The literature shows many different approaches for treatment of perineal hernia, such as open or laparoscopic mesh repair, and perineal, abdominal or combined access. Our case confirms that primary closure of the hernial orifice through an abdominal approach is also feasible.
Taking into account duration of incapacity, general patient satisfaction and recurrence rate, the radical excision method with subsequent open wound granulation provides a reasonable alternative to closed methods. But a definitive assessment of the advantages of the open method with respect to these criteria must await the results of prospective randomized series.
When an ileostoma is performed on rats, they usually die as a result of cachexia, which is caused by poor utilization of ingesta on account of rapid intestinal transit times. Assuming that oral administration of hydrophilic substances would prolong this transit and thereby the time of survival, rats with an ileostoma were fed a newly developed organic monomer. Its capacity to bind water is about 100 times its own weight. This substance was supplemented with standard diet of different concentrations. A much firmer fecal consistency resulted when 33% monomer was added to the diet. Animals fed a diet containing 50% monomer produced well-formed feces. There was no difference in survival time of the animals on a normal diet. furthermore, administration of a special hypercaloric diet did not cause a prolonged survival time. The reasons and possible therapeutic implications for patients with an ileostoma are discussed.
Improved healing results are achieved by surgical treatment of fractures of the lumbar spine and of the thoracic transition, if the indication is correct, i.e. in case of splintered fracture with severe instability or neurologic troubles, but also in case of luxations occurring rarely in the region of the lumbar spine. The anterior fusion of fractions with bone defects in the region of the vertebral body is more logical with regard to the biomechanical aspect.
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