Preservation of deep epigastric perforators during anterior component separation technique (ACST) results in equivalent wound complications compared to transversus abdominis release (TAR).

PURPOSE: The use of component separation results in myofascial release and increased rates of fascial closure in abdominal wall reconstruction(AWR). These complex dissections have been associated with increased rates of wound complications with anterior component separation having the greatest wound morbidity. The aim of this paper was to compare the wound complication rate between perforator sparing anterior component separation(PS-ACST) and transversus abdominus release(TAR). METHODS: Patients were identified from a prospective, single institution hernia center database who underwent PS-ACST and TAR from 2015 to 2021. The primary outcome was wound complication rate. Standard statistical methods were used, univariate analysis and multivariable logistic regression were performed. RESULTS: A total of 172 patients met criteria, 39 had PS-ACST and 133 had TAR performed. The PS-ACST and TAR groups were similar in terms of diabetes (15.4% vs 28.6%, p = 0.097), but the PS-ACST group had a greater percentage of smokers (46.2% vs 14.3%, p < 0.001). The PS-ACST group had a larger hernia defect size (375.2 ± 156.7 vs 234.4 ± 126.9cm2, p < 0.001) and more patients who underwent preoperative Botulinum toxin A (BTA) injections (43.6% vs 6.0%, p < 0.001). The overall wound complication rate was not significantly different (23.1% vs 36.1%, p = 0.129) nor was the mesh infection rate (0% vs 1.6%, p = 0.438). Using logistic regression, none of the factors that were significantly different in the univariate analysis were associated with wound complication rate (all p > 0.05). CONCLUSION: PS-ACST and TAR are comparable in terms of wound complication rates. PS-ACST can be used for large hernia defects and promote fascial closure with low overall wound morbidity and perioperative complications.

Robotic Sugarbaker parastomal hernia repair: technique and outcomes.

PURPOSE: To present a novel technique for the repair of parastomal hernias. METHODS: A total of 15 patients underwent parastomal hernia repair. A robotic Sugarbaker technique was utilized for repair. The fascial defect was closed prior to robotic intraperitoneal placement of the mesh. Baseline demographics of the patients were obtained, and intra-operative and post-operative outcomes were tracked. RESULTS: The etiology of the ostomies was oncologic in all but three patients. Five of the stomas were urostomies (33.3%). Patient characteristics were as follows: age 64.9.1 ± 9.3 years, BMI 30.1 ± 4.7 kg/m2, smoking history 60.0%, and diabetes 6.7%. The mean size of the hernia defect was 46.0 ± 40.1 cm2 with a mesh size of 372.0 ± 101.2 cm2. The mean operative time was 182.0 ± 51.9 min. In seven patients, an inferolateral preperitoneal flap was created for mesh placement. Intraoperatively, only one enterotomy was made during dissection, which was repaired without complication. The mean length of stay was 4.2 ± 1.9 days. There was only one hernia recurrence (6.7%). There were no wound complications, surgical site infections, or mesh infections. A mean follow-up time of 14.2 ± 9.4 months was achieved. CONCLUSIONS: Robotic Sugarbaker parastomal hernia repair is a safe and effective technique. The results demonstrate the feasibility of fascial closure with this technique and a low recurrence rate. The authors propose this technique should be widely considered for parastomal hernia repair.

A systematic review of CT chest in COVID-19 diagnosis and its potential application in a surgical setting.

AIM: The aim of this work was to investigate the sensitivity and utility of CT of the chest in diagnosing active SARS-Cov-2 (COVID-19) infection, and its potential application to the surgical setting. METHOD: A literature review was conducted using Google Scholar® and MEDLINE®/PubMed® to identify current available evidence regarding the sensitivity of CT chest compared with RT-PCR for the diagnosis of COVID-19-positive patients. GRADE criteria and the QUADAS 2 tool were used to assess the level of evidence. RESULTS: A total of 20 articles were identified that addressed the question of sensitivity of CT for diagnosis of symptomatic and asymptomatic COVID-19-positive patients. Overall sensitivity of CT scan ranged from 57%-100% for symptomatic and 46%-100% for asymptomatic COVID-19 patients, while that of RT-PCR ranged from 39%-89%. CT chest was a better diagnostic modality and capable of detecting active infection earlier in the time course of infection than RT-PCR in symptomatic patients. In asymptomatic patients, disease prevalence seems to play a role in the positive predictive value. Minimal evidence exists regarding the sensitivity of CT in patients who are asymptomatic. CONCLUSIONS: In surgical patients, CT chest should be considered as an important adjunct for detection of COVID-19 infection in patients who are symptomatic with negative RT-PCR prior to any operation. For surgical patients who are asymptomatic, there is insufficient evidence to recommend routine preoperative CT chest for COVID-19 screening.

