Sac Contents Research Articles

Sonographic imaging of Spigelian hernias.

The aim of the workwas to present clinical material referring to rarely occurring abdominal cavity hernias in semilunar line – Spigelian hernias diagnosed with the help of ultrasound.Material and methodsIn the period from 1995 to 2001 785 anterior abdominal wall hernias were diagnosed including 11 Spigelian hernias (1.4%) diagnosed in 10 patients (7 women and 3 men) aged from 38 to 65 years old (average age 48). Eight patients complained of spastic pain in abdomen, in 5 of them it was accompanied by bloating and sometimes loud peristalsis. All the patients had been observing the mentioned symptoms from 2 to 5 years. Each of them had had colonoscopy and abdominal cavity ultrasound examination performed, some of them even three times. In 3 women with uterine fibroid the uterus was removed which did not eliminate the symptoms.The ultrasound examination of the abdominal integument was performed mainly with the use of linear transducers of the frequency of 7–12 MHz; in obese patients also convex transducers were used (3,5–6 MHz). Each examination of abdominal integument included the assessment of the following areas: linea alba from xiphoid process to pubic symphysis including umbilicus, both semilunar lines from costal margins to pubic bones, and also inguinal areas. Moreover, all types of postoperative scars were examined. Each hernia was assessed in terms of size (the greatest dimension), hernia sac contents, width of the ring and reducibility under the compression of the transducer. Moreover, cough test and Valsalva's maneuver were performed. Generally, the examination was performed in a standing position.ResultsIn 9 patients hernias were localized unilaterally, in one patient bilaterally. In 7 cases the hernia sac contained small bowel, in 2 cases the preperitoneal and omental fat, and in 2 cases preperitoneal fat only. Eight patients presenting with clinical symptoms underwent operative repair.ConclusionUltrasound examination is beneficial in confirming the diagnosis of Spigelian hernias especially in terms of proper, therapeutic decision-making.

Hernioscopy is a good option in strangulated inguinal hernias that retract under general anesthesia

We read with great interest the article entitled ‘‘Prognostic factors of postoperative morbidity and mortality in strangulated groin hernia’’ by Romain et al. [1]. The study aimed to find significant prognostic factors of postoperative morbidity and mortality, and the authors concluded that first intention exploratory midline laparotomy was a significant prognostic factor of postoperative mortality. In the minority of the patients with strangulated hernia, the contents of hernia sac can reduce spontaneously following the administration of muscle relaxants during induction of anesthesia, and an additional exploration will be necessary to inspect intra-abdominal contents. In their series, the authors had to perform an additional exploration in 12 patients, either with a midline laparotomy (3 patients with groin hernia, and 5 patients with femoral hernia) or with laparoscopy (1 groin hernia) or hernioscopy (3 groin hernia). While there were postoperative morbidity and mortality in 6 of 8 patients in laparotomy group, postoperative recovery after laparoscopy and hernioscopy was uneventful. Although choice of laparotomy might depends on a great suspicion of intestinal necrosis and effects the results, we think that hernioscopy rather than a laparoscopy is a good technique to start the evaluation of intraabdominal contents. Hernioscopy is an alternative technique for laparoscopy, where the trocar was placed through the dissected hernia sac [2]. Hernioscopy allows a full exploration of peritoneal cavity without the need for laparotomy. In the presence of a suspicious view of an intestinal segment or necrosis, hernioscopy can also be used for retrieval of effected bowel by insertion of a second trocar [3]. In case of an inadequate evaluation, the technique can be switched to a laparoscopy. Thus, the possible complications of laparotomy, such as postoperative ileus, evisceration, increased length of hospitalization, and increased cost, can be prevented. Our clinical experience and the literature information support that hernioscopy is a safe and simple technique and very useful in the evaluation of retracted intestinal segments. To avoid from an unnecessary laparotomy, hernioscopy can be used as an initial diagnostic technique.

