Closed-incision negative-pressure therapy decreases complications in ventral hernia repair with concurrent panniculectomy.

PURPOSE: Ventral hernia repair with concurrent panniculectomy (VHR-PAN) is associated with high wound complication rates despite reported increased patient satisfaction. Some surgeons believe negative-pressure therapy after primary closure of the surgical incision (ciNPT) may lower wound complications in high-risk abdominal wounds. This study aims to evaluate if ciNPT improves outcomes in patients undergoing VHR-PAN. METHODS: An 8-year retrospective cohort study was performed on patients who underwent VHR-PAN. Patients were divided into two groups: those who received closed-incision negative-pressure therapy ("ciNPT") and those who received standard sterile dressings ("SSD"). The primary outcome of interest was the rate of postoperative complications between these groups. Complications were subdivided into surgical site occurrences (which included surgical site occurrences that required an intervention), return to the operating room, and hernia recurrence. RESULTS: A total of 104 patients were analyzed: 62 in the ciNPT group and 42 in the SSD group. Median follow-up duration was similar between both groups (182 days vs 195 days, p = 0.624). Patients in the ciNPT group had fewer total complications (57% vs. 83%, p = 0.004) and fewer SSO (47% vs. 69%, p = 0.025). However, no differences were noted when comparing individual complications (SSI, wound dehiscence, skin necrosis, chronic wound, seroma, and hematoma). There was no difference in return to the operating room (27% vs. 26%, p = 0.890) or hernia recurrence (21% vs 19%, p = 0.811). Multivariate analysis showed that ciNPT decreased the risk of SSOPI nearly fourfold (odds ratio 0.28, 95% CI = 0.09-0.87, p = 0.027). CONCLUSIONS: This study showed that closed-incision negative-pressure therapy in ventral hernia repair with concurrent panniculectomy may decrease the rate of wound complications in this high-risk population.

Helicobacter pylori infection: old and new.

Helicobacter pylori is a spiral-shaped bacterium that grows in the digestive tract and may be present in more than half of the world's population. The clinical features of Helicobacter pylori range from asymptomatic gastritis to gastrointestinal malignancy. Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade B-cell marginal zone lymphoma and Helicobacter pylori has been detected in more than 75% of the patients with MALT lymphoma. Many tests for the detection of Helicobacter pylori are available, including antibody tests, urea breath tests, stool antigen tests and endoscopic biopsies. The eradication of Helicobacter pylori usually prevents the return of ulcers and ulcer complications even after appropriate medications such as PPIs are stopped. The eradication of Helicobacter pylori is important in the treatment of the rare condition of the stomach known as MALT lymphoma. The treatment of Helicobacter pylori to prevent stomach cancer is controversial. Confirmation of eradication is recommended in associated ulcers, persistent dyspepsia despite a test-and-treat approach, MALT lymphoma, and previous treatment for early-stage gastric cancer. The urea breath test and stool antigen test can be used to confirm the eradication and should be performed at least 4 weeks after the completion of therapy. Several diseases have been reported to be associated with Helicobacter pylori infection, including hematologic diseases, such as ITP, idiopathic iron deficiency anemia and vitamin B12 deficiency. There is a positive trend in the association between Helicobacter pylori infection and neurodegenerative disorders and new data showed a reduced risk of death due to stroke and lung cancer but an increased risk of preeclampsia in infected women, which requires further investigations.

Hepatitis C treatment & management.

Combination therapy with pegylated interferon alfa (PEG-IFN alfa) and the nucleoside analogue ribavirin is the current standard of care in patients infected with hepatitis C virus (HCV). Patients with HCV genotype 1 have a much less favorable response to therapy and are treated for 12 months, compared with patients infected with genotypes 2 and 3, in whom a 6-month course of therapy is sufficient. If viremia is present after 6 months, additional therapy has a negligible benefit, and treatment should be stopped in all patients regardless of the viral genotype. With HIV coinfection, all patients with a response to therapy at the end of 6 months should receive an additional 6 months of combination therapy regardless of the genotype. Patients with acute HCV infection should be treated for 6 months. The addition of protease inhibitors to the combination of PEG-IFN alfa and ribavirin is becoming the new standard of care for the treatment of chronic HCV infection. Regimens that include a protease inhibitor significantly improve sustained virologic response rates in patients with genotype 1 HCV infection.

[Research on the occurrence of functional anomalies of the peripheral bronchi (small bronchi disease) in workers in a factory with respiratory noxious substances]. / Cercetari asupra frecventei anomaliilor functionale în bronhiile periferice (boala bronhiilor mici) la muncitorii dintr-o întreprindere cu noxe respiratorii.

A group of 908 subjects has been studied, of which two-thirds were males, classified in 5 categories: unexposed, with light exposure, and severely exposed to inhalation of volatile substances, or various types of dust. A B.M.R.C. file was filled for each of the subjects. This file concerns respiratory symptoms. A forced expirogram was also performed, and FEV 25-75%, FEV 75-85%, and TEM were determined. The two expiratory flows (median and final) are frequently disturbed in subjects without respiratory symptoms, more frequently in smokers with a normal FEV 1. In those exposed to respiratory risk the proportion of alterations increases, but association of smoking with inhalation of noxious chemical substances will determine a modification of FEW 1 and anomalies of the peripheral bronchi occur more frequently in smokers. Between the criteria suggesting the presence of small airways disease, the ratio FEV 25-75% under 60%, with a FEV 1/FVC ratio within normal limits, this being the most sensitive of the criteria, also appears as the most reliable.

[Long-term study of the evolution of chronic bronchitis detected by questionnaire 10 years earlier]. / Studiu longitudinal asupra evolutici bronsitelor cronice, depistate prin chestionar cu 10 ani anterior.

The longitudinal study carried out in a group of inhabitants from Craiova showed that 16,2% of these, classified according to previously filled questionnaires as suffering from chronic bronchitis, and 10,7% of those classified as suffering from minor forms of bronchitis (sporadic symptoms) had died, and one third of them were not found when the investigation was repeated. Re-examination of 106 adults with chronic bronchitis showed that the symptoms had disappeared in two-thirds of them, especially in those who gave up smoking; in 19,8% of them the symptoms had become more severe due to repeated attacks. Bronchial obstruction was present in 36% of the cases, and alterations in the small bronchial ducts were present in two-thirds of the patients. In 18-24% of the patients with minor forms of bronchitis the symptoms were more severe and chronic, and they can be classified as chronically ill patients. Frequently there were altered spirographic values. This study demonstrates that chronic bronchitis may evolve to: a) remission of the symptomatology (especially after suppression of smoking); b) more or less unmodified persistence of symptoms; c) increased severity of the symptoms following repeated acute attacks. Almost 25% of cases with sporadic coughing and expectoration became chronically ill over a period of 10 years. The questionnaire was demonstrated as having retrospective value for making a diagnosis of chronic bronchitis, but cough and expectoration are not sufficient for a differential assessment of the evolution, the spirographic data being of decisive importance.