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Whitcroft KL, Altundag A, Balungwe P, Boscolo-Rizzo P, Douglas R, Enecilla MLB, Fjaeldstad AW, Fornazieri MA, Frasnelli J, Gane S, Gudziol H, Gupta N, Haehner A, Hernandez AK, Holbrook EH, Hopkins C, Hsieh JW, Huart C, Husain S, Kamel R, Kim JK, Kobayashi M, Konstantinidis I, Landis BN, Lechner M, Macchi A, Mazal PP, Miri I, Miwa T, Mori E, Mullol J, Mueller CA, Ottaviano G, Patel ZM, Philpott C, Pinto JM, Ramakrishnan VR, Roth Y, Schlosser RJ, Stjärne P, Van Gerven L, Vodicka J, Welge-Luessen A, Wormald PJ, Hummel T. Position paper on olfactory dysfunction: 2023. Rhinology 2023; 61:1-108. [PMID: 37454287 DOI: 10.4193/rhin22.483] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Since publication of the original Position Paper on Olfactory Dysfunction in 2017 (PPOD-17), the personal and societal burden of olfactory disorders has come sharply into focus through the lens of the COVID-19 pandemic. Clinicians, scientists and the public are now more aware of the importance of olfaction, and the impact of its dysfunction on quality of life, nutrition, social relationships and mental health. Accordingly, new basic, translational and clinical research has resulted in significant progress since the PPOD-17. In this updated document, we present and discuss currently available evidence for the diagnosis and management of olfactory dysfunction. Major updates to the current version include, amongst others: new recommendations on olfactory related terminology; new imaging recommendations; new sections on qualitative OD and COVID-19 OD; updated management section. Recommendations were agreed by all co-authors using a modified Delphi process. CONCLUSIONS We have provided an overview of current evidence and expert-agreed recommendations for the definition, investigation, and management of OD. As for our original Position Paper, we hope that this updated document will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency, and generalisability of work in this field.
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Affiliation(s)
- K L Whitcroft
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
- and UCL Ear Institute, Faculty of Brain Sciences, University College London, London, UK
- and The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Studies, University of London, London, UK
| | - A Altundag
- Department of Otorhinolaryngology, Istanbul Surgery Hospital, Istanbul, Turkey
| | - P Balungwe
- Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- and Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - P Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - R Douglas
- Department of Otorhinolaryngology, University of Auckland, New Zealand
| | - M L B Enecilla
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Luke's Medical Center, Global City, Philippines
- and Department of Otolaryngology - Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines
- and Department of Otorhinolaryngology, Medical Center Taguig, Taguig, Philippines
| | - A W Fjaeldstad
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Studies, University of London, London, UK
- and Department of Otorhinolaryngology, University Clinic for Flavour, Balance and Sleep, Regional Hospital Gødstrup, Herning, Denmark
- and Department of Clinical Medicine, Flavour Institute, Aarhus University, Aarhus, Denmark
- and Center for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, UK
| | - M A Fornazieri
- Department of Clinical Surgery, Universidade Estadual de Londrina and Pontifícia Universidade Católica do Paraná, Londrina, Brazil
| | - J Frasnelli
- Research Chair in Chemosensory Neuroanatomy, Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- and Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - S Gane
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Studies, University of London, London, UK
- and Royal National Throat Nose and Ear Hospital, UCLH, London
| | - H Gudziol
- Department of Otorhinolaryngology, University of Jena, Jena, Germany
| | - N Gupta
- Department of Otorhinolaryngology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - A Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - A K Hernandez
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
- and Department of Otolaryngology - Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines
- and Department of Otolaryngology - Head and Neck Surgery, Philippine General Hospital, University of the Philippines - Manila, Manila, Philippines
| | - E H Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - C Hopkins
- Guys and St Thomas NHS Trust, London, United Kingdom
| | - J W Hsieh
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Geneva Medical School, Geneva, Switzerland
| | - C Huart
- Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- and Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - S Husain
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - R Kamel
- Department of Otorhinolaryngology, Cairo University, Cairo, Egypt
| | - J K Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University, College of Medicine, Seoul, Republic of Korea
| | - M Kobayashi
- Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - I Konstantinidis
- Smell and Taste Clinic, Second Academic Otorhinolaryngology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - B N Landis
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Geneva Medical School, Geneva, Switzerland
| | - M Lechner
- Division of Surgery and Interventional Science, University College London, London, UK
- and UCL Cancer Institute, University College London, London, UK
- and ENT Department, Homerton Healthcare NHS Foundation Trust, London, UK
| | - A Macchi
- ENT Clinic, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - P P Mazal
- Servicio de Otorrinolaringología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - I Miri
- Service Médecine Physique Réadaptation fonctionnelle, Institut Mohamed Kassab d'Orthopédie, Mannouba, Tunisia
| | - T Miwa
- Department of Otorhinolaryngology, Kanazawa Medical University, Uchinada, Kahoku, Ishikawa, Japan
| | - E Mori
- Department of Otorhinolaryngology, Jikei University, School of Medicine, Tokyo, Japan
| | - J Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, Universitat de Barcelona
- IDIBAPS
- CIBERES. Barcelona, Catalonia, Spain
| | - C A Mueller
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - G Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University, Padua, Italy
| | - Z M Patel
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK
- and The Smell and Taste Clinic, James Paget University Hospital, Gorleston, UK
| | - J M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - V R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Indiana University of School Medicine, Indianapolis, IN, USA
| | - Y Roth
- The Institute for Nose and Sinus Therapy and Clinical Investigations, Department of Otolaryngology - Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
| | - R J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - P Stjärne
- Section of Rhinology, Department of Otorhinolaryngology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - L Van Gerven
- Department of Otorhinolaryngology, UZ Leuven, Belgium
- and Department of Neurosciences, Experimental Otorhinolaryngology, KU Leuven, Belgium
- and Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Belgium
| | - J Vodicka
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Pardubice, Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - A Welge-Luessen
- University Hospital Basel - Otorhinolaryngology, Basel, Switzerland
| | - P J Wormald
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
| | - T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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Hodler R, Lechner M, Raschky PA. Institutions and the resource curse: New insights from causal machine learning. PLoS One 2023; 18:e0284968. [PMID: 37262065 PMCID: PMC10234542 DOI: 10.1371/journal.pone.0284968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/13/2023] [Indexed: 06/03/2023] Open
Abstract
There is a widely held belief that natural resource rents are a blessing if institutions are strong, but a curse if institutions are weak. We use data from 3,800 Sub-Saharan African districts and apply a causal forest estimator to reassess the relationship between institutions and the effects of resource rents. Consistent with this belief, we document that stronger institutions increase the positive effect of the presence of mining activities on economic development and dampen the negative effect of mining activities on conflict. In contrast, we find that the effects of higher world mineral prices on economic development and conflict in mining districts are non-linear and vary little in institutional quality.
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Affiliation(s)
- Roland Hodler
- Department of Economics and SIAW-HSG, University of St. Gallen, St. Gallen, Switzerland
- CEPR, London, United Kingdom
- CESifo, Munich, Germany
- OxCarre, University of Oxford, Oxford, England
| | - Michael Lechner
- IAB, Nuremberg, Germany
- IZA, Bonn, Germany
- RWI, Essen, Germany
| | - Paul A. Raschky
- Department of Economics and SoDa Labs Monash University, Caulfield East, VIC, Australia
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Philpott C, Kumaresan K, Fjaeldstad AW, Macchi A, Monti G, Frasnelli J, Konstantinidis I, Pinto J, Mullol J, Boardman J, Vodička J, Holbrook E, Ramakrishnan VR, Lechner M, Hummel T. Developing a core outcome set for clinical trials in olfactory disorders: a COMET initiative. Rhinology 2023; 0:3082. [PMID: 37243690 DOI: 10.4193/rhin22.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
STATEMENT OF PROBLEM Evaluating the effectiveness of the management of Olfactory Dysfunction (OD) has been limited by a paucity of high-quality randomised and/or controlled trials. A major barrier is heterogeneity of outcomes in such studies. Core outcome sets (COS) -standardized sets of outcomes that should be measured/reported as determined by consensus-would help overcome this problem and facilitate future meta-analyses and/or systematic reviews (SRs). We set out to develop a COS for interventions for patients with OD. METHODS A long-list of potential outcomes was identified by a steering group utilising a literature review, thematic analysis of a wide range of stakeholders' views and systematic analysis of currently available Patient Reported Outcome Measures (PROMs). A subsequent e-Delphi process allowed patients and healthcare practitioners to individually rate the outcomes in terms of importance on a 9-point Likert scale. RESULTS After 2 rounds of the iterative eDelphi process, the initial outcomes were distilled down to a final COS including subjective questions (visual analogue scores, quantitative and qualitative), quality of life measures, psychophysical testing of smell, baseline psychophysical testing of taste, and presence of side effects along with the investigational medicine/device and patient's symptom log. CONCLUSIONS Inclusion of these core outcomes in future trials will increase the value of research on clinical interventions for OD. We include recommendations regarding the outcomes that should be measured, although future work will be required to further develop and revalidate existing outcome measures.
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Affiliation(s)
- C Philpott
- James Paget University Hospital, Great Yarmouth, United Kingdom
| | - K Kumaresan
- James Paget University Hospital, Great Yarmouth, United Kingdom
| | - A W Fjaeldstad
- Flavour Clinic, University Clinic for Flavour, Balance and Sleep, Department of Otorhinolaryngology, Regional Hospital Gødstrup, Denmark
| | - A Macchi
- ENT University of Insubria, Italian Academy of Rhinology, Varese, Italy
| | - G Monti
- Department of Biomedicine, Aarhus University, Denmark
| | - J Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, Canada
| | | | - J Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, IL, USA
| | | | - J Boardman
- Fifth Sense UK Charity, Bicester, United Kingdom
| | - J Vodička
- Department of Otorhinolaryngology and Head and Neck Surgery, Regional Hospital and University of Pardubice, Czech Republic
- Department of Otorhinolaryngology and Head and Neck Surgery, Regional Hospital and Faculty of Heath Studies, University of Pardubice, Czech Republic
| | - E Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - V R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indiana
| | - M Lechner
- Division of Surgery and Interventional Science and UCL Cancer Institute, University College London and Barts Health NHS Trust, United Kingdom
| | - T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden Germany
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Lechner M, Liu J, Counsell N, Gillespie D, Chandrasekharan D, Ta NH, Jumani K, Gupta R, Rocke J, Williams C, Tetteh A, Amnolsingh R, Khwaja S, Batterham RL, Yan CH, Treibel TA, Moon JC, Woods J, Brunton R, Boardman J, Hatter M, Abdelwahab M, Holsinger FC, Capasso R, Nayak JV, Hwang PH, Patel ZM, Paun S, Eynon-Lewis N, Kumar BN, Jayaraj S, Hopkins C, Philpott C, Lund VJ. The burden of olfactory dysfunction during the COVID-19 pandemic in the United Kingdom. Rhinology 2023; 61:93-96. [PMID: 36286227 DOI: 10.4193/rhin22.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- M Lechner
- Division of Surgery and Interventional Science, University College London, London, UK; UCL Cancer Institute, University College London, London, UK; ENT Department, Barts Health NHS Trust, London, UK
| | - J Liu
- UCL Cancer Institute, University College London, London, UK
| | - N Counsell
- CRUK and UCL Cancer Trials Centre, University College London, London, UK
| | - D Gillespie
- UCL Cancer Institute, University College London, London, UK
| | - D Chandrasekharan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - N H Ta
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - K Jumani
- Division of Surgery and Interventional Science, University College London, London, UK
| | - R Gupta
- Division of Surgery and Interventional Science, University College London, London, UK
| | - J Rocke
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - C Williams
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - A Tetteh
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - R Amnolsingh
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Khwaja
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - R L Batterham
- Centre for Obesity Research, University College London, London, UK; Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospitals NHS Trust, London, UK; National Institute for Health Research, UCLH Biomedical Research Centre, London, UK
| | - C H Yan
- Department of Otolaryngology, University of San Diego School of Medicine, San Diego, USA
| | - T A Treibel
- National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK
| | - J C Moon
- National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK
| | - J Woods
- The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, UK
| | - R Brunton
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - M Hatter
- Medical University of South Carolina, Charleston, SC, USA
| | - M Abdelwahab
- Medical University of South Carolina, Charleston, SC, USA
| | - F C Holsinger
- Medical University of South Carolina, Charleston, SC, USA
| | - R Capasso
- Medical University of South Carolina, Charleston, SC, USA
| | - J V Nayak
- Medical University of South Carolina, Charleston, SC, USA
| | - P H Hwang
- Medical University of South Carolina, Charleston, SC, USA
| | - Z M Patel
- Medical University of South Carolina, Charleston, SC, USA
| | - S Paun
- Division of Surgery and Interventional Science, University College London, London, UK
| | - N Eynon-Lewis
- Division of Surgery and Interventional Science, University College London, London, UK
| | - B N Kumar
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - S Jayaraj
- Division of Surgery and Interventional Science, University College London, London, UK
| | - C Hopkins
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK; The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, UK
| | - V J Lund
- Royal National ENT Hospital, University College London Hospitals NHS Trust, London, UK
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Bodory H, Busshoff H, Lechner M. High Resolution Treatment Effects Estimation: Uncovering Effect Heterogeneities with the Modified Causal Forest. Entropy 2022; 24:e24081039. [PMID: 36010703 PMCID: PMC9407165 DOI: 10.3390/e24081039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 01/27/2023]
Abstract
There is great demand for inferring causal effect heterogeneity and for open-source statistical software, which is readily available for practitioners. The mcf package is an open-source Python package that implements Modified Causal Forest (mcf), a causal machine learner. We replicate three well-known studies in the fields of epidemiology, medicine, and labor economics to demonstrate that our mcf package produces aggregate treatment effects, which align with previous results, and in addition, provides novel insights on causal effect heterogeneity. For all resolutions of treatment effects estimation, which can be identified, the mcf package provides inference. We conclude that the mcf constitutes a practical and extensive tool for a modern causal heterogeneous effects analysis.
