A; Mehta, A; Liang, H; Hui, X; Wyman, C; Ouanes, J P P; Nguyen, H T

2017-12-01

Inguinal hernia repair is a common general surgery procedure with low morbidity. However, postoperative urinary retention (PUR) occurs in up to 22% of patients, resulting in further extraneous treatments.This single institution series investigates whether patient comorbidities, surgical approaches, and anesthesia methods are associated with developing PUR after inguinal hernia repairs. This is a single institution retrospective review of inguinal hernia from 2012 to 2015. PUR was defined as patients without a postoperative urinary catheter who subsequently required bladder decompression due to an inability to void. Univariate and multivariate logistic regressions were performed to quantify the associations between patient, surgical, and anesthetic factors with PUR. Stratification analysis was conducted at age of 50 years. 445 patients were included (42.9% laparoscopic and 57.1% open). Overall rate of PUR was 11.2% (12% laparoscopic, 10.6% open, and p = 0.64). In univariate analysis, PUR was significantly associated with patient age >50 and history of benign prostatic hyperplasia (BPH). Risk stratification for age >50 revealed in this cohort a 2.49 times increased PUR risk with lack of intraoperative bladder decompression (p = 0.013). At our institution, we found that patient age, history of BPH, and bilateral repair were associated with PUR after inguinal hernia repair. No association was found with PUR and laparoscopic vs open approach. Older males may be at higher risk without intraoperative bladder decompression, and therefore, catheter placement should be considered in this population, regardless of surgical approach.

Laparoscopic repair of bilateral and recurrent hernias.

PubMed

Frankum, C E; Ramshaw, B J; White, J; Duncan, T D; Wilson, R A; Mason, E M; Lucas, G; Promes, J

1999-09-01

The optimal inguinal hernia repair has been controversial for decades. Since the advent of minimally invasive surgery, laparoscopic techniques have added to the controversy. Laparoscopic hernia repair has been advocated by many experts for the repair of bilateral and recurrent inguinal hernias. This study reviews the experience of a single community-based teaching hospital using the total extraperitoneal (TEP)-approach laparoscopic hernia repair for treating patients with bilateral and/or recurrent inguinal hernias. Since the TEP approach was adopted in June 1993, a total of 457 patients were treated for bilateral (322 patients) and/or recurrent (175) inguinal hernias (40 patients had recurrent and bilateral hernias). A total of 779 hernias were repaired with this technique. The average age of this patient group was 47 years, and there were 413 males and 44 females. Operative time averaged 68.3 minutes per patient, and there were 26 (5.7%) minor complications. There were 2 (0.4%) major complications, an enterotomy and a cystotomy, both early in the series and both in patients with previous lower abdominal surgery. There have been no deaths. With an average follow-up of 30 months (range, 1-60 months), there have been three (0.2%) recurrences. These recurrences were due to technical problems (inadequate mesh coverage), and each was repaired with a laparoscopic transabdominal approach or an anterior open approach. The use of the TEP-approach laparoscopic hernia repair is safe and effective in patients with recurrent and/or bilateral inguinal hernias.

Minilaparoscopic technique for inguinal hernia repair combining transabdominal pre-peritoneal and totally extraperitoneal approaches.

PubMed

Carvalho, Gustavo L; Loureiro, Marcelo P; Bonin, Eduardo A; Claus, Christiano P; Silva, Frederico W; Cury, Antonio M; Fernandes, Flavio A M

2012-01-01

Endoscopic surgical repair of inguinal hernia is currently conducted using 2 techniques: the totally extraperitoneal (TEP) and the transabdominal (TAPP) hernia repair. The TEP procedure is technically advantageous, because of the use of no mesh fixation and the elimination of the peritoneal flap, leading to less postoperative pain and faster recovery. The drawback is that TEP is not performed as frequently, because of its complexity and longer learning curve. In this study, we propose a hybrid technique that could potentially become the gold standard of minimally invasive inguinal hernia surgery. This will be achieved by combining established advantages of TEP and TAPP associated with the precision and cosmetics of minilaparoscopy (MINI). Between January and July 2011, 22 patients were admitted for endoscopic inguinal hernia repair. The combined technique was initiated with TAPP inspection and direct visualization of a minilaparoscopic trocar dissection of the preperitoneum space. A10-mm trocar was then placed inside the previously dissected preperitoneal space, using the same umbilical TAPP skin incision. Minilaparoscopic retroperitoneal dissection was completed by TEP, and the surgical procedure was finalized with intraperitoneal review and correction of the preperitoneal work. The minilaparoscopic TEP-TAPP combined approach for inguinal hernia is feasible, safe, and allows a simple endoscopic repair. This is achieved by combining features and advantages of both TAPP and TEP techniques using precise and sophisticated MINI instruments. Minilaparoscopic preperitoneal dissection allows a faster and easier creation of the preperitoneal space for the TEP component of the procedure.

Single incision laparoscopic surgery (SILS) inguinal hernia repair - recent clinical experiences of this novel technique.

PubMed

Yussra, Y; Sutton, P A; Kosai, N R; Razman, J; Mishra, R K; Harunarashid, H; Das, S

2013-01-01

Inguinal hernia remains the most commonly encountered surgical problem. Various methods of repair have been described, and the most suitable one debated. Single port access (SPA) surgery is a rapidly evolving field, and has the advantage of affording 'scarless' surgery. Single incision laparoscopic surgery (SILS) for inguinal hernia repair is seen to be feasible in both total extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) approaches. Data and peri-operative information on both of these however are limited. We aimed to review the clinical experience, feasibility and short term complications related to laparoscopic inguinal hernia repair via single port access. A literature search was performed using Google Scholar, Springerlink Library, Highwire Press, Surgical Endoscopy Journal, World Journal of Surgery and Medscape. The following search terms were used: laparoscopic hernia repair, TAPP, TEP, single incision laparoscopic surgery (SILS). Fourteen articles in English language related to SILS inguinal hernia repair were identified. Nine articles were related to TEP repair and the remaining 5 to TAPP. A total of 340 patients were reported within these studies: 294 patients having a TEP repair and 46 a TAPP. Only two cases of recurrence were reported. Various ports have been utilized, including the SILS port, Tri-Port and a custom- made port using conventional laparoscopic instruments. The duration of surgery was 40-100 minutes and the average length of hospital stay was one day. Early outcomes of this novel technique show it to be feasible, safe and with potentially better cosmetic outcome.

[Management of penile cancer patients: new aspects of a rare tumour entity].

PubMed

Roiner, M; Maurer, O; Lebentrau, S; Gilfrich, C; Schäfer, C; Haberl, C; Brookman-May, S D; Burger, M; May, M; Hakenberg, O W

2018-06-01

Over the past few decades, some principles in the treatment of penile cancer have changed fundamentally. While 15 years ago a negative surgical margin of at least 2 cm was considered mandatory, organ-sparing surgery permitting minimal negative surgical margins has a high priority nowadays. The current treatment principle requires as much organ preservation as possible and as much radicality as necessary. The implementation of organ-sparing and reconstructive surgical techniques has improved the quality of life of surviving patients. However, oncological and functional outcomes are still unsatisfactory. Alongside with adequate local treatment of the primary tumour, a consistent management of inguinal lymph nodes is of fundamental prognostic significance. In particular, clinically inconspicuous inguinal lymph nodes staged T1b and upwards need a surgical approach. Sentinel node biopsy, minimally-invasive surgical techniques and modified inguinal lymphadenectomy have reduced morbidity compared to conventional inguinal lymph node dissection. Multimodal treatment with surgery and chemotherapy is required in all patients with lymph node-positive disease; neoadjuvant chemotherapy has been established for patients with locally advanced lymph node disease, and adjuvant treatment after radical inguinal lymphadenectomy for lymph node-positive disease. An increasing understanding of the underlying tumour biology, in particular the role of the human papilloma virus (HPV) and epidermal growth factor receptor (EGFR) status, has led to a new pathological classification and may further enhance treatment options. This review summarises current aspects in the therapeutic management of penile cancer. © Georg Thieme Verlag KG Stuttgart · New York.

Sac ligation in inguinal hernia repair: A meta-analysis of randomized controlled trials.

PubMed

Kao, Chun-Yu; Li, Ching-Li; Lin, Chao-Chun; Su, Chih-Ming; Chen, Chia-Che; Tam, Ka-Wai

2015-07-01

Traditionally, hernia sac ligation during inguinal hernia repair is considered mandatory to prevent postoperative development of hernia. However, ligation may induce postoperative pain. The aim of this study was to evaluate the outcomes of hernia sac ligation after inguinal hernia repair. We conducted a systematic review and meta-analysis of randomized controlled trials to investigate the outcomes of hernia sac ligation for open or laparoscopic inguinal hernia repair. Incidence of hernia recurrence was assessed following the surgery. The secondary outcomes included pain scores and postoperative complications. Five trials were selected and their results were summarized. These 5 trials were published between 1984 and 2014, and the sample sizes ranged from 50 to 467 patients. Four trials had recruited patients with inguinal hernia who underwent open repair, and one study enrolled patients who underwent laparoscopic procedures. We observed no difference in the incidence of hernia recurrence and postoperative complications between the sac ligation and nonligation groups. Postoperatively, the intensity of pain was significantly higher in the ligation group than in the nonligation group at Day 7 (Weight mean difference 1.46; 95% confident interval: 0.98-1.95). Hernia sac ligation was associated with higher postoperative pain, and did not show any benefit over sac nonligation regarding the incidence of recurrence and postoperative complications in patients undergoing open tension-free mesh repair or laparoscopic procedures. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

[Non-incarcerated inguinal hernia in children: operation within 7 days not necessary].

PubMed

Timmers, L; Hamming, J F; Oostvogel, H J M

2005-01-29

To assess the necessity to operate on non-incarcerated inguinal hernia in children within 7 days of diagnosis. Retrospective. Data on 360 children, 0-10 years old (104 girls and 256 boys) who were operated on for inguinal hernia between 1 January 1993-31 December 2001 at the St. Elisabeth Hospital in Tilburg, the Netherlands, were collected from the medical records. These data included sex, age, interval between diagnosis and repair, recurrence, incarceration, length of hospitalisation and complications. In the group of 113 children 0-1 years old, 137 inguinal hernias were repaired, ofwhich 16 were incarcerated on presentation. The interval between diagnosis and repair was known in 93 of 121 cases: 37 hernias were repaired within 7 days and 56 at a later stage. In the latter group, there was one case of secondary incarceration (1.8%; 95% CI: 0-5.4). The number needed to treat was 56. In the group of 247 children 1-10 years old, 269 inguinal hernias were repaired, of which 8 were primarily incarcerated. The interval between diagnosis and repair was known in 208 of 261 cases: 34 hernias were repaired within 7 days and 174 at a later stage. In the latter group, 3 hernias incarcerated secondarily (1.7%; 95% CI: 0-3.7). The number needed to treat was 58. In the group of non-incarcerated hernias 1 complication occurred, in the group of incarcerated hernias none. The mean length of hospitalisation of children with non-incarcerated hernia was 0.85 days, and of children with incarcerated hernia 2.4 days. In children with a non-incarcerated inguinal hernia who are waiting for an operation, the risk of secondary incarceration and complications is 2% which we do not think is enough reason to carry out an elective hernia-repair procedure within 7 days.

Central Somatosensory Networks Respond to a De Novo Innervated Penis: A Proof of Concept in Three Spina Bifida Patients.

PubMed

Kortekaas, Rudie; Nanetti, Luca; Overgoor, Max L E; de Jong, Bauke M; Georgiadis, Janniko R

2015-09-01

Spina bifida (SB) causes low spinal lesions, and patients often have absent genital sensation and a highly impaired sex life. TOMAX (TO MAX-imize sensation, sexuality and quality of life) is a surgical procedure whereby the penis is newly innervated using a sensory nerve originally targeting the inguinal area. Most TOMAX-treated SB patients initially experience penile stimulation as inguinal sensation, but eventually, the perception shifts to penis sensation with erotic feelings. The brain mechanisms mediating this perceptual shift, which are completely unknown, could hold relevance for understanding the brain's role in sexual development. The aim of this study was to study how a newly perceived penis would be mapped onto the brain after a lifelong disconnection. Three TOMAX-treated SB patients participated in a functional magnetic resonance imagery experiment while glans penis, inguinal area, and index finger were stimulated with a paint brush. Brush stimulation-induced activation of the primary somatosensory cortex (SI) and functional connectivity between SI and remote cerebral regions. Stimulation of the re-innervated side of the glans penis and the intact contralateral inguinal area activated a very similar location on SI. Yet, connectivity analysis identified distinct SI functional networks. In all three subjects, the middle cingulate cortex (MCC) and the parietal operculum-insular cortex (OIC) were functionally connected to SI activity during glans penis stimulation, but not to SI activity induced by inguinal stimulation. Investigating central somatosensory network activity to a de novo innervated penis in SB patients is feasible and informative. The consistent involvement of MCC and OIC above and beyond the brain network expected on the basis of inguinal stimulation suggests that these areas mediate the novel penis sensation in these patients. The potential role of MCC and OIC in this process is discussed, along with recommendations for further research. © 2015 International Society for Sexual Medicine.

Impact of a bladder scan protocol on discharge efficiency within a care pathway for ambulatory inguinal herniorraphy.

PubMed

Antonescu, I; Baldini, G; Watson, D; Kaneva, P; Fried, G M; Khwaja, K; Vassiliou, M C; Carli, F; Feldman, L S

2013-12-01

Postoperative urinary retention (POUR) is a common complication of ambulatory inguinal herniorraphy, with an incidence reaching 38%, and many surgeons require patients to void before discharge. This study aimed to assess whether the implementation of a bladder scan-based voiding protocol reduces the time until discharge after ambulatory inguinal herniorraphy without increasing the rate of POUR. As part of a perioperative care pathway, a protocol was implemented to standardize decision making after elective inguinal hernia repair (February 2012). Patients were assessed with a bladder scan, and those with <600 mL of urine were discharged home, whereas those with more than 600 mL of urine had an in-and-out catheterization before discharge. The patients received written information about urinary symptoms and instructions to present to the emergency department if they were unable to void at home. An audit of scheduled outpatient inguinal hernia repairs between October 2011 and July 2012 was performed. Comparisons were made using the t test, Fisher's exact test, and Wilcoxon rank sum test where appropriate. Statistical significance was defined a priori as a p value lower than 0.05. During the study period, 124 patients underwent hernia repair: 60 before and 64 after implementation of the protocol. The findings showed no significant differences in patient characteristics, laparoscopic approach (35 vs. 33%; p = 0.80), proportion receiving general anesthesia (70 vs. 73%; p = 0.67), or amount of intravenous fluids given (793 vs. 663 mL; p = 0.07). The proportion of patients voiding before discharge was higher after protocol implementation (73 vs. 89%; p = 0.02). The protocol had no impact on median time to discharge (190 vs. 205 min; p = 0.60). Only one patient in each group presented to the emergency department with POUR (2%). After ambulatory inguinal herniorraphy, implementation of a bladder scan-based voiding protocol did not result in earlier discharge. The incidence of POUR was lower than reported in the literature.

Clinical Utility of the Modified Segmental Boost Technique for Treatment of the Pelvis and Inguinal Nodes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moran, M.S., E-mail: meena.moran@yale.ed; Yale New Haven Hospital, New Haven, Connecticut and William W. Backus Hospital, Norwich, Connecticut; Castrucci, W.A.

2010-03-15

Purpose: Low-lying pelvic malignancies often require simultaneous radiation to pelvis and inguinal nodes. We previously reported improved homogeneity with the modified segmental boost technique (MSBT) compared to that with traditional methods, using phantom models. Here we report our institutional clinical experience with MSBT. Methods and Materials: MSBT patients from May 2001 to March 2007 were evaluated. Parameters analyzed included isocenter/multileaf collimation shifts, time per fraction (four fields), monitor units (MU)/fraction, femoral doses, maximal dose relative to body mass index, and inguinal node depth. In addition, a dosimetric comparison of the MSBT versus intensity modulated radiation therapy (IMRT) was conducted. Results:more » Of the 37 MSBT patients identified, 32 were evaluable. Port film adjustments were required in 6% of films. Median values for each analyzed parameter were as follows: MU/fraction, 298 (range, 226-348); delivery time, 4 minutes; inguinal depth, 4.5 cm; volume receiving 45 Gy (V45), 7%; V27.5, 87%; body mass index, 25 (range, 16.0-33.8). Inguinal dose was 100% in all cases; in-field inhomogeneity ranged from 111% to 118%. IMRT resulted in significantly decreased dose to normal tissue but required more time for treatment planning and a higher number of MUs (1,184 vs. 313 MU). Conclusions: In our clinical experience, the mono-isocentric MSBT provides a high degree of accuracy, improved homogeneity compared with traditional techniques, ease of simulation, treatment planning, treatment delivery, and acceptable femoral doses for pelvic/inguinal radiation fields requiring 45 to 50.4 Gy. In addition, the MSBT delivers a relatively uniform dose distribution throughout the treatment volume, despite varying body habitus. Clinical scenarios for the use of MSBT vs. intensity-modulated radiation therapy are discussed. To our knowledge, this is the first study reporting the utility of MSBT in the clinical setting.« less

Inguinal hernia vs. arthritis of the hip in sporting adolescents--case report and review of the literature.

PubMed

Holzheimer, R G; Gresser, U

2007-07-26

Chronic pain in the hip, groin or thigh can be caused by a wide spectrum of diseases posing extended diagnostic problems. We describe the case of a 10-years old child with chronic pain in the groin with gait restriction for more than six months without successful classification and treatment. The girl suffered from heavy pain in the groin after a sporting contest which forced her to walk with walking sticks and to avoid climbing stairs. Within six months she was examined by pediatric, orthopedic, pediatric surgery, pediatric orthopedic, radiology, pediatric rheumatology specialists. Working diagnoses were transient synovitis (coxitis fugax), arthritis, streptococcal arthritis, Morbus Perthes, rheumatic fever, rheumatoid arthritis. She was treated with antibiotics and ibuprofen in high dosage. Repeated laboratory tests and imaging studies (ultrasound, x-rays, magnetic resonance imaging) of the hip and pelvis did not support any of these diagnoses. Six months after beginning of the complaints the girl was presented by her mother to our institution. The physical examination showed a sharp localized pain in the groin, just in the region of the inguinal ligament with otherwise free hip movement. There was no visible inguinal hernia. The family history for hernia was positive. After infiltration of the ilioinguinal nerve the girl had a complete long-lasting disappearance of pain and gait disturbance. This led to the diagnosis of inguinal hernia with nerve entrapment. After hernia repair and neurolysis/neurectomy there was a continuous state of disappearance of pain and gait disturbances. To avoid such a diagnostic dilemma one should always discuss all possible causes. Non-visible inguinal hernia may be more common in females than previously thought. Nerve entrapment as a cause of groin pain has been well described. The relationship of the start of complaints with sporting activity, a positive family history for inguinal hernia, a lack of signs of inflammation and bone involvement in the laboratory and imaging studies together with a localized pain in the groin, almost immediate long-lasting disappearance of pain after infiltration of the ilioinguinal nerve allowing free motion leads to the diagnosis of inguinal hernia with nerve entrapment. Hernia repair and neurolysis are the adequate treatment avoiding unnecessary radiation.

Avascular Necrosis of Acetabulum: The Hidden Culprit of Resistant Deep Wound Infection and Failed Fixation of Fracture Acetabulum - A Case Report.

PubMed

K, Kandhari V; M, Desai M; S, Bava S; N, Wade R

2015-01-01

Chances of avascular necrosis of acetabulum are rare as it enjoys a rich blood supply. But cases of post - traumatic avascular necrosis of acetabulum following fracture of posterior column have been well documented. Importance of identifying and suspecting the avascular necrosis of acetabulum is essential in cases of failed fixation of fracture acetabulum, previously operated using extensile approach to acetabulum; either extended anterior ilio - femoral or tri - radiate approach. Such patients usually present with repeated deep bone infection or with early failure of fixation with aseptic loosening and migration of its components. We present a similar case. 40 years female presented with inadequately managed transverse fracture of left acetabulum done by anterior extended ilio-inguinal approach. The fixation failed. She presented 6 months later with painful hip. Cemented total hip replacement was performed with reconstruction of acetabulum by posterior column plating. Six months postoperatively patient presented with dislodgement of cup, pelvic discontinuity and sinus in the thigh. Two stage revision surgery was planned. First implant, removal; debridement and antibiotic spacer surgery was performed. At second stage of revision total hip replacement, patient had Paprosky grade IIIb defect in acetabulum. Spacer was removed through the posterior approach. Anterior approach was taken for anterior plating. Intra-operatively external iliac pulsations were found to be absent so procedure was abandoned after expert opinion. Postoperatively digital subtraction angiography demonstrated a chronic block in the external iliac artery and corona mortis was the only patent vascular channel providing vascular to the left lower limb. Thus, peripheral limb was stealing blood supply from the acetabulum to maintain perfusion. Patient was ultimately left with pelvic discontinuity, excision arthroplasty and pseudoarthrosis of the left hip. Avascular necrosis of acetabulum is a rare entity & often not recognized. One should be suspicious about diagnosis of avascular necrosis of acetabulum in select cases of failed acetabular fixation, previously operated via extensile anterior ilio - inguinal approach. Angiographic evaluation is essential in revision cases of failed acetabular fixation. Corona mortis (crown or circle of death) can sometimes act as a savior of limb.

Sectional anatomy aid for improvement of decompression surgery approach to vertical segment of facial nerve.

PubMed

Feng, Yan; Zhang, Yi Qun; Liu, Min; Jin, Limin; Huangfu, Mingmei; Liu, Zhenyu; Hua, Peiyan; Liu, Yulong; Hou, Ruida; Sun, Yu; Li, You Qiong; Wang, Yu Fa; Feng, Jia Chun

2012-05-01

The aim of this study was to find a surgical approach to a vertical segment of the facial nerve (VFN) with a relatively wide visual field and small lesion by studying the location and structure of VFN with cross-sectional anatomy. High-resolution spiral computed tomographic multiplane reformation was used to reform images that were parallel to the Frankfort horizontal plane. To locate the VFN, we measured the distances as follows: from the VFN to the paries posterior bony external acoustic meatus on 5 typical multiplane reformation images, to the promontorium tympani and the root of the tympanic ring on 2 typical images. The mean distances from the VFN to the paries posterior bony external acoustic meatus are as follows: 4.47 mm on images showing the top of the external acoustic meatus, 4.20 mm on images with the best view of the window niche, 3.35 mm on images that show the widest external acoustic meatus, 4.22 mm on images with the inferior margin of the sulcus tympanicus, and 5.49 mm on images that show the bottom of the external acoustic meatus. The VFN is approximately 4.20 mm lateral to the promontorium tympani on images with the best view of the window niche and 4.12 mm lateral to the root of the tympanic ring on images with the inferior margin of the sulcus tympanicus. The other results indicate that the area and depth of the surgical wound from the improved approach would be much smaller than that from the typical approach. The surgical approach to the horizontal segment of the facial nerve through the external acoustic meatus and the tympanic cavity could be improved by grinding off the external acoustic meatus to show the VFN. The VFN can be found by taking the promontorium tympani and tympanic ring as references. This improvement is of high potential to expand the visual field to the facial nerve, remarkably without significant injury to the patients compared with the typical approach through the mastoid process.

Inguinal Hernia and Airport Scanners: An Emerging Indication for Repair?

PubMed Central

Cawich, Shamir O.; Maharaj, Ravi; Dan, Dilip

2013-01-01

The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency. PMID:24368923

Inguinal hernia and airport scanners: an emerging indication for repair?

PubMed

Naraynsingh, Vijay; Cawich, Shamir O; Maharaj, Ravi; Dan, Dilip

2013-01-01

The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency.

Sclerotherapy with bleomycin for recurrent massive inguinal lymphoceles following partial vulvectomy and bilateral lymphadenectomy-Case report and literature review.

PubMed

Elsandabesee, D; Sharma, B; Preston, J; Ostrowski, J; Nieto, J

2004-02-01

Formation of lymphoceles following radical vulvectomy presents a formidable problem that is associated with high degree of morbidity. A variety of approaches have been described in the literature to treat this condition. An 82-year-old woman developed massive inguinal lymphoceles following partial vulvectomy and inguinal lymphadenectomy for cancer vulva. The lymphoceles involved wide surface areas extending to both flanks, and accumulation of lymph was very rapid at a rate of 1 l daily. The condition failed to respond to continuous drainage and compression for 6 weeks, but responded quickly to sclerotherapy using bleomycin without any significant side effects. Intracavitary bleomycin could be used safely and effectively in huge rapidly accumulating lymphoceles.

Tension-free repair during extensive radical surgery for cecal cancer with abdominal wall invasion and inguinal lymph node metastasis

PubMed Central

Xu, Kaiwu; Chen, Zhihui; Song, Xinming

2014-01-01

We report a case of cecal cancer with invasion of the abdominal wall and right inguinal lymph node metastasis. This patient had undergone an appendectomy 2 years previously. He underwent extensive radical right hemicolectomy with anastomosis and tension-free repair of the damaged right lower abdominal wall. The surgery progressed successfully, and the vital signs of the patient were stable (approximately 200 mL blood loss). Postoperative diagnosis revealed moderately to poorly differentiated adenocarcinoma of the cecum with invasion of the abdominal wall and metastasis of the inguinal lymph nodes (pT4bN2bM1, IV4a). The patient has remained well post-surgery. PMID:24855366

Physical mechanisms for chemotactic pattern formation by bacteria.

PubMed Central

Brenner, M P; Levitov, L S; Budrene, E O

1998-01-01

This paper formulates a theory for chemotactic pattern formation by the bacteria Escherichia coli in the presence of excreted attractant. In a chemotactically neutral background, through chemoattractant signaling, the bacteria organize into swarm rings and aggregates. The analysis invokes only those physical processes that are both justifiable by known biochemistry and necessary and sufficient for swarm ring migration and aggregate formation. Swarm rings migrate in the absence of an external chemoattractant gradient. The ring motion is caused by the depletion of a substrate that is necessary to produce attractant. Several scaling laws are proposed and are demonstrated to be consistent with experimental data. Aggregate formation corresponds to finite time singularities in which the bacterial density diverges at a point. Instabilities of swarm rings leading to aggregate formation occur via a mechanism similar to aggregate formation itself: when the mass density of the swarm ring exceeds a threshold, the ring collapses cylindrically and then destabilizes into aggregates. This sequence of events is demonstrated both in the theoretical model and in the experiments. PMID:9545032

Recommendations for numerical solution of reinforced-panel and fuselage-ring problems

NASA Technical Reports Server (NTRS)

Hoff, N J; Libby, Paul A

1949-01-01

Procedures are recommended for solving the equations of equilibrium of reinforced panels and isolated fuselage rings as represented by the external loads and the operations table established according to Southwell's method. From the solution of these equations the stress distribution can be easily determined. The method of systematic relaxations, the matrix-calculus method, and several other methods applicable in special cases are discussed. Definite recommendations are made for obtaining the solution of reinforced-panel problems which are generally designated as shear lag problems. The procedures recommended are demonstrated in the analysis of a number of panels. In the case of fuselage rings it is not possible to make definite recommendations for the solution of the equilibrium equations for all rings and loadings. However, suggestions based on the latest experience are made and demonstrated on several rings.

Application of Newton's method to the postbuckling of rings under pressure loadings

NASA Technical Reports Server (NTRS)

Thurston, Gaylen A.

1989-01-01

The postbuckling response of circular rings (or long cylinders) is examined. The rings are subjected to four types of external pressure loadings; each type of pressure is defined by its magnitude and direction at points on the buckled ring. Newton's method is applied to the nonlinear differential equations of the exact inextensional theory for the ring problem. A zeroth approximation for the solution of the nonlinear equations, based on the mode shape corresponding to the first buckling pressure, is derived in closed form for each of the four types of pressure. The zeroth approximation is used to start the iteration cycle in Newton's method to compute numerical solutions of the nonlinear equations. The zeroth approximations for the postbuckling pressure-deflection curves are compared with the converged solutions from Newton's method and with similar results reported in the literature.

Exploring the ring current of carbon nanotubes by first-principles calculations.

PubMed

Ren, Pengju; Zheng, Anmin; Xiao, Jianping; Pan, Xiulian; Bao, Xinhe

2015-02-01

Ring current is a fundamental concept to understand the nuclear magnetic resonance (NMR) properties and aromaticity for conjugated systems, such as carbon nanotubes (CNTs). Employing the recently developed gauge including projector augmented wave (GIPAW) method, we studied the ring currents of CNTs systematically and visualized their distribution. The ring current patterns are determined by the semiconducting or metallic properties of CNTs. The discrepancy is mainly caused by the axial component of external magnetic fields, whereas the radial component induced ring currents are almost independent of the electronic structures of CNTs, where the intensities of the ring currents are linearly related to the diameters of the CNTs. Although the ring currents induced by the radial component are more intense than those by the axial component, only the latter determines the overall NMR responses and aromaticity of the CNTs as well. Furthermore, the semiconducting CNTs are more aromatic than their metallic counterparts due to the existence of delocalized ring currents on the semiconducting CNTs. These fundamental features are of vital importance for the development of CNT-based nanoelectronics and applications in magnetic fields.

Exploring the ring current of carbon nanotubes by first-principles calculations

PubMed Central

Ren, Pengju; Zheng, Anmin; Xiao, Jianping; Pan, Xiulian

2015-01-01

Ring current is a fundamental concept to understand the nuclear magnetic resonance (NMR) properties and aromaticity for conjugated systems, such as carbon nanotubes (CNTs). Employing the recently developed gauge including projector augmented wave (GIPAW) method, we studied the ring currents of CNTs systematically and visualized their distribution. The ring current patterns are determined by the semiconducting or metallic properties of CNTs. The discrepancy is mainly caused by the axial component of external magnetic fields, whereas the radial component induced ring currents are almost independent of the electronic structures of CNTs, where the intensities of the ring currents are linearly related to the diameters of the CNTs. Although the ring currents induced by the radial component are more intense than those by the axial component, only the latter determines the overall NMR responses and aromaticity of the CNTs as well. Furthermore, the semiconducting CNTs are more aromatic than their metallic counterparts due to the existence of delocalized ring currents on the semiconducting CNTs. These fundamental features are of vital importance for the development of CNT-based nanoelectronics and applications in magnetic fields. PMID:29560175

Simulating Local Area Network Protocols with the General Purpose Simulation System (GPSS)

DTIC Science & Technology

1990-03-01

generation 15 3.1.2 Frame delivery . 15 3.2 Model artifices 16 3.3 Model variables 17 3.4 Simulation results 18 4. EXTERNAL PROCEDURES USED IN SIMULATION 19...46 15. Token Ring: Frame generation process 47 16. Token Ring: Frame delivery process 48 17 . Token Ring: Mean transfer delay vs mean throughput 49...assumed to be zero were replaced by the maximum values specified in the ANSI 802.3 standard (viz &MI=6, &M2=3, &M3= 17 , &D1=18, &D2=3, &D4=4, &D7=3, and

A national trainee-led audit of inguinal hernia repair in Scotland.

PubMed

O'Neill, S; Robertson, A G; Robson, A J; Richards, C H; Nicholson, G A; Mittapalli, D

2015-10-01

This audit assessed inguinal hernia surgery in Scotland and measured compliance with British Hernia Society Guidelines (2013), specifically regarding management of bilateral and recurrent inguinal hernias. It also assessed the feasibility of a national trainee-led audit, evaluated regional variations in practise and gauged operative exposure of trainees. A prospective audit of adult inguinal hernia repairs across every region in Scotland (30 hospitals in 14 NHS boards) over 2-weeks was co-ordinated by the Scottish Surgical Research Group (SSRG). 235 patients (223 male, median age 61) were identified and 96 % of cases were elective. Anaesthesia was 91 % general, 5 % spinal and 3 % local. Prophylactic antibiotics were administered in 18 %. Laparoscopic repair was used in 33 % (30 % trainee-performed). Open repair was used in 67 % (42 % trainee-performed). Elective primary bilateral hernia repairs were laparoscopic in 97 % while guideline compliance for an elective recurrence was 77 %. For elective primary unilateral hernias, the use of laparoscopic repair varied significantly by region (South East 43 %, North 14 %, East 7 % and West 6 %, p < 0.001) as did repair under local anaesthesia for open cases (North 21 %, South East 4 %, West 2 % and East 0 %, p = 0.001). Trainees independently performed 9 % of procedures. There were no significant differences in trainee or unsupervised trainee operator rates between laparoscopic and open cases. Mean hospital stay was 0.7-days with day case surgery performed in 69 %. This trainee-lead audit provides a contemporary view of inguinal hernia surgery in Scotland. Increased compliance on recurrent cases appears indicated. National re-audit could ensure improved adherence and would be feasible through the SSRG.

Laparoscopic inguinal hernia repair: a prospective evaluation at Eastern Nepal

PubMed Central

Shakya, Vikal Chandra; Sood, Shasank; Bhattarai, Bal Krishna; Agrawal, Chandra Shekhar; Adhikary, Shailesh

2014-01-01

Introduction Inguinal hernias have been treated traditionally with open methods of herniorrhaphy or hernioplasty. But the trends have changed in the last decade with the introduction of minimal access surgery. Methods This study was a prospective descriptive study in patients presenting to Surgery Department of B. P. Koirala Institute of Health Sciences, Dharan, Nepal with reducible inguinal hernias from January 2011 to June 2012. All patients >18 years of age presenting with inguinal hernias were given the choice of laparoscopic repair or open repair. Those who opted for laparoscopic repair were included in the study. Results There were 50 patients, age ranged from 18 to 71 years with 34 being median age at presentation. In 41 patients, totally extraperitoneal repair was attempted. Of these, 2 (4%) repairs were converted to transabdominal repair and 2 to open mesh repair (4%). In 9 patients, transabdominal repair was done. The median total hospital stay was 4 days (range 3-32 days), the mean postoperative stay was 3.38±3.14 days (range 2-23 days), average time taken for full ambulation postoperatively was 2.05±1.39 days (range 1-10 days), and median time taken to return for normal activity was 5 days (range 2-50 days). One patient developed recurrence (2%). None of the patients who had laparoscopic repair completed complained of neuralgias in the follow-up. Conclusion Laparoscopic repair of inguinal hernias could be contemplated safely both via totally extra peritoneal as well as transperitoneal route even in our setup of a developing country with modifications. PMID:25170385

Transabdominal preperitoneal laparoscopic inguinal herniorrhaphy: assessment of initial experience.

PubMed

Barry, M K; Donohue, J H; Harmsen, W S; Ilstrup, D M

1998-08-01

To evaluate our initial experience with laparoscopic inguinal herniorrhaphy. We retrospectively studied a consecutive series of patients selectively chosen for laparoscopic repair of inguinal hernia. The study cohort consisted of 173 patients treated by a single surgeon between 1992 and 1995. For all operations, a transabdominal approach was used. Follow-up was obtained by telephone contact or letter. The study group consisted of 167 male and 6 female patients with a mean age at operation of 55 years (range, 15 to 81). During the study period, 206 laparoscopic inguinal hernia repairs were performed in the 173 patients. Only one patient (0.6%) required conversion to laparotomy. Bilateral hernia repair was done in 31 patients (18%). Of the 206 procedures, 63 repairs (31%) were performed for recurrent hernias. In 69% of the patients, the procedure was completed on an outpatient basis. Early postoperative complications necessitating surgical intervention occurred in four patients. The median time to return to work or normal physical activity was 7 days for unilateral and 12 days for bilateral hernia repair (P = 0.18). A mean follow-up of 29 months was obtained for 171 patients (99%). In six patients (3%), a recurrent hernia developed. Four of these six patients had previously undergone an open surgical procedure on the side of the recurrence. Laparoscopic inguinal herniorrhaphy is a feasible alternative to open hernia repair. This operation, however, should be reserved for selected patients. Longer follow-up and controlled trials comparing laparoscopic and tension-free open herniorrhaphy are necessary for assessment of the relative benefits of this procedure.

Local anesthetic infusion pump for pain management following open inguinal hernia repair: a meta-analysis.

PubMed

Wu, Chien-Chih; Bai, Chyi-Huey; Huang, Ming-Te; Wu, Chih-Hsiung; Tam, Ka-Wai

2014-01-01

Open inguinal hernia repair is one of the most painful procedures in day surgery. A continuous ambulatory analgesic is thought to reduce postoperative pain when it is applied to the surgical site. The aim of this study is to evaluate the efficacy of local anesthetic infusion pump following open inguinal hernia repair for the reduction of postoperative pain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that have investigated the outcomes of using an infusion pump for delivering a local anesthetic contrasted to a control group for open inguinal hernia repair. Pain was assessed from Day 1 to Day 5 following the surgery. The secondary outcomes included analgesia use and postoperative complications. We reviewed 5 trials that totaled 288 patients. The analgesic effects of bupivacaine (4 trials) and ropivacaine (one trial) were compared with a placebo group. The pooled mean difference in the score measuring the degree of pain diminished significantly at Day 1 to Day 4 in the experimental group. Two studies have reported that the number of analgesics required also decreased in the experimental group. No bupivacaine-related complication was reported. Our results revealed that applying a local anesthetic infusion pump following inguinal hernia repairs was more efficacious for reducing postoperative pain than a placebo. However, the findings were based on a small body of evidence in which methodological quality was not high. The potential benefits of applying a local anesthetic infusion pump to hernia repair must still be adequately investigated using further RCTs. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

A multivariate analysis of clinical and morphological prognostic factors in squamous cell carcinoma of the vulva.

PubMed

Smyczek-Gargya, B; Volz, B; Geppert, M; Dietl, J

1997-01-01

Clinical and histological data of 168 patients with squamous cell carcinoma of the vulva were analyzed with respect to survival. 151 patients underwent surgery, 12 patients were treated with primary radiation and in 5 patients no treatment was performed. Follow-up lasted from at least 2 up to 22 years' posttreatment. In univariate analysis, the following factors were highly significant: presurgery lymph node status, tumor infiltration beyond the vulva, tumor grading, histological inguinal lymph node status, pre- and postsurgery tumor stage, depth of invasion and tumor diameter. In the multivariate analysis (Cox regression), the most powerful factors were shown to be histological inguinal lymph node status, tumor diameter and tumor grading. The multivariate logistic regression analysis worked out as main prognostic factors for metastases of inguinal lymph nodes: presurgery inguinal lymph node status, tumor size, depth of invasion and tumor grading. Based on these results, tumor biology seems to be the decisive factor concerning recurrence and survival. Therefore, we suggest a more conservative treatment of vulvar carcinoma. Patients with confined carcinoma to the vulva, with a tumor diameter up to 3 cm and without clinical suspected lymph nodes, should be treated by wide excision/partial vulvectomy with ipsilateral lymphadenectomy.

[Advantages of ilio-inguinal extraction of the kidney after retroperitoneoscopic nephroureterectomy].

PubMed

Burghelea, C; Lucan, M; Ghervan, L; Lucan, C V; Bologa, F; Elec, F; Moga, S; Bărbos, A; Iacob, G

2008-01-01

The manner to extract the specimen after retro-peritoneoscopic nephroureterectomy varies to different surgical teams. The aim of the surgeon is to extract the specimen with minimum parietal injuries, according with oncologic principles. The objective of our study was to evaluate the ilio-inguinal approach to extract the specimen after retro-peritoneoscopic nephroureterectomy. Evaluation and follow-up of 71 patients with retroperitoneoscopic nephroureterectomy for urothelial cancer (65 pelvic urothelial carcinoma and 6 urothelial carcinoma of the ureter). Ilio-inguinal incision was used for 68 patients to extract the specimen. The operating time was 110 +/- 47 min. Blood lost 101 +/- 57 ml. Retroperitoneoscopic approach 10 +/- 4 min. Ilio-inguinal approach 25 +/- 10 min. The weight of the specimen was 601 +/- 127g. Tumor dimension was 5.9 +/- 1.9 cm. No conversion to open surgery was made. No late post surgery complications were registered ( follow-up at 2 and 6 months). The enlarged nephroureterectomy can be performed using retroperitoneoscopic approach and the specimen can be extracted through an incision at iliac fossa. This approach can be used to extract large specimens preserving the esthetic laparoscopic benefit as well as the oncologic salty and reducing the risk of post-operative eventration.

Preoperative radiotherapy followed by radical vulvectomy with inguinal lymphadenectomy for advanced vulvar carcinomas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rotmensch, J.; Rubin, S.J.; Sutton, H.G.

1990-02-01

A therapeutic alternative to exenteration for large locally advanced vulvar carcinoma involving the rectum, anus, or vagina is the use of preoperative radiation followed by radical surgery. Between 1980 and 1988, 13 patients with Stage III and 3 with Stage IV vulvar carcinoma involving the rectum/anus, urethra, or vagina were treated with 4000 rad to the vulva and 4500 rad to the inguinal and pelvic nodes followed by a radical vulvectomy and inguinal lymphadenectomy 4 weeks later. The overall 5 year cumulative survival was 45%. Twelve tumors regressed after radiation with 62.5% of the patients having visceral preservation while inmore » 4 patients there was no major response to radiation and urinary or fecal diversion was required. Of the 6 recurrences 4 were central and 2 distant. Three patients with central recurrences had tumor within 1 cm of the vulvectomy margin. Complications included wet desquamation, inguinal wound separation, lymphedema, and urethral strictures. There were no operative deaths. It is concluded that the use of preoperative radiation followed by radical vulvectomy may be an alternative to pelvic exenteration in selected patients with advanced vulvar lesions.« less

Elective ilioingunial lymph node irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Henderson, R.H.; Parsons, J.T.; Morgan, L.

