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Vulvar Leiomyosarcomas: A Case Series with Clinical Comparison to Uterine Leiomyosarcomas and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e939402. [PMID: 37243328 DOI: 10.12659/ajcr.939402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Leiomyosarcomas of the vulva (VLMS) are very rare among gynecological malignancies, with a lack of knowledge on clinical presentation, prognosis, and therapeutic management. CASE REPORT The database of the German Clinical Center of Competence for Genital Sarcomas and Mixed Tumors in Greifswald (DKSM) was reviewed between the years 2010 and 2020. A total of 8 cases of VLMS were retrieved and analyzed retrospectively. One exemplary case of VLMS was outlined in detail: A 45-year-old premenopausal woman presented with increasing vulvar swelling and discomfort. Given the suspicion of a Bartholin's gland abscess, the mass was excised. Final pathology revealed a solid tumor consistent with a moderately differentiated leiomyosarcoma of the vulva. A wide local excision was subsequently performed followed by adjuvant external beam radiation. The clinical features of these 8 cases of VLMS were compared to 26 cases of VLMS found in a review of the literature and to a total of 276 cases of uterine leiomyosarcoma (ULMS) from the same database (DKSM). CONCLUSIONS In addition to rapid growth, observed in both tumor entities, VLMS most commonly presented as Bartholin's gland abscess or cyst and ULMS as leiomyoma. In this cohort, the prognosis of VLMS was much better than that of ULMS, most probably due to the significantly smaller tumor size of VLMS at diagnosis. Further data and larger studies on VLMS are needed to calculate recurrence and survival rates more accurately and define the role of adjuvant radiotherapy.
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Comment to: surgical strategies for recurrent parastomal hernia after a primary repair with a Dynamesh® IPST mesh. Hernia 2023; 27:723-724. [PMID: 36961626 DOI: 10.1007/s10029-023-02780-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 03/05/2023] [Indexed: 03/25/2023]
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[Inguinal hernia operations-Always outpatient?]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:230-236. [PMID: 36786812 PMCID: PMC9950173 DOI: 10.1007/s00104-023-01818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 06/17/2023]
Abstract
Inguinal hernia operations represent the most frequent operations overall with 300,000 interventions annually in Germany, Austria and Switzerland (DACH region). Despite the announced political willingness and the increasing pressure from the legislator to avoid costly inpatient treatment by carrying out as many outpatient operations as possible, outpatient treatment has so far played a subordinate role in the DACH region. The Boards of the specialist societies the German Hernia Society (DHG), the Surgical Working Group Hernia (CAH of the DHG), the Austrian Hernia Society (ÖHG) and the Swiss Working Group Hernia Surgery (SAHC) make inroads into this problem, describe the initial position and assess the current situation.
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P-085 MANAGEMENT OF LATERAL ABDOMINAL WALL HERNIAS. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Lateral abdominal wall hernias are rare and inconsistently defined, which is why the use of the EHS classification makes sense, not least for the purpose of comparing the quality of surgical results. A distinction must be made between true fascial defects and denervation atrophy. Based on the available literature, there is generally a low level of evidence with no consensus on the best operative strategy. The proximity to bony structures and the complex anatomy of the three-layer abdominal wall make lateral hernias difficult to care for. The surgical variability include laparo-endoscopic, robotic, minimally- invasive, open or hybrid approaches with different mesh positions in relation to the layers of the abdominal wall. The extensive preperitoneal mesh reinforcement open, transperitoneally laparoscopic (TAPP) or endoscopic extraperitoneally (TEP, TES) has met with the greatest approval. The extent of the required medial mesh- overlap is determined by the distance between the medial defect boundary and the lateral edge of the straight rectus-abdominal muscles. The lateral pre- and retroperitoneal dissection can be extended into the homolateral retrorectus compartment by laterally incising the posterior rectus sheath or can even be expanded by crossing the midline behind the intact linea alba into the contralateral retrorectus compartment. The “intraperitoneal onlay meshplasty” (IPOM) is only a suitable procedure for smaller and closable defects, but it is also important as an “exit strategy” in the case of a defective peritoneum. All procedures are explained using clear illustrations which are protected by copyright and were exclusively published in German in “der Chirurg”.
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[Accreditation in pathology and neuropathology : Paths and pitfalls]. PATHOLOGIE (HEIDELBERG, GERMANY) 2022; 43:338-345. [PMID: 35925317 DOI: 10.1007/s00292-022-01098-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
There are many good reasons for accreditation in pathology or neuropathology as per DIN EN ISO/IEC 17020, regardless of the size and range of services of the facility. Only accreditation - in contrast to certification - also confirms professional competence. This article describes how to establish a quality management system that conforms to standards as effectively as possible and how to maintain it, involve staff, and avoid common pitfalls. Adequate resources and active management support are essential. In this way, not only can accreditation succeed, but the facility itself and its employees can benefit from quality management in their daily work.
