Common Wall Research Articles

Comparison of postoperative urinary complications in laparoscopic-assisted anorectoplasty versus posterior sagittal anorectoplasty for anorectal malformation with rectourethral fistula.

Long-term urinary outcomes after anorectal malformation (ARM) repair are affected by surgical approach and sacral anomalies. This study aimed to compare laparoscopic-assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) in terms of urinary complications. Between 2001 and 2022, 45 patients were treated with LAARP or PSARP. The rectourethral fistula and inflow angle between the fistula and rectum was confirmed by preoperative colonography. The incidence of urinary complications and treatment were compared between the two groups. Four patients (14%) had remnant fistula and five patients (17%) had neurogenic bladder dysfunction in LAARP group, while three patients (18%) had urethral injury in PSARP group. All patients with remnant fistula were asymptomatic and followed without treatment. The incidence of remnant fistula improved between earlier decade and later decade. In all cases with urethral injury, suture repair was performed and no postoperative leakage was noted. All five patients with neurogenic bladder dysfunction had spine abnormalities that required clean intermittent catheterization (CIC) and two were free from CIC finally. It is important to check inflow angle preoperatively to prevent remnant fistula. For PSARP, meticulous dissection is required when separating fistula from urethra because they create common wall. The most contributing factor to neurogenic bladder is sacral anomalies. Preoperative evaluation and postoperative urinary drainage are important.

A preliminary study on the normal values of the thoracic Haller index in children.

The Haller index (HI) is widely utilized as a quantitative indicator to assess the extent of the pectus excavatum (PE) deformity, which is the most common chest wall abnormality in children. Both preoperative correction planning and postoperative follow-up need to be based on the standard of normal thoracic growth and development. However, there is currently no established reference range for the HI in children. Consequently, the goal of this study was to conduct a preliminary investigation of normal HI values among children to understand thoracic developmental characteristics. Chest computed tomography images obtained from January 2012 to March 2022 were randomly selected from the imaging system of the Children's Hospital of Chongqing Medical University. We divided the images of children into a total of 19 groups: aged 0-3 months (1 group), 4-12 months (1 group) and 1 year to 17 years (17 groups), with 50 males and 50 females, totaling 100 children in each group. HI was measured in the plane where the lowest point of the anterior thoracic wall was located and statistically analysed using SPSS 26.0 software. A total of 1900 patients were included in the study. Our results showed that HI, transverse diameter and anterior-posterior diameter were positively correlated with age (P < 0.05). Using age as the independent variable and HI as the dependent variable, the best-fit regression equations were HI-male = 2.047 * Age0.054(R2 = 0.276, P<0.0001) and HI-female = 2.045 * Age0.067(R2 = 0.398, P<0.0001). Males had significantly larger thoracic diameters than females, and there was little difference in the HI between the 2 sexes. The HI rapidly increases during the neonatal period, slowly increases during infancy and stops increasing during puberty, with no significant differences between the sexes.

The role of historical biogeography in shaping colour morph diversity in the common wall lizard.

The maintenance of polymorphisms often depends on multiple selective forces, but less is known on the role of stochastic or historical processes in maintaining variation. The common wall lizard (Podarcis muralis) is a colour polymorphic species in which local colour morph frequencies are thought to be modulated by natural and sexual selection. Here, we used genome-wide single-nucleotide polymorphism data to investigate the relationships between morph composition and population biogeography at a regional scale, by comparing morph composition with patterns of genetic variation of 54 populations sampled across the Pyrenees. We found that genetic divergence was explained by geographic distance but not by environmental features. Differences in morph composition were associated with genetic and environmental differentiation, as well as differences in sex ratio. Thus, variation in colour morph frequencies could have arisen via historical events and/or differences in the permeability to gene flow, possibly shaped by the complex topography and environment. In agreement with this hypothesis, colour morph diversity was positively correlated with genetic diversity and rates of gene flow and inversely correlated with the likelihood of the occurrence of bottlenecks. Concurrently, we did not find conclusive evidence for selection in the two colour loci. As an illustration of these effects, we observed that populations with higher proportions of the rarer yellow and yellow-orange morphs had higher genetic diversity. Our results suggest that processes involving a decay in overall genetic diversity, such as reduced gene flow and/or bottleneck events have an important role in shaping population-specific morph composition via non-selective processes.

