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3- OUTCOME OF LARGE INCISIONAL HERNIA REPAIR WITH POLYPROPYLENE MESH

Authors: Safwan A Taha --- Mazin H Alhawaz --- Nezar A Almahfooz --- Sadiq Galib Kadum
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2009 Volume: 15 Issue: 1 Pages: 8-19
Publisher: Basrah University جامعة البصرة

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Abstract

Incision hernia remains a frequent complication of abdominal surgeries with a reportedincidence of (2-20%). Repair of large incision hernia is a difficult surgical problem with short andlong term complications, severity of these complications are related in part to the type ofoperative technique adopted.The aim of this study is to evaluate the outcome of repair of large incision hernia with the (onlaytension free) mesh technique.This is a retrospective study includes 46 patients who underwent mesh repair for large incisionhernia during the period from January 1997 to December 2004. The operations were done bythe same surgeon and by the same procedure (i.e; onlay tension free polypropylene mesh withtwo points fixation). Data regarding relevant patients with big ventral incision hernia with (onlaymeshrepair) in Basrah teaching hospital and private hospital were revised. The presentingcondition, hernia description, associated systemic and local factors, procedure of repair andfollow up duration were all taken in consideration. Possible complications like; hematoma,seroma, wound infection, intestinal obstruction and enterocutaneous fistula were recorded anddiscussed once they occurred. The follow up period ranged from 4 to 21 months.Forty six patients were included in the study: 20 females and 26 males with median age of 50.5year (range 35-68 year). Eleven patients (23.91%) were overweight and had body mass index"BMI" equal to more than 30, four patients (8.69%) had controlled diabetes mellitus, five(10.86%) had controlled hypertension and two (4.34%) suffered from chronic obstructive air waydisease, there were eleven smokers (23.91%). Sixteen patients made regular visits thatextended up to 12 months, 12 patients made regular visits up to 6 months, one made regularvisits up to 18 month mainly due to partial intestinal obstruction., one patient was followed-up to17 month because of multiple wound sinuses while 8 patients made irregular visits up to 21month due to causes other than the hernia, eight patients lost from follow-up after 4 months.The original operation was bowel related in 18 cases, gynecological in twelve,hepatopancreatobiliary in 10, repair of paraumbalical hernia in six patients. The old incisionswere long midline in 23 cases, paramedian in 17 and transverse in six patients. The mainpostoperative complications were seroma formation (13.04 %), wound haematoma (6.52 %),wound infection (4.34 %). no recurrence of hernia and no enterocutanous fistula were reportedduring our follow-up period.In conclusion, tension free onlay mesh repair is a feasible operative procedure for repair of largeincision hernia with no significant major morbidity.


Article
EVALUATION OF THE P53 GENE EXPRESSION IN BREAST CANCER IN RESPECT TO AGE, GRADE, STAGE AND LYMPH NODES

Authors: Haider Kahdim Abdul-Razaq --- Mazin H Alhawaz --- Noori H Jasim Al-Echrish
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2016 Volume: 22 Issue: 2 Pages: 17-25
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract It is previously reported that cancer prognosis is affected by mutations of P53 gene. However, the prognostic significance of P53 mutated gene detection in breast cancer is a subject demanding numerous investigations in a view of numerous facts such as presence of different tumor subtypes, P53 positivity in early breast cancer, different overall survival and disease free period as well as variability of tumor response to chemotherapeutic agents and presence of primary resistance of tumor among patients whether same or different grade and stage. Hence, it is of interest to detect this mutated gene in our area and evaluate its relation to other prognostic factors in terms of age, stage, histological grade and lymph node status. This study aimed to evaluate the relation of P53 mutated gene expression in female with breast cancer in respect to the other prognostic factors such as age, grade, stage and lymph node status. Fifty female patients diagnosed as a breast cancer, underwent clinical and pathological staging (I,IIA,IIB,IIIA,IIIB,IIIC, and IV), histopathological grading (I,II,III). All patients underwent same surgical operation which was modified radical mastectomy and axillary dissection. All specimens were sent to histopathological study and P53 mutated gene detection study by using immunohistochemistry (IHC). P53 mutated gene was detected by immunohistochemistry in 72% of patients with breast cancer. P53 positivity showed a statistically significant direct proportion to histological grade, stage and lymph node status. In addition, more P53 mutated gene expression was detected in younger patients (age group ≤49 years old) and this probably explaining more advance stage observed in this group in this study. All these data leads to a conclusion that the presence of mutated p53 gene is associated with worse prognosis. This study detected P53 mutated gene by IHC for the first time in our region and showed a statically significant association between status of P53 gene mutations and the other prognostic factors such as age, histological grade, stage and lymph node status and consequently to tumor aggressiveness and thereafter to prognosis.

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