Inguinal Hernia Incarceration in the Setting of Postoperative Ileus.

Postoperative ileus (POI) occurs after gastrointestinal and other intra-abdominal surgeries, and its incidence rate is reported to range between 10 and 30% following major abdominal surgery. Should ileus remain for several days or if symptoms worsen despite management, further investigation is warranted to consider other diagnoses such as small bowel obstruction (SBO), intra-abdominal abscess, or perforation. The etiology of postoperative obstructive symptoms can evolve during the postoperative course and many possible factors contribute to postoperative gastrointestinal dysfunction. Prolonged POI may be a risk factor for hernia incarceration. We describe the case of a 72-year-old male with a history of perforated diverticulitis and Hartmann procedure status post-colostomy takedown complicated by prolonged POI for six days. Clinical workup revealed incarcerated inguinal hernia, which was treated with urgent inguinal hernia repair. Follow-up revealed resolution of gastrointestinal dysfunction within 48 hours of hernia repair.

Simulation study comparing the effectiveness of the Gynecare Morcellex®, the MOREsolution™, and the Rotocut™ G1 tissue Morcellators.

Laparoscopic surgery has revolutionized the manner in which many operations are performed today. The volume of tissue to be removed during some operations can be a limiting factor for laparoscopy and is frequently a reason for converting from a minimally invasive laparoscopic surgical approach to the conventional open surgical approach. The introduction of the electronic morcellator has helped facilitate the removal of large specimens via minimally invasive surgery. The purpose of this study is to evaluate the effectiveness of the Gynecare Morcellex® morcellator (Ethicon, Inc., Somerville, NJ), the MOREsolution™ morcellator (Blue Endo, Lenexa, Kansas), and the Rotocut™ G1 morcellator (Karl Storz, Tuttlingen, Germany) tissue morcellators based upon their ease of use and efficacy in a simulation setting among an unbiased cohort of novice surgeons. University of Central Florida College of Medicine students were observed using the three different morcellators in a randomized order on 250 g beef tissue models and were surveyed on the ease of use of the morcellators. The MOREsolution™ tissue morcellator demonstrated significantly faster tissue morcellation times (544.6 ± 123.0 sec) and produced a higher number of long tissue fragments (7.44 ± 0.683) compared to the Rotocut™ G1 morcellators' time (609.7 ± 153.2 sec) and number of long tissue fragments (6.00 ± 0.638). No significant differences were found between the Gynecare Morcellex® and other morcellators in the total number of fragments obtained nor study participant opinion on the ease of use of the three morcellators. This study demonstrates that the MOREsolution™ morcellator is a faster morcellator and produces larger tissue fragments as compared to the Rotocut™ G1; however, more studies should be performed to confirm these findings in a clinical setting.

A polymeric nanoparticle formulation of curcumin (NanoCurc™) ameliorates CCl4-induced hepatic injury and fibrosis through reduction of pro-inflammatory cytokines and stellate cell activation.

Plant-derived polyphenols such as curcumin hold promise as a therapeutic agent in the treatment of chronic liver diseases. However, its development is plagued by poor aqueous solubility resulting in poor bioavailability. To circumvent the suboptimal bioavailability of free curcumin, we have developed a polymeric nanoparticle formulation of curcumin (NanoCurc™) that overcomes this major pitfall of the free compound. In this study, we show that NanoCurc™ results in sustained intrahepatic curcumin levels that can be found in both hepatocytes and non-parenchymal cells. NanoCurc™ markedly inhibits carbon tetrachloride-induced liver injury, production of pro-inflammatory cytokines and fibrosis. It also enhances antioxidant levels in the liver and inhibits pro-fibrogenic transcripts associated with activated myofibroblasts. Finally, we show that NanoCurc™ directly induces stellate cell apoptosis in vitro. Our results suggest that NanoCurc™ might be an effective therapy for patients with chronic liver disease.