Ventral hernia repair in conjunction with LIPO-ABDOMINOPLASTY in overweight patients: A comprehensive approach.

Repair of large midline ventral hernias still represents a challenge for general surgeons. As obesity is a key factor of this type of hernias, usually the patients are presented with abdominal wall laxity, excess skin and subcutaneous fat. Combined procedures has evolved over the last six decades to repair the hernias and to improve the shape of the abdomen, but was associated with high rate of wound complications. The components separation technique for ventral hernia repair was introduced in 1990 by Ramirez et al to avoid mesh repair was associated with a high rate of success. Until recently, the convenience of simultaneously performing ventral hernia repair and abdominal contouring surgery remains controversial. The aim of this study is to present our experience in the integration of the anterior component separation technique for repair of midline wide ventral defects, with the lipoabdominoplasty in selected patients with high body mass index, to achieve a functional abdominal wall repair and to provide a better aesthetic outcome. In this prospective case-control study, 15 adult female multiparous women, all were overweight and obese, presented with midline ventral hernias and abdominal deformity was operated upon where a comprehensive technique in the form of herniorapphy, anterior component separation technique and lipoabdominoplasty were performed. The patients were followed up for 3-6 months period to monitor incidence of complications, hernia recurrence and to assess the aesthetic outcome. All the 15 patients were overweight and obese with BMI ranged between 26.5 and 39.6 kg/m2 . The mean operative time was 184 ± 28.8 minutes (range 150-240 minutes). The mean postoperative length of hospital stay was 3 days ranging from 1 to 5 days. In addition to the hernia, all the patients suffered from diastasis of recti ranged from 9 to 15 cm in the transverse dimension. No mortality or major complications encountered, no hernia recurrence, only minor complications occurred in four patients (26.8%). Two patients developed seroma which resolved by aspiration, one patient suffered wound infection with partial loss of the umbilicus and one developed superficial skin necrosis at the central area of the flaps which healed uneventfully by secondary intention. All the patients were satisfied with the cosmetic outcome. In conclusion, this comprehensive approach is effective technique for reconstruction of large midline ventral defects and provide a good aesthetic appearance of the anterior and lateral abdomen in appropriately selected obese patients.

Molecularly matched therapy in the context of sensitivity, resistance, and safety; patient outcomes in end-stage cancer - the MetAction study.

Background: In precision cancer medicine, the challenge is to prioritize DNA driver events, account for resistance markers, and procure sufficient information for treatment that maintains patient safety. The MetAction project, exploring how tumor molecular vulnerabilities predict therapy response, first established the required workflow for DNA sequencing and data interpretation (2014-2015). Here, we employed it to identify molecularly matched therapy and recorded outcome in end-stage cancer (2016-2019).Material and methods: Metastatic tissue from 26 patients (16 colorectal cancer cases) was sequenced by the Oncomine assay. The study tumor boards interpreted called variants with respect to sensitivity or resistance to matched therapy and recommended single-agent or combination treatment if considered tolerable. The primary endpoint was the rate of progression-free survival 1.3-fold longer than for the most recent systemic therapy. The objective response rate and overall survival were secondary endpoints.Results: Both common and rare actionable alterations were identified. Thirteen patients were found eligible for therapy following review of tumor sensitivity and resistance variants and patient tolerability. The interventions were inhibitors of ALK/ROS1-, BRAF-, EGFR-, FGFR-, mTOR-, PARP-, or PD-1-mediated signaling for 2-3 cases each. Among 10 patients who received treatment until radiologic evaluation, 6 (46% of the eligible cases) met the primary endpoint. Four colorectal cancer patients (15% of the total study cohort) had objective response. The only serious adverse event was a transient colitis, which appeared in 1 of the 2 patients given PD-1 inhibitor with complete response. Apart from those two, overall survival was similar for patients who did and did not receive study treatment.Conclusions: The systematic MetAction approach may point forward to a refined framework for how to interpret the complexity of sensitivity versus resistance and patient safety that resides in tumor sequence data, for the possibly improved outcome of precision cancer medicine in future studies. ClinicalTrials.gov, identifier: NCT02142036.

Implementing precision cancer medicine in the public health services of Norway: the diagnostic infrastructure and a cost estimate.

