Evaluating the effectiveness of patient tailored treatment for patients with non-specific low back pain: A systematic review.

OBJECTIVE: This systematic review summarizes the relevant literature on the effectiveness of tailored interventions in non-specific low back pain (NSLBP). METHODS: The search strategy has been executed in December 2019 in the electronic databases PubMed, Web of Science and Embase. Study selection, data extraction and quality assessment were done independently by two authors. RESULTS: A total six eligible studies were identified. Five out of six articles used a classification system to subgroup patients. All active patient tailored interventions had similar or better results than the non-patient tailored interventions, most importantly on pain (short- and mid-term, not for long term follow-up). Two motor control interventions revealed sustained or increased effects at 12 months follow-up for disability. For cost-effectiveness, medication use and work absenteeism, results were inconclusive. Global rating of change evaluation confirmed significant between-group results at 10 weeks to 4 months follow-up, but results were not maintained at 12-month evaluation. DISCUSSION & CONCLUSION: Our findings support the preliminary evidence for the use of patient tailored treatment for reductions in pain and disability. However, our results are of very low to moderate quality evidence and the observed effects strongly depend on the subgroups and the chosen interventions. More high-quality RCT's with homogenous designs and larger sample sizes are needed.

Giant idiopathic benign retroperitoneal cyst: a case report.

BACKGROUND: Primary retroperitoneal cyst formation without connection to adjacent anatomical structures is a rare and benign entity with the majority of these cysts being discovered incidentally. If symptoms develop, they are generally non-specific and related to compression of the adjacent retro-/or intraperitoneal structures. Complete resection of the cyst is curative and therefore the preferred treatment option. We report a case of giant retroperitoneal cyst for which a total surgical removal was performed. CASE REPORT: A 79-year-old female consulted our department with complaints of long lasting abdominal pain and progressive abdominal distension. CT abdomen revealed a giant retroperitoneal cyst (35 cm × 25 cm × 21 cm) without radiological features of malignancy but with severe mass effect on the surrounding intra-abdominal structures. A median laparotomy was performed with a complete excision of cyst. No signs of malignancy or atypia were observed on histological examination. CONCLUSION: Idiopathic retroperitoneal cysts can slowly grow to giant proportions and subsequently lead to chronic vague abdominal symptoms. Complete surgical excision is curative and should be pursued.

A goblet cell carcinoma of the appendix presenting as an acute appendicitis: a case report.

Background: A goblet cell carcinoma of the appendix is a rare neoplasm with histological features of both adenocarcinomas and carcinoid tumours. It has a more aggressive behaviour in comparison to the more common classic neuroendocrine appendiceal tumours. Clinical presentation is variable and a significant proportion of patients present with an acute appendicitis. The aggressive evolution of these tumours makes the management more challenging.Case report: We report the case of a 43-year-old man with acute right iliac fossa pain who was initially diagnosed with an acute appendicitis. Histological analysis of the resected appendix demonstrated the presence of a goblet cell carcinoma with perineural and lymphovascular invasion. No distant metastasis was present. A right hemicolectomy was performed and adjuvant chemotherapy was administered.Conclusion: Goblet cell carcinomas is a distinct entity which should be delineated from the classical appendiceal carcinoids. Its clinical evolution obliges a more aggressive therapeutic strategy.

Perianal Paget's disease: case report and review of the literature.

A peri-anal skin lesion, often eczema-like and with symptoms of pruritus, that does not resolve after classical local therapy should be biopsied. We present a case of peri-anal extramammary Paget's disease (EMDP) and associated anal adenocarcinoma. Reviewing the literature, more than 30% of patients with EMDP present a second primary tumour in their past, present or future history. In Europe, the risk of developing a new primary tumour in patients with this condition is increased compared with the standard population. In cases of peri-anal Paget's disease (PPD), specific histochemical markers allow us to differentiate between a primary and a secondary form, the secondary one is strongly associated with colorectal and anal tumours. We provide information about the most commonly suggested therapy for PPD with or without associated malignancy and about the recommended follow-up.

Single centre observational study to evaluate the safety and efficacy of the Proceed™ Ventral Patch to repair small ventral hernias.