The effect of the contents of exomphalos and nuchal translucency at 11–14 weeks on the likelihood of associated chromosomal abnormality

Previous publications suggest that exomphalos containing the liver as less likely to be associated with aneuploidy. The objective of the study was to explore the influence of exomphalos contents and nuchal translucency (NT) on the likelihood of aneuploidy. A retrospective search was conducted to identify all cases of exomphalos from the databases of two fetal medicine units seen from September 2000 to March 2011. A total of 95 fetuses with exomphalos were selected. NT was normal in 42 fetuses (44.2%). The exomphalos content was bowel alone in 68 (71.6%). The effect of exomphalos content and NT on likelihood of aneuploidy was explored using logistic regression. It showed no significant contribution of exomphalos content on the likelihood of aneuploidy (adjusted odds ratio: 1.44, 95% CI: 0.538 to 3.84). When the diagnosis is made in the first trimester, the risk of aneuploidy is no different when the sac contains only bowel as compared with when it contains the liver. Increase in the NT is 4-5 times as likely with an abnormal karyotype as with normal NT. Detection of exomphalos in the first trimester warrants an offer of chromosomal assessment regardless of sac contents or NT.

Can Lacrimal Sac Washout Predict Outcomes of Endoscopic DCR?

Objective: High success rates for endoscopic dacryocystorhinostomy (END-DCR) in partial nasolacrimal duct obstruction (NLDO) have been reported, but comparisons with complete NLDO are lacking. This study compares the success of primary END-DCR with respect to the preoperative nasolacrimal duct patency and reviews factors associated with failure. Method: Retrospective review of END-DCRs performed at a tertiary referral center. Partial and complete NLDO were defined by the presence or absence of flow into the nose with lacrimal sac washout (SWO), respectively. Intraoperative findings including thickness of bone, level and state of the common canaliculus, state of inflammation, and contents of the lacrimal sac during END-DCR were recorded. For patients with at least 3 months follow-up, the outcome of resolution of epiphora (none/partial/complete), postop Jones 1 (J1; positive/ negative) and endoscopy of the neo-ostium (closed/partially or fully-open) were defined. Results: A total of 245 primary END-DCRs were reviewed (mean age, 63.6 ± 5.3 years, 70% women). Based on SWO, the groups were defined as 39.6% and 60.4% complete NLDO. Overall improvement in epiphora was 95.5%. In cases where symptoms improved, absence of flow into nose on SWO was associated with a higher rate of complete resolution (93.6% vs 84.9%, RR 1.102 [1.001, 1.213]). The ostia were fully open in 93.9% and postop J1 was positive in 97.1% of patients and were not different between groups. Conclusion: END-DCR is highly successful for both types of NLDO. Preoperative absence of flow into nose on SWO was associated with slightly higher chance of complete resolution.

Cervical vertebral fracture in a patient with juvenile idiopathic arthritis and osteopoikilosis

Cervical vertebral fracture in a patient with juvenile idiopathic arthritis and osteopoikilosis

Transfer of Chicken Immunoglobulin Y (IgY) from the Hen to the Chick

Chicks depend on maternal antibodies as the main source of passive natural humoral protection until they become immunocompetent. Immunoglobulin Y (IgY), the avian homologue of mammalian IgG is transferred from the circulation of the hen into the egg yolk and then absorbed by the embryo. In the post-hatching period, protein integrity within the yolk sac is critical for normal absorption of the yolk sac content and for IgY transfer to the circulation of the chick. Factors affecting transfer of IgY to the chick may threaten the chick's immune status and increase disease susceptibility during the early post-hatching period. Here we review basic concepts of IgY with special emphasis on the mechanisms of IgY transfer to egg yolk and yolk sac during embryonic development and first days post-hatching.

