Patent urachus with methicillin-resistant coagulase negative staphylococcal sepsis in a 23 days old neonate

A remnant of the umbilical arteries, urachus, is a transverse structure lying between the peritoneum and the fascia transversalis. Urachus results from the involution of the embryonic duct and the ventral cloaca. The Urachus drains the bladder of the fetus by running within the umbilical cord. Usually, during embryonic development, the urachal tract obliterates. Failure of complete obliteration of the urachus, which is reported to be present in approximately 30% of adults, can lead to several abnormalities of the urachus. Common abnormalities of the urachus include - urachal cyst, diverticulum, umbilical sepsis, or patent urachus. This is a case report of a 23 days old female neonate who presented to us with complaints of fever for 11 days and umbilical discharge for 4 days. Clinical, microbiological, and radiological examinations revealed patent urachus with Methicillin-resistant coagulase-negative staphylococcal (MR-CoNS) umbilical sepsis. It is a rare condition that requires management with higher antibiotics based on culture and sensitivity tests.

COMPARATIVE STUDY OF INGUINAL HERNIA REPAIR WITH PLACEMENT OF MESH ANTERIOR AND POSTERIOR TO FASCIA TRANSVERSALIS IN CASES OF UNILATERAL INGUINAL HERNIA

Background: Since inception hernia surgery evolved a lot and achieved the gold standard of Lichtenstein hernioplasty. Chronic post-surgical inguinal pain and mesh related wound complications are still issues of concern for surgeons. To minimize these problems different modifications are being evaluated worldwide. OBJECTIVE: To compare the incidence of post-surgical chronic inguinal pain duration of surgery between two different techniques of mesh placement, one is placing the mesh anterior to Fascia Transversalis and other is placing the mesh posterior to Fascia Transversalis. STUDY DESIGN: Randomized superiority trial done among patients selected from opd and divided in two groups undergone hernioplasty by two different techniques of mesh placement. MATERIALS AND METHODS: Each group of patients contained fifty patients of 18 to 65 years of age with unilateral inguinal hernia. Duration of surgery recorded and post-surgical chronic inguinal pain evaluated at 2 weeks 2 months 4 months and 6 months after surgery. CONCLUSION: The study showed that placement of mesh posterior to fascia tranversalis gave better result than placing it anterior to FT in respect of post operative chronic pain but with a longer operative duration.

Meshless treatment of open inguinal hernia repair: a prospective study

OBJECTIVE: To evaluate two types of meshless open inguinal repair and to evaluate the recurrence rate. METHODS: We operated on sequentially 98 men and 15 women with 144 unilateral or bilateral inguinal hernias between December 1988 and April 2007. The surgeries were performed by two experienced surgeons and divided into two groups: Bassini or McVay reconstructive surgery techniques. Bassini type reinforcements were employed for Nyhus II and IIIB with minor destruction of the posterior wall. Patients with Nyhus type IIIA, type IIIB with major destruction of the fascia transversalis, and type IIIC were subjected to the McVay technique. RESULTS: Seventy-five hernias were corrected using the McVay technique. Only two recurrences (2.67%) were observed in this group. For group Bassini, two recurrences for 69 hernias (2.89%) were observed (p=0.658). Mean age for the recurrent group was 56 years. No differences were observed between the ages of males and females (52 years). CONCLUSIONS: Non-mesh repair in inguinal hernia can be safely used if performed by experienced surgeons.

Quantitative and qualitative analysis of collagen types in the fascia transversalis of inguinal hernia patients

BACKGROUND: Inguinal hernia is the second most common surgical case in our field. The anatomical factors alone are not enough to explain the inguinal hernia. Studies show changes in the proportion and quantity of collagen fibers in the developing of inguinal hernia. The greater production of collagen type III compared to the type I could justify the thinning of the fascia transversalis and its weakness. AIM: To determine the quantitative and qualitative changes of collagen in the fascia transversalis in inguinal hernia patients and compare them to findings from corpses without inguinal hernia. METHOD: Prospective case-control study based on the biopsy of fascia transversalis of 27 patients and 24 corpses. The technique used was hematoxylin-eosin and picrosirius colorimetry. RESULTS: The medium percent area of collagen (types I + III) and collagen type I, in both groups, show no statistic difference. The quantity of collagen type III was greater in the patients. Patients classified with Nyhus IIIa presented greater quantity of collagen type III. CONCLUSION: There is no significant difference in the quantity of collagen in the fascia transversalis of patients compared to the controls. An increase in the quantity of collagen type III was found in patients with inguinal hernia and a greater quantity in those patients classified with Nyhus IIIa.