Spatiotemporal distribution of microbial communities in a coastal, sandy aquifer system (Doñana, SW Spain).

The aquifer system of Doñana (SW Spain) represents the most important freshwater source in the Doñana Natural Area. Its spatiotemporal dynamics favours the hydrological connection between surface and subsurface ecosystems, and promotes matter fluxes among the different terrestrial and aquatic systems present here. This aquifer has been intensively studied from a hydrogeological point of view but little is known from an ecological perspective. In order to understand the ecological roles played by microbial communities in this system, we conducted a long-term seasonal study of bacterial abundance, cell biomass, bacterial biomass and functional activities over a 2-year period. Bacterial abundance ranged between 2.11 +/- 1.79 x 10(5) and 8.58 +/- 6.99 x 10(7) bacteria mL(-1) groundwater, average cell biomass was estimated to be 77.01 +/- 31.56 fgC and bacterial biomass varied between 8.99 +/- 4.10 x 10(-2) and 5.65 +/- 0.70 microgC mL(-1). Iron-related bacteria showed the highest activities among the functional groups studied. Moreover, among the variables that usually control spatial distributions of microbial communities in aquifer systems, depth did not have a relevant effect on this aquifer, at least in the range of depths studied, but grain size, probably due to its direct effects on hydrogeological parameters, such as permeability or porosity, appeared to exert moderate control, principally in terms of bacterial abundance. Finally, significant seasonal differences in the means of these microbiological variables were also observed; temperature seems to be the main factor controlling the temporal distribution of microbial communities in this aquifer system.

Síndromes dolorosos en relación con el accidente cerebrovascular: dolor de hombro y dolor central / Painful syndromes in relationship to cerebrovascular accident: shoulder pain and central pain

El hombro doloroso y el dolor central post-ictus son causas importantes de discapacidad, que interfieren con los esfuerzos que debe realizar el paciente durante la rehabilitación.El dolor de hombro es un síndrome común en las personas que sufren un accidente cerebrovascular (ACV). Los principales factores etiológicos son el desequilibrio muscular, inducido por la debilidad de la musculatura periarticular y la espasticidad de los adductores y rotadores internos, junto con las maniobras inadecuadas que sufren los pacientes hemipléjicos que dependen de la asistencia de otras personas para su movilidad. Lo más importante es realizar la prevención: tratamiento postural que prevenga los acortamientos musculares y tendinosos; evitar microtraumatismos sobre el hombro parético; dar soporte a la extremidad para impedir los estiramientos de las partes blandas y la subluxación; y realizar la fisioterapia de forma adecuada. Cuando aparece dolor en el hombro se intentará llegar a un diagnóstico etiológico igual que se realiza en la población general sin ACV, pudiendo acceder a las mismas intervenciones médicas y terapéuticas.El dolor central suele presentarse meses después del ACV y con una frecuencia de presentación mayor de la esperada. Es importante identificarlo y tratarlo. Se manifiesta por alteraciones disestésicas y puede relacionarse con alodinia e hiperpatía, en todo el hemicuerpo o en una región más localizada. El dolor central puede responder a los antidepresivos tricíclicos (AU)

Rehabilitación psicosocial de un enfermo diagnosticado de esquizofrenia / Psycosocial rehabilitation of a patient diagnosticated as suffering schizophrenia

Se presenta el caso de una paciente que acude al Centro de Rehabilitación Psicosocial derivada por su psiquiatra de Rehabilitación Psicosocial derivada por su psiquiatra con síntomas residuales interepisodios desde hace con síntomas residuales interepisodios desde hace 16 años. En el momento de acceder al Centro la paciente presentaba sintomatología tanto positiva como negativa, con importante deterioro cognitivo, así como personal, familiar y social (AU)

Clinical assessment and serum hormonal profile in prepubertal hypertrichosis.