Lack of thrombus organization in nonshrinking aneurysms years after endovascular abdominal aortic aneurysm repair

During endovascular abdominal aortic aneurysm repair (EVAR), blood is trapped in the aneurysm sac at the moment the endograft is deployed. It is generally assumed that this blood will coagulate and evolve into an organized thrombus. It is unknown whether this process always occurs, what its time span is, and how it influences aneurysm shrinkage. With magnetic resonance imaging (MRI), quantitative analysis of the aneurysm sac is possible in terms of endoleak volume as well as unorganized thrombus volume and organized thrombus volume. We investigated the presence of unorganized thrombus in nonshrinking aneurysms years after EVAR. Fourteen patients with a nonshrinking aneurysm without endoleak on computed tomography/computed tomography angiography underwent MRI with a blood pool agent (gadofosveset trisodium). Precontrast T1-, precontrast T2-, and postcontrast T1-weighted images (3 and 30 minutes after injection) were acquired and evaluated for the presence of endoleak. The aneurysm sac was segmented into endoleak, unorganized thrombus, and organized thrombus by interactively thresholding the differently weighted images. The classification was visualized in real-time as a color overlay on the MR images. The volumes of endoleak, unorganized thrombus, and organized thrombus were calculated. Median time after EVAR was 2 years (range, 1-8.2 years). The average aneurysm sac volume of the patients was 167 ± 107 mL (mean ± standard deviation). Nine patients had an endoleak on the postcontrast T1-w images 30 minutes after injection. On average, the aneurysm sac contained 78 ± 61 mL unorganized thrombus, which corresponded to 51 ± 21 volume-percentage, irrespective of the presence of an endoleak on the blood pool agent enhanced MRI images (independent t-test, P = .8). In our study group, half of the nonshrinking aneurysm sac contents consisted of unorganized thrombus years after EVAR.

The effects of notoginsenoside R1 on the intestinal absorption of geniposide by the everted rat gut sac model

Ethnopharmacological relevanceGeniposide is derived from Gardenia jasminoides Ellis (Rubiaceae). Its anti-inflammatory, antithrombotic effects as well as its preventive effect against ischemic stroke have been reported. Radix notoginseng (Chinese name tienchi or sanqi) is the dried root of Panax notoginseng (Burk.) F.H. Chen, an herb noted for its promotion of blood circulation, blood stasis removal and pain alleviation, and has been widely utilized for the prevention and treatment of microcirculatory disturbances in China and other Asian countries for many years. Notoginsenoside R1 is an effective and structurally representative bioactive constituent of R. notoginseng. In our preliminary study, notoginsenoside R1 was able significantly to improve the bioavailability of geniposide in beagle dogs, but the underlying mechanisms remain unknown. Materials and MethodsThe present study aimed to investigate the intestinal kinetic absorptive characteristics of geniposide as well as the absorptive behavior influenced by the co-administration of notoginsenoside R1 using an in vitro everted rat gut sac model. ResultsThe results showed good linear correlation between the geniposide absorption in sac contents and the incubation time from 0 to 120min. The concentration dependence showed a non-linear correlation between the geniposide absorption and the concentrations 0.356–1.424mg/mL, the absorption was saturated about 1.424mg/mL. Notoginsenoside R1 at 0.1 and 0.2mg/mL concentrations was able significantly to enhance the absorption of geniposide (1.424mg/mL) by 1.7- and 1.4-fold. Moreover, verapamil, a well-known P-glycoprotein inhibitor, was able significantly to elevate the absorption of geniposide 2.4-fold. Notoginsenoside R1 influenced geniposide's absorption in a way similar to that of a P-glycoprotein inhibitor. ConclusionsIn conclusion, notoginsenoside R1 significantly enhances the intestinal absorption of geniposide. As for the mechanism underlying the improvement of geniposide's bioavailability, it is proposed that notoginsenoside R1 was able to decrease the efflux transport of geniposide by P-glycoproteins.

Richter’s Hernia in Paraumbilical Region with Caecum and Ascending Colon as Content of Sac: a Case Report

A 12 year old boy presented with history of irreducible swelling in the Para umbilical region, no history of vomiting and abdominal distension. On examination non tender swelling in the Para umbilical region, cough impulse present and soft in consistency. The swelling is not reducible and there was no change in skin around the swelling. Patient underwent exploration of the hernia which revealed Richter’s hernia with normal caecum and ascending colon as content with bands around the mesentery.