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Affiliation(s)
- Hugo Bodory
- Vice-President’s Board (Research & Faculty), University of St. Gallen, Dufourstrasse 50, 9000 St. Gallen, Switzerland;
| | - Hannah Busshoff
- Swiss Institute for Empirical Research, University of St. Gallen, Varnbüelstrasse 14, 9000 St. Gallen, Switzerland;
- Correspondence:
| | - Michael Lechner
- Swiss Institute for Empirical Research, University of St. Gallen, Varnbüelstrasse 14, 9000 St. Gallen, Switzerland;
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Lechner M, Liu J, Counsell N, Gillespie D, Chandrasekharan D, Ta NH, Jumani K, Gupta R, Rao-Merugumala S, Rocke J, Williams C, Tetteh A, Amnolsingh R, Khwaja S, Batterham RL, Yan CH, Treibel TA, Moon JC, Woods J, Brunton R, Boardman J, Paun S, Eynon-Lewis N, Kumar BN, Jayaraj S, Hopkins C, Philpott C, Lund VJ. The COVANOS trial - insight into post-COVID olfactory dysfunction and the role of smell training. Rhinology 2022; 60:188-199. [PMID: 35901492 DOI: 10.4193/rhin21.470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Olfactory dysfunction is a cardinal symptom of COVID-19 infection, however, studies assessing long-term olfactory dysfunction are limited and no randomised-controlled trials (RCTs) of early olfactory training have been conducted. METHODOLOGY We conducted a prospective, multi-centre study consisting of baseline psychophysical measurements of smell and taste function. Eligible participants were further recruited into a 12-week RCT of olfactory training versus control (safety information). Patient-reported outcomes were measured using an electronic survey and BSIT at baseline and 12 weeks. An additional 1-year follow-up was open to all participants. RESULTS 218 individuals with a sudden loss of sense of smell of at least 4-weeks were recruited. Psychophysical smell loss was observed in only 32.1%; 63 participants were recruited into the RCT. The absolute difference in BSIT improvement after 12 weeks was 0.45 higher in the intervention arm. 76 participants completed 1-year follow-up; 10/19 (52.6%) of participants with an abnormal baseline BSIT test scored below the normal threshold at 1-year, and 24/29 (82.8%) had persistent parosmia. CONCLUSIONS Early olfactory training may be helpful, although our findings are inconclusive. Notably, a number of individuals who completed the 1-year assessment had persistent smell loss and parosmia at 1-year. As such, both should be considered important entities of long-Covid and further studies to improve management are highly warranted.
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Affiliation(s)
- M Lechner
- ENT Department, Barts Health NHS Trust, London, UK; UCL Cancer Institute, University College London, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - J Liu
- UCL Cancer Institute, University College London, London, UK
| | - N Counsell
- CRUK and UCL Cancer Trials Centre, University College London, London, UK
| | - D Gillespie
- UCL Cancer Institute, University College London, London, UK
| | | | - N H Ta
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - K Jumani
- ENT Department, Barts Health NHS Trust, London, UK
| | - R Gupta
- ENT Department, Barts Health NHS Trust, London, UK
| | | | - J Rocke
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - C Williams
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - A Tetteh
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - R Amnolsingh
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Khwaja
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - R L Batterham
- Centre for Obesity Research, University College London, London, UK; Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospitals NHS Foundation Trust, London, UK; National Institute for Health Research, UCLH Biomedical Research Centre, London, UK
| | - C H Yan
- Department of Otolaryngology-Head and Neck Surgery, University of San Diego School of Medicine, San Diego, USA
| | - T A Treibel
- National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK
| | - J C Moon
- National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK
| | - J Woods
- The Norfolk Smell and Taste Clinic, Norfolk
| | - R Brunton
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - S Paun
- ENT Department, Barts Health NHS Trust, London, UK
| | | | - B N Kumar
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - S Jayaraj
- ENT Department, Barts Health NHS Trust, London, UK
| | - C Hopkins
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK; The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, UK
| | - V J Lund
- Royal National ENT Hospital, University College London Hospital NHS Foundation Trust, London, UK
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7
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Ramspott JP, Regenbogen S, Jäger T, Lechner M, Mayer F, Gabersek A, Emmanuel K, Schredl P. Case Report: Adult Right-Sided Bochdalek Hernia Complicated by Intrathoracic Bowel Perforation. Front Surg 2021; 8:755279. [PMID: 34869563 PMCID: PMC8639588 DOI: 10.3389/fsurg.2021.755279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Right-sided Bochdalek hernia is a mostly congenital condition of the diaphragm caused by a persistence of the pleuroperitoneal cavity and a rare disease in adults. As it often presents as an emergent situation, urgent diagnostics and surgical intervention are essential to reduce morbidity and mortality rates. Choosing the right surgical approach (abdominal, thoracic, or a combination of both) can be very challenging for clinicians. Here, we report a case of a 40-year-old woman, who presented with severe abdominal pain and tachypnoea. Imaging revealed a right-sided Bochdalek hernia. Emergency laparotomy was performed followed by reduction of hernia content, right-sided hemicolectomy, and side-to-side anastomosis from the ileum to the transverse colon due to intestinal ischemia and intrathoracic bowel perforation. The post-operative course was complicated by a pleural empyema. Therefore, the patient underwent thoracotomy. One year after surgical repair the patient had no recurrence. Here, we discuss feasible approaches for the surgical management of complicated Bochdalek hernias.
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Affiliation(s)
- Jan Philipp Ramspott
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria.,Department of Gynecology and Obstetrics, Münster University Hospital, Münster, Germany
| | - Stephan Regenbogen
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria.,Department of Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Michael Lechner
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Franz Mayer
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Ana Gabersek
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Philipp Schredl
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
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Mayer F, Lechner M, Gabersek A, Bittner R, Emmanuel K. O24 10 YEARS PARTICIPATING IN THE HERNIAMED-REGISTRY: REFLECTING ON RESULTS OF THE PAST HELPS US TO SHAPE THE FUTURE. Br J Surg 2021. [DOI: 10.1093/bjs/znab396.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Between 01/2011 and 12/2020 5,068 AWR-patients at our department (tertiary referral center) – 884 (17.4%) incisionals. Over this 10-years period considerable changes (patients characteristics, surgical techniques, results) were analyzed.
Material and Methods
Herniamed® offers an internet-based registry-platform to document all kinds of abdominal wall repairs on a voluntary basis since 2009. Demographic data, interventional details and outcomes are documented using the EHS-classification-system. Follow-up is standardized and sheduled for 10 years.
Results
Up to 54.7% of patients (in 2020) show at least one risk factor (diabetes, smoking ….), in contrast to the age pyramid patients >70 years are decreasing (47.2% in 2011 down to 29.3% in 2020), share of ASA III/IV is initially increasing (up to 42.9% in 2017) with a constant decrease after 2017 to 25.3% in 2020. Emergent cases are increasing (6.9% in 2011 up to 10.8% in 2019). Recurrent hernia repairs stays almost constant at median 21.7%. After 2015 we decided – for various reasons - not to routinely apply the laparoscopic IPOM-technique (with an interim ratio of up to 46.2%) – with a post-OP complication rate of median 23.3% anymore. From 2016 onwards we performed an increasing number of „other techniques“ (E-MILOS, E-TEP, ….) up to 36% in 2020 instead.
Conclusions
By analysing trends we recognized that patients show increasing numbers of risk factors and ASA-scores which led us to implement a prehabilitational strategy in clinical routine. However rate of post-OP complication is still high representing AWR as demanding in many aspects. A temporary cessation of MIS did not led to an extensive increase in post-OP wound complications.
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Affiliation(s)
- Franz Mayer
- Paracelsus Medical University Salzburg, Department of General, Visceral and Thoracic Surgery, Salzburg, Austria
| | - Michael Lechner
- Chirurgie West, UK für Chirurgie, Department of General, Visceral and Thoracic Surgery, Salzburg, Austria
| | - Ana Gabersek
- Paracelsus Medical University Salzburg, Department of Surgery, Department of General, Visceral and Thoracic Surgery, Salzburg, Austria
| | - Reinhard Bittner
- Paracelsus Medical University Salzburg, Department of General, Visceral and Thoracic Surgery, Salzburg, Austria
| | - Klaus Emmanuel
- UK für Chirurgie, Paracelsus Medical University Salzburg, Department of General, Visceral and Thoracic Surgery, Salzburg, Austria
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Gabersek A, Mayer F, Mitterwallner S, Kaufmann R, Bittner R, Emmanuel K, Lechner M. P010 FEASIBILITY OF MIDLINE RECONSTRUCTION WITHOUT MYOFASCIAL RELEASE (COMPONENT SEPARATION) AFTER PREOPERATIVE INFILTRATION OF LATERAL ABDOMINAL WALL MUSCULATURE WITH BOTULINUM TOXIN. Br J Surg 2021. [DOI: 10.1093/bjs/znab395.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Aim of the analysis was to evaluate whether preoperative botulinum toxin infiltration may facilitate anatomical midline reconstruction without the need for – otherwise pre-operative assumed – surgical component separation.
Material and Methods
Total of 58 patients with complex abdominal wall hernias were included in our single-center retrospective analysis between 03/2015 and 12/2020. Size of the defect, HSV/ACV-ratio, rectus-to-defect-width-ratio (“Carbonell-Index”) as well as risk factors were analyzed. In all patients muscles of the lateral abdominal wall were infiltrated with 300-500 IE of botulinum toxin 4 weeks prior to the abdominal wall reconstruction. CT scans were performed before and 4 weeks after the botulinum toxin infiltration.
Results
Total of 58 patients (M/F-ratio 36:22), with a mean age of 63.8 years were included in our analysis. Mean BMI was 29.5 kg/m². Total of 50 incisional, 3 umbilical, 2 posttraumatic diaphragmatic hernias and 3 scrotal hernias were analyzed. Surgical component separation after the infiltration with botulinum toxin was necessary in 43% of the cases.
Conclusions
Preoperative infiltration of the lateral abdominal wall musculature with botulinum toxin facilitated midline reconstruction of the abdominal wall without the need for myofascial release in 57%. Reduction of surgical trauma could therefore be achieved in several patients.