Lizards in the wind: The impact of wind on the thermoregulation of the common wall lizard

Lizards in the wind: The impact of wind on the thermoregulation of the common wall lizard

FPre-Operative Ultrasound Diagnostics of Mirizzi Syndrome

Background. Mirizzi syndrome (MS) is one of the most severe complications of the gastrointestinal tract and the most complex pathological process in biliary surgery in general. The issue of ultrasound diagnostics (USD) of MS in patients with gallstone disease (GLC) at the preoperative stage for planning the scope of surgical intervention and warning the patient about possible complications is acute. The goal. Determine the sensitivity of preoperative ultrasound in the diagnosis of MS and finding the most significant echo pattern of MS during ultrasound. Materials and Methods. The results of 9126 cholecystectomies performed in the Kharkiv Clinical Hospital on railway transport No. 2 for the period from 1997 to 2023 were analyzed, while MS was suspected in 159 (1.7%) patients by ultrasound. Out of 159 in whom signs of MS were detected by ultrasound, MS was reliably confirmed intraoperatively in 116 (72,9%) patients, and no SM was detected in 43 (27,1%) patients. MS I type was detected in 98 (84.49%) patients, MS II type – 18 (15.51%). Among them there were 87 (75) women, 29 (25) men, the age of the patients ranged from 37 to 80 years (on average – 66.4 years). To analyze the sensitivity of certain echo characteristics during preoperative ultrasound in case of suspicion of SM, the diagnostic sensitivity index (DS) was used. Results. It was established that the most sensitive echocardiogram is the absence of a clear border between the back wall of the gallbladder and the hepaticocholedochus, the frequency is 75.40%. The next sign of sensitivity, which was confirmed intraoperatively, is a shrunken gall bladder, the DS indicator is 54.55%. It was also established that the combination of such echo features as: a shrunken gallbladder and the absence of a clear border between the back wall of the gallbladder and hepatic choledochal, which was detected in 25, in 23 of them, MS was confirmed intraoperatively, the DS rate was 92%. Conclusions. Ultrasound allows with a high (72,9%) degree of probability to establish the presence of SM at the preoperative stage. A reliable ultrasound sign of the presence of SM is the visualization of the common wall between the gallbladder and the hepaticocholedochus – DS 75.40%. With a combination of echo signs: shrunken gallbladder and deformation of the wall of the hepaticocholedochus in the place of attachment of the gallbladder, it is possible to assume MS with a high percentage of reliability (92%) with the help of ultrasound at the preoperative stage. The received information about the high probability of the presence of MS before the operation allows you to correctly plan possible options for the volume and tactics of surgical intervention.

Smarter in the city? Lizards from urban and semi-natural habitats do not differ in a cognitive task in two syntopic species.

Urbanization occurs at a global scale, imposing dramatic and abrupt environmental changes that lead to biodiversity loss. Yet, some animal species can handle these changes, and thrive in such artificial environments. One possible explanation is that urban individuals are equipped with better cognitive abilities, but most studies have focused on birds and mammals and yielded varied results. Reptiles have received much less attention, despite some lizard species being common city dwellers. The Italian wall lizard, Podarcis siculus, and the common wall lizard, Podarcis muralis, are two successful lizards in anthropogenic habitats that thrive in urban locations. To test for differences in a cognitive skill between urban and semi-natural environments, we investigated inhibitory control through a detour task in syntopic populations of the two species, across 249 lizards that were tested in partially artificial field settings. Sophisticated inhibitory control is considered essential for higher degrees of cognitive flexibility and other higher-level cognitive abilities. In this task, we confronted lizards with a transparent barrier, separating them from a desired shelter area that they could only reach by controlling their impulse to go straight and instead detour the barrier. We found no differences between lizards in urban and semi-natural environments, nor between species, but females overall performed better than males. Moreover, 48% of the lizards in our study did not perform a correct trial in any of the 5 trials, hinting at the difficulty of the task for these species. This study is among the first to address lizard cognition, through their inhibitory control, as a potential explanation for success in cities and highlights one should be careful with assuming that urban animals generally have enhanced cognitive performance, as it might be taxa, task, or condition dependent.