Erythrocyte as a biological sensor

The erythrocytes ability of sensing the local oxygen gradient through the hemoglobin conformation, along with changes in nitric oxide mobilization and vasomotor repercussions at the microcirculation, were reviewed in detail in this article. Different approachs trying to explain the erythrocyte death were additionally documented. Also, the influence of several types of molecules (vasoactive, oxidant/reductor) on the erythrocyte roles as sensor of (i) oxygen tissue needs, (ii) blood viscosity and myogenic environment, (iii) and inflammatory conditions were mentioned in order to highlight its physiologycal function and substitute the erroneous idea of the erythrocyte being simply a hemoglobin sac content.

A Uterine Fibroid Presenting as an Incarcerated Umbilical Hernia During Pregnancy

Abstract Background: The incidence of uterine fibroid entrapped in umbilical hernias during pregnancy is very low. Only 3 case reports of this kind have been published to date. Case: This article discusses the case of a 38-year-old woman in the 33rd week of gestation, who presented with an incarcerated umbilical hernia, and underwent emergency surgical repair. A pedicled uterine fibroid was found in the hernia sac, which was mobilized and resected. The hernia defect was repaired by the Mayo technique. Results: No complications were observed during the postoperative period and she subsequently delivered a full-term baby boy. Conclusions: The possibility of a fibroid entrapped in a hernia sac should be taken into consideration in the evaluation of incarcerated hernias during pregnancy. If the contents of the hernia sac cannot be reduced safely into the abdominal cavity by manual reduction, emergency surgical repair should be considered as a means to prevent further pregnancy-related complications. (J GYNECO...

Femoral hernia containing incarcerated fallopian tube

We read with interest the article entitled ‘‘Presence of a uterine horn and fallopian tube within an indirect sac: report of a rare case’’ by Kokcu et al. [1]. The article describes the clinical case of a woman with sterility as the only relevant symptom in her clinical history, who presented an indirect hernia that contained a fallopian tube and a uterine horn. The author states that sliding hernias of the tube, ovaries, and uterus occur occasionally in newborn female infants, but are rare in young women [1, 2]. Considering the rarity of this event, we present a new case similar to that published by Kokcu and colleagues. A 47-year-old female patient, mother of three children, carrier of an intrauterine device (IUD) and with no relevant medical history, attended the Emergency Service referring to pain and swelling in her right inguinal region. She presented a mass of 3–4 cm in her right femoral region that could not be reduced. The left inguinal region was normal. Further physical exploration and laboratory tests were unremarkable. In accordance with clinical findings that suggested the presence of an incarcerated femoral hernia, emergency surgery was performed. During the surgical procedure, the presence of the hernia was confirmed, and the right fallopian tube was found inside the hernia sac (Fig. 1), with no signs of ischemia (Fig. 2). The sac contents were introduced into the abdomen and the hernia defect was repaired with Lichtenstein’s technique using a polypropylene mesh plug. In our case, the use of open surgery in the femoral region did not lead to the identification of any anatomical abnormality. As in the case reported by Kokcu et al. [1], our patient was a female in her reproductive years, a mother of three healthy children and with no known problems during conception. Around 70% of hernias containing a fallopian tube or an ovary appear in female children under the age of 5 years, and they are secondary to congenital abnormalities of the inguinal or femoral region [3]. Intrauterine exposure to diethylbestrol, a synthetic non-steroidal estrogen used mainly for postcoital contraception, has been related to anatomical malformations of the uterus [4]. The aetiology of these hernias in adult women is not clear; congenital abnormalities of the reproductive organs or previous history of hormone-induced pregnancy have been described as

“Laparoscopic Excision of a Large Ovarian Cyst Herniating Into the Inguinal Canal

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.

