Incidence and risk factors of symptomatic Petersen's hernias in bariatric and upper gastrointestinal surgery: a systematic review and meta-analysis

PURPOSE

The aim of this study was to investigate the actual incidence of symptomatic Petersen's hernias (PH) as well as identify risk factors for their occurrence.

METHODS

Search was performed in Medline (via PubMed), Web of Science, and Cochrane library, using the keywords "Petersen Or Petersen's AND hernia" and "Internal hernia." Only studies of symptomatic PH were eligible. Fifty-three studies matched our criteria and were included. Risk of bias for each study was independently assessed using the checklist modification by Hoy et al. Analysis was performed using random-effects models, with subsequent subgroup analyses.

RESULTS

A total of 81,701 patients were included. Mean time interval from index operation to PH diagnosis was 17.8 months. Total small bowel obstruction (SBO) events at Petersen's site were 737 (0.7%). SBO incidence was significantly higher in patients without defect closure (1.2% vs 0.3%, p < 0.01), but was not significantly affected by anastomosis fashion (retrocolic 0.7% vs antecolic 0.8%, p = 0.99). SBO incidence was also not significantly affected by the surgical approach (laparoscopic = 0.7% vs open = 0.1%, p = 0.18). However, retrocolic anastomosis was found to be associated with marginally, but not significantly, increased SBO rate in patients with Petersen's space closure, compared with the antecolic anastomosis (p = 0.09).

CONCLUSION

PH development may occur after any gastric operation with gastrojejunal anastomosis. Contrary to anastomosis fashion and surgical approach, defect closure was demonstrated to significantly reduce SBO incidence. Limitations of this study may include the high heterogeneity and the possible publication bias across the included studies.

Myocardial work analysis in screening of familial dilated cardiomyopathy

Introduction

Early detection of affected family relatives of patients with dilated cardiomyopathy (DCM) is essential in order to guide follow up, outcomes and initiate early treatment. Myocardial work analysis is a novel method which integrated strain imaging and blood pressure and has the potential to identify patients with subclinical disease.

Purpose

We analysed myocardial work in family relatives of DCM patients with positive genotype but negative phenotype in order to identify whether myocardial work can identify early changes.

Methods

Seventy-four family relatives of DCM patients attending for screening were examined. All individuals were asymptomatic with either positive (45/74, G+) or negative (29/74, G-) genotype and no echocardiographic evidence of left ventricular dilatation or systolic impairment. Non-invasive myocardial work analysis using two-dimensional (2D) speckle tracking echocardiography was analysed. Global longitudinal strain (GLS) was measured by the same vendor specific software used for myocardial work analysis. Left ventricular (LV) ejection fraction (EF) was measured with the Simpson's biplane method. The peak systolic arm cuff blood pressure (BP) measurement at the time of echocardiography was used for the myocardial work study.

Results

In total we included 74 individuals (37±15 years old, 50.7% women) with mean systolic and diastolic BP of 121.3±14 and 73.2±10 mmHg respectively, mean EF was 58±5% and mean GLS at 18.4±2.5%.

G+ individuals had pathogenic and very likely pathogenic mutations in 8 different genes (TTN, BAG3, DSP, FLNC, LMNA, DMD, RBM20, TPM1). There was no difference in age, systemic hypertension, diabetes or medical treatment between the 2 groups.

No significant difference was found among G+ and G- individuals in mean systolic and diastolic BP (121.2±14.7 vs 121.2±15.2 mmHg), mean EF (57.3±5 vs 59.1±4%), GLS (−18.2±1.5 vs −18.6±2.9%), mean global work index (1818±403 vs 1928±295 mmHg%) and global constructive work (2192±464 vs 2260±318 mmHg%).

However, we found significant reduction of the global work efficiency (GWE) with a GWE of 94.4±2.7% in the G+ versus 95.9±1.6% in the G- individuals (p 0.02). Moreover, the global wasted work (GWW) was increased in the G+ with a GWW of 111±58 mmHg% versus 82±41 mmHg% in the G- individuals (p 0.03).

Conclusion

DCM gene carriers show, early on, decreased myocardial work efficiency and increased wasted work compared to unaffected family members, which appears to be earlier than other parameters such as EF and GLS. Myocardial work analysis could potentially recognize individuals showing early cardiac involvement and guide closer follow up and early initiation of treatment.