1984-06-01

Most radiologists accept that modest doses of irradiation (4500-5000 rad/4 1/2-5 weeks) can control subclinical regional lymph node metastases from squamous cell carcinomas of the head and neck and adenocarcinomas of the breast. There have been few reports concerning elective irradiation of the ilioinguinal region. Between October 1964 and March 1980, 91 patients whose primary cancers placed the ilioinguinal lymph nodes at risk received elective irradiation at the University of Florida. Included are patients with cancers of the vulva, penis, urethra, anus and lower anal canal, and cervix or vaginal cancers that involved the distal one-third of the vagina. Inmore » 81 patients, both inguinal areas were clinically negative; in 10 patients, one inguinal area was positive and the other negative by clinical examination. The single significant complication was a bilateral femoral neck fracture. The inguinal areas of four patients developed mild to moderate fibrosis. One patient with moderate fibrosis had bilateral mild leg edema that was questionably related to irradiation. Complications were dose-related. The advantages and dis-advantages of elective ilioinguinal node irradiation versus elective inguinal lymph node dissection or no elective treatment are discussed.« less

Compendium of fracture mechanics problems

NASA Technical Reports Server (NTRS)

Stallworth, R.; Wilson, C.; Meyers, C.

1990-01-01

Fracture mechanics analysis results are presented from the following structures/components analyzed at Marshall Space Flight Center (MSFC) between 1982 and 1989: space shuttle main engine (SSME), Hubble Space Telescope (HST), external tank attach ring, B-1 stand LOX inner tank, and solid rocket booster (SRB). Results from the SSME high pressure fuel turbopump (HPFTP) second stage blade parametric analysis determine a critical flaw size for a wide variety of stress intensity values. The engine 0212 failure analysis was a time dependent fracture life assessment. Results indicated that the disk ruptured due to an overspeed condition. Results also indicated that very small flaws in the curvic coupling area could propagate and lead to failure under normal operating conditions. It was strongly recommended that a nondestructive evaluation inspection schedule be implemented. The main ring of the HST, scheduled to launch in 1990, was analyzed by safe-life and fail-safe analyses. First safe-life inspection criteria curves for the ring inner and outer skins and the fore and aft channels were derived. Afterwards the skins and channels were determined to be fail-safe by analysis. A conservative safe-life analysis was done on the 270 redesign external tank attach ring. Results from the analysis were used to determine the nondestructive evaluation technique required.

Electric dipole moment of magnetoexciton in concentric quantum rings

NASA Astrophysics Data System (ADS)

García, L. F.; Mikhailov, I. D.; Revinova, S. Yu

2017-12-01

We study properties of exciton in a weakly coupled concentric quantum rings, penetrated by an axially directed magnetic flux and subjected to an electric field in the ring’s plane. To this end, we adopt a simple model of quasi-one-dimensional rotator, for which the wave functions and the corresponding energies we found by using the double Fourier series expansion method. Revealed multiple intersections of the energy levels provide conditions for abrupt changes of the radial and the angular quantum numbers, making possible the tunnelling of carriers between rings and allowing the formation of a permanent large dipole moment. We show that the electric and magnetic polarizability of concentric quantum rings with a trapped exciton are very sensible to external electric and magnetic fields.

TSR: A storage and cooling ring for HIE-ISOLDE

NASA Astrophysics Data System (ADS)

Butler, P. A.; Blaum, K.; Davinson, T.; Flanagan, K.; Freeman, S. J.; Grieser, M.; Lazarus, I. H.; Litvinov, Yu. A.; Lotay, G.; Page, R. D.; Raabe, R.; Siesling, E.; Wenander, F.; Woods, P. J.

2016-06-01

It is planned to install the heavy-ion, low-energy ring TSR, currently at the Max-Planck-Institute for Nuclear Physics in Heidelberg, at the HIE-ISOLDE facility in CERN, Geneva. Such a facility will provide a capability for experiments with stored, cooled secondary beams that is rich and varied, spanning from studies of nuclear ground-state properties and reaction studies of astrophysical relevance, to investigations with highly-charged ions and pure isomeric beams. In addition to experiments performed using beams recirculating within the ring, the cooled beams can be extracted and exploited by external spectrometers for high-precision measurements. The capabilities of the ring facility as well as some physics cases will be presented, together with a brief report on the status of the project.

Cases of death caused by gas or warning firearms.

PubMed

Rothschild, M A; Maxeiner, H; Schneider, V

1994-01-01

Five cases of lethal injuries caused by gas or warning firearms are discussed. In one suicide case a modified weapon (elongated barrel) and steel bullets were used to fire a shot into the head, the bullets lodged in the skull and lethal bleeding resulted. In the other cases conventional gas weapons without evidence of alteration were used for contact shots; injuries were caused by the effect of propelling powder gases. Two of these cases were suicides (temporal contact shot and back of the neck contact shot), one was an accident (inguinal contact shot with lethal bleeding), and one was an attack by another person with a contact shot against the neck with bilateral tears of the hypopharynx. After successful surgery, a delayed death occurred 12 days later caused by bleeding into the airways from the ruptured external carotid artery.

Acute Pelvic Fractures: II. Principles of Management.

PubMed

Tile

1996-05-01

The past two decades have seen many advances in pelvic-trauma surgery. Provisional fixation of unstable pelvic-ring disruptions and open-book fractures with a pelvic clamp or an external frame with a supracondylar pin has proved markedly beneficial in the resuscitative phase of management. In the completely unstable pelvis, external clamps and frames can act only as provisional fixation and should be combined with skeletal traction. The traction pin is usually used only until a definitive form of stabilization can be applied to keep the pelvic ring in a reduced position. If the patient is too ill to allow operative intervention, the traction pin can remain in place with the external frame as definitive treatment. Symphyseal disruptions and medial ramus fractures should be plated at the time of laparotomy. Lateral ramus fractures can usually be controlled with external frames. A role has been suggested for percutaneous retrograde fixation of the superior pubic ramus; however, the benefits to be gained may not be enough to outweigh the serious risks of penetrating the hip, and this technique should therefore be used only by surgeons trained in its performance. The techniques for posterior fixation are becoming more standardized, but all still carry significant risks, especially to neurologic structures.

Mechanical improvement of metal reinforcement rings for a finite ring-shaped superconducting bulk

NASA Astrophysics Data System (ADS)

Huang, Chen-Guang; Zhou, You-He

2018-03-01

As a key technique, reinforcement of type-II superconducting bulks with metal rings can efficiently improve their mechanical properties to enhance the maximum trapped field. In this paper, we study the magnetostrictive and fracture behaviors of a finite superconducting ring bulk reinforced by three typical reinforcing structures composed of metal rings during the magnetizing process by means of the minimization of magnetic energy and the finite element method. After a field-dependent critical current density is adopted, the magnetostriction, pinning-induced stress, and crack tip stress intensity factor are calculated considering the demagnetization effects. The results show that the mechanical properties of the ring bulk are strongly dependent on the reinforcing structure and the material and geometrical parameters of the metal rings. Introducing the metal ring can significantly reduce the hoop stress, and the reduction effect by internal reinforcement is much improved relative to external reinforcement. By comparison, bilateral reinforcement seems to be the best candidate structure. Only when the metal rings have particular Young's modulus and radial thickness will they contribute to improve the mechanical properties the most. In addition, if an edge crack is pre-existing in the ring bulk, the presence of metal rings can effectively avoid crack propagation since it reduces the crack tip stress intensity factor by nearly one order of magnitude.

Double autologous lymph node transplantation (ALNT) at the level of the knee and inguinal region for advanced lymphoedema of the lower limb (elephantiasis).

PubMed

Gómez Martín, C; Murillo, C; Maldonado, A A; Cristóbal, L; Fernández-Cañamaque, J L

2014-02-01

Primary lower-limb lymphoedema is a chronic, progressive and debilitating condition with a difficult management, especially in advanced cases (elephantiasis). Recently, autologous lymph node transplantation (ALNT) appears to be a promising treatment for extremity lymphoedema. A case of a double ALNT for an advanced primary lower-limb lymphoedema is here reported: a contralateral inguinal lymph node flap was transferred to the knee and, in a second surgery, a thoracic lymph node flap was transplanted to the inguinal region. Clinical outcomes at 5 months postoperatively are very satisfactory with reduction in limb circumferences and improvement in skin quality and social impairment. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

An extraneural primary anaplastic ependymoma at the subcutaneous inguinal region: Report of a rare case.

PubMed

Sayar, Hamide; Ersen, Ayca; Kurtul, Neslihan; Yazar, Mehmet Fatih; Balakan, Ozan

2015-01-01

Ependymomas commonly arise in the central nervous system. Extraneural presentation is quite rare. Herein, we describe a primary extraneural ependymoma in a young female. The mass was located in the right inguinal area. The cut surface of the 7.5 mm × 6.5 mm × 4.5 mm sized tumor was brownish-yellow in color. Histologically, it was hypercellular exhibiting pseudorosette or rosette formations and some papillary structures. Mitosis was counted as high as 10 per 10 high power fields. Neither necrosis nor vascular endothelial proliferation within the tumor was observed. Tumor cells showed strong glial fibrillary acidic protein immunoreactivity. On epithelial membrane antigen, intracytoplasmic dot-like immunostaining was observed. This is the first report presenting a primary extraneural anaplastic ependymoma arising in the inguinal subcutaneous region.

Fractional conductance oscillations in quantum rings: wave packet picture of transport in a few-electron system.

PubMed

Chwiej, T; Szafran, B

2013-04-17

We study electron transfer across a two-terminal quantum ring using a time-dependent description of the scattering process. For the considered scattering event the quantum ring is initially charged with one or two electrons, with another electron incident to the ring from the input channel. We study the electron transfer probability (T) as a function of the external magnetic field. We determine the periodicity of T for a varied number of electrons confined within the ring. For that purpose we develop a method to describe the wave packet dynamics for a few electrons participating in the scattering process, taking into full account the electron-electron correlations. We find that electron transfer across the quantum ring initially charged by a single electron acquires a distinct periodicity of half of the magnetic flux quantum (Φ0/2), corresponding to the formation of a transient two-electron state inside the ring. In the case of a three-electron scattering problem with two electrons initially occupying the ring, a period of Φ0/3 for T is formed in the limit of thin channels. The effect of disorder present in the confinement potential of the ring is also discussed.

Treatment of refractory chylothorax with externalized pleuroperitoneal shunts in children.

PubMed

Wolff, A B; Silen, M L; Kokoska, E R; Rodgers, B M

1999-09-01

Traditional therapy for refractory chylothorax in the pediatric population has included pleurodesis and thoracic duct ligation. These procedures are associated with high morbidity and questionable success rates. We retrospectively reviewed our experience with 15 patients who underwent treatment for chylous effusions using pleuroperitoneal shunts with exteriorized pump chambers. Mean patient age at time of shunt placement was 2.1 (0.1 to 11.5) years and the most common indication (7 of 15) was refractory chylothorax following surgical correction of congenital heart disease. Mean chylothorax duration before shunt placement was 76 (5 to 810) days and shunts were in place for an average of 104 (12 to 365) days. A total of 19 chylous effusions (pleural or pericardial) were treated with shunts. Nine of 11 right-sided chylothoraces, 5 of 6 left-sided chylothoraces, and 2 of 2 chylopericardia resolved with shunt therapy (84% total). Pleuroperitoneal shunting failed to clear the effusion in 3 children. There were six episodes of shunt malfunction that were repaired and two episodes of infection. Inguinal or umbilical hernia developed in 4 patients. Externalized pleuroperitoneal shunting is a safe, effective, and minimally invasive treatment for children with refractory chylous effusions.

Effect of boundary conditions on magnetocapacitance effect in a ring-type magnetoelectric structure

NASA Astrophysics Data System (ADS)

Zhang, Juanjuan

2017-12-01

By considering the nonlinear magneto-elastic coupling relationships of magnetostrictive materials, an analytical model is proposed. The resonance frequencies can be accurately predicted by this theoretical model, and they are in good agreement with experimental data. Subsequently, the magnetocapacitance effect in a ring-type magnetoelectric (ME) structure with different boundary conditions is investigated, and it is found that various mechanical boundaries, the frequency, the magnetic field, the geometric size, and the interface bonding significantly affect the capacitance of the ME structure. Further, additional resonance frequencies can be predicted by considering appropriate imperfect interface bonding. Finally, the influence of an external force on the capacitance is studied. The result shows that an external force on the boundary changes the capacitance, but has only a weak influence on the resonance frequency.

Dynamical mechanism for sharp orientation tuning in an integrate-and-fire model of a cortical hypercolumn.

PubMed

Bressloff, P C; Bressloff, N W; Cowan, J D

2000-11-01

Orientation tuning in a ring of pulse-coupled integrate-and-fire (IF) neurons is analyzed in terms of spontaneous pattern formation. It is shown how the ring bifurcates from a synchronous state to a non-phase-locked state whose spike trains are characterized by clustered but irregular fluctuations of the interspike intervals (ISIs). The separation of these clusters in phase space results in a localized peak of activity as measured by the time-averaged firing rate of the neurons. This generates a sharp orientation tuning curve that can lock to a slowly rotating, weakly tuned external stimulus. Under certain conditions, the peak can slowly rotate even to a fixed external stimulus. The ring also exhibits hysteresis due to the subcritical nature of the bifurcation to sharp orientation tuning. Such behavior is shown to be consistent with a corresponding analog version of the IF model in the limit of slow synaptic interactions. For fast synapses, the deterministic fluctuations of the ISIs associated with the tuning curve can support a coefficient of variation of order unity.

Tolerance doses of cutaneous and mucosal tissues in ring-necked parakeets (Psittacula krameri) for external beam megavoltage radiation.

PubMed

Barron, Heather W; Roberts, Royce E; Latimer, Kenneth S; Hernandez-Divers, Stephen; Northrup, Nicole C

2009-03-01

Currently used dosages for external-beam megavoltage radiation therapy in birds have been extrapolated from mammalian patients and often appear to provide inadequate doses of radiation for effective tumor control. To determine the tolerance doses of cutaneous and mucosal tissues of normal birds in order to provide more effective radiation treatment for tumors that have been shown to be radiation responsive in other species, ingluvial mucosa and the skin over the ingluvies of 9 ring-necked parakeets (Psittacula krameri) were irradiated in 4-Gy fractions to a total dose of either 48, 60, or 72 Gy using an isocentric cobalt-60 teletherapy unit. Minimal radiation-induced epidermal changes were present in the high-dose group histologically. Neither dose-related acute nor chronic radiation effects could be detected in any group grossly in cutaneous or mucosal tissue over a 9-month period. Radiation doses of 72 Gy in 4-Gy fractions were well tolerated in the small number of ring-necked parakeets in this initial tolerance dose study.

Laparoscopic repair of inguinal hernia in adults

PubMed Central

Yang, Xue-Fei

2016-01-01

Laparoscopic repair of inguinal hernia is mini-invasive and has confirmed effects. The procedures include intraperitoneal onlay mesh (IPOM) repair, transabdominal preperitoneal (TAPP) repair and total extraperitoneal (TEP) repair. These procedures have totally different anatomic point of view, process and technical key points from open operations. The technical details of these operations are discussed in this article, also the strategies of treatment for some special conditions. PMID:27867954

Transversus Abdominis Plane Block versus Ilioinguinal/Iliohypogastric Nerve Block with Wound Infiltration for Postoperative Analgesia in Inguinal Hernia Surgery: A Randomized Clinical Trial.

PubMed

Sujatha, Chinthavali; Zachariah, Mamie; Ranjan, R V; George, Sagiev Koshy; Ramachandran, T R; Pillai, Anil Radhakrishna

2017-01-01

Various analgesic modalities have been used for postoperative analgesia in patients undergoing inguinal hernia surgery. In this randomized clinical trial, we have compared the analgesic efficacy of transversus abdominis plane (TAP) block with that of ilioinguinal/iliohypogastric (IIIH) nerve block with wound infiltration in patients undergoing unilateral open inguinal hernia repair. The primary objective of this study was to compare the efficacy of postoperative analgesia of ultrasound-guided TAP block and IIIH block with wound infiltration (WI) in patients undergoing open inguinal hernia surgery. This was a randomized clinical trial performed in a tertiary care hospital. Sixty patients scheduled for hernia repair were randomized into two groups, Group T and Group I. Postoperatively, under ultrasound guidance, Group T received 20 ml of 0.25% ropivacaine - TAP block and Group I received 10 ml of 0.25% ropivacaine - IIIH block + WI with 10 ml of 0.25% ropivacaine. The primary outcome measure was the time to rescue analgesia in the first 24 h postoperatively. Fentanyl along with diclofenac was given as first rescue analgesic when the patient complained of pain. Statistical comparisons were performed using Student's t -test and Chi-square test. Mean time to rescue analgesia was 5.900 ± 1.881 h and 3.766 ± 1.754 h ( P < 0.001) and the mean pain scores were 5.73 ± 0.784 and 6.03 ± 0.850 for Group TAP and IIIH + WI, respectively. Hemodynamics were stable in both the groups. One-third of the patients received one dose of paracetamol in addition to the rescue analgesic in the first 24 h. There were no complications attributed to the block. As a multimodal analgesic regimen, definitely both TAP block and IIIH block with wound infiltration have a supporting role in providing analgesia in the postoperative period for adult inguinal hernia repair. In this study, ultrasound-guided TAP block provided longer pain control postoperatively than IIIH block with WI after inguinal hernia repair. There were no complications attributed to the blocks in either of the group.

The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery.

PubMed

Lindström, D; Sadr Azodi, O; Bellocco, R; Wladis, A; Linder, S; Adami, J

2007-04-01

The extent to which lifestyle factors such as tobacco consumption and obesity affect the outcome after inguinal hernia surgery has been poorly studied. This study was undertaken to assess the effect of smoking, smokeless tobacco consumption and obesity on postoperative complications after inguinal hernia surgery. The second aim was to evaluate the effect of tobacco consumption and obesity on the length of hospital stay. A cohort of 12,697 Swedish construction workers with prospectively collected exposure data on tobacco consumption and body mass index (BMI) from 1968 onward were linked to the Swedish inpatient register. Information on inguinal hernia procedures was collected from the inpatient register. Any postoperative complication occurring within 30 days was registered. In addition to this, the length of hospitalization was calculated. The risk of postoperative complications due to tobacco exposure and BMI was estimated using a multiple logistic regression model and the length of hospital stay was estimated in a multiple linear regression model. After adjusting for the other covariates in the multivariate analysis, current smokers had a 34% (OR 1.34, 95% CI 1.04, 1.72) increased risk of postoperative complications compared to never smokers. Use of "Swedish oral moist snuff" (snus) and pack-years of tobacco smoking were not found to be significantly associated with an increased risk of postoperative complications. BMI was found to be significantly associated with an increased risk of postoperative complications (P = 0.04). This effect was mediated by the underweighted group (OR 2.94; 95% CI 1.15, 7.51). In a multivariable model, increased BMI was also found to be significantly associated with an increased mean length of hospital stay (P < 0.001). There was no statistically significant association between smoking or using snus, and the mean length of hospitalization after adjusting for the other covariates in the model. Smoking increases the risk of postoperative complications even in minor surgery such as inguinal hernia procedures. Obesity increases hospitalization after inguinal hernia surgery. The Swedish version of oral moist tobacco, snus, does not seem to affect the complication rate after hernia surgery at all.

Athletic pubalgia and associated rehabilitation.

PubMed

Ellsworth, Abigail A; Zoland, Mark P; Tyler, Timothy F

2014-11-01

Evaluation and treatment of groin pain in athletes is challenging. The anatomy is complex, and multiple pathologies often coexist. Different pathologies may cause similar symptoms, and many systems can refer pain to the groin. Many athletes with groin pain have tried prolonged rest and various treatment regimens, and received differing opinions as to the cause of their pain. The rehabilitation specialist is often given a non-specific referral of "groin pain" or "sports hernia." The cause of pain could be as simple as the effects of an adductor strain, or as complex as athletic pubalgia or inguinal disruption. The term "sports hernia" is starting to be replaced with more specific terms that better describe the injury. Inguinal disruption is used to describe the syndromes related to the injury of the inguinal canal soft tissue environs ultimately causing the pain syndrome. The term athletic pubalgia is used to describe the disruption and/or separation of the more medial common aponeurosis from the pubis, usually with some degree of adductor tendon pathology. Both non-operative and post-operative treatment options share the goal of returning the athlete back to pain free activity. There is little research available to reference for rehabilitation guidelines and creation of a plan of care. Although each surgeon has their own specific set of post-operative guidelines, some common concepts are consistent among most surgeons. Effective rehabilitation of the high level athlete to pain free return to play requires addressing the differences in the biomechanics of the dysfunction when comparing athletic pubalgia and inguinal disruption. Proper evaluation and diagnostic skills for identifying and specifying the difference between athletic pubalgia and inguinal disruption allows for an excellent and efficient rehabilitative plan of care. Progression through the rehabilitative stages whether non-operative or post-operative allows for a focused rehabilitative program. As more information is obtained through MRI imaging and the diagnosis and treatment of inguinal disruption and athletic pubalgia becomes increasingly frequent, more research is warranted in this field to better improve the evidence based practice and rehabilitation of patients. 5.

Risks and Benefits of Adjuvant Radiotherapy After Inguinal Lymphadenectomy in Node-positive Penile Cancer: A Systematic Review by the European Association of Urology Penile Cancer Guidelines Panel.

PubMed

Robinson, Richard; Marconi, Lorenzo; MacPepple, Ekelechi; Hakenberg, Oliver W; Watkin, Nick; Yuan, Yuhong; Lam, Thomas; MacLennan, Steven; Adewuyi, Temitope E; Coscione, Alberto; Minhas, Suks S; Compérat, Eva M; Necchi, Andrea

2018-04-24

Management of men with penile squamous cell carcinoma (PSCC) who have high-risk features following radical inguinal lymphadenectomy (ILND) remains controversial. European Association of Urology guidelines state that adjuvant inguinal radiotherapy (AIRT) is "not generally recommended". Despite this, many centres continue to offer AIRT to a subset of men. To undertake a systematic review of the evidence on AIRT in node-positive men with PSCC. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with no language or date restriction. Inclusion criteria were men with PSCC, pathologically staged inguinal node positive after ILND. The intervention included ILND with AIRT compared with ILND alone. Primary outcomes were relapse-free survival and toxicity. Risk of bias assessment was undertaken. A total of 913 abstracts were identified and screened independently by two reviewers. Seven studies were eligible for inclusion: six full-text manuscripts and one conference abstract. All were retrospective series and at a high risk of bias. The selected studies included 1605 men. Indications for AIRT varied but were typically involvement of two or more inguinal nodes or extranodal extension. Regional recurrence rate following AIRT was reported at 10-91.7%. Only one study reported on toxicity. Two studies compared recurrence and survival between men who received and who did not receive AIRT, with no significant difference (p>0.05). The evidence indicates that men treated with AIRT do not gain benefit with respect to relapse or survival. Uncertainty remains due to the retrospective nature and high risks of bias across the evidence. Given the lack of evidence supporting AIRT, it cannot be recommended for routine practice. Men with penile cancer who have involvement of the inguinal lymph nodes are at a high risk of cancer recurrence and death. We reviewed the literature to see if radiation treatment after removal of the nodes provided benefit. We did not find any good-quality evidence supporting this treatment, and hence it cannot be recommended. Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

[What is the value of the internet as a source of information for patients with inguinal hernias? First results of an observational study].

PubMed

Zieren, J; Neuss, H; Maecker, F; Müller, J M

2002-05-01

The increasing use of the internet has led to a variety of medical web pages and an increasing amount of information about hospitals. Little is known about the extent to which this new medium is already used by patients as a source of information. For patients with inguinal hernia, for example, a frequent surgical symptom with large method variety, the value of the internet as a source of information should be examined. One hundred patients facing an elective inguinal hernia repair at the Surgical Department Charité Berlin took part in a prospective observation study (a questionnaire with 10 questions) between July 1999 and March 2001. The questions referred to the possibility of PC/internet access, other sources of information (e.g., general practitioner, friends, internet) as well as the criteria by which the clinic was chosen. Patients were asked to answer basic questions about the development and treatment of inguinal hernia and to give a self-assessment of their knowledge of inguinal hernia (0 = no knowledge; 10 = maximum knowledge). The questionnaire revealed that 39% of the patients (average age 47 +/- 16 years) had a PC in their homes, 24% of those with internet access; 11% had internet access at other places. It also showed that 53% of the patients sought medical information from their general practitioner, 29% from friends, and 18% from the internet. Young patients (median age 29 years), employees and patients with private internet access use the internet with significantly more frequency. Their medical knowledge as well as their self-assessment of medical knowledge was significantly higher (median 19 versus 7 points and median 8.6 versus 5.7, respectively) and they chose the clinic because of the information from their research on the internet. At present, the internet still plays a subordinate role as a source of information for patients with an inguinal hernia. The increasing presence of this medium as well as the higher internet acceptance of future patients indicates that it has a promising future as a source of medical information.

Inguinal hernia repair: is there a benefit to using the robot?

PubMed

Charles, Eric J; Mehaffey, J Hunter; Tache-Leon, Carlos A; Hallowell, Peter T; Sawyer, Robert G; Yang, Zequan

2018-04-01

The number of robotic surgical procedures performed yearly is constantly rising, due to improved dexterity and visualization capabilities compared with conventional methods. We hypothesized that outcomes after robotic-assisted inguinal hernia repair would not be significantly different from outcomes after laparoscopic or open repair. All patients undergoing inguinal hernia repair between 2012 and 2016 were identified using institutional American College of Surgeons National Surgical Quality Improvement Program data. Demographics; preoperative, intraoperative, and postoperative characteristics; and outcomes were evaluated based on method of repair (Robot, Lap, or Open). Categorical variables were analyzed by Chi-square test and continuous variables using Mann-Whitney U. A total of 510 patients were identified who underwent unilateral inguinal hernia repair (Robot: 13.8% [n = 69], Lap: 48.1% [n = 241], Open: 38.1% [n = 191]). There were no demographic differences between groups other than age (Robot: 52 [39-62], Lap: 57 [45-67], and Open: 56 [48-67] years, p = 0.03). Operative duration was also different (Robot: 105 [76-146] vs. Lap: 81 [61-103] vs. Open: 71 [56-88] min, p < 0.001). There were no operative mortalities and all patients except one were discharged home the same day. Postoperative occurrences (adverse events, readmissions, and death) were similar between groups (Robot: 2.9% [2], Lap: 3.3% [8], Open: 5.2% [10], p = 0.53). Although rare, there was a significant difference in rate of postoperative skin and soft tissue infection (Robot: 2.9% [2] vs. Lap: 0% [0] vs. Open: 0.5% [1], p = 0.02). Cost was significantly different between groups (Robot: $7162 [$5942-8375] vs. Lap: $4527 [$2310-6003] vs. Open: $4264 [$3277-5143], p < 0.001). Outcomes after robotic-assisted inguinal hernia repair were similar to outcomes after laparoscopic or open repair. Longer operative duration during robotic repair may contribute to higher rates of skin and soft tissue infection. Higher cost should be considered, along with surgeon comfort level and patient preference when deciding whether inguinal hernia repair is approached robotically.

On the buckling of elastic rings by external confinement.

PubMed

Hazel, Andrew L; Mullin, Tom

2017-05-13

We report the results of an experimental and numerical investigation into the buckling of thin elastic rings confined within containers of circular or regular polygonal cross section. The rings float on the surface of water held in the container and controlled removal of the fluid increases the confinement of the ring. The increased compressive forces can cause the ring to buckle into a variety of shapes. For the circular container, finite perturbations are required to induce buckling, whereas in polygonal containers the buckling occurs through a linear instability that is closely related to the canonical Euler column buckling. A model based on Kirchhoff-Love beam theory is developed and solved numerically, showing good agreement with the experiments and revealing that in polygons increasing the number of sides means that buckling occurs at reduced levels of confinement.This article is part of the themed issue 'Patterning through instabilities in complex media: theory and applications.' © 2017 The Author(s).

On the buckling of elastic rings by external confinement

PubMed Central

Hazel, Andrew L.

2017-01-01

We report the results of an experimental and numerical investigation into the buckling of thin elastic rings confined within containers of circular or regular polygonal cross section. The rings float on the surface of water held in the container and controlled removal of the fluid increases the confinement of the ring. The increased compressive forces can cause the ring to buckle into a variety of shapes. For the circular container, finite perturbations are required to induce buckling, whereas in polygonal containers the buckling occurs through a linear instability that is closely related to the canonical Euler column buckling. A model based on Kirchhoff–Love beam theory is developed and solved numerically, showing good agreement with the experiments and revealing that in polygons increasing the number of sides means that buckling occurs at reduced levels of confinement. This article is part of the themed issue ‘Patterning through instabilities in complex media: theory and applications.’ PMID:28373386

Electron localization and optical absorption of polygonal quantum rings

NASA Astrophysics Data System (ADS)

Sitek, Anna; Serra, Llorenç; Gudmundsson, Vidar; Manolescu, Andrei

2015-06-01

We investigate theoretically polygonal quantum rings and focus mostly on the triangular geometry where the corner effects are maximal. Such rings can be seen as short core-shell nanowires, a generation of semiconductor heterostructures with multiple applications. We show how the geometry of the sample determines the electronic energy spectrum, and also the localization of electrons, with effects on the optical absorption. In particular, we show that irrespective of the ring shape low-energy electrons are always attracted by corners and are localized in their vicinity. The absorption spectrum in the presence of a magnetic field shows only two peaks within the corner-localized state domain, each associated with different circular polarization. This picture may be changed by an external electric field which allows previously forbidden transitions, and thus enables the number of corners to be determined. We show that polygonal quantum rings allow absorption of waves from distant ranges of the electromagnetic spectrum within one sample.

New Synthetic Approaches to TAT

DTIC Science & Technology

1990-03-30

stabilized externally by resonance stabilization of electron withdrawing substituents placed on all four Nitrogen aL,.ms (T,- N -:, ...7; 4- N -NO2 HMX, etc...or internally by ring carbonyl groups adja- cent to the ring- N -atoms (amide resonance). 1. Cyclization experiments on methylene-bisacetamide (MBA4...more, the high instability of the desired 8-membered [8]ane- N 4 system, and the difficulty to apply proper cond’tion-. what the final products can

Dynamic apical surface rings in superficial layer cells of koi Cyprinus carpio scale epidermis.

PubMed

DePasquale, J A

2016-09-01

This study examined the novel ring-shaped structures found in the apical surface of individual cells of the scale epidermis of koi Cyprinus carpio. These apical rings are highly dynamic structures with lifetimes ranging from a few to several minutes. While several ring forms were observed, the predominant ring morphology is circular or oval. Two distinct ring forms were identified and designated type I and type II. Type I rings have a well-defined outer border that encircles the surface microridges. Type II rings are smooth-surfaced, dinner-plate-like structures with membranous folds or compressed microridges in the centre. Type II rings appear less frequently than type I rings. Type I rings form spontaneously, arising from swollen or physically interrupted microridges but without initially perturbing the encircled microridges. After persisting for up to several minutes the ring closes in a centripetal movement to form a circular or irregular-shaped structure, the terminal disc. The terminal disc eventually disappears, leaving behind a submembranous vesicle-like structure, the terminal body. Type I rings can undergo multiple cycles of formation and closing. Recycling epidermal apical rings form through centrifugal expansion from the terminal disc followed by apparent contraction back to the disc structure, whereupon the cycle may repeat or cease. The findings demonstrate a novel skin surface structure in fishes and are discussed with respect to communication with the external aqueous environment. © 2016 The Fisheries Society of the British Isles.

Laparoscopic totally extraperitoneal repair of inguinal hernia using two-hand approach--a gold standard alternative to open repair.

PubMed

Rajapandian, S; Senthilnathan, P; Gupta, Atul; Gupta, Pinak Das; Praveenraj, P; Vaitheeswaran, V; Palanivelu, C

2010-10-01

As laparoscopy gained popularity, minimal invasive approach was also applied for hernia surgery. Unfortunately the initial efforts were disappointing due to high early recurrence rate. Experience led to refinement of technique, with acceptable recurrence rates. This combined with the advantages of minimal invasive surgery resulted in a gradual rise in worldwide acceptance of this technique. Our preferred approach for inguinal hernia repair is laparoscopic totally extraperitoneal (TEP); only in complicated hernias (sliding or incarcerated inguinal hernias) we use the transabdominal preperitoneal repair (TAPP) technique. Records of all patients who underwent TEP repair for inguinal hernia at our centre in last 15 years were retrospectively analysed. We have done 8659 hernias in 7023 patients by TEP approach. We have developed minor modifications for the TEP repair over the years. Out of total 8659 hernias 5262 was right sided and 3397 left sided. Of these, 5387 hernias were unilateral and the remainder were bilateral; 324 cases of recurrent hernias following open repair underwent TEP. Most of the patients were males with a mean age of 46 years. Indirect hernias were most common, followed by direct hernias. Right-sided hernias were more common than left-sided hernias. In 39 cases conversion to TAPP was needed. There were intra-operative problems in 250 patients (3.56%).Postoperative complications were seen in 192 patients (2.73%), majority of which were minor complications. There was no mortality. Recurrence rate was 0.39%. The TEP technique is comfortable and highly effective. Our port placement maintains triangular orientation that is considered vital to the ergonomics of laparoscopy. Nearly 98-99% of inguinal hernias can be treated by TEP approach with excellent results.

Inguinal hernia repair: are the results from a general hospital comparable to those from dedicated hernia centres?

PubMed Central

Cheong, Kai Xiong; Lo, Hong Yee; Neo, Jun Xiang Andy; Appasamy, Vijayan; Chiu, Ming Terk

2014-01-01

INTRODUCTION We aimed to report the outcomes of inguinal hernia repair performed at Tan Tock Seng Hospital and compare them with those performed at dedicated hernia centres. METHODS We retrospectively analysed the medical records and telephone interviews of 520 patients who underwent inguinal hernia repair in 2010. RESULTS The majority of the patients were male (498 [95.8%] men vs. 22 [4.2%] women). The mean age was 59.9 ± 15.7 years. Most patients (n = 445, 85.6%) had unilateral hernias (25.8% direct, 64.3% indirect, 9.9% pantaloon). The overall recurrence rate was 3.8%, with a mean time to recurrence of 12.0 ± 8.6 months. Risk factors for recurrence included contaminated wounds (odds ratio [OR] 50.325; p = 0.004), female gender (OR 8.757; p = 0.003) and pantaloon hernias (OR 5.059; p = 0.013). Complication rates were as follows: chronic pain syndrome (1.2%), hypoaesthesia (5.2%), wound dehiscence (0.4%), infection (0.6%), haematoma/seroma (4.8%), urinary retention (1.3%) and intraoperative visceral injury (0.6%). Most procedures were open repairs (67.7%), and laparoscopic repair constituted 32.3% of all the inguinal hernia repairs. Open repairs resulted in longer operating times than laparoscopic repairs (86.6 mins vs. 71.6 mins; p < 0.001), longer hospital stays (2.7 days vs. 0.7 days; p = 0.020) and a higher incidence of post-repair hypoaesthesia (6.8% vs. 1.8%; p = 0.018). However, there were no significant differences in recurrence or other complications between open and laparoscopic repair. CONCLUSION A general hospital with strict protocols and teaching methodologies can achieve inguinal hernia repair outcomes comparable to those of dedicated hernia centres. PMID:24763834

Chronic pain after open inguinal hernia repair.

PubMed

Nikkolo, Ceith; Lepner, Urmas

2016-01-01

Following the widespread use of mesh repairs, recurrence rates after inguinal hernia surgery have become acceptable and focus has shifted from recurrence to chronic pain. Although pain can be controlled with analgesics, chronic postsurgical pain is a major clinical problem, which can significantly influence the patient's quality of life. The rate of chronic pain after inguinal hernia mesh repair can reach 51.6%. The reasons for posthernioplasty chronic pain are often unclear. It has been linked to nerve injury and nerve entrapment, but there is also association between the rate of chronic pain and the type of mesh used for hernia repair. As there are >160 meshes available in the market, it is difficult to choose a mesh whose usage would result in the best outcome. Different mesh characteristics have been studied, among them weight of mesh has probably gained the most attention. The choice of adequate therapy for chronic groin pain after inguinal hernia repair is controversial. The European Hernia Society recommends that a multidisciplinary approach at a pain clinic should be considered for the treatment of chronic postoperative pain. Although surgical treatment of chronic posthernioplasty pain is limited because of the lack of relevant research data, resection of entrapped nerves, mesh removal in the case of mesh related pain or removal of fixation sutures can be beneficial for the patient with severe pain after inguinal hernia surgery. One drawback of published studies is the lack of consensus over definition of chronic pain, which makes it complicated to compare the results of different studies and to conduct meta-analyses and systematic reviews. Therefore, a uniform definition of chronic pain and its best assessment methods should be developed in order to conduct top quality multicenter randomized trials. Further research to develop meshes with optimal parameters is of vital importance and should be encouraged.

Benefits of pre-emptive analgesia by local infiltration at day-case general anaesthetic open inguinal hernioplasty.

PubMed

Radwan, R W; Gardner, A; Jayamanne, H; Stephenson, B M

2018-03-15

Introduction The open prosthetic repair of inguinal hernias under local anaesthesia (LA) is well established, with the concept of intraoperative 'pre-emptive analgesia' evolving so that patients are as comfortable as possible. We used a peri-incisional LA solution in patients undergoing day-case inguinal hernioplasty under general anaesthesia (GA) and recorded use of analgesia in the immediate postoperative period. Methods In this observational cohort study, 100 consecutive unselected men underwent open inguinal hernia repair as a day case. Of these, 75 underwent repair under GA and 25 with peri-incisional LA solution (equal mixture of 0.5% bupivacaine and 1% lignocaine with 1:200,000 adrenaline). Analgesia prescribed at induction, for maintenance and after cessation of anaesthesia was scored in accordance with the World Health Organization (WHO) analgesic ladder. Results The median age in the GA group was 59 years (range: 25-89 years) and in the GA+LA group, it was 62 years (range: 27-88 years). Of the 100 patients, 82 underwent a mesh plug repair by seven surgeons whereas 18 underwent a flat (Lichtenstein) mesh repair by two surgeons. WHO analgesic induction and postoperative scores were significantly lower in the GA+LA group (p=0.034 and p<0.001 respectively). There was also a significant difference in use of postoperative antiemetics (23% vs 0% in the GA only and GA+LA cohorts respectively, p=0.020). Six patients (8%) in the GA group failed day-case discharge criteria. Conclusions Patients undergoing contemporary day-case GA inguinal hernioplasty with pre-emptive LA solution infiltration require lower levels of postoperative opioid analgesia and antiemetics. These cases are less likely to fail discharge criteria for planned day surgery.

Anorectal and inguinal lymphogranuloma venereum among men who have sex with men in Amsterdam, The Netherlands: trends over time, symptomatology and concurrent infections.

PubMed

de Vrieze, Nynke Hesselina Neeltje; van Rooijen, Martijn; Schim van der Loeff, Maarten Franciscus; de Vries, Henry John C

2013-11-01

To examine lymphogranuloma venereum (LGV) trends over time among men who have sex with men (MSM) visiting the Amsterdam sexually transmitted infection (STI) clinic; to investigate anal LGV symptomatology; and to examine the positivity and characteristics of anorectal and inguinal LGV. We included MSM consultations from whom a swab (from anorectum, bubo or an genital ulcer) was taken for Chlamydia trachomatis (Ct) screening. Anorectal swabs were taken from all MSM who reported receptive anorectal intercourse in the preceding 6 months. Ct positive samples were further tested with a pmpH PCR to identify L-genovars. Patient symptoms, clinical and anoscopic inflammatory signs, and STI co-infections were noted; Gram-stained anorectal mucosal smears were examined. Between January 2005 and June 2012, 48 570 consultations among MSM were conducted. In 3628/35 650 visits, anorectal Ct infections were diagnosed, including 411 anal LGV (1.2%). Moreover, 65/1649 genital ulcer swabs were Ct positive; 10 were inguinal LGV (0.6%) Since January 2011 a significant increase in the positivity of LGV occurred (p<0.0001). 89 (27.2%) anorectal LGV cases were asymptomatic. HIV prevalence among anorectal LGV cases was significantly higher (p=0.008) than among inguinal LGV cases. STI co-morbidity in anorectal LGV cases remained invariably high during the study period. Since January 2011, LGV positivity in MSM consultations in Amsterdam has risen significantly. The great majority comprise anal LGV; inguinal LGV is rare. Anal LGV is asymptomatic in a quarter of cases. In all MSM with anal Ct infections LGV should be excluded, irrespective of symptoms or inflammatory signs.

Inguinal hernia repair: are the results from a general hospital comparable to those from dedicated hernia centres?

PubMed

Cheong, Kai Xiong; Lo, Hong Yee; Neo, Jun Xiang Andy; Appasamy, Vijayan; Chiu, Ming Terk

2014-04-01

We aimed to report the outcomes of inguinal hernia repair performed at Tan Tock Seng Hospital and compare them with those performed at dedicated hernia centres. We retrospectively analysed the medical records and telephone interviews of 520 patients who underwent inguinal hernia repair in 2010. The majority of the patients were male (498 [95.8%] men vs. 22 [4.2%] women). The mean age was 59.9 ± 15.7 years. Most patients (n = 445, 85.6%) had unilateral hernias (25.8% direct, 64.3% indirect, 9.9% pantaloon). The overall recurrence rate was 3.8%, with a mean time to recurrence of 12.0 ± 8.6 months. Risk factors for recurrence included contaminated wounds (odds ratio [OR] 50.325; p = 0.004), female gender (OR 8.757; p = 0.003) and pantaloon hernias (OR 5.059; p = 0.013). Complication rates were as follows: chronic pain syndrome (1.2%), hypoaesthesia (5.2%), wound dehiscence (0.4%), infection (0.6%), haematoma/seroma (4.8%), urinary retention (1.3%) and intraoperative visceral injury (0.6%). Most procedures were open repairs (67.7%), and laparoscopic repair constituted 32.3% of all the inguinal hernia repairs. Open repairs resulted in longer operating times than laparoscopic repairs (86.6 mins vs. 71.6 mins; p < 0.001), longer hospital stays (2.7 days vs. 0.7 days; p = 0.020) and a higher incidence of post-repair hypoaesthesia (6.8% vs. 1.8%; p = 0.018). However, there were no significant differences in recurrence or other complications between open and laparoscopic repair. A general hospital with strict protocols and teaching methodologies can achieve inguinal hernia repair outcomes comparable to those of dedicated hernia centres.