Use of Multispectral MRI to Monitor Aneurysm Sac Contents After Endovascular Abdominal Aortic Aneurysm Repair

To validate a newly developed semi-automatic multispectral magnetic resonance imaging (MRI) tool for quantitatively monitoring aneurysm sac contents in patients after endovascular aneurysm repair (EVAR). MRI studies from 24 EVAR patients were retrospectively analyzed. The precontrast T₁-weighted and T₂-weighted and the postcontrast T₁-weighted images were displayed simultaneously. Two independent observers classified the aneurysm sac voxels into categories for endoleak, unorganized thrombus, or organized thrombus by interactively thresholding the multispectral images relative to the signal intensity of fat. Voxel classification was visualized as a color overlay on the MR images; when the observer changed the thresholds, the color overlay was updated immediately. The volumes of the voxels in each category were calculated and expressed in milliliters. The intra- and interobserver variability for measuring the volumes of endoleak and unorganized and organized thrombus were calculated; a Bland and Altman analysis was applied to determine the mean differences and the repeatability coefficient (RC). Mean aneurysm sac volume was 78 ± 42 mL. The intraobserver mean difference for the endoleak volume was 0.5 ± 1.9 mL with an RC of 3.7 mL; the interobserver mean difference was -0.8 ± 3.6 mL (RC 7.1 mL). The intraobserver mean difference for unorganized thrombus volume was -1.2 ± 4.4 mL (RC 8.6 mL); the interobserver mean difference was 0.3 ± 6.3 mL with an RC of 12.3 mL. The intraobserver mean difference for organized thrombus volume was 0.8 ± 5.0 mL (RC 9.7 mL); the interobserver mean difference was 0.4 ± 6.3 mL (RC 12.4 mL). Reproducible monitoring of aneurysm sac contents in EVAR patients is feasible with multispectral MRI in combination with our semi-automatic post-processing tool.

Repair of large abdominal incisional hernia by reconstructing the midline and use of an onlay of biological material

Background The aim of this study was to determine the feasibility and efficacy of repairing large abdominal incisional hernias by reconstructing the midline using bilateral abdominis rectus muscle sheath (ARS) relaxing incisions and a biological material onlay. Methods Between January 2002 and December 2008, 71 patients underwent repair of large incisional hernias at 2 community hospitals. After replacement of hernia sac contents into the peritoneal cavity, a relaxing incision was made in the ARS bilaterally. Then, the midline was closed primarily. The biological material was used as an onlay and sutured to the lateral edges of the relaxed ARS. Main outcome measures were postoperative complications and hernia recurrence. Results Median defect size was 195 cm 2 (range, 150–420 cm 2), median surgical time was 125 minutes, and median hospital stay was 6 days. There were no deaths and no wound infections. Wound seroma, the most frequent postoperative complication, occurred in 51 (72%) of the 71 patients. There was 1 (1.4%) recurrence. Conclusions In these 71 patients, our technique for repair of large abdominal incisional hernias was safe and effective.

Femoral hernia containing strangulated ileum along with the uterus and both ovaries: a first case report

Strangulated femoral hernia is a common surgical emergency. The contents of the hernial sac commonly include omentum and small bowel, but, occasionally, strangulation of other organs such as Meckel's diverticulum, stomach, ovary, or appendix may occur, resulting in unusual clinical presentations. We report of a case with strangulated femoral hernia containing the uterus and both ovaries, and this is the first report of such a case. We believe that it is important to take into consideration herniation of the uterus and ovaries with omentum or small bowel into the femoral canal to prevent various complications related to the reproductive functions of the patient.

Unusual Contents of Inguinal Hernia Sac. An Approach to Management

Background-Unusual contents of hernia sac are uncommon, but are likely to be encountered by a surgeon in his career due to the frequency of hernia repair. The aim of this study, is to present our experience of unusual contents in inguinal hernia sac, discuss its management and review the relevant literature with regards to others experience. Patients and methods-Retrospective study of 662 patients who underwent inguinal hernia repair over an 8 year period from 2000 to 2008 was carried out. Results-Seven patients presented with unusual contents in inguinal hernia sac; an incidence of 1.05%. Three of them had vermiform appendix, with acute appendicitis (Amyand’s Hernia) noted in one of them. All patients underwent appendicectomy with repair of hernia, with mesh being employed only in patients with normal appendix. In 2 cases urinary bladder had herniated and there was one case each of ovarian cyst and fallopian tube with ovary as its content. In all these patients hernia repair was carried out after carefully reducing the contents. Conclusion-Unusual contents of hernia may pose a surgical dilemma during hernia repair even to an experienced surgeon. Although rare, a hernia may contain vermiform appendix and exceptionally it may be acutely inflamed. Tubal and ovarian herniation in an inguinal hernia may be found in adult and perimenopausal women, though the incidence is reported to be more common in children. Urinary bladder herniation occurs with similar incidence as tubo ovarian hernia; however it requires special attention because of the risk of iatrogenic bladder injury during inguinal dissection. Though appendix as a content is dealt with by appendicectomy followed by hernioplasty, every effort should be made to preserve other organs found in the hernia sac to achieve an uneventful postoperative period.

