RESUMEN
Ventral and incisional hernias of the abdominal wall are common problems treated by surgeons around the globe. Incisional hernias are common postoperative complications of abdominal laparotomies with a reported incidence of up to 20 per cent. The increasing use of prosthetic mesh in open ventral hernia repairs necessitated the development of different operative techniques used in the repairs. It also required that surgeons become facile with placement of the mesh in different anatomical positions on the abdominal wall. One of the most common locations is placement of the mesh in the underlay position. Many surgeons who use the underlay technique have expressed significant concerns. Among these are fear of an inadvertent bowel injury while placing the mesh, poor visualization during mesh placement, and the inability to use the underlay technique for difficult hernias. We present a very useful, if not, novel technique of open hernia repair using mesh in the underlay position that helps to 1) prevent complications, 2) facilitate easier mesh fixation, 3) simplify open repair of atypical ventral hernias, and 4) reduce total operative time while still adhering to the important fundamental principles of a tension-free hernia repair. This technique as we describe it has been compared with the old parachute technique, but we think this is a significant improvement of that seldom used technique. We believe the use of this technique for the underlay position makes open ventral hernia repair safer, faster, and easier; however, our goal for this article is to describe the procedure in detail. In addition, we recently have started using this technique to fix the mesh when doing the retrorectus approach as well.
Asunto(s)
Hernia Ventral/cirugía , Herniorrafia/métodos , Mallas Quirúrgicas , Herniorrafia/instrumentación , Humanos , Tempo Operativo , Complicaciones Posoperatorias/prevención & control , Resultado del TratamientoAsunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Enterostomía/métodos , Hernia Ventral/cirugía , Fístula Intestinal/cirugía , Femenino , Tejido de Granulación/patología , Humanos , Persona de Mediana Edad , Terapia de Presión Negativa para Heridas , Repitelización/fisiología , Cicatrización de Heridas/fisiologíaRESUMEN
Subungual Melanoma accounts for less than three percent of all cutaneous melanomas and has a dismal prognosis. Our case report outlines the current approach for diagnosis and management of this rare form of acral lentiginous melanoma.
Asunto(s)
Melanoma/diagnóstico , Melanoma/terapia , Enfermedades de la Uña/diagnóstico , Enfermedades de la Uña/terapia , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/terapia , Humanos , Metástasis Linfática , Masculino , Melanoma/patología , Persona de Mediana Edad , Enfermedades de la Uña/patología , Tomografía de Emisión de Positrones , Neoplasias Cutáneas/patología , Úlcera Cutánea/patologíaRESUMEN
We characterized two novel members of the RAET1/ULBP gene cluster, RAET1E and RAET1G. The encoded proteins were similar to the ULBP in their class I-like alpha1 and alpha2 domains, but differed in that, instead of being GPI-anchored, their sequences were type 1 membrane-spanning molecules. Both proteins were capable of being expressed at the cell surface. Both proteins bound the activating receptor NKG2D, and RAET1G bound the human CMV protein UL16. The expression of diverse NKG2D-binding molecules in different tissues and with different properties is consistent with multiple modes of infection- or stress-induced activation.