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Affiliation(s)
- Ana Gabersek
- Paracelsus Medical Private University, Department of Surgery, Salzburg, Austria, Universitätsklinik für Chirurgie, Abteilung für Allgemein- und Viszeralchirurgie, Salzburg, Austria
| | - Franz Mayer
- Paracelsus Medical Private University, Department of Surgery, Salzburg, Austria, Salzburg, Austria
| | | | - Reinhard Kaufmann
- Paracelsus Medical Private University, Department of Radiology, Salzburg, Austria, Austria
| | - Reinhard Bittner
- Paracelsus Medical Private University, Department of Surgery, Salzburg, Austria, Austria
| | - Klaus Emmanuel
- Paracelsus Medical Private University, Department of Surgery, Salzburg, Austria, Austria
| | - Michael Lechner
- Paracelsus Medical Private University, Department of Surgery, Salzburg, Austria, Austria
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Varga M, Köckerling F, Mayer F, Lechner M, Fortelny R, Bittner R, Borhanian K, Adolf D, Bittner R, Emmanuel K. Are immunosuppressive conditions and preoperative corticosteroid treatment risk factors in inguinal hernia repair? Surg Endosc 2021; 35:2953-2964. [PMID: 32556698 DOI: 10.1007/s00464-020-07736-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Immunosuppressive conditions and/or preoperative corticosteroid treatment have a negative influence on wound healing and can, therefore, lead to higher rates of surgical site infections (SSIs) and seromas. For inguinal hernia, no such studies have been carried out to date. METHODS In an analysis of data from the Herniamed Registry, 2312 of 142,488 (1.6%) patients with primary unilateral inguinal hernia repair had an anamnestic history of an immunosuppressive condition and/or preoperative corticosteroid treatment. Using propensity score matching, 2297 (99.4%) pairs with comparative patient characteristics were formed. These were then compared using the following primary outcome criteria: intra- and postoperative complications, complication-related reoperations, recurrence at one-year follow-up, pain on exertion, pain at rest, and chronic pain requiring treatment at one-year follow-up. Of the 2297 matched pairs with primary unilateral inguinal hernia repair, 82.76% were male patients. 1010 (44.0%) were operated in laparo-endoscopic techniques (TEP, TAPP), 1225 (53.3%) in open techniques (Bassini, Shouldice, Lichtenstein, Plug, TIP, Gilbert, Desarda), and 62 (2.7%) in other techniques. RESULTS The matched pair analysis results did not identify any disadvantage in terms of the outcome criteria for patients with an anamnestic history of immunosuppressive condition and/or preoperative corticosteroid treatment (yes vs no). In particular, no disadvantage was noted in the rate of surgical site infections (0.65% vs 0.70%; ns) or seromas (1.22% vs 1.57%; ns). The overall rates of postoperative complications were 3.40% vs 4.31% (p = ns) (plus 0.22% concordant events in five matched pairs). CONCLUSION In primary unilateral inguinal hernia surgery, an immunosuppressive condition and/or preoperative corticosteroid treatment does not appear to have a negative influence on wound complications.
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Affiliation(s)
- M Varga
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany.
| | - F Mayer
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - M Lechner
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - R Fortelny
- Sigmund Freud Medical University, Vienna, Austria
| | - R Bittner
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - K Borhanian
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - D Adolf
- StatConsult GmbH, Magdeburg, Germany
| | - R Bittner
- Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenow University), Trubetskaya Street 8, b. 2., Moscow, Russia, 119992
| | - K Emmanuel
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
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11
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Lechner M, Chandrasekharan D, Jumani K, Liu J, Gane S, Lund VJ, Philpott C, Jayaraj S. Anosmia as a presenting symptom of SARS-CoV-2 infection in healthcare workers - A systematic review of the literature, case series, and recommendations for clinical assessment and management. Rhinology 2020; 58:394-399. [PMID: 32386285 DOI: 10.4193/rhin20.189] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Healthcare workers are at the forefront of the ongoing COVID-19 pandemic and are at high risk for both the contraction and subsequent spread of virus. Understanding the role of anosmia as an early symptom of infection may improve monitoring and management of SARS-CoV2 infection. METHODOLOGY We conducted a systematic review of the literature of SARS-CoV2 infection/COVID-19 and anosmia to help inform management of anosmia in healthcare works. We report a case series of healthcare workers, who presented with a loss of sense of smell secondary to COVID-19 infection to demonstrate management principles. RT-PCR was used to confirm COVID-19 positivity and psychophysical testing of olfaction was performed using the British version of the University of Pennsylvania Smell Identification Test, UPSIT. RESULTS The systematic literature search returned 31 articles eligible for inclusion in the study and informed our recommendations for clinical assessment and management. All three healthcare professionals who presented with loss of sense of smell subsequently tested positive for SARS-CoV-2. Psychophysical testing of olfaction using the UPSIT confirmed mild and moderate microsmia in two, respectively, and normosmia at day 17 in one. CONCLUSIONS Olfactory (± gustatory) dysfunction is indicative of COVID-19 infection and thus has important implications in the context of healthcare workers, or key workers in general, who work in close contact with others if not recognised as suffering from COVID. This leads to a potentially higher likelihood of spreading the virus. In conjunction with our literature review these findings have helped with creating recommendations on the assessment and management of olfactory dysfunction during the ongoing COVID-19 pandemic, both for healthcare workers and patients.
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Affiliation(s)
- M Lechner
- Whipps Cross University Hospital, Barts Health NHS Trust, UK; UCL Cancer Institute, University College London, London, UK
| | | | - K Jumani
- Whipps Cross University Hospital, Barts Health NHS Trust, UK
| | - J Liu
- UCL Cancer Institute, University College London, London, UK
| | - S Gane
- Royal National Throat, Nose and Ear Hospital, UCLH Foundation Trust, London, UK
| | - V J Lund
- Royal National Throat, Nose and Ear Hospital, UCLH Foundation Trust, London, UK
| | - C Philpott
- The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, UK; Norwich Medical School, University of East Anglia, Norwich, UK
| | - S Jayaraj
- Whipps Cross University Hospital, Barts Health NHS Trust, UK
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12
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Forjan M, David V, Wagner M, Dolesch L, Lechner M, Sauermann S. Conceptualization of an ICU Infrastructure for Simulation Based Education in Medical Engineering & eHealth. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:4186-4189. [PMID: 31946792 DOI: 10.1109/embc.2019.8856949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of simulation-based training is gaining importance in medical as well as engineering related education. The complex environment of an intensive care unit is characterized by a high need of interaction between clinical as well as technical components and views. These diverse interactions and the connected requirements are the focus for the presented simulation infrastructure, enabling research, education and training. The presented concept of a modular and flexible intensive care environment provides a high degree of interoperability and flexibility for individual research questions and full support of connectivity for typical clinical workflows. The presented simulation and testing bed will allow both, education for engineering and medical students using patient simulation and simultaneous data transfer as well as research on medical workflows, infrastructural demands and connectivity conformance questions.
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13
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Lorenz R, Oppong C, Frunder A, Lechner M, Sedgwick DM, Tasi A, Wiessner R. Improving surgical education in East Africa with a standardized hernia training program. Hernia 2020; 25:183-192. [PMID: 32157505 DOI: 10.1007/s10029-020-02157-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 02/19/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Inguinal hernias are among the most common surgical diseases in Africa. The current International HerniaSurge Guidelines recommend mesh-based surgical techniques in Low Resource Settings (LRS). This recommendation is currently unachievable in large parts of Africa due to the unaffordability of mesh and lack of appropriate training of the few available surgeons. There is, therefore, a need for formal training in mesh surgery. There is an experience in Hernia Repair for the Underserved in Central and South America, however, inadequate evidence of structured training in Africa. MATERIAL AND METHODS Since 2016, the aid Organizations, Surgeons for Africa and Operation Hernia have developed and employed a structured hernia surgical training program for postgraduate surgical trainees and medical doctors in Rwanda. This course consists of lectures on relevant aspects of hernia surgery and hands-on training in operating theatres. The lectures emphasize anatomy and surgical technique. All parts of the training were evaluated. Formal pre-course evaluation was conducted to assess the personal surgical experience of the trainees. RESULTS Over a 3-year period, a structured hernia training programme was employed to train a total of 36 surgical trainees in both mesh and also non mesh hernia surgery. The key principle in this course is the continuous competence assessment and feedback. Evidence is provided to demonstrate improvement in surgical skills as well as knowledge of surgical anatomy which is essential to acquiring surgical competency. With self-assessment, expressed on a Likert scale, the participants could improve the theoretical knowledge about hernias from median 4.4 (on a scale of 1-10) before training to 8.4 after the training. The specific knowledge about anatomy could be improved in the same assessment from 4.8 before training to 8.1. after the training. After training course 12 of the 36 participants (33.33%) were able to carry out both suture- and mesh-based operations of simple inguinal hernias completely and independently. 20 of the 36 participants (55.55%) required only minimal supervision and only four participants (11.11%) required surgical supervision even after the completion of the course. CONCLUSION We have demonstrated that, medical personnel in Africa can be trained in mesh and non-mesh hernia surgery using a structured training programme.
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Affiliation(s)
- R Lorenz
- 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany.
| | - C Oppong
- University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth, PL6 8DH, UK
| | - A Frunder
- Lorettoklinik Tübingen, Katharinenstraße 10, 72072, Tübingen, Germany
| | - M Lechner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | | | - A Tasi
- Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany
| | - R Wiessner
- Department of General and Visceral Surgery, Bodden-Kliniken Ribnitz-Damgarten, Sandhufe 2, 18311, Ribnitz-Damgarten, Germany
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14
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Köhler G, Lechner M, Kaltenböck R, Pfandner R, Hartig N. [Preperitoneal Umbilical Hernia Mesh Plasty (PUMP): Indications, Technique and Results]. Zentralbl Chir 2019; 145:64-71. [PMID: 31394581 DOI: 10.1055/a-0972-1792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The principle of the preperitoneal umbilical mesh plasty (PUMP) technique is placement of the prosthesis in the extraperitoneal space, posterior to the rectus muscles, followed by ventral fascia closure. Difficulties can arise from preperitoneal dissection, mesh insertion, deployment, and positioning. METHODS 81 elective patients underwent preperitoneal repair of primary umbilical or epigastric hernias sized from 2 - 4 cm between January 2015 and March 2018 and were prospectively collected in the Herniamed database and retrospectively analysed. The same general technique was applied, but over time three different types of mesh devices were used. The experience from these cases and the gradual change between the implants during the observation period is described in this study. RESULTS No intraoperative complications were recorded. Postoperative complications occurred in 6 of 81 patients (7.4%) with the need for unplanned re-operation in 3 cases. Seventy-six of 81 patients (93.8%) attended the one year follow-up evaluation. Three of 76 patients (3.9%) suffered recurrence and five patients (6.6%) requires treatment for chronic pain. CONCLUSION Surgeons must work with the implant that best suits their patients' needs and that also provides good results and adequate working comfort. The PUMP technique performs well for ventral hernias sized between 2 and 4 cm without the need of midline reconstruction due to diastasis of the rectus muscles. It enables a local extraperitoneal mesh augmentation without the risk of intraperitoneal complications. PUMP repair lowers the risk of recurrence in comparison with suture repair without increasing the risk of complications.
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Affiliation(s)
- Gernot Köhler
- Allgemein- und Viszeralchirurgie, Ordensklinikum Linz, Österreich
| | - Michael Lechner
- Chirurgie, Paracelsus medizinische Universität Salzburg, Österreich
| | | | - Richard Pfandner
- Allgemein- und Viszeralchirurgie, Ordensklinikum Linz, Österreich
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Lechner M, Meissnitzer M, Borhanian K, Bittner R, Kaufmann R, Mayer F, Jäger T, Mitterwallner S, Emmanuel K, Forstner R. Surgical and radiological behavior of MRI-depictable mesh implants after TAPP repair: the IRONMAN study. Hernia 2019; 23:1133-1140. [PMID: 31367964 PMCID: PMC6938468 DOI: 10.1007/s10029-019-02019-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/20/2019] [Indexed: 10/29/2022]
Abstract
PURPOSE Knowledge of postoperative behavior of mesh implants used for hernia repair is generally limited to cases of recurrence, local complications or return to the previous operative field in other pathological conditions. Previous studies with MRI-visible mesh implants in different parts of the abdominal wall have led to variable findings with regard to mesh properties and mostly described a reduction in size over time with subsequently limited mesh overlap over hernia defects which could contribute to recurrence. We aimed to evaluate implant properties in a mechanically stable anatomical region after TAPP repair of primary unilateral inguinal hernias in men with clinical and MRI examinations 4 weeks and 1 year after surgery. METHODS From 11/2015 to 01/2019, 23 men with primary, unilateral, inguinal hernias underwent TAPP repair with iron particle-loaded, MRI-visible mesh implants in a prospective cohort study. In 16 patients the operative outcome could be evaluated 4 weeks and 12 months after surgery by clinical examination and MRI evaluation with regard to postoperative course, possible adverse outcomes and radiological findings related to implant behavior-namely MRI-identifiability, mesh dislocation or reduction in surface area. RESULTS All included patients had an uneventful postoperative clinical course. MRI after 4 weeks revealed one postoperative seroma, which resolved spontaneously. No recurrence was detected. Mesh implants could be accurately delineated in DIXON-IN studies and showed neither clinically nor statistically significant changes in size or position. CONCLUSION 4 weeks and 1 year after a standardized TAPP procedure the mesh implant used in this study showed no tendency towards dislocation or reduction in size in this anatomical position. Its MRI visibility allows accurate delineation during the postoperative course by experienced radiologists in appropriate MRI protocols. Larger patient series are desirable to further support these findings. Shrinkage of implants in the groin as a reason for early recurrence may be overestimated.