Athletes with inguinal disruption benefit from endoscopic totally extraperitoneal (TEP) repair.

PubMed

Roos, M M; Bakker, W J; Goedhart, E A; Verleisdonk, E J M M; Clevers, G J; Voorbrood, C E H; Sanders, F B M; Naafs, D B; Burgmans, J P J

2018-06-01

Inguinal disruption, a common condition in athletes, is a diagnostic and therapeutic challenge. The aim of this study was to evaluate the effect of endoscopic totally extraperitoneal (TEP) repair in athletes with inguinal disruption, selected through a multidisciplinary, systematic work-up. An observational, prospective cohort study was conducted in 32 athletes with inguinal disruption. Athletes were assessed by a sports medicine physician, radiologist and hernia surgeon and underwent subsequent endoscopic TEP repair with placement of polypropylene mesh. The primary outcome was pain reduction during exercise on the numeric rating scale (NRS) 3 months postoperatively. Secondary outcomes were sports resumption, physical functioning and long-term pain intensity. Patients were assessed preoperatively, 3 months postoperatively and after a median follow-up of 19 months. Follow-up was completed in 30 patients (94%). The median pain score decreased from 8 [interquartile range (IQR) 7-8] preoperatively to 2 (IQR 0-5) 3 months postoperatively (p < 0.001). At long-term follow-up, the median pain score was 0 (IQR 0-3) (p < 0.001). At 3 months, 60% of patients were able to complete a full training and match. The median intensity of sport was 50% (IQR 20-70) preoperatively, 95% (IQR 70-100) 3 months postoperatively (p < 0.001), and 100% (IQR 90-100) at long-term follow-up (p < 0.001). The median frequency of sport was 4 (IQR 3-5) times per week before development of symptoms and 3 (IQR 3-4) times per week 3 months postoperatively (p = 0.025). Three months postoperatively, improvement was shown on all physical functioning subscales. Athletes with inguinal disruption, selected through a multidisciplinary, systematic work-up, benefit from TEP repair.

Spinal anesthesia for inguinal hernia repair in infants: a feasible and safe method even in emergency cases.

PubMed

Lambertz, A; Schälte, G; Winter, J; Röth, A; Busch, D; Ulmer, T F; Steinau, G; Neumann, U P; Klink, C D

2014-10-01

Inguinal hernia repair is the most frequently performed surgical procedure in infants and children. Especially in premature infants, prevalence reaches up to 30% in coincidence with high rates of incarceration during the first year of life. These infants carry an increased risk of complications due to general anesthesia. Thus, spinal anesthesia is a topic of growing interest for this group of patients. We hypothesized that spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants even at high risk and cases of incarceration. Between 2003 and 2013, we operated 100 infants younger than 6 months with inguinal hernia. Clinical data were collected prospectively and retrospectively analyzed. Patients were divided into two groups depending on anesthesia procedure (spinal anesthesia, Group 1 vs. general anesthesia, Group 2). Spinal anesthesia was performed in 69 infants, and 31 infants were operated in general anesthesia, respectively. In 7 of these 31 infants, general anesthesia was chosen because of lumbar puncture failure. Infants operated in spinal anesthesia were significantly smaller (54 ± 4 vs. 57 ± 4 cm; p = 0.001), had a lower body weight (4,047 ± 1,002 vs. 5,327 ± 1,376 g; p < 0.001) and higher rate of prematurity (26 vs. 4%; p = 0.017) compared to those operated in general anesthesia. No complications related to surgery or to anesthesia were found in both groups. The number of relevant preexisting diseases was higher in Group 1 (11 vs. 3%; p = 0.54). Seven of eight emergent incarcerated hernia repairs were performed in spinal anesthesia (p = 0.429). Spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants, especially in high-risk premature infants and in cases of hernia incarceration.

Endoscopic repair of primary versus recurrent male unilateral inguinal hernias: Are there differences in the outcome?

PubMed

Köckerling, F; Jacob, D; Wiegank, W; Hukauf, M; Schug-Pass, C; Kuthe, A; Bittner, R

2016-03-01

To date, there are no prospective randomized studies that compare the outcome of endoscopic repair of primary versus recurrent inguinal hernias. It is therefore now attempted to answer that key question on the basis of registry data. In total, 20,624 patients were enrolled between September 1, 2009, and April 31, 2013. Of these patients, 18,142 (88.0%) had a primary and 2482 (12.0%) had a recurrent endoscopic repair. Only patients with male unilateral inguinal hernia and with a 1-year follow-up were included. The dependent variables were intra- and postoperative complications, reoperations, recurrence, and chronic pain rates. The results of unadjusted analyses were verified via multivariable analyses. Unadjusted analysis did not reveal any significant differences in the intraoperative complications (1.28 vs 1.33%; p = 0.849); however, there were significant differences in the postoperative complications (3.20 vs 4.03%; p = 0.036), the reoperation rate due to complications (0.84 vs 1.33%; p = 0.023), pain at rest (4.08 vs 6.16%; p < 0.001), pain on exertion (8.03 vs 11.44%; p < 0.001), chronic pain requiring treatment (2.31 vs 3.83%; p < 0.001), and the recurrence rates (0.94 vs 1.45%; p = 0.0023). Multivariable analysis confirmed the significant impact of endoscopic repair of recurrent hernia on the outcome. Comparison of perioperative and 1-year outcome for endoscopic repair of primary versus recurrent male unilateral inguinal hernia showed significant differences to the disadvantage of the recurrent operation. Therefore, endoscopic repair of recurrent inguinal hernias calls for particular competence on the part of the hernia surgeon.

Association between thoracic aortic disease and inguinal hernia.

PubMed

Olsson, Christian; Eriksson, Per; Franco-Cereceda, Anders

2014-08-21

The study hypothesis was that thoracic aortic disease (TAD) is associated with a higher-than-expected prevalence of inguinal hernia. Such an association has been reported for abdominal aortic aneurysm (AAA) and hernia. Unlike AAA, TAD is not necessarily detectable with clinical examination or ultrasound, and there are no population-based screening programs for TAD. Therefore, conditions associated with TAD, such as inguinal hernia, are of particular clinical relevance. The prevalence of inguinal hernia in subjects with TAD was determined from nation-wide register data and compared to a non-TAD group (patients with isolated aortic stenosis). Groups were balanced using propensity score matching. Multivariable statistical analysis (logistic regression) was performed to identify variables independently associated with hernia. Hernia prevalence was 110 of 750 (15%) in subjects with TAD versus 29 of 301 (9.6%) in non-TAD, P=0.03. This statistically significant difference remained after propensity score matching: 21 of 159 (13%) in TAD versus 14 of 159 (8.9%) in non-TAD, P<0.001. Variables independently associated with hernia in multivariable analysis were male sex (odds ratio [OR] with 95% confidence interval [95% CI]) 3.4 (2.1 to 5.4), P<0.001; increased age, OR 1.02/year (1.004 to 1.04), P=0.014; and TAD, OR 1.8 (1.1 to 2.8), P=0.015. The prevalence of inguinal hernia (15%) in TAD is higher than expected in a general population and higher in TAD, compared to non-TAD. TAD is independently associated with hernia in multivariable analysis. Presence or history of hernia may be of importance in detecting TAD, and the association warrants further study. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Paravertebral blocks reduce the risk of postoperative urinary retention in inguinal hernia repair.

PubMed

Bojaxhi, E; Lee, J; Bowers, S; Frank, R D; Pak, S H; Rosales, A; Padron, S; Greengrass, R A

2018-06-16

Inguinal hernia repair and general anesthesia (GA) are known risk factors for urinary retention. Paravertebral blocks (PVBs) have been utilized to facilitate enhanced recovery after surgery. We evaluate the benefit of incorporating PVBs into our anesthetic technique in a large cohort of ambulatory patients undergoing inguinal hernia repair. Records of 619 adults scheduled for ambulatory inguinal hernia repair between 2010 and 2015 were reviewed and categorized based on anesthetic and surgical approach [GA and open (GAO), GA and laparoscopic (GAL), PVB and open (PVBO), and GA/PVB and open (GA/PVBO)]. Patients were excluded for missing data, self-catheterization, chronic opioid tolerance, and additional surgical procedures coinciding with hernia repair. Risk factors associated with the primary outcome of urinary retention were examined using logistic regression. PVBO (n = 136) had significantly lower odds than GAO of experiencing urinary retention (odds ratio 0.16; 95% CI 0.05-0.51); overall (P < .01), with 4.4% (n = 6) of the patients in the PVBO group having urinary retention versus 22.6% (n = 7) with GAO. Expressed as intravenous morphine equivalences, the PVBO group had the lowest median opioid use (5 mg), followed by GA, PVB, and open (7.5 mg); GAO 25 mg; and GAL 25 mg. Also, 30% (n = 41) of the PVBO group required no opioid analgesia in the postanesthesia care unit. PVBs as the primary anesthetic or an adjunct to GA is the preferred anesthetic technique for open inguinal hernia repair as it facilitates enhanced recovery after surgery by decreasing risk of urinary retention, opioid requirements, and length of stay.

Synthesis of 5/7-, 5/8- and 5/9-bicyclic lactam templates as constraints for external beta-turns.

PubMed

Duggan, Heather M E; Hitchcock, Peter B; Young, Douglas W

2005-06-21

The 5/7-, 5/8- and 5/9-bicyclic lactams 3, 17, 5 and 6 have been synthesised as single diastereoisomers by a route involving ring closing olefin metathesis. The X-ray crystal structure of the amino acid hydrochloride has been carried out and compared to that of the saturated external beta-turn constraint 18.

Large dermoid cyst of the spermatic cord presenting as an incarcerated hernia: a rare presentation and literature review.

PubMed

Salemis, N S; Karagkiouzis, G; Sambaziotis, D; Tsiambas, E

2010-06-01

Dermoid cyst of the spermatic cord is a very rare clinical entity with only a few cases reported in the literature so far. We herein describe an extremely rare case of a large dermoid cyst of the spermatic cord measuring 8.5 x 5 x 5 cm in a young patient who presented with clinical manifestations of an incarcerated inguinal hernia. After the cyst excision, a diffuse direct hernia became apparent and a Lichtenstein polypropylene mesh repair was performed. Direct hernia was likely the result of chronic pressure on the inguinal floor maintained by the large cyst. We conclude that although very rare, dermoid cyst of the spermatic cord should be considered as a part of the differential diagnosis in patients presenting with an irreducible inguinal mass of a long course.

Ring-rearrangement metathesis of nitroso Diels-Alder cycloadducts.

PubMed

Vincent, Guillaume; Kouklovsky, Cyrille

2011-03-01

Strained nitroso Diels-Alder bicyclo[2.2.1] or [2.2.2] adducts functionalized with alkene side chains of diverse length undergo a ring-rearrangement metathesis process with external alkenes and Grubbs II or Hoveyda-Grubbs II ruthenium catalysts, under microwave irradiation or classical heating, to deliver cis-fused bicycles of various ring sizes, which contain a N-O bond. These scaffolds are of synthetic relevance for the generation of molecular diversity and to the total synthesis of alkaloids. The observation of unexpected reactions, such as epimerization or one-carbon homologation of the alkene side chain, is also reported. Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Spin-dependent heat and thermoelectric currents in a Rashba ring coupled to a photon cavity

NASA Astrophysics Data System (ADS)

Abdullah, Nzar Rauf; Tang, Chi-Shung; Manolescu, Andrei; Gudmundsson, Vidar

2018-01-01

Spin-dependent heat and thermoelectric currents in a quantum ring with Rashba spin-orbit interaction placed in a photon cavity are theoretically calculated. The quantum ring is coupled to two external leads with different temperatures. In a resonant regime, with the ring structure in resonance with the photon field, the heat and the thermoelectric currents can be controlled by the Rashba spin-orbit interaction. The heat current is suppressed in the presence of the photon field due to contribution of the two-electron and photon replica states to the transport while the thermoelectric current is not sensitive to changes in parameters of the photon field. Our study opens a possibility to use the proposed interferometric device as a tunable heat current generator in the cavity photon field.

After 10 years and 1903 inguinal hernias, what is the outcome for the laparoscopic repair?

PubMed

Schwab, J R; Beaird, D A; Ramshaw, B J; Franklin, J S; Duncan, T D; Wilson, R A; Miller, J; Mason, E M

2002-08-01

The procedure of choice for inguinal hernia repair has remained controversial for decades. The laparoscopic approach has now been utilized for more than 10 years, and a significant volume of patient outcomes is now available for review. The hospital and office records of 1388 patients who underwent 1903 laparoscopic inguinal hernia repairs at Atlanta Medical Center during the past 10 years were retrospectively reviewed in order to determine demographics, recurrence rate, and complications. In addition, 123 hernia repairs were prospectively studied in 71 patients during this time period in order to accurately evaluate postoperative pain and return to activity. Two hundred fifty-five (13.4%) hernias were recurrent and 1648 (86.6%) were primary. Five hundred and fifteen (37.1%) hernias were bilateral. The total extraperitoneal approach was utilized for 1561 (82.0%) of the 1903 repairs. The average operative time was 75.4 (14-193) minutes. Estimated blood loss was 22.0 (0-250) ml. Seventeen patients (1.2%) were converted to an open form of hernia repair. Minor complications occurred in 83 (6.0%) patients and major complications occurred in 18 (1.3%) patients. The laparoscopic approach is a safe form of inguinal hernia repair that offers the patient a shorter and less painful recovery with an extremely low recurrence rate.

Combined open and laparoscopic approach to chronic pain after inguinal hernia repair.

PubMed

Keller, Jennifer E; Stefanidis, Demitrios; Dolce, Charles J; Iannitti, David A; Kercher, Kent W; Heniford, B Todd

2008-08-01

Chronic groin pain is the most frequent long-term complication after inguinal hernia repair affecting up to 34 per cent of patients. Traditional surgical management includes groin exploration, mesh removal, and neurectomy. We evaluate outcomes of a combined laparoscopic and open approach to chronic pain after inguinal herniorrhaphy. All patients undergoing surgical exploration for chronic pain after inguinal herniorrhaphy were analyzed. In most, the operation consisted of mesh removal (open or laparoscopic), neurectomy, and placement of mesh in the opposite location of the first mesh (laparoscopic if the first was open and vice-versa). Main outcome measures included pain status, numbness, and hernia recurrence. Twenty-one patients (16 male and 5 female) with a mean age of 41 years (22-51 years) underwent surgical treatment for unilateral (n = 18) or bilateral (n = 3) groin pain. Percutaneous nerve block was unsuccessful in all patients. Four had previous surgery for pain. There were no complications. With a minimum of 6 weeks follow-up, 20 of 21 patients reported significant improvement or resolution of symptoms. A combined laparoscopic and open approach for postherniorrhaphy groin pain results in excellent patient satisfaction with minimal morbidity. It may be the preferred technique for the definitive management of chronic neuralgia after hernia repair.

Management of vulvar melanoma.

PubMed

Trimble, E L; Lewis, J L; Williams, L L; Curtin, J P; Chapman, D; Woodruff, J M; Rubin, S C; Hoskins, W J

1992-06-01

Considerable debate centers on the optimal treatment for vulvar melanoma, as well as those clinicopathological factors influencing prognosis. We reviewed 80 patients with vulvar melanoma seen between 1949 and 1990. Primary tumors were assessed according to Chung (47 patients) and Breslow (65 patients) microstaging systems. Fifty-nine patients (76%) underwent radical vulvectomy, ten patients (13%) had a partial vulvectomy, and nine patients (12%) had a wide local excision. Fifty-six also underwent inguinal node dissection. Median follow-up was 193 months. Median survival was 63 months. Ten-year survival by Chung level was as follows: I 100%; II, 81%; III, 87%; IV, 11%; V, 33%. Ten-year survival by tumor thickness was as follows: 0.75 mm, 48%; 0.75-1.5 mm, 68%; 1.51-3.0 mm, 44%; greater than 3.0 mm, 22%. Increased depth of invasion was associated with increased incidence of inguinal node metastasis. Cox regression analysis demonstrated prognostic significance for tumor thickness (P less than 0.001), inguinal node metastasis (P less than 0.001), and older age at diagnosis (P less than 0.001). Radical vulvectomy did not seem to improve survival over less radical procedures. Based on this experience, we recommend radical local excision for patients with malignant melanoma of the vulva. Patients who have more than a superficially invasive melanoma should also have inguinal lymph node dissection.

Pregnancy, parturition, parity and position in the family. Any influence on the development of paediatric inguinal hernia/hydrocele?

PubMed

Irabor, D O; Ogundoyin O O; Ogunlana, D I

2014-01-01

To see if pre-partum factors have a relationship to the development of inguinal hernia in children. A prospective study on children with hernia. On first contact, the affected child was examined and data like the age, sex, weight, blood group, the diagnosis, side of the lesion and other co-morbid conditions was recorded. The mother filled a questionnaire about her age, parity, illness during pregnancy, her mode of delivery and the patient's position in the family. There were 104 patients from 103 mothers, their ages ranged from 13 days to 14 years with the highest incidence in the 1-4 age group. The sex ratio was overwhelmingly male (M:F ratio was 38:1). Right sided hernias were predominant. Only 7% had a family history. The peak age group of the mothers was 26-32 years and about 33% of the mothers had some illness during pregnancy. The birth positions of the patients showed that majority of them were either 1st or 2nd born children. Women of ages 26-32 likelyto have children with inguinal hernia. Malaria during pregnancy is unlikely to have a role to play. 1st and 2nd born male children have a higher chance of having inguinal hernia.

NiTiNol Hernia Device Stability in Inguinal Hernioplasty Without Fixation

PubMed Central

2011-01-01

Background and Objective: To determine whether the NiTiNol frame of a novel hernia repair device utilizing polypropylene mesh for inguinal hernioplasty remains stable and intransient without fixation after a minimum of 6 months. Methods: Twenty patients had 27 inguinal hernias repaired using a novel hernia repair device that has a NiTiNol frame without any fixation. Initial single-view, postoperative X-rays were compared with a second X-ray obtained at least 6 months later. The NiTiNol frame, which can be easily visualized on a plain X-ray, was measured in 2 dimensions, as were anatomic landmarks. The measurements obtained and the appearances of the 2 X-rays were compared to determine the percentage of change in device size and device stability with regard to device location and shape. Results: There were minimal changes noted between the 2 sets of measurements obtained with an overall trend towards a slight increase in the size of the hernia repair device. The devices demonstrated intransience of position and stability of shape. Conclusions: The NiTiNol frame of a novel hernia repair device utilizing polypropylene mesh exhibits radiographic evidence of size and shape stability and intransience of position without fixation when used in inguinal hernioplasty after a minimum follow-up of 6 months. PMID:21902967

Laparoscopic management and its outcomes in cases with nonpalpable testis.

PubMed

Erdoğan, Cankat; Bahadır, Berktuğ; Taşkınlar, Hakan; Naycı, Ali

2017-06-01

Diagnostic laparoscopy is the gold standard in the algorithm of nonpalpable testis. Testicular tissue is examined and treatment is planned accordingly. In this study we reviewed the place of diagnostic laparoscopy, and evaluated the results and effectiveness of laparoscopy in the diagnosis and management of nonpalpable testis. Children who had diagnostic laparoscopy for nonpalpable testes were included in the study. Physical examination results, ultrasonography (USG) reports, age at surgery, laparoscopic and inguinal exploration findings, surgical procedures, orchiopexy results, early and late-term complications were evaluated. Follow-up visits were performed at 3-month intervals for the first, at 6-month intervals for the 2. year, then at yearly intervals. Testicular size and location was evaluated by during control examination. Overall 58 boys, and 68 testes (26 left: 44.8%; 22 right: 37.9%, and 10 bilateral: 17.2%) were included in the study. Mean age at surgery was 5.5 years (10 months-17 years). Diagnostic value of USG was 15.7%. Diagnostic laparoscopy findings were as follows: Group 1: blind-ended vessels, n=7 (10.2%); Group 2: intraabdominal testes, n=8 (11.7%); Group 3: vas and vessels entering internal ring, n=53 (77.9%). Overall 43 testes underwent orchiopexy, which were normal (n=8) or hypoplastic (n=35). Mean follow-up period was 19 months (1-12 years), and on an average 7 visits were performed (5-14). On follow-up, 5 testes were normal-sized and located in the scrotum, while 4 testes were atrophic and underwent orchiectomy. Two testes were found in the inguinal canal and redo orchiopexy was performed. Control USG revealed reduced testicular blood supply and volume. Laparoscopic surgery is safe and effective in the management of nonpalpable testes. In the majority, routine use of diagnostic laparoscopy in the algorithma does not confer any additional contributions in many patients.

Continuous wave external-cavity quantum cascade laser-based high-resolution cavity ring-down spectrometer for ultrasensitive trace gas detection.

PubMed

De, Anulekha; Banik, Gourab Dutta; Maity, Abhijit; Pal, Mithun; Pradhan, Manik

2016-05-01

A high-resolution cavity ring-down spectroscopic (CRDS) system based on a continuous wave (cw) mode-hop-free (MHF) external-cavity quantum cascade laser (EC-QCL) operating at λ∼5.2  μm has been developed for ultrasensitive detection of nitric oxide (NO). We report the performance of the high-resolution EC-QCL based cw-CRDS instrument by measuring the rotationally resolved Λ-doublet e and f components of the P(7.5) line in the fundamental band of NO at 1850.169  cm^-1 and 1850.179  cm^-1. A noise-equivalent absorption coefficient of 1.01×10^-9  cm^-1  Hz^-1/2 was achieved based on an empty cavity ring-down time of τ₀=5.6  μs and standard deviation of 0.11% with averaging of six ring-down time determinations. The CRDS sensor demonstrates the advantages of measuring parts per billion NO concentrations in N₂, as well as in human breath samples with ultrahigh sensitivity and specificity. The CRDS system could also be generalized to measure simultaneously many other trace molecular species within the broad tuning range of cw EC-QCL, as well as for studying the rotationally resolved hyperfine structures.

Glue versus suture for mesh fixation in inguinal hernia repair.

PubMed

Chandrasekar, Shruthi; Jeyakumar, S; Ganapathy, Tharun

2018-03-22

Inguinal hernia is one of the most common surgical problem presenting to the surgical OPD. Surgery is the mainstay of treatment for inguinal hernia today. Surgery for inguinal hernia has undergone a great evolution over a period of several centuries. Lichenstein's tension free hernioplasty is the one of the first surgeries taught to a surgical resident. The main aim of surgeries in this era is to give the best possible results with the least possible pain, scar and time. This has given rise to so many modifications to the classical Lichenstein's procedure and also to laparoscopic hernioplasty. Pain after inguinal hernia surgery is found to be debilitating and altering the quality of life in several patients, which has been attributed to the traumatic fixation of the mesh with sutures. This has paved way to the development of various atraumatic methods of fixation, tissue glue is one such development. Hence this study, to compare traumatic and atraumatic methods of mesh fixation in inguinal hernia repair. The aim of this study was to compare suture fixation versus tissue glue fixation of the mesh in inguinal hernia repair. Primary objective was to compare the immediate and chronic post-operative pain. Secondary objective was to compare the time taken for the procedure by the two methods in use and also to compare the presence of any complications. and methodology: This study was done in the General Surgery department of XXX hospital, medical college and research centre, kattangulathur after Ethics committee clearance. It is a single blinded study. The study was done on 51 patients consenting for the study and meeting the inclusion criterias from the period of March 2016 to August 2017 out of which 26 were selected for glue mesh fixation and 25 for suture mesh fixation according to simple randomization. The suture group patients underwent classical Lichenstein's tension free hernioplasty and the glue group underwent Lichenstein's hernioplasty with glue where dots of glue were used to fix the mesh instead of sutures. The tissue glue used in this study was N Butyl- 2 - Cyanoacrylate. All patients in the study underwent surgery only by one group of surgeons to maintain homogeneity and were observed in the hospital for 72 h. A note of the pain on VAS scale was made at 12, 24, 48, 72 h, 1 week, 1 month, 3 months and 6 months. Operative time and any complications were also recorded. Results developed using SPSS software show that there is a significant difference in the time taken by both the methods, with glue taking a significantly lower time than sutures. Significance is also seen in the difference in the immediate and chronic post-operative pain between both the groups. However the complication rates in both the groups were found to be the same. It can thus be concluded from this study that tissue glue mesh fixation is superior to suture mesh fixation in open inguinal repair in terms of operative time, immediate and chronic post-operative time. Copyright © 2018. Published by Elsevier Ltd.

The status of the SNS external antenna ion source and spare RFQ test facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Welton, R. F., E-mail: welton@ornl.gov; Aleksandrov, A. V.; Han, B. X.

The Oak Ridge National Laboratory operates the Spallation Neutron Source, consisting of a H{sup −} ion source, a 1 GeV linac and an accumulator ring. The accumulated <1 μs-long, ∼35 A beam pulses are extracted from the ring at 60 Hz and directed onto a liquid Hg target. Spalled neutrons are directed to ∼20 world class instruments. Currently, the facility operates routinely with ∼1.2 MW of average beam power, which soon will be raised to 1.4 MW. A future upgrade with a second target station calls for raising the power to 2.8 MW. This paper describes the status of twomore » accelerator components expected to play important roles in achieving these goals: a recently acquired RFQ accelerator and the external antenna ion source. Currently, the RFQ is being conditioned in a newly constructed 2.5 MeV Integrated Test Facility (ITF) and the external antenna source is also being tested on a separate test stand. This paper presents the results of experiments and the testing of these systems.« less

Effect of electron beam cooling on transversal and longitudinal emittance of an external proton beam

NASA Astrophysics Data System (ADS)

Kilian, K.; Machner, H.; Magiera, A.; Prasuhn, D.; von Rossen, P.; Siudak, R.; Stein, H. J.; Stockhorst, H.

2018-02-01

Benefits of electron cooling to the quality of extracted ion beams from storage rings are discussed. The transversal emittances of an external proton beam with and without electron cooling at injection energy are measured with the GEM detector assembly. While the horizontal emittance remains the vertical emittance shrinks by the cooling process. The longitudinal momentum variance is also reduced by cooling.

Athletic injuries of the lateral abdominal wall: review of anatomy and MR imaging appearance.

PubMed

Stensby, J Derek; Baker, Jonathan C; Fox, Michael G

2016-02-01

The lateral abdominal wall is comprised of three muscles, each with a different function and orientation. The transversus abdominus, internal oblique, and external oblique muscles span the abdominal cavity between the iliocostalis lumborum and quadratus lumborum posteriorly and the rectus abdominis anteriorly. The lateral abdominal wall is bound superiorly by the lower ribs and costal cartilages and inferiorly by the iliac crest and inguinal ligament. The lateral abdominal wall may be acutely or chronically injured in a variety of athletic endeavors, with occasional acute injuries in the setting of high-energy trauma such as motor vehicle collisions. Injuries to the lateral abdominal wall may result in lumbar hernia formation, unique for its high incarceration rate, and also Spigelian hernias. This article will review the anatomy, the magnetic resonance (MR) imaging approach, and the features and complications of lateral abdominal wall injuries.

Confirmed inguinal lymphogranuloma venereum genovar L2c in a man who had sex with men, Slovenia, 2015.

PubMed

Matičič, Mojca; Klavs, Irena; Videčnik Zorman, Jerneja; Vidmar Vovko, Darja; Kogoj, Rok; Keše, Darja

2016-01-01

A laboratory-confirmed lymphogranuloma venereum (LGV) case in Slovenia was reported in 2015, in a human immunodeficiency virus (HIV)-negative man presenting with inguinal lymphadenopathy. He reported unprotected insertive anal intercourse with two male partners in Croatia. Variant L2c of Chlamydia trachomatis was detected in clinical samples. Although the patient was eventually cured, the recommended treatment regimen with doxycycline had to be prolonged.

[Multiple recurrent eccrine porocarcinoma with inguinal metastasis. A case report].

PubMed

Acosta-Arencibia, Aida; Abrante-Expósito, Begoña; Ramos-Gordillo, Matilde

2016-01-01

Eccrine porocarcinoma, first described in 1963, is a rare malignant lesion arising from the eccrine sweat glands. It is usually a primary tumour, or even more common, a malignant degeneration of an eccrine poroma. It usually affects older persons and is located most commonly on the lower extremities. About 20% of eccrine porocarcinoma will recur after treatment. The treatment is wide local excision of the primary lesion. This uncommon skin tumour has a locally aggressive behaviour and a high recurrence rate. An 82 year-old man presenting with multiple recurrent eccrine porocarcinoma with inguinal metastasis. The treatment was a radical excision and inguinal lymphadenectomy. There were no postoperative complications, but there was local recurrence after six months. Early diagnosis and wide excision is the best way to achieve a good prognosis, due to the aggressiveness of this tumour. Copyright © 2015. Published by Masson Doyma México S.A.

Laparoscopic inguinal hernia repair: review of 6 years experience.

PubMed

Vanclooster, P; Smet, B; de Gheldere, C; Segers, K

2001-01-01

Since 6 years, the totally extraperitoneal laparoscopic hernia repair has become our procedure of choice to manage inguinal hernia in adult patients, especially for bilateral hernias and recurrences after classical anterior repair. Between March 1993 and March 1999, 976 patients underwent 1259 hernia repairs by an endoscopic total extraperitoneal approach. A large polypropylene prosthesis (15 x 15 cm) is placed and covers all potential defects. Follow-up on patients ranged from 6 to 79 months (mean, 39 months). Per- and postoperative morbidity and complications were acceptable (8.4%) and included conversion to open surgery (0.4%), bleedings (0.3%), urinary retention (4.2%), seromas (2.7%), neuralgias (0.2%), vague persistent groin discomfort (0.4%), orchitis (0.08%) and sigmoido-cutaneous fistula (0.08%). Recurrence rate so far is 0.1%. This retrospective study shows that the totally extraperitoneal repair for inguinal hernia should have a promising future because of low morbidity and low recurrence rate.

Instabilities of Current Carrying Torus

NASA Astrophysics Data System (ADS)

Liu, Wenjuan; Qiu, J.

2010-05-01

We investigate the initial equilibrium and stability conditions for an uniform current-carrying plasma ring with a non-trivial toroidal magnetic field Bt. Realistic parameters comparable to observations are used to describe the magnetic field inside and outside the torus. The external poloidal magnetic field is assumed to fall off as a power function with decay index n (n = - d log (Bex) /d log(h)). The parameter space is explored to find all initial equilibrium solutions, at which perturbation is introduced. It is shown that with non-trivial toroidal field, the current ring attains equilibrium with a weaker external field. It is also shown that the torus attains equilibrium at higher altitude when the external field decays more rapidly (greater n) or the ratio of the toroidal flux in the torus to the external field increases. We further study stabilities of the torus at equilibrium by defining a critical decay index ncr (Kliem and Török 2006). A sufficiently strong toroidal field can completely suppress the torus instability due to the current hoop force. With a weak toroidal field, similar to the case of Bt=0, the instability occurs when the external magnetic field declines rapidly with height when the field decay index n>ncr. For realistic sets of parameters, the equilibrium height is within 10 solar radii, and the effective ncr is in the range of 1.0-1.6. The critical decay index increases when the ratio of the toroidal flux to the external field decreases. This work is supported by NSF CAREER grant ATM-0748428.

Filament wound data base development, revision 1, appendix A

NASA Technical Reports Server (NTRS)

Sharp, R. Scott; Braddock, William F.

1985-01-01

Data are presented in tabular form for the High Performance Nozzle Increments, Filament Wound Case (FWC) Systems Tunnel Increments, Steel Case Systems Tunnel Increments, FWC Stiffener Rings Increments, Steel Case Stiffener Rings Increments, FWC External Tank (ET) Attach Ring Increments, Steel Case ET Attach Ring Increments, and Data Tape 8. The High Performance Nozzle are also presented in graphical form. The tabular data consist of six-component force and moment coefficients as they vary with angle of attack at a specific Mach number and roll angle. The six coefficients are normal force, pitching moment, side force, yawing moment, axial force, and rolling moment. The graphical data for the High Performance Nozzle Increments consist of a plot of a coefficient increment as a function of angle of attack at a specific Mach number and at a roll angle of 0 deg.

1200008

NASA Image and Video Library

2012-01-18

EXTERNAL TANK TEST ARTICLE (ETTA2) IS IN TRANSIT TO BE ROTATED 180° FOR INTERFACE RING INSTALLATION FOR SBKF (SHELL BUCKLING KNOCKDOWN FACTOR) CRITICAL FEEDBACK, UNDERSTANDING AND IDEAS THAT WILL ENABLE THE DEVELOPMENT AND IMPLEMENTATION OF NEW DESIGN APPROACHES AND TECHNOLOGY .

Stent fabric fatigue of grafts supported by Z-stents versus ringed stents: an in vitro buckling test.

PubMed

Lin, Jing; Wang, Lu; Guidoin, Robert; Nutley, Mark; Song, Ge; Zhang, Ze; Du, Jia; Douville, Yvan

2014-03-01

Stent-grafts externally fitted with a Z-shaped stents were compared to devices fitted with ringed stents in an in vitro oscillating fatigue machine at 200 cycles per minute and a pressure of 360 mmHg for scheduled durations of up to 1 week. The devices fitted with Z-stents showed a considerably lower endurance limit to buckling compared to the controls. The contact between the apexes of adjacent Z-stents resulted in significant damage to the textile scaffolds and polyester fibers due to the sharp angle of the Z-stents. The ringed stents did not cause any fraying in the textile scaffolds.

Stress intensity and displacement coefficients for radially cracked ring segments subject to three-point bending

NASA Technical Reports Server (NTRS)

Gross, B.; Srawley, J. E.

1983-01-01

The boudary collocation method was used to generate Mode 1 stress intensity and crack mouth displacement coefficients for internally and externally radially cracked ring segments (arc bend specimens) subjected to three point radial loading. Numerical results were obtained for ring segment outer to inner radius ratios (R sub o/ R sub i) ranging from 1.10 to 2.50 and crack length to width ratios (a/W) ranging from 0.1 to 0.8. Stress intensity and crack mouth displacement coefficients were found to depend on the ratios R sub o/R sub i and a/W as well as the included angle between the directions of the reaction forces.

Optical coefficients in a semiconductor quantum ring: Electric field and donor impurity effects

NASA Astrophysics Data System (ADS)

Duque, C. M.; Acosta, Ruben E.; Morales, A. L.; Mora-Ramos, M. E.; Restrepo, R. L.; Ojeda, J. H.; Kasapoglu, E.; Duque, C. A.

2016-10-01

The electron states in a two-dimensional quantum dot ring are calculated in the presence of a donor impurity atom under the effective mass and parabolic band approximations. The effect of an externally applied electric field is also taken into account. The wavefunctions are obtained via the exact diagonalization of the problem Hamiltonian using a 2D expansion within the adiabatic approximation. The impurity-related optical response is analyzed via the optical absorption, relative refractive index change and the second harmonics generation. The dependencies of the electron states and these optical coefficients with the changes in the configuration of the quantum ring system are discussed in detail.

Computer program: Jet 3 to calculate the large elastic plastic dynamically induced deformations of free and restrained, partial and/or complete structural rings

NASA Technical Reports Server (NTRS)

Wu, R. W.; Witmer, E. A.

1972-01-01

A user-oriented FORTRAN 4 computer program, called JET 3, is presented. The JET 3 program, which employs the spatial finite-element and timewise finite-difference method, can be used to predict the large two-dimensional elastic-plastic transient Kirchhoff-type deformations of a complete or partial structural ring, with various support conditions and restraints, subjected to a variety of initial velocity distributions and externally-applied transient forcing functions. The geometric shapes of the structural ring can be circular or arbitrarily curved and with variable thickness. Strain-hardening and strain-rate effects of the material are taken into account.

Piston-Skirt Lubrication System For Compressor

NASA Technical Reports Server (NTRS)

Schroeder, Edgar C.; Burzynski, Marion, Jr.

1994-01-01

Piston-skirt lubrication system provides steady supply of oil to piston rings of gas compressor. No need for oil-filled crankcase or external oil pump. Instead, part of each piston acts as its own oil pump circulating oil from reservoir. Annular space at bottom of piston and cylinder constitutes working volume of small oil pump. Depending on application, reservoir open to atmosphere, or sealed and pressurized in bellows to prevent contact between oil and atmosphere. Filter removes particles worn away from piston rings and cylinder wall during normal operation.

The effect of tobacco use on outcomes of laparoscopic and open inguinal hernia repairs: a review of the NSQIP dataset.

PubMed

Landin, MacKenzie; Kubasiak, John C; Schimpke, Scott; Poirier, Jennifer; Myers, Jonathan A; Millikan, Keith W; Luu, Minh B

2017-02-01

As the effort to reduce postoperative morbidity and mortality continues, the search for modifiable patient risk factors to reduce complications is ongoing. Tobacco use is associated with impaired wound healing, but its effect on inguinal hernia repair has not been studied in a large population. An ACS-NSQIP dataset was used to evaluate the effect of tobacco use on outcomes of inguinal hernia repairs. The ACS-NSQIP dataset was queried for patients who underwent open or laparoscopic inguinal hernia repairs, by primary procedure CPT codes, between years 2009-2012. Tobacco use was registered, as defined by the ACS-NSQIP, in two ways: current smoking (within the past 12 months), or history of smoking (having ever smoked). Univariate and multivariate analyses were used to investigate outcome variables for 30-day morbidity by type of smoking status, while adjusting for preoperative risk factors. During the study period, 90,162 patients underwent inguinal hernia repair. 76 % of the cases were open compared to 24 % laparoscopic. The population was overwhelmingly male, 91 %, compared to 9 % female. The average age of patients was 42.5 years. Of the available data (69 % of patients), 38.5 % had a history of smoking. 18 % had smoked within the 12 months prior to surgery (current smokers). Their average number of pack years was 27.2 (SD 24.0) compared to 4.5 pack years (SD 14.7) for those who had not smoked 12 months prior to surgery (historical smokers). Using Fisher's exact test, having ever smoked was found to be significantly associated with pneumonia (p = 0.0008) and return to the operating room (p = 0.010). This relationship held when preoperative variables were controlled for using logistic regression (pneumonia, p = 0.002; return to the operating room, p = 0.002). When preoperative variables were controlled for and logistic regression was performed for current smokers, there was also a significant association with pneumonia (p = 0.005) and return to the operating room (p = 0.01). Current smoking status is a modifiable risk of patients undergoing laparoscopic and open inguinal hernia repair. Failure to quit smoking prior to surgical repair is associated with complications like pneumonia and return to the operating room.

Patient-reported opioid analgesic requirements after elective inguinal hernia repair: A call for procedure-specific opioid-administration strategies.

PubMed

Mylonas, Konstantinos S; Reinhorn, Michael; Ott, Lauren R; Westfal, Maggie L; Masiakos, Peter T

2017-11-01

A better understanding of the analgesia needs of patients who undergo common operative procedures is necessary as we address the growing opioid public health crisis in the United States. The aim of this study was to evaluate patient experience with our opioid prescribing practice after elective inguinal hernia repairs. A prospective, observational study was conducted between October 1, 2015, and September 30, 2016, in a single-surgeon, high-volume, practice of inguinal hernia operation. Adult patients undergoing elective inguinal herniorrhaphy under local anesthesia with intravenous sedation were invited to participate. All patients were prescribed 10 opioid analgesic tablets postoperatively and were counseled to reserve opioids for pain not controlled by nonopioid analgesics. Their experience was captured by completing a questionnaire 2 to 3 weeks postoperatively during their postoperative visit. A total of 185 patients were surveyed. The majority of the participants were males (177, 95.7%) and ≥60 years old (96, 51.9%). Of the 185 patients, 159 (85.9%) reported using ≤4 opioid tablets; 110 patients (59.5%) reported that they used no opioid analgesics postoperatively. None of the patients was taking opioids within 7 days of their postoperative appointment. Of the 147 patients who were employed, 111 (75.5%) reported missing ≤3 work days, 57 of whom (51.4%) missed no work at all. Patients who were employed were more likely to take opioid analgesics postoperatively (P = .049). Patients who took no opioid analgesics experienced less maximum (P < .001) and persistent groin pain (P = .037). Pain interfered less with daily activities (P = .012) and leisure activities (P = .018) for patients who did not use opioids. The majority of our patients reported that they did not require any opioid analgesics, and nearly all of those who thought that they did need opioids used <5 tablets. Our data suggest that for elective inguinal hernia repair under a local anesthetic with intravenous sedation, a policy of low opioid analgesic prescribing is achievable; these findings call for further investigation of how to best prescribe opioid medications to patients after an inguinal herniorrhaphy. Copyright © 2017 Elsevier Inc. All rights reserved.

A new concept and classification of corona mortis and its clinical significance.

PubMed

Al Talalwah, Waseem

2016-10-01

The obturator artery and its accessory (aberrant) arising from different origins and crossing the pubic rami are vascular variations. The internal iliac artery usually provides the obturator artery which may communicates with the external iliac artery through either the accessory obturator or inferior epigastric artery. A collateral circulation between the external and internal iliac system is known as corona mortis. The aim of current study is to provide sufficient data of vascular variability crossing the pubic rami for clinical field. Present study includes 208 hemipelvises dissected in the Institution of Anatomy, Medical University of Graz. During dissection, the obturator artery and its accessory crossing the superior rami of pubic bone were found to have different origins. The obturator artery arising from the external iliac artery and from the femoral artery accounts for 9.8% and 1.1% respectively. Therefore, it passes over the superior pubic rami in 10.9%. Further, the accessory (aberrant) artery arises only from the femoral artery in 1.1%. In present study, the vascular variation crossing the superior pubic rami with or without collateral circulation between external and internal iliac system referred as corona mortis is addressed. This study includes new classification of obturator and accessory obturator arteries as well as the corona mortis. It includes a comparison of corona mortis incidence in Austria population and other populations. The corona mortis found to be in 12% of Austrian population. A great attention of clinicians, radiologists, surgeons, orthopedic surgeons, obstetricians and gynecologists has to be considered before pubic surgical procedures such as internal fixation of pubic fracture, an inguinal hernia repair. Further, traumatic pubic rami fracture may lead to massive hemor- rhage due to laceration of the obturator artery.