Vacuum bell therapy for pectus excavatum: a retrospective study

BackgroundPectus excavatum, the most common chest wall deformity, is frequently treated with Nuss procedure. Here we will describe non-invasive procedure and analyze the variables associated vacuum bell therapy for patients with pectus excavatum.MethodsRetrospective case–control study in a single center between July 2018 and February 2022, including patients with pectus excavatum treated with vacuum bell. Follow-up was continued to September 2022. The Haller index and Correction index was calculated before and after treatment to analysis the effectiveness of vacuum bell therapy.ResultsThere were 98 patients enrolled in the treatment group, with 72 available for analysis, and the follow-up period ranged from 1.1 to 4.4 years (mean 3.3 years). When analyzing with the Haller Index, 18 patients (25.0%) showed excellent correction, 13 patients (18.1%) achieved good correction, and 4 patients (5.6%) had fair correction. The remaining patients had a poor outcome. Characteristics predicting a non-poor prognosis included initial age ≤ 11 years (OR = 3.94, p = 0.013) and patients with use over 24 consecutive months (OR = 3.95, p = 0.013). A total of 9 patients (12.5%) achieved a CI reduction below 10. Patients who started vacuum bell therapy at age > 11 had significantly less change compared to those who started at age ≤ 11 (P < 0.05). Complications included chest pain (5.6%), swollen skin (6.9%), chest tightness (1.4%) and erythema (15.3%).ConclusionsA certain percentage of patients with pectus excavatum can achieve excellent correction when treated with pectus excavatum therapy. Variables predicting better outcome including initial age ≤ 11 years both in HI and CI and vacuum bell use over 24 consecutive months in HI. In summary, pectus excavatum is an emerging non-invasive therapy for pectus excavatum and will be widely performed in a certain group of patients.

Evaluation of common carotid artery wall stiffness by shear wave elastography in smokers and non-smokers.

Smoking is one of the most important preventable causes of cardiovascular diseases. Vascular disease caused by smoking is associated with vascular endothelial damage, platelet aggregation, and adhesion. In our study, we examined the effect of chronic smoking on vessel wall stiffness in smokers and control group by measuring carotid artery wall stiffness by shear wave ultrasonography. Sixty-two smokers of similar ages and genders, and 67 people who never smoked in the last ten years were included as the control group in this cross-sectional study. Arterial wall stiffness over the common carotid arteries of all participants was measured by shear wave elastography (SWE). In addition, each patient's blood pressure, fasting blood glucose, body mass index (BMI), HDL and LDL cholesterol measurements were recorded. Arterial wall stiffness values in smokers were found to be statistically significantly higher than in non-smokers. The mean of SWE measurements of the smokers was 47.3 ± 6.2 kPa, and that of the control group was 42.9 ± 4 kPa. The mean values of HDL and LDL of the smokers were 46.9 ± 5.6 mg/dL and 147.3 ± 9.3 mg/dL, respectively, and those of the control group were 50.3 ± 5.1 mg/dL and 136.9 ± 5.9 mg/dL. The LDL cholesterol values were statistically significantly higher in smokers compared to the control group, and HDL cholesterol values were statistically significantly lower in smokers. In our study, the arterial wall stiffness values measured by the SWE technique were higher in smokers than non-smokers.