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Affiliation(s)
- M Lechner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - M Meissnitzer
- Department of Radiology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - K Borhanian
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - R Bittner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - R Kaufmann
- Department of Radiology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - T Jäger
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - S Mitterwallner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - K Emmanuel
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - R Forstner
- Department of Radiology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Lechner M, Bittner R, Borhanian K, Mitterwallner S, Emmanuel K, Mayer F. Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years. Hernia 2019; 24:633-637. [PMID: 30900041 PMCID: PMC7210230 DOI: 10.1007/s10029-019-01928-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
Purpose Short-term effects of round ligament varicosity (RLV) in pregnancy have been investigated in small-scale studies. The long-term effects are unknown. This study aims to evaluate the risk of groin hernia manifestation after RLV in pregnancy, to delineate possible risk factors and to analyze the natural course of pregnancy and post-partum period with regard to RLV. Methods In a prospective analysis 28 pregnant women with RLV presented to the hernia clinic over 9 years. After clinical and ultrasound examination during pregnancy and publication of early results in 2013 a second structured follow-up was conducted. Demographic data, hernia-specific risk factors, comorbidities, pregnancy and birth-related data as well as post-partum period were documented without loss of follow-up. In these women, all pregnancies that occurred, including the ones without RLV, were analyzed. Results Median follow-up was 68 months (11.4–104.9). Only one groin hernia was found. No risk factors could be identified. After uncomplicated childbirth complaints subsided spontaneously in all but one patient within 4 weeks. Recurrence rates in subsequent pregnancies are up to 89%. Conclusion Temporary RLV-induced dilation of the deep inguinal ring in pregnancy is not a common precursor for the development of inguinal hernias later in life. All findings support the theory that the hindrance of venous blood flow caused by the gravid uterus is an important contributing factor for RLV in pregnancy, which is self-limited but has a high risk of recurrence and is not an indication for surgery before or after delivery or for cesarean section.
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Affiliation(s)
- M Lechner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, Salzburg, 5020, Austria.
| | - R Bittner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, Salzburg, 5020, Austria
| | - K Borhanian
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, Salzburg, 5020, Austria
| | - S Mitterwallner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, Salzburg, 5020, Austria
| | - K Emmanuel
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, Salzburg, 5020, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, Salzburg, 5020, Austria
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Lechner M, Borhanian K, Mitterwallner S, Bittner R, Klieser E, Köhler G, Emmanuel K, Mayer F. Retroperitoneal Liposarcoma: A Concern in Inguinal Hernia Repair. JSLS 2019; 23:JSLS.2018.00064. [PMID: 30700965 PMCID: PMC6345196 DOI: 10.4293/jsls.2018.00064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background and Objectives: The goal of the study was to evaluate retroperitoneal sarcomas with continuous growth into the scrotum through the inguinal canal with regard to diagnostic approach, surgical treatment, and outcome. The analysis is based on a comprehensively documented case and a complete systematic review of published literature. Potential pitfalls are highlighted. Methods: We describe the case of a 57-year-old male Caucasian who presented with a swelling in the right groin. Suspecting a scrotal hernia, transabdominal preperitoneal plasty surgery was planned but intraoperatively a large retroperitoneal mass was revealed. After computed tomography scan and magnetic resonance imaging, a complete resection of the tumor was performed. Ten previously published cases describing the same pathology were retrieved from the PubMed database and analyzed systematically in a complete literature review. Results: Histology showed a well-differentiated liposarcoma with tumor-free resection margins. Twenty-two months postoperatively, the patient is in complete clinical remission. Conclusion: Preoperative clinical suspicion of retroperitoneal involvement is paramount for developing of a surgical strategy and in unclear cases demands extended preoperative diagnostic workup. Following the appropriate patient management is crucial to prognosis.
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Affiliation(s)
- M Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - K Borhanian
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - S Mitterwallner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - R Bittner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - E Klieser
- Department of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - G Köhler
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - K Emmanuel
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
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Sutton L, Mozaffari M, Mintarti A, Indrasari SR, Narula A, Lechner M. Barriers to improving tracheostomy care in low- and middle-income countries: Our experience of a 23 patient closed loop audit cycle. Clin Otolaryngol 2018; 43:1392-1395. [PMID: 29802686 DOI: 10.1111/coa.13151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/28/2022]
Affiliation(s)
- L Sutton
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK.,UCL Cancer Institute, University College London, London, UK
| | - M Mozaffari
- UCL Cancer Institute, University College London, London, UK
| | - A Mintarti
- Faculty of Medicine, Department of ENT H&N Surgery, Universitas GadjahMada/Sardjito Hospital, Yogyakarta, Indonesia
| | - S R Indrasari
- Faculty of Medicine, Department of ENT H&N Surgery, Universitas GadjahMada/Sardjito Hospital, Yogyakarta, Indonesia
| | - A Narula
- ENT UK, Royal College of Surgeons, London, UK
| | - M Lechner
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK.,UCL Cancer Institute, University College London, London, UK.,Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK
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19
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Warner E, Liu ZW, Lechner M, Kotecha B. Attitudes to local anaesthesia in radiofrequency thermotherapy sleep surgery: Our experience in a single centre with 42 adult patients. Clin Otolaryngol 2018; 43:1401-1402. [PMID: 29856532 DOI: 10.1111/coa.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Z-W Liu
- Royal National Throat Nose and Ear, London, UK
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20
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Köhler G, Fischer I, Kaltenböck R, Lechner M, Dauser B, Jorgensen LN. Evolution of Endoscopic Anterior Component Separation to a Precostal Access with a New Cylindrical Balloon Trocar. J Laparoendosc Adv Surg Tech A 2018; 28:730-735. [DOI: 10.1089/lap.2017.0480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gernot Köhler
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), Linz, Austria
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
- Academic Teaching Hospital of the Medical Universities, Vienna, Austria; Graz, Austria; Innsbruck, Austria
| | - Ines Fischer
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), Linz, Austria
- Academic Teaching Hospital of the Medical Universities, Vienna, Austria; Graz, Austria; Innsbruck, Austria
| | - Richard Kaltenböck
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), Linz, Austria
- Academic Teaching Hospital of the Medical Universities, Vienna, Austria; Graz, Austria; Innsbruck, Austria
| | - Michael Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Dauser
- Department of Surgery, St John of God Hospital, Vienna, Austria
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21
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Sutton L, Schartinger V, Url C, Schmutzhard J, Lechner D, Kavasogullari C, Sandhu JS, Shaida A, Laszig R, Loehler J, Plontke S, Riechelmann H, Lechner M. Intratympanic steroid use for idiopathic sudden sensorineural hearing loss: current otolaryngology practice in Germany and Austria. Eur Arch Otorhinolaryngol 2018; 275:1103-1110. [PMID: 29605865 DOI: 10.1007/s00405-018-4958-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/27/2018] [Indexed: 01/23/2023]
Abstract
AIMS The frequency of the use of intratympanic steroids (ITS) as a treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) in Europe is still unknown and remains a contentious issue amongst otolaryngologists. We undertook a survey of otolaryngologists in Germany and Austria to establish if there is any professional consensus with which to form a protocol for its use. METHODS A survey of 21 questions was distributed electronically to otolaryngologists in Germany and Austria and data on demographics, indications for intratympanic treatment, procedure, follow-up, and outcomes were analysed. RESULTS We received 908 responses. 49.1% of otolaryngologists used ITS for ISSNHL. Of those otolaryngologists who use ITS, 73.7% do not use it as primary treatment. 20.6% use ITS in conjunction with oral steroids for primary treatment and only 5.8% use ITS as monotherapy for primary treatment. 90.5% use ITS as salvage therapy. 81.1% do not consider the use of ITS after 2 weeks from the onset of symptoms. 8.3% used a tympanostomy tube and while the most commonly used steroid was dexamethasone at a concentration of 4 mg/ml (61%), a wide variety or other steroids and concentrations were used. CONCLUSIONS This survey illustrates wide variation of current practice of intratympanic corticosteroid injection for ISSHL in Germany and Austria. In the absence of high-level evidence, knowing what current practice is allows clinicians to assess what they do against what their colleagues are doing, and if they do something very different, make them question their practice. Moreover, the obtained data will help to direct future clinical trials with the aim to compare the outcomes of more commonly used protocols.
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Affiliation(s)
- L Sutton
- Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6DD, UK
| | - V Schartinger
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria
| | - C Url
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria
| | - J Schmutzhard
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria
| | - D Lechner
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria
| | | | - J S Sandhu
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AT, UK
| | - A Shaida
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, 330 Grays Inn Road, London, WC1X 8DA, UK
| | - R Laszig
- Department of Otorhinolaryngology, University Hospital of Freiburg, Breisacher Str., Freiburg, Germany
| | - J Loehler
- ENT Clinic, Maienbeeck, Bad Bramstedt, Germany
| | - S Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Halle, Ernst-Grube-Str., Halle, Germany
| | - H Riechelmann
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria
| | - M Lechner
- Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK.
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6DD, UK.
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Innsbruck, Anichstr., Innsbruck, Austria.
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, 330 Grays Inn Road, London, WC1X 8DA, UK.
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22
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Breitung J, Chaganty NR, Daniel RM, Kenward MG, Lechner M, Martus P, Sabo RT, Wang YG, Zorn C. Discussion of “Generalized Estimating Equations: Notes on the Choice of the Working Correlation Matrix”. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1625133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Summary
Objective: To discuss generalized estimating equations as an extension of generalized linear models by commenting on the paper of Ziegler and Vens “Generalized Estimating Equations: Notes on the Choice of the Working Correlation Matrix”.
Methods: Inviting an international group of experts to comment on this paper.
Results: Several perspectives have been taken by the discussants. Econometricians have established parallels to the generalized method of moments (GMM). Statisticians discussed model assumptions and the aspect of missing data. Applied statisticians commented on practical aspects in data analysis.
Conclusions: In general, careful modeling correlation is encouraged when considering estimation efficiency and other implications, and a comparison of choosing instruments in GMM and generalized estimating equations (GEE) would be worthwhile. Some theoretical drawbacks of GEE need to be further addressed and require careful analysis of data. This particularly applies to the situation when data are missing at random.
