RESUMEN
There is yet no generally accepted incisional hernia classification.This article highlights practical issues of classification, treatment modalities, and multidisciplinary decision-making. We summarized many existing classifications of hernia and suggested the classification that facilitates pre-operative, intra and postoperative planning. Progressive Preoperative Pneumoperitoneum effectively helps to overcome postoperative respiratory complications. For big defects, we use Botox injections in according to Thomas Ibarra-Hurtado method one month prior to surgery. Rives-Stoppa procedure is a golden standard in incisional hernia repair. Component Separation (anterior and posterior) gives good results as well. It maintains flexibility of anterior abdominal wall. We prefer to cover relaxing incisions after CS on newly formed midline with triple sheet of mesh. It prevents recurrences in the mentioned areas. Treatment of giant hernias needs surgeons high experience in the field and multidisciplinary approach. Management of this kind of hernias should be done in specialized Hernia Centers.
Asunto(s)
Pared Abdominal , Hernia Ventral , Hernia Incisional , Pared Abdominal/cirugía , Hernia Ventral/cirugía , Herniorrafia , Humanos , Hernia Incisional/cirugía , Complicaciones Posoperatorias , Recurrencia , Estándares de Referencia , Mallas QuirúrgicasRESUMEN
Inflammation sometimes can be associated with the development of number of diseases, among them cancer. Few studies show prognostic value of different inflammatory markers, such as lymphocyte and monocyte count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and others in some types of blood cancers. There is further need to investigate easy measurable diagnostic and prognostic novel biomarkers in hematologic malignancies. Our aim was to investigate the role of inflammatory markers: NLR, PLR, platelet-monocyte ratio (PMR), hemoglobin-platelet ratio (HPR), hemoglobin-lymphocyte ratio (HLR), lymphocyte-monocyte ratio (LMR), systemic immune-inflammation index (SII) and derived neutrophil-lymphocyte ratio (dNLR), which were used alone or in combination, in early diagnoses of hematologic malignancies. The counts for total white blood cells, neutrophils, lymphocytes, platelets, monocyte and hemoglobin as well as systemic inflammatory factors, such as NLR, PLR, PMR, HPR, HLR, LMR, SII and dNLRwere analysed from patients with hematologic malignancies and their age-matched controls. The area under the curve (AUC), sensitivity, specificity and cut-off values, as well as correlations between these inflammatory markers were analyzed. The patients with hematologic malignancies have significantly increased level of inflammatory markers: NLR, PLR, PMR, HLR, SII and dNLR in comparison with age-matched controls. NLR and PLR positively correlate with each other and SII and negatively correlate with HGB. Additionally, PLR has positive correlation with HLR. dNLR has the highest AUC score. For diagnosing hematologic malignancies the AUC of the ROC curve for dNLR was 0.810 with a 95% CI of 0.646-0.975. However, combining these six markers - NLR, PLR, PMR, HLR, SII and dNLR reached the best AUC score - 0.923 with a 95% of CI of 0.778-1.000. Results indicate that NLR, PLR, PMR, HLR, SII and dNLR, which are easily detectable laboratory parameters and reflect systemic inflammatory response can be predictive factors for hematologic malignancies.
Asunto(s)
Neoplasias Hematológicas , Linfocitos , Biomarcadores , Biomarcadores de Tumor , Recuento de Células Sanguíneas , Plaquetas , Humanos , Recuento de Linfocitos , Neutrófilos , Pronóstico , Estudios RetrospectivosRESUMEN
Few cases have been reported in the literature on acute appendicitis located in the hernial sac. Information scantiness is determined by rarity of pathology and difficulties in diagnosis. Incidence rate of the condition is 0.4-0.6% of cases. The acute appendicitis is frequently located in the sac of right inguinal hernia or femoral hernia sac. The studies of three cases are presented in the article. In 1994-2007 at The Surgical Department of Phyphia Clinical Hospital (Tbilisi, Georgia) there have been performed 1064 hernia repairs. Entrapped hernia was diagnosed in 189 patients of whom three patients (from 70 to 84 years old, of whom two male and one female)--with acute perforated appendicitis located in hernia sac. In two cases perforated appendix was within the right inguinal hernia area and in one case--gangrenous appendix was located in femoral hernia sac. All three patients were operated upon routinely as for entrapped hernias. Laparoscopic inguinal herniotomy with removal of gangrenous-perforated appendix was performed in two patients. Herniotomy and laparotomy was performed in one patient. In spite of old age and heavy concomitant diseases postoperative period passed uneventfully. The patients were discharged from the Clinic under further ambulatory observation.