Successful surgical management of ruptured umbilical hernias in cirrhotic patients

Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual,but potentially lifethreatening complication,with postoperative morbidity about 70% and mortality between 60%-80% after supportive care and 6%-20% after urgent surgical repair.Management options include primary surgical repair with or without concomitant portal venous system decompression for the control of the ascites.We present a retrospective analysis of our centre's experience over the last 6 years.Our cohort consisted of 11 consecutive patients(median age:53 years,range:36-63 years) with advanced hepatic cirrhosis and refractory ascites.Appropriate patient resuscitation and optimisation with intravenous fluids,prophylactic antibiotics and local measures was instituted.One failed attempt for conservative management was followed by a successful primary repair.In all cases,with one exception,a primary repair with non-absorbable Nylon,interrupted sutures,without mesh,was performed.The perioperative complication rate was 25% and the recurrence rate 8.3%.No mortality was recorded.Median length of hospital stay was 14 d(range:4-31 d).Based on our experience,the management of ruptured umbilical hernias in patients with advanced hepatic cirrhosis and refractory ascites is feasible without the use of transjugular intrahepatic portosystemic shunt routinely in the preoperative period,provided that meticulous patient optimisation is performed.

灾害事件后如何认知遗产——基于瑞典森林火灾后的风景研究

【目的】旨在从风景变化的角度阐述如何认识森林火灾后的风景遗产,揭示塑造风景的多种因素,并探讨风景的定义及其自明性。【方法】运用案例分析了瑞典韦斯特曼兰地区风景变化的驱动因素,并从过去的联系和未来的遗产两个方面来讨论与火灾地区相关的遗产话语的发展。【结果】风景作为特质和遗产的载体及来源,其特征是自然或人为因素相互作用和互动的结果。瑞典韦斯特曼兰地区风景变化的驱动因素受风景管理的影响和界定。【结论】在森林火灾后,自然保护区的设置延续了火灾的遗产,但对于象征重新焕发活力和创造新事物的火灾区域,应了解当地居民的价值观和愿望,并结合其他利益相关者如“外部参与者”的意见,以确定灾后风景遗产的保护目标。