Hernia width explains differences in outcomes between primary and incisional hernias: a prospective cohort study of 9159 patients.

PURPOSE: Data on primary (PH) and incisional hernias (IH) are often pooled, even though several studies have illustrated that these are different entities with worse outcomes for IHs. The aim of this study is to validate previous research comparing PHs and IHs and to examine whether hernia width is an important contributor to the differences between these hernia types. METHODS: A registry-based, prospective cohort study was performed, utilizing the French Hernia Club database. All patients undergoing PH or IH repair between September 8th 2011 and May 22nd 2019 were included. Baseline, hernia and surgical characteristics, and postoperative outcomes were collected. Outcomes were analyzed per width category (≤ 2 cm, 3-4 cm, 5-10 cm and > 10 cm). RESULTS: A total of 9159 patients were included, of whom 4965 (54%) had PH and 4194 (46%) had IH. PHs and IHs differed significantly in 12/15 baseline characteristics, 9/10 hernia and surgical characteristics, and all outcomes. Overall, complications and re-interventions were more common in patients with IH. After correcting for width, the differences between PH and IH were no longer significant, except for medical complications, which were more common after IH repair compared to PH. CONCLUSION: After correcting for hernia width, most outcomes do not significantly differ between PH and IH, indicating that not hernia type, but hernia width is an important factor contributing to the differences between PH and IH.

Incidence, risk factors and prevention of stoma site incisional hernias: a systematic review and meta-analysis.

AIM: Stoma reversal might lead to a stoma site incisional hernia. Recently, prophylactic mesh reinforcement of the stoma site has gained increased attention, supporting the need for accurate data on the incidence of and risk factors for stoma site incisional hernia and to identify high-risk patients. The aim of this study was to assess incidence, risk factors and prevention of stoma site incisional hernias. METHOD: Embase, MEDLINE, Web of Science, Cochrane and Google Scholar databases were searched. Studies reporting the incidence of stoma site incisional hernia after stoma reversal were included. Study quality was assessed with the Newcastle-Ottawa Scale and Cochrane risk of bias tool. Data on incidence, risk factors and prophylactic mesh reinforcement were extracted. RESULTS: Of 1440 articles found, 33 studies comprising 4679 reversals were included. The overall incidence of incisional hernia was 6.5% [range 0%-38%, median follow-up 27.5 (17.54-36) months]. Eleven studies assessed stoma site incisional hernia as the primary end-point, showing an incidence of 17.7% [range 1.7%-36.1%, median follow-up 28 (15.25-51.70) months]. Body mass index, diabetes and surgery for malignant disease were found to be independent risk factors, as derived from eight studies. Two retrospective comparative cohort studies showed significantly lower rates of stoma site incisional hernia with prophylactic mesh reinforcement compared with nonmesh controls [6.4% vs 36.1% (P = 0.001); 3% vs 19% (P = 0.04)]. CONCLUSION: Stoma site incisional hernia should not be underestimated as a long-term problem. Body mass index, diabetes and malignancy seem to be potential risk factors. Currently, limited data are available on the outcomes of prophylactic mesh reinforcement to prevent stoma site incisional hernia.

Unexpected urinary Schistosoma infection in a Belgian travel group returning from Malawi.

Urinary schistosomiasis, caused by Schistosoma haematobium, is a prevalent parasitic infection in certain areas of Africa and the Middle East. Humans can be infected by cercariae when they are in contact with contaminated freshwater. The adult worms reside in the veins of the vesical and pelvis plexuses. The urinary bladder, the seminal vesicles and the lower ends of the ureters are the most commonly affected organs. In this case report, we describe an unrecognised case of urinary schistosomiasis in a woman who was part of a Belgian travel group; two other patients out of eight were also infected. In Belgium, the number of reported cases of S. haematobium infection is limited. The aim of this report is to emphasize this parasitic infection should be suspected in patients who travel to endemic areas.

Interlaboratory comparison of the determination of chlorinated dibenzo-p-dioxins and dibenzofurans according to regulatory methods EN 1948 and EPA 1613b.