Spin wave modes in out-of-plane magnetized nanorings

NASA Astrophysics Data System (ADS)

Zhou, X.; Tartakovskaya, E. V.; Kakazei, G. N.; Adeyeye, A. O.

2017-07-01

We investigated the spin wave modes in flat circular permalloy rings with a canted external bias field using ferromagnetic resonance spectroscopy. The external magnetic field H was large enough to saturate the samples. For θ =0∘ (perpendicular geometry), three distinct resonance peaks were observed experimentally. In the case of the cylindrical symmetry violation due to H inclination from normal to the ring plane (the angle θ of H inclination was varied in the 0∘-6∘ range), the splitting of all initial peaks appeared. The distance between neighbor split peaks increased with the θ increment. Unexpectedly, the biggest splitting was observed for the mode with the smallest radial wave vector. This special feature of splitting behavior is determined by the topology of the ring shape. Developed analytical theory revealed that in perpendicular geometry, each observed peak is a combination of signals from the set of radially quantized spin wave excitation with almost the same radial wave vectors, radial profiles, and frequencies, but with different azimuthal dependencies. This degeneracy is a consequence of circular symmetry of the system and can be removed by H inclination from the normal. Our findings were further supported by micromagnetic simulations.

Methanol clusters (CH3OH)n, n = 3-6 in external electric fields: density functional theory approach.

PubMed

Rai, Dhurba; Kulkarni, Anant D; Gejji, Shridhar P; Pathak, Rajeev K

2011-07-14

Structural evolution of cyclic and branched-cyclic methanol clusters containing three to six molecules, under the influence of externally applied uniform static electric field is studied within the density functional theory. Akin to the situation for water clusters, the electric field is seen to stretch the intermolecular hydrogen bonds, and eventually break the H-bonded network at certain characteristic threshold field values of field strength in the range 0.009-0.016 a.u., yielding linear or branched structures with a lower energy. These structural transitions are characterized by an abrupt increase in the electric dipole moment riding over its otherwise steady nonlinear increase with the applied field. The field tends to rupture the H-bonded structure; consequently, the number of hydrogen bonds decreases with increasing field strength. Vibrational spectra analyzed for fields applied perpendicular to the cyclic ring structures bring out the shifts in the OH ring vibrations (blueshift) and the CO stretch vibrations (redshift). For a given field strength, the blueshifts increase with the number of molecules in the ring and are found to be generally larger than those in the corresponding water cluster counterparts.

Vibration characteristics of two-stage planetary transmission system with thin-walled ring gear on elastic supports

NASA Astrophysics Data System (ADS)

Li, JianYing; Hu, QingChun; Zong, ChangFu; Zhu, TianJun; Zhang, ZeXing

2018-03-01

A dual-clutch and dual-speed planetary gears mechanism of a hybrid car coupled-system is taken as research subject, in which the ring gear of planet set II is a thin-walled structure and the clutch friction plates of planet set II are used as its elastic supports. Based on the lumped parameter-rigid elastic coupled dynamic model of two-stage planetary transmission system with thin-walled ring gear on elastic supports, the motion differential equations are established and the dynamic responses are solved by the Runge-Kutta method considering each stage internal and external time-varying mesh stiffness. The vibration displacements of each stage ring gear have been affected differently in time-domain, the translational vibration displacement of the ring gear of planet set I are obviously more than the torsional vibration displacement, but it is opposite for the ring gear of planet set II; The translational and torsional vibration responses of each stage ring gear arrive the peak in low-frequency. The analysis results of this paper can enrich the theoretical research of multistage planetary transmission and provide guidance for dynamic design.

Evolution of Residual Stress and Distortion of Cold-Rolled Bearing Ring from Annealing to Quenched-Tempered Heat Treatment

NASA Astrophysics Data System (ADS)

Lu, Bohan; Lu, Xiaohui

2018-02-01

This study investigates the correlation between the residual stress and distortion behavior of a cold-rolled ring from the annealing to quenching-tempering (QT) process. Due to the cold-rolled process, the external periphery of the bearing ring experiences a compressive residual stress. To relieve the residual stress, cold-rolled rings are annealed at 700 °C which is higher than the starting temperature of recrystallization. When cold-rolled rings are annealed at 700 °C for 15 min, the compressive residual stress is reduced to zero and the outer diameter of the annealed ring becomes larger than that of a non-annealed sample, which is unrelated to annealing time. Simultaneously, the roundness and taper deviation do not obviously change compared with those of non-annealed sample. The stress relaxation during the annealing process was attributed to the recovery and recrystallization of ferrite. Annealing has a genetic influence on the following QT heat treatment, wherein the lowest residual stress is in the non-annealed cold-rolled ring. From the annealing to QT process, the deviation of the outer diameter, roundness, and taper increased with annealing time, a large extend than that of non-annealed samples.

Mechanical deformation of carbon nanotube nano-rings on flat substrate

NASA Astrophysics Data System (ADS)

Zheng, Meng; Ke, Changhong

2011-04-01

We present a numerical analysis of the mechanical deformation of carbon nanotube (CNT) nano-rings on flat graphite substrates, which is motivated by our recent experimental findings on the elastic deformation of CNT nano-rings. Our analysis considers a perfectly circular CNT ring formed by bending a straight individual or bundled single-walled nanotube to connect its two ends. The seamless CNT ring is placed vertically on a flat graphite substrate and its respective deformation curvatures under zero external force, compressive, and tensile forces are determined using a continuum model based on nonlinear elastica theory. Our results show that the van der Waals interaction between the CNT ring and the substrate has profound effects on the deformation of the CNT ring, and that the interfacial binding interaction between the CNT ring and the substrate is strongly modulated by the ring deformation. Our results demonstrate that the CNT ring in force-free conditions has a flat ring segment in contact with the substrate if the ring radius R ≥√EI/2Wvdw , in which EI is the flexural rigidity of the nanotube and Wvdw is the per-unit-length van der Waals energy between the flat ring segment and the substrate. Our results reveal that the load-deformation profiles of the CNT ring under tensile loadings exhibit bifurcation behavior, which is ascribed to its van der Waals interaction with the substrate and is dependent on its relaxed conformation on the substrate. Our work suggests that CNT nano-rings are promising for a number of applications, such as ultrasensitive force sensors and stretchable and flexible structural components in nanoscale mechanical and electromechanical systems.

A rare complication from total extraperitoneal (TEP) laparoscopic inguinal hernia repair: bladder rupture associated with a balloon dissector.

PubMed

Chow, P-M; Su, Y-R; Chen, Y-S

2013-12-01

We report a rare complication of TEP herniorrhaphy. A 47-year-old man underwent TEP inguinal hernia repair. Bladder rupture was noted after balloon dissection. The defect was sutured, and the hernia was repaired under laparoscopy. Cystoscopy showed the site of injury at anterior bladder neck. This is the first report of bladder rupture associated with balloon dissector in a patient with no prior abdominal surgery.

Transperitoneal rectus sheath block and transversus abdominis plane block for laparoscopic inguinal hernia repair: A novel approach.

PubMed

Nagata, Jun; Watanabe, Jun; Nagata, Masato; Sawatsubashi, Yusuke; Akiyama, Masaki; Tajima, Takehide; Arase, Koichi; Minagawa, Noritaka; Torigoe, Takayuki; Nakayama, Yoshifumi; Horishita, Reiko; Kida, Kentaro; Hamada, Kotaro; Hirata, Keiji

2017-08-01

A laparoscopic approach for inguinal hernia repair is now considered the gold standard. Laparoscopic surgery is associated with a significant reduction in postoperative pain. Epidural analgesia cannot be used in patients with perioperative anticoagulant therapy because of complications such as epidural hematoma. As such, regional anesthetic techniques, such as ultrasound-guided rectus sheath block and transversus abdominis plane block, have become increasingly popular. However, even these anesthetic techniques have potential complications, such as rectus sheath hematoma, if vessels are damaged. We report the use of a transperitoneal laparoscopic approach for rectus sheath block and transversus abdominis plane block as a novel anesthetic procedure. An 81-year-old woman with direct inguinal hernia underwent laparoscopic transabdominal preperitoneal inguinal repair. Epidural anesthesia was not performed because anticoagulant therapy was administered. A Peti-needle™ was delivered through the port, and levobupivacaine was injected though the peritoneum. Surgery was performed successfully, and the anesthetic technique did not affect completion of the operative procedure. The patient was discharged without any complications. This technique was feasible, and the procedure was performed safely. Our novel analgesia technique has potential use as a standard postoperative regimen in various laparoscopic surgeries. Additional prospective studies to compare it with other techniques are required. © 2017 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

[Prosthetic bilateral laparoscopic hernioplasty. Extra-peritoneal approach].

PubMed

Rossi, M; Castoro, C; Zaninotto, G; Comandella, M G; Polo, R; Nolli, M L; Ancona, E

1997-03-01

The use of prosthetic mesh in inguinal hernia repairs is becoming increasingly popular. In recent years different laparoscopic procedures for prosthetic repair of inguinal hernias have been developed. The authors describe their initial experience with a totally extra-peritoneal prosthetic approach in laparoscopic repair of bilateral inguinal hernias. From November 1993 to May 1994, ten consecutive patients with bilateral primary inguinal hernias underwent laparoscopic repair under general anesthesia. A totally extra-peritoneal approach has been performed beginning through a 2 centimeter vertical midline sub-umbilical incision. Two additional trocars have been inserted on the midline: a 10/12 mm one halfway between the umbilicus and the pubis and 5 mm one 2 cm above the pubis. Average operative time was 141 minutes. Two cases were converted to traditional open Stoppa procedure because of holes made in the peritoneum during blunt dissection of the hernia sac. In the remaining 8 cases a polypropylene mesh of about 8 cm in height and 13 cm in length have been placed on each hernia site. No major complications have been observed and recovery was quick in all cases. In conclusion we think that laparoscopic hernia repair through a totally extra-peritoneal approach is technically feasible for general surgeons trained in laparoscopic surgery. Nevertheless the operation in costly and the patient's benefit in terms of rapid recovery, complications and recurrences has not yet been demonstrated in controlled prospective trials.

Treatment of bilateral inguinal hernia -- minimally invasive versus open surgery procedure.

PubMed

Timişescu, L; Turcu, F; Munteanu, R; Gîdea, C; Drăghici, L; Ginghină, O; Iordache, N

2013-01-01

The aim of this study is to evaluate and compare the treatment outcomes of the bilateral inguinal hernia repair in one stage using minimally invasive technique (totally extraperitoneal) and conventional surgery (Lichtenstein). Records from all hospitalized cases in our institution between 2006 and 2011 that underwent surgery having the diagnosis of bilateral inguinal hernia were analysed. The study consists of two groups selected by means of the used procedure: the study arm which is laparoscopic (234 cases) and the control arm that consists of Lichtenstein procedure (91 cases). One conversion was recorded due to difficult dissection (0.4% of cases). There were complications reported in 2.5% cases in the laparoscopic group and 27.4% complications noted in the conventional group (p less then 0.01). Reinterventions were logged in 1.7% cases in the laparoscopic group and 2.1% reinterventions in the open group (p less then 0.01). The postoperative hospital stay was 2.1 days in the laparoscopic group and 4.7 days for the open procedure. Mortality was not recorded. In our department the procedure of choice for bilateral inguinal repair is the laparoscopic approach (TEP) which has a 10 fold decrease in complications rate than Lichtenstein operation and also a shortening by half of the hospital stay. Hernia recurrence is the same for both procedures. Celsius.

Open transinguinal preperitoneal mesh repair of inguinal hernia: a targeted systematic review and meta-analysis of published randomized controlled trials

PubMed Central

Sajid, Muhammad S.; Craciunas, L.; Singh, K.K.; Sains, P.; Baig, M.K.

2013-01-01

Objective: The objective of this article is to systematically analyse the randomized, controlled trials comparing transinguinal preperitoneal (TIPP) and Lichtenstein repair (LR) for inguinal hernia. Methods: Randomized, controlled trials comparing TIPP vs LR were analysed systematically using RevMan® and combined outcomes were expressed as risk ratio (RR) and standardized mean difference. Results: Twelve randomized trials evaluating 1437 patients were retrieved from the electronic databases. There were 714 patients in the TIPP repair group and 723 patients in the LR group. There was significant heterogeneity among trials (P < 0.0001). Therefore, in the random effects model, TIPP repair was associated with a reduced risk of developing chronic groin pain (RR, 0.48; 95% CI, 0.26, 0.89; z = 2.33; P < 0.02) without influencing the incidence of inguinal hernia recurrence (RR, 0.18; 95% CI, 0.36, 1.83; z = 0.51; P = 0.61). Risk of developing postoperative complications and moderate-to-severe postoperative pain was similar following TIPP repair and LR. In addition, duration of operation was statistically similar in both groups. Conclusion: TIPP repair for inguinal hernia is associated with lower risk of developing chronic groin pain. It is comparable with LR in terms of risk of hernia recurrence, postoperative complications, duration of operation and intensity of postoperative pain. PMID:24759818

Evaluation of Anesthesia Profile in Pediatric Patients after Inguinal Hernia Repair with Caudal Block or Local Wound Infiltration.

PubMed

Gavrilovska-Brzanov, Aleksandra; Kuzmanovska, Biljana; Kartalov, Andrijan; Donev, Ljupco; Lleshi, Albert; Jovanovski-Srceva, Marija; Spirovska, Tatjana; Brzanov, Nikola; Simeonov, Risto

2016-03-15

The aim of this study is to evaluate anesthesia and recovery profile in pediatric patients after inguinal hernia repair with caudal block or local wound infiltration. In this prospective interventional clinical study, the anesthesia and recovery profile was assessed in sixty pediatric patients undergoing inguinal hernia repair. Enrolled children were randomly assigned to either Group Caudal or Group Local infiltration. For caudal blocks, Caudal Group received 1 ml/kg of 0.25% bupivacaine; Local Infiltration Group received 0.2 ml/kg 0.25% bupivacaine. Investigator who was blinded to group allocation provided postoperative care and assessments. Postoperative pain was assessed. Motor functions and sedation were assessed as well. The two groups did not differ in terms of patient characteristic data and surgical profiles and there weren't any hemodynamic changes between groups. Regarding the difference between groups for analgesic requirement there were two major points - on one hand it was statistically significant p < 0.05 whereas on the other hand time to first analgesic administration was not statistically significant p = 0.40. There were significant differences in the incidence of adverse effects in caudal and local group including: vomiting, delirium and urinary retention. Between children undergoing inguinal hernia repair, local wound infiltration insures safety and satisfactory analgesia for surgery. Compared to caudal block it is not overwhelming. Caudal block provides longer analgesia, however complications are rather common.

Outcomes of hypnosis combined with local anesthesia during inguinal repair: a pilot study.

PubMed

Romain, B; Rodriguez, M; Story, F; Delhorme, J-B; Brigand, C; Rohr, S

2017-02-01

To evaluate the usefulness and outcomes of hypnosis associated with local anesthesia during inguinal hernia repair procedure, notably on post-operative pain. A prospective study included patients operated on inguinal hernia repair according to Lichtenstein technique from January 2013 to September 2014. The cohort was divided into three groups (group 1: local anesthesia; group 2: hypnosis and local anesthesia; and group 3: general anesthesia). A questionnaire was filled by each participant before and after surgery. Pre-operative apprehension, pain at hospital discharge, surgeon comfort during procedure, immediate satisfaction after hospital discharge, and satisfaction at 1 month after surgery were evaluated. A total of 103 patients were included in this study (group 1: n = 55; group 2: n = 35; and group 3: n = 13). Pre-operative apprehension and pain at hospital discharge's scores were significantly higher in the group 3 than in the groups 1 and 2 (p < 0.001). Pain at hospital discharge was significantly lower in the group 2 than in the group 1 (p = 0.03). Pre-operative apprehension, surgeon comfort during procedure, immediate satisfaction after hospital discharge, and satisfaction at 1 month after surgery were similar between groups 1 and 2. Hypnosis combined with local anesthesia is a feasible technique which allows extending inguinal hernia repair to a large population. There is no complication associated with its use.

Malignant Mesothelioma of Tunica Vaginalis Testis: Macroscopic and Microscopic Features of a Very Rare Malignancy

PubMed Central

Arda, Ersan; Cetin, Gizem; Kuyumcuoğlu, Uğur; Usta, Ufuk

2017-01-01

Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is an extremely rare tumour, usually mimicking benign pathologies of the scrotum. Our case is an 84-year-old male patient who appealed with a painless, left-sided scrotal swelling longer than 2 months. Although the level of tumour markers was normal, ultrasonographic examination results forced us to perform an inguinal scrotal exploration. Multiple small papillary tumours, both on tunica vaginalis and tunica albuginea, were detected intraoperatively. Due to these findings, radical orchiectomy was performed. A pathological evaluation showed malignant mesothelioma (MM) of the tunica vaginalis testis. Exposure to asbestos is a well-known risk factor. Furthermore, a history of trauma, herniorrhaphy and chronic hydroceles is blamed as a possible risk factor. Scrotal ultrasonography is the mainstay of primary diagnosis and, therefore, it should not be overlooked when dealing with benign scrotal cysts or hydroceles, which are very common pathologies at these decades, too. Radical inguinal orchiectomy is the primary treatment choice for localised MMTVT disease, whereas in signs of lymph node metastasis, inguinal lymph node dissection is required. Radical resection should be completed with chemotherapy and/or radiotherapy for an advanced or recurrent disease. This case, which is very rarely reported in the literature and detected during inguinal exploration, along with the pathological works that supported the diagnosis, was presented with this report. PMID:29375946

Experimental and data analysis techniques for deducing collision-induced forces from photographic histories of engine rotor fragment impact/interaction with a containment ring

NASA Technical Reports Server (NTRS)

Yeghiayan, R. P.; Leech, J. W.; Witmer, E. A.

1973-01-01

An analysis method termed TEJ-JET is described whereby measured transient elastic and inelastic deformations of an engine-rotor fragment-impacted structural ring are analyzed to deduce the transient external forces experienced by that ring as a result of fragment impact and interaction with the ring. Although the theoretical feasibility of the TEJ-JET concept was established, its practical feasibility when utilizing experimental measurements of limited precision and accuracy remains to be established. The experimental equipment and the techniques (high-speed motion photography) employed to measure the transient deformations of fragment-impacted rings are described. Sources of error and data uncertainties are identified. Techniques employed to reduce data reading uncertainties and to correct the data for optical-distortion effects are discussed. These procedures, including spatial smoothing of the deformed ring shape by Fourier series and timewise smoothing by Gram polynomials, are applied illustratively to recent measurements involving the impact of a single T58 turbine rotor blade against an aluminum containment ring. Plausible predictions of the fragment-ring impact/interaction forces are obtained by one branch of this TEJ-JET method; however, a second branch of this method, which provides an independent estimate of these forces, remains to be evaluated.

Numerical Simulation of Vortex Ring Formation in the Presence of Background Flow: Implications for Squid Propulsion

NASA Astrophysics Data System (ADS)

Jiang, Houshuo; Grosenbaugh, Mark A.

2002-11-01

Numerical simulations are used to study the laminar vortex ring formation in the presence of background flow. The numerical setup includes a round-headed axisymmetric body with a sharp-wedged opening at the posterior end where a column of fluid is pushed out by a piston inside the body. The piston motion is explicitly included into the simulations by using a deforming mesh. The numerical method is verified by simulating the standard vortex ring formation process in quiescent fluid for a wide range of piston stroke to cylinder diameter ratios (Lm/D). The results from these simulations confirm the existence of a universal formation time scale (formation number) found by others from experimental and numerical studies. For the case of vortex ring formation by the piston/cylinder arrangement in a constant background flow (i.e. the background flow is in the direction of the piston motion), the results show that a smaller fraction of the ejected circulation is delivered into the leading vortex ring, thereby decreasing the formation number. The mechanism behind this reduction is believed to be related to the modification of the shear layer profile between the jet flow and the background flow by the external boundary layer on the outer surface of the cylinder. In effect, the vorticity in the jet is cancelled by the opposite signed vorticity in the external boundary layer. Simulations using different end geometries confirm the general nature of the phenomenon. The thrust generated from the jet and the drag forces acting on the body are calculated with and without background flow for different piston programs. The implications of these results for squid propulsion are discussed.

The trigger system for the external target experiment in the HIRFL cooling storage ring

NASA Astrophysics Data System (ADS)

Li, Min; Zhao, Lei; Liu, Jin-Xin; Lu, Yi-Ming; Liu, Shu-Bin; An, Qi

2016-08-01

A trigger system was designed for the external target experiment in the Cooling Storage Ring (CSR) of the Heavy Ion Research Facility in Lanzhou (HIRFL). Considering that different detectors are scattered over a large area, the trigger system is designed based on a master-slave structure and fiber-based serial data transmission technique. The trigger logic is organized in hierarchies, and flexible reconfiguration of the trigger function is achieved based on command register access or overall field-programmable gate array (FPGA) logic on-line reconfiguration controlled by remote computers. We also conducted tests to confirm the function of the trigger electronics, and the results indicate that this trigger system works well. Supported by the National Natural Science Foundation of China (11079003), the Knowledge Innovation Program of the Chinese Academy of Sciences (KJCX2-YW-N27), and the CAS Center for Excellence in Particle Physics (CCEPP).

Management of tibial fractures using a circular external fixator in two calves.

PubMed

Aithal, Hari Prasad; Kinjavdekar, Prakash; Amarpal; Pawde, Abhijit Motiram; Singh, Gaj Raj; Setia, Harish Chandra

2010-07-01

To report the repair of tibial diaphyseal fractures in 2 calves using a circular external skeletal fixator (CEF). Clinical report. Crossbred calves (n=2; age: 6 months; weight: 55 and 60 kg). Mid-diaphyseal tibial fractures were repaired by the use of a 4-ring CEF (made of aluminum rings with 2 mm K-wires) alone in 1 calf and in combination with hemicerclage wiring in 1 calf. Both calves had good weight bearing with moderate lameness postoperatively. Fracture healing occurred by day 60 in 1 calf and by day 30 in calf 2. The CEF was well maintained and tolerated by both calves through fracture healing. Joint mobility and limb usage improved gradually after CEF removal. CEF provided a stable fixation of tibial fractures and healing within 60 days and functional recovery within 90 days. CEF can be safely and successfully used for the management of selected tibial fractures in calves.

The electrical conductivity of the Earth's upper mantle as estimated from satellite measured magnetic field variations. Ph.D. Thesis

NASA Technical Reports Server (NTRS)

Didwall, E. M.

1981-01-01

Low latitude magnetic field variations (magnetic storms) caused by large fluctuations in the equatorial ring current were derived from magnetic field magnitude data obtained by OGO 2, 4, and 6 satellites over an almost 5 year period. Analysis procedures consisted of (1) separating the disturbance field into internal and external parts relative to the surface of the Earth; (2) estimating the response function which related to the internally generated magnetic field variations to the external variations due to the ring current; and (3) interpreting the estimated response function using theoretical response functions for known conductivity profiles. Special consideration is given to possible ocean effects. A temperature profile is proposed using conductivity temperature data for single crystal olivine. The resulting temperature profile is reasonable for depths below 150-200 km, but is too high for shallower depths. Apparently, conductivity is not controlled solely by olivine at shallow depths.

On sound transmission through double-walled cylindrical shells lined with poroelastic material: Comparison with Zhou's results and further effect of external mean flow

NASA Astrophysics Data System (ADS)

Liu, Yu; He, Chuanbo

2015-12-01

In this discussion, the corrections to the errors found in the derivations and the numerical code of a recent analytical study (Zhou et al. Journal of Sound and Vibration 333 (7) (2014) 1972-1990) on sound transmission through double-walled cylindrical shells lined with poroelastic material are presented and discussed, as well as the further effect of the external mean flow on the transmission loss. After applying the corrections, the locations of the characteristic frequencies of thin shells remain unchanged, as well as the TL results above the ring frequency where BU and UU remain the best configurations in sound insulation performance. In the low-frequency region below the ring frequency, however, the corrections attenuate the TL amplitude significantly for BU and UU, and hence the BB configuration exhibits the best performance which is consistent with previous observations for flat sandwich panels.

Potential value of routine contralateral patent processus vaginalis repair in children with unilateral inguinal hernia.

PubMed

Zhao, J; Chen, Y; Lin, J; Jin, Y; Yang, H; Wang, F; Zhong, H; Zhu, J

2017-01-01

The development of laparoscopy as a means of evaluation and treatment of inguinal hernia in children has raised the question of whether simultaneous closure of a contralateral patent processus vaginalis (CPPV) is justified. The present study aimed to determine the rate of metachronous inguinal hernia (MIH) in children with CPPV. Children with unilateral inguinal hernia from two hospitals underwent either open or laparoscopic repair, and were followed up for MIH. The presence of CPPV was evaluated during laparoscopy and, if detected, the CPPV was closed. The relationship between CPPV and subsequent MIH was studied. The study included children who had complete follow-up (90·0 per cent of those having open repair and 92·2 per cent of those undergoing laparoscopic repair). Of 2538 children who had open hernia repair, 62 (2·4 per cent) developed MIH (30 on the right side and 32 on the left; P = 0·015). Among 2855 children who underwent laparoscopic repair, a CPPV was identified and closed in 1469 (51·5 per cent). The rate of MIH after negative laparoscopic evaluation for CPPV was three of 2855 (0·1 per cent). There were no significant differences in the rate of CPPV between sexes and either the right or left side (P = 0·072 and P = 0·099 respectively). Ipsilateral recurrence was less frequent after laparoscopic repair: seven (0·2 per cent) versus 26 (1·0 per cent) for open repair (P < 0·001). Laparoscopic inguinal hernia repair was associated with a lower recurrence rate than open repair. Routine repair of CPPV reduced the rate of subsequent MIH, but 21 CPPVs needed to be closed to prevent one MIH. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

Follow-up period of 13 years after endoscopic total extraperitoneal repair of inguinal hernias: a cohort study.

PubMed

Brandt-Kerkhof, Alexandra; van Mierlo, Marjolein; Schep, Niels; Renken, Nondo; Stassen, Laurents

2011-05-01

Endoscopic inguinal hernia repair was introduced in the Netherlands in the early 1990s. The authors' institution was among the first to adopt this technique. In this study, long-term hernia recurrence among patients treated by the total extraperitoneal (TEP) approach for an inguinal hernia is described. A cohort study was conducted. Between January 1993 and December 1997, 346 TEP hernia repairs were performed for 318 patients. After a mean follow-up period of 13-years, a senior resident examined each patient. An experienced surgeon subsequently examined the patients with a diagnosis of recurrent hernia. Data were collected on an intention-to-treat basis, meaning that conversions were included in the analysis. Univariant tests were used to analyze age older than 50 years, chronic obstructive pulmonary disease, body mass index, smoking habit, hernia type, history of open hernia repair, conversion, and surgeon as potential risk factors. The analysis included 191 patients (62%) with 213 hernias. Of the original 318 patients, 59 patients died, and 68 were lost to follow-up evaluation. Perioperatively, 105 lateral, 55 medial, and 53 pantalon hernias were observed. Of the 213 hernias, 176 were primary and 37 were recurrent. The overall recurrence rate was 8.9% (8.5% for primary and 10.8% for recurrent hernias). Of the total study group, 48% of the patients experienced a bilateral inguinal hernia during their lifetime. No predicting factor for recurrent hernia could be identified. The current long-term results for TEP repair of primary and secondary inguinal hernia show an overall recurrence rate of 8.9%, which is slightly higher than in previous studies. The thorough examination at follow-up assessment, the learning curve effect, and the intention-to-treat-analysis may have influenced the observed recurrence rate. Also, the percentage of bilateral hernias was higher than known to date. Therefore, examination of the contralateral side should be standard procedure.

Diagnosing the occult contralateral inguinal hernia.

PubMed

Koehler, R H

2002-03-01

The incidence of bilateral inguinal hernias reported for total extra peritoneal (TEP) laparoscopic hernia repair, which reaches 45%, appears to be higher than that seen in studies of transabdominal laparoscopic and open repair. Given the unique ability of diagnostic laparoscopy to diagnose occult contralateral hernias (OCH) accurately, this study looked at how concurrent transabdominal diagnostic laparoscopy (TADL) would influence planned TEP repairs. A prospective study oF 100 consecutive TEP cases was conducted. All patients had diagnostic laparoscopy via a 5-mm 45 degrees scope through an umbilical incision with 15 mmHg of pneumoperitoneum, followed by laparoscopic TEPrepair. A contralateral occult hernia was diagnosed and repaired if a true peritoneal eventration through the inguinal region was observed. Among the 100 patients, preoperative diagnosis suggested 31 bilateral hernias (31%), whereas TADL confirmed 25 bilateral hernias (25%). Of these 25 bilateral hernias, TADL confirmed 16 that had been diagnosed preoperatively (64%), but excluded 15 contralateral hernias that were incorrectly diagnosed (37%). Transabdominal diagnostic laparoscopy found nine OCHs, representing 36% of all bilateral hernias and 13% of the 69 preoperatively determined unilateral hernias. The preoperative physician examination false-negative rate for contralateral hernias was 36%, and the false-positive rate was 37%. In 26 cases (26%), TADL changed the operative approach. In this study, patients believed to have unilateral inguinal hernias had OCHs in 13% of cases when examined by TADL. The actual bilateral hernia incidence was 25%, with a 37% false-positive rate for preoperatively diagnosed bilateral hernias. The high rate of bilateral hernias reported by the TEP approach alone suggests that some OCH findings may be an artifact of the TEP dissection. However, failure to search for an OCH could result in up to 13% of patients subsequently requiring a second repair. Because some surgeons are concerned about unnecessary TEP dissection of the asymptomatic contralateral side, the approach described here may offer a solution to accurate diagnosis of the contralateral inguinal region during planned laparoscopic TEP hernia repair.

Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years.

PubMed

Dulucq, Jean-Louis; Wintringer, Pascal; Mahajna, Ahmad

2009-03-01

Two revolutions in inguinal hernia repair surgery have occurred during the last two decades. The first was the introduction of tension-free hernia repair by Liechtenstein in 1989 and the second was the application of laparoscopic surgery to the treatment of inguinal hernia in the early 1990s. The purposes of this study were to assess the safety and effectiveness of laparoscopic totally extraperitoneal (TEP) repair and to discuss the technical changes that we faced on the basis of our accumulative experience. Patients who underwent an elective inguinal hernia repair at the Department of Abdominal Surgery at the Institute of Laparoscopic Surgery (ILS), Bordeaux, between June 1990 and May 2005 were enrolled retrospectively in this study. Patient demographic data, operative and postoperative course, and outpatient follow-up were studied. A total of 3,100 hernia repairs were included in the study. The majority of the hernias were repaired by TEP technique; the repair was done by transabdominal preperitoneal (TAPP) repair in only 3%. Eleven percent of the hernias were recurrences after conventional repair. Mean operative time was 17 min in unilateral hernia and 24 min in bilateral hernia. There were 36 hernias (1.2%) that required conversion: 12 hernias were converted to open anterior Liechtenstein and 24 to laparoscopic TAPP technique. The incidence of intraoperative complications was low. Most of the patients were discharged at the second day of the surgery. The overall postoperative morbidity rate was 2.2%. The incidence of recurrence rate was 0.35%. The recurrence rate for the first 200 repairs was 2.5%, but it decreased to 0.47% for the subsequent 1,254 hernia repairs According to our experience, in the hands of experienced laparoscopic surgeons, laparoscopic hernia repair seems to be the favored approach for most types of inguinal hernias. TEP is preferred over TAPP as the peritoneum is not violated and there are fewer intra-abdominal complications.

Elective Inguinal Node Irradiation in Early-Stage T2N0 Anal Cancer: Prognostic Impact on Locoregional Control

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zilli, Thomas, E-mail: Thomas.Zilli@hcuge.ch; Betz, Michael; Radiation Oncology Institute, Hirslanden Lausanne, Lausanne

2013-09-01

Purpose: To evaluate the influence of elective inguinal node radiation therapy (INRT) on locoregional control (LRC) in patients with early-stage T2N0 anal cancer treated conservatively with primary RT. Methods and Materials: Between 1976 and 2008, 116 patients with T2 node-negative anal cancer were treated curatively with RT alone (n=48) or by combined chemoradiation therapy (CRT) (n=68) incorporating mitomycin C and 5-fluorouracil. Sixty-four percent of the patients (n=74) received elective INRT. Results: Over a median follow-up of 69 months (range, 4-243 months), 97 (84%) and 95 patients (82%) were locally and locoregionally controlled, respectively. Rates for 5-year actuarial local control, LRC,more » cancer-specific, and overall survival for the entire population were 81.7% ± 3.8%, 79.2% ± 4.1%, 91.1% ± 3.0%, and 72.1% ± 4.5%, respectively. The overall 5-year inguinal relapse-free survival was 92.3% ± 2.9%. Isolated inguinal recurrence occurred in 2 patients (4.7%) treated without INRT, whereas no groin relapse was observed in those treated with INRT. The 5-year LRC rates for patients treated with and without INRT and with RT alone versus combined CRT were 80.1% ± 5.0% versus 77.8% ± 7.0% (P=.967) and 71.0% ± 7.2% versus 85.4% ± 4.5% (P=.147), respectively. A trend toward a higher rate of grade ≥3 acute toxicity was observed in patients treated with INRT (53% vs 31%, P=.076). Conclusions: In cases of node-negative T2 anal cancer, the inguinal relapse rate remains relatively low with or without INRT. The role of INRT in the treatment of early-stage anal carcinoma needs to be investigated in future prospective trials.« less

Laparoscopic transabdominal preperitoneal inguinal hernia repair using needlescopic instruments: a 15-year, single-center experience in 317 patients.

PubMed

Wada, Hidetoshi; Kimura, Taizo; Kawabe, Akihiro; Sato, Masanori; Miyaki, Yuichirou; Tochikubo, Junpei; Inamori, Kouji; Shiiya, Norihiko

2012-07-01

Laparoscopic inguinal hernia repair is associated with a decrease in postoperative pain, shortened hospital stay, earlier return to normal activity, and decrease in chronic pain. Moreover, laparoscopic surgery performed with needlescopic instruments has more advantages than conventional laparoscopic surgery. However, there are few reports of large-scale laparoscopic transabdominal preperitoneal inguinal hernia repair using needlescopic instruments (nTAPP). This report reviews our experiences with 352 nTAPP in 317 patients during the 15-year period from April 1996 to April 2011. We performed nTAPP as the method of choice in 88.5% of all patients presenting with inguinal hernia. To perform the nTAPP, 3-mm instruments were used. A 5-mm laparoscope was inserted from the umbilicus, and surgical instruments were inserted through 5- and 3-mm trocars. After reduction of the hernia sac and dissection of the preperitoneal space, we placed polyester mesh or polypropylene soft mesh with staple fixation. The peritoneum was closed with 3-0 silk interrupted sutures. The mean operative time was 102.9 min for unilateral hernias and 155.8 min for bilateral hernias. There was no conversion to open repair. Forty-three patients (13.6%) used postoperative analgesics, and the mean frequency of use was 0.5 times. Regarding intraoperative complications, we observed one bladder injury, but no bowel injuries or major vessel injuries. Postoperative complications occurred in 32 patients (10.1%). One patient with a retained lipoma required reoperation. There was no incidence of chronic pain or mesh infection. The operative time for experienced surgeons (≥ 20 repairs) was significantly shorter than that of inexperienced surgeons (< 20 repairs; P < 0.05). The nTAPP was a safe and useful technique for inguinal hernia repair. Large prospective, randomized controlled trials will be required to establish the benefit of nTAPP.

[Pre-surgical period and non-work-related sickness absence due to inguinal hernia].

PubMed

Ruiz-Moraga, Montserrat; Catalina-Romero, Carlos; Martínez-Muñoz, Paloma; Cobo-Santiago, María Dolores; González-López, Maite; Cabrera-Sierra, Martha; Porrero-Carro, José Luis; Calvo-Bonacho, Eva

2014-04-01

To analyze non-work-related sickness absence (NWR-SA) due to inguinal hernia and the factors related to its duration, paying particular attention to the pre-surgical period of NWR-SA. Prospective cohort study was conducted on 1,003 workers with an episode of NWR-SA due to an inguinal hernia, belonging to the insured population of a mutual insurance company. We assessed the duration of the NWR-SA episodes and the main demographic, occupational and clinical variables potentially related to it. Cox regression analyses were conducted to establish the predictors of NWR-SA duration. The mean duration of NWR-SA due to inguinal hernia was 68.6 days. After multivariate analysis (Cox regression), having a pre-surgical period of NWR-SA (HR = 0.35; 95%CI: 0.28-0.43), manual occupations (HR=0.68; 95%CI: 0.49-0.95), construction sector (HR=0.71; 95%CI: 0.58-0.88), direct payment methods by a Mutual Insurance Company during sick leave in self-employed workers (HR=0.58; 95%CI, 0.41-0.82), or employees (HR=0.51; 95%CI: 0.36-0.72), comorbidity (HR=0.45; 95%CI:0.34-0.59), and surgery performed under an entity other than the Public Health System or a mutual insurance company (HR=0,76; 95%CI: 0.59-0.97) were associated with longer NWR-SA. The Mutual Insurance Company always performed the surgery when a pre-surgery period of NWR-SA existed (mean duration=47 ±39.6 days); that was associated with shorter periods of post-surgical NWR-SA (P=.001). The NWR-SA due to inguinal hernia is a multifactorial phenomenon in which the pre-surgery period plays an important role. The collaboration between organizations involved in the management of NWR-SA seems to be an effective strategy for reducing its duration. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

The examination of biophysical parameters of skin (transepidermal water loss, skin hydration and pH value) in different body regions of normal cats of both sexes.

PubMed

Szczepanik, Marcin P; Wilkołek, Piotr M; Adamek, Lukasz R; Pomorski, Zbigniew J H

2011-04-01

The purpose of this study was to evaluate transepidermal water loss (TEWL), skin hydration and skin pH in normal cats. Twenty shorthaired European cats of both sexes were examined in the study. Measurements were taken from five different sites: the lumbar region, the axillary fossa, the inguinal region, the ventral abdominal region and the left thoracic region. In each of the regions, TEWL, skin hydration and skin pH were measured. The highest TEWL value was observed in the axillary fossa (18.22g/h/m(2)) and the lowest in the lumbar region (10.53g/h/m(2)). The highest skin hydration was found in the inguinal region (18.29CU) and the lowest in the lumbar region (4.62CU). The highest skin pH was observed in the inguinal region (6.64) and the lowest in the lumbar region (6.39). Statistically significant differences in TEWL were observed between the lumbar region and the left side of the thorax region (P=0.016), the axillary fossa (P=0.0004), the ventral region (P=0.005), and the inguinal region (P=0.009). There were significant differences in skin hydration between the lumbar region and the left thorax (P=0.000003), the axillary fossa (P=0.002), the ventral abdomen (P=0.03), and the inguinal region (P=0.0003) as well as between the thorax and the ventral abdomen (P=0.005). TEWL was higher in females (15g/h/m(2)) than in males (4.57g/h/m(2)). Skin hydration was higher in females (13.89CU) than in males (12.28CU). Significant differences were not found between males and females for TEWL and skin hydration. Skin pH was higher in males (6.94) than in females (6.54), which was significant (P=0.004). Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

Review of 1000 fibrin glue mesh fixation during endoscopic totally extraperitoneal (TEP) inguinal hernia repair.

PubMed

Berney, Christophe R; Descallar, Joseph

2016-10-01

Chronic pain is a common complication arising after conventional open herniorrhaphy and to a lesser extent postlaparoscopic inguinal hernia repairs as groin incision is avoided. Although published studies support elimination of mesh fixation during endoscopic procedures, the vast majority of surgeons will still recommend it by fear of encountering increased recurrence rates, if omitted. Regrettably, penetrating staple or tack fixation devices are the preferred methods to secure the mesh and cannot be applied at the level of the triangles of 'doom' and 'pain' where hernia tends to reoccur the most. This ongoing prospective cohort study aimed to confirm the safety and advantages of fibrin glue, as a substitute to staple mesh fixation during totally extraperitoneal (TEP) inguinal hernia repair. Over a 10-year period, 703 patients underwent 1000 elective TEP inguinal hernia repairs. Mesh fixation was achieved using exclusively fibrin sealant. Patients were reviewed at 2, 6 weeks and thereafter on an ad hoc basis if judged necessary until complete resolution of their symptoms. Quality of life (QoL) was assessed in a subgroup of 320 patients using the Carolina Comfort Scale (CCS). No conversion to open surgery was observed. There were three cases of major morbidities and no mortality. Three months after surgery, only seven patients (1 %) experienced chronic groin or testicular discomfort and none of them required prescription painkillers. When using the CCS, at 2 weeks 93.1 % of the patients were either satisfied or very satisfied with their outcome. This satisfaction index increased up to 99.2 % at 6 weeks post surgery. Finally, only eight hernia recurrences (1.1 %) were reported, of which five occurred during the first month of the study. Fibrin glue mesh fixation of inguinal hernia during TEP repair is extremely safe and reliable, with a very high satisfaction index for the patients and limited risk of developing chronic pain.