OBJECTIVE: Through the conduct of an individual-based intervention study, the main purpose of this project was to build and evaluate the required infrastructure that may enable routine practice of precision cancer medicine in the public health services of Norway, including modelling of costs. METHODS: An eligible patient had end-stage metastatic disease from a solid tumour. Metastatic tissue was analysed by DNA sequencing, using a 50-gene panel and a study-generated pipeline for analysis of sequence data, supplemented with fluorescence in situ hybridisation to cover relevant biomarkers. Cost estimations compared best supportive care, biomarker-agnostic treatment with a molecularly targeted agent and biomarker-based treatment with such a drug. These included costs for medication, outpatient clinic visits, admission from adverse events and the biomarker-based procedures. RESULTS: The diagnostic procedures, which comprised sampling of metastatic tissue, mutation analysis and data interpretation at the Molecular Tumor Board before integration with clinical data at the Clinical Tumor Board, were completed in median 18 (8-39) days for the 22 study patients. The 23 invasive procedures (12 from liver, 6 from lung, 5 from other sites) caused a single adverse event (pneumothorax). Per patient, 0-5 mutations were detected in metastatic tumours; however, no actionable target case was identified for the current single-agent therapy approach. Based on the cost modelling, the biomarker-based approach was 2.5-fold more costly than best supportive care and 2.5-fold less costly than the biomarker-agnostic option. CONCLUSIONS: The first project phase established a comprehensive diagnostic infrastructure for precision cancer medicine, which enabled expedite and safe mutation profiling of metastatic tumours and data interpretation at multidisciplinary tumour boards for patients with end-stage cancer. Furthermore, it prepared for protocol amendments, recently approved by the designated authorities for the second study phase, allowing more comprehensive mutation analysis and opportunities to define therapy targets.

An epidemiologic study of elderly burn patients in Ain Shams University Burn Unit, Cairo, Egypt.

Recent statistics from Egypt indicate that elderly persons comprise 5.8% of the general population. Elderly patients remain a high-risk group in all burn units. This prospective study investigated geriatric burn patients (defined as 60 years and older) who were present at our center between May 1995 and October 2001. Of the 4220 patients who were present during this period, 97 (2.3%) were elderly, and 63 (7.1%) of the 880 total admitted were geriatrics. Of the 97 elderly burn patients who were present during the study period, 31 died (mortality rate 31.9%). Other epidemiological data, including duration of hospitalization, seasonal and day/hour variation in burn incidence and burn causes and accident site are presented. Ideas for management and prevention are also presented.

Colonization of burn wounds in Ain Shams University Burn Unit.

A prospective study was carried out on 70 burned patients admitted to the Burn Unit, Ain Shams University Hospital, Cairo, with the aim to verify the pattern of microbial colonization of burn wounds. Throughout the study period starting from 1 June 1999 till 31 May 2001, 281 sampling procedures (surface swabs) were performed from the burn wounds. A total of 301 microbial isolates were grown in cultures. Eight different species of bacteria, and only one species of Candida (C. albicans) were detected. There was no incidence of recovery of anaerobic microorganisms. Our results revealed that the most frequent isolate was Pseudomonas aeruginosa (21.6%), followed by Klebsiella pneumoniae (15.2%), then Escherichia coli (13.6%), Staphylococcus aureus (13.2%), coagulase-negative Staphylococci (11.6%), Streptococcus pyogenes (8.3%), Enterobacter species (6.6%), and lastly Streptococcus faecalis and Candida albicans (5.9 and 3.6%, respectively). Studying the time-related changes in burn wound microbial colonization showed an initial predominance of gram-positive cocci upon admission (70.7%) over gram-negative bacilli (27.6%). During the first 5 days, gram-negative bacilli started to predominate (55.7%) over gram-positive cocci (40.3%). Burn wound sampling performed starting from the sixth day onwards, revealed further prevalence of gram-negative bacilli (72.7%) over gram-positive cocci (22.7%). As for Candida albicans, there was a gradual increase in the frequency of its recovery as time elapsed from admission. It is crucial for every burn institution to determine the specific pattern of burn wound microbial colonization, the time-related changes in the dominant flora, and the antimicrobial sensitivity profiles. This would enable early treatment of imminent septic episodes with proper empirical systemic antibiotics, without waiting for culture results, thus improving the overall infection-related morbidity and mortality.