Feeling Of Foreign Body Research Articles

Динамика клинических и иммунологических показателей при патогенетической терапии острого или обострения хронического фарингита

Objective. To study the anti-inflammatory properties of Tonsilgon N preparation and its effect on the indices of local immunity of oropharyngeal mucosa in patients with acute or exacerbation of chronic pharyngitis without a pronounced systemic inflammatory syndrome. Patients and methods. 60 people diagnosed with acute catarrhal pharyngitis with intoxication syndrome were examined. Group 1 – 30 people took the drug Tonsilgon N in the form of alcohol solution, group 2 – 30 people – sage in the form of tablets for resorption in the oral cavity according to the scheme of 25 drops or 1 tablet every 2 hours for the first 3 days of treatment, then 3 times a day until day 7 inclusive. Pharyngoscopy was performed by an otorhinolaryngologist at each visit on day 1, day 3–4 and day 7–8 of the disease. Using a 10-point visual analogue scale (VAS) with scores from 0 (no sign) to 10, we evaluated the severity of symptoms (pain when swallowing, a feeling of parching in the oropharynx, a feeling of a foreign body in the oropharynx, dry cough, weakness, headache) and the condition of the oropharyngeal mucosa. Additionally, at 3 visits, scrapings from the oropharyngeal mucosa were made with a cytobrush probe and the content of IL-6 and sIgA proteins was determined by enzyme immunoassay. For the control group, 30 conventionally healthy people were taken, not differing in sex and age from the main group of patients and having no inclusion criteria. Results. All patients by day 7 of observation had no expressed complaints, none of them had progression of inflammatory process or development of any complications, patients did not need further continuation of treatment. Pain at swallowing, feelings of foreign body in the oropharynx, feelings of feathering and intensity of hyperemia of the mucous membrane of the posterior pharyngeal wall when treated with Tonsilgon N on the 3–4 day of observation compared to the group of patients taking Sage. On the 7th day of observation at Tonsilgon N treatment all analyzed clinical manifestations of pharyngitis were absent, and in Sage group in some cases weakly expressed symptoms of pain at swallowing, feeling of foreign body in the oropharynx, feeling of fever, intensity of hyperemia of the mucous membrane of the back wall of the pharynx (Me = 0 [0;1] points) and dry cough (Me = 0 [0;0.5] points) remained. On day 1 of observation, an increase in IL-6 protein content compared with normal was noted in pharyngitis, and sIgA levels were low. Further, both groups showed a decrease in IL-6 level, in group 1 in the group receiving Tonsilgon N, its level on the 2nd and 3rd visit was lower compared to group 2. The amount of sIgA on the first day with pharyngitis was minimal, then in group 1 its values increased on day 3 but remained below control, and in group 2 further decreased, on day 7 of observation in group 1 sIgA slightly increased but was below control. In group 2 the sIgA level was determined in minimal values. Conclusion. Tonsilgon N or sage therapy showed a clear relief of clinical symptoms of tonsillopharyngitis during the treatment period without taking non-steroidal anti-inflammatory drugs, and their reduction was significantly faster with Tonsilgon N. Decrease of proinflammatory cytokine IL-6 on the background of treatment was faster on the background of treatment with Tonsilgon N. Increased synthesis of sIgA against the background of Tonsilgon N treatment allows to explain the rapid onset of clinical recovery in patients and to identify an additional mechanism of action of this drug on the local immune response of the oropharyngeal mucosa. It can be assumed that Tonsilgon N is not only pathogenetic, but also immunoregulatory, creating the most effective response of the body to inflammation. Key words: pharyngitis, oropharyngeal mucosa, interleukin-6 (IL-6), secretory immunoglobulin A (sIgA), enzyme-linked immunosorbent assay (ELISA), treatment, Tonsilgon N, sage

Тактика хирургического лечения пациента с непроникающей травмой роговицы, после ранее перенесенной операции ФемтоЛАЗИК (клинический случай)

