Neurofibromas are generally well-circumscribed tumors of the nervous system, often found in association with neurofibromatosis 1 (NF1). They uncommonly present as a single sporadic form in the retroperitoneum and in the pancreas. We present a case of a 40-year-old man who presented with a 4- to 5-year history of right upper quadrant pain with associated nausea and vomiting. Medical imaging showed a 3.8 by 3.4-cm mass encasing the hepatic artery and the porta hepatis. Surgical resection was performed, with removal of the gallbladder. The mass was histologically diagnosed as a neurofibroma. At 1 year following his surgery, the patient is doing well.

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The polyethylene surfaces of four metal on plastic prosthetic knee joints were cpmpared w i t h those of four h i p j o i n t replacements, by the use of scanning electron microscopy. T h e acetabular components o f the h i p j o i n t s showed concentric machining marks, b u t were generally smooth, and in some areas plastic deformation of the articular surface was evident after 24 months' use. In contrast, the tibial components of knee j o i n t s removed after 12 t o 22 months showed deep scoring and p i t t i n g near the centre of t h e i r articular surfaces. T h i s appeared t o be due t o abrasion by a t h i r d material, possibly fragments of cement, which sometimes became embedded in the j o i n t surface. These results indicate t h a t wear in prosthetic knee joints may be much more rapid t h a n in h i p Joint replacements made f r o m similar materials.

Operative classification of ventral abdominal hernias: new and practical classification. Yasser Selim. From the Ministry of Health.Background: Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system for ventral hernias. One of the more accepted classification systems is that of the European Hernia Society (EHS). Its limitation is that it does not include individual patient risk factors and wound classification. The aim of this work was to find out the basic principles of hernia etiology and pathogenesis, clarify the factors that are important in treatment of ventral hernias, and categorize hernia patients according to those factors. Methods: This retrospective study included 238 patients who presented to our surgery department between 2010 and 2020. A full description of ventral hernias was made, including their type according to the EHS. In addition, abdominal wall components were assessed, including strength of rectus muscles, lateral abdominal muscles, and abdominal fascia, namely the linea alba. Patients with spontaneous hernias were grouped according to the size of the defect and the condition of the rectus abdominis muscles, the fascia and other abdominal muscles. Results: Patients were put into 6 clinical categories: type 1A, type 1B, type 2, type 3, type 4, and type 5. The grouping of patients was done according to the factors we believed affect the choice of surgical procedure and the prognosis of repair. Patients with types 1 and 2 have normal abdominal muscles, whereas those with types 3 and 4 have weak muscles and weak stretched fascia (linea alba). Type 5 includes incisional hernias. Conclusion: The primary purpose of any classification should be to improve the possibility of comparing different studies and their results. By describing hernias in a standardized way, different patient populations can be compared. Numerous classifications for groin and ventral hernias have been proposed over the past 5-6 decades. For primary abdominal wall hernias, there was agreement with EHS classification on the use of localization and size as classification variables.

linked, porcine pericardial patch (dCELL, Tissue Regenix, UK).Methods: Informed consent was obtained. Elective FEA with dCELL patch closure was performed using standard technique. Postoperative examination and Doppler ultrasound was performed at 1, 3, 6, and 12 months.Results: 21 patients participated; all were examined at 6 months and 18 were followed at 12 months (86%). 64% were active smokers; 27% had diabetes; 55% had previous vascular procedures. Mean time to hemostasis was 3.5 Ϯ 2.1 min. Handling characteristics were considered excellent. There was one wound hemorrhage requiring reoperation, not due to the patch. There was one superficial wound infection not related to the patch. There was one early asymptomatic occlusion (22 d) associated with an occluded profunda. In mid-term followup, 4 patients developed non-flow-limiting neointimal hyperplasia Ͼ2mm; mean neointima was 0.78mm. Mean mid-patch PSV was 93.3 cm/s at 12 months which was similar to 90.18 cm/s at 1 month; there was no change in mid-patch neointima at 1 and 6 months (diameter 9.22 Ϯ 0.22 mm vs. 8.99 Ϯ 1.31 mm, pϭ0.583). No aneurysmal dilation occurred (mean internal diameter 8.12 cm vs. 8.39 cm proximal, pϭ0.71). In 56% it was impossible to distinguish the patch wall due to remodelling. There were no pseudoaneurysms.Conclusions: dCELL porcine pericardial patches are safe and effective for patch angioplasty, with minimal restenosis and excellent tissue incorporation. dCELL patches may be a platform for next-generation tissue-engineered closure devices.

Background: The Continuing Professional Development (CPD) (Education) Committee of the Canadian Association of Thoracic Surgeons (CATS) has established a goal of describing the essential knowledge of thoracic surgery. We aimed to develop a national standardized set of undergraduate learning objectives for thoracic surgery. Methods: We obtained these learning objectives from 4 medical schools in Canada. These 4 institutions were selected to provide a broad geographical representation of medical schools of varying sizes and of both official languages. The resulting list of learning objectives underwent critical review by the CPD (Education) Committee, made up of 5 Canadian community and academic thoracic surgeons, 1 thoracic surgery fellow and 2 general surgery residents. A national survey was developed and circulated to all CATS members ( n = 209). Respondents were asked to indicate on a 5-point Likert scale whether each objective should be a priority for all medical students. Results: Among 209 CATS members, 56 responded (response rate 27%). The mean length of experience in clinical practice among survey respondents was 10.6 (standard deviation 10.0) years. Respondents most commonly reported teaching or supervising medical students monthly (37.0%), followed by daily (29.6%). Eight of the 10 proposed objectives received a mean Likert score of 4/5 or higher and were selected for inclusion in the final list. A finalized list of 8 learning objectives was created, following a final review from the CATS Executive Committee. Conclusion: We developed a standardized set of learning objectives for medical students that was reflective of the core concepts within thoracic surgery.