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23
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Hofmann AT, Gruber-Blum S, Lechner M, Petter-Puchner A, Glaser K, Fortelny R. Delayed closure of open abdomen in septic patients treated with negative pressure wound therapy and dynamic fascial suture: the long-term follow-up study. Surg Endosc 2017; 31:4717-4724. [PMID: 28424908 DOI: 10.1007/s00464-017-5547-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 03/28/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Negative pressure wound therapy (NPWT) is widely used in the treatment of open abdomen (OA). The use of dynamic fascial sutures (DFS) increases the rate of successful delayed closure by reducing fascial lateralization. We recently published a prospective controlled trial including 87 patients undergoing abdominal surgery for secondary peritonitis between 2007 and 2012. Patients were treated with NPWT and DFS for approximation of fascial edges. The present study represents a follow-up assessment of these patients 5-9 years after OA treatment with NPWT and DFS. METHODS The 39 patients still alive were included in the recent study according to the protocol of our last study in 2013. All patients received a questionnaire regarding long-term complications after OA treatment between 2007 and 2012. Mean follow-up was 5-9 years. Analyzed parameters included pain, the presence of incisional hernia, and subsequent surgical interventions. Results were analyzed quantitatively. RESULTS One patient had deceased since the last publication in 2013, and hence 38 patients were included in the current study. The median age was 60.9 (25.2-86.1) years, and 17 (44.7%) were females. Overall 56.3% of the original 87 patients had died during the long-term follow-up period. 21 patients (55.3%) answered the questionnaire. Six (28.6%) declared that they suffered from pain in the previous operating field, five (23.8%) at rest, and three (14.3%) during exercise. In five patients (23.8%), pain lasted for more than 3 months. One patient (4.8%) still requires analgesic treatment. Among the 21 patients, seven (33.3%) were found to have incisional hernias. Three hernias (42.9%) were treated by surgery. CONCLUSION Incisional hernia rates after OA treatment remain high, but are accompanied by little pain. The ideal technique of fascial closure after NPWT should be investigated in further research.
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Affiliation(s)
- Anna Theresa Hofmann
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Montleartstrasse 37, 1160, Vienna, Austria.
| | - Simone Gruber-Blum
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Montleartstrasse 37, 1160, Vienna, Austria
| | - Michael Lechner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Alexander Petter-Puchner
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Montleartstrasse 37, 1160, Vienna, Austria
| | - Karl Glaser
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Montleartstrasse 37, 1160, Vienna, Austria
| | - René Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Montleartstrasse 37, 1160, Vienna, Austria.,Sigmund Freud University, Freudplatz 1, 1020, Vienna, Austria
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24
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Randhawa PS, Watson N, Lechner M, Ritchie L, Choudhury N, Andrews PJ. The outcome of septorhinoplasty surgery on olfactory function. Clin Otolaryngol 2016; 41:15-20. [PMID: 25974245 DOI: 10.1111/coa.12463] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess olfactory outcomes in patients undergoing septorhinoplasty surgery in our unit. DESIGN Prospective cohort study. SETTING The Royal National Throat Nose and Ear Hospital, London. PARTICIPANTS Forty-three patients undergoing functional septorhinoplasty (Males = 26; mean age = 34.1 ± 12.2) were recruited into the study. MAIN OUTCOME MEASURES The primary outcome of olfactory function was assessed using 'Sniffin sticks'. Our secondary outcomes were assessment of patient quality of life using the disease specific Sino-nasal Outcome Test-23 questionnaire (SNOT-23) and a visual analogue scale for sense of smell. These measures were repeated at 12 weeks post operatively. RESULTS There was a significant change in the Sniffin' sticks score post-operatively (8.3 versus 9.6; P < 0.001). The SNOT-23 score also showed a significant improvement post-operatively (53.5 versus 40.4; P < 0.001). A significant improvement was not found in the smell/taste question (question 21) of the SNOT-23 questionnaire as well as the visual analogue scale for sense of smell. A difference in olfactory outcome was not found between open versus closed approaches, primary versus revision surgery and traumatic versus non traumatic cases. CONCLUSIONS The results show a measured significant improvement in olfaction following functional Septorhinoplasty but not a subjective improvement in the patients perception of their sense of smell and hence not a clinically significant difference. The reasons for the measured improvement are not clear and are likely to be multifactorial.
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Affiliation(s)
- P S Randhawa
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - N Watson
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - M Lechner
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - L Ritchie
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - N Choudhury
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - P J Andrews
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK
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25
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Hutter J, Lechner M, Reich-Weinberger S. VATS unterstützte Rippenstabilisierung bei Rippenfrakturen und Pseudoarthrosen. Zentralbl Chir 2016. [DOI: 10.1055/s-0036-1587554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Köhler G, Mayer F, Wundsam H, Schrittwieser R, Emmanuel K, Lechner M. Changes in the Surgical Management of Parastomal Hernias Over 15 Years: Results of 135 Cases. World J Surg 2016; 39:2795-804. [PMID: 26264458 DOI: 10.1007/s00268-015-3187-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Over the years, various open and laparoscopic approaches toward the repair of parastomal hernias (PSH) have been described. The variety of published techniques itself can be seen as an indicator for the often low level of satisfaction reached with the surgical procedures. METHODS From January 1999 to January 2014, we assessed all cases of PSH repair performed at the three participating surgical departments in a retrospective analysis. The results were evaluated with regard to different surgical techniques focusing on complications and recurrences. RESULTS One hundred and thirty-five individuals could be included in the analysis. They were operated on with eight different surgical techniques. Laparoscopic procedures were carried out in 46.7 % (63/135) of the cases. Median follow-up was 54 months (12-146 months). We found 44 cases of recurrence (32.6 %) and 24 (17.8 %) of the patients experienced perioperative complications and 12 of them needed to return to theater. Fourteen of the 135 patients (10.4 %) were operated as emergency cases which were associated with a mortality of 28.6 % (4/14). In case of elective PSH repair, no mortality occured. CONCLUSION The results achieved by direct suture or the use of incised flat meshes for the repair of PSH were poor with these procedures having unacceptably high recurrence rates. With regard to the latter ostomy revision through three-dimensional funnel-shaped meshes and the laparoscopic sandwich technique showed the best results. Emergency procedures were linked to a dramatic increase in morbidity and mortality (p < 0.001).
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Affiliation(s)
- Gernot Köhler
- Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria. .,Academic Teaching Hospital of the Medical Universitiy of Graz, Graz, Austria. .,Academic Teaching Hospital of the Medical Universitiy of Innsbruck, Innsbruck, Austria. .,Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
| | - Franz Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Helwig Wundsam
- Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.,Academic Teaching Hospital of the Medical Universitiy of Graz, Graz, Austria.,Academic Teaching Hospital of the Medical Universitiy of Innsbruck, Innsbruck, Austria
| | | | - Klaus Emmanuel
- Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.,Academic Teaching Hospital of the Medical Universitiy of Graz, Graz, Austria.,Academic Teaching Hospital of the Medical Universitiy of Innsbruck, Innsbruck, Austria
| | - Michael Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
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Abstract
The role of curricular activities for the formation of education, health and behavioural outcomes has been widely studied. Yet, the role of extra-curricular activities has received little attention. This study analyzes the effect of participation in sports clubs—one of the most popular extra-curricular activities among children. We use alternative datasets and flexible semi-parametric estimation methods with a specific way to use the panel dimension of the data to address selection into sports. We find positive and robust effects on children’s school performance and peer relations. Crowding out of passive leisure activities can partially explain the effects.
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Affiliation(s)
- Christina Felfe
- Swiss Institute for Empirical Economic Research, University of St. Gallen, St. Gallen, Switzerland
- Center for Economic Studies and ifo Institut, Munich, Germany
| | - Michael Lechner
- Swiss Institute for Empirical Economic Research, University of St. Gallen, St. Gallen, Switzerland
- Center for Economic Studies and ifo Institut, Munich, Germany
- Center for Economic Policy Research, London, England
- Policy Studies Institute, London, England
- Institute for the Study of Labor, Bonn, Germany
- Institut for Employment Research, Nuremberg, Germany
| | - Andreas Steinmayr
- Institute for the Study of Labor, Bonn, Germany
- Department of Economics, University of Munich (LMU), Munich, Germany
- * E-mail:
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Abstract
Background and Objectives: We aimed to evaluate the first human use of magnetic resonance–visible implants for intraperitoneal onlay repair of incisional hernias regarding magnetic resonance presentability. Methods: Ten patients were surgically treated with intraperitoneally positioned superparamagnetic flat meshes. A magnetic resonance investigation with a qualified protocol was performed on postoperative day 1 and at 3 months postoperatively to assess mesh appearance and demarcation. The total magnetic resonance–visible mesh surface area of each implant was calculated and compared with the original physical mesh size to evaluate potential reduction of the functional mesh surfaces. Results: We were able to show a precise mesh demarcation, as well as accurate assessment of the surrounding tissue, in all 10 cases. We documented a significant decrease in the magnetic resonance–visualized total mesh surface area after release of the pneumoperitoneum compared with the original mesh size (mean, 190 cm2 vs 225 cm2; mean reduction of mesh area, 35 cm2; P < .001). At 3 months postoperatively, a further reduction of the surface area due to significant mesh shrinkage could be observed (mean, 182 cm2 vs 190 cm2; mean reduction of mesh area, 8 cm2; P < .001). Conclusion: The new method of combining magnetic resonance imaging and meshes that provide enhanced signal capacity through direct integration of iron particles into the polyvinylidene fluoride base material allows for detailed mesh depiction and quantification of structural changes. In addition to a significant early postoperative decrease in effective mesh surface area, a further considerable reduction in size occurred within 3 months after implantation.
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Affiliation(s)
- Gernot Köhler
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
| | - Leo Pallwein-Prettner
- Department of Diagnostic and Interventional Radiology, Sisters of Charity Hospital, Linz, Austria
| | - Oliver Owen Koch
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
| | | | - Michael Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Klaus Emmanuel
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
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29
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Lechner M, Fenton TR. The Genomics, Epigenomics, and Transcriptomics of HPV-Associated Oropharyngeal Cancer--Understanding the Basis of a Rapidly Evolving Disease. Adv Genet 2016; 93:1-56. [PMID: 26915269 DOI: 10.1016/bs.adgen.2015.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Human papillomavirus (HPV) has been shown to represent a major independent risk factor for head and neck squamous cell cancer, in particular for oropharyngeal carcinoma. This type of cancer is rapidly evolving in the Western world, with rising trends particularly in the young, and represents a distinct epidemiological, clinical, and molecular entity. It is the aim of this review to give a detailed description of genomic, epigenomic, transcriptomic, and posttranscriptional changes that underlie the phenotype of this deadly disease. The review will also link these changes and examine what is known about the interactions between the host genome and viral genome, and investigate changes specific for the viral genome. These data are then integrated into an updated model of HPV-induced head and neck carcinogenesis.