Purpose. to present the tactics of surgical treatment of a patient with non-penetrating corneal trauma after previously undergone FemtolaSIK surgery. Material and methods. Patient m., 28 years old, addressed to the clinic of Volgograd branch with complaints of decreased visual acuity and feeling of foreign bODy on the right eye after trauma. during the repair of the braking system foreign bODies got into the right eye, which resulted in the rupture of the corneal flap in the paracentral region, with multiple metal foreign bODies getting into the corneal flap, under the corneal flap and into the stromal bed. Results. the patient underwent surgery: repositioning of the corneal flap with removal of multiple foreign bODies. mechanical partial deepithelization of the corneal flap in the zone of nonpenetrating corneal wound was performed. Foreign bODies and epithelial cells from the surface of the corneal bed and the back side of the epithelial-stromal flap were completely removed. the corneal flap was straightened and adapted. a soft contact lens was applied. Conclusion. repositioning of the corneal flap with removal of foreign bODies and epithelial cells in nonpenetrating corneal trauma allowed to preserve high visual functions in the patient after FemtolaSIK. Keywords: FemtoLASIK, keratorefractive surgery, corneal foreign body, non-penetrating corneal wound

Conjunctivitis in unusual populations: A review of rare cases and challenges in diagnosis and management

Conjunctivitis is defined as any inflammatory condition of the membrane that borders the eyelids and covers the exposed sclera. It is the most frequent reason for "red eye." The word "conjunctivitis" refers to a wide range of illnesses that manifest as conjunctival inflammation. Hyper acute, acute, or chronic inflammations are all possible, and their causes might be infectious or noninfectious. Conjunctival injection, sometimes known as "red eye," is a common presentation for various ocular illnesses and can represent up to 1% of all visits to the primary care physician. The presence of these two symptoms may identify 59% of instances with "serious eye conditions," including anterior uveitis and keratitis. Anisocoria and moderate photophobia were substantially related with "serious eye conditions. Before beginning antibiotic therapy, it is preferable to collect swabs from the discharge. The swabs are then cultured in the lab by placing them in different growth media. It is recommended to use Sabouraud agar plates to detect fungus in immunocompromised individuals and those with persistent blepharitis. Additionally, anaerobic culture plates may be beneficial, particularly for individuals who have a history of prior surgery or trauma. A very contagious kind of viral conjunctivitis is acute hemorrhagic conjunctivitis (AHC). It presents with a feeling of a foreign body, excessive weeping, and edema of the eyelids, dilated conjunctival vessels, chemosis, and subconjunctival hemorrhage. When a person is sexually active as an adult or a newborn, Neisseria gonorrhoeae is frequently the cause of hyperacute conjunctivitis. Conjunctiva, eyelids, and cornea can all be impacted by ocular allergies along with other ocular surface areas. Ocular allergy disorders have been divided into three main categories by Leonardi et al based on the immunological mechanism responsible for the final clinical appearance. Patients suffering with viral conjunctivitis have quick onset foreign body feeling, red eyes, irritation, light sensitivity, burning, and watery discharge. Patients with bacterial conjunctivitis have all of the aforementioned symptoms as well as mucopurulent discharge and mattering of the eyelids upon awakening. For individuals with conjunctivitis, general supportive therapies include allergen avoidance (pollens, animals, and dust mites), the use of artificial tears, proper hand hygiene, cold compresses, avoidance of eye rubbing, and mild cleanser to remove any allergens or debris.

Case Report of Protruded Implantable Cardiac Device through Chest in 50 Years Old Male

Background: Implantable cardiac defibrillators use has been increasing for the last two decades and they are prone to infections. ICD device infection risk factors are many, some are host related while the others are procedures related. Staphylococcus aureus and staphylococcus epidermidis are accountable for 65 to 75% of the total cases of Implantable cardiac devices infections. Case Presentation: A 50 years old male presented to our emergency department with ICD pocket migrated through the skin. The symptoms started over 2 weeks, started as gradual feeling of foreign body moving underneath the skin, associated with mild pain and 3 days before presentation, the ICD penetrated the skin. The patient denied any history of fever, bleeding, pus discharge, palpitations, abnormal shocks or syncope. He was admitted to the hospital, treated for a presumed infection and his ICD device was removed. Conclusion: ICD devices complications are many, including infections. But, to have an infected device protruded through the skin is not a common presentation. We outlined the approach that was taken for this patient and his management in order to enhance the literature in terms of the above mentioned rare presentation.