Gastroschisis and omphalocele: Incidence and outcome

Gastroschisis and omphalocele are the most common congenital abdominal wall defects. The main purpose of this study was to investigate the incidence, other associated anomalies and the course of these diseases in Iceland. The study was retrospective. The population was all newborns who were admitted to the NICU of Children's Hospital Iceland due to gastroschisis or omphalocele in 1991-2020. Furthermore, all fetuses diagnosed prenatally or post mortem where the pregnancy ended in spontaneous or induced abortion, were included. During the study period, 54 infants were born with gastroschisis and five with omphalocele. The incidence of gastroschisis was 4.11 and omphalocele 0,38/10,000 births. There was no significant change in the incidence of the diseases during the study period. In addition, five fetuses were diagnosed with gastroschisis and 31 with omphalocele where the pregnancy was terminated. In addition to gastroschisis in the live born infants and fetuses the most common associated anomalies were in the gastrointestinal or urinary tract but in infants and fetuses with omphalocele anomalies of the cardiac, central nervous or skeletal systems were the most common. Sixteen fetuses diagnosed with omphalocele had trisomy 18. Mothers aged 16-20 were more likely to give birth to an infant with gastroschisis than older mothers (p< 0.001). Primary closure was successful in 86% of the infants. Those reached full feedings significantly earlier and were discharged earlier. Overall survival rate was 95%. Three children were still receiving parenteral nutrition at discharge due to short bowel syndrome. The incidence of gastroschisis in Iceland is in accordance with studies in other countries but but the incidence of omphalocele is lower, which can be partly explained by spontaneous or induced abortions. Other anomalies associated with omphalocele are more severe than those associated with gastroschisis. Primary closure was associated with more benign course. Children with gastroschisis may need prolonged parenteral nutrition due to shortening of their intestines.

Introducing the sound transmission loss suite at the British Columbia Institute of Technology

A sound transmission loss suite is a facility for measuring the airborne sound insulation by building elements such as wall assemblies and partitions. It consists of two neighboring reverberation chambers (called the source and receiving rooms), where the only significant sound transmission path is presented by the test specimen, enclosed in the common wall separating the two chambers. In this talk, an overview of the sound transmission loss suite that was newly built and commissioned at the British Columbia Institute of Technology in late 2023 is given. The suite is comprised of two reverberation chambers with interior volumes of 200 m3 (source room) and 125 m3 (receiving room) and can test for frequencies from 63 to 20000 Hz, making it one of a kind in Western Canada. The talk touches upon the acoustical characteristics of the suite and the relevant test method for measuring transmission loss according to the ASTM E90 standard. [Work supported by Canada Foundation for Innovation—Project No. 36346.]

Heart Rate Variability as a Prognostic Tool for Gastroschisis Infants in the Neonatal Intensive Critical Unit.

Gastroschisis is the most common congenital abdominal wall defect, with an increasing incidence. It results in extrusion of abdominal contents with associated delayed intestinal motility. Abnormal heart rate characteristics (HRCs) such as decreased variability occur due to the inflammatory response to sepsis in preterm infants. This study aimed to test the hypothesis that infants with gastroschisis have decreased heart rate variability (HRV) after birth and that this physiomarker may predict outcomes. We analyzed heart rate data from and clinical variables for all infants admitted with gastroschisis from 2009 to 2020. Forty-seven infants were admitted during the study period and had available data. Complex gastroschisis infants had reduced HRV after birth. For those with sepsis and necrotizing enterocolitis, abnormal HRCs occurred early in the course of illness. Decreased HRV was associated with complex gastroschisis. Infants in this group experienced complications that prolonged time to full enteral feeding and time on total parenteral nutrition. · Infants with gastroschisis can be classified into two subcategories, simple and complex disease.. · Those with complex disease often require prolonged stays in the neonatal intensive care unit and costly hospitalizations. We hypothesized that infants with complex gastroschisis are more likely to have abnormal HRC due to intestinal inflammation.. · In this study, we identified associations between abnormal HRV, heart rate characteristicHRC, and the development of gastroschisis complications. Additionally, we described differences in clinical characteristics between infants with complex versus simple gastroschisis..