Four laboratories participated in a collaborative study to determine differences in analytical results generated according to two different compliance methods, US EPA Method 1613b and European Union Method EN 1948 for the determination of chlorinated dibenzo-p-dioxins and dibenzofurans (CDD/CDFs). Various sample matrices containing the analytes at levels ranging from parts-per-quadrillion (ppq) to parts-per-billion (ppb) were used to illustrate differences and similarities between the two analytical methods. The choice of the sample matrices analyzed in this study was made to mirror many of the real-world samples that are of interest to Dow and also to test the laboratories on many different, complex matrices. For this reason, commercially available performance evaluation samples were not used. The study results indicate that the 1613b requirement for confirmation of analyte identity and concentration on a second, polar gas chromatographic column for 2378-tetrachlorodibenzofuran (TCDF) only may lead to quantitative results which are biased high compared to EN 1948 which additionally requires confirmation for all 2378-substituted tetra--through hexachlorodibenzo-p-dioxins and dibenzofurans.

Both CD34+38+ and CD34+38- cells home specifically to the bone marrow of NOD/LtSZ scid/scid mice but show different kinetics in expansion.

Human hemopoietic stem cells (HSC) have been shown to engraft, differentiate, and proliferate in the hemopoietic tissues of sublethally irradiated NOD/LtSZ scid/scid (NOD/SCID) mice. We used this model to study homing, survival, and expansion of human HSC populations from different sources or phenotype. We observed that CD34+ cells homed specifically to bone marrow (BM) and spleen, but by 3 days after injection, survived only in the BM. These BM-homed CD34+ cells proliferated intensively and gave rise to a 12-fold, 5.5-fold, and 4-fold expansion in 3 days for umbilical cord blood, adult mobilized peripheral blood, and adult BM-derived cells, respectively. By injection of purified subpopulations, it was demonstrated that both CD34+38+ and CD34+38- umbilical cord blood HSC homed to the BM and expanded. Importantly, kinetics of expansion were different: CD34+38+ cells started to increase in cell number from day 3 onwards, and by 4 wk after injection, virtually all CD34+ cells had disappeared. In contrast, CD34+38- cells remained quiescent during the first week and started to expand intensively from the third week on. In this paper, we have shown that homing, survival, and expansion of stem cells are three independent phenomena important in the early phase of BM engraftment and that kinetics of engraftment differ between CD34+38+ and CD34+38- cells.

De novo 46,XX, dir dup (11)(q133.3-->q14.2) in a patient with mental retardation, congenital cardiopathy and thrombopenia.

A 31-year-old female is reported with mild to moderate mental retardation, facial dysmorphy, congenital cardiopathy, and mild thrombocytopenia as the most important clinical findings. Chromosome analysis in lymphocytes showed a de novo dir dup (11)(q13.3-->14.2), by both G-banding and FISH techniques. Previously reported constitutional duplications of 11q are mostly the result of unbalanced translocations involving chromosome 11q, and are associated with a partial monosomy or trisomy of the translocation partner chromosome. In case of an unbalanced translocation it is not clear which clinical findings result from the chromosome 11 duplication and which result from the abnormality on the translocation partner chromosome. This is the first report on a constitutional duplication of chromosome region 11q13.3-->14.2 without involvement of other chromosomes.

Anaesthesia-free extracorporeal shock wave lithotripsy in patients with renal calculi.

Modern extracorporeal shock wave lithotripsy can be performed with combined ECG and respiratory triggered shock wave release. Disconnecting the ECG triggering increases the risk of ventricular arrhythmias, including potentially malignant ones. The aim of this study was to assess the relationship of any sympatho-adrenal excitation as a possible explanation for the occurrence of cardiac arrhythmia. Plasma catecholamine levels were assessed in 5 patients during and after 50 min of anaesthesia-free extracorporeal shock wave lithotripsy for the treatment of calculi in the upper pole of the left kidney. Venous blood sampling showed no significant increase in catecholamines (epinephrine, norepinephrine and dopamine) during or after treatment. The heart rate and arterial blood pressure were measured simultaneously and showed no significant increase when shock waves were released during ECG triggering. However, when disconnecting the ECG-triggering mode, the incidence of ventricular extrasystoles on Holter monitoring became more apparent during respiratory triggered shock wave release only, although there was no rise in plasma catecholamine levels. These data suggest that cardiac arrhythmias are related to direct and accidental mechanical stimulation of the heart rather than to any sympatho-adrenal discharge during shock wave release.