Influence of neural adaptation on dynamics and equilibrium state of neural activities in a ring neural network

NASA Astrophysics Data System (ADS)

Takiyama, Ken

2017-12-01

How neural adaptation affects neural information processing (i.e. the dynamics and equilibrium state of neural activities) is a central question in computational neuroscience. In my previous works, I analytically clarified the dynamics and equilibrium state of neural activities in a ring-type neural network model that is widely used to model the visual cortex, motor cortex, and several other brain regions. The neural dynamics and the equilibrium state in the neural network model corresponded to a Bayesian computation and statistically optimal multiple information integration, respectively, under a biologically inspired condition. These results were revealed in an analytically tractable manner; however, adaptation effects were not considered. Here, I analytically reveal how the dynamics and equilibrium state of neural activities in a ring neural network are influenced by spike-frequency adaptation (SFA). SFA is an adaptation that causes gradual inhibition of neural activity when a sustained stimulus is applied, and the strength of this inhibition depends on neural activities. I reveal that SFA plays three roles: (1) SFA amplifies the influence of external input in neural dynamics; (2) SFA allows the history of the external input to affect neural dynamics; and (3) the equilibrium state corresponds to the statistically optimal multiple information integration independent of the existence of SFA. In addition, the equilibrium state in a ring neural network model corresponds to the statistically optimal integration of multiple information sources under biologically inspired conditions, independent of the existence of SFA.

Biomechanical comparison of supraacetabular external fixation and anterior pelvic bridge plating.

PubMed

Çavuşoğlu, Ali Turgay; Erbay, Fatma Kübra; Özsoy, Mehmet Hakan; Demir, Teyfik

2017-10-01

Unstable pelvic ring injuries are complex and risky injuries due to high morbidity and mortality. Although anterior pelvic external fixator is a suitable method for rapid stabilization of an injured pelvic ring, due to some disadvantages such as high complication rate, nerve damage, and difficulties of patient's mobility and comfort, there has recently been increased searching for alternative methods for stabilization of the pelvic ring. Pubic symphysis zone freely moves in pelvic models. This study aims to evaluate the biomechanical stability of anterior pelvic bridge plating and compare it with supraacetabular external fixators in an untreated unstable pelvic fracture model. Samples were loaded statically with 2-mm/min loading rate in single leg standing position. Maximum load was 2.3 kN. When loading the samples, photographs were taken continuously. Stiffness values were calculated from the load displacement curves. Some reference parameters were described and were measured from unloaded and 2.3-kN-loaded photographs of the test. The mean stiffness values were 491.14 ± 52.22, 478.55 ± 41.44, and 470.25 ± 44.51 N/mm for anterior pelvic bridge plating group, supraacetabular external fixator group, and Control group, respectively. According to the measured parameters from photographs, the mean displacement at the pubic symphysis was 4.7 ± 0.32, 15.8 ± 2.01, and 18.2 ± 0.47 mm for anterior pelvic bridge plating, supraacetabular external fixator, and Control group, respectively. The highest displacement in the pubic symphysis was found in Control group, and minimum displacement was observed in anterior pelvic bridge plating group. When the perpendicular distance between the right and left lower end of ischium was examined, it was observed that displacement was minimum in anterior pelvic bridge plating group compared to other two groups, regarding to the high stability of pubic symphysis. In conclusion, this study revealed superiority of anterior subcutaneous plate fixation with biomechanical results.

[The ultrasound semiotics of uncomplicated wound healing after inguinal mesh plastics].

PubMed

Kharitonov, S V; Ziniakova, M V

2012-01-01

Dynamic ultrasound (US) investigation was performed in 89 patients operated on inguinal hernia with the use of meshes of various type. The US scanning proved to be a highly informative means of visualization, allowing the objective postoperative assessment of muscular and aponeurotic structures as well as the implant form and position. The study showed, that the mesh implantation was always accompanied by the exudative tissue reaction, which was determined by the physico-chemical characteristics of the implant.

Left Sided Amyand's Hernia, A Rare Occurance: A Case Report.

PubMed

Ravishankaran, Praveen; Mohan, G; Srinivasan, A; Ravindran, G; Ramalingam, A

2013-06-01

This is a case report about a 35 year old man admitted with complains of obstructed left sided inguinal hernia. On exploration of the left inguinal canal to our surprise a normal appendix was found in addition to a gangrenous omentum. Resection of the gangrenous omentum was done. Appendectomy was done. This case is reported for its rare occurance as only three such cases of left sided amyand's hernia has been reported so far in literature[4-6].

Extramammary Paget's disease of the vulva.

PubMed

Gavriilidis, Paschalis; Chrysanthopoulos, Konstantinos; Gerasimidou, Domniki

2013-11-21

Vulvar Paget's disease is an extremely rare neoplasm that accounts for less than 1% of the vulvar malignancies. We present a case of a 75-year-old woman, who had an eczematoid lesion involving the labia majora and minora bilaterally, with infiltration to the clitoris. Enlarged non-fixed lymph nodes were palpable in the inguinal region bilaterally. A biopsy of the vulva showed Paget's disease. She underwent radical vulvectomy with bilateral inguinal lymph node dissection. The patient remained disease free at 6-month follow-up.

High resolution interrogation system for fiber Bragg grating (FBG) sensor application using radio frequency spectrum analyser

NASA Astrophysics Data System (ADS)

Muhammad, F. D.; Zulkifli, M. Z.; Harun, S. W.; Ahmad, H.

2013-05-01

In this paper, we propose a fiber Bragg grating (FBG) interrogation system for high resolution sensor application based on radio frequency (RF) generation technique by beating a single longitudinal mode (SLM) fiber ring laser with an external tunable laser source (TLS). The external TLS provides a constant wavelength (CW), functioning as the reference signal for the frequency beating technique. The TLS used has a constant output power and wavelength over time. The sensor signal is provided by the reflected wavelength of a typical fiber Bragg grating (FBG) in the SLM fiber ring laser, which consists of a 1 m long highly doped Erbium doped fiber as the gain medium. The key to ensure the SLM laser oscillation is the role of graphene as saturable absorber which is opposed to the commonly used unpumped erbiumdoped fiber and this consequently contributes to the simple and short cavity design of our proposed system. The signal from the SLM fiber ring laser, which is generated by the FBG in response to external changes, such as temperature, strain, air humidity and air movement, is heterodyned with the CW signal from the TLS at a 6 GHz photodetector using a 3-dB fused coupler to generate the frequency beating. This proposed system is experimentally demonstrated as a temperature sensor and the results shows that the frequency response of the system towards the changes in temperature is about 1.3 GHz/°C, taking into account the resolution bandwidth of 3 MHz of the radio frequency spectrum analyzer (RFSA).

Electromagnetic pulse-driven spin-dependent currents in semiconductor quantum rings.

PubMed

Zhu, Zhen-Gang; Berakdar, Jamal

2009-04-08

We investigate the non-equilibrium charge and spin-dependent currents in a quantum ring with a Rashba spin-orbit interaction (SOI) driven by two asymmetric picosecond electromagnetic pulses. The equilibrium persistent charge and persistent spin-dependent currents are investigated as well. It is shown that the dynamical charge and the dynamical spin-dependent currents vary smoothly with a static external magnetic flux and the SOI provides a SU(2) effective flux that changes the phases of the dynamic charge and the dynamic spin-dependent currents. The period of the oscillation of the total charge current with the delay time between the pulses is larger in a quantum ring with a larger radius. The parameters of the pulse fields control to a certain extent the total charge and the total spin-dependent currents. The calculations are applicable to nanometre rings fabricated in heterojunctions of III-V and II-VI semiconductors containing several hundreds of electrons.

Traction studies of piston ring wear using an external radiometric method with proton activation

NASA Astrophysics Data System (ADS)

Scharf, Waldemar; Niewczas, Andrzej

1987-04-01

A method and results are presented of traction studies of piston ring wear in a Polski Fiat 126p passenger car and Star 200 lorry. The rings sliding surface was activated with a beam of 9.6-MeV protons and the measurements were made using a collimated scintillation detector placed outside the engine, i.e. without interfering with the engine's operation. The cars were run under varying traction conditions, their mileages having ranged between 7000 and 12000 km. In stable wear conditions on the road the piston ring wear for the passenger car and the lorry was {0.28%}/{100} km and {0.045%}/{100} km, respectively. The method was found to be particularly suitable for traction studies because it is simple and cheap. It can be employed as early as after the first 100 km of the car mileage.

Self-gripping mesh versus fibrin glue fixation in laparoscopic inguinal hernia repair: a randomized prospective clinical trial in young and elderly patients

PubMed Central

Bindi, Marco; Rivelli, Matteo; Solej, Mario; Enrico, Stefano; Martino, Valter

2016-01-01

Abstract Laparoscopic transabdominal preperitoneal inguinal hernia repair is a safe and effective technique. In this study we tested the hypothesis that self-gripping mesh used with the laparoscopic approach is comparable to polypropylene mesh in terms of perioperative complications, against a lower overall cost of the procedure. We carried out a prospective randomized trial comparing a group of 30 patients who underwent laparoscopic inguinal hernia repair with self-gripping mesh versus a group of 30 patients who received polypropylene mesh with fibrin glue fixation. There were no statistically significant differences between the two groups with regard to intraoperative variables, early or late intraoperative complications, chronic pain or recurrence. Self-gripping mesh in transabdominal hernia repair was found to be a valid alternative to polypropylene mesh in terms of complications, recurrence and postoperative pain. The cost analysis and comparability of outcomes support the preferential use of self-gripping mesh. PMID:28352842

[Lymphogranuloma venereum: new serovariant L2b and old "groove sign"].

PubMed

de Lavaissière, M; Nougué, J

2013-08-01

An ongoing lymphogranuloma venereum (LGV) outbreak has been reported in several European countries since 2003, related to a new variant L2b. This serovar appears to affect men who have sex with men (MSM), most of them being co-infected with the Human Immunodeficiency Virus (HIV). The secondary stage of LGV may involve lymph nodes and the inguinal form has sometimes been described on each side of the inguinal ligament thus named the "groove sign". We report the case of LGV serovariant L2b acquired by an heterosexual intercourse in an HIV seronegative patient who presented with an inguinal lymph node and a "groove sign". This is an uncommon but suggestive sign of LGV and we suggest that the clinical presentation of L2b LGV might not be so different than other variants and than the 20th century authors' description. Such a new Chlamydia trachomatis variant may circulate in other populations than MSM in Europe and clinical awareness must prevail.

As in Real Estate, Location Is What Matters: A Case Report of Transplant Ureteral Obstruction Due to an Inguinal Hernia.

PubMed

Bugeja, Ann; Clark, Edward G; Sood, Manish M; Ali, Sohrab N

2018-01-01

Kidney allograft dysfunction is common and often reversible but can lead to allograft loss if not promptly evaluated. Transplant ureteral obstruction in an inguinal hernia is a rare cause of allograft dysfunction, but early recognition may prevent allograft loss. We present a case of a man with acute kidney allograft dysfunction who received a deceased donor kidney transplant 6 years earlier for end-stage kidney disease secondary to polycystic kidney disease. Abdominal ultrasounds revealed hydronephrosis without full visualization of the transplant ureter. Abdominal computed tomography revealed moderate hydronephrosis of the transplant kidney due to obstructed herniation of the transplant ureter in a right inguinal hernia. A stent was inserted into the transplant ureter to prevent further allograft dysfunction and facilitate hernia repair. Transplant ureteral obstruction is a rare cause of acute kidney allograft dysfunction, and its detection can be challenging. The recognition of transplant ureteral obstruction is vital to timely management for preventing allograft loss.

Parecoxib sodium in the treatment of postoperative pain after Lichtenstein tension-free mesh inguinal hernia repair.

PubMed

Kyriakidis, A V; Perysinakis, I; Alexandris, I; Athanasiou, K; Papadopoulos, Ch; Mpesikos, I

2011-02-01

This prospective, randomized, double-blind study compared the analgesic efficacy and safety of parecoxib sodium versus lornoxicam and diclofenac, after Lichtenstein tension-free mesh inguinal hernia repair. Patients were randomly assigned to receive parecoxib 80 mg daily i.v. (Group A), lornoxicam 16 mg daily i.v. (Group B) or diclofenac 150 mg daily i.m. (Group C). Rescue analgesia in all groups consisted of pethidine 25 mg i.m. Pain was measured with an analogue scale (pain intensity score). Patients treated with parecoxib 80 mg reported significantly lower summed pain intensity scores compared with lornoxicam and diclofenac-treated patients. Duration of analgesia was also significantly longer with parecoxib than with lornoxicam and diclofenac. Adverse events were significantly less common in the parecoxib and lornoxicam group, compared with diclofenac group. Multiple-day administration of parecoxib 40 mg twice daily is more effective than equivalent doses of lornoxicam and diclofenac, and generally better tolerated than diclofenac after Lichtenstein tension-free mesh inguinal hernia repair.

Teaching three-dimensional surgical concepts of inguinal hernia in a time-effective manner using a two-dimensional paper-cut.

PubMed

Mann, B D; Seidman, A; Haley, T; Sachdeva, A K

1997-06-01

Because inguinal hernia repair is difficult for third-year students to comprehend, a 2-dimensional paper-cut was developed to teach the concepts of inguinal hernia in a time-effective manner before students' observation of herniorrhaphy in the operating room. Using Adobe Illustrator 5.5 for MacIntosh, a 2-dimensional inexpensively printed paper-cut was created to allow students to perform their own simulated hernia repair before observing surgery. The exercise was performed using a no.15 scalpel or an iris scissors and was evaluated by comparing 10-question pre-tests and post-tests. Seventy-five students performed the exercise, most completing it within 15 minutes. The mean pre-test score was 7.4/10 and the mean post-test score was 9.1/10. Students performing the paper-cut reported better understanding when observing actual herniorrhaphy. A 2-dimensional paper-cut ("surgical origami") may be a time-effective method to prepare students for the observation of hernia repair.

Hernia repair during endoscopic extraperitoneal radical prostatectomy: outcome after 93 cases.

PubMed

Do, Minh; Liatsikos, Evangelos N; Kallidonis, Panagiotis; Wedderburn, Andrew W; Dietel, Anja; Turner, Kevin J; Stolzenburg, Jens-Uwe

2011-04-01

To investigate the outcome of preperitoneal inguinal hernia mesh repairs performed during endoscopic extraperitoneal radical prostatectomy (EERPE). Ninety-three patients underwent inguinal hernia repair during 2125 EERPEs performed between 2002 and 2008. Seventy-seven patients had a unilateral hernia and 16 bilateral inguinal hernias. Patients were treated with EERPE or nerve-sparing EERPE and pelvic lymphadenectomy (if indicated) for localized prostate cancer. The mean age of the patients was 63 years (range 49-75 years). Operative time was 150 minutes (range 85-285 minutes) and estimated mean blood loss was 240 mL (range 30-600 mL). Blood transfusion was never deemed necessary. No conversions to open surgery took place. The mean duration of catheterization was 6.5 days (range 4-25 days). One patient developed a pelvic haematoma, three patients had symptomatic pelvic lymphoceles, and one developed an anastomotic stricture. One patient suffered a rectal injury during the procedure and another developed deep venous thrombosis. The only complication of hernia repair was mild penile bruising and edema. During the follow-up period, we have never observed mesh infection or hernia recurrence. EERPE combined with either a unilateral or bilateral laparoscopic hernia repair appears to be a safe and effective procedure. The incidence of complications related to either EERPE or the hernia repair was not increased. Oncological and functional outcome of EERPE seems not to be influenced by the performance of inguinal hernia repair.

Repair of Large Sliding Inguinal Hernias.

PubMed

Samra, Navdeep S; Ballard, David H; Doumite, Darin F; Griffen, F Dean

2015-12-01

Sliding inguinal hernias are often unexpected intra-operative findings, and repair of which can be technically challenging. A number of repair techniques have been described. The author modified a technique based on an approach described by Bevan. The purpose of our study is to describe this modified Bevan technique for repair of sliding inguinal hernias and report its efficacy in a series of patients. We retrospectively reviewed all patients with open inguinal hernia repairs performed by a single surgeon from August 2007 to April 2013 for sliding indirect hernias using the modified Bevan technique. Patient records were reviewed for demographics, hernia characteristics, complications, admission status, length of stay, and complications. There were 25 patients eligible for our review (male = 25, mean age = 49 years). All sliding hernias were indirect, none were bilateral, and two were incarcerated. The sliding component involved the bladder and perivesical fat (n = 12), sigmoid colon (n = 10), and the cecum and appendix (n = 3). Eighteen patients were treated as outpatients; seven patients were admitted with a mean stay of 2.2 days. Complications included intra-operative bleeding (n = 1), subcutaneous wound hematoma (n = 1), scrotal seroma (n = 1), transient orchialgia (n = 1), and ileus (n = 1). All patients were seen postoperatively for short-term follow-up with no hernia recurrences. Thirteen patients were available for long-term follow-up (mean = 13.6 months); all had no hernia recurrences. The modification of Bevan's technique for repair of large sliding hernias worked well in our series.

Routine laparoscopic repair of primary unilateral inguinal hernias--a viable alternative in the day surgery unit?

PubMed

Duff, M; Mofidi, R; Nixon, S J

2007-08-01

In September 2004 the NICE institute revised its guidelines on the management of primary inguinal hernias to include laparoscopic repair of unilateral hernias. While published trials have confirmed the equal efficacy of the two approaches, it is not clear what impact a switch to laparoscopic repairs would have on resources and patient throughput in a Day Surgery Unit. All elective hernia repairs performed in a one-year period were considered. Data were obtained from operation notes, discharge summaries and out-patient records. Operating times are routinely documented in theatre. Of the 351 operations studied, 150 were performed laparoscopically predominantly by an extraperitoneal (TEP)approach. Six required conversion to an open procedure. There was no significant difference in operating times, total theatre time or recovery room times between the two groups (51 min, 75 min and 34 min for the laparoscopic group and 53 min, 74 min and 31 min for the open repair group). Among the laparoscopic repair group there were 48 bilateral hernias and 20 recurrent hernias while 190 of the 201 open repairs were for primary unilateral hernias. Rates of overnight stay and immediate complications were similar between the groups though haematoma was more common following open repair (7 vs 2). There is no difference in theatre times, immediate complication rates or rates of overnight stay between open and laparoscopic repair of inguinal hernia. Routine laparoscopic repair of primary unilateral inguinal hernia is a viable alternative within the Day Surgery Unit.

Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia.

PubMed

Taylor, D C; Meyers, W C; Moylan, J A; Lohnes, J; Bassett, F H; Garrett, W E

1991-01-01

There has been increasing interest within the European sports medicine community regarding the etiology and treatment of groin pain in the athlete. Groin pain is most commonly caused by musculotendinous strains of the adductors and other muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. Cases may be termed "pubalgia" if physical examination does not reveal inguinal hernia and there is an absence of other etiology for groin pain. We present nine cases of patients who underwent herniorrhaphies for groin pain. Two patients had groin pain without evidence of a hernia preoperatively (pubalgia). In the remaining seven patients we determined the presence of a hernia by physical examination. At operation, eight patients were found to have inguinal hernias. One patient had no hernia but had partial avulsion of the internal oblique fibers from their insertion at the public tubercle. The average interval from operation to return to full activity was 11 weeks. All patients returned to full activity within 3 months of surgery. One patient had persistent symptoms of mild incisional tenderness, but otherwise there were no recurrences, complications, or persistence of symptoms. Abnormalities of the abdominal wall, including inguinal hernias and microscopic tears or avulsions of the internal oblique muscle, can be an overlooked source of groin pain in the athlete. Operative treatment of this condition with herniorrhaphy can return the athlete to his sport within 3 months.

Skin secretion peptides: the molecular facet of the deimatic behavior of the four-eyed frog, Physalaemus nattereri (Anura, Leptodactylidae).

PubMed

Barbosa, Eder Alves; Iembo, Tatiane; Martins, Graciella Ribeiro; Silva, Luciano Paulino; Prates, Maura Vianna; Andrade, Alan Carvalho; Bloch, Carlos

2015-11-15

Amphibians can produce a large amount of bioactive peptides over the skin. In order to map the precise tissue localization of these compounds and evaluate their functions, mass spectrometry imaging (MSI) and gene expression studies were used to investigate a possible correlation between molecules involved in the antimicrobial defense mechanisms and anti-predatory behavior by Physalaemus nattereri. Total skin secretion of P. nattereri was analyzed by classical Protein Chemistry and proteomic techniques. Intact inguinal macroglands were dissected from the rest of the skin and both tissues were analyzed by MSI and real-time polymerase chain reaction (RT-PCR) experiments. Peptides were primarily identified by de novo sequencing, automatic Edman degradation and cDNA data. Fifteen bradykinin (BK)-related peptides and two antimicrobial peptides were sequenced and mapped by MSI on the inguinal macrogland and the rest of P. nattereri skin. RT-PCR results revealed that BK-related peptide levels of expression were about 30,000 times higher on the inguinal macroglands than on the any other region of the skin, whilst antimicrobial peptide ions appear to be evenly distributed in both investigated regions. The presence of antimicrobial peptides in all investigated tissue regions is in accordance with the defensive role against microorganisms thoroughly demonstrated in the literature, whereas BK-related molecules are largely found on the inguinal macroglands suggesting an intriguing link between their noxious activities against potential predators of P. nattereri and the frog's deimatic behavior. Copyright © 2015 John Wiley & Sons, Ltd.

Evaluation of Anesthesia Profile in Pediatric Patients after Inguinal Hernia Repair with Caudal Block or Local Wound Infiltration

PubMed Central

Gavrilovska-Brzanov, Aleksandra; Kuzmanovska, Biljana; Kartalov, Andrijan; Donev, Ljupco; Lleshi, Albert; Jovanovski-Srceva, Marija; Spirovska, Tatjana; Brzanov, Nikola; Simeonov, Risto

2016-01-01

AIM: The aim of this study is to evaluate anesthesia and recovery profile in pediatric patients after inguinal hernia repair with caudal block or local wound infiltration. MATERIAL AND METHODS: In this prospective interventional clinical study, the anesthesia and recovery profile was assessed in sixty pediatric patients undergoing inguinal hernia repair. Enrolled children were randomly assigned to either Group Caudal or Group Local infiltration. For caudal blocks, Caudal Group received 1 ml/kg of 0.25% bupivacaine; Local Infiltration Group received 0.2 ml/kg 0.25% bupivacaine. Investigator who was blinded to group allocation provided postoperative care and assessments. Postoperative pain was assessed. Motor functions and sedation were assessed as well. RESULTS: The two groups did not differ in terms of patient characteristic data and surgical profiles and there weren’t any hemodynamic changes between groups. Regarding the difference between groups for analgesic requirement there were two major points - on one hand it was statistically significant p < 0.05 whereas on the other hand time to first analgesic administration was not statistically significant p = 0.40. There were significant differences in the incidence of adverse effects in caudal and local group including: vomiting, delirium and urinary retention. CONCLUSIONS: Between children undergoing inguinal hernia repair, local wound infiltration insures safety and satisfactory analgesia for surgery. Compared to caudal block it is not overwhelming. Caudal block provides longer analgesia, however complications are rather common. PMID:27275337

Paravertebral block can be an alternative to unilateral spinal anaesthesia for inguinal hernia repair.

PubMed

Mandal, M C; Das, S; Gupta, Sunil; Ghosh, T R; Basu, S R

2011-11-01

Inguinal hernia repair can be performed under satisfactory anaesthetic conditions using general, regional and peripheral nerve block anaesthesia. Unilateral spinal anaesthesia provides optimal anaesthesia, with stable haemodynamics and minimal adverse events. The paravertebral block, being segmental in nature, can be expected to produce some advantages regarding haemodynamic stability and early ambulation and may be a viable alternative. Fifty-four consenting male patients posted for inguinal hernia repair were randomized into two groups, to receive either the two-segment paravertebral block (group-P, n=26) at T10 and L1 or unilateral spinal anaesthesia (group-S, n=28), respectively. The time to ambulation (primary outcome), time to the first analgesic, total rescue analgesic consumption in the first 24-hour period and adverse events were noted. Block performance time and time to reach surgical anaesthesia were significantly higher in the patients of group-P (P<0.001). Time to ambulation was significantly shorter in group-P compared to group-S (P<0.001), while postoperative sensory block was prolonged in patients of group-S; P<0.001. A significantly higher number of patients could bypass the recovery room in group-P compared to group-S, (45% versus 0%, respectively, P<0.001). No statistically significant difference in adverse outcomes was recorded. Both the paravertebral block and unilateral spinal anaesthesia are effective anaesthetic techniques for uncomplicated inguinal hernia repair. However, the paravertebral block can be an attractive alternative as it provides early ambulation and prolonged postoperative analgesia with minimal adverse events.

Advanced Solid Rocket Motor case design status

NASA Technical Reports Server (NTRS)

Palmer, G. L.; Cash, S. F.; Beck, J. P.

1993-01-01

The Advanced Solid Rocket Motor (ASRM) case design aimed at achieving a safer and more reliable solid rocket motor for the Space Shuttle system is considered. The ASRM case has a 150.0 inch diameter, three equal length segment, and 9Ni-4CO-0.3C steel alloy. The major design features include bolted casebolted case joints which close during pressurization, plasma arc welded factory joints, integral stiffener for splash down and recovery, and integral External Tank attachment rings. Each mechanical joint has redundant and verifiable o-ring seals.

Self-seeding ring optical parametric oscillator

DOEpatents

Smith, Arlee V [Albuquerque, NM; Armstrong, Darrell J [Albuquerque, NM

2005-12-27

An optical parametric oscillator apparatus utilizing self-seeding with an external nanosecond-duration pump source to generate a seed pulse resulting in increased conversion efficiency. An optical parametric oscillator with a ring configuration are combined with a pump that injection seeds the optical parametric oscillator with a nanosecond duration, mJ pulse in the reverse direction as the main pulse. A retroreflecting means outside the cavity injects the seed pulse back into the cavity in the direction of the main pulse to seed the main pulse, resulting in higher conversion efficiency.

The Phylogenetic Signature Underlying ATP Synthase c-Ring Compliance

DOE PAGES

Pandini, Alessandro; Kleinjung, Jens; Taylor, Willie R.; ...

2015-09-01

The proton-driven ATP synthase (F OF 1) is comprised of two rotary, stepping motors (F O and F 1) coupled by an elastic power transmission. The elastic compliance resides in the rotor module that includes the membrane-embedded FO c-ring. Proton transport by FO is firmly coupled to the rotation of the c-ring relative to other F O subunits (ab 2). It drives ATP synthesis. We used a computational method to investigate the contribution of the c-ring to the total elastic compliance. We performed principal component analysis of conformational ensembles built using distance constraints from the bovine mitochondrial c-ring x-ray structure.more » Angular rotary twist, the dominant ring motion, was estimated to show that the c-ring accounted in part for the measured compliance. Ring rotation was entrained to rotation of the external helix within each hairpin-shaped c-subunit in the ring. Ensembles of monomer and dimers extracted from complete c-rings showed that the coupling between collective ring and the individual subunit motions was independent of the size of the c-ring, which varies between organisms. Molecular determinants were identified by covariance analysis of residue coevolution and structural-alphabet-based local dynamics correlations. The residue coevolution gave a readout of subunit architecture. The dynamic couplings revealed that the hinge for both ring and subunit helix rotations was constructed from the proton-binding site and the adjacent glycine motif (IB-GGGG) in the midmembrane plane. IB-GGGG motifs were linked by long-range couplings across the ring, while intrasubunit couplings connected the motif to the conserved cytoplasmic loop and adjacent segments. The correlation with principal collective motions shows that the couplings underlie both ring rotary and bending motions. Noncontact couplings between IB-GGGG motifs matched the coevolution signal as well as contact couplings. The residue coevolution reflects the physiological importance of the dynamics that may link proton transfer to ring compliance.« less

The Phylogenetic Signature Underlying ATP Synthase c-Ring Compliance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pandini, Alessandro; Kleinjung, Jens; Taylor, Willie R.

The proton-driven ATP synthase (F OF 1) is comprised of two rotary, stepping motors (F O and F 1) coupled by an elastic power transmission. The elastic compliance resides in the rotor module that includes the membrane-embedded FO c-ring. Proton transport by FO is firmly coupled to the rotation of the c-ring relative to other F O subunits (ab 2). It drives ATP synthesis. We used a computational method to investigate the contribution of the c-ring to the total elastic compliance. We performed principal component analysis of conformational ensembles built using distance constraints from the bovine mitochondrial c-ring x-ray structure.more » Angular rotary twist, the dominant ring motion, was estimated to show that the c-ring accounted in part for the measured compliance. Ring rotation was entrained to rotation of the external helix within each hairpin-shaped c-subunit in the ring. Ensembles of monomer and dimers extracted from complete c-rings showed that the coupling between collective ring and the individual subunit motions was independent of the size of the c-ring, which varies between organisms. Molecular determinants were identified by covariance analysis of residue coevolution and structural-alphabet-based local dynamics correlations. The residue coevolution gave a readout of subunit architecture. The dynamic couplings revealed that the hinge for both ring and subunit helix rotations was constructed from the proton-binding site and the adjacent glycine motif (IB-GGGG) in the midmembrane plane. IB-GGGG motifs were linked by long-range couplings across the ring, while intrasubunit couplings connected the motif to the conserved cytoplasmic loop and adjacent segments. The correlation with principal collective motions shows that the couplings underlie both ring rotary and bending motions. Noncontact couplings between IB-GGGG motifs matched the coevolution signal as well as contact couplings. The residue coevolution reflects the physiological importance of the dynamics that may link proton transfer to ring compliance.« less

Efficient second harmonic generation of a diode-laser-pumped CW Nd:YAG laser using monolithic MgO:LiNbO3 external resonant cavities

NASA Technical Reports Server (NTRS)

Kozlovsky, William J.; Nabors, C. D.; Byer, Robert L.

1988-01-01

56-percent efficient external-cavity-resonant second-harmonic generation of a diode-laser pumped, CW single-axial-mode Nd:YAG laser is reported. A theory of external doubling with a resonant fundamental is presented and compared to experimental results for three monolithic cavities of nonlinear MgO:LiNbO3. The best conversion efficiency was obtained with a 12.5-mm-long monolithic ring cavity doubler, which produced 29.7 mW of CW, single-axial model 532-nm radiation from an input of 52.5 mW.

V-shaped resonators for addition of broad-area laser diode arrays

DOEpatents

Liu, Bo; Liu, Yun; Braiman, Yehuda Y.

2012-12-25

A system and method for addition of broad-area semiconductor laser diode arrays are described. The system can include an array of laser diodes, a V-shaped external cavity, and grating systems to provide feedback for phase-locking of the laser diode array. A V-shaped mirror used to couple the laser diode emissions along two optical paths can be a V-shaped prism mirror, a V-shaped stepped mirror or include multiple V-shaped micro-mirrors. The V-shaped external cavity can be a ring cavity. The system can include an external injection laser to further improve coherence and phase-locking.

Characteristics of the Single-Longitudinal-Mode Planar-Waveguide External Cavity Diode Laser at 1064 nm

NASA Technical Reports Server (NTRS)

Numata, Kenji; Alalusi, Mazin; Stolpner, Lew; Margaritis, Georgios; Camp, Jordan; Krainak, Michael

2014-01-01

We describe the characteristics of the planar-waveguide external cavity diode laser (PW-ECL). To the best of our knowledge, it is the first butterfly-packaged 1064 nm semiconductor laser that is stable enough to be locked to an external frequency reference. We evaluated its performance from the viewpoint of precision experiments. Using a hyperfine absorption line of iodine, we suppressed its frequency noise by a factor of up to 104 at 10 mHz. The PWECL's compactness and low cost make it a candidate to replace traditional Nd:YAG nonplanar ring oscillators and fiber lasers in applications that require a single longitudinal mode.

[Results of an individualized surgical therapy of vulvar carcinoma from 1973-1993].

PubMed

Köhler, U; Schöne, M; Pawlowitsch, T

1997-01-01

From 1973 through 1993, the University of Leipzig Women's Hospital treated 285 patients with primary vulvar malignancies. Of these, 269 cases (94.3%) were squamous cell carcinomas. The patients age averaged 69 years (25-95 years). 232 women (81.4%) were older than 60 years. Only 20 women (7%) were younger than 50 years. During the given time period, 266 patients (93.3%) underwent primary surgery. Standard operative treatment, performed in 105 cases (39.5%), was radical vulvectomy and bilateral superficial inguinal lymph node dissection. Rather than en bloc resection (Butterfly method), separate incisions were used during node dissection. Only 3 patients (2.9%) experienced a relapse within the remaining skin bridge. Irradiation with a focal doses of ca. 50 Gy followed postoperative-adjuvant in those cases involving the inguinal lymph nodes. In contrast, 161 patients received largely individualized surgical treatment. Local tumor extension and patient age-dependent operability influenced the choice of treatment. Partial vulvectomy was performed in 37 cases (13.9%). Simple vulvectomy without inguinal node dissection was performed in 115 cases (43.2%) and 9 patients underwent vulvectomy with vaginal-, urethral- and partial sphincter resection, accompanied by myocutaneous flap transposition (M. gluteus maximus lobe). The cumulative (corrected) 5-year survival rate for all patients with squamous cell carcinoma was 68.6%. No significant relationship between patient age (> 60 years vs. < or = 60 years) and prognosis could be seen. Factors of importance to the prognosis, however, were primary tumor size (FIGO stage I vs. II vs. III/IV), principal tumor site (significantly poorer survival rates characterize both clitoral and multifocal carcinomas), histological staging (G1 vs. G2/G3), inguinal lymph node involvement (pN+ vs. pN-) and degree of tumor resection in "healthy" (> or = 2 cm vs. < 2 cm). 5-year survival rates among those patients receiving individualized operative care did not differ significantly. Patient survival rates were 70.3% by partial vulvectomy, 78.2% by simple vulvectomy without inguinal node dissection and 67.6% by radical vulvectomy and bilateral inguinal node dissection with or without postoperative-adjuvant irradiation. These findings, therefore, justify the individualized operative treatment of patients with vulvar carcinoma according to each patient's initial prognostic situation. The relatively seldom vulvar carcinoma should only be treated by experienced surgeons in an appropriate hospital environment. Moreover, assessment of histological sections must be standardized, reproducible and above all, include the very accurate evaluation of all resection edges.

Smoking Habits of Patients Undergoing Treatment for Intermittent Claudication in the Vascular Quality Initiative.

PubMed

Gabel, Joshua; Jabo, Brice; Patel, Sheela; Kiang, Sharon; Bianchi, Christian; Chiriano, Jason; Teruya, Theodore; Abou-Zamzam, Ahmed M

2017-10-01

Society for Vascular Surgery practice guidelines for the medical treatment of intermittent claudication give a GRADE 1A recommendation for smoking cessation. Active smoking is therefore expected to be low in patients suffering from intermittent claudication selected for vascular surgical intervention. The aim of this study is to evaluate the prevalence of smoking in patients undergoing intervention for intermittent claudication at the national level and to determine the relationship between smoking status and intervention. The Vascular Quality Initiative (VQI) registries for infra-inguinal bypass, supra-inguinal bypass, and peripheral vascular intervention (PVI) were queried to identify patients who underwent invasive treatment for intermittent claudication. Patient factors, procedure type (bypass versus PVI), and level of disease (supra-inguinal versus infra-inguinal) were evaluated for associations with smoking status (active smoking or nonsmoking) by univariate and covariate analysis. Between 2010 and 2015, 101,055 procedures were entered in the 3 registries, with 40,269 (40%) performed for intermittent claudication. Complete data for analysis were present in 37,632 cases. At the time of intervention, 44% of patients were active smokers, with wide variation by regional quality group (16-53%). In covariate analysis, active smoking at treatment was associated with age <70 years (prevalence ratio [PR] 2.42), male gender (PR 1.03), chronic obstructive pulmonary disease (PR 1.35), absence of prior cardiovascular procedures (PR 1.15), poor medication usage (PR 1.10), preoperative ankle-brachial index (ABI) <0.9 (PR 1.19), and supra-inguinal disease (PR 1.14). Invasiveness of treatment (PVI versus bypass procedures) was not significantly associated with smoking status. During follow-up, 36% of patients had quit smoking. Predictors of smoking cessation included age ≥70 years (RR 1.45), ABI ≥0.9 (RR 1.12), and bypass procedures (RR 1.22). At the time of treatment, 44% of patients undergoing intervention for intermittent claudication in the VQI were active smokers and there was a wide regional variation. Prevalence of active smoking was greater in the presence of younger age, fewer comorbidities, lower ABI, and supra-inguinal disease. Type of procedure performed, and in turn level of invasiveness required, did not appear to be influenced by smoking status. Elderly patients and those undergoing open procedures were more likely to quit smoking during follow up. These findings suggest opportunities for greater smoking cessation efforts before invasive therapies for intermittent claudication. Copyright © 2017 Elsevier Inc. All rights reserved.

Effect of temperature and gap opening rate on the resiliency of candidate solid rocket booster O-ring materials

NASA Technical Reports Server (NTRS)

Lach, Cynthia L.

1992-01-01

In the redesign of the Space Shuttle solid rocket motor following the Challenger accident, the field and nozzle-to-case joints were designed to minimize gap opening caused by internal motor pressurization during ignition. The O-ring seals and glands for these joints were designed both to accommodate structural deflections and to promote pressure assisted sealing. The resiliency behavior of several candidate O-ring materials was evaluated for the effects of temperature and gap opening rates. The performance of three of the elastomeric materials was tested under the specific redesign gap opening requirement. Dynamic flexure conditions unique to launch produce low frequency vibrations in the gap opening. The effect of these vibrations on the ability of the O-ring to maintain contact with the sealing surface was addressed. The resiliency of the O-ring materials was found to be extremely sensitive to variations in temperature and gap opening rate. The top three elastomeric materials tracked the simulated solid rocket booster (SRB) field joint deflection at 75 and 120 F. The external tank/SRB attach strut load vibrations had a negligible effect on the ability of the O-ring to track the simulated SRB field joint deflection.

Insulative laser shell coupler

DOEpatents

Arnold, Phillip A.; Anderson, Andrew T.; Alger, Terry W.

1994-01-01

A segmented coaxial laser shell assembly having at least two water jacket sections, two pairs of interconnection half rings, a dialectric break ring, and a pair of threaded ring sections. Each water jacket section with an inner tubular section that defines an inner laser cavity with water paths adjacent to at least a portion of the exterior of the inner tubular section, and mating faces at the end of the water jacket section through which the inner laser cavity opens and which defines at least one water port therethrough in communication with the water jackets. The water paths also define in their external surface a circumferential notch set back from and in close proximity to the mating face. The dielectric break ring has selected thickness and is placed between, and in coaxial alignment with, the mating faces of two of the adjacent water jacket sections. The break ring also defines an inner laser cavity of the same size and shape as the inner laser cavity of the water jacket sections and at least one water passage through the break ring to communicate with at least one water port through the mating faces of the water jacket sections.

Insulative laser shell coupler

DOEpatents

Arnold, P.A.; Anderson, A.T.; Alger, T.W.

1994-09-20

A segmented coaxial laser shell assembly having at least two water jacket sections, two pairs of interconnection half rings, a dielectric break ring, and a pair of threaded ring sections is disclosed. Each water jacket section with an inner tubular section that defines an inner laser cavity with water paths adjacent to at least a portion of the exterior of the inner tubular section, and mating faces at the end of the water jacket section through which the inner laser cavity opens and which defines at least one water port therethrough in communication with the water jackets. The water paths also define in their external surface a circumferential notch set back from and in close proximity to the mating face. The dielectric break ring has selected thickness and is placed between, and in coaxial alignment with, the mating faces of two of the adjacent water jacket sections. The break ring also defines an inner laser cavity of the same size and shape as the inner laser cavity of the water jacket sections and at least one water passage through the break ring to communicate with at least one water port through the mating faces of the water jacket sections. 4 figs.

The influence of gravity on the distribution of the deposit formed onto a substrate by sessile, hanging, and sandwiched hanging drop evaporation.

PubMed

Sandu, Ion; Fleaca, Claudiu Teodor

2011-06-15

The focus of the present article is the study of the influence of gravity on the particle deposition profiles on a solid substrate during the evaporation of sessile, hanging and sandwiched hanging drops of colloidal particle suspensions. For concentrations of nanoparticles in the colloidal solutions in the range 0.0001-1 wt.%, highly diluted suspensions will preferentially form rings while concentrated suspensions will preferentially form spots in both sessile and hanging drop evaporation. For intermediary concentrations, the particle deposition profiles will depend on the nanoparticle aggregation dynamics in the suspension during the evaporation process, gravity and on the detailed evaporation geometry. The evaporation of a drop of toluene/carbon nanoparticle suspension hanging from a pendant water drop will leave on the substrate a circular spot with no visible external ring. By contrast, a clear external ring is formed on the substrate by the sessile evaporation of a similar drop of suspension sandwiched between a water drop and the substrate. From the application viewpoint, these processes can be used to create preferential electrical conductive carbon networks and contacts for arrays of self-assembled nanostructures fabricated on solid substrates as well as on flexible polymeric substrates. Copyright © 2011 Elsevier Inc. All rights reserved.

High-resolution climate signals in the Bølling Allerød Interstadial (Greenland Interstadial 1) as reflected in European tree-ring chronologies compared to marine varves and ice-core records

NASA Astrophysics Data System (ADS)

Friedrich, Michael; Kromer, Bernd; Kaiser, Klaus F.; Spurk, Marco; Hughen, Konrad A.; Johnsen, Sigfus J.

2001-05-01

Lateglacial and Holocene tree-ring chronologies are unique archives, which provide various information on past environments on a true annual time scale. Changes in ring-width can be related to past climate anomalies and dendrodated wood provides an ideal source for radiocarbon calibration. We present a 1051 year tree-ring chronology from the Late Glacial, built from subfossil Scots pines (Pinus sylvestris) that grew in different regions of Central and Southern Europe. Through a series of high-precision radiocarbon measurements we obtained a floating radiocarbon chronology, which allowed accurate wiggle-matching to the INTCAL98 calibration curve. The trees show a coherent pattern in ring-width variations throughout Central Europe, and extending into the Mediterranean, which indicates a strong external climatic factor, most probably temperature during the growing season. We identified major growth events, which appear synchronous with events seen in isotopic and tracer signals in the Greenland ice cores and with changes in the strength of upwelling in the Cariaco Basin.

Persistent Müllerian duct syndrome with transverse testicular ectopia presenting as an incarcerated inguinal hernia.