Evaluation of the results of the modified Blumgartpancreatic-intestinal anastomosis technique according to Satoi in pancreaticoduodenectomy at Bach Mai Hospital

Objectives: This study aims to research on the safety and effectiveness of the modified Blumgart pancreaticojejunostomy anastomosis by Satoi in Bach Mai Hospital. Research subjects: Seventy-three patients underwent modified Blumgart pancreaticojejunostomy anastomosis by Satoi after pancreaticoduodenectomy at Gastrointestinal and Hepato-Biliary-Pancreatic Surgery Department, Bach Mai Hospital between October 2020 and April 2023. Method: Cross-sectional study combining retrospective and prospective studies. The Blumgart anastomosis was modified to simplify with 2 U-shaped sutures. Results: The average age of the study subjects was 58.49±12.69 years; the age group over 60 accounted for over 50%; male/female ratio was ~1. The number of patients with complications was 22/73; the total number of complications was 33, including 3 grade-III-or-above complications, according to Clavien-Dindo: 1 case had complications of grade C pancreatic fistula causing late hemorrhage, from the common hepatic artery wall, needs re-surgery, 1 case needs hemostasis under intervention radiology, 1 case needs to be drained under ultrasound guidance, and no patient deaths. Conclusion: The modified Blumgart pancreaticojejunostomy by Satoi is a safe and effective technique.

Common femoral vein wall thickness measurement by Doppler ultrasonography is an accurate diagnostic test for Behçet's Disease both in supine and standing positions.

We recently reported the first controlled Doppler ultrasonography (US) study demonstrating increased common femoral vein (CFV) thickness in Behçet's Disease (BD). Standard lower extremity venous Doppler US is performed in erect position. In order to confirm accuracy and applicability of method, we measured CFV thickness in both supine and standing positions in this study. We included sex and age-matched 42 BD patients and 41 healthy controls (HCs). After routine visits, bilateral CFV thickness was measured with Doppler US both in supine and standing positions. Bilateral CFV thickness was significantly higher in BD than in HC. There were no statistically significant differences in measurements of CFV wall thickness between standing and supine positions in both groups. CFV measurement by Doppler US is a new and non-invasive diagnostic tool for the diagnosis of BD. Our study confirmed that patient position does not affect CFV wall thickness measurement for diagnosis of BD.

Increased inferior vena cava wall thickness as a sign of extensive venous inflammation in Behçet's Disease.

Behçet's disease (BD) affects both arterial and venous vessels. We have previously shown that common femoral vein wall thickness (WT) is increased in BD and can be used as a diagnostic test. However, there is limited data assessing large veins. Therefore, this study seeks to assess inferior vena cava wall thickness (IVC) by transthoracic echocardiography (TTE) in BD compared to healthy controls (HC). Age- and gender-matched 70 BD patients and 51 HC were included. IVC wall thickness and common femoral vein WT were measured by TTE and Doppler ultrasonography, respectively. All examinations were performed on the same day as the clinical assessment. The mean IVC wall thickness of BD patients was significantly higher than HC (2.9mm (0.3) vs 2.6mm (0.3), p < 0.001). Patients with mucocutaneous involvement (2.8mm (0.3)) and major organ involvement (2.9mm (0.3)) had significantly thicker walls compared to HC (p = 0.003, p < 0.001, respectively). IVC wall thickness was higher in patients with vascular involvement compared to those with nonvascular major organ involvement (3.1mm (0.3) vs 2.8mm (0.2), p = 0.04). There was a moderate correlation between IVC and common femoral vein WT (r = 0.49 for the right, r = 0.43 for the left, p = 0.01 for both). This study shows that venous wall inflammation is not limited to lower extremity veins and is also present in IVC walls of BD patients regardless of IVC involvement. Vascular wall inflammation is probably a widespread vascular event of all venous walls in BD. Key Points • Venous wall inflammation is not limited to lower extremity veins and is present also in IVC wall in Behçet's disease. • Extensive venous wall inflammation in Behçet's disease includes large venous structures despite not being clinically involved.

Pectus Excavatum: A review of current treatment possibilities

Anterior chest wall depression known as Pectus excavatum (PE) , is currently the most common congenital chest wall deformation, with incidence estimated at 1/400 births, five times more frequently in boys than girls (5:1 ratio in occurrence). 1 Etiology of this deformity is formed by several hypothesis, including overgrowth of the ribs, developmental failure of the bony thorax or weakness and abnormal flexibility of the sternum. While theoretical concepts of its origin may differ, the common ground is the characteristics of said deformation: a posterior depression of the sternum and the lower costal cartilages. 2Surgical treatment options were described since 1949 with Ravitch procedure and since then a number of new ones has been developed.&#x0D; For many years Ravitch and Nuss procedures were the main way to treat pectus excavatum, with a growing bias towards latter one. Since the Nuss procedure characterizes with less invasive approach and fever overall complications 3 its popularity outgrew Ravitch procedure and currently is described as MIRPE – Minimally Invasive Pectus Excavatum Repair. 4 However afterward then many new techniques were developed, focusing on reducing overall procedure risks, improving patient safety and quality of life and including new technical possibilities.&#x0D; The aim of this study was to gather and evaluate current literature to highlight new treatment options.