Aortofemoral reconstruction for multilevel disease: a prospective hemodynamic study.

A prospective study was undertaken to evaluate the clinical and hemodynamic effects of aortofemoral Dacron reconstruction in patients with multilevel disease (i.e. aortoiliac and femoropopliteal occlusive disease). Thirty nine patients underwent, apart from clinical evaluation, segmental plethysmography and Doppler pressures before operation, immediately after operation and again at 3 and 6 months. All patients improved by the reconstruction, but 12 (31%) continued to complain of disabling claudication during normal daily activities. The mean ankle pressure and thigh pressure index improved by 37.5%. This was accompanied by a decrease of peak flow time, an increase of peak flow and an improved recovery during reactive hyperemia. Furthermore an additional significant rise of the ankle pressure index was noted between 3 and 6 months. Continuing claudication was always associated with both initial and late hemodynamic failure (the criterium for hemodynamic success was defined as an increase of the ankle pressure index with more than 0.1). Hemodynamic success resulted unvariably in clinical success. However 4 patients were clinically symptomfree, although they had to be classified as hemodynamic failures. It is concluded that a significant number of patients fail to obtain complete relief after proximal reconstruction. Preoperative hemodynamic studies may provide additional information, but hemodynamic and clinical results do not always correlate with each other.

Transabdominal or retroperitoneal approach to the aorto-iliac tract: a pulmonary function study.

An unselected consecutive series of 30 males, receiving an aorto-bifemoral Dacron graft for occlusive arterial disease, were randomised preoperatively to a transperitoneal or extraperitoneal approach. Pulmonary function tests (Forced Vital Capacity--Forced Expiratory Volume at 1 s) were performed once preoperatively and repeated four times postoperatively. As far as pulmonary function tests are concerned the results clearly demonstrated the superiority of the retroperitoneal to the transperitoneal approach. It is therefore recommended that the extraperitoneal approach should be used more frequently in reconstructive aorto-ilio-femoral surgery.

Intravenous digital subtraction angiography and Duplex scanning in the detection of late human umbilical vein degeneration.

To define the exact incidence of late degeneration, 32 patients underwent intravenous digital subtraction angiography (IVDSA) and/or a Duplex scan more than 3 years after human umbilical vein (HUV) grafting. IVDSA (n = 26) showed a 23 per cent aneurysmal degeneration rate which increased to 40 per cent with Duplex scanning (n = 25). Although the differences obtained in those patients receiving both examinations (n = 19) were statistically not significant, Duplex scanning appeared to be more sensitive, demonstrating two additional cases of aneurysmal degeneration not detected by IVDSA. Since, moreover, Duplex scanning proved able to detect anastomotic stenosis, it appears to be the examination of choice in long-term follow-up of the HUV graft. Despite this relatively high degeneration rate, the authors consider continued use of the HUV graft in selected patients to be justified, especially when the long-term patency rates, the available alternatives, and the less favourable long-term survival after femoropopliteal reconstruction are taken into consideration.

Extensive aorto-ilio-femoral endarterectomy with LeVeen plaque cracker.

The authors present a series of 98 patients, who underwent an aorto-ilio-femoral endarterectomy according to the technique of LeVeen. The operative mortality was 1% with an adjusted early patency rate of 99%. For a total of 52 documented cases, erectile function was lost in 25%. Ejaculatory disorders were seen in 35 patients. With a mean follow-up period of 22 months (range 1 to 60 months) there were no occlusions in the aortoiliac group. Patency in the aortofemoral group decreased to 92.5% after 4 years. It is concluded that the results support continued use of the reported technique. A longer period of follow-up however is recommended to define its exact role in reconstructive surgery for aortoiliac occlusive disease.