Uncommon content in groin hernia sac

Groin hernia may have very unusual sac content. Vermiform appendix, acute appendicitis, ovary, fallopian tube and urinary bladder have been rarely reported. We aimed to present our experience with these unusual hernia contents. Records of 1,950 groin hernia patients were retrospectively analyzed. Vermiform appendix was found in 0.51% and acute appendicitis was found in 0.10% of groin hernia sacs. The incidence of appendix in femoral hernia was 5%, while inguinal hernia sac contained ovary and fallopian tube in 2.9% of the cases. The incidence of groin hernias containing urinary bladder was 0.36%. We also had 1 patient with incarcerated bladder diverticula in an indirect hernia sac. Iatrogenic bladder injury occurred in 2 patients. Although rare, a groin hernia sac may contain vermiform appendix and exceptionally acute appendicitis. Tubal and ovarian herniation in inguinal hernias can be found in adult and perimenopausal women with an incidence as high as in children. Urinary bladder hernia occurs with a similar incidence of tuba-ovarian hernia, however, it requires special attention because of a high risk of iatrogenic bladder injury during the inguinal dissection. Every effort should be made to preserve the organ found in hernia sac for an uneventful postoperative period.

Neutrophil-to-lymphocyte ratio as a diagnostic biomarker for the diagnosis of acute mesenteric ischemia

PURPOSE

Due to the diagnostic challenges and dreadful consequences of delayed treatment of acute mesenteric ischemia (AMI), a variety of diagnostic markers have been previously studied. However, the diagnostic value of neutrophil-to-lymphocyte ratio (NLR), which has been suggested to be a predictor of inflammation, has never been studied for AMI.

METHODS

The data of 70 patients who underwent laparotomy (n = 8) and/or bowel resection (n = 62) for AMI (n = 70) between January 2009 and March 2014 were retrospectively analyzed. To investigate the studied parameters' role in the differential diagnosis of AMI, control groups were selected from most common reasons of inflammation-related emergent surgery, acute appendicitis (AA, n = 62) and normal appendix (NA, n = 61). White blood cell (WBC), red cell distribution width (RDW), NLR and mean platelet volume (MPV) values were recorded. Outcome variables of the study were defined as diagnostic and prognostic role of NLR in AMI.

RESULTS

RDW and NLR values were found to be higher in the AMI group than the AA group (p < 0.001 and p < 0.001). Also, WBC and MPV values were higher in the AMI group than the NA group (p = 0.001 and p < 0.001). Combined sensitivity, specificity, positive predictive value and negative predictive value of RDW and NLR for recommended cut-off values were 69.4, 71.2, 57.8 and 80.4 %, respectively.

CONCLUSION

High NLR value (>9.9) seems to be a valuable diagnostic marker of acute mesenteric ischemia. Combined use of NLR, RDW and other clinical assessment, could help the diagnosis of AMI, especially in the absence of advanced imaging modalities and expert radiologic interpretation.

Hyperbaric oxygenation attenuates renal ischemia-reperfusion injury in rats

BACKGROUND

Oxygen-derived free radicals play an important role in ischemia-reperfusion injury (IR). Hyperbaric oxygenation (HO) decreases free radical production. The aim of this study was to determine the effect of HO treatment on renal ischemia-reperfusion injury in rats.

METHODS

Rats were divided into four groups. All groups underwent right nephrectomy. Group I served as the control group; group II had left renal ischemia-reperfusion; group III was pretreated with HO; and group IV, ischemia-reperfusion and HO pretreatment. Tissue malondialdehyde (MDA) and glutathione (GSH) levels were measured, and histopathologic damage scored.

RESULTS

HO pretreatment significantly decreased tissue MDA levels and histopathologic scores among rats with IR. There was an increased GSH in HO-pretreated rats with IR; however, the difference was not significant.

CONCLUSION

HO prior to ischemia displayed a beneficial effect on renal IR by reducing oxygen radical peroxidation of lipid membranes.

Repairing great duodenal defects in rabbits by ePTFE patch

The aim of this experimental study was to evaluate the results of repairing large duodenal defects in rabbits by an ePTFE (Gore-Tex) soft tissue patch graft. A defect as large as 50% of the total circumference of the duodenum (i.e. Grade 3 injury) on anterior surface of the second part in 14 white New Zealand rabbits was done and repaired by 1 mm ePTFE graft. The stomach and duodenum were inspected for evidence of either leak or obstruction, and completeness of the mucosa covering the defect. Neither leak nor obstruction were observed and the whole grafted area was covered by the mucosa at the end of the sixth month. The main conclusion is that the method we used, is easy and reliable. Further experience will appropriate animal models is needed before this technique can be considered for application (in human duodenal injuries).