PubMed

Kaul, A; Srivastava, K N; Rehman, S M F; Goel, V; Yadav, V

2011-12-01

The presence of both of the testes in one scrotal sac is one of the very rare presentations of testicular ectopia, which is known as transverse testicular ectopia (TTE) and is also known as crossed testicular ectopia. The presence of the uterus and fallopian tubes in a normally virilized male is termed as persistent Müllerian duct syndrome (PMDS). We report a case of an adult male who had a unique combination of both TTE and PMDS presenting as an incarcerated inguinal hernia.

Round ligament leiomyoma: a rare manifestation of a common entity.

PubMed

Deol, Madhvi; Arleo, Elizabeth Kagan

A 68-year-old woman with a history of multifocal uterine leiomyomas presented with left groin pain and was referred for cross-sectional imaging to assess for the presence of an inguinal hernia. In this patient, MRI demonstrated a round ligament leiomyoma encased in the proximal left inguinal canal. Leiomyomas are the most common benign gynecologic tumors, however round ligament leiomyomas are very rare. The purpose of this case report is to highlight a rare manifestation of a common entity. Copyright © 2016 Elsevier Inc. All rights reserved.

The Large Ring Laser G for Continuous Earth Rotation Monitoring

NASA Astrophysics Data System (ADS)

Schreiber, K. U.; Klügel, T.; Velikoseltsev, A.; Schlüter, W.; Stedman, G. E.; Wells, J.-P. R.

2009-09-01

Ring Laser gyroscopes exploit the Sagnac effect and measure rotations absolute. They do not require an external reference frame and therefore provide an independent method to monitor Earth rotation. Large-scale versions of these gyroscopes promise to eventually provide a similar high resolution for the measurement of the variations in the Earth rotation rate as the established methods based on VLBI and GNSS. This would open the door to a continuous monitoring of LOD (Length of Day) and polar motion, which is not yet available today. Another advantage is the access to the sub-daily frequency regime of Earth rotation. The ring laser “G” (Grossring), located at the Geodetic Observatory Wettzell (Germany) is the most advanced realization of such a large gyroscope. This paper outlines the current sensor design and properties.

Magnetoelectric effect in concentric quantum rings induced by shallow donor

NASA Astrophysics Data System (ADS)

Escorcia, R.; García, L. F.; Mikhailov, I. D.

2018-05-01

We study the alteration of the magnetic and electric properties induced by the off-axis donor in a double InAs/GaAs concentric quantum ring. To this end we consider a model of an axially symmetrical ring-like nanostructure with double rim, in which the thickness of the InAs thin layer is varied smoothly in the radial direction. The energies and of contour plots of the density of charge for low-lying levels we find by using the adiabatic approximation and the double Fourier-Bessel series expansion method and the Kane model. Our results reveal a possibility of the formation of a giant dipole momentum induced by the in-plane electric field, which in addition can be altered by of the external magnetic field applied along the symmetry axis.

Long-term quality of life and outcomes following robotic assisted TAPP inguinal hernia repair.

PubMed

Iraniha, Andrew; Peloquin, Joshua

2018-06-01

Laparoscopic TAPP inguinal hernia repair is an established alternative to open hernia repair, which offers equivalent outcomes with less postoperative pain and faster recovery. Unfortunately, it remains technically challenging, requiring advanced laparoscopic skills which have limited its popularity among surgeons. The robotic platform has the potential to overcome these challenges. The objective of this study was to examine the long-term quality of life and outcomes following robotic assisted TAPP inguinal hernia repair, since these data have not been reported up to now. From October 2012 to October 2015, 159 inguinal hernias in 82 consecutive patients were repaired with 3D mesh (BARD) using da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). The patients' demographics and intraoperative data were documented. Patients were seen 2 and 6 weeks after the surgery and the complications were recorded. Patients were assessed 6 weeks after the surgery by a survey using a universal pain assessment tool to document their post-operative pain, narcotic use and time of return to work and exercise. A modified short form 12 (SF 12) was also sent out to the patients 12-36 months after the surgery to measure their health-related quality of life prior to surgery and at the 12- to 36-month follow-up, and to document any evidence of recurrence. Postoperative health-related quality of life scores were compared to the pre-operative baseline quality of life scores using the unpaired t test. Over the course of 3 years, 159 robotic assisted TAPP inguinal hernia repair were performed in 82 patients, 73 men and 9 women by one surgeon as an outpatient basis. The mean age was 53 and mean body mass index was 26. There were no intraoperative complications or conversions. The average operative time was 99 min. Four patients developed urinary retention post-operatively and one patient developed postoperative bowel obstruction requiring laparoscopic lysis of adhesion with no long-term complications. All patients completed the pain assessment survey and the median pain score, 3 days after the surgery was 3. Narcotics were used for an average of 3.1 days. The modified SF 12 survey assessing for quality of life before and 12-36 months after surgery was completed and returned by 29 patients (response rate of 35.4% and median follow-up of 32 months). Only one recurrence was reported which was repaired with open technique. The analysis of the SF 12 survey that evaluated patient's quality of life, pain score and the ability to perform activities of daily living before and after surgery revealed a significant improvement in those measures 12-36 months after the surgery compare to their baseline. Hernia recurrence, chronic pain and physical impairment are the major long-term concerns after any type of inguinal hernia repair. Our results demonstrate that robotic assisted TAPP inguinal hernia repair appears to be a technically feasible, reproducible and safe minimally invasive alternative with low recurrence, low chronic pain and high health-related quality of life in the long term.

Self-gravity and dissipation in polar rings

NASA Technical Reports Server (NTRS)

Dubinski, John; Christodoulou, Dimitris M.

1994-01-01

Studies of inclined rings inside galaxy potentials have mostly considered the influence of self-gravity and viscous dissipation separately. In this study, we construct models of highly inclined ('polar') rings in an external potential including both self-gravity and dissipation due to a drag force. We do not include pressure forces and thus ignore shock heating that dominates the evolution of gaseous rings inside strongly nonspherical potentials. We adopt an oblate spheroidal scale-free logarithmic potential with axis ratio q = 0.85 and an initial inclination of 80 deg for the self-gravitating rings. We find that stellar (dissipationless) rings suffer from mass loss during their evolution. Mass loss also drives a secular change of the mean inclination toward the poles of the potential. As much as half of the ring mass escapes in the process and forms an inner and an outer shell of precessing orbits. If the remaining mass is more than approximately 0.02 of the enclosed galaxy mass, rings remain bound and do not fall apart from differential precession. The rings precess at a constant rate for more than a precession period tau(sub p) finding the configuration predicted by Sparke in 1986 which warps at larger radii toward the poles of the potential. We model shear viscosity with a velocity-dependent drag force and find that nuclear inflow dominates over self-gravity if the characteristic viscous inflow time scale tau(sub vi) is shorter than approximately 25(tau(sub p)). Rings with (tau(sub vi))/(tau(sub p)) less than or approximately equal to 25 collapse toward the nucleus of the potential within one precession period independent of the amount of self-gravity. Our results imply that stars and gas in real polar rings exhibit markedly different dynamical evolutions.

Effect of blue dye guided lymph channel ligation on the surgical morbidity of groin lymphadenectomy for vulval cancer: a feasibility study.

PubMed

Bharathan, Rasiah; Madhuri, Kavitha; Fish, Andrew; Larsen-Disney, Peter; Chatterjee, Jayanthan; Butler-Manuel, Simon; Tailor, Anil; Kehoe, Sean

2018-02-09

Inguinal lymphadenectomy has significant morbidity. Blue dye-guided lymph channel ligation is an effective technique for resolving lymphocele. This was a feasibility study in a preventative setting. Patients with vulval cancer requiring bilateral inguinal lymphadenectomy were recruited. After lymphadenectomy, patent blue V dye was injected and the severed lymph channels leaking blue dye, on the randomly-designated side were ligated. The median age was 72.5 years and the median body mass index was 25. The median lymph node harvest was 18.5. There were no significant surgical procedural differences between the right and the left sides. There was no significant difference between the two arms in terms of the duration or the volume of drainage and post-operative complications. All patients were alive at the follow-up period of 40.5 months. In this feasibility study, blue dye-guided lymph channel ligation did not significantly impact on post-operative outcomes. Impact statement What is already known on this subject? Lymph channel ligation with blue dye-guidance is an effective strategy for managing recalcitrant inguinal lymphocyst. This strategy was prospectively-studied in a small series of patients with non-gynaecological cancers. This particular study by Nakamura et al. ( 2011 ) revealed that such a strategy might be efficacious in reducing wound drain output. What do the results of this study add? Our study is the first study to assess this technique exclusively in vulval cancer. Blue dye-guided lymph channel ligation at the time of inguinal lymphadenectomy does not appear to reduce wound drainage. However, this study suggests that primary lymphocyst predominantly results from inflammatory exudates, whereas persistent secondary lymphocysts are likely to result from lymphorrhoea. What are the implications of these findings for clinical practice and/or further research? Future studies, which aim to reduce the morbidity of open inguinal lymphadenectomy, should employ a composite strategy to reduce inflammatory secretions. In addition, a biochemical and cytological analysis on lymphocysts at various time points should be performed to characterise the natural history of groin lymphocysts.

AMP-Activated Protein Kinase (AMPK) Regulates Energy Metabolism through Modulating Thermogenesis in Adipose Tissue

PubMed Central

Wu, Lingyan; Zhang, Lina; Li, Bohan; Jiang, Haowen; Duan, Yanan; Xie, Zhifu; Shuai, Lin; Li, Jia; Li, Jingya

2018-01-01

Obesity occurs when excess energy accumulates in white adipose tissue (WAT), whereas brown adipose tissue (BAT), which is specialized in dissipating energy through thermogenesis, potently counteracts obesity. White adipocytes can be converted to thermogenic “brown-like” cells (beige cells; WAT browning) under various stimuli, such as cold exposure. AMP-activated protein kinase (AMPK) is a crucial energy sensor that regulates energy metabolism in multiple tissues. However, the role of AMPK in adipose tissue function, especially in the WAT browning process, is not fully understood. To illuminate the effect of adipocyte AMPK on energy metabolism, we generated Adiponectin-Cre-driven adipose tissue-specific AMPK α1/α2 KO mice (AKO). These AKO mice were cold intolerant and their inguinal WAT displayed impaired mitochondrial integrity and biogenesis, and reduced expression of thermogenic markers upon cold exposure. High-fat-diet (HFD)-fed AKO mice exhibited increased adiposity and exacerbated hepatic steatosis and fibrosis and impaired glucose tolerance and insulin sensitivity. Meanwhile, energy expenditure and oxygen consumption were markedly decreased in the AKO mice both in basal conditions and after stimulation with a β3-adrenergic receptor agonist, CL 316,243. In contrast, we found that in HFD-fed obese mouse model, chronic AMPK activation by A-769662 protected against obesity and related metabolic dysfunction. A-769662 alleviated HFD-induced glucose intolerance and reduced body weight gain and WAT expansion. Notably, A-769662 increased energy expenditure and cold tolerance in HFD-fed mice. A-769662 treatment also induced the browning process in the inguinal fat depot of HFD-fed mice. Likewise, A-769662 enhanced thermogenesis in differentiated inguinal stromal vascular fraction (SVF) cells via AMPK signaling pathway. In summary, a lack of adipocyte AMPKα induced thermogenic impairment and obesity in response to cold and nutrient-overload, respectively, whereas chronic AMPK activation by A-769662 promoted WAT browning in inguinal WAT and protected against HFD-induced obesity and related metabolic dysfunction. These findings reveal a vital role for adipocyte AMPK in regulating the browning process in inguinal WAT and in maintaining energy homeostasis, which suggests that the targeted activation of adipocyte AMPK may be a promising strategy for anti-obesity therapy. PMID:29515462

Academic performance in adolescence after inguinal hernia repair in infancy: a nationwide cohort study.

PubMed

Hansen, Tom G; Pedersen, Jacob K; Henneberg, Steen W; Pedersen, Dorthe A; Murray, Jeffrey C; Morton, Neil S; Christensen, Kaare

2011-05-01

Although animal studies have indicated that general anesthetics may result in widespread apoptotic neurodegeneration and neurocognitive impairment in the developing brain, results from human studies are scarce. We investigated the association between exposure to surgery and anesthesia for inguinal hernia repair in infancy and subsequent academic performance. Using Danish birth cohorts from 1986-1990, we compared the academic performance of all children who had undergone inguinal hernia repair in infancy to a randomly selected, age-matched 5% population sample. Primary analysis compared average test scores at ninth grade adjusting for sex, birth weight, and paternal and maternal age and education. Secondary analysis compared the proportions of children not attaining test scores between the two groups. From 1986-1990 in Denmark, 2,689 children underwent inguinal hernia repair in infancy. A randomly selected, age-matched 5% population sample consists of 14,575 individuals. Although the exposure group performed worse than the control group (average score 0.26 lower; 95% CI, 0.21-0.31), after adjusting for known confounders, no statistically significant difference (-0.04; 95% CI, -0.09 to 0.01) between the exposure and control groups could be demonstrated. However, the odds ratio for test score nonattainment associated with inguinal hernia repair was 1.18 (95% CI, 1.04-1.35). Excluding from analyses children with other congenital malformations, the difference in mean test scores remained nearly unchanged (0.05; 95% CI, 0.00-0.11). In addition, the increased proportion of test score nonattainment within the exposure group was attenuated (odds ratio = 1.13; 95% CI, 0.98-1.31). In the ethnically and socioeconomically homogeneous Danish population, we found no evidence that a single, relatively brief anesthetic exposure in connection with hernia repair in infancy reduced academic performance at age 15 or 16 yr after adjusting for known confounding factors. However, the higher test score nonattainment rate among the hernia group could suggest that a subgroup of these children are developmentally disadvantaged compared with the background population.

Male infertility following inguinal hernia repair: a systematic review and pooled analysis.

PubMed

Kordzadeh, A; Liu, M O; Jayanthi, N V

2017-02-01

The aim of this systematic review is to establish the clinical impact of open (mesh and/or without mesh) and laparoscopic hernia repair (transabdominal pre-peritoneal (TAP) and/or totally extra-peritoneal (TEP)) on male fertility. The incidence of male infertility following various types of inguinal hernia repair is currently unknown. The lack of high-quality evidence has led to various speculations, suggestions and reliance on anecdotal experience in the clinical practice. An electronic search of the literature in Medline, Scopus, Embase and Cochrane library from 1966 to October 2015 according to PRISMA checklist was conducted. Quality assessment of articles was conducted using the Oxford Critical Appraisal Skills Programme (CASP) and their recommendation for practice was examined through National Institute for Health and Care Excellence (NICE). This resulted in ten studies (n = 10), comprising 35,740 patients. Sperm motility could be affected following any type and/or technique of inguinal hernia repair but this is limited to the immediate postoperative period (≤48 h). Obstructive azoospermia was noted in 0.03% of open and 2.5% of bilateral laparoscopic (TAP) hernia repair with mesh. Male infertility was detected in 0.8% of the open hernia repair (mesh) with no correlation to the type of mesh (lightweight vs. heavyweight). Inguinal hernia repair without mesh has no impact on male fertility and obstructive azoospermia. However, the use of mesh in bilateral open and/or laparoscopic repair may require the inclusion of male infertility as the part of informed consent in individuals that have not completed their family or currently under investigations.

Preperitoneal surgery using a self-adhesive mesh for inguinal hernia repair.

PubMed

Mangram, Alicia; Oguntodu, Olakunle F; Rodriguez, Francisco; Rassadi, Roozbeh; Haley, Michael; Shively, Cynthia J; Dzandu, James K

2014-01-01

Laparoscopic preperitoneal hernia repair with mesh has been reported to result in improved patient outcomes. However, there are few published data on the use of a totally extraperitoneal (TEP) approach. The purpose of this study was to present our experience and evaluate early outcomes of TEP inguinal hernia repair with self-adhesive mesh. This cohort study was a retrospective review of patients who underwent laparoscopic TEP inguinal hernial repair from April 4, 2010, through July 22, 2014. Data assessed were age, sex, body mass index (BMI), hernia repair indications, hernia type, pain, paresthesia, occurrence (bilateral or unilateral), recurrence, and patient satisfaction. Descriptive and regression analyses were performed. Six hundred forty patients underwent laparoscopic preperitoneal hernia surgery with self-adhesive mesh. The average age was 56 years, nearly all were men (95.8%), and the mean BMI was 26.2 kg/m(2). Cases involved primary hernia more frequently than recurrent hernia (94% vs 6%; P < .05). After surgery, 92% of the patients reported no more than minimal pain, <1% reported paresthesia, and 0.2% had early recurrence. There were 7 conversions to an open procedure. The patients had no adverse reactions to anesthesia and no bladder injury. Postoperative acute pain or recurrence was not explained by demographics, BMI, or preoperative pain. There were significant associations of hernia side, recurrence, occurrence, and sex with composite end points. Nearly all patients (98%) were satisfied with the outcome. The use of self-adhesive, Velcro-type mesh in laparoscopic TEP inguinal hernia repair is associated with reduced pain; low rates of early recurrence, infection, and hematoma; and improved patient satisfaction.

[Clinical and economic evaluation of laparoscopic surgery for inguinal hernia. Return of a difficult clinical choice].

PubMed

Bataille, N

2002-06-01

In the year 2000, the ANAES (National Agency for Accreditation and Evaluation of Health Care) published a technological and economic evaluation of the laparascopic approach to the repair of inguinal hernias based principally on the analysis of randomized studies. This analysis was all the more difficult because of the heterogeneity of the studies for which end results had a very weak level of proof. Laparascopic surgical techniques for inguinal hernia repair require the systematic use of mesh prosthesis and also general anesthesia. Published results are insufficient to compare specific laparascopic techniques with each other. The efficacy of laparoscopic repair compared to open repair with regard to hernia recurrence (the principal criteria of efficacy) has not been demonstrated--mainly because longterm results are not yet available. The overall evaluation of complications is too heterogeneous to show a difference between laparascopic and open surgery. There are, however, certain complications specific to laparascopic repair which, though rare, are potentially very serious. Excellent results reported with laparascopic repair may be due more to the systematic placement of mesh than-to to the approach itself--as has been shown in studies of open repairs "with tension" and "tension free." Superiority of the laparoscopic approach for specific types of hernia (primary unilateral, bilateral, recurrent) has not been demonstrated. Open surgery costs less than laparascopic hernia repair. The evaluation to date for laparascopic inguinal hernia repair is insufficient. Controlled studies with rigorous longterm follow-up and analysis of economic impact must be performed in comparable populations of patients.

Laparoscopic inguinal hernia repair in the Armed Forces: A 5-year single centre study.

PubMed

Jakhmola, C K; Kumar, Ameet

2015-10-01

Surgery for inguinal hernia continues to evolve. The most recent development in the field of surgery for inguinal hernia is the emergence of laparoscopic inguinal hernia surgery (LIHS) which is challenging the gold standard Lichtenstein's tension free mesh repair. Our centre has the largest series of LIHS from any Armed Forces hospital. The aim of this study was to analyze the short and long term outcomes at our center since its inception. Retrospective review of prospectively maintained data base of 501 LIHS done in 434 patients by a single surgeon between April 2008 and October 2013. Preoperative, intraoperative, postoperative and follow-up data was analyzed with emphasis on the recurrence rates and the incidence of inguinodynia. 402 (92.6%) patients had primary hernias and 367 (84.6%) patients had unilateral hernias. Of the 501 repairs, 453 (90.4 %) were done totally extraperitoneal approach and 48 (9.6 %) were done by the transabdominal preperitoneal approach. The mean operative time for unilateral and bilateral repairs was 40.9 ± 11.2 and 76.2 ± 15.0 minutes, respectively. The conversion rate to open surgery was 0.6%. The intraoperative, and early and late postoperative complication rates were 1.7%, 6.2% and 3%, respectively. The incidence of chronic groin pain was 0.7% and the recurrence rate was 1.6%. The median hospital stay was 1 day (1-5 days). We, in this series of over 500 repairs have demonstrated that feasibility as well as safety of LIHS at our centre with good short and long term outcomes.

An international consensus algorithm for management of chronic postoperative inguinal pain.

PubMed

Lange, J F M; Kaufmann, R; Wijsmuller, A R; Pierie, J P E N; Ploeg, R J; Chen, D C; Amid, P K

2015-02-01

Tension-free mesh repair of inguinal hernia has led to uniformly low recurrence rates. Morbidity associated with this operation is mainly related to chronic pain. No consensus guidelines exist for the management of this condition. The goal of this study is to design an expert-based algorithm for diagnostic and therapeutic management of chronic inguinal postoperative pain (CPIP). A group of surgeons considered experts on inguinal hernia surgery was solicited to develop the algorithm. Consensus regarding each step of an algorithm proposed by the authors was sought by means of the Delphi method leading to a revised expert-based algorithm. With the input of 28 international experts, an algorithm for a stepwise approach for management of CPIP was created. 26 participants accepted the final algorithm as a consensus model. One participant could not agree with the final concept. One expert did not respond during the final phase. There is a need for guidelines with regard to management of CPIP. This algorithm can serve as a guide with regard to the diagnosis, management, and treatment of these patients and improve clinical outcomes. If an expectative phase of a few months has passed without any amelioration of CPIP, a multidisciplinary approach is indicated and a pain management team should be consulted. Pharmacologic, behavioral, and interventional modalities including nerve blocks are essential. If conservative measures fail and surgery is considered, triple neurectomy, correction for recurrence with or without neurectomy, and meshoma removal if indicated should be performed. Surgeons less experienced with remedial operations for CPIP should not hesitate to refer their patients to dedicated hernia surgeons.

Correlation of ultrasound appearance, gross anatomy, and histology of the femoral nerve at the femoral triangle.

PubMed

Lonchena, Tiffany K; McFadden, Kathryn; Orebaugh, Steven L

2016-01-01

Correlation between ultrasound appearance, gross anatomic characteristics, and histologic structure of the femoral nerve (FN) is lacking. Utilizing cadavers, we sought to characterize the anatomy of the FN, and provide a quantitative measure of its branching. We hypothesize that at the femoral crease, the FN exists as a group of nerve branches, rather than a single nerve structure, and secondarily, that this transition into many branches is apparent on ultrasonography. Nineteen preserved cadavers were investigated. Ultrasonography was sufficient to evaluate the femoral nerve in nine specimens; gross dissection was utilized in all 19. Anatomic characteristics were recorded, including distances from the inguinal ligament to femoral crease, first nerve branch, and complete arborization of the nerve. The nerves from nine specimens were excised for histologic analysis. On ultrasound, the nerve became more flattened, widened, and less discrete as it coursed distally. Branching of the nerve was apparent in 12 of 18 images, with mean distance from inguinal ligament of 3.9 (1.0) cm. However, upon dissection, major branching of the femoral nerve occurred at 3.1 (1.0) cm distal to the inguinal ligament, well proximal to the femoral crease. Histologic analysis was consistent with findings at dissection. The femoral nerve arborizes into multiple branches between the inguinal ligament and the femoral crease. Initial branching is often high in the femoral triangle. As hypothesized, the FN exists as a closely associated group of nerve branches at the level of the femoral crease; however, the termination of the nerve into multiple branches is not consistently apparent on ultrasonography.

Approach to inguinal hernia in high-risk geriatric patients: Should it be elective or emergent?

PubMed

Işıl, Rıza Gürhan; Yazıcı, Pınar; Demir, Uygar; Kaya, Cemal; Bostancı, Özgür; İdiz, Ufuk Oğuz; Işıl, Canan Tülay; Demircioğlu, Mahmut Kaan; Mihmanlı, Mehmet

2017-03-01

Elderly patients are more prone to have inguinal hernia due to weakened abdominal musculature. However, surgical repair of inguinal hernia (SRIH) may not be performed or may be delayed due to greater risk in presence of comorbidities. Present study is investigation of outcome of elective and emergency SRIH in geriatric patients. Records of total of 384 high-risk (American Society of Anesthesiology classification III-IV) patients aged >65 years who underwent SRIH between January 2010 and December 2014 were reviewed. Patients were divided into 2 groups according to procedure type: elective (Group EL) or emergency (Group EM). Demographic features and surgical and postoperative period data of 2 groups were recorded and compared. Demographic data were similar, but number of ASA IV patients was greater in Group EM. Frequency of intestinal resection was significantly greater in emergency surgery group (1% vs 21%; p<0.01). Length of hospital stay (1.3 days vs 7.9 days; p<0.01) and intensive care unit stay (0.17 days vs 4.04 days; p<0.01) were also greater in Group EM. Morbidity (1% vs 24%; p<0.01) and mortality (0.3% vs 11%; p<0.01) were also significantly higher in Group EM compared to elective SRIH group. Emergency inguinal hernia surgery is associated with significantly higher morbidity and mortality compared with elective SRIH in high-risk geriatric patients. Elective hernia repair in these patients should be considered to reduce risk of need for intestinal resection as well as length of hospital stay.

Ipsilateral superficial inguinal lymphadenectomy for the treatment of early cancer of the vulva.

PubMed

Gori, Jorge R; Fritsches, Heriberto W; Castaño, Roberto; Toziano, Mariano; Habich, Diego

2002-07-01

This study compared the rates of survival, recurrence, and the occurrence of complications after surgery for vulvar cancer in selected patients treated by simple vulvectomy or wide local excision (WLE) and ipsilateral superficial inguinal lymphadenectomies (ISIL) and who were in a representative group of previous patients treated by standard radical surgery (control). Superficial inguinal lymphadenectomies were performed in 32 patients with laterally localized squamous cell tumors of 1 to 3 cm in size and without palpable lymph nodes. Eight cases, which showed histological evidence of lymph node metastasis, were submitted to conventional radical treatment and excluded from the study. Of the remaining 24 patients, 12 underwent vulvectomy, 7 hemivulvectomy, and 5 WLE. The results of this group were compared with those of 21 historical controls who previously had tumors of 1 to 3 cm and had been treated by radical vulvectomy with superficial and deep bilateral inguinal lymphadenectomy. Dehiscence of the flaps occurred in 66.6% of the control patients and in 8.3% of the ISIL group (chi , p <.0001). There was lymphedema in 13.8% of the controls and none in the ISIL group (Fisher exact test, p <.02). Upon follow-up (3 to 8 years, results are reported for 3 years of follow-up), there were 9.5% vulvar recurrences in the controls and 12.5% in the ISIL group (Fisher exact test, p <.652 not significant). WLE and deep local excision of the primary lesion and ISIL in selected patients with early vulvar cancer seems to be a safe alternative to the traditional radical method.

A high-fat diet enriched with low omega-6 to omega-3 fatty acid ratio reduced fat cellularity and plasma leptin concentration in Sprague-Dawley rats.

PubMed

Tekeleselassie, A W; Goh, Y M; Rajion, M A; Motshakeri, M; Ebrahimi, M

2013-01-01

This study was aimed to investigate the effects of dietary fatty acids on the accretion pattern of major fat pads, inguinal fat cellularity, and their relation with plasma leptin concentration. Forty Sprague-Dawley rats were randomly assigned into four groups and received the following diets for 22 weeks: (1) standard rat chow diet (CTRL), (2) CTRL + 10% (w/w) butter (HFAR), (3) CTRL + 3.33% (w/w) menhaden fish oil + 6.67% (w/w) soybean oil (MFAR), and (4) CTRL + 6.67% (w/w) menhaden fish oil + 3.33% (w/w) soybean oil (LFAR). Inguinal fat cellularity and plasma leptin concentration were measured in this study. Results for inguinal fat cellularity showed that the mean adipocyte number for the MFAR (9.2 ∗ 10⁵ ± 3.6) and LFAR (8.5 ∗ 10⁵ ± 5.1) groups was significantly higher (P < 0.05) than the rest, while the mean adipocyte diameter of HFAR group was larger (P < 0.05) (46.2 ± 2.8) than the rest. The plasma leptin concentration in the HFAR group was higher (P < 0.05) (3.22 ± 0.32 ng/mL), than the other groups. The higher inguinal fat cellularity clearly indicated the ability of the polyunsaturated fatty acids (PUFA) and butter supplemented diets to induce hyperplasia and hypertrophy of fat cells, respectively, which caused adipocyte remodeling due to hyperleptinemia.

Experimental results of mesh fixation by a manual manipulator in a laparoscopic inguinal hernia repair model.

PubMed

Inaki, N; Waseda, M; Schurr, M O; Braun, M; Buess, G F

2007-02-01

Laparoscopic mesh fixation using a stapler can lead to complications such as nerve injury and bowel injury. However, mesh fixation by suturing with conventional laparoscopic instruments (CLI) is difficult because of limited degrees of freedom. A manual manipulator--Radius Surgical System (Radius)--whose tip can deflect and rotate, gives the surgeon two additional degrees of freedom. The aim of this study is to evaluate the introduction of Radius to mesh fixation in laparoscopic inguinal hernia repair. A model for inguinal hernia repair was prepared using animal organs in a trainer. Mesh fixation was performed using Radius, stapler, and CLI. Tensile strength during extraction of mesh toward the vertical direction, and execution time, were measured. The mean number of fixation points of Radius, stapler, and CLI was 9.3 +/- 1.5, 8.5 +/- 1.4, and 9.0 +/- 1.0, respectively. The mean tensile strength of fixation of mesh of Radius, stapler, and CLI was 140.7 +/- 48.9, 73.1 +/- 23.4, and 53.6 +/- 31.5 (N), respectively. The mean tensile strength per one fixation point by Radius, stapler, and CLI was 16.5 +/- 5.3, 8.7 +/- 2.8, and 6.3 +/- 3.6 (N), respectively. The mean execution time of Radius, stapler, and CLI was 479 +/- 108, 54 +/- 31, and 431 +/- 77 (sec), respectively. The mesh fixation by Radius was stronger than that by staples and CLI. Two additional degrees of freedom were useful in difficult angles. The introduction of Radius is feasible and facilitates the fixation of mesh with sutures in laparoscopic inguinal hernia repair.

Ultrasound-guided transversus abdominis plane block in patients undergoing open inguinal hernia repair: 0.125% bupivacaine provides similar analgesic effect compared to 0.25% bupivacaine.

PubMed

Erdoğan Arı, Dilek; Yıldırım Ar, Arzu; Karadoğan, Firdevs; Özcabı, Yetkin; Koçoğlu, Ayşegül; Kılıç, Fatih; Akgün, Fatma Nur

2016-02-01

To evaluate the effectiveness of 0.125% bupivacaine compared to 0.25% bupivacaine for ultrasound-guided transversus abdominis plane (TAP) block in patients undergoing open inguinal hernia repair. Randomized, double-blind study. Educational and research hospital. Forty adult patients of American Society of Anesthesiologists physical status I-III undergoing elective primary unilateral open inguinal hernia repair under spinal anesthesia. Patients in group I received 20 mL of 0.25% bupivacaine, whereas patients in group II received 20 mL of 0.125% bupivacaine for TAP block at the end of the surgery. Pain intensity was assessed at rest and during coughing using 10-cm visual analog scale score at 5, 15, 30, and 45 minutes and 1, 2, 4, 6, 12, and 24 hours after TAP block. Morphine consumption and time to first morphine requirement were recorded. Visual analog scale scores at rest and during coughing were not significantly different between groups at all time points measured. Twenty-four hours of morphine consumption (7.72±7.33 mg in group I and 6.06±5.20 mg in group II; P=.437) and time to first morphine requirement (182.35±125.16 minutes in group I and 143.21±87.28 minutes in group II; P=.332) were not different between groups. 0.125% Bupivacaine provides similar analgesic effect compared to 0.25% bupivacaine for ultrasound-guided TAP block in patients undergoing open inguinal hernia repair. Copyright © 2016 Elsevier Inc. All rights reserved.

[Hidradenocarcinoma of the heel associated with inguinal metastases].

PubMed

Labbardi, W; Hali, F; Marnissi, F; Cribier, B; Chiheb, S

Hidradenocarcinoma is a rare malignant tumour involving the sweat glands. It classically arises de novo, only rarely resulting from pre-existing hidradenoma. The literature contains few reports of lymph node metastasis in this tumour. We report a case of a patient with hidradenocarcinoma of the heel associated with inguinal node metastases. We report the case of a 64-year-old patient with a history of chronic smoking, who in the last two years developed a painless nodule in his right heel, with no prior injury, and which gradually increased in size to become an ulcerated tumour. Physical examination revealed a rounded tumour mass, ulcerated in the centre, and associated with multiple inguinal adenopathies. Histological and immunohistochemical examination was suggestive of hidradenocarcinoma. The patient had undergone extensive local excision with inguinal lymphadenectomy. Histological examination showed infiltration of lymph nodes by the tumour with capsular rupture. Radiotherapy was subsequently given. The outcome was good without recurrence after 34 months of follow-up. Hidradenocarcinoma is a rare malignant tumour. Diagnosis is based on histological and immunohistochemical examination. However, hidradenocarcinoma may on occasion be difficult to differentiate from hidradenoma, a benign tumour, hence the interest of complete surgical resection with safety margins even in the absence of cytological malignancy. Local recurrences are common. The occurrence of lymph node metastasis during hidradenocarcinoma has been described only rarely in the literature. Such metastases usually occur after tumour resection. The specific features of our case are the rarity of lymph node metastases in hidradenocarcinoma coupled with the fact that these metastases were discovered upon diagnosis of the primary tumour. Copyright © 2017. Published by Elsevier Masson SAS.

A prospective randomised trial comparing mesh types and fixation in totally extraperitoneal inguinal hernia repairs.

PubMed

Cristaudo, Adam; Nayak, Arun; Martin, Sarah; Adib, Reza; Martin, Ian

2015-05-01

The totally extraperitoneal (TEP) approach for surgical repair of inguinal hernias has emerged as a popular technique. We conducted a prospective randomised trial to compare patient comfort scores using different mesh types and fixation using this technique. Over a 14 month period, 146 patients underwent 232 TEP inguinal hernia repairs. We compared the comfort scores of patients who underwent these procedures using different types of mesh and fixation. A non-absorbable 15 × 10 cm anatomical mesh fixed with absorbable tacks (Control group) was compared with either a non-absorbable 15 × 10 cm folding slit mesh with absorbable tacks (Group 2), a partially-absorbable 15 × 10 cm mesh with absorbable tacks (Group 3) or a non-absorbable 15 × 10 cm anatomical mesh fixed with 2 ml fibrin sealant (Group 4). Outcomes were compared at 1, 2, 4 and 12 weeks using the Carolina Comfort Scale (CCS) scores. At 1, 2, 4 and 12 weeks, the median global CCS scores were low for all treatment groups. Statistically significant differences were seen only for median CCS scores and subscores with the use of partially-absorbable mesh with absorbable tacks (Group 3) at weeks 2 and 4. However, these were no longer significant at week 12. In this study, the TEP inguinal hernia repair with minimal fixation results in low CCS scores. There were no statistical differences in CCS scores when comparing types of mesh, configuration of the mesh or fixation methods. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Anti-parallel polarization switching in a triglycine sulfate organic ferroelectric insulator: The role of surface charges

NASA Astrophysics Data System (ADS)

Ma, He; Wu, Zhuangchun; Peng, Dongwen; Wang, Yaojin; Wang, Yiping; Yang, Ying; Yuan, Guoliang

2018-04-01

Four consecutive ferroelectric polarization switchings and an abnormal ring-like domain pattern can be introduced by a single tip bias of a piezoresponse force microscope in the (010) triglycine sulfate (TGS) crystal. The external electric field anti-parallel to the original polarization induces the first polarization switching; however, the surface charges of TGS can move toward the tip location and induce the second polarization switching once the tip bias is removed. The two switchings allow a ring-like pattern composed of the central domain with downward polarization and the outer domain with upward polarization. Once the two domains disappear gradually as a result of depolarization, the other two polarization switchings occur one by one at the TGS where the tip contacts. However, the backswitching phenomenon does not occur when the external electric field is parallel to the original polarization. These results can be explained according to the surface charges instead of the charges injected inside.

Determination of ankle external fixation stiffness by expedited interactive finite element analysis.

PubMed

Nielsen, Jonathan K; Saltzman, Charles L; Brown, Thomas D

2005-11-01

Interactive finite element analysis holds the potential to quickly and accurately determine the mechanical stiffness of alternative external fixator frame configurations. Using as an example Ilizarov distraction of the ankle, a finite element model and graphical user interface were developed that provided rapid, construct-specific information on fixation rigidity. After input of specific construct variables, the finite element software determined the resulting tibial displacement for a given configuration in typically 15s. The formulation was employed to investigate constructs used to treat end-stage arthritis, both in a parametric series and for five specific clinical distraction cases. Parametric testing of 15 individual variables revealed that tibial half-pins were much more effective than transfixion wires in limiting axial tibial displacement. Factors most strongly contributing to stiffening the construct included placing the tibia closer to the fixator rings, and mounting the pins to the rings at the nearest circumferential location to the bone. Benchtop mechanical validation results differed inappreciably from the finite element computations.

Silicon Photonics Transmitter with SOA and Semiconductor Mode-Locked Laser.

PubMed

Moscoso-Mártir, Alvaro; Müller, Juliana; Hauck, Johannes; Chimot, Nicolas; Setter, Rony; Badihi, Avner; Rasmussen, Daniel E; Garreau, Alexandre; Nielsen, Mads; Islamova, Elmira; Romero-García, Sebastián; Shen, Bin; Sandomirsky, Anna; Rockman, Sylvie; Li, Chao; Sharif Azadeh, Saeed; Lo, Guo-Qiang; Mentovich, Elad; Merget, Florian; Lelarge, François; Witzens, Jeremy

2017-10-24

We experimentally investigate an optical link relying on silicon photonics transmitter and receiver components as well as a single section semiconductor mode-locked laser as a light source and a semiconductor optical amplifier for signal amplification. A transmitter based on a silicon photonics resonant ring modulator, an external single section mode-locked laser and an external semiconductor optical amplifier operated together with a standard receiver reliably supports 14 Gbps on-off keying signaling with a signal quality factor better than 7 for 8 consecutive comb lines, as well as 25 Gbps signaling with a signal quality factor better than 7 for one isolated comb line, both without forward error correction. Resonant ring modulators and Germanium waveguide photodetectors are further hybridly integrated with chip scale driver and receiver electronics, and their co-operability tested. These experiments will serve as the basis for assessing the feasibility of a silicon photonics wavelength division multiplexed link relying on a single section mode-locked laser as a multi-carrier light source.

Robotic-assisted Laparoscopic Repair of Scrotal Inguinal Hernias.

PubMed

Yheulon, Christopher G; Maxwell, Daniel W; Balla, Fadi M; Patel, Ankit D; Lin, Edward; Stetler, Jamil L; Davis, Steven S

2018-06-01

Scrotal inguinal hernias represent a challenging surgical pathology. Although some advanced laparoscopists can repair these hernias through a minimally invasive approach, open repair is considered the technique of choice for most surgeons. The purpose of this study is to show our results of robotic-assisted laparoscopic repair of scrotal inguinal hernias. We reviewed the charts of 14 patients with inguinoscrotal hernias who underwent robotic-assisted transabdominal preperitoneal (TAPP) hernia repair. Mean follow-up was 7 months. The European Registry for Abdominal Wall Hernia Quality of Life score, a 90-point scale, was utilized to quantify patient reported outcomes. Robotic TAPP repair was successful in all 14 patients. Average case duration was 100 minutes (78 to 140 min) for unilateral hernias and 208 minutes (166 to 238 min) for bilateral hernias. Trainees were involved in 93% (13/14) of cases. There were no recurrences. Three patients developed postoperative seromas. The mean European Registry for Abdominal Wall Hernia Quality of Life score was 3.7 (0 to 10). Scrotal hernias can be safely repaired using robotic-assisted TAPP methods with low morbidity and favorable patient reported outcomes.

The Danish Inguinal Hernia database.

PubMed

Friis-Andersen, Hans; Bisgaard, Thue

2016-01-01

To monitor and improve nation-wide surgical outcome after groin hernia repair based on scientific evidence-based surgical strategies for the national and international surgical community. Patients ≥18 years operated for groin hernia. Type and size of hernia, primary or recurrent, type of surgical repair procedure, mesh and mesh fixation methods. According to the Danish National Health Act, surgeons are obliged to register all hernia repairs immediately after surgery (3 minute registration time). All institutions have continuous access to their own data stratified on individual surgeons. Registrations are based on a closed, protected Internet system requiring personal codes also identifying the operating institution. A national steering committee consisting of 13 voluntary and dedicated surgeons, 11 of whom are unpaid, handles the medical management of the database. The Danish Inguinal Hernia Database comprises intraoperative data from >130,000 repairs (May 2015). A total of 49 peer-reviewed national and international publications have been published from the database (June 2015). The Danish Inguinal Hernia Database is fully active monitoring surgical quality and contributes to the national and international surgical society to improve outcome after groin hernia repair.

An overlooked complication of the inguinal hernia repair: Dysejaculation

PubMed Central

Yılmaz, Hüseyin

2018-01-01

The objective of this study was to investigate the rate of post-herniorrhaphy dysejaculation in the current literature. A comprehensive search of PubMed, Medline, Google Scholar, and Google databases was performed using the keywords “groin hernia and chronic pain,” “inguinal hernia and chronic pain,” “dysejaculation,” and “ejaculatory pain.” The eligible studies were evaluated in terms of ejaculatory pain and surgical technique used. Ten studies with 122 patients were eligible for the analysis. The rate of ejaculatory pain for a total of 5521 patients was found to be 2.2%. The incidence of postoperative ejaculatory pain was found to be 2.1% following laparoscopic techniques and 1.1 % following open repair. Open techniques were not related to the increased frequency of dysejaculation. Sufficient data could not be obtained from the studies for the ejaculatory pain, and thus, no statistical evaluation was performed. Dysejaculation is a common cause of postoperative morbidity after inguinal hernia repair. Attention to technical details of the primary operation may reduce the incidence of dysejaculation. PMID:29756096

[Diagnostic issues of lymphogranuloma venereum: A case series of 5 patients].

