Sebastian Freudenberg

Commercial Mesh versus Nylon Mosquito Net for Hernia Repair. A Randomized Double-blind Study in Burkina Faso

PurposeThe goal of this study was to investigate whether locally available Nylon mosquito net might be a useful alternative to expensive commercial mesh implants for hernia repair, a clinical randomized double-blind study was performed.Materials and MethodsOver a period of 3 months 35 patients with a total of 40 inguinal hernias were randomized for hernia repair with either a commercial graft (Ultrapro®) or a piece of sterilized 100% Nylon mesh available as mosquito net in most African village markets. The surgeons’ comfort in handling the meshes, the incidence of complications, and the patients’ quality of life before and 30 days after hernia repair were evaluated. In addition, the costs of the two materials were compared.ResultsThere was no significant difference in the clinical short-term outcome of the hernia treatment or the surgeons’ comfort in handling the two different materials. The price of the locally bought Nylon mesh was 0.0043 US

Biodegradation of absorbable sutures in body fluids and pH buffers

as compared to 108 US

Sterilized Mosquito Net versus Commercial Mesh for Hernia Repair

for the commercial mesh.ConclusionsIn situations where superior results of hernia repair depend on the use of a mesh prosthesis but where commercial material is not available or affordable, the use of Nylon mosquito net may be an alternative. Further studies with a larger number of patients and longer follow-up are justified and recommended.

HIV-related and Epstein-Barr virus-associated anal Burkitt's lymphoma: report of a case.

Objective: This study measures the influence of body fluids on the loss of tensile strength of absorbable sutures in vitro. Methods: Nine synthetic absorbable sutures were incubated in different gastrointestinal fluids, as well as in blood and three buffers. Stretch tests were performed after days 0, 7, 14, and 21. Results: Tensile strength varied from 18.5 to 32.8 N, and elasticity varied from 9.5 to 51% of the initial length. The influence of pH, blood, and gastric juice was negligible on all sutures except PDS II®. Except for Monocryl®, all sutures, especially Polysorb® and Vicryl®, lost tensile strength much faster in bile, jejunal and pancreatic juices than in the corresponding buffers. Conclusion: The biodegradation of sutures varies greatly in different body fluids independent of differences in pH.

Fishing Line Suture: Cost-saving Alternative for Atraumatic Intracutaneous Skin Closure—Randomized Clinical Trial in Rwanda

Background: In industrialized countries alloplastic meshes are routinely used for hernia repair. However, in developing countries they are rarely available or affordable. This study compares textile properties and tissue response of commercial polypropylene mesh (PM) vs. sterilized nylon mosquito net (MN). Methods: Textile properties were examined in vitro. In 12 goats one MN and one PM (5.5 × 8 cm) were implanted onto the posterior layer of the rectus sheath. Wound healing was clinically assessed. Histology was assessed after 4 or 16 weeks. Results: MN was thinner and lighter, but weaker than PM. All wounds healed without complications. After 16 weeks foreign body granulomas in the MN group contained a higher proportion of inflammatory tissue (32.7 vs. 22.1%) and more giant cells (3.1 vs. 1.7/10 granulomas) with a significantly lower partial volume of foreign body (23.2 vs. 36.9%). Partial volume of fibrotic tissue was similar. MN was 1,000-fold cheaper than PM. Conclusions: PM was superior concerning strength and extent of inflammatory response. However, the findings indicate that MN might serve as a cheap substitute if an alloplastic mesh is needed but no commercial one is available or affordable. Further studies are justified which should include mosquito nets of different materials and long-term outcome.

Local Application of Hyperthermia in the Esophagus with a Heatable Malleable Thermoplastic Stent

PURPOSEThis article describes and discusses primary Burkitt’s lymphoma of the anus which is an extremely rare site of origin.METHODS AND RESULTSA 38-year-old HIV+ Rwandan farmer had an 8-cm × 13-cm anal tumor. Histopathology and immunohistology provided evidence of an Epstein–Barr virus-associated Burkitt’s lymphoma. Chemotherapy in combination of virostatic therapy is the gold standard for treatment, but because of economic constraints surgical treatment was the only practicable intervention and an abdominoperineal resection of the anorectum was performed.CONCLUSIONSBecause of the AIDS epidemic and the increase of anal malignant pathologies, anal Burkitt’s lymphoma may appear more frequently. Adequate treatment is available for only a small percentage of patients.

Atraumatic intracutaneous skin closure with self-made fishing line suture compared to commercial thread

Experience with the use of nylon fishing line for surgical sutures has been reported from several African countries. A recent publication suggested that fishing line and an injection needle may provide an atraumatic suture that is especially suitable for intracutaneous skin closures. This article provides further empirical support for such alternative technology. We describe a randomized, blinded clinical trial conducted in Butare (Rwanda) with 220 cutaneous wounds closed by intracutaneous sutures, with either the homemade suture or a commercial nylon thread (Ethilon). We compared the clinical outcomes as well as the costs of those two materials. There are no significant differences between the two sutures in terms of clinical findings or in the reported ease of use by the surgeons. The cost of a homemade atraumatic suture is US

Small bowel intussusseption from malignant posttransplantation Non-Hodgkin’s lymphoma

0.07, which is less than one-thirtieth the cost of the commercial thread. The advantage of the commercial thread is the assurance of quality. We consider whether this quality assurance justifies the large price difference, and if the homemade suture should be recommended to surgeons in countries where the costs of surgical material often remain an obstacle for life-saving operations.

IDV-related and Epstein-Barr virus-associated anal Burkitt's Lymphoma: report of a case

Objective: This study measures the effect of hyperthermia applied through a heatable stent in the esophagus in order to investigate whether this procedure offers a therapeutic option for tumor treatment. Material and Methods: Thermoplastic malleable stents, with the capacity to be heated after implantation, were placed endoscopically in the middle third of the esophagi of 30 pigs. After placement the stents were heated in vivo for 60 min at temperatures ranging from 43 to 52°C. Temperature was measured in the surrounding tissue at various distances from the stent, determining heat penetration. The esophagi were histologically examined after 7 days. Results: The maximal heating temperature tolerated in the esophagi without transmural necrosis was 46.5°C, when applied twice for 60 min with a pause of 48 h. With this procedure a tumor damaging temperature of 42.5°C was achieved at a maximum distance of 12 mm surrounding the stent. Conclusion: Application of hyperthermia through a heatable stent in the esophagus is feasible. The maximal depth of therapeutic temperature achieved by this procedure (12 mm) is not sufficient to heal esophageal cancer, but may be of palliative value.