Twenty-two prepubertal girls with hypertrichosis were studied and compared to 10 prepubertal normal girls. Hypertrichosis was assessed according to a score that considers the amount and the distribution of vellus hair in androgen- and non-androgen-sensitive areas. Serum androgen profile and free androgen index (FAI) were determined in both groups. The hypertrichosis score was higher in patients than in the normal girls. Testosterone levels and FAI were increased in patients when compared to control; 3alpha-androstanediol glucuronide levels above 2 SD from the control mean were found in 10 girls and all hormonal parameters falling in the normal range were found in 4 girls. The new score designed to assess the degree of hypertrichosis was useful to differentiate between normal and pathological hair growth. Although most of the girls with prepubertal hypertrichosis showed an increased androgen bio-availability, a slight increase in peripheral 5alpha-reductase activity and a completely normal androgen profile was also associated with a pathological hair growth.

Sexual dimorphism in circulating monomeric and dimeric inhibins in normal boys and girls from birth to puberty.

BACKGROUND AND OBJECTIVE: Inhibins are peptides, mainly of gonadal origin, that suppress FSH production. Dimeric forms of inhibin (A and B) have been proposed as peripheral markers of Sertoli and granulosa cell function. The aim of this study was to establish the relationship between circulating dimeric and monomeric inhibins, and gonadotrophins and sex steroids, in normal boys and girls from birth to puberty. SUBJECTS: One hundred and forty-six normal children (females: 57; males: 89) were studied. MEASUREMENTS: Serum LH and FSH were measured by an immunofluorometric assay. Serum oestradiol and testosterone were measured by radioimmunoassay. Serum inhibin A and B, and Pro-alphaC, were measured by specific two-site enzyme-linked immunosorbent assays. RESULTS: In boys from birth to 6 months of age, the mean serum inhibin B concentration was as high (477 +/- 53.7 ng/l) as that found at puberty (400 +/- 70.2 ng/l). After the first year, inhibin B gradually decreased to reach its lowest concentration (153 +/- 23.6 ng/l) at age 4-6 years. At approximately age 10, it rose progressively to reach pubertal concentrations. Pro-alphaC showed a similar pattern but at lower concentrations. Inhibin A was not detected at any age. In girls from birth to 6 months, inhibin B levels (83.0 +/- 18.3 ng/l) were approximately 50% lower than those found at puberty (181 +/- 25.7 ng/l). After 6 months of age, these levels dropped (17.5 +/- 1.6 ng/l) and remained low until the prepubertal years. Thereafter, they increased to pubertal concentrations. The serum inhibin A concentration after birth (29.9 +/- 8.7 ng/l) was similar to that found at puberty (18.3 +/- 5.7 ng/l); after 6 months, it fell to undetectable levels until the prepubertal years. CONCLUSION: The sex difference in serum levels of gonadotrophins is associated with sex differences in the levels and proportions of circulating dimeric and monomeric inhibins.

Monosymptomatic primary enuresis: differences between patients responding or not responding to oral desmopressin.

OBJECTIVES: To evaluate the 24-h diuresis, urinary osmolality, plasma arginine vasopressin (AVP) and urinary prostaglandin E2 (PGE2) before and during desmopressin treatment in patients with monosymptomatic primary enuresis (MPE), and to investigate the possible depressor effect of desmopressin on the detrusor in such patients with urodynamically confirmed bladder instability. PATIENTS AND METHODS: Seven healthy children (control group) and 11 consecutive patients with MPE (mean age 10.4 years, range 7-15) were assessed using laboratory tests, renal and bladder ultrasonography, and video-urodynamic investigations. A 24-h inpatient assessment with a controlled water intake of 20 mL/kg per day included determinations of diuresis, urinary osmolality, AVP and PGE2 in both normal children and those with MPE. After 30 days of treatment at optimal doses of desmopressin, all children were hospitalized and re-evaluated during desmopressin treatment; all completed 3 months of treatment at optimal doses. At the end of this period, patients whose symptoms improved by > or = 80% were defined as 'responders' while those in whom they did not were defined as 'non-responders'. RESULTS: After treatment, six of the 11 patients with MPE were 'responders' and five 'non-responders'. Urodynamic evaluation showed bladder instability in seven of the 11 patients with MPE but in those with bladder dysfunction, urodynamic studies carried out during desmopressin treatment showed no changes in detrusor activity. There were significant differences in the morning values of AVP between normal children and responders (P < 0.03), and between responders and non-responders (P < 0.02); none of the non-responders had AVP levels of < 2.5 pg/mL, while none of the responders exceeded this value. At midnight, responders had the lowest mean AVP and non-responders the highest; this correlated with the highest PGE2 value in the nonresponders at 00.00-08.00 hours. Non-responders had an overnight mean PGE2 level greater than that in normal subjects or responders. CONCLUSIONS: Polyuria occurred in all patients with MPE, independently of the response to desmopressin. Responders had the lowest AVP values over the 24 h; the morning AVP levels differentiated normal subjects from enuretic patients and responders from non-responders. In patients with MPE, clinically undetected bladder instability was unrelated to the results of treatment and there were no urodynamic changes during desmopressin treatment. The differences between enuretic patients suggested a different aetiology of MPE, probably related to an increase in PGE2 concentration and an antagonistic mechanism of action of AVP or desmopressin.