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Affiliation(s)
- M Lechner
- Head and Neck Centre, University College London Hospital, London, UK; UCL Cancer Institute, University College London, London, United Kingdom
| | - T R Fenton
- UCL Cancer Institute, University College London, London, United Kingdom
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30
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Affiliation(s)
- Michael Lechner
- Swiss Institute for Empirical Economic Research, University of St. Gallen, St. Gallen, Switzerland
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31
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Köhler G, Lechner M, Mayer F, Köckerling F, Schrittwieser R, Fortelny RH, Adolf D, Emmanuel K. Self-Gripping Meshes for Lichtenstein Repair. Do We Need Additional Suture Fixation? World J Surg 2015; 40:298-308. [DOI: 10.1007/s00268-015-3313-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Yasuo S, Kenichi Y, Ueno N, Arimoto A, Hosono M, Yoshikawa T, Toyokawa A, Kakeji Y, Tsai Y, Tsai C, Sul J, Lim M, Park J, Jang CE, Santilli O, Tripoloni D, Santilli H, Nardelli N, Greco A, Estevez M, Sakurai S, Ryu S, Cesana G, Ciccarese F, Uccelli M, Grava G, Castello G, Carrieri D, Legnani G, Olmi S, Naito M, Yamamoto H, Sawada Y, Mandai Y, Asano H, Ino H, Tsukuda K, Nagahama T, Ando M, Ami K, Arai K, Miladinovic M, Kitanovic A, Lechner M, Mayer F, Meissnitzer M, Fortsner R, Öfner D, Köhler G, Jäger T, Kumata Y, Fukushima R, Inaba T, Yaguchi Y, Horikawa M, Ogawa E, Katayama T, Kumar PS, Unal D, Caparlar C, Akkaya T, Mercan U, Kulacoglu H, Barreiro JJ, Baer IG, García LS, Cumplido PL, Florez LJG, Muñiz PF, Fujino K, Mita K, Ohta E, Takahashi K, Hashimoto M, Nagayasu K, Murabayashi R, Asakawa H, Koizumi K, Hayashi G, Ito H, Felberbauer F, Strobl S, Kristo I, Riss S, Prager G, El Komy H, El Gendi A, Nabil W, Karam M, El Kayal S, Chihara N, Suzuki H, Watanabe M, Uchida E, Chen T, Wang J, Wang H, Bouchiba N, Elbakary T, Ramadan A, Elakkad M, Berney C, Vlasov V, Babii I, Pidmurnyak O, Prystupa M, Asakage N, Molinari P, Contino E, Guzzetti L, Oggioni M, Sambuco M, Berselli M, Farassino L, Cocozza E, Crespi A, Ambrosoli A, Zhao Y. Topic: Inguinal Hernia - Unsolved problem in the daily practice. Hernia 2015; 19 Suppl 1:S293-304. [PMID: 26518826 DOI: 10.1007/bf03355374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- S Yasuo
- Department of Surgery. Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc. Saiseikai Wakakusa Hospital, Yokohama, Japan
| | - Y Kenichi
- Department of Surgery. Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc. Saiseikai Wakakusa Hospital, Yokohama, Japan
| | - N Ueno
- Department of General Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - A Arimoto
- Department of General Surgery, Takatsuki General Hospital, Takatsuki, Japan
| | - M Hosono
- Division of Gastrointestinal Surgery, Kobe University Hospital, Kobe, Japan
| | - T Yoshikawa
- Department of General Surgery, Takatsuki General Hospital, Takatsuki, Japan
| | - A Toyokawa
- Department of General Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Y Kakeji
- Division of Gastrointestinal Surgery, Kobe University Hospital, Kobe, Japan
| | - Y Tsai
- Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - C Tsai
- Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - J Sul
- Chungnam National University Hospital, Daejeon, South Korea
| | - M Lim
- Chungnam National University Hospital, Daejeon, South Korea
| | - J Park
- Chungnam National University Hospital, Daejeon, South Korea
| | | | - O Santilli
- Centro De Patologia Herniaria, Buenos Aires, Argentina
| | - D Tripoloni
- Centro De Patologia Herniaria, Buenos Aires, Argentina
| | - H Santilli
- Centro De Patologia Herniaria, Buenos Aires, Argentina
| | - N Nardelli
- Centro De Patologia Herniaria, Buenos Aires, Argentina
| | - A Greco
- Centro De Patologia Herniaria, Buenos Aires, Argentina
| | - M Estevez
- Centro De Patologia Herniaria, Buenos Aires, Argentina
| | - S Sakurai
- St. Luke's International Hospital, Tokyo, Japan
| | - S Ryu
- Samsung Changwon Hospital, Changwon-si, Gyeongsangnam-do, South Korea
| | - G Cesana
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - F Ciccarese
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - M Uccelli
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - G Grava
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - G Castello
- General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - D Carrieri
- General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - G Legnani
- General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - S Olmi
- School of General Surgery, University of Milan, Milan, Italy.,General and Oncologic Surgery Department, S. Marco Hospital, Zingonia, BG, Italy
| | - M Naito
- Department of Surgery, Okayama Medical Center, Okayama, Japan
| | - H Yamamoto
- Department of Surgery, Okayama Medical Center, Okayama, Japan
| | - Y Sawada
- Himeji Daiichi Hospital, Himeji, Japan
| | - Y Mandai
- Okayama University Hospital, Okayama, Japan
| | - H Asano
- Okayama University Hospital, Okayama, Japan
| | - H Ino
- Okayama University Hospital, Okayama, Japan
| | - K Tsukuda
- Okayama University Hospital, Okayama, Japan
| | - T Nagahama
- Department of Surgery, Toshima Hospital, Tokyo, Japan
| | - M Ando
- Department of Surgery, Toshima Hospital, Tokyo, Japan
| | - K Ami
- Department of Surgery, Toshima Hospital, Tokyo, Japan
| | - K Arai
- Department of Surgery, Toshima Hospital, Tokyo, Japan
| | | | - A Kitanovic
- Surgery ward, General hospital, Krusevac, Serbia
| | - M Lechner
- Department of General Surgery, Paracelsus Medical University, Salzburg, Austria
| | - F Mayer
- Department of General Surgery, Paracelsus Medical University, Salzburg, Austria
| | - M Meissnitzer
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - R Fortsner
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - D Öfner
- Department of General Surgery, Paracelsus Medical University, Salzburg, Austria
| | - G Köhler
- Department of General Surgery, Sisters of Charity Hospital, Linz, Austria
| | - T Jäger
- Department of General Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Y Kumata
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - R Fukushima
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - T Inaba
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - Y Yaguchi
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - M Horikawa
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - E Ogawa
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - T Katayama
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - P S Kumar
- ESI-PGIMSR and Medical College, Bangalore, India
| | - D Unal
- Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - C Caparlar
- Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - T Akkaya
- Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - U Mercan
- Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - H Kulacoglu
- Diskapi Teaching and Research Hospital, Ankara, Turkey
| | | | | | | | | | | | | | - K Fujino
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - K Mita
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - E Ohta
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - K Takahashi
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - M Hashimoto
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - K Nagayasu
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - R Murabayashi
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - H Asakawa
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - K Koizumi
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - G Hayashi
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - H Ito
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - F Felberbauer
- Div. of General Surgery, Dpt. of Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | - H El Komy
- Faculty of medicine, Alexandria, Egypt
| | | | - W Nabil
- Faculty of medicine, Alexandria, Egypt
| | - M Karam
- Faculty of medicine, Alexandria, Egypt
| | | | - N Chihara
- Nippon Medical School, Musashikosugi Hospital, Institute of Gastroenterology, Kawasaki, Japan
| | - H Suzuki
- Nippon Medical School, Musashikosugi Hospital, Institute of Gastroenterology, Kawasaki, Japan
| | - M Watanabe
- Nippon Medical School, Musashikosugi Hospital, Institute of Gastroenterology, Kawasaki, Japan
| | - E Uchida
- Department of Surgery, Nippon Medical School, Tokyo, Japan
| | - T Chen
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - J Wang
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - H Wang
- Department of Biliary-pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - N Bouchiba
- Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - T Elbakary
- Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - A Ramadan
- Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - M Elakkad
- Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - C Berney
- Bankstown-Lidcombe Hospital, University of NSW, Sydney, Australia
| | - V Vlasov
- Khmelnitskiy regional hospital, Khmelnitskiy, Ukraine
| | | | | | | | - N Asakage
- Department of Surgery, Tsudanuma Central General Hospital, Chiba, Japan
| | - P Molinari
- University Of Insubria Anesthesia and Intensive Care, Varese, Italy
| | - E Contino
- University Of Insubria Anesthesia and Intensive Care, Varese, Italy
| | - L Guzzetti
- Department Of Anesthesia and Palliative Care, University Hospital Of Varese, Varese, Italy
| | - M Oggioni
- Department Of Anesthesia and Palliative Care, University Hospital Of Varese, Varese, Italy
| | - M Sambuco
- Department Of Anesthesia and Palliative Care, University Hospital Of Varese, Varese, Italy
| | - M Berselli
- University Hospital Of Varese Department Of Surgery, Varese, Italy
| | - L Farassino
- University Hospital Of Varese Department Of Surgery, Varese, Italy
| | - E Cocozza
- University Hospital Of Varese Department Of Surgery, Varese, Italy
| | - A Crespi
- University Of Insubria Anesthesia and Intensive Care, Varese, Italy
| | - A Ambrosoli
- Department Of Anesthesia and Palliative Care, University Hospital Of Varese, Varese, Italy
| | - Y Zhao
- Department of vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
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33
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Vanini R, Kabbara S, Elia E, Piancastelli A, Guglielminetti D, Tuveri M, Tuveri A, Nicolo E, Tomizawa K, Kuroyanagi H, Matoba S, Moriyama J, Toda S, Hanaoka Y, Fukui Y, Haruta S, Clara ES, Tang S, Tan WB, Wijerathne S, Hu J, Shabbir A, Lomanto D, Son G, Park S, Pietrantoni S, Pietrantoni C, Nishihara M, Takehara H, Nakagawa H, Kuniyoshi N, Aka H, Takushi Y, Miyahira T, Hanashiro N, Okushima N, Mayer F, Lechner M, Öfner D, Bittner R, Köhler G, Fortelny R, Köckerling F, Lim R, Berney C, Kato J, Iuamoto L, Meyer A, Floridi A, Bombelli E, Giuliani D, Galli I, Monti M, Longo A, Pisano G, Li J, Tian D. Topic: Inguinal Hernia - Tailored surgery. Hernia 2015; 19 Suppl 1:S287-92. [PMID: 26518825 DOI: 10.1007/bf03355373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- R Vanini
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | - S Kabbara
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | - E Elia
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | | | | | - M Tuveri
- U.O. Chirurgia Generale, Ospedale N.S. di Bonaria, San Gavino Monreale, Italy
| | - A Tuveri
- U. O. Chirurgia Generale, CDC Sant'Elena, Quartu Sant Elena, Italy
| | - E Nicolo
- Dept. of General Surgery, Jefferson Hospital, Pittsburgh, USA
| | - K Tomizawa
- Toranomon Hospital Surgery, Tokyo, Japan
| | | | | | | | | | | | | | | | - E Sta Clara
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - S Tang
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - W B Tan
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - S Wijerathne
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore
| | - J Hu
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - A Shabbir
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - D Lomanto
- Minimally Invasive Surgery Centre, Department of Surgery, National University Health System (NUHS), Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - G Son
- Yangsan Busan National Univ. Hospital, Yangsan-si, Gyeongsangnam-do, South Korea
| | - S Park
- Yangsan Busan National Univ. Hospital, Yangsan-si, Gyeongsangnam-do, South Korea
| | - S Pietrantoni
- General Surgery Department (Director: C. Pietrantoni), S.S. Filippo e Nicola Hospital, Avezzano, AQ, Italy
| | | | | | - H Takehara
- Heart-life Hospital, Nakagami-gun, Japan
| | - H Nakagawa
- Heart-life Hospital, Nakagami-gun, Japan
| | | | - H Aka
- Heart-life Hospital, Nakagami-gun, Japan
| | - Y Takushi
- Heart-life Hospital, Nakagami-gun, Japan
| | - T Miyahira
- Heart-life Hospital, Nakagami-gun, Japan
| | | | - N Okushima
- Heart-life Hospital, Nakagami-gun, Japan
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - M Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - D Öfner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - R Bittner
- Winghofer Medicum Hernia Center, Rottenburg, Germany
| | - G Köhler
- Department Surgery, Sisters of Charity Hospital, Linz, Austria
| | - R Fortelny
- Department of General Surgery, Wilhelminenspital, Vienna, Austria
| | - F Köckerling
- Department of Surgery and Center of Minimally Invasive Surgery, Vivantes Hospital, Berlin, Germany
| | - R Lim
- Department of Surgery, University of N.S.W., Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - C Berney
- Department of Surgery, University of N.S.W., Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - J Kato
- University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - L Iuamoto
- University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - A Meyer
- Director of Abdominal Wall Repair Center, Samaritano Hospital, Sao Paulo, Brazil
| | - A Floridi
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - E Bombelli
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - D Giuliani
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - I Galli
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - M Monti
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - A Longo
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - G Pisano
- U.O. Chirugia Genarele, A.O. Ospedale Maggiore di Crema, Crema, Italy
| | - J Li
- The 2nd Affiliated Hospital of Jilin University, Changchun, China
| | | |
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34
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Kubota T, Mizuta T, Katagiri H, Shimaguchi M, Okumura K, Sakamoto T, Sakata T, Kunisaki S, Matsumoto R, Nishida K, Schaprynsky V, Vorovsky O, Romanchuk V, Basta M, Fischer J, Wink J, Kovach S, Tan WB, Tang SW, Clara ES, Hu J, Wijerathne S, Cheah WK, Shabbir A, Lomanto D, Siawash M, de Jager-Kieviet JWA, Tjon A Ten W, Roumen RM, Scheltinga MR, van Assen T, Boelens OB, van Eerten PV, Perquin C, DeAsis F, Salabat M, Leung D, Schindler N, Robicsek A, Denham W, Ujiki M, Bauder A, Mackay D, Maggiori L, Moszkowicz D, Zappa M, Mongin C, Panis Y, Köhler G, Hofmann A, Lechner M, Mayer F, Emmanuel K, Fortelny R, Gruber-Blum S, May C, Glaser K, Redl H, Petter-Puchner A, Narang S, Alam N, Campain N, McGrath J, Daniels IR, Smart NJ. Complex Cases in Abdominal Wall Repair and Prophilactic Mesh. Hernia 2015; 19 Suppl 1:S133-7. [PMID: 26518790 DOI: 10.1007/bf03355340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Kubota
- Tokyo Bay Medical Center, Urayasu, Japan
| | - T Mizuta
- Tokyo Bay Medical Center, Urayasu, Japan