Multiple migratory caterpillar hairs in the eye – A case report

A 40-year-old male presented with a history of caterpillar fall in his right eye with subsequent foreign body feeling, discomfort, and redness to a tertiary care facility in southern India. His best corrected visual acuity in both eyes was 6/6. The IOP in both eyes were within normal range. Multiple caterpillar hairs were seen during a thorough examination of the right eye, in the palpebral conjunctiva, the superficial and deep corneal stroma, and the anterior chamber. There was no anterior chamber reaction. The fundus examination were within normal limits. Under topical anaesthesia, caterpillar hairs in the conjunctiva were removed with the help of forceps. The patient was started on topical steroids and antibiotics. The patient was carefully monitored. The patient's symptoms had improved. During the next visit, caterpillar hairs in the superficial cornea was removed. Despite having hairs in the anterior chamber, this patient had no anterior or posterior chamber reactivity. Two hairs on the iris were visible during the next follow-up, but there were none in the cornea or conjunctiva. The patient is still being followed up on regular basis (9 months). Caterpillar hairs have the capacity to move intraocularly through the cornea and are known to elicit an inflammatory response in the eye. Therefore, it is important to be aware of the potential for intraocular inflammation following the quiescent stage.

Das Eagle-Syndrom

In patients with chronic pain in the temporomandibular joint (TMJ) and/or upper cervical region, particularly when they also complain of a foreign body feeling in their throat and dysphagia, treating physicians should always consider Eagle’s syndrome as part of the differential diagnosis. An elongated or unfavourably angled styloid process and/or ossifications of the stylohyoid ligament can be the causes of symptoms. In most cases, panoramic imaging is sufficient to diagnose this condition. Given the diagnosis, resection of the elongated process via an intraoral approach should be considered. For oral and maxillofacial surgeons, it is important to keep Eagle’s syndrome in mind as part of the differential diagnosis, especially in patients with chronic, treatment-refractory pain.

Pterygium management and comparison of different surgical approaches with supportive treatment in Rural Maharashtra

BACKGROUND: Numerous surgical procedures and changes have been ineffective in preventing the recurrence of pterygium. A prospective clinical observational analysis of 205 individuals with primary pterygium was conducted where patients were treated with various surgical procedures. The patients were observed for two to five years in order to examine the frequency of recurrences and consequences. RESULT: Patients were divided into four groups and treated using a variety of surgical methods. Straightforward excision of pterygium was the treatement of choice in group 1. Excision with conjunctival rotation pedicle graft was used on patients in Group 2. Excision and conjunctival autograft were used to treat Group 3 patients. Patients in Group 4 received excision and a 0.02 percent solution of mitomycin c drops as a postoperative treatment. Age varied from 22 to 58, with a median of 34. All four groups had an equal number of men and women. Hemorrhage, astigmatism, symblepheron, foreign body feeling, and a corneo-scleral ulcer were among complications that were reported. There were 12 percent complications in group 1, 16 percent complications in group 2, 6 percent complications in group 3, and 8 percent complications in group 4. Criteria for recurrence was defined as the regrowth of fibrovascular tissue or the appearance of an aesthetic flaw. It's 30 percent for group 1; 14 percent for group 2, 9 per cent for group 3, and 8 per cent for group 4. CONCLUSION: The least rate of recurrence was noted in patients of Group 4 who had pterygium excision with postoperative mitomycin c instillation, and complications were least common in patients in Group 3 who had pterygium resection with conjunctival autograft..

Immediate Repair With a Self-Gripping Retromuscular Mesh for Abdominal Wall Defect Following Tumor Resection.

Background: Prosthetic repair is always employed after large abdominal wall tumor resection, while chronic pain is one of the mesh-related complications after traumatic fixation. The objective of this research was to evaluate the outcomes of retromuscular repair with self-gripping mesh after abdominal wall tumor resection.Methods: The study was a monocentric retrospective analysis following STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statements of all patients with abdominal wall tumor >5cm in diameter undergoing tumor excision and retromuscular repair with self-gripping mesh. Demographic, operative, early postoperative, and follow-up data were noted. Visual Analog Scale, ranging from 0 (no pain) to 10 (very severe pain), was used to estimate the wound pain.Results: 24 patients were included in this study, and the defect following tumor resection was 26.9±10.0cm2. There was no tumor recurrence or incisional hernia in median follow-up of 20months, and the mean VAS score was 0.4. Three had foreign body feeling and no one suffered chronic pain.Conclusions: Immediate repair with a self-gripping retromuscular mesh can be considered as an effective way to treat an abdominal wall defect after resecting an abdominal wall tumor.