An unusual case of a strangulated right inguinal hernia containing the sigmoid colon

The strangulated inguinal hernia is one of the most common emergencies in surgery. Although the diagnosis is usually made by physical examination, the content of the hernia sac and the extent of the following operation may vary. We present an extremely rare case of a strangulated right inguinal hernia containing the sigmoid colon and review the relevant literature.

Study on the Effectiveness of Antibiotic Prophylaxis in External Dacryocystorhinostomy: A Review of 697 Cases

To evaluate the prophylactic use of antibiotics in external dacryocystorhinostomy for the prevention of postoperative complications. This study included 697 patients diagnosed with distal nasolacrimal duct obstruction and who were operated on by the same surgeon. Direct culture of the lacrimal sac content was carried out. Data were collected regarding clinical signs and symptoms, use of intraoperative antibiotics, results of culture samples obtained during surgery, and antibiogram analysis. Also, the postoperative period was analyzed with regard to the presence of postoperative complications. Out of 697 patients, 536 were women. The mean age at surgery was 67.0 ± 13.3 years. Prior to surgery, 19.5%, 18.5%, 11%, and 17.8% of patients showed recurrent conjunctivitis, mucocele, mucopyocele, and episodes of acute dacryocystitis, respectively. Seventy-three patients did not receive prophylactic treatment during surgery. A total of 8.3% of lacrimal sacs were culture positive, the most commonly isolated organism being Staphylococcus aureus. The use of antibiotics during surgery was not associated with a lower rate of postoperative complications. A statistically significant association was found between some clinical pictures, such as mucocele, mucopyocele, and dacryocystitis, and a higher rate of positive cultures. This study questions the generalized use of prophylactic antibiotics for external dacryocystorhinostomy, while providing evidence to indicate their use for patients who have had prior episodes of mucocele, mucopyocele, or acute dacryocystitis.

Effects of in ovo Administration of L-carnitine on Hatching Events and Juvenile Performance of Layer-type Chick

The effects of in ovo injection of L-carnitine on hatchability and juvenile performance of 360 layer- type chicks were investigated. Fertilized eggs were injected in air chamber with L-carnitine (500 and 1000 µmol) dissolved in 0.9% of Saline (NaCl) at d 18 of incubation. Two control groups (non-injected and injected with 0.9% of Saline were also included. Hatched chicks was recorded after every 4 h, beginning at 490 h of incubation and ending at 514 h, for incubation length and hatching spread determination. At the end of incubation, hatched chicks were recorded according to treatment for determination of hatchability. At 3, 7 and 14 d post-hatch, chick body weight (BW) and morbidity were recorded. Also, at d 3 and 7 post-hatch, 14 birds from each of 2 replicate groups within each treatment were used for intestine and yolk sac weight determination. Results indicate that BW, hatchability, or relative intestine weights were not affected by treatment. However, incubation length was longer while hatching spread was shorter in L-carnitine groups compared to control groups. Yolk sac relative weight was decreased by treatment with L-carnitine (P < 0.05). Also, the percentage of chicks showing morbidity sign was lower in L-carnitine treated groups from d 7 onwards. The results of the present study suggest that in ovo injection of L-carnitine at d 18 of incubation delayed hatching time but resulted in narrower hatching spread, faster utilization of yolk sac content and improved morbidity.