BACKGROUND: There is evidence that mesh repair for primary umbilical hernias results in less recurrences and similar wound complication rates compared to tissue repair. In recent years, several mesh devices for the repair of small ventral hernias have been developed, but some reports have been published on serious complications and adverse effects encountered with those mesh devices. METHODS: The Proceed™ Ventral Patch (PVP™) is a partially absorbable lightweight polypropylene mesh. We introduced PVP™ in our department in April 2009 and collected patient data and outcome in an observational study of 101 consecutive patients until December 2011 (Clinical.Trials.gov: NCT01307696). In addition to the routine control 3 weeks postoperative, prospective follow-up included a questionnaire, clinical investigation and ultrasound after 12 months. RESULTS: The study included 91 primary (76 umbilical/15 epigastric) and 10 incisional ventral hernias (including 6 trocar hernias). In all patients a PVP™ with a diameter of 6.4 cm was used. Wound problems were the most frequent complication (n = 18). Follow-up of at least 12 months was achieved in 98 patients (97 %) and the mean follow-up time was 15.9 months. Follow-up by clinical examination diagnosed a recurrence in 11/92 patients (12.0 %). Only four patients were aware of their recurrent hernia, the seven others reported no problems in the questionnaire. The additional ultrasound performed did not reveal recurrences that were not already diagnosed by clinical examination. In five patients a reoperation for repair of the recurrence was performed (reoperation rate 5/98 = 5.1 %). Hernia defect size (p = 0.032) and type of hernia (p = 0.029) were found to be a significant risk factors for development of a recurrent hernia (Fisher's exact test). Hernia size was a significant risk factor both in a univariate (p = 0.005) and in a multivariate Cox model (p = 0.017). Incisional hernia was of borderline significance in a univariate (p = 0.047) and in a multivariate Cox model (p = 0.08). CONCLUSION: Intensive clinical follow-up yields a high percentage (12.0 %) of clinically proven, but often asymptomatic recurrences after repair of small ventral hernias with the PVP™. Reoperation rate for recurrence was 5.1 %. Hernia defect size is a significant risk factor for recurrence. Therefore, we recommend using the PVP™ only for primary ventral hernias smaller than 2 cm. For larger or incisional hernias other techniques allowing the use of larger meshes is advocated.

Open preperitoneal mesh repair of inguinal hernias using a mesh with nitinol memory frame.

PURPOSE: To prospectively evaluate the use of a continuous Nitinol containing memory frame patch during a TIPP-technique in the open repair of inguinal and femoral hernias. METHODS: Over a 3-year period all consecutive adult patients that needed treatment for an inguinal or femoral hernia were treated by the TIPP repair using the Rebound Shield mesh. Intra-operatively the type and size of the hernia were evaluated according to the EHS classification, as well as the size of the mesh used. Baseline characteristics for all patients were evaluated considering age, gender, BMI and American society of Anesthesiologists score. Standard X-ray was performed to evaluate mesh position. All patients were evaluated for post-operative pain using the visual analogue scale (VAS 0-10 scale). RESULTS: In total 289 groin hernias were operated using a nitinol containing patch in 235 patients. The mean operating time was 38 min for unilateral hernias and 59 min for bilateral hernias. The median follow-up is 21.2 months (14-33 months) during which three patients died, unrelated to the groin hernia repair. At the time of re-evaluation 12 patients (5.0 %) complained of chronic pain, with a VAS score higher than 3 after 3 months (range 3-10). Two of these patients already had severe pain pre-operatively. A total of 3 recurrences (2.9 %) were noted with strong correlation with X-ray findings. CONCLUSION: A nitinol memory frame containing mesh is a valuable tool to achieve complete deployment of a large pore mesh in a TIPP repair for inguinal hernias with acceptable morbidity and a low recurrence rate.

Complications of mesh devices for intraperitoneal umbilical hernia repair: a word of caution.

Several mesh devices for the treatment of umbilical and other small ventral hernias have become available in recent years. These meshes have a dual layer consisting of a permanent or temporary barrier against adhesion formation between the viscera and the intraperitoneally exposed part of the mesh. We have seen several patients with serious late complications of these meshes placed intraperitoneally. Some of these patients needed small bowel resection and mesh removal. Others developed a recurrence because of improper deployment of the mesh in the intraperitoneal position. We think that, if preperitoneal deployment of such mesh devices is possible, this should be the preferred position, notwithstanding the fact that these meshes have a dual layer. There is a complete lack of convincing data on these mesh devices in the medical literature. No long-term data have been published, and, for three of the four mesh devices available, no publications on their use in humans were found. We think that surgeons adopting innovative mesh devices should register and follow their patients prospectively, at least until there are enough published studies with sufficiently large patient samples, acceptable follow up times, and favourable outcomes.