Large outbreak of typhoid fever on a river cruise ship used as accommodation for asylum seekers, the Netherlands, 2022.

On 6 April 2022, the Public Health Service of Kennemerland, the Netherlands, was notified about an outbreak of fever and abdominal complaints on a retired river cruise ship, used as shelter for asylum seekers. The diagnosis typhoid fever was confirmed on 7 April. An extensive outbreak investigation was performed. Within 47 days, 72 typhoid fever cases were identified among asylum seekers (n = 52) and staff (n = 20), of which 25 were hospitalised. All recovered after treatment. Consumption of food and tap water on the ship was associated with developing typhoid fever. The freshwater and wastewater tanks shared a common wall with severe corrosion and perforations, enabling wastewater to leak into the freshwater tank at high filling levels. Salmonella Typhi was cultured from the wastewater tank, matching the patient isolates. In the freshwater tank, Salmonella species DNA was detected by PCR, suggesting the presence of the bacterium and supporting the conclusion of contaminated freshwater as the probable source of the outbreak. Outbreaks of uncommon infections may occur if persons from endemic countries are accommodated in crowded conditions. Especially when accommodating migrants on ships, strict supervision on water quality and technical installations are indispensable to guarantee the health and safety of the residents.

Location of the phase-change material layer on thermal performance of light-weight walls

Abstract Light-weight materials are commonly used in high-rise buildings to reduce the building weight, but their thermal inertia will increase the fluctuation of air-conditioning and heating load and reduce indoor thermal comfort. Phase-change material (PCM) is employed to improve the thermal behavior by latent thermal storage, but its location has the obvious impact on the thermal behavior improvement of the light-weight wall. According to this condition, by taking the common multi-layer wall as a reference, three walls were built with different locations of the PCM layer, including locating the PCM layer in inner side, locating the PCM layer in outer side and distributing PCM uniformly into foamed concrete. The dynamic heat transfer model with the phase change was built and verified by an experiment. Numerical results showed locating the PCM layer in inner side is the best in three locations and followed by distributing PCM uniformly into foamed concrete, while locating the PCM layer in outer side is the worst in spite of the high liquid fraction variation. Locating the PCM layer in the inner side can lower the attenuation factor by 101.25% and 33.87%, increase the delay time by 40.00% and 17.14%, reduced by the peak heat flow by 47.69% and 17.28%, compared to locating the PCM layer in the outer side and distributing PCM into foamed concrete uniformly.

16S rRNA Gene Sequencing-Based Identification and Comparative Analysis of the Fecal Microbiota of Five Syntopic Lizard Species from a Low-Mountain Area in Western Bulgaria

Studies on the gut microbiome of free-living reptiles in Europe are generally fragmentary and still missing in Bulgaria. We aimed to identify and compare the fecal microbiota profiles of five syntopic lizard species from three families: the European green lizard (Lacerta viridis), the common wall lizard (Podarcis muralis), the meadow lizard (Darevskia praticola) (Lacertidae), the European snake-eyed skink (Ablepharus kitaibelii) (Scincidae), and the European slow worm (Anguis fragilis) (Anguidae), which coinhabit a low mountainous area in the western part of the country. A high-throughput sequencing of the hypervariable V3-V4 region of the 16S rRNA gene, performed on the Illumina HiSeq2500 platform, was used. The core microbiota of lizard hosts seems to be species-specific. A dynamic phyla proportion between hosts was found. The richest alpha diversity was observed in D. praticola, and the lowest alpha diversity was observed in P. muralis and A. fragilis. Within the three lacertids, the microbiota of D. praticola and L. viridis were more closely related to each other than they were to those of P. muralis. Sharing a largely common trophic resource (all species except A. fragilis are mainly insectivorous) was not an indication of similarity in their gut microbial communities.