Funding Acknowledgement

Type of funding source: None

Étude sur les hospitalisations d’office dans quatre régions françaises (Nord – Pas-de-Calais, Île-de-France, Aquitaine, Provence-Alpes) : analyse de l’hypothèse principale

Cette enquête vise à étudier la variabilité du taux d’hospitalisation d’office (HO) constatée entre les départements. En 2007, ce taux variait de 1 à 10 [1].

L’objectif principal étant d’étudier cette variabilité en partant de l’hypothèse selon laquelle : « La variabilité du recours à l’HO n’est pas principalement en rapport avec la sévérité des troubles présentés par les patients ».

Depuis la loi en application au 1er août 2011, la notion d’« HO » a été remplacée par « soins psychiatriques sur décision du représentant de l’État (SDRE) [2] ».

Une phase transversale sur un an vise, à évaluer de façon clinique le patient (diagnostic, MINI, EGF) et, à étudier les modalités du contexte d’entrée (questionnaires : patient, psychiatre ayant établi l’admission, équipe soignante, famille, médecin et/ou psychiatre traitant et élu local) [3]. Une phase longitudinale de suivi de cohorte sur 5 ans, à partir de l’inclusion, étudiera les parcours de soins à partir des relevés d’informations médicales. Les certificats médicaux et préfectoraux sont également étudiés.

Le but de cette étude est d’essayer de faire émerger le ou les facteurs qui pourraient être à l’origine des disparités des taux, ce qui amènerait à pouvoir identifier comment prévenir les SDRE.

L’étude a été construite autour d’un plan statistique qui permettra de comparer les différents secteurs selon leur groupe d’appartenance (faible, moyen ou fort taux d’HO). Ces trois groupes seront décrits grâce à la distribution des taux de SDRE des secteurs participants. Le critère de jugement principal est un score global de fonctionnement (EGF3), cette communication le décrira avec les résultats statistiques qui découlent de la comparaison de ce score entre les 3 groupes de taux. Aucune différence significative n’a été observée entre les 3 groupes, sous tendant notre hypothèse de départ. D’autres analyses, sur l’offre de soins des secteurs nous amèneront vers plusieurs hypothèses secondaires.

Degenerative Erkrankungen der Wirbelsäule

GOAL

The aim of this article is to describe rare and often unrecognized causes of spinal pain syndromes.

METHOD

Intervertebral disc degeneration frequently appears in early adulthood and can have a symptomatic or asymptomatic course. This article discusses incidence, pathophysiology, imaging, and pain symptomatology involved in the origin of back pain.

RESULTS

Anulus tears are often found in asymptomatic individuals but could be implicated in lumbar pain symptomatology in correlation with the provocative discography. Transient disorders can lead to pseudarthrosis of the iliac bone and to degeneration or to a reactive hypermobility with intervertebral disc degeneration in the level above. Modic type 1 erosive osteochondrosis is characterized by bone marrow edema near the hyaline cartilage end plate, which mostly elicits severe pain and results in serious limitations in everyday activities. The most important differential diagnosis is spondylodiscitis. Schmorl's nodes can exhibit considerable surrounding bone marrow edema that can be mistaken for metastases. A combination of MRI and CT should be employed for the diagnostic work-up of fatigue fracture of the interarticular portion, which is often overlooked due to its location. Synovial cysts of the facet joints can lead to radicular symptoms. Insufficiency fracture of the sacrum is frequently mistaken for metastasis due to intense scintigraphic enhancement and its signal behavior in MRI. CT provides instructive information.

CONCLUSION

Differential diagnosis should include less common causes such as anulus tears, transient disorders, activated Schmorl's nodes, synovial cysts of the facet joints, fatigue fractures of the interarticular portion of the spine and the sacrum and distinguish from metastases in particular.

[Pre- and postoperative radioligical evaluation of knee joint endoprothesis. Orthopedist's view]

The implantation of a knee arthroplasty is still a demanding operation. There is still no "golden standard" available, although a lot of guidelines have been declared. Because of this fact this article should provide the radiologist with an overview of and some background knowledge for the radiological evaluation of knee arthroplasty.

Determination of organochlorine pesticide residues in honey, applying solid phase extraction with RP-C18 material

In this study, a new clean up method was developed for the routine multiresidue determination of organochlorine pesticide residues in honey. The analytical procedure requires sample extraction with methanol, followed by a clean up step through a C18 Sep-Pak cartridge. Finally, pesticides are eluted with hexane. The determination of organochlorine pesticide residues was performed by capillary gas chromatography with electron capture detection. The mean recoveries of 18 organochlorine pesticides were estimated at various concentrations and found very efficient in most cases. The detection limits were found to be between 0.05 and 0.20 microgram kg-1.