Clinical profile and management of foreign body ingestion in children

Abstract Background: This study is conducted to estimate the type, location, clinical features of the ingested foreign bodies, its complication and management at tertiary care center. Methods: This prospective observational study was conducted from February 2016 to January 2021. All the children below 12 years of age with history of ingestion of foreign body and confirmation on imaging were included. The demographic and clinical details like Age, Sex, Clinical features, anatomical location, type, management, complications, and outcome were recorded. All the patients were subjected to plain X-ray radiograph of thoraco-abdominal region within the first hour of their presentation. Results: During this study period 72 children of foreign body ingestions were included. The age of the children ranged from 3 months to 12 years with mean age of 5.1years. In our study the clinical presentation was abdominal pain (27.78%), vomiting (18%), hematemesis (2.7%), drooling or food refusal (2.7%), and foreign body feeling (1.4%) whereas 35 children were completely asymptomatic (48.6%). Foreign bodies that were ingested were coins (52.77%), followed by button batteries, plastic toys (8.33% each), screws (6.94%), Needles, safety pins, pins, small stones 4.16% each, marbles, magnetic balls (2.77%) each, Glass piece 1(1.38%). In our study 25% foreign bodies removed with endoscopy, 8.33% foreign bodies required operative intervention. And remaining 66.67% foreign bodies were passed naturally without intervention. Conclusion: Children with ingested foreign body are mostly asymptomatic and most of the ingested foreign bodies pass through the intestine without any complications. Early recognition and appropriate management can reduce morbidity. Keywords: Foreign body ingestions, Endoscopy, Children, Coins, Batteries.

Long-term outcomes after Lichtenstein repair using titanium-coated mesh: A retrospective cohort study.

Objective:To examine the long-term outcomes such as recurrence, foreign body feeling and chronic pain of titanium-coated mesh (TCM) versus standard polypropylene mesh (PM) after Lichtenstein repair (LR).Methods:In this retrospective cohort study, patients who underwent TCM and PM in LR were evaluated between May 2014 and January 2018 at Ordu University Training and Research Hospital in Turkey. Primary outcomes (age, gender, body mass index, smoking habits, comorbid diseases, American Society of Anesthesiologists score, hernia type, side of hernia, duration of hernia presentation and operative time) and secondary outcomes (surgical site occurence, recurrence, foreign body feeling and chronic pain) were analyzed. Patients were divided into two groups according to the mesh elected (TCM and PM); titanium group (TG) and polypropylene group (PG), respectively.Results:In this study, 221 patients were analyzed; TCM was used in 72 (32.6%) patients and PM was used in 149 (67.4%) patients. No difference was found between groups in terms of primary outcomes (p>0.05). In the analysis of secondary outcomes, surgical site occurence was similar in both groups (p>0.05). Recurrence was observed in 1.39% (n=1) of TG and 2.01% (n=3) of PG. No difference was found between groups in terms of recurrence (p=0.606). Foreign body feeling was observed in 15.3% (n=11) of TG and 27.5% (n=41) of PG. Chronic pain was observed in 4.2% (n=3) of TG and 12.8% (n=9) of PG. Significant differences were found between groups in terms of chronic pain and foreign body feeling (p=0.046 and p=0.044, respectively).Conclusion:The result of this study shows that in LR, TCM leads to less foreign body feeling and chronic pain than PM. However, there was no difference in terms of recurrence between these meshes.

Oral dysesthesia with a psychiatric perspective

Oral dysesthesia defines unusual sensation like inexplicable tingling sensation that could not be explained by organic causes, foreign body feeling, taste changes, oral burn, and pain in the oral area. Burning mouth syndrome, atypic odontalgia, persistent idiopathic facial pain are considered a variant of oral dysesthesia and they are characterized by pain in the orofacial area and abnormal sensation. Many of the oral dysesthesia and variants are idiopathic and the underlying pathogenesis is not yet clear. It has been shown that it can coexist with many psychiatric diseases, especially somatoform disorder. Despite the frequency of psychiatric comorbidity, patients with oral dysesthesia apply to non-psychiatric branches, especially dental clinics, and possible psychiatric diagnoses may be skipped. This can cause symptoms to become chronic. In this regard, patients with oral dysesthesia and their complaints also need to be handled psychiatricly.

Is it necessary to use tobramycin-dexamethasone eye ointment prophylactically in eyes at the end of intraocular surgery?