| | - H Katagiri
- Tokyo Bay Medical Center, Urayasu, Japan
| | | | - K Okumura
- Tokyo Bay Medical Center, Urayasu, Japan
| | - T Sakamoto
- Tokyo Bay Medical Center, Urayasu, Japan
| | - T Sakata
- Tokyo Bay Medical Center, Urayasu, Japan
| | - S Kunisaki
- Tokyo Bay Medical Center, Urayasu, Japan
| | | | - K Nishida
- Yokosuka Uwamachi Hospital, Yokosuka, Japan
| | - V Schaprynsky
- National Pirogov Memorial Medical University Vinnitsa, Vinnitsa, Ukraine
| | - O Vorovsky
- National Pirogov Memorial Medical University Vinnitsa, Vinnitsa, Ukraine
| | - V Romanchuk
- National Pirogov Memorial Medical University Vinnitsa, Vinnitsa, Ukraine
| | - M Basta
- University of Pennsylvania Health System, Philadelphia, USA
| | - J Fischer
- University of Pennsylvania Health System, Philadelphia, USA.,Hospital of the University of Pennsylvania, Philadelphia, USA
| | - J Wink
- University of Pennsylvania Health System, Philadelphia, USA
| | - S Kovach
- University of Pennsylvania Health System, Philadelphia, USA.,Hospital of the University of Pennsylvania, Philadelphia, USA
| | - W B Tan
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - S W Tang
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - E Sta Clara
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - J Hu
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - S Wijerathne
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - W K Cheah
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - A Shabbir
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - D Lomanto
- Minimally Invasive Surgical Center - Department of Surgery, National University Health System, Singapore, Singapore
| | - M Siawash
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands
| | | | - W Tjon A Ten
- Department of Pediatrics, Máxima Medical Center, Veldhoven, Netherlands
| | - R M Roumen
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands.,Máxima Medical Center, Veldhoven, Netherlands.,Center of Excellence for Abdominal Wall and Groin Pain, SolviMáx, Eindhoven, Netherlands
| | - M R Scheltinga
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands.,Máxima Medical Center, Veldhoven, Netherlands.,Center of Excellence for Abdominal Wall and Groin Pain, SolviMáx, Eindhoven, Netherlands
| | - T van Assen
- Máxima Medical Center, Veldhoven, Netherlands
| | - O B Boelens
- Maasziekenhuis Pantein, Boxmeer, Netherlands
| | - P V van Eerten
- Máxima Medical Center, Veldhoven, Netherlands.,Center of Excellence for Abdominal Wall and Groin Pain, SolviMáx, Eindhoven, Netherlands
| | - C Perquin
- Máxima Medical Center, Veldhoven, Netherlands.,Center of Excellence for Abdominal Wall and Groin Pain, SolviMáx, Eindhoven, Netherlands
| | - F DeAsis
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - M Salabat
- Department of Surgery, University Chicago Pritzker School of Medicine, Chicago, USA
| | - D Leung
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - N Schindler
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University Chicago Pritzker School of Medicine, Chicago, USA
| | - A Robicsek
- Department of Clinical Analytics, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University Chicago Pritzker School of Medicine, Chicago, USA
| | - W Denham
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University Chicago Pritzker School of Medicine, Chicago, USA
| | - M Ujiki
- Department of Surgery, University Chicago Pritzker School of Medicine, Chicago, USA
| | - A Bauder
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | - D Mackay
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | - L Maggiori
- Colorectal Surgery, Hopital Beaujon, Clichy, France
| | - D Moszkowicz
- Colorectal Surgery, Hopital Beaujon, Clichy, France
| | - M Zappa
- Radiology, Hopital Beaujon, Clichy, France
| | - C Mongin
- Colorectal Surgery, Hopital Beaujon, Clichy, France
| | - Y Panis
- Colorectal Surgery, Hopital Beaujon, Clichy, France
| | - G Köhler
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
| | - A Hofmann
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - M Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - K Emmanuel
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
| | - R Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - S Gruber-Blum
- Cluster of Tissue engeneering, Ludwig Boltzmann Institute of Traumatology, Vienna, Austria
| | - C May
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - K Glaser
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - H Redl
- Cluster of Tissue engeneering, Ludwig Boltzmann Institute of Traumatology, Vienna, Austria
| | - A Petter-Puchner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - S Narang
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N Alam
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N Campain
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - J McGrath
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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35
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Huber M, Lechner M, Wunsch C. Workplace health promotion and labour market performance of employees. J Health Econ 2015; 43:170-189. [PMID: 26300489 DOI: 10.1016/j.jhealeco.2015.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 07/07/2015] [Accepted: 07/10/2015] [Indexed: 06/04/2023]
Abstract
This paper investigates the average effects of firm-provided workplace health promotion measures on labour market outcomes of the firms' employees. Exploiting linked employer-employee panel data that consist of rich survey-based and administrative information on firms, workers and regions, we apply a flexible propensity score matching approach that controls for selection on observables and time-constant unobserved factors. While the effects of analysing sickness absenteeism appear to be rather limited, our results suggest that health circles/courses increase tenure and job stability across various age groups. A key finding is that health circles/courses strengthen the labour force attachment of elderly employees (51-60), implying potential cost savings for public transfer schemes such as unemployment insurance or early retirement schemes.
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Affiliation(s)
- Martin Huber
- University of Fribourg, Department of Economics, Fribourg, Switzerland.
| | - Michael Lechner
- University of St. Gallen, Swiss Institute for Empirical Economic Research, St. Gallen, Switzerland.
| | - Conny Wunsch
- University of Basel, Department of Labour Economics, Basel, Switzerland.
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36
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Köhler G, Pallwein-Prettner L, Lechner M, Spaun GO, Koch OO, Emmanuel K. First human magnetic resonance visualisation of prosthetics for laparoscopic large hiatal hernia repair. Hernia 2015; 19:975-82. [PMID: 26129921 DOI: 10.1007/s10029-015-1398-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 06/08/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Mesh repair of large hiatal hernias has increasingly gained popularity to reduce recurrence rates. Integration of iron particles into the polyvinylidene fluoride mesh-based material allows for magnetic resonance visualisation (MR). METHODS In a pilot prospective case series eight patients underwent surgical repair of hiatal hernias repair with pre-shaped meshes, which were fixated with fibrin glue. An MR investigation with a qualified protocol was performed on postoperative day four and 3 months postoperatively to evaluate the correct position of the mesh by assessing mesh appearance and demarcation. The total MR-visible mesh surface area of each implant was calculated and compared with the original physical mesh size to evaluate potential reduction of the functional mesh surfaces. RESULTS We documented no mesh migrations or dislocations but we found a significant decrease of MR-visualised total mesh surface area after release of the pneumoperitoneum compared to the original mesh size (mean 78.9 vs 84 cm(2); mean reduction of mesh area = 5.1 cm(2), p < 0.001). At 3 months postoperatively, a further reduction of the mesh surface area could be observed (mean 78.5 vs 78.9 cm(2); mean reduction of mesh area = 0.4 cm(2), p < 0.037). CONCLUSION Detailed mesh depiction and accurate assessment of the surrounding anatomy could be successfully achieved in all cases. Fibrin glue seems to provide effective mesh fixation. In addition to a significant early postoperative decrease in effective mesh surface area a further reduction in size occurred within 3 months after implantation.
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Affiliation(s)
- G Köhler
- Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.
- Academic Teaching Hospital of the Medical Universities Graz and Innsbruck, Graz, Austria.
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
| | - L Pallwein-Prettner
- Department of Diagnostic and Interventional Radiology, Sisters of Charity Hospital, Linz, Austria
- Academic Teaching Hospital of the Medical Universities Graz and Innsbruck, Graz, Austria
| | - M Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - G O Spaun
- Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria
- Academic Teaching Hospital of the Medical Universities Graz and Innsbruck, Graz, Austria
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - O O Koch
- Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria
- Academic Teaching Hospital of the Medical Universities Graz and Innsbruck, Graz, Austria
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - K Emmanuel
- Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria
- Academic Teaching Hospital of the Medical Universities Graz and Innsbruck, Graz, Austria
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37
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Köhler G, Hofmann A, Lechner M, Mayer F, Wundsam H, Emmanuel K, Fortelny RH. Prevention of parastomal hernias with 3D funnel meshes in intraperitoneal onlay position by placement during initial stoma formation. Hernia 2015; 20:151-9. [PMID: 25899106 DOI: 10.1007/s10029-015-1380-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 04/11/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE In patients with terminal ostomies, parastomal hernias (PSHs) occur on a frequent basis. They are commonly associated with various degrees of complaints and occasionally lead to life-threatening complications. Various strategies and measures have been tested and evaluated, but to date there is a lack of published evidence with regard to the best surgical technique for the prevention of PSH development. METHODS We conducted a retrospective analysis of prospectively collected data of eighty patients, who underwent elective permanent ostomy formation between 2009 and 2014 by means of prophylactic implantation of a three-dimensional (3D) funnel mesh in intraperitoneal onlay (IPOM) position. RESULTS PSH developed in three patients (3.75%). No mesh-related complications were encountered and none of the implants had to be removed. Ostomy-related complications had to be noted in seven (8.75%) cases. No manifestation of ostomy prolapse occurred. Follow-up time was a median 21 (range 3-47) months. CONCLUSION The prophylactical implantation of a specially shaped, 3D mesh implant in IPOM technique during initial formation of a terminal enterostomy is safe, highly efficient and comparatively easy to perform. As opposed to what can be achieved with flat or keyhole meshes, the inner boundary areas of the ostomy itself can be well covered and protected from the surging viscera with the 3D implants. At the same time, the vertical, tunnel-shaped part of the mesh provides sufficient protection from an ostomy prolapse. Further studies will be needed to compare the efficacy of various known approaches to PSH prevention.
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Affiliation(s)
- G Köhler
- Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria. .,Academic Teaching Hospital of the University of Graz, Graz, Austria. .,Academic Teaching Hospital of the University of Innsbruck, Innsbruck, Austria. .,Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
| | - A Hofmann
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - M Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - H Wundsam
- Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.,Academic Teaching Hospital of the University of Graz, Graz, Austria.,Academic Teaching Hospital of the University of Innsbruck, Innsbruck, Austria
| | - K Emmanuel
- Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.,Academic Teaching Hospital of the University of Graz, Graz, Austria.,Academic Teaching Hospital of the University of Innsbruck, Innsbruck, Austria
| | - R H Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria.,Department of Surgery, Paracelsus Medical University, Salzburg, Austria
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Mayer F, Lechner M, Adolf D, Öfner D, Köhler G, Fortelny R, Bittner R, Köckerling F. Is the age of >65 years a risk factor for endoscopic treatment of primary inguinal hernia? Analysis of 24,571 patients from the Herniamed Registry. Surg Endosc 2015; 30:296-306. [PMID: 25899813 PMCID: PMC4710662 DOI: 10.1007/s00464-015-4209-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/31/2015] [Indexed: 11/27/2022]
Abstract
Introduction
Several analyses of hernia registries have demonstrated that patients older than 65 years have significantly higher perioperative complication rates compared with patients up to the age of 65. To date, no special analyses of endoscopic/laparoscopic inguinal hernia surgery or of the relevant additional influence factors have been carried out. Besides, there is no definition to determine whether 65 years should really be considered to be the age limit. Methods In the Herniamed Hernia Registry, it was possible to identify 24,571 patients with a primary inguinal hernia and aged at least 16 years who had been operated on between September 1, 2009, and April 15, 2013, using either the TAPP technique (n = 17,214) or TEP technique (n = 7,357). Patients in the age group up to and including 65 years (≤65 years) were compared with those older than 65 years (>65 years) in terms of their perioperative outcome. That was done first using unadjusted analysis and then multivariable analysis. Results Unadjusted analysis revealed significantly different results for the intraoperative (1.19 vs 1.60 %; p = 0,010), postoperative surgical (2.72 vs 4.59 %; p < 0.001) and postoperative general complications (0.85 vs 1.98 %; p < 0.001) as well as for complication-related reoperations (1.07 vs 1.37 %; p = 0,044), which were more favorable in the ≤65 years age group. However, in multivariable analysis, it was not possible to confirm that for the intraoperative complications or the reoperations. Reoperations were needed more often for bilateral procedures (p < 0.001; OR 2.154 [1.699; 2.730]), higher ASA classification (IV vs I: p = 0.004; OR 6.001 [1.786; 20.167]), larger hernia defect and scrotal hernias. The impact of these factors, in addition to that of age >65 years, was also reflected in the postoperative complication rates. The age limit for increased onset of perioperative complication rates tends to be more than 80 rather than 65 years. Conclusion The higher perioperative complication rate associated with endoscopic/laparoscopic inguinal hernia surgery in patients older than 65 years is of multifactorial genesis and is observed in particular as from the age of 80 years.
