Purpose. The efficacy of ULTRAPROTM HERNIA SYSTEM (UHS) technique was evaluated by comparison with standard Prolene hernia system (PHS) technique and the direct Kugel patch (DKP) technique. Methods. Forty-one patients with inguinal hernias treated by using UHS technique. They were compared with 84 patients treated with PHS technique and 116 patients treated by the DKP technique. These 3 groups were compared with respect to postoperative wound pain, wound swelling, and seroma formation. Results. The incidence of wound pain at the first outpatient visit after discharge was 7.3%, 17.9%, and 13.8%, in the UHS, PHS, and DKP groups, respectively. It was lower in the UHS group. The incidence of wound swelling was 4.9%, 11.9%, and 15.5%, respectively. The incidence of seroma was 2.4%, 9.5%, and 9.5% respectively. Both of these postoperative complications showed also lower incidence in the UHS group. Conclusion. Although we found that postoperative pain, wound swelling, and seroma tended to be less frequent in the UHS group than in the PHS and DKP groups, it did not show significant superiority in this study.
Secondary abdominal compartment syndrome (s-ACS) is a serious complication with high mortality in patients with extensive burns requiring extensive fluid therapy to maintain the hemodynamic state. This report presents 2 cases of extensive burn patients complicated with s-ACS requiring surgical decompression. Fluid resuscitation was administered according to Parkland formula, using urinary output as the primary parameter to assess the volume status and tissue perfusion. The first case had a scald burn with an 80% total burn surface area (TBSA) requiring 28 L over 17 h. The second case was scald burn with a 77% TBSA requiring 31 L over 20 h. These cases required a revision of the institutional fluid resuscitation protocol for burn patients during the initial 24 h after the injury. The revised protocol divided burn patients into ≥ 60% TBSA or < 60%, according to the risk for the development of s-ACS following fluid resuscitation using crystalloids. In addition, the protocol provide mandatory sequential monitoring of intra-abdominal pressure (IAP) by measuring intra-bladder pressure (IBP) and aggressive intervention from the early post-burn period, when the patients required more than 250cc/kg during the first 24 h post-burn period. The revised protocol may reduce the development of s-ACS.
Mohsペーストは塩化亜鉛を主成分とする外用剤で，皮膚科領域の悪性腫瘍に用いられている．今回われわれは，Mohsペーストが著効した局所進行乳癌の１例を経験したので報告する．患者は70歳代女性．2009年７月左乳房腫瘤を主訴に当院を受診した．左乳房に悪臭と大量の滲出液を伴う10cm大の腫瘍を認め，生検で硬癌と診断された．FEC療法を開始したが定期的な通院が困難で，2011年５月に腫瘍からの出血のため入院した．入院後よりMohsペーストによる処置を開始した．腫瘍からの出血は速やかに消失し，滲出液や悪臭も減少した．約１カ月後腫瘍は自然に脱落した．その後全身転移のため2011年11月永眠するまで，quality of life（QOL）は良好に保たれた．Mohsペーストは局所進行乳癌患者のQOLを改善するだけで無く，積極的な局所治療の１つになりえると考えられた．
A 44-year-old woman with a 10-year history of anemia presented to our hospital with anemia. At the Emergency Room, her initial hemoglobin and hematocrit levels were 10.9 g/dL and 33.4 %, respectively. A gastroscopy and contrast-enhanced computed tomographic scan of the abdomen did not identify any bleeding site. A colonoscopy showed a Meckelʼs diverticulum (MD) with an ulcer, at about 60 cm proximal to the ileocecal junction on the antimesenteric side, and few blood clots in the terminal ileum. Therefore, we performed a diagnostic and therapeutic single-incision laparoscopic surgery (SILS). The diverticulum was resected using a gastrointestinal anastomosis stapler, without requiring small bowel resection. Histopathological examination revealed MD with ectopic gastric tissue. The patient was discharged on postoperative day 7 without any complications. We report our initial experience from Japan with one patient who underwent SILS for MD.