BackgroundThere are no data available regarding the complications associated with using antibiotic ointment at the end of intraocular surgery. This study aimed to explore the necessity of using ocular tobramycin-dexamethasone prophylactically at the end of intraocular surgery.MethodsThis was a retrospective cohort study of patients who received intraocular surgery at Tianjin Medical University General Hospital from January 2015 to December 2017. The patients were grouped according to whether they received tobramycin-dexamethasone eye ointment or not after surgery. The Tobramycin dexamethasone eye ointment was sampled to observe bacterial contamination pathogens at 0.5, 1, 1.5, 2, 2.5, 3, 6, 8, 24, 36, 48, 72, and 168 h after being opened.ResultsA total of 3811 eyes in 3811 patients (mean age of 63 ± 12 years) were included: 2397 eyes that received prophylactic tobramycin-dexamethasone eye ointment and 1414 eyes that did not. The overall rate of endophthalmitis was 0.08% (3/3811) in our study, all in the eye ointment group (0.12%, 3/2397); no patients developed endophthalmitis in the non-ointment group (0%, 0/1414)(P = 0.184). The anterior chamber reactions 1 day after surgery were more serious in the eye ointment group compared with the non-ointment group (all P < 0.05), but there were no statistically significant differences at 1 month postoperatively (all P > 0.05). The contamination rate was 0% at all time points over 7 days.ConclusionWe did not observe a statistically significant difference in the incidence of endophthalmitis in patients with or without prophylactic tobramycin-dexamethasone eye ointment. And tobramycin-dexamethasone eye ointment seemed to increase some side effects such as eye secretions increasing and foreign body feeling.

Randomized Trial Comparing Self-Gripping Mesh with Polypropylene Mesh in Female Lichtenstein Hernioplasty

Several randomized trials comparing self-gripping mesh with polypropylene (PL) mesh in Lichtenstein hernioplasty revealed that the self-gripping mesh significantly reduced the operation time. In these studies, some enrolled only male patients, and in others, the proportion of women was extremely low. The aim of this research was to compare outcomes after self-gripping mesh repair with PL mesh secured with sutures in female Lichtenstein hernioplasty. Female patients with primary unilateral inguinal hernia were assigned randomly to undergo Lichtenstein hernioplasty with a self-gripping ProGrip (PG) mesh or a sutured PL mesh, followed-up at one week, one month, three months, one year, and two years. Demographics, hernia characteristics, and operative outcomes data were analyzed. Pain was assessed with a visual analog scale (0-10), and quality of life (QOL) was estimated by a 36-item short-form general survey (0-26). Forty eight patients in the PG group and 51 participants in the PL group completed the follow-up. The operation time of the PG (54.1 ± 12 minutes) group was significantly shorter than that of the PL (60.9 ± 11.3 minutes) group (P = 0.045). At the one-month follow-up, the incidence of foreign body feeling in the PG group was significantly higher than that in the PL group (P = 0.031), whereas no significant difference was observed in visual analog scale ≥3 and QOL. In a follow-up of three months, one year, and two years, there was no significant difference in foreign body feeling, chronic pain, QOL, and recurrence between two groups. The surgical outcomes of self-gripping mesh are comparable to those of the ordinary PL mesh with a reduced operation time in female Lichtenstein hernioplasty. Registration number: ChiCTR1800017360 (<ext-link ext-link-type="uri" xlink:href="http://www.chictr.org.cn">http://www.chictr.org.cn</ext-link>).

Computer vision syndrome: prevalence and predictors among students

Background: Globally around 60 million people are suffering from Computer vision syndrome (CVS). A well-known eye and vision-related problem resulting from prolonged computer, tablet, e-reader and cell phone use. Viewing a digital screen often increases the visual load therefore the aim of this study was to explore the prevalence of CVS among students.&#x0D; Methodology: This cross-sectional study was conducted from 1st September 2018 to 31st May 2019 on a sample of 320 students from diverse physiotherapy institutes of Karachi. Participants of both genders between the age of 18-24 years were included in the study. Data regarding demographics, CVS assessment, associated symptoms, intensity of symptoms and daily vision routine was recorded. CVS was assessed using a standardized CVS questionnaire (CVS-Q) and analyzed using SPSS version 21.&#x0D; Results: A total of 320 physiotherapy students with a mean age of 21.04+0.8 years were enrolled in the study, majority of them were females 245(76.6%). Out of these, 186 students were diagnosed with CVS as they scored ≥6 on Segui and Colleagues CVS questionnaire with headache being the most prevalent symptom (63.1%) followed by itching (52.8%), increased sensitivity to light (43.6%), eye pain (42.6%) and feeling of foreign body (39.5%). Among the activities involved in daily vision routine, optical use and sitting posture were significantly associated with CVS.&#x0D; Conclusion: It can be concluded from the study results that CVS is highly prevalent among physiotherapy students, one of the reasons for this might be the increased digital screens usage for academic purpose and clinical decision making.