Duramesh registry study: short-term outcomes using mesh suture for abdominal wall closure.

Sutures are flexible linear elements that join tissue and maintain their hold with a surgeon-created knot. Tension at the suture/tissue interface can cut the very tissues that sutures are designed to hold, leading to dehiscence and incisional hernia formation. A new suture design (Duramesh, Mesh Suture Inc., Chicago, IL) was approved for marketing by the United States Food and Drug Administration in September 2022. The multiple filaments of the mesh suture are designed to diffuse tension at the suture/tissue interface thereby limiting pull-through. The macroporosity and hollow core of the mesh suture encourage fibrovascular incorporation for a durable repair. We created the first registry and clinical report of patients undergoing mesh suture implantation to assess its real-world effectiveness. A patient registry was created based on institutional implant logs from January to August 2023 at an integrated health-care system. Operative reports were reviewed by the study team to verify use of "Duramesh" by dictation. Retrospective chart review was conducted to evaluate patient and surgical characteristics, follow-up, and short-term outcomes of interest. Results were analyzed using descriptive statistics and Chi-squared analysis with Microsoft Excel and GraphPad Prism. Three hundred seventy-nine separate implantations by 56 surgeons across 12 (sub) specialties at a university hospital and two community hospitals were performed. Mesh suture was used for treatment of the abdominal wall in 314 cases. Follow-up averaged 80.8 ± 52.4 days. The most common abdominal wall indications were ventral hernia repair (N = 97), fascial closure (N = 93), abdominal donor site closure from autologous breast reconstruction (N = 51), and umbilical hernia repair (N = 41). Mesh suture was used in all Centers for Disease Control (CDC) wound classifications, including 92 CDC class 2 or 3 abdominal operations. There were 19 surgical site infections (6.1%) and 37 surgical site events (11.8%). Short-term registry data demonstrates the wide diversity of surgical disciplines and scenarios in which mesh suture has been used to date. The early adoption of mesh suture into practice highlights that consequences of suture pull-through influence operative decision making. As this is the first interim report of the Duramesh mesh suture registry, follow-up is too short for characterization of long-term durability of abdominal wall closures.

Umblikal Hernili Hastaların Değerlendirilmesi: 6 Yıllık Deneyim

Objective: Umbilical hernia is a common anterior abdominal wall defect in childhood. Although the defect is present at birth, unlike other hernias of childhood, it may close spontaneously over time without the need for surgery. However, when these hernias do not close spontaneously, complications can develop that require emergency surgery. The aim of this study was to determine the incidence of spontaneous closure in patients diagnosed with umbilical hernia and the factors that influence this incidence, the complications that may develop during follow-up, the indications for surgery and the issues to consider when planning the follow-up of patients. Material and Methods: Between January 2006 and December 2011, 1928 patients diagnosed with umbilical hernia and followed up and treated in our clinic were included in the study. In this retrospective cohort study the current size of umbilical hernia, comorbidities and demographic characteristics of the patients were analysed. Operative data, complications and postoperative follow-up of the operated patients were evaluated. Results: The spontaneous closure rate of umbilical hernia was found to be 60%. The rate of spontaneous closure of umbilical hernia was higher in boys and the rate of operation was higher in girls. The risk of incarceration was higher in girls than in boys. The rate of spontaneous closure decreased with increasing defect size. It was found that comorbidities did not affect spontaneous closure of umbilical hernias. The rate of emergency surgery for incarceration was low (2%). Strangulation was noted in 1% of patients. All patients with incarceration were in Lassaletta group 2 (defect diameter 0.5-1.5 cm). Conclusion: Conservative management is still the most accepted and safest method in the treatment of umbilical hernia. Incarceration and strangulation are very rare in umbilical hernias. Even if the umbilical hernia is complicated, surgical treatment is possible and peri- and post-operative complication rates are very low. Long-term morbidity and mortality due to incarceration have not been reported in the literature.