Characterization of serum SHBG isoforms in prepubertal and pubertal girls.

OBJECTIVE: SHBG is a circulating glycoprotein that binds dihydrotestosterone, testosterone and oestradiol with high affinity and low capacity. In girls, serum concentrations of SHBG gradually decrease with age due to a true fall in concentration and not to a change in the binding characteristics. The aim of our study was to determine the pattern of serum SHBG isoforms in normal girls in early childhood (ECh), late childhood (LCh) and puberty (P). SUBJECTS: Fifteen normal girls were studied. They were divided into three groups according to their age: ECh: 3.7 +/- 0.9 years (mean +/- SD, n = 5); LCh: 6.4 +/- 0.5 years (n = 5); and P: 13.4 +/- 1.5 years (n = 5). METHODS AND MEASUREMENTS: Preparative isoelectric focusing was used to isolate SHBG isoforms according to their isoelectric point (pI). Three groups of isoforms were isolated: SI: pI 5.2-5.4; SII: pI 5.4-5.6 and SIII: pI 5.6-5.8. Steroid levels in serum were determined by RIA. RESULTS: The relative distribution of SHBG isoforms (% of the total SHBG recovered, mean +/- SD) in the three groups of girls studied was: ECh: SI: 25.8 +/- 9.9, SII: 53 +/- 10.5 and SIII: 21.2 +/- 1.6; LCh: SI: 8.8 +/- 3.1, SII: 58.8 +/- 12.2 and SIII: 31.8 +/- 8.6; P: SI: non-detectable; SII: 51.6 +/- 12.6 and SIII: 48.4 +/- 12.6. CONCLUSION: These results indicate that serum SHBG is more heterogeneous before puberty. A considerable proportion of acidic isoforms are present early in life; they decrease during the prepubertal period and disappear when sexual development is completed. After puberty the glycoprotein is more homogeneous and an important proportion of more basic isoforms is present. At puberty serum SHBG not only falls in concentration but also has an altered sialic acid content which modulates its circulating half-life.

Testicular steroidogenesis in the Cebus monkey throughout postnatal development.

There is scant information on testicular steroidogenesis during postnatal development in monkeys, particularly in New World species. Our purpose was to study the in vitro steroidogenic capacity of the Cebus monkey testis from birth to advanced puberty. Fresh testicular tissue was incubated in Medium 199 with or without hCG (10 IU/ml); and levels of pregnenolone (P5), dehydroepiandrosterone (DHA), progesterone (P4), androstenedione (A), testosterone (T), dihydrotestosterone (DHT), and 3 alpha-androstanediol (3 alpha-DIOL) were measured in tissue and incubation media by RIA. To determine the predominant steroidogenic pathway, the ratio between the concentrations of the 5-ene and the 4-ene T precursors was determined, and the relative conversion of 3H-P5 and 14C-P4 to T was calculated. The number of Leydig cells per testis was determined in all experimental groups. The testes of the Cebus monkeys could produce T in vitro without the addition of gonadotropins at all ages. T and the 5-ene precursors (P5 and DHA) were the main steroids found within testicular tissue throughout postnatal development. T content per Leydig cell increased continuously with age, but testicular T concentration reached maximal levels at early puberty and did not change thereafter. The ratios between 5-ene and 4-ene T precursors ranged between 2.8 and 13.2, which suggested a predominance of the delta-5 pathway. This was confirmed by the finding that 3H-P5 was more efficiently converted to T than was 14C-P4. The T production relative to that of its d-ene precursors progressively increased to reach maximal values in late puberty.(ABSTRACT TRUNCATED AT 250 WORDS)