Approach to foreign bodies in the upper Gastrointestinal system

Objective: The aim of this study is to reveal the clinical presentations and treatment approaches to the patients applied with foreign body ingestion and food residue accompanied by literature. Materials and Methods: Patients who were admitted to the general surgery clinic of Ceylanpinar State Hospital between March 2018 and March 2019 with the suspicion of ingestion of foreign bodies in the upper gastrointestinal tract and food residue were evaluated retrospectively. Findings: The mean age of our patients was 31.3 (min-max: 18-76). Endoscopy without sedation was performed to 3 patients (37.5%) due to the feeling of stuck. In 2 patients, the bone fragments detected in the esophagus were excised with the help of endoscopic forceps. One of the three endoscopic procedures have failed. Patient whose endoscopy was unsuccessful and five other patients were followed-up medically in order to let foreign bodies or food residues to leave the digestive tract spontaneously. None of the patients had esophageal disease or a known psychiatric disorder. The mean duration of admission to the hospital was 12.5 (min-max: 6-36) hours. Three patients (37.5%) had foreign body feeling and dysphagia. Four of the patients (50%) had foreign bodies and the rest of the patients had food residue. The localization of foreign bodies or food residues were detected as; stomach in 1 patient (12.5%), esophagus in 3 patients (37.5%) and intestines in other 4 patients (50%). None of the patients required surgical intervention. Conclusion: In the early period, endoscopic procedures show a high success rate without complications in the treatment of foreign bodies in the upper gastrointestinal tract. However, it is an appropriate approach to wait for the spontaneous exit of the foreign body in cases that the foreign body have already passed the upper gastrointestinal system.

Is young age a risk factor for chronic postoperative inguinal pain after endoscopic totally extraperitoneal (TEP) repair?

A generally known risk factor for developing chronic postoperative inguinal pain after inguinal hernia repair is young age. However, studies discussing young age as a risk factor are mainly based on open repairs. The aim of this study was to determine if young adults (age 18-30) are also more prone to experience chronic postoperative inguinal pain after totally extraperitoneal (TEP) inguinal hernia repair, compared to older adults (age ≥ 31). A prospective study was conducted in a high-volume TEP hernia clinic in 919 patients. Patients were assessed using the Numeric (Pain) Rating Scale, Inguinal Pain Questionnaire and Carolina Comfort Scale preoperatively, at 3 months, 1year and 2years after TEP mesh repair. The primary outcome was clinically relevant pain in young adults compared to older adults at 3months follow-up. Secondary outcomes were pain 1 and 2years postoperatively, the impact of pain on daily living, foreign body feeling and testicular pain. Furthermore, age categories were analyzed to determine potential age-dependent risk factors. Follow-up was completed in 867 patients. No significant difference was found between young adults and older adults for clinically relevant pain at 3 months follow-up (p = 0.723). At all follow-up time points, no significant differences were found for clinically relevant pain, any pain, mean pain scores, the Inguinal Pain Questionnaire and the Carolina Comfort Scale. The subgroup analyses showed no age-dependent risk factor. Young age is not associated with a higher risk of chronic postoperative inguinal pain after endoscopic TEP hernia repair.

Groin Pain Characteristics and Recurrence Rates: Three-year Results of a Randomized Controlled Trial Comparing Self-gripping Progrip Mesh and Sutured Polypropylene Mesh for Open Inguinal Hernia Repair.

The aim of this study was to investigate long-term groin pain and inguinal hernia recurrence rates of 2 types of mesh and to describe the evolution of postoperative groin sensory disturbances. Some patients with an inguinal hernia develop chronic pain following open mesh insertion. Previous trials comparing a semi-resorbable, self-gripping Progrip mesh with a standard sutured polypropylene mesh found conflicting results regarding recurrence rates and residual groin pain. Patients aged >18 years scheduled for open primary hernia repair were randomized to a self-gripping mesh (Progrip) or a polypropylene mesh (standard). Removal of the inguinal nerves was left to the discretion of the surgeon. Pain was measured using Visual Analogue Scale (VAS) over a 3-year period. Pain characteristics and hernia recurrences were determined using physical examination. Data of 274 patients were complete (75% three-year follow-up rate). Pain steadily decreased over time in both groups in a similar fashion (moderate pain 3.7% in each group). Hyperesthesia was experienced by 2.2% and 3.7% and hypoesthesia in 12% and 19% in Progrip and standard group, respectively. One of seven Progrip patients reported a foreign body feeling versus 1 of 5 standard patients (P = 0.06). Altered skin sensations were not related to a neurectomy. Hernia recurrence rate was 11.5% in the Progrip and 5% in the standard group (P = 0.05). Three years after insertion of a self-gripping Progrip mesh or a sutured polypropylene mesh for an open primary inguinal hernia repair, groin pain is minimal, although altered groin skin sensations and foreign body feeling are quite common. A Progrip hernia repair is associated with a high recurrence rate.