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Affiliation(s)
- F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - M Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - D Adolf
- StatConsult GmbH, Magdeburg, Germany
| | - D Öfner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - G Köhler
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
| | - R Fortelny
- Department of General Surgery, Wilhelminenspital, Vienna, Austria
| | - R Bittner
- Hernia Center, Winghofer Medicum, Rottenburg am Neckar, Germany
| | - F Köckerling
- Department of Surgery and Center of Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
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Köhler G, Antoniou SA, Lechner M, Mayer F, Mair J, Emmanuel K. Stenting for Emergency Colorectal Obstruction: An Analysis of 204 Patients in Relation to Predictors of Failure and Complications. Scand J Surg 2014; 104:146-53. [DOI: 10.1177/1457496914552342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 07/03/2014] [Indexed: 12/19/2022]
Abstract
Background and Aims: Self-expanding metallic stents are increasingly used in the management of malignant and benign colorectal obstructions. We aimed to identify relevant predictive factors for stent failure and stent-related complications. Material and Methods: We conducted a retrospective single-center analysis of 204 consecutive patients who underwent emergency colorectal stenting procedures because of symptomatic bowel obstructions from 1996 to 2011 at the Sisters of Charity Hospital Linz, Austria. Results: A total of 204 patients (median age 74 years) with 36 (17.7%) benign and 168 (82.3%) malignant obstructions were included in the study. Technical success was achieved in 92.5% and clinical success in 86.8% of the cases. Major complications occurred in 2.9% and minor ones in 19.6%. Overall mortality during a median follow-up period of 4.3 years was 73% (149 patients). Relevant predictors of increased risk of complications were extracolonic obstruction (p = 0.001), complete obstruction (p = 0.066), and inflammatory bowel disease (p = 0.05). Stent localization at the splenic flexure, a stenosis of >8 cm in length, and the need for endoscopic guidance were associated with higher rates of technical and/or clinical stenting failure. Conclusion: Colorectal stenting is less invasive than other means of emergency treatment for large bowel obstruction; it is generally safe and effective in different types of colorectal obstruction. However, relevant rates of failure and complications were recorded and predictors could be determined.
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Affiliation(s)
- G. Köhler
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
- Academic Teaching Hospital of the Universities Graz and Innsbruck, Linz, Austria
| | - S. A. Antoniou
- Center for Minimally Invasive Surgery, Hospital Neuwerk, Moenchengladbach, Germany
| | - M. Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - F. Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - J. Mair
- Department of Diagnostic and Interventional Radiology, Sisters of Charity Hospital, Linz, Austria
| | - K. Emmanuel
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
- Academic Teaching Hospital of the Universities Graz and Innsbruck, Linz, Austria
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Köhler G, Mayer F, Lechner M, Bittner R. Small bowel obstruction after TAPP repair caused by a self-anchoring barbed suture device for peritoneal closure: case report and review of the literature. Hernia 2014; 19:389-94. [PMID: 25112384 DOI: 10.1007/s10029-014-1301-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 07/28/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Transabdominal preperitoneal hernioplasty (TAPP) is a common procedure for groin hernia repair in adults. The peritoneal closure after mesh placement can be performed in various ways. In any case, thorough closure is recommended to avoid mesh exposure to the viscera with the risk of adhesions and bowel incarceration into peritoneal defects. Postoperative intestinal obstructions can mainly occur due to adhesions or bowel herniation through peritoneal defects into the dissected preperitoneal space. Incarcerations can also occur as a consequence of trocar site herniation. RESULTS AND CONCLUSION Recently barbed self-anchoring knotless suturing devices are frequently used for peritoneal closure. The correct handling of such sutures is crucial to avoid potential complications. Despite of accurate management, bowel adherence and injuries or volvulus can occur. METHODS We present an unusual case of a postoperative small bowel obstruction owing to strained adhesions and ingrowth between a small bowel segment and a polyglyconate unidirectional self-anchoring barbed suture device. Medline and PudMed databases were searched using the below-mentioned keywords and the literature on efficacy and safety of barbed sutures for peritoneal closure is reviewed as well as the usage of such devices in other fields of surgery.
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Affiliation(s)
- G Köhler
- Academic Teaching Hospital of the Universities Graz and Innsbruck, Linz, Austria,
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Köhler G, Koch OO, Antoniou SA, Lechner M, Mayer F, Klinge U, Emmanuel K. Parastomal hernia repair with a 3-D mesh device and additional flat mesh repair of the abdominal wall. Hernia 2014; 18:653-61. [PMID: 25112385 DOI: 10.1007/s10029-014-1302-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 07/28/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE Parastomal hernias (PSHs) have been a major clinical problem. The aim of this study was to evaluate a new method of PSH repair in combination with an additional flat mesh reinforcement of the abdominal wall. METHODS In a pilot case series, seven patients suffering from complex PSHs (≥5 cm diameter and/or recurrence) underwent surgery and were treated by intraperitoneal onlay technique (IPOM) with a synthetic 3-D funnel-shaped mesh implant. The demographics, perioperative, and follow-up data are presented in this report. RESULTS The surgical strategy varied between purely laparoscopic (n = 1), laparoscopically assisted (hybrid n = 3), or open techniques (n = 3) using original or suture-reconstructed mesh devices. The funnel mesh implantations in IPOM technique were combined with attached flat meshes in the appropriate position of the abdominal wall. No procedure-related complications occurred. The mean length of hospital stay was 12 days and the mean operating time was 171 min. No recurrence of PSH or incisional hernias was observed during a mean follow-up period of 12.3 months (range from 7 to 22). CONCLUSION The use of a 3-D mesh implant has so far shown to be a promising option in the treatment of primary and recurrent PSHs. Its use proved to be reasonable in both laparoscopic and open IPOM technique. PSHs were preferably repaired using the original, unmodified implant, but when we also found it safe to incise, place and then suture the mesh around the pre-existing ostomy.
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Affiliation(s)
- G Köhler
- Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria,
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Aspalter M, Lechner M, Linni K, Hitzl W, Hölzenbein T, öfner D, Emmanuel K. Morbidity after Insertion of Totally Implantable Venous Access Ports in Oncological Patients: Results of a Retrospective Clinical Study. Am Surg 2014. [DOI: 10.1177/000313481408000232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Manuela Aspalter
- Department of Surgery and the Department of Vascular and Endovascular Surgery Paracelsus Medical University Salzburg, Austria
| | - Michael Lechner
- Department of Surgery Paracelsus Medical University Salzburg, Austria
| | - Klaus Linni
- Department of Vascular and Endovascular Surgery Paracelsus Medical University Salzburg, Austria
| | - Wolfgang Hitzl
- Research Office, Biostatistics Paracelsus Medical University Salzburg, Austria
| | - Thomas Hölzenbein
- Department of Vascular and Endovascular Surgery Paracelsus Medical University Salzburg, Austria
| | - Dietmar öfner
- Department of Surgery Paracelsus Medical University Salzburg, Austria
| | - Klaus Emmanuel
- Department of Surgery Paracelsus Medical University Salzburg, Austria
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Aspalter M, Lechner M, Linni K, Hitzl W, Hölzenbein T, Ofner D, Emmanuel K. Morbidity after insertion of totally implantable venous access ports in oncological patients: results of a retrospective clinical study. Am Surg 2014; 80:204-207. [PMID: 24480224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Manuela Aspalter
- Department of Surgery and the Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
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Augschöll C, Nawara C, Lechner M, Mayer F, Reich-Weinberger S, Jäger T, Öfner D. Pyoderma gangrenosum after ventral hernia repair: a pitfall and how to avoid it. Eur Surg 2013. [DOI: 10.1007/s10353-013-0234-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Martin Freyer
- Department of Neurology, Municipal Hospital, Robert Koch Str. 1, Landshut 84034, Germany
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Affiliation(s)
- Markus Frölich
- Markus Frölich is Professor of Econometrics, Department of Economics, University of Mannheim, Germany. Michael Lechner is Professor of Econometrics and Director of the Swiss Institute for Empirical Economic Research (SEW), University of St. Gallen, CH-9000 St. Gallen, Switzerland . Markus Frölich is also affiliated with IZA, Bonn and IFAU, Uppsala. Michael Lechner has further affiliations with ZEW, Mannheim, CEPR, London, IZA, Bonn, and PSI, London. We gratefully acknowledge financial support from the
| | - Michael Lechner
- Markus Frölich is Professor of Econometrics, Department of Economics, University of Mannheim, Germany. Michael Lechner is Professor of Econometrics and Director of the Swiss Institute for Empirical Economic Research (SEW), University of St. Gallen, CH-9000 St. Gallen, Switzerland . Markus Frölich is also affiliated with IZA, Bonn and IFAU, Uppsala. Michael Lechner has further affiliations with ZEW, Mannheim, CEPR, London, IZA, Bonn, and PSI, London. We gratefully acknowledge financial support from the
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Abstract
AIM Transanal irrigation (TAI) has been reported to be a cheap and effective treatment for the 'anterior resection syndrome (ARS)'. This study aimed to evaluate its effect on the quality of life (QOL) of patients suffering from ARS. METHOD In a prospective study involving two colorectal centres, 14 patients (11 male; median age 68 (45-80) years) were included in the study. The median duration of ARS was 19 (9-48) months. The median number of defaecations was 8 (4-12)/day and 3 (2-5)/night. All patients were trained to perform TAI using the Peristeen™ System under the guidance of a stoma nurse. Anal physiology was performed, quality of life (QOL) was estimated by the SF-36 and Rockwood (ASCRS) questionnaires and continence by the Cleveland Incontinence Score. RESULTS At the last follow up the median time of using TAI was 29 (15-46) months. The median volume of water used for the irrigation was 900 (500-1500) ml. There was a significant decrease in the number of defaecations during the day (baseline, 8 [4-12]; last follow up, 1 [1-2]) and at night (baseline, 3 [2-5]; last follow up, 0 [0-0]). The Cleveland Incontinence Score fell from 17 [15-20] (baseline) to 5 [4-9] (last follow up) and the mental component of the SF-36 and all domains of the Rockwood QOL instrument improved. CONCLUSION Transanal irrigation is an effective treatment of anterior resection syndrome and results in a marked improvement of the continence score and QOL.
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Affiliation(s)
- H Rosen
- Department of Surgery, St Vincent Hospital, Vienna, Austria.
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Kratochwill K, Boehm M, Herzog R, Lichtenauer AM, Salzer E, Lechner M, Kuster L, Bergmeister K, Rizzi A, Mayer B, Aufricht C. Alanyl–glutamine dipeptide restores the cytoprotective stress proteome of mesothelial cells exposed to peritoneal dialysis fluids. Nephrol Dial Transplant 2011; 27:937-46. [DOI: 10.1093/ndt/gfr459] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Using exceptionally rich linked administrative and survey information on German welfare recipients we investigate the health effects of transitions from welfare to employment and of assignments to welfare-to-work programmes. Applying semi-parametric propensity score matching estimators we find that employment substantially increases (mental) health. The positive effects are mainly driven by males and individuals with bad initial health conditions and are largest for males with poor health. In contrast, the effects of welfare-to-work programmes, including subsidised jobs, are ambiguous and statistically insignificant for most outcomes.
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Affiliation(s)
- Martin Huber
- Swiss Institute for Empirical Economic Research, University of St. Gallen, Switzerland
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Lechner M. A Note on the Relation of Inverse-Probability-Weighting and Matching Estimators. COMMUN STAT-THEOR M 2011. [DOI: 10.1080/03610920903453434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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