Croat Med J

Todays controversies in hernia surgery.

Amid PK.
Lichtenstein Hernia Institute, 9201 Sunset Boulevard, Suite 505, Los Angeles, 90069, CA, USA.
For more than a century, since the introduction of modern hernia repair by Basinni, technical aspects of hernia surgery have been surrounded by controversies. The purpose of this article is to examine these controversies with special attention to (a) mechanical versus degenerative nature of hernias, (b) traditional tissue approximation repair (tension repair) versus tension-free mesh repair, (c) patch or plug repair, and (d) open versus laparoscopic approach. It is concluded that the concept of open tension-free hernioplasty, utilizing a patch of appropriate synthetic material through an anterior approach, is a potential resolution of the controversies that have surrounded the subject of hernia surgery for more than a century.

Carcinoembryonic antigen (CEA) in colonic inflammatory-regenerative and dysplastic epithelial lesions.

Radovic S. Selak I. Babic M. Pasic F.
Institute of Pathology, Sarajevo University School of Medicine, Bolnicka 8, Sarajevo, 71000, Bosnia and Herzegovina. nosovic@un.org
AIM: Immunohistochemical study of carcinoembryonic antigen (CEA) distribution in inflammatory-regenerative and dysplastic changes of bowel mucosa. The relationship between the presentation of CEA and the intensity of inflammatory-regenerative and dysplastic processes in the flat colon mucosa was also examined. METHODS: Biopsy specimens from 105 patients were examined: 45 classified as inflammatory-regenerative and 60 as dysplastic (21 mild, 23 moderate, and 16 severe dysplasia). The expression of CEA was assessed on the basis of location, quantity, and intensity of CEA immunostaining, by counting antigen-positive cells, and the presence of antigen in the lumen of crypts and glycocalyx on the surface of the mucosa. Using a semiquantitative method, antigen staining intensity was defined as weak, moderate, and intense. RESULTS: The quantity of CEA in columnar, goblet mucous, and undifferentiated cells, as well as in the glycocalyx on the surface of the mucosa and in the crypts' content increased proportionally with the intensity of epithelial dysplasia. In inflammatory-regenerative lesions, CEA was located in the apical and supranuclear part of the cytoplasm, and in the dysplastic mucosa, in lateral and basal parts of the cells. CONCLUSION: The quantity of immunohistochemically demonstrable CEA and its intracellular distribution changed in the colon mucosa during the transition from regenerative to dysplastic epithelial lesions. The intensity of CEA expression was closely related to the intensity of dysplastic lesion.