The Medical Economic Approaches to the Choice of Method of Surgical Treatment of Inguinal Hernias in Modern Conditions of Insurance Medicine

Грыжи брюшной стенки остаются самым распространенным заболеванием, требующим планового хирургического лечения,встречаясь у каждого 3–5-го жителя планеты. Ежегодно в мире выполняют более 20 млн. хирургических операций, из кото-рых 10-15% составляют грыжесечения, занимающие третье место в структуре хирургических операций после аппендэкто-мии и холецистэктомии.Паховые грыжи диагностируются у 80% от общего числа больных с вентральными грыжами, с количеством рецидивов по-сле пластики косой паховой грыжи от 5 до 30% наблюдений, при прямой – до 10%. Вероятность повторного рецидива припластике паховых грыж достигает до 40%.Операцией выбора при паховых грыжах в настоящий момент является ненатяжная герниопластика задней стенки паховогоканала с использованием различных сетчатых имплантов, которая может быть выполнена как традиционным (открытым),так и лапароскопическим способами. И только при отсутствии возможности осуществить ненатяжную гернипластиткупо каким либо причинам, прибегают к натяжным методам.Целью работы явился выбор наиболее эффективного и рационального с экономической точки зрения способа герниопластикипри паховых грыжах у пациентов, среди наиболее часто применяемых современных хирургических методик.Материалы и методы. Ретроспективному медико-экономическому анализу были подвергнуты 100 медицинских карт ста-ционарных больных, оперированных по поводу паховых грыж в хирургическом отделении ФНКЦ за период 2013-2015 гг.Средний возраст пациентов составил 51,4 ± 3,7 лет, из них 83 было мужчин и 17 – женщин. У 53 больных выявлена право-сторонняя паховая грыжа, из них у 39 грыжа была косой и у 14 - прямой. У 40 пациентов наблюдалась левосторонняяпаховая грыжа: у 28 – косая и у 12 – прямая. 7 больных имели двухстороннюю паховую грыжу. Анализируемым пациентамбыли выполнены в плановом порядке следующие операции: 1) герниопластика по методу Lichtenstein с использованиемполипропиленового сетчатого имплантата фирмы «Еticon» (США), 53 больных; 2) герниопластика по методу Onstep с ис-пользованием полипропиленового сетчатого имплантата «Polysoft» фирмы «C.R. Bardinc.» (США), 21 пациент и лапаро-скопическая интраперитонеальная герниопластика с использованием полипропиленового сетчатого имплантата фирмы«Еticon» (США), 26 больных.Результаты и их обсуждение. Длительность оперативных вмешательств при односторонних паховых грыжах была прак-тически одинаковой в группах больных оперированных лапароскопическим способом и по методу по методу Lichtenstein,соответственно 42,8 ± 12,4 мин. и 39,7 ± 8,9 мин. (р ˃ 0,05). Общее время, затраченное на выполнение операций по методуOnstep, было существенно меньше, чем при использовании других 2 методик, а именно: 25,3 ± 4,7 мин. (р ˂ 0,05).С финансовой точки зрения, себестоимость анестезиологического пособия была значительно больше у пациентов с лапа-роскопической интраперитонеальной герниопластикой - 3,5 тысячи рублей, тогда как у больных, оперированных по методуLichtenstein или Onstep – 2 тысячи рублей. Наибольшая общая стоимость расходных материалов, как и ожидалось, оказаласьпри выполнении лапароскопической интраперитонеальной герниопластики, за счет использования инструмента для фик-сации сетчатого имплантата (герниостеплер). Послеоперационное ведение пациентов было одинаковым и не зависело отспособа хирургического лечения грыжи. К основным осложнениям герниопластики в послеоперационном периоде относятся:серома или гематома в области послеоперационной раны, невралгия, отек мошонки, чувство инородного тела, водянка илиатрофия яичка, орхит, орхоэпидидимит, раневая инфекция и образование свища. В нашем наблюдении встретились следую-щие осложнения: при лапароскопической интраперитонеальной герниопластике – 1 острая задержка мочи, потребовавшаякатетеризации мочевого пузыря; при герниопластике по методу Lichtenstein – в 1 случае длительная невралгия и в 2 случаях– жалобы пациентов на чувство инородного тела в области послеоперационного рубца. Осложнений при герниопластикепо методу Onstep не наблюдали. В исследуемой группе из 100 больных сроки наблюдения составили от 6 месяцев до 2-х лет.Рецидив грыжи выявлен у двух пациентов через 1 и 1,5 года соответственно, после лапароскопической интраперитонеальнойгерниопластике и гернипластике по методу Lichtenstein.Выводы. 1. Высокая эффективность лечения, простота в применении, а также надежность в отношении риска возникно-вения рецидивов заболевания позволяет рекомендовать грыжесечение по методике Onstep для пластики практически у всехпациентов с паховыми грыжами. 2. Герниопластика по методу Onstep особенно показана у лиц пожилого и старческоговозраста, имеющим сопутствующие заболевания, которая может быть выполнена под местной анестезией. 3. Для гер-ниопластики по методу Onstep необходимо использовать полипропиленовый сетчатый имплантат «Polysoft» фирмы «C.R.Bardinc.» (США), размером 14 х 7,5 см или 16 х 9,5 см. 4. При выделении грыжевого мешка необходимо добиться полной егомобилизации и отделения от семенного канатика. В случае косых паховых грыж целесообразно иссечение грыжевого мешка,при прямых грыжах допустимо погружение его в брюшную полость. 5. Не позднее чем через 2 часа после операции, больныхнеобходимо активизировать, что способствует их ранней реабилитации и благоприятному послеоперационному течению.Ключевые слова Паховая грыжа, медико-экономический стандарт лечения, метод «ONSTEP», паховый имплантат, стра-ховая медицина.