PubMed

Fabre-Baudouin, A; Roux, A L; Marin, C; Lachatre, M; De Laroche, M; Ponsoye, M; Hanslik, T; Trad, S

2017-12-01

Lymphogranuloma venereum (LG) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis L serovar. These five consecutive cases aim to highlight the risk of LG misdiagnosis, in case of initial presentation with isolated inguinal adenitis. Five men (mean age: 30±7 years) were seen in an internal medicine department, for inguinal adenopathy. One patient had clinical signs of urethritis. None presented an associated rectitis. Three patients had a history of STI, and two had a discovery of related HIV disease. Urinary polymerase chain reaction (PCR) was positive for the symptomatic patient and negative for the others. Lymph node PCR was positive in all patients within a L2b serotype (searched in 4 out of 5 cases). LG should be evoked in any patient with inguinal adenomegaly, particularly in case of STI history or risk factors. Negativity of urinary PCR should lead to further investigations, essentially a lymph node cytopuncture to evidence C. trachomatis. Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Malignant inguinal monophasic synovial sarcoma: report of a case and review of the literature.

PubMed

Xu, Ji; Wang, Jia; Cui, Long; Wu, Xiangru

2010-11-21

A synovial sarcoma (SS) is an aggressive soft tissue tumor that classically occurs in the extremities near, but rarely within large joints, in young adults. Variable symptoms and clinical manifestations may be encountered and a definite diagnosis should depend on pathological results. This poses certain difficulties in arriving at a prompt diagnosis and appropriate treatment. We report the case of a 68-year-old woman patient who presented an inguinal mass with swelling and pain in the right lower limb. She underwent surgery, and later received systematic intravenous chemotherapy. The pathological studies, especially the specific chromosomal translocation of a t(X;18) (p11.2;q11.2), confirmed the diagnosis as a synovial sarcoma. To the best of our knowledge, this is the first report of a monophasic synovial sarcoma in the inguinal region. Besides making the readership aware of the rarity of location and age of this present case, this report distinctly highlights the great value of a molecular analysis of an SYT associated genetic alteration in the diagnosis of synovial sarcoma occurring at rare sites especially when immunochemical results are equivocal.

Cutaneous apocrine carcinoma in groin with bilateral lymph node metastasis: a case report and review of the literature

PubMed Central

Guo, Jingjing; Wu, Gang; Xu, Jinhua; Ma, Zhenyu; Zhou, Zhongwen

2014-01-01

Cutaneous apocrine carcinoma (CAC) is a rare type of malignant adnexal tumour with only scattered reports. We report a 52-year-old male patient of CAC in groin with bilateral lymph node metastasis. The patient had a left inguinal subcutaneous mass 3 cm × 2 cm in size for 4 years, and received a wide local excision of the tumour. Pathological sectioning suggested CAC. The immunohistochemical staining revealed GCDFP15 (+), 34BE12 (+), ER (+), PR (+), CK7 (+), Ki67 (5%-10%), HER2/Neu (-), P53 (-), P63 (-), and CK20 (-). Two subcutaneous masses of 2 cm × 1 cm were found below the original incision 10 months after the operation, and regional lymphadenectomy was performed. During the outpatient follow-up, B-ultrasound examination showed abnormal enlargement of the right inguinal lymph nodes 17 months later, and right inguinal lymphadenectomy was performed. No evidence of recurrent or metastasis disease has been seen after a follow-up period of 16 months till now. We review the literature on pathological and immunohistochemical study of CAC and discuss its diagnostic dilemma. PMID:25550884

Modeling of price and profit in coupled-ring networks

NASA Astrophysics Data System (ADS)

Tangmongkollert, Kittiwat; Suwanna, Sujin

2016-06-01

We study the behaviors of magnetization, price, and profit profiles in ring networks in the presence of the external magnetic field. The Ising model is used to determine the state of each node, which is mapped to the buy-or-sell state in a financial market, where +1 is identified as the buying state, and -1 as the selling state. Price and profit mechanisms are modeled based on the assumption that price should increase if demand is larger than supply, and it should decrease otherwise. We find that the magnetization can be induced between two rings via coupling links, where the induced magnetization strength depends on the number of the coupling links. Consequently, the price behaves linearly with time, where its rate of change depends on the magnetization. The profit grows like a quadratic polynomial with coefficients dependent on the magnetization. If two rings have opposite direction of net spins, the price flows in the direction of the majority spins, and the network with the minority spins gets a loss in profit.

Electrochemically Triggered Co-Conformational Switching in a [2]catenane Comprising a Non-Symmetric Calix[6]arene Wheel and a Two-Station Oriented Macrocycle.

PubMed

Zanichelli, Valeria; Dallacasagrande, Luca; Arduini, Arturo; Secchi, Andrea; Ragazzon, Giulio; Silvi, Serena; Credi, Alberto

2018-05-11

Catenanes with desymmetrized ring components can undergo co-conformational rearrangements upon external stimulation and can form the basis for the development of molecular rotary motors. We describe the design, synthesis and properties of a [2]catenane consisting of a macrocycle-the 'track' ring-endowed with two distinct recognition sites (a bipyridinium and an ammonium) for a calix[6]arene-the 'shuttle' ring. By exploiting the ability of the calixarene to thread appropriate non-symmetric axles with directional selectivity, we assembled an oriented pseudorotaxane and converted it into the corresponding oriented catenane by intramolecular ring closing metathesis. Cyclic voltammetric experiments indicate that the calixarene wheel initially surrounds the bipyridinium site, moves away from it when it is reduced, and returns in the original position upon reoxidation. A comparison with appropriate model compounds shows that the presence of the ammonium station is necessary for the calixarene to leave the reduced bipyridinium site.

Controlling three-dimensional vortices using multiple and moving external fields

NASA Astrophysics Data System (ADS)

Das, Nirmali Prabha; Dutta, Sumana

2017-08-01

Spirals or scroll wave activities in cardiac tissues are the cause of lethal arrhythmias. The external control of these waves is thus of prime interest to scientists and physicians. In this article, we demonstrate the spatial control of scroll waves by using external electric fields and thermal gradients in experiments with the Belousov-Zhabotinsky reaction. We show that a scroll ring can be made to trace cyclic trajectories under a rotating electric field. Application of a thermal gradient in addition to the electric field deflects the motion and changes the nature of the trajectory. Our experimental results are analyzed and corroborated by numerical simulations based on an excitable reaction diffusion model.

Characteristics of the Single-Longitudinal-Mode Planar-Waveguide External Cavity Diode Laser at 1064 nm

NASA Technical Reports Server (NTRS)

Numata, Kenji; Alalusi, Mazin; Stolpner, Lew; Margaritis, Georgios; Camp, Jordan B.; Krainak, Michael A.

2014-01-01

We describe the characteristics of the planar-waveguide external cavity diode laser (PW-ECL). To the best of our knowledge, it is the first butterfly-packaged 1064-nm semiconductor laser that is stable enough to be locked to an external frequency reference. We evaluated its performance from the viewpoint of precision experiments. Especially, using a hyperfine absorption line of iodine, we suppressed its frequency noise by a factor of up to104 at 10 mHz. The PW-ECLs compactness and low cost make it a candidate to replace traditional Nd:YAGnon-planar ring oscillators and fiber lasers in applications which require a single longitudinal-mode.

Gravitating lepton bag model

NASA Astrophysics Data System (ADS)

Burinskii, A.

2015-08-01

The Kerr-Newman (KN) black hole (BH) solution exhibits the external gravitational and electromagnetic field corresponding to that of the Dirac electron. For the large spin/mass ratio, a ≫ m, the BH loses horizons and acquires a naked singular ring creating two-sheeted topology. This space is regularized by the Higgs mechanism of symmetry breaking, leading to an extended particle that has a regular spinning core compatible with the external KN solution. We show that this core has much in common with the known MIT and SLAC bag models, but has the important advantage of being in accordance with the external gravitational and electromagnetic fields of the KN solution. A peculiar two-sheeted structure of Kerr's gravity provides a framework for the implementation of the Higgs mechanism of symmetry breaking in configuration space in accordance with the concept of the electroweak sector of the Standard Model. Similar to other bag models, the KN bag is flexible and pliant to deformations. For parameters of a spinning electron, the bag takes the shape of a thin rotating disk of the Compton radius, with a ring-string structure and a quark-like singular pole formed at the sharp edge of this disk, indicating that the considered lepton bag forms a single bag-string-quark system.

Strong excitation of surface and bulk spin waves in yttrium iron garnet placed in a split ring resonator

NASA Astrophysics Data System (ADS)

Tay, Z. J.; Soh, W. T.; Ong, C. K.

2018-02-01

This paper presents an experimental study of the inverse spin Hall effect (ISHE) in a bilayer consisting of a yttrium iron garnet (YIG) and platinum (Pt) loaded on a metamaterial split ring resonator (SRR). The system is excited by a microstrip feed line which generates both surface and bulk spin waves in the YIG. The spin waves subsequently undergo spin pumping from the YIG film to an adjacent Pt layer, and is converted into a charge current via the ISHE. It is found that the presence of the SRR causes a significant enhancement of the mangetic field near the resonance frequency of the SRR, resulting in a significant increase in the ISHE signal. Furthermore, the type of spin wave generated in the system can be controlled by changing the external applied magnetic field angle (θH ). When the external applied magnetic field is near parallel to the microstrip line (θH = 0 ), magnetostatic surface spin waves are predominantly excited. On the other hand, when the external applied magnetic field is perpendicular to the microstrip line (θH = π/2 ), backward volume magnetostatic spin waves are predominantly excited. Hence, it can be seen that the SRR structure is a promising method of achieving spin-charge conversion, which has many advantages over a coaxial probe.

Laparoscopic trans-peritoneal hernioplasty (TAPP) for the acute management of strangulated inguino-crural hernias: a report of nine cases.

PubMed

Legnani, G L; Rasini, M; Pastori, S; Sarli, D

2008-04-01

Inguinal hernioplasty has always been one of the most commonly performed operations in clinical practice. In the last 15 years, thanks to the development of mini-invasive surgery, new video-endoscopic techniques for the treatment of inguinal hernia using trans-peritoneal (TAPP) and extraperitoneal (TEP) access have emerged. Both have a definite role in the treatment of bilateral and recurrent hernias, while the debate is still open about the treatment of primary mono-lateral hernias. In acute incarcerated hernia requiring an emergency operation, the endoscopic approach is uncommon and controversial, and even considered contraindicated. The aim of this publication is to verify the efficacy and the technical feasibility of TAPP operation by analyzing a consecutive series of patients operated on for incarcerated inguino-crural hernia associated with suspected visceral ischemic lesion in an emergency setting. From September 2004 to October 2005, 13 patients were operated on acutely for inguino-crural incarcerated hernia associated with suspected visceral ischemic damage. Four were excluded from the endoscopic treatment due to anesthesiologic contraindications or huge hernia dimensions. Nine patients were operated on using a trans-peritoneal approach (TAPP). Visceral mobilization and hernia reduction were obtained by incision and opening of the hernia ring. Visceral resection was performed in one case with intestinal ischemia following a prolonged observation time or "test time." One case was associated with intestinal resection and incisional hernia repair, one with obturator hernia repair, and one with hepiployc appendix repair. None of the cases were converted to open technique, and no intra- or postoperative complications were recorded. Mean operative time was 72 min (35-180); mean hospital stay was 2.7 days (1-8). No recurrences were observed after a mean follow-up time of 18 months (8-24). The TAPP procedure can be proposed for emergency treatment of inguino-crural incarcerated hernias, allowing not only hernia correction, but also visual control and the contestual treatment of the hernia content. TAPP is a more challenging procedure compared to the traditional open anterior approach and therefore requires an adequate laparoscopic training. Exclusion criteria are constituted by anesthesiologic contraindications or dimensional criteria of the hernia.

Nonequilibrium molecular dynamics study of ring polymer melts under shear and elongation flows: A comparison with their linear analogs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yoon, Jeongha; Kim, Jinseong; Baig, Chunggi, E-mail: cbaig@unist.ac.kr

We present detailed results for the structural and rheological properties of unknotted and unconcatenated ring polyethylene (PE) melts under shear and elongation flows via direct atomistic nonequilibrium molecular dynamics simulations. Short (C{sub 78}H{sub 156}) and long (C{sub 400}H{sub 800}) ring PE melts were subjected to planar Couette flow (PCF) and planar elongational flow (PEF) across a wide range of strain rates from linear to highly nonlinear flow regimes. The results are analyzed in detail through a direct comparison with those of the corresponding linear polymers. We found that, in comparison to their linear analogs, ring melts possess rather compact chainmore » structures at or near the equilibrium state and exhibit a considerably lesser degree of structural deformation with respect to the applied flow strength under both PCF and PEF. The large structural resistance of ring polymers against an external flow field is attributed to the intrinsic closed-loop configuration of the ring and the topological constraint of nonconcatenation between ring chains in the melt. As a result, there appears to be a substantial discrepancy between ring and linear systems in terms of their structural and rheological properties such as chain orientation, the distribution of chain dimensions, viscosity, flow birefringence, hydrostatic pressure, the pair correlation function, and potential interaction energies. The findings and conclusions drawn in this work would be a useful guide in future exploration of the characteristic dynamical and relaxation mechanisms of ring polymers in bulk or confined systems under flowing conditions.« less

[Laparoscopic treatment of hemoabdomen in a dog after prescrotal castration].

PubMed

Brückner, Michael

2018-06-01

A 2-year-old Bearded Collie was referred for suspected hemoabdomen after prescrotal castration. On presentation the dog was in stable body condition and the hematocrit was within the reference range. Abdominal ultrasound revealed a moderate amount of free corpuscular fluid; therefore the dog was prepared for laparoscopic surgery. A single port access at the umbilicus was performed and insufflation with CO 2 started with a pressure of 8 mmHg. Approximately one liter of blood was removed from the abdominal cavity with a suction/irrigation tube to allow inspection of the inguinal rings. The laparoscopic approach allowed excellent visualization of the spermatic cord and testicular vessels, which were then sealed with a vessel-sealing device. After surgery, the dog recovered well and did not develop further complications. This case report shows that laparoscopy is feasible in the event of hemoabdomen after castration in dogs and can be considered as an alternative treatment method in the hands of a surgeon, well experienced in minimally invasive surgery. The experience of this case report raises the question, if hemoabdomen should be no longer considered as an absolute contraindication for laparoscopy and should be considered as a relative contraindication instead. Schattauer GmbH.

Hand tremor and activity sensor

NASA Technical Reports Server (NTRS)

Konigsberg, E.

1975-01-01

System detects hand tremor and activity and transmitting signals over distance of at least 3 meters to receiver system. Designed for use in studies of effect of fatigue on individual's judgement or reaction time, sensor is installed within mounting of finger-ring; no external wiring or power source is needed.

Malignant Mesothelioma of Spermatic Cord in an Elderly Man With a History of Asbestos Exposure.

PubMed

D'Antonio, Antonio; Mastella, Federica; Colucci, Angelo; Silvestre, Gianmarco

2016-01-01

We report a case of malignant mesothelioma of the spermatic cord in 80-year-old man presented with retained testis, hydrocele, and right inguinal mass. The patient had a long history of asbestos exposure as a railway worker. The patient was submitted to inguinal radical orchiectomy. One year after surgery, the patient is alive without signs of disease. Malignant mesothelioma of spermatic cord is a very rare disease, but this diagnosis should be suspected in patient with a history of asbestos exposure. Copyright © 2015 Elsevier Inc. All rights reserved.

[Umbilical and inguinal hernioplasty in cirrhotic patients].

PubMed

Zepeda, R; Herrera, M F; Mercado, M A

1994-01-01

The overall results of surgical treatment of abdominal wall hernias in patients with hepatic cirrhosis were assessed by a retrospective study in 41 cirrhotic patients. They underwent 22 umbilical and 22 inguinal herniorrhapies between 1982 and 1992. Sixteen patients were classified as Child-Pugh A, 16 as B and 9 as C. Clinical evidence of ascitis was documented in 19 patients. The operative mortality was 5% (two Child-Pugh C cases). Postoperative complications occurred in 10 patients, most of them related to the surgical wound. We recommend herniorraphy in symptomatic cirrhotic patients but with fairly good hepatic function.

Persistent müllerian duct syndrome associated with irreducible inguinal hernia, bilateral cryptorchidism and testicular neoplasia: a case report.

PubMed

Yuksel, B; Saygun, O; Hengirmen, S

2006-01-01

Persistent müllerian duct syndrome is a rare form of male pseudohermaphroditism. A case is reported of normal male appearance with bilateral cryptorchidism and a right irreducible inguinal hernia. On exploration, an uterus with two fallopian tubes and a testicle were found in the hernia sac. The uterus, fallopian tubes and left testicle were en bloc removed. Right orchidopexy and hernia repair were performed. In conclusion, if there is an adult bilateral cryptorchidism, surgeons should take into consideration a persistent müllerian duct syndrome.

18F-FDG PET/CT Imaging of Hidradenocarcinoma Arising From Preexisting Hidradenoma of the Knee.

PubMed

Patel, Tirth V; Oldan, Jorge

2018-01-01

Malignant tumors of the sweat glands are exceedingly rare and aggressive tumors. We present here a case of a 60-year-old man with a malignant hidradenocarcinoma that developed in a background of preexisting benign hidradenoma on the lateral aspect of the knee that was initially resected, but rapidly recurred with associated inguinal lymphadenopathy. F-FDG PET/CT was performed as part of preoperative staging, which demonstrated abnormal inguinal lymph nodes and metastatic disease to the lungs. FDG PET/CT can play an invaluable role in the initial staging and follow-up of this rare malignancy.

Nonpalpable testes: Ultrasound and contralateral testicular hypertrophy predict the surgical access, avoiding unnecessary laparoscopy.

PubMed

Berger, Christoph; Haid, Bernhard; Becker, Tanja; Koen, Mark; Roesch, Judith; Oswald, Josef

2018-04-01

In up to 20% of patients presenting with undescended testes, one or both are non-palpable. Whereas the most reliable means to exclude an abdominal testis is laparoscopy, there has been a lot of debate about the role of inguinal ultrasound (US) in detecting non-palpable inguinal testis. While we do not aim to add another paper claiming the benefits of US, we wanted to determine the excess capability of US to determine the correct surgical approach - inguinal or laparoscopy. In the light of avoiding unnecessary diagnostic laparoscopies, even the cost-effectiveness raised in many current papers might be called into question. Of a total of 684 boys who underwent surgery for undescended testes at our department between 2011 and 2014, in 58 (8.5%), one or both testes were neither palpable preoperatively nor under general anesthesia. These boys were examined by two experienced pediatric urologists clinically as well as by US. Besides the size of the contralateral testis, the presence of a testis in the inguinal channel was investigated. The additional impact of US over clinical exam and consideration of the size of the contralateral testis was assessed by means of intra-individual comparisons using Cochran-Q as well as McNemar tests. Clinical exam without considering the size of the contralateral testis had a sensitivity of 9% (95% CI 2-24%) and a specificity of 100% (95% CI 86-100%) to accurately predict the surgical approach deemed appropriate postoperatively. The consideration of the size of the contralateral testis - taken as an isolated factor - accurately predicted the surgical approach with a sensitivity of 21% (95% CI 9-38%) and a specificity of 88% (95% CI 68-97%). Ultrasound accounted for a sensitivity of 53% (95% CI 35-70%) and a specificity of 100% (95% CI 86-100%). The addition of US increased the sensitivity to correctly predict an inguinal incision from 29% to 71% and specificity slightly increased from 88% to 92%. This difference is significant (p = 0.008) in the bilateral McNemar test (Figure). Inguinal US of non-palpable testes and measurement of the contralateral testis are synergistic in predicting the surgical approach. The addition of ultrasound to a clinical exam, performed also under general anesthesia and by an experienced pediatric urologist significantly increases the prediction of the correct surgical approach. Our results translate into five boys needing an US of the NPT to prevent one laparoscopy. Whereas cost-effectiveness of US might be debatable in regard to different healthcare systems, it is proven to be an effective, non-harmful tool to avoid unnecessary diagnostic laparoscopies. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Multiple shadows from distorted static black holes

NASA Astrophysics Data System (ADS)

Grover, Jai; Kunz, Jutta; Nedkova, Petya; Wittig, Alexander; Yazadjiev, Stoytcho

2018-04-01

We study the local shadow of the Schwarzschild black hole with a quadrupole distortion and the influence of the external gravitational field on the photon dynamics. The external matter sources modify the light ring structure and lead to the appearance of multiple shadow images. In the case of negative quadrupole moments we identify the most prominent mechanism causing multiple shadow formation. Furthermore, we obtain a condition under which this mechanism can be realized. This condition depends on the quadrupole moment, but also on the position of the observer and the celestial sphere.

Discrete element modeling of shock-induced particle jetting

NASA Astrophysics Data System (ADS)

Xue, Kun; Cui, Haoran

2018-05-01

The dispersal of particle shell or ring by divergent impulsive loads takes the form of coherent particle jets with the dimensions several orders larger than that of constituent grain. Particle-scale simulations based on the discrete element method have been carried out to reveal the evolution of jets in semi-two-dimensional rings before they burst out of the external surface. We identify two key events which substantially change the resulted jetting pattern, specifically, the annihilation of incipient jets and the tip-slipping of jets, which become active in different phases of jet evolution. Parametric investigations have been done to assess the correlations between the jetting pattern and a variety of structural parameters. Overpressure, the internal and outer diameters of ring as well as the packing density are found to have effects on the jet evolution with different relative importance.

Distribution of Prostate Sentinel Nodes: A SPECT-Derived Anatomic Atlas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ganswindt, Ute, E-mail: ute.ganswindt@med.uni-muenchen.d; Schilling, David; Mueller, Arndt-Christian

2011-04-01

Purpose: The randomized Radiation Therapy Oncology Group 94-13 trial revealed that coverage of the pelvic lymph nodes in high-risk prostate cancer confers an advantage (progression-free survival and biochemical failure) in patients with {>=}15% risk of lymph node involvement. To facilitate an improved definition of the adjuvant target volume, precise knowledge regarding the location of the relevant lymph nodes is necessary. Therefore, we generated a three-dimensional sentinel lymph node atlas. Methods and Materials: In 61 patients with high-risk prostate cancer, a three-dimensional visualization of sentinel lymph nodes was performed using a single photon emission computed tomography system after transrectal intraprostatic injectionmore » of 150 to 362 (median 295) mega becquerel (MBq) {sup 99m}Technetium-nanocolloid (1.5-3h after injection) followed by an anatomic functional image fusion. Results: In all, 324 sentinel nodes in 59 of 61 patients (96.7%) were detected, with 0 to 13 nodes per patient (median 5, mean 5.3). The anatomic distribution of the sentinel nodes was as follows: external iliac 34.3%, internal iliac 17.9%, common iliac 12.7%, sacral 8.6%, perirectal 6.2%, left paraaortic 5.3%, right paraaortic 5.3%, seminal vesicle lymphatic plexus 3.1%, deep inguinal 1.5%, superior rectal 1.2%, internal pudendal 1.2%, perivesical 0.9%, inferior rectal 0.9%, retroaortic 0.3%, superficial inguinal 0.3%, and periprostatic 0.3%. Conclusions: The distribution of sentinel nodes as detected by single photon emission computed tomography imaging correlates well with the distribution determined by intraoperative gamma probe detection. A lower detection rate of sentinels in close proximity to the bladder and seminal vesicles is probably caused by the radionuclide accumulation in the bladder. In regard to intensity-modulated radiotherapy techniques, the presented anatomic atlas may allow optimized target volume definitions.« less

Electronic confinement in graphene quantum rings due to substrate-induced mass radial kink.

PubMed

Xavier, L J P; da Costa, D R; Chaves, A; Pereira, J M; Farias, G A

2016-12-21

We investigate localized states of a quantum ring confinement in monolayer graphene defined by a circular mass-related potential, which can be induced e.g. by interaction with a substrate that breaks the sublattice symmetry, where a circular line defect provides a change in the sign of the induced mass term along the radial direction. Electronic properties are calculated analytically within the Dirac-Weyl approximation in the presence of an external magnetic field. Analytical results are also compared with those obtained by the tight-binding approach. Regardless of its sign, a mass term [Formula: see text] is expected to open a gap for low-energy electrons in Dirac cones in graphene. Both approaches confirm the existence of confined states with energies inside the gap, even when the width of the kink modelling the mass sign transition is infinitely thin. We observe that such energy levels are inversely proportional to the defect line ring radius and independent on the mass kink height. An external magnetic field is demonstrated to lift the valley degeneracy in this system and easily tune the valley index of the ground state in this system, which can be polarized on either K or [Formula: see text] valleys of the Brillouin zone, depending on the magnetic field intensity. Geometrical changes in the defect line shape are considered by assuming an elliptic line with different eccentricities. Our results suggest that any defect line that is closed in a loop, with any geometry, would produce the same qualitative results as the circular ones, as a manifestation of the topologically protected nature of the ring-like states investigated here.

The Bonn Electron Stretcher Accelerator ELSA: Past and future

NASA Astrophysics Data System (ADS)

Hillert, W.

2006-05-01

In 1953, it was decided to build a 500MeV electron synchrotron in Bonn. It came into operation 1958, being the first alternating gradient synchrotron in Europe. After five years of performing photoproduction experiments at this accelerator, a larger 2.5GeV electron synchrotron was built and set into operation in 1967. Both synchrotrons were running for particle physics experiments, until from 1982 to 1987 a third accelerator, the electron stretcher ring ELSA, was constructed and set up in a separate ring tunnel below the physics institute. ELSA came into operation in 1987, using the pulsed 2.5GeV synchrotron as pre-accelerator. ELSA serves either as storage ring producing synchrotron radiation, or as post-accelerator and pulse stretcher. Applying a slow extraction close to a third integer resonance, external electron beams with energies up to 3.5GeV and high duty factors are delivered to hadron physics experiments. Various photo- and electroproduction experiments, utilising the experimental set-ups PHOENICS, ELAN, SAPHIR, GDH and Crystal Barrel have been carried out. During the late 90's, a pulsed GaAs source of polarised electrons was constructed and set up at the accelerator. ELSA was upgraded in order to accelerate polarised electrons, compensating for depolarising resonances by applying the methods of fast tune jumping and harmonic closed orbit correction. With the experimental investigation of the GDH sum rule, the first experiment requiring a polarised beam and a polarised target was successfully performed at the accelerator. In the near future, the stretcher ring will be further upgraded to increase polarisation and current of the external electron beams. In addition, the aspects of an increase of the maximum energy to 5GeV using superconducting resonators will be investigated.

Evaluation of growth disturbances of Picea abies (L.) Karst. to disturbances caused by landslide movements

NASA Astrophysics Data System (ADS)

Šilhán, Karel

2017-01-01

Dendrogeomorphic methods are frequently used in landslide analyses. Although methods of landslide dating based on tree rings are well developed, they still indicated many questions. The aim of this study was to evaluate the frequently used theoretical scheme based on the event-response relationship. Seventy-four individuals of Norway spruce (Picea abies (L.) Karst.) exhibiting visible external disturbance, were sampled on the Girová landslide (the largest historical flow-like landslide in the Czech Republic). This landslide reactivated in May 2010, and post-landslide tree growth responses were studied in detail. These growth responses were compared with the intensity and occurrence of visible external tree disturbance: tilted stems, damaged root systems, and decapitation. Twenty-nine trees (39.2%) died within one to four years following the 2010 landslide movement. The trees that died following the landslide movement were significantly younger and displayed significantly greater stem tilting than the live trees. Abrupt growth suppression was a more-frequent response among the dead trees, whereas growth release dominated among the live trees. Only two trees (2.7%) created no reaction wood in response to the landslide movement. Forty-four percent of the trees started to produce reaction wood structure after a delay, which generally spanned one year. Some eccentric growth was evident in the tree rings of the landslide year and was significant in the first years following the landslide movement. Missing rings were observed only on the upper sides of the stems, and no false tree rings were observed. The results confirm the general validity of event-response relationship, nevertheless this study points out the limitations and uncertainties of this generally accepted working scheme.

Robust Adaptive Synchronization of Ring Configured Uncertain Chaotic FitzHugh–Nagumo Neurons under Direction-Dependent Coupling

PubMed Central

Iqbal, Muhammad; Rehan, Muhammad; Hong, Keum-Shik

2018-01-01

This paper exploits the dynamical modeling, behavior analysis, and synchronization of a network of four different FitzHugh–Nagumo (FHN) neurons with unknown parameters linked in a ring configuration under direction-dependent coupling. The main purpose is to investigate a robust adaptive control law for the synchronization of uncertain and perturbed neurons, communicating in a medium of bidirectional coupling. The neurons are assumed to be different and interconnected in a ring structure. The strength of the gap junctions is taken to be different for each link in the network, owing to the inter-neuronal coupling medium properties. Robust adaptive control mechanism based on Lyapunov stability analysis is employed and theoretical criteria are derived to realize the synchronization of the network of four FHN neurons in a ring form with unknown parameters under direction-dependent coupling and disturbances. The proposed scheme for synchronization of dissimilar neurons, under external electrical stimuli, coupled in a ring communication topology, having all parameters unknown, and subject to directional coupling medium and perturbations, is addressed for the first time as per our knowledge. To demonstrate the efficacy of the proposed strategy, simulation results are provided. PMID:29535622

A Guess about light quantum model

NASA Astrophysics Data System (ADS)

Yongquan, Han

2016-03-01

Photon is a ring, the diameter of the ring is the quantum fluctuated wave length. The linear movement of the ring, namely, the transmission of light, is reflected in the particle of light. A plurality of light quantum interactions or through a very narrow gap, the shape of quantum would temporarily be changed. The motion of photons to interference and diffraction phenomena occurs is determined by the structure of light quantum, the quantum ring radius and light quantum mass squared product is a constant. The smaller the light quantum ring radius is, the bigger the quality is, just consistent as the modern scientific experimental results, the energy of the purple is bigger than the red. This conclusion can be extrapolated to all of the electromagnetic wave. The shorter the photon wavelength is, the bigger the quality and density is , when the wavelength is less than 10-15 meters, it will convergence to atomic or subatomic composition material entity due to the gravity. In fact, the divergence and convergence of quantum is reversible, that is, the phenomenon of radiate ``light'' quantum occurs due to the energy exchange or other external energy. Author: hanyongquan TEL: 15611860790.

Rings in Evolved Stars: Fingerprints of Their Mass-Loss History

NASA Astrophysics Data System (ADS)

Ramos-Larios, Gerardo; Santamaria, Edgar; Sabin, Laurence; Guerrero, Martin; Marquez-Lugo, Alejandro

2015-08-01

The majority of intermediate mass evolved stars i.e. asymptotic giant branch (AGB) stars, post-AGB and pre-planetary nebulae (PPN) are well known for been characterized by external structures such as knots, arcs, ansae, jets, haloes, shells and even annular enhancements in intensity -features which are commonly referred to as rings. These are well described either as spherical bubbles of periodic isotropic nuclear mass pulsations (Balick, Wilson & Hajian 2001) or projections of spherical shells onto the plane of the sky by Kwok (2001).These interesting structures are part of the AGB wind, suggesting that this wind comes in a series of semi periodic lapses, indicating that the outflow has quasi-periodic oscillations.After an extensive analysis in the Hubble Space Telescope (HST) archives we found new ring-like structures in several evolved stars. Following the image analysis procedure described by Corradi et al. (2004), and using unsharp masking techniques it was possible to enhance the ring structures, and to obtain an effective removal of the underlying halo emission.Our new findings will help first to constrain the physical processes responsible for the rings creation and then to better understand the mass loss activity in these evolved stars.

Performance Evaluation of the Honeywell GG1308 Miniature Ring Laser Gyroscope

DTIC Science & Technology

1993-01-01

information. The final display line provides the current DSB configuration status. An external strobe was established between the Contraves motion...components and systems. The core of the facility is a Contraves -Goerz Model 57CD 2-axis motion simulator capable of highly precise position, rate and

Reduction of the posterior pelvic ring by non-invasive stabilisation: a report of two cases.

PubMed

Qureshi, A; McGee, A; Cooper, J P; Porter, K M

2005-12-01

We demonstrate radiological evidence that an external pelvic splint is effective at reducing open book pelvic fractures. Its use in the pre-hospital and emergency department settings should be encouraged in the initial management and resuscitation of patients with pelvic fractures.

Small-Scale Structure in Saturn's Rings

NASA Astrophysics Data System (ADS)

Rehnberg, Morgan

2017-08-01

The rings of Saturn are the largest and most complex in the Solar System. Decades of observation from ground- and space-based observatories and spacecraft missions have revealed the broad structure of the rings and the intricate interactions between the planet's moons and its rings. Stellar occultations observed by the Ultraviolet Imaging Spectrograph's High Speed Photometer onboard the Cassini spacecraft now enable the direct study of the small-scale structure that results from these interactions. In this dissertation, I present three distinct phenomena resulting from the small-scale physics of the rings. Many resonance locations with Saturn's external satellites lie within the main (A and B) rings. Two of these satellites, Janus and Epimetheus, have a unique co-orbital relationship and move radially to switch positions every 4.0 years. This motion also moves the resonance locations within the rings. As the spiral density waves created at these resonances interact, they launch an enormous solitary wave every eight years. I provide the first-ever observations of this never-predicted phenomenon and detail a possible formation mechanism. Previous studies have reported a population of kilometer-scale aggregates in Saturn's F ring, which likely form as a result of self-gravitation between ring particles in Saturn's Roche zone. I expand the known catalog of features in UVIS occultations and provide the first estimates of their density derived from comparisons with the A ring. These features are orders of magnitude less dense than previously believed, a fact which reconciles them with detections made by other means. Theory and indirect observations indicate that the smallest regular structures in the rings are wavelike aggregates called self-gravity wakes. Using the highest-resolution occulta- tions, I provide the first-ever direct detection of these features by identifying the gaps that represent the minima of the wakes. I demonstrate that the distribution of these gaps is con- sistent with the broad brightness asymmetries previously observed in the rings. Furthermore, the presence of spiral density waves affects the formation of self-gravity waves.

Serum MMP 2 and TIMP 2 in patients with inguinal hernias.

PubMed

Smigielski, Jacek; Brocki, Marian; Kuzdak, Krzysztof; Kołomecki, Krzysztof

2011-06-01

  More than sixty thousand inguinal hernia operations are performed every year in Poland. Despite many years of related research, the exact pathologic mechanism of this condition is still not fully understood. Recent studies suggested a pronounced relationship between the molecular structure of collagen fibers and the activity of metalloproteinases, the enzymes taking part in the degradation of collagen, as well as their tissue inhibitors. A prospective study has been established to measure serum levels of the matrix metalloproteinase 2 (MMP-2) and Matrix metalloproteinase tissue inhibitor 2 (TIMP-2) in 150 males between the ages of 26 and 70. The control group (CG) consisted of thirty healthy male volunteers of a similar age distribution. Our results indicate that MMP-2 was highest in the direct hernia group, a statistically very significant elevation (P<0(.) 05) of 1562ng mL(-1) against the CG 684ng mL(-1) . The highest level of TIMP, 78ng mL(-1) , was found in the group with recurrent hernia, against 49(.) 5ng mL(-1) of the CG (statistical significance of P<0(.) 05). The MMP-2 and TIMP-2 levels were concurrently elevated only in the recurrent hernia group. The patients with inguinal hernia have a statistically significant increase in serum levels of MMP-2. Our finding of the MMP-2 and TIMP-2 distinctly higher in the patients suffering from recurrence of direct inguinal hernia (reflecting a previous surgical failure) may suggest the theory that the extracellular matrix defect lies at the basis of this disorder. © 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation.

Preemptive Analgesic Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Postoperative Pain: A Randomized, Double-Blind, Placebo-Controlled Trial.

PubMed

Eidy, Mohammad; Fazel, Mohammad Reza; Janzamini, Monir; Haji Rezaei, Mostafa; Moravveji, Ali Reza

2016-04-01

Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological analgesic method used to control different types of pain. The aim of this study was to evaluate the effects of preoperative TENS on post inguinal hernia repair pain. This randomized, double-blind, placebo-controlled clinical trial was performed on 66 male patients with unilateral inguinal hernias who were admitted to the Shahid Beheshti hospital in Kashan, Iran, from April to October 2014. Participants were selected using a convenience sampling method and were assigned to intervention (n = 33) and control (n = 33) groups using permuted-block randomization. Patients in the intervention group were treated with TENS 1 hour before surgery, while the placebo was administered to patients in the control group. All of the patients underwent inguinal hernia repair by the Lichtenstein method, and pain intensity was evaluated at 2, 4, 6, and 12 hours after surgery using a visual analogue scale. Additionally, the amounts of analgesic administered by pump were calculated and compared between the two groups. The mean estimated postoperative pain intensity was 6.21 ± 1.63 in the intervention group and 5.45 ± 1.82 in the control group (P = 0.08). In the intervention group pain intensity at 2 and 4 hours after surgery were 3.54 ± 1.48 and 5.12 ± 1.41 (P < 0.001), respectively. In the control group these values were 4.0±1.5 and 4.76 ± 1.39 (P = 0.04), respectively. No significant differences were observed in mean pain intensities at 6 and 12 hours. TENS can reduce postoperative pain in the early hours after inguinal hernia repair surgery.

Combined open and laparoscopic approach to chronic pain following open inguinal hernia repair.

PubMed

Rosen, M J; Novitsky, Y W; Cobb, W S; Kercher, K W; Heniford, B Todd

2006-03-01

Chronic groin pain is the most common long-term complication after open inguinal hernia repair. Traditional surgical management of the associated neuralgia consists of injection therapy followed by groin exploration, mesh removal, and nerve transection. The resultant hernia defect may be difficult to repair from an anterior approach. We evaluate the outcomes of a combined laparoscopic and open approach for the treatment of chronic groin pain following open inguinal herniorrhaphy. All patients who underwent groin exploration for chronic neuralgia after a prior open inguinal hernia repair were prospectively analyzed. Patient demographics, type of prior hernia repair, and prior nonoperative therapies were recorded. The operation consisted of a standard three trocar laparoscopic transabdominal preperitoneal hernia repair, followed by groin exploration, mesh removal, and nerve transection. Outcome measures included recurrent groin pain, numbness, hernia recurrence, and complications. Twelve patients (11 male and 1 female) with a mean age of 41 years (range 29-51) underwent combined laparoscopic and open treatment for chronic groin pain. Ten patients complained of unilateral neuralgia, one patient had bilateral complaints, and one patient complained of orchalgia. All patients failed at least two attempted percutaneous nerve blocks. Prior repairs included Lichtenstein (n=9), McVay (n=1), plug and patch (n=1), and Shouldice (n=1). There were no intraoperative complications or wound infections. With a minimum of 6 weeks follow up, all patients were significantly improved. One patient complained of intermittent minor discomfort that required no further therapy. Two patients had persistent numbness in the ilioinguinal nerve distribution but remained satisfied with the procedure. A combined laparoscopic and open approach for postherniorrhaphy groin pain results in good to excellent patient satisfaction with no perioperative morbidity. It may be the preferred technique for the definitive management of chronic neuralgia after prior open hernia repair.

Single-Port Onlay Mesh Repair of Recurrent Inguinal Hernias after Failed Anterior and Laparoscopic Repairs

PubMed Central

Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne J.