An epidemiological study of foreign body sensation throat in the population of Garhwal region of Uttrakhand

Foreign body sensation or feeling of lump in throat is one of the commonest complaint, with which patient presents to ENT out patient’s department. The patient usually complains of “something being stuck in my throat” or “heaviness of throat” or “sticky sensation in throat”. Although sometime there may be a pathology found in the throat to go with the symptom but most of the time the symptoms are vague and after extensive workup also no significant cause could be found. This study aims at finding the diseases associated with the symptom along with the gender, occupational, regional propensity of the symptom amongst the population of Garhwal region of Uttrakhand. Keywords: Globu pharyngeus, Throat, Pharyngitis, Thyroid, Laryngitis

Mesh Removal and Selective Neurectomy for Persistent Groin Pain Following Lichtenstein Repair.

Some patients with persistent inguinodynia following a Lichtenstein hernia repair fail all non-surgical treatments. Characteristics of mesh-related pain are not well described whereas a meshectomy is controversial. Aims were to define mesh-related pain symptoms, to investigate long-term effects of a meshectomy and to provide recommendations on meshectomy. Consecutive patients undergoing open meshectomy with/without selective neurectomy for chronic inguinodynia following Lichtenstein repair were analysed including a follow-up questionnaire. Outcome measures were complications, satisfaction (excellent, good, moderate, poor) and hernia recurrence rate. Recommendations for meshectomy are proposed based on a literature review. Seventy-four patients (67 males, median age 56years) underwent mesh removal (exclusively mesh, 26%; combined with tailored neurectomy, 74%) between June 2006 and March 2015 in a single centre. Complications were intraoperatively recognized small bowel injury (n=1) and testicular atrophy (n=2). A 64% excellent/good long-term result was attained (median 18months). Success rates of a meshectomy (63%) or combined with a neurectomy (64%) were similar. Five hernia recurrences occurred during follow-up (7%). A patient with a pure mesh-related groin pain characteristically reports a 'foreign body feeling'. Pain intensifies during hip flexion (car driving) and is attenuated following hip extension or supine position. Palpation is painful along the inguinal ligament whereas neuropathic characteristics (hyperpathic skin, trigger points) are lacking. Mesh removal either or not combined with tailored neurectomy is beneficial in two of three patients with characteristics of mesh-related inguinodynia following Lichtenstein hernia repair who are refractory to alternative pain treatments.