2015-01-01

Background and Objectives: Despite the exponential increase in the use of laparoscopic inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, a growing number of patients are presenting with recurrent hernias after conventional anterior and laparoscopic repairs have failed. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair of these hernias. Methods: Patients referred with two or more recurrences of inguinal hernia underwent SIL-IPOM from November 1, 2009, to June 24, 2014. A 2.5-cm infraumbilical incision was made, and an SIL port was placed intraperitoneally. Modified dissection techniques were used: chopstick and inline dissection, 5.5-mm/52-cm/30° angled laparoscope, and conventional straight dissecting instruments. The peritoneum was incised above the pubic symphysis, and dissection was continued laterally and proximally, raising the inferior flap below the previous extraperitoneal mesh while reducing any direct, indirect, femoral, or cord lipoma before placement of antiadhesive mesh, which was fixed to the pubic ramus, as well as superiorly, with nonabsorbable tacks before the inferior border was fixed with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh. Results: Nine male patients underwent SIL-IPOM. Their mean age was 53 years and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes, with a hospital stay of 1 day. The umbilical scar length was 23 mm at the 6-week follow-up. There were no intra-/postoperative complications, port-site hernias, chronic groin pain, or recurrence of the hernia during a mean follow-up of 24 months. Conclusion: Inguinal hernias recurring after two or more failed conventional anterior and laparoscopic repairs can be safely and efficiently treated with SIL-IPOM. PMID:25848186

Single-Incision Laparoscopic Intraperitoneal Onlay Mesh Repair for the Treatment of Multiple Recurrent Inguinal Hernias

PubMed Central

Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne

2014-01-01

Introduction: Despite an exponential rise in laparoscopic surgery for inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, an increasing number of patients present with recurrent hernias after having failed anterior and laparoscopic repairs. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair for these hernias. Materials and methods: All patients referred with multiply recurrent inguinal hernias underwent SIL-IPOM from November 1 2009 to October 30 2013. A 2.5-cm infraumbilical incision was made and a SIL surgical port was placed intraperitoneally. Modified dissection techniques, namely, “chopsticks” and “inline” dissection, 5.5 mm/52 cm/30° angled laparoscope and conventional straight dissecting instruments were used. The peritoneum was incised above the symphysis pubis and dissection continued laterally and proximally raising an inferior flap, below a previous extraperitoneal mesh, while reducing any direct/indirect/femoral/cord lipoma before placement of antiadhesive mesh that was fixed into the pubic ramus as well as superiorly with nonabsorbable tacks before fixing its inferior border with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh. Results: There were 9 male patients who underwent SIL-IPOM. Mean age was 55 years old and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes with hospital stay of 1 day and umbilical scar length of 21 mm at 4 weeks' follow-up. There were no intraoperative/postoperative complications, port-site hernias, chronic groin pain, or recurrence with mean follow-up of 20 months. Conclusions: Multiply recurrent inguinal hernias after failed conventional anterior and laparoscopic repairs can be treated safely and efficiently with SIL-IPOM. PMID:25392643

Laparoscopic inguinal hernia repair in the Armed Forces: A 5-year single centre study

PubMed Central

Jakhmola, C.K.; Kumar, Ameet

2015-01-01

Background Surgery for inguinal hernia continues to evolve. The most recent development in the field of surgery for inguinal hernia is the emergence of laparoscopic inguinal hernia surgery (LIHS) which is challenging the gold standard Lichtenstein's tension free mesh repair. Our centre has the largest series of LIHS from any Armed Forces hospital. The aim of this study was to analyze the short and long term outcomes at our center since its inception. Methods Retrospective review of prospectively maintained data base of 501 LIHS done in 434 patients by a single surgeon between April 2008 and October 2013. Preoperative, intraoperative, postoperative and follow-up data was analyzed with emphasis on the recurrence rates and the incidence of inguinodynia. Results 402 (92.6%) patients had primary hernias and 367 (84.6%) patients had unilateral hernias. Of the 501 repairs, 453 (90.4 %) were done totally extraperitoneal approach and 48 (9.6 %) were done by the transabdominal preperitoneal approach. The mean operative time for unilateral and bilateral repairs was 40.9 ± 11.2 and 76.2 ± 15.0 minutes, respectively. The conversion rate to open surgery was 0.6%. The intraoperative, and early and late postoperative complication rates were 1.7%, 6.2% and 3%, respectively. The incidence of chronic groin pain was 0.7% and the recurrence rate was 1.6%. The median hospital stay was 1 day (1–5 days). Conclusion We, in this series of over 500 repairs have demonstrated that feasibility as well as safety of LIHS at our centre with good short and long term outcomes. PMID:26663957

Preemptive Analgesic Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Postoperative Pain: A Randomized, Double-Blind, Placebo-Controlled Trial

PubMed Central

Eidy, Mohammad; Fazel, Mohammad Reza; Janzamini, Monir; Haji Rezaei, Mostafa; Moravveji, Ali Reza

2016-01-01

Background Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological analgesic method used to control different types of pain. Objectives The aim of this study was to evaluate the effects of preoperative TENS on post inguinal hernia repair pain. Patients and Methods This randomized, double-blind, placebo-controlled clinical trial was performed on 66 male patients with unilateral inguinal hernias who were admitted to the Shahid Beheshti hospital in Kashan, Iran, from April to October 2014. Participants were selected using a convenience sampling method and were assigned to intervention (n = 33) and control (n = 33) groups using permuted-block randomization. Patients in the intervention group were treated with TENS 1 hour before surgery, while the placebo was administered to patients in the control group. All of the patients underwent inguinal hernia repair by the Lichtenstein method, and pain intensity was evaluated at 2, 4, 6, and 12 hours after surgery using a visual analogue scale. Additionally, the amounts of analgesic administered by pump were calculated and compared between the two groups. Results The mean estimated postoperative pain intensity was 6.21 ± 1.63 in the intervention group and 5.45 ± 1.82 in the control group (P = 0.08). In the intervention group pain intensity at 2 and 4 hours after surgery were 3.54 ± 1.48 and 5.12 ± 1.41 (P < 0.001), respectively. In the control group these values were 4.0±1.5 and 4.76 ± 1.39 (P = 0.04), respectively. No significant differences were observed in mean pain intensities at 6 and 12 hours. Conclusions TENS can reduce postoperative pain in the early hours after inguinal hernia repair surgery. PMID:27275401

Surgery for chronic inguinodynia following routine herniorrhaphy: beneficial effects on dysejaculation.

PubMed

Verhagen, T; Loos, M J A; Scheltinga, M R M; Roumen, R M H

2016-02-01

Pain during sexual activities and ejaculation is reported by 3-4% of men after routine inguinal herniorrhaphy. The potential beneficial effects of surgery for chronic groin pain on dysejaculation are unknown. The objective of this study was to determine dysejaculation rates in a series of patients reporting chronic postherniorrhaphy pain and evaluate the effects of tailored neurectomy on dysejaculation. We evaluated male patients (>18 years) operated for chronic groin pain after inguinal herniorrhaphy during a 6-year time period (2004-2010). Dysejaculation was defined as a burning or searing sensation associated with ejaculation. Men reporting symptoms possibly associated with dysejaculation were sent a questionnaire investigating pain characteristics (VAS, 0-100), influence on sex life and effects of the tailored neurectomy. A Post-Herniorrhaphy Dysejaculation Score (PHDS, 0-12 points) was introduced to quantify the severity of the dysejaculation syndrome. A series of 100 males operated for chronic inguinal pain after standard herniorrhaphy were studied. Thirty-four men reported symptoms of dysejaculation prior to the tailored neurectomy. Sex life was negatively influenced in 20 of these, and 5 completely abstained from any sexual activity. Following surgery including tailored neurectomy, funicular release and/or mesh removal, VAS for dysejaculation pain was significantly reduced [n = 20, 55 (95% CI 47-63) versus 21 (95% CI 13-29), p < 0.001]. PHDS scores were also significantly attenuated [n = 20, 10 (3-12) versus 2 (0-10), p < 0.001]. Sex life normalized in two-thirds of these men (13/20). Dysejaculation in men suffering from chronic pain after routine inguinal herniorrhaphy is not uncommon. A tailored neurectomy, funicular release and/or mesh removal offer relief in the majority of these patients.

Aligning incentives in the management of inguinal hernia: the impact of the payment model.

PubMed

Devarajan, Karthik; Rogers, Loni; Smith, Paul; Schwaitzberg, Steven D

2012-09-01

The Affordable Care Act has stimulated discussion to find feasible, alternate payment models. Adopting a global payment (GP) mechanism may dampen the high number of procedures incentivized by the fee-for-service (FFS) system. The evolving payment mechanism should reflect collaboration between surgeon and system goals. Our aim was to model and perform simulation of a GP system for hernia care and its impact on cost, revenue, and physician reimbursement in an integrated health care system. The results of the 2006 Watchful Waiting (WW) vs Repair of Inguinal Hernia in Minimally Symptomatic Men trial was used as a clinical model for the natural history and progression of inguinal hernia disease Simulations were built using 2009 financial and clinical data from the Cambridge Health Alliance to model costs and revenues in managing care for a 4-year cohort of inguinal hernia patients; FFS, FFS-WW, and the GP-WW were modeled. To build this GP model, surgeons were paid a constant $500 per patient whether herniorrhaphy was performed or not. Compared with the actual combined physician and hospital revenue under the current FFS model ($308,820), implementing the FFS-WW system for 4 years for 139 hernia patients decreased hospital and physician revenues by $93,846 and $19,308, respectively. This resulted in a total savings of $113,154 for the payors only. In contrast, when using WW methodology within a GP model, system savings of $69,174 were observed after 4 years, with preservation of physician and hospital income. Collaboration to achieve shared savings can be accomplished by pooling physician and hospital revenue in order to meet the goals of all parties. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Reduction of chronic post-herniotomy pain and recurrence rate. Use of the anatomical self-gripping ProGrip laparoscopic mesh in TAPP hernia repair. Preliminary results of a prospective study

PubMed Central

Hoskovec, David

2015-01-01

Introduction The role of fixation of the mesh is especially important in the endoscopic technique. The fixation of mesh through penetrating techniques using staples, clips or screws is associated with a significantly increased risk of developing a post-herniotomy pain syndrome. Aim To demonstrate the safety and efficacy of the self-fixating anatomical Parietex ProGrip laparoscopic mesh (Sofradim Production, Trévoux France) used with laparoscopic transabdominal preperitoneal hernia repair. The incidence of chronic post-herniotomy pain and recurrence rate in the follow-up after 12 months were evaluated. Material and methods Data analysis included all patients who underwent inguinal hernia surgery at our Surgical Department within the period from 1.05.2013 to 31.12.2014, who fulfilled the inclusion criteria. Standard surgical technique was used. Data were prospectively entered and subsequently analyzed on the Herniamed platform. Herniamed is an internet-based register in German and English language and includes all data of patients who underwent surgery for some types of hernia. Results There were 95 patients enrolled in the group and there were in total 156 inguinal hernias repaired. The mean follow-up was 15.52 months. At the assessment at 1 year mild discomfort in the groin was reported in 2 patients (3.51%) (1–3 VAS). No recurrence or chronic postoperative pain was reported. Conclusions Laparoscopic inguinal hernia repair using the transabdominal preperitoneal technique with implantation of the ProGrip laparoscopic mesh is a fast, effective and reliable method in experienced hands, which according to our results reduces the occurrence of chronic post-operative inguinal pain with simultaneously a low recurrence rate. PMID:26649083

Estimating Lymphodynamic Conditions and Lymphovenous Anastomosis Efficacy Using 99mTc-phytate Lymphoscintigraphy with SPECT-CT in Patients with Lower-limb Lymphedema

PubMed Central

Fukushima, Yoshimitsu; Kumita, Shinichiro; Ogawa, Rei; Hyakusoku, Hiko

2015-01-01

Background: Diagnostic and therapeutic strategies for lower-limb lymphedema have not yet been established. The purpose of this study was to estimate the lymphodynamic condition and therapeutic efficacy of lymphovenous anastomosis (LVA) in lower-limb lymphedema patients using 2-phase 99mTc-phytate lymphoscintigraphy with single-photon emission computed tomography-computed tomography (SPECT-CT). Methods: In this study, consecutive patients with lower-limb lymphedema who underwent 2-phase lymphoscintigraphy using 99mTc-phytate were enrolled between June 2013 and June 2014. SPECT-CT was also performed to clarify the relationships between functional and morphological information. In both the early and delayed images, inguinal lymph node accumulation, dermal backflow, and their sequential alternations were evaluated, and liver-to-blood ratio and inguinal lymph node-to-blood ratio were calculated. All participants were classified into 6 types of lymphodynamic conditions based on the image findings. Patients with both dermal backflow and associated normal lymphatic vessel accumulation proceeded to LVA and underwent a second lymphoscintigraphy after the operation. Results: Of all 30 participants, the largest population was categorized as type 4, which had consistent inguinal lymph node accumulation defect with dermal backflow. In 12 operated cases, dermal backflow was degraded in 10 cases by LVA. Liver-to-blood ratio in both early and delayed images and inguinal lymph node-to-blood ratio in delayed image significantly increased after LVA. Conclusions: Lymphoscintigraphy with SPECT-CT can provide both functional and morphological information simultaneously in patients with lower-limb lymphedema. Using these procedures, a type categorization for the patients was devised, which reflects their lymphodynamic conditions. The therapeutic efficacy of LVA could also be estimated quantitatively by the derived findings. PMID:26090294

Is CDX2 immunostaining useful for delineating anorectal from penile/vulvar squamous cancer in the setting of squamous cell carcinoma with clinically unknown primary site presenting with histologically confirmed inguinal lymph node metastasis?

PubMed

Gunia, Sven; Koch, Stefan; May, Matthias

2013-02-01

Penile, vulvar and anal squamous cell carcinomas (SCCs) share histomorphological overlap and are prone to lymphatic dissemination into inguinal nodes. Anal SCCs might derive from the anorectal zone (ARZ), anal transitional zone, squamous zone or from perianal skin. These anatomically distinct zones differ in terms of their embryological development. We sought to investigate the role of caudal-related homeobox 2 (CDX2), a homeobox gene implicated in the development and anterior/posterior pattern specification from duodenum to rectum including the ARZ, in terms of narrowing the possible sites of origin to be considered in the setting of SCC with unknown primary presenting with histologically confirmed inguinal lymph node metastasis. By immunohistochemistry (IHC) employing a panel of antibodies directed against CK5/6, CK7, CK20, p63, p16, CEA and CDX2, we compared 89 penile, 11 vulvar and eight anal SCCs with respect to their staining profiles. Moreover, anal SCCs were subjected to in situ hybridisation (ISH) for high-risk human papillomavirus (HPV) subtypes. By IHC, CDX2 expression was observed in 2/8 anal SCCs (25%) while being absent from all penile and vulvar SCCs examined. High-risk HPV subtypes were detected by ISH in all anal SCCs examined, which were uniformly p16-positive by IHC. CDX2 might be valuable in terms of narrowing the possible sites of origin to be considered in the setting of SCC with unknown primary presenting with inguinal lymph node metastasis. However, despite its favourable specificity, the diagnostic benefit achieved by this observation is limited by the low sensitivity.

Preperitoneal Surgery Using a Self-Adhesive Mesh for Inguinal Hernia Repair

PubMed Central

Oguntodu, Olakunle F.; Rodriguez, Francisco; Rassadi, Roozbeh; Haley, Michael; Shively, Cynthia J.; Dzandu, James K.

2014-01-01

Background and Objectives: Laparoscopic preperitoneal hernia repair with mesh has been reported to result in improved patient outcomes. However, there are few published data on the use of a totally extraperitoneal (TEP) approach. The purpose of this study was to present our experience and evaluate early outcomes of TEP inguinal hernia repair with self-adhesive mesh. Methods: This cohort study was a retrospective review of patients who underwent laparoscopic TEP inguinal hernial repair from April 4, 2010, through July 22, 2014. Data assessed were age, sex, body mass index (BMI), hernia repair indications, hernia type, pain, paresthesia, occurrence (bilateral or unilateral), recurrence, and patient satisfaction. Descriptive and regression analyses were performed. Results: Six hundred forty patients underwent laparoscopic preperitoneal hernia surgery with self-adhesive mesh. The average age was 56 years, nearly all were men (95.8%), and the mean BMI was 26.2 kg/m2. Cases involved primary hernia more frequently than recurrent hernia (94% vs 6%; P < .05). After surgery, 92% of the patients reported no more than minimal pain, <1% reported paresthesia, and 0.2% had early recurrence. There were 7 conversions to an open procedure. The patients had no adverse reactions to anesthesia and no bladder injury. Postoperative acute pain or recurrence was not explained by demographics, BMI, or preoperative pain. There were significant associations of hernia side, recurrence, occurrence, and sex with composite end points. Nearly all patients (98%) were satisfied with the outcome. Conclusion: The use of self-adhesive, Velcro-type mesh in laparoscopic TEP inguinal hernia repair is associated with reduced pain; low rates of early recurrence, infection, and hematoma; and improved patient satisfaction. PMID:25587212

Local anesthesia for treatment of hernia in elder patients: Levobupicavaine or Bupivacaine?

PubMed Central

2013-01-01

Background Inguinal hernia is one of the most common diseases in the elderly. Treatment of this pathology is exclusively surgical and relies almost always on the use of local anesthesia. While in the past hernia surgery was carried out mainly by general anesthesia, in recent years there has been growing emphasis on the role of local anesthesia. Methods The aim of our study was to compare intra-and postoperative analgesia obtained by the use of levobupivacaine to the same obtained by bupivacaine. Bupivacaine is one of the main local anesthetics used in the intervention of inguinal hernioplasty. Levobupivacaine is an enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity. The study was conducted from March 2011 to March 2013. We collected data of eighty patients, male and female, aged between 65 and 86 years, who underwent inguinal hernioplasty with local anesthesia. Results Evaluation of intra-operatively pain shows that minimal pain is the same in both groups. Mild pain was more frequent in the group who used levobupivacaine. Moderate pain was slightly more frequent in the group who used bupivacaine. Only one reported intense pain. Two drugs seem to have the same effect at a distance of six, twelve, eighteen and twentyfour hours. Bupivacaine shows a significantly higher number of complications, as already demonstrated by previous studies. Degree of satisfaction expressed by patients has been the same in the two groups. Levobupivacaine group has shown a greater request for paracetamol while patients who experienced bupivacaine have showed a higher request of other analgesics. Conclusions Clinical efficacy of levobupivacaine and racemic bupivacaine are actually similar, when used under local intervention of inguinal hernioplasty. In the field of ambulatorial surgery our working group prefers levobupivacaine for its fewer side effects and for its easy handling. PMID:24267484

Mesh fixation in endoscopic inguinal hernia repair: evaluation of methodology based on a systematic review of randomised clinical trials.

PubMed

Lederhuber, Hans; Stiede, Franziska; Axer, Stephan; Dahlstrand, Ursula

2017-11-01

The issue of mesh fixation in endoscopic inguinal hernia repair is frequently debated and still no conclusive data exist on differences between methods regarding long-term outcome and postoperative complications. The quantity of trials and the simultaneous lack of high-quality evidence raise the question how future trials should be planned. PubMed, EMBASE and the Cochrane Library were searched, using the filters "randomised clinical trials" and "humans". Trials that compared one method of mesh fixation with another fixation method or with non-fixation in endoscopic inguinal hernia repair were eligible. To be included, the trial was required to have assessed at least one of the following primary outcome parameters: recurrence; surgical site infection; chronic pain; or quality-of-life. Fourteen trials assessing 2161 patients and 2562 hernia repairs were included. Only two trials were rated as low risk for bias. Eight trials evaluated recurrence or surgical site infection; none of these could show significant differences between methods of fixation. Two of 11 trials assessing chronic pain described significant differences between methods of fixation. One of two trials evaluating quality-of-life showed significant differences between fixation methods in certain functions. High-quality evidence for differences between the assessed mesh fixation techniques is still lacking. From a socioeconomic and ethical point of view, it is necessary that future trials will be properly designed. As small- and medium-sized single-centre trials have proven unable to find answers, register studies or multi-centre studies with an evident focus on methodology and study design are needed in order to answer questions about mesh fixation in inguinal hernia repair.

Postoperative analgesic efficacy of ultrasound-guided ilioinguinal-iliohypogastric nerve block compared with medial transverse abdominis plane block in inguinal hernia repair: A prospective, randomised trial.

PubMed

Bhatia, Nidhi; Sen, Indu Mohini; Mandal, Banashree; Batra, Ankita

2018-03-29

Analgesic efficacy of ultrasound-guided transverse abdominis plane block, administered a little more medially, just close to the origin of the transverse abdominis muscle has not yet been investigated in patients undergoing unilateral inguinal hernia repair. We hypothesised that medial transverse abdominis plane block would provide comparable postoperative analgesia to ilioinguinal-iliohypogastric nerve block in inguinal hernia repair patients. This prospective, randomised trial was conducted in 50 ASA I and II male patients≥18 years of age. Patients were randomised into two groups to receive either pre-incisional ipsilateral ultrasound-guided ilioinguinal-iliohypogastric nerve block or medial transverse abdominis plane block, with 0.3ml/kg of 0.25% bupivacaine. Our primary objective was postoperative 24-hour analgesic consumption and secondary outcomes included pain scores, time to first request for rescue analgesic and side effects, if any, in the postoperative period. There was no significant difference in the total postoperative analgesic consumption [group I: 66.04mg; group II: 68.33mg (P value 0.908)]. Time to first request for rescue analgesic was delayed, though statistically non-significant (P value 0.326), following medial transverse abdominis plane block, with excellent pain relief seen in 58.3% patients as opposed to 45.8% patients in ilioinguinal-iliohypogastric nerve block group. Medial transverse abdominis plane block being a novel, simple and easily performed procedure can serve as an useful alternative to ilioinguinal-iliohypogastric nerve block for providing postoperative pain relief in inguinal hernia repair patients. Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Effect of addition of dexamethasone to ropivacaine on post-operative analgesia in ultrasonography-guided transversus abdominis plane block for inguinal hernia repair: A prospective, double-blind, randomised controlled trial.

PubMed

Sharma, Uma Datt; Prateek; Tak, Himani

2018-05-01

Ultrasonography (USG)-guided transversus abdominis plane (TAP) block is an abdominal field block with high efficacy. This study was undertaken with the aim of determining the effect of the addition of dexamethasone to 0.5% ropivacaine on post-operative analgesia in USG-guided TAP block for inguinal hernia repair. A double-blind randomised control study was conducted on sixty patients posted for inguinal hernia repair with the American Society of Anesthesiologists physical Status I or II, who were allocated two groups of 30 each. Patients in Group RS received 0.5% ropivacaine (20 ml) and normal saline (2 ml) whereas patients in Group RD received 0.5% ropivacaine (20 ml) and dexamethasone (2 ml, i.e., 8 mg), in USG-guided TAP Block on the same side, after repair of inguinal hernia under spinal anaesthesia. Visual analogue scale (VAS) scores, time for request of first analgesia and total tramadol consumption in first 24 h were compared. Unpaired Student's t -test and Mann-Whitney U-test were performed using SPSS 23 Software. Patients in Group RD had significantly lower VAS scores as compared to Group RS from 4 th to 12 th h, postoperatively. Duration of analgesia was significantly more in Group RD (547.50 [530,530] min) when compared with Group RS (387.50 [370,400] min) ( P < 0.001). The demand for intravenous tramadol was significantly low in Group RD (223.33 ± 56.83 mg) as compared to Group RS (293.33 ± 25.71 mg) ( P < 0.001). Addition of dexamethasone to ropivacaine in USG-guided TAP block significantly reduces post-operative pain and prolongs the duration of post-operative analgesia, thereby reducing analgesic consumption.

Safety of minimally invasive radical prostatectomy in patients with prior abdominopelvic or inguinal surgery.

PubMed

Ball, Mark W; Reese, Adam C; Mettee, Lynda Z; Pavlovich, Christian P

2015-02-01

Despite the widespread use of minimally invasive radical prostatectomy (MIRP), there remain concerns regarding its safety in patients with a history of prior abdominopelvic or inguinal surgery. A prospective database of 1165 MIRP procedures performed by a single surgeon at a high-volume tertiary care center from 2001 to 2013 was analyzed. After an initial period of transperitoneal MIRP (TP), an extraperitoneal (EP) approach was used preferentially beginning in 2005 (for both laparoscopic and robotic cases), and robotics were used preferentially beginning in 2010. Overall perioperative complications, major complications (Clavien-Dindo III or IV), and abdominal complications (e.g., ileus, bowel/organ injury, or vascular injury) were compared for patients with and without a prior surgical history. Uni- and multivariate logistic regression were used to control the impact of robotics, approach, operative time, estimated blood loss, case number, prostate weight, and primary Gleason on complications. Three hundred patients undergoing MIRP had prior abdominopelvic or inguinal surgery (25.8%). Of these, 102 (34%) underwent TP and 198 (66%) EP MIRP. Robotics was used in 286 cases (24.6%) and pure laparoscopy in 879 (75.4%). Complications occurred in 111 patients (9.5%) from the total cohort, with major complications in 32 (2.75%) and abdominal complications in 19 (1.63%). Prior surgery was not associated with overall, major, or abdominal complications. Of the controlling factors, only increasing operative time was associated with postoperative abdominal complications (most of which were ileus) on multivariate analysis. In this large single-surgeon series where both EP and TP approaches to MIRP are utilized, prior abdominopelvic or inguinal surgery was not associated with an increased risk of perioperative complications.

Risk Group Systems for Penile Cancer Management: A Study of 203 Patients With Invasive Squamous Cell Carcinoma.

PubMed

Chaux, Alcides

2015-10-01

To evaluate the accuracy of previously published risk group systems for predicting inguinal nodal metastases in patients with penile carcinoma. Two hundred three cases of invasive penile squamous cell carcinomas (SCC) were stratified using the following systems: Solsona et al (J Urol 2001;165:1509), Hungerhuber et al (Urology 2006;68:621), and the system proposed by the European Association of Urology (EAU; Eur Urol 2004;46:1). Receiver operating characteristic (ROC) analysis was carried out to compare accuracy in predicting final nodal status and cancer-related death. Most of cases were pT2/pT3 high-grade tumors with a small percentage of low-grade pT1 carcinomas. The metastatic rates for the Solsona et al, EAU, and Hungerhuber et al systems in the high-risk category were 15 of 73 (21%), 16 of 103 (16%), and 10 of 35 (29%) in patients with clinically negative inguinal lymph nodes and 52 of 75 (69%), 55 of 93 (59%), and 34 of 47 (72%) in patients with palpable inguinal lymph nodes, respectively. Performance by ROC analysis showed a low accuracy for all stratification systems although the Solsona et al and the Hungerhuber et al systems performed better than the EAU system. Patients in intermediate-risk categories and with clinically palpable inguinal lymph nodes were more likely to have nodal metastasis than patients with clinically negative lymph nodes in the same category. These stratification systems may be useful for patients with low-grade superficial tumors and less accurate for evaluating patients with high-grade locally advanced penile carcinomas. These data may be useful for therapeutic planning of patients with penile SCC. Copyright © 2015 Elsevier Inc. All rights reserved.

Pain and quality of life after inguinal hernia surgery: a multicenter randomized controlled trial comparing lightweight vs heavyweight mesh (Supermesh Study).

PubMed

Bona, Stefano; Rosati, Riccardo; Opocher, Enrico; Fiore, Barbara; Montorsi, Marco

2018-03-01

Mesh repair has significantly reduced recurrence rate after groin hernia surgery. Recently, attention has shifted to issues such as chronic pain and discomfort, leading to development of lightweight and partially re-absorbable meshes. The aim of the study was to evaluate the effect of lightweight mesh vs heavyweight mesh on post-operative pain, discomfort and quality of life in short and medium term after inguinal hernia surgery. Eight hundred and eight patients with primary inguinal hernia were allocated to anterior repair (Lichtenstein technique) using a lightweight mesh (Ultrapro ® ) or a heavyweight mesh (Prolene ® ). Primary outcomes were incidence of chronic pain and discomfort at 6-month follow-up. Secondary endpoints were quality of life (QoL), pain and complication at 1 week, 1 and 6 months. At 6 months, 25% of patients reported pain of some intensity; severe pain was reported by 1% of patients in both groups. A statistically significant difference in favour of lightweight mesh was found at multivariable analysis for pain (1 week and 6 months after surgery: p = 0.02 and p = 0.04, respectively) and QoL at 1 month and 6 months (p = 0.05 and p = 0.02, respectively). There was no difference in complication rate and no hernia recurrences were detected. The use of lightweight mesh in anterior Lichtenstein inguinal hernia repair significantly reduced the incidence of pain and favourably affected the perceived quality of life at 6 months after surgery compared to heavyweight mesh.

Obesity is associated with depot-specific alterations in adipocyte DNA methylation and gene expression.

PubMed

Sonne, Si Brask; Yadav, Rachita; Yin, Guangliang; Dalgaard, Marlene Danner; Myrmel, Lene Secher; Gupta, Ramneek; Wang, Jun; Madsen, Lise; Kajimura, Shingo; Kristiansen, Karsten

2017-04-03

The present study aimed to identify genes exhibiting concomitant obesity-dependent changes in DNA methylation and gene expression in adipose tissues in the mouse using diet-induced obese (DIO) C57BL/6J and genetically obese ob/ob mice as models. Mature adipocytes were isolated from epididymal and inguinal adipose tissues of ob/ob and DIO C57BL/6J mice. DNA methylation was analyzed by MeDIP-sequencing and gene expression by microarray analysis. The majority of differentially methylated regions (DMRs) were hypomethylated in obese mice. Global methylation of long interspersed elements indicated that hypomethylation did not reflect methyl donor deficiency. In both DIO and ob/ob mice, we observed more obesity-associated methylation changes in epididymal than in inguinal adipocytes. Assignment of DMRs to promoter, exon, intron and intergenic regions demonstrated that DIO-induced changes in DNA methylation in C57BL/6J mice occurred primarily in exons, whereas inguinal adipocytes of ob/ob mice exhibited a higher enrichment of DMRs in promoter regions than in other regions of the genome, suggesting an influence of leptin on DNA methylation in inguinal adipocytes. We observed altered methylation and expression of 9 genes in epididymal adipocytes, including the known obesity-associated genes, Ehd2 and Kctd15, and a novel candidate gene, Irf8, possibly involved in immune type 1/type2 balance. The use of 2 obesity models enabled us to dissociate changes associated with high fat feeding from those associated with obesity per se. This information will be of value in future studies on the mechanisms governing the development of obesity and changes in adipocyte function associated with obesity.

Pelvic ring injuries: Surgical management and long-term outcomes

PubMed Central

Halawi, Mohamad J.

2016-01-01

Pelvic ring injuries present a therapeutic challenge to the orthopedic surgeon. Management is based on the patient's physiological status, fracture classification, and associated injuries. Surgical stabilization is indicated in unstable injury patterns and those that fail nonsurgical management. The optimal timing for definitive fixation is not clearly defined, but early stabilization is recommended. Surgical techniques include external fixation, open reduction and internal fixation, and minimally invasive percutaneous osteosynthesis. Special considerations are required for concomitant acetabular fractures, sacral fractures, and those occurring in skeletally immature patients. Long-term outcomes are limited by lack of pelvis-specific outcome measures and burden of associated injuries. PMID:26908968

Chiral solitons in spinor polariton rings

NASA Astrophysics Data System (ADS)

Zezyulin, D. A.; Gulevich, D. R.; Skryabin, D. V.; Shelykh, I. A.

2018-04-01

We consider theoretically one-dimensional polariton ring accounting for both longitudinal-transverse (TE-TM) and Zeeman splittings of spinor polariton states and spin-dependent polariton-polariton interactions. We present a class of solutions in the form of the localized defects rotating with constant angular velocity and analyze their properties for realistic values of the parameters of the system. We show that the effects of the geometric phase arising from the interplay between the external magnetic field and the TE-TM splitting introduce chirality in the system and make solitons propagating in clockwise and anticlockwise directions nonequivalent. This can be interpreted as a solitonic analog of the Aharonov-Bohm effect.

Method for making electro-fluidic connections in microfluidic devices

DOEpatents

Frye-Mason, Gregory C.; Martinez, David; Manginell, Ronald P.; Heller, Edwin J.; Chanchani, Rajen

2004-08-10

A method for forming electro-fluidic interconnections in microfluidic devices comprises forming an electrical connection between matching bond pads on a die containing an active electrical element and a microfluidic substrate and forming a fluidic seal ring that circumscribes the active electrical element and a fluidic feedthrough. Preferably, the electrical connection and the seal ring are formed in a single bonding step. The simple method is particularly useful for chemical microanalytical systems wherein a plurality of microanalytical components, such as a chemical preconcentrator, a gas chromatography column, and a surface acoustic wave detector, are fluidically interconnected on a hybrid microfluidic substrate having electrical connection to external support electronics.

Phagraphene: A Low-Energy Graphene Allotrope Composed of 5-6-7 Carbon Rings with Distorted Dirac Cones.

PubMed

Wang, Zhenhai; Zhou, Xiang-Feng; Zhang, Xiaoming; Zhu, Qiang; Dong, Huafeng; Zhao, Mingwen; Oganov, Artem R

2015-09-09

Using systematic evolutionary structure searching we propose a new carbon allotrope, phagraphene [fæ'græfi:n], standing for penta-hexa-hepta-graphene, because the structure is composed of 5-6-7 carbon rings. This two-dimensional (2D) carbon structure is lower in energy than most of the predicted 2D carbon allotropes due to its sp(2)-binding features and density of atomic packing comparable to graphene. More interestingly, the electronic structure of phagraphene has distorted Dirac cones. The direction-dependent cones are further proved to be robust against external strain with tunable Fermi velocities.

Simulation of collisional transport processes and the stability of planetary rings

NASA Technical Reports Server (NTRS)

Brophy, Thomas G.; Esposito, Larry W.

1989-01-01

The utility of the phase-space fluid method for the study of planetary ring dynamics is presently demonstrated through the numerical solution of a model kinetic equation for a flattened Keplerian disk. Attention is given to ringlets composed of single-sized particles, as well as to ringlets composed of two different-sized particles; in the latter case, the ringlets evolve in such a way that the lighter particles are confined by the heavier ones. The results obtained indicate that some natural process may sharpen the optical depth profile of edges even without an external forcing mechanism, and that intermediate optical depths are dynamically preferred in some cases.

[Inguinal hernia repair: results of randomized clinical trials and meta-analyses].

PubMed

Slim, K; Vons, C

2008-01-01

This evidence-based review of the literature aims to answer two questions regarding inguinal hernia repair: 1. should a prosthetic patch be used routinely? 2. Which approach is better - laparoscopic or open surgery? After a comprehensive search of electronic databases we retained only meta-analyses (n=14) and/or randomised clinical trials (n=4). Review of this literature suggests with a good level of evidence that prosthetic hernia repair is the gold standard; the laparoscopic approach has very few proven benefits and may involve more serious complications when performed outside expert centers. The role of laparoscopy for the repair of bilateral or recurrent hernias needs better evaluation.

Current options in inguinal hernia repair in adult patients

PubMed Central

Kulacoglu, H

2011-01-01

Inguinal hernia is a very common problem. Surgical repair is the current approach, whereas asymptomatic or minimally symptomatic hernias may be good candidate for watchful waiting. Prophylactic antibiotics can be used in centers with high rate of wound infection. Local anesthesia is a suitable and economic option for open repairs, and should be popularized in day-case setting. Numerous repair methods have been described to date. Mesh repairs are superior to "nonmesh" tissue-suture repairs. Lichtenstein repair and endoscopic/laparoscopic techniques have similar efficacy. Standard polypropylene mesh is still the choice, whereas use of partially absorbable lightweight meshes seems to have some advantages. PMID:22435019

Inguinal hernia repair: totally preperitoneal laparoscopic approach versus Stoppa operation: randomized trial of 100 cases.

PubMed

Champault, G G; Rizk, N; Catheline, J M; Turner, R; Boutelier, P

1997-12-01

In a prospective randomized trial comparing the totally preperitoneal (TPP) laparoscopic approach and the Stoppa procedure (open), 100 patients with inguinal hernias (Nyhus IIIA, IIIB, IV) were followed over a 3-year period. Both groups were epidemiologically comparable. In the laparoscopic group, operating time was significantly longer (p = 0.01), but hospital stay (3.2 vs. 7.3 days) and delay in return to work (17 vs. 35 days) were significantly reduced (p = 0.01). Postoperative comfort (less pain) was better (p = 0.001) after laparoscopy. In this group, morbidity was also reduced (4 vs. 20%; p = 0.02). The mean follow-up was 605 days, and 93% of the patients were reviewed at 3 years. There were three (6%) recurrences after TPP, especially at the beginning of the surgeon's learning curve, versus one for the Stoppa procedure (NS). For bilateral hernias, the authors suggest the use of a large prosthesis rather than two small ones to minimize the likelihood of recurrence. In the conditions described, the laparoscopic (TPP) approach to inguinal hernia treatment appears to have the same long-term recurrence rate as the open (Stoppa) procedure but a real advantage in the early postoperative period.

Adjuvant radiation therapy for malignant Abrikossoff's tumor: a case report about a femoral triangle localisation.

PubMed

Marchand Crety, C; Garbar, C; Madelis, G; Guillemin, F; Soibinet Oudot, P; Eymard, J C; Servagi Vernat, S

2018-06-20

Granular cell or Abrikossoff's tumors are usually benign however rare malignant forms concern 1 to 3% of cases reported. Pelvic locations are exceptional. We report a case of a 43-years-old patient who had a benign Abrikossoff's tumor localized in the right femoral triangle diagnosed at the biopsy. The patient underwent a surgical tumorectomy and inguinal lymph nodes resection. Histologically, the tumor showed enough criteria to give diagnosis of malignancy: nuclear pleomorphism, tumor cell spindling, vesicular nuclei with large nucleoli. Moreover, five lymph nodes were metastatic. Immunohistochemistry findings confirmed the diagnosis of granular cell tumor which is positive for S100 protein and CD68 antibodies. The mitotic index was nevertheless low with a Ki67 labeling index of 1-2%. A large surgical revision with an inguinal curage following radiotherapy were decided on oncology committee. Adjuvant radiotherapy on the tumor bed and right inguinal area of ​​50 Gy in conventional fractionation was delivered with the aim of reducing local recurrence risk. There was no recurrence on longer follow-up (10 months post radiotherapy). Adjuvant radiotherapy seems an appropriate therapeutic approach, even if controversial, given that some authors report effectiveness on local disease progression.

Sports Hernia: Diagnosis, Management and Operative Treatment

PubMed Central

Emblom, Benton A.

2017-01-01

Objectives: Athletic Pubalgia, also known as sports hernia or core muscle injury, causes significant dysfunction in athletes. Increased recognition of this specific injury distinct from inguinal hernia pathology has led to better management of this debilitating condition. We hypothesize that patients who undergo our technique of athletic pubalgia repair will recover and return to high-level athletics. Methods: Using our billing and clinical database, patients who underwent sports hernia repair by single surgeon at a single institution were contacted for Harris hip score, functional outcome, and return to play data. Results: Of 101 patients who met criteria, 43 were contacted. 93% of patients were able to return to play at an average of 4.38 mo. Normal activities were rated at 95.5% and athletic function was rated at 88.9%. Negative predictors were female sex, multiple operations, and prior inguinal hernia repair. Overall complication rate was 4.6%, and reoperation rate was 4.6%. Conclusion: Our method of adductor to rectus abdominis turn up flap is a safe procedure with high return to play success. Patients who had previously undergone inguinal hernia repair or other hip/pelvic related surgery had a worse outcome.

The case of an Sry-negative XX male Pug with an inguinal gonad.

PubMed

Rota, A; Cucuzza, A Starvaggi; Iussich, S; Delorenzi, L; Parma, P

2010-08-01

A case of intersexuality in a Pug that was bought as a male in a pet shop is described. The dog was presented at the Veterinary Teaching Hospital, University of Turin, for a reddish mass protruding from the prepuce. The mass had the aspect of an enlarged clitoris, with a caudoventral direction and a dorsal urethral ostium. A gonad was palpable in the left inguinal region. Laparotomy confirmed ultrasound detection of an abdominal uterine structure together with the right gonad. The histology of both gonads was similar, showing an exclusively masculine character, with seminiferous tubules lined only by Sertoli cells; the uterus showed a normal histological structure. Karyological analysis revealed a female karyotype (78,XX), and polymerase chain reaction showed the absence of Sry. The diagnosis was an XX male. The pathogenesis of the XX sex reversal syndrome in dogs is not completely understood, as Sry, the master gene regulating testis differentiation, is not present; to date, no genetic cause has been identified for this phenotypic condition in dogs. This case is unusual because the dog showed an inguinal testis, implying a partial activity of the mechanisms leading to abdominal testis translocation along a gubernaculum and transinguinal migration.

Lichtenstein hernia repair under different anaesthetic techniques with special emphasis on outcomes in older people.

PubMed

Sanjay, Pandanaboyana; Leaver, Heather; Shaikh, Irshad; Woodward, Alan

2011-06-01

This study compared local (LA) and general anaesthesia (GA) for elective inguinal hernia repair with specific reference to older people (≥70 years). A total of 470 inguinal hernia repairs were compared for demographics, operating time, day case rates and complications. Subgroup analysis was performed to evaluate outcomes in <70 and >70 years. A total of 288 LA and 182 GA repairs were performed. One hundred and forty-four (30.6%) patients were older than 70 years of which 80 (55%) were ASA (American Society of Anaesthesiologists) grades 3 and 4. Older (≥70 years) ASA grade 3 and 4 patients are more likely to undergo surgery under LA than GA (63% LA, 35% GA, P = 0.005) with higher day case rates of 81% LA, 33% GA, P = 0.0001). No significant difference in early complications, satisfaction rate and long-term recurrence rates were noted between the two groups. LA inguinal hernia repair has significant short-term advantages and facilitates day surgery in older patients. LA should be the preferred option in the older patients. © 2011 The Authors. Australasian Journal on Ageing © 2011 ACOTA.

Three-year follow-up of modified Lichtenstein inguinal hernioplasty using lightweight poliglecaprone/polypropylene mesh.

PubMed

Smietański, M; Bigda, J; Zaborowski, K; Worek, M; Sledziński, Z

2009-06-01

This prospective cohort study evaluated whether partially absorbable monofilament mesh could influence postoperative pain and time of the return to normal activity while not increasing recurrence in modified Lichtenstein inguinal hernioplasty. Two hundred and forty-two patients were operated on using poliglecaprone/polypropylene mesh. A modified Lichtenstein technique was used (more stitches and larger margin of mesh on the inguinal ligament, additional suture near the pubic bone). Follow-up data were collected at 3 years. The objective was to assess the incidence of late persistent postoperative pain and the recurrence rate. The follow-up rate reached 88.37%. The recurrence rate was 2.2% (four patients). All recurrences appeared within the first 12 months. Slight discomfort, feelings of stiffness, and the occasional appearance of foreign bodies that did not influence daily activity were noted in 20 patients (10.8%). Chronic pain was found in 22 patients (11.1%), but only affected the daily activities of seven (3.24%). Only one patient suffering from pain described it as stronger than before the operation. The use of partially absorbable light mesh reduces postoperative pain at long-term follow-up. The recurrence rate was not increased at 36 months follow-up.

Factors Influencing Relapse-Free Survival in Merkel Cell Carcinoma of the Lower Limb-A Review of 60 Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Poulsen, Michael, E-mail: michael_poulsen@health.qld.gov.a; Round, Caroline; Keller, Jacqui

2010-02-01

Purpose: Factors affecting relapse-free survival (RFS) in patients with Merkel cell carcinoma (MCC) of the lower limb were reviewed. Methods and Materials: The records of 60 patients from 1986 to 2005 with a diagnosis of MCC of the lower limb or buttock were retrospectively reviewed. The patients were treated with curative intent with surgery, radiation, or chemotherapy. Results: The 5-year overall survival, disease-specific survival, and RFS were 53%, 61%, and 20%, respectively. Factors influencing RFS were analyzed using univariate analysis. It appeared that recurrent disease worsened RFS (p = 0.03) and the addition of any radiotherapy improved RFS (p <0.001),more » as did radiotherapy to the inguinal nodes (p = 0.01) or primary site and inguinal nodes (p = 0.003). Age, surgical margins, and stage were not statistically significant. On multivariate analysis, the only significant factor was the addition of radiotherapy (hazard ratio = 0.51 p = 0.03). Conclusion: The addition of radiotherapy improves RFS compared with surgery alone. Elective treatment should be given to the inguinal nodes to reduce the risk of relapse.« less