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Correspondence on 'Clinical value of pre-operative scoring systems to predict leiomyosarcoma: results of a validation study in 177 patients from the NOGGO-REGSA Registry' by Condic et al. Int J Gynecol Cancer 2022; 32:963. [PMID: 35618309 DOI: 10.1136/ijgc-2022-003607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Einfluss der Rezidivdiagnostik auf Überlebensdaten bei high-grade uterinen Sarkomen (HGUS). Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Einfluss einer Ovarektomie (BSO) auf das Überleben bei uterinen Leiomyosarkomen (LMS). Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Einfluss einer Ovarektomie (BSO) auf das 5-Jahres-rezidivfreie Überleben (RFI) bei uterinen low-grade endometrialen Stromasarkomen (LG-ESS). Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Increasing Operating Room Efficiency with Shop Floor Management: an Empirical, Code-Based, Retrospective Analysis. J Med Syst 2020; 44:168. [PMID: 32789703 DOI: 10.1007/s10916-020-01640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022]
Abstract
With increasing economic pressure on health care, modern hospital management is focusing at industrial optimization techniques to improve efficiency while maintaining quality. Shop floor management, a technique of code-based, process-oriented guidance directly on site is a method of lean management intended to increase efficiency in the operating room. In the literature, there is only scant evidence that the introduction of this technique alone can increase efficiency. The aim of this retrospective study is to determine whether a single tool alone can significantly improve codes. We performed an empirical, retrospective analysis of a number of codes from 3800 operations during two periods of comparison: upon introduction of shop floor management, and one year thereafter. Data was extracted from the Hospital Information System and transferred to a database. There was no statistically significant change in the relevant codes chosen, whether specific to the operating room (turnover time, first patient in the room, waiting times for anesthesia and surgery (p = 0.637) or to planning stability (scheduled, cancelled (p = 0.505), unscheduled and total operations performed (p = 0.984)). There were absolute changes, such as a reduction in the turnover time from 17:37 min to 16:26 min, even though not statistically significant (p = 0.238). Implementation of shop floor management as a single intervention is not appropriate to achieve a significant, continuous improvement in codes. A combination with other techniques such as detailed process analyses is definitely required. This could be important additional information for units using Lean Health Care strategies.
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Green-brown polymorphism in alpine grasshoppers affects body temperature. Ecol Evol 2020; 10:441-450. [PMID: 31988736 PMCID: PMC6972831 DOI: 10.1002/ece3.5908] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/05/2019] [Accepted: 11/18/2019] [Indexed: 11/06/2022] Open
Abstract
Ectothermic animals depend on external heat sources for pursuing their daily activities. However, reaching sufficiently high temperature can be limiting at high altitudes, where nights are cold and seasons short. We focus on the role of a green-brown color polymorphism in grasshoppers from alpine habitats. The green-brown polymorphism is phylogenetically and spatially widespread among Orthopterans and the eco-evolutionary processes that contribute to its maintenance have not yet been identified.We here test whether green and brown individuals heat up to different temperatures under field conditions. If they do, this would suggest that thermoregulatory capacity might contribute to the maintenance of the green-brown polymorphism.We recorded thorax temperatures of individuals sampled and measured under field conditions. Overall, thorax temperatures ranged 1.7-42.1°C. Heat up during morning hours was particularly rapid, and temperatures stabilized between 31 and 36°C during the warm parts of the day. Female body temperatures were significantly higher than body temperatures of males by an average of 2.4°C. We also found that brown morphs were warmer by 1.5°C on average, a pattern that was particularly supported in the polymorphic club-legged grasshopper Gomphocerus sibiricus and the meadow grasshopper Pseudochorthippus parallelus.The difference in body temperature between morphs might lead to fitness differences that can contribute to the maintenance of the color polymorphism in combination with other components, such as crypsis, that functionally trade-off with the ability to heat up. The data may be of more general relevance to the maintenance of a high prevalence polymorphism in Orthopteran insects.
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[Verumontanum mucosal hyperplasia as a differential diagnosis of a local recurrence following radical prostatectomy]. Aktuelle Urol 2019; 53:354-357. [PMID: 31797337 DOI: 10.1055/a-1032-8126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Verumontanum mucosal gland hyperplasia (VMGH) is a benign microacinar proliferative lesion, which occurs exclusively in the verumontanum and the posterior urethra and is one of the lesions that may be confused with a low-risk adenocarcinoma of the prostate gland.We present the case of a 72-year-old male patient who underwent radical prostatectomy due to an adenocarcinoma of the prostate gland (pT2c pN0 cM0 R0, Gleason Score: 3 + 3 = 6). Five years after the operation, we sonographically detected a 3x2 cm large tumour in the prostate bed. While our first assumption was a PSA-negative local recurrence following radical prostatectomy, a comprehensive histological examination along with the clinical evaluation led us to the diagnosis of a VMGH. VMGH is a less well-known differential diagnosis of PSA-negative local recurrence following radical prostatectomy, whose clinical manifestation should be presented.
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Sarcoma of the Uterus. Guideline of the DGGG and OEGGG (S2k Level, AWMF Register Number 015/074, February 2019). Geburtshilfe Frauenheilkd 2019; 79:1043-1060. [PMID: 31656317 DOI: 10.1055/a-0882-4116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/21/2022] Open
Abstract
Aims This is an official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). Because of their rarity and heterogeneous histopathology, uterine sarcomas are challenging in terms of how they should be managed clinically, and treatment requires a multidisciplinary approach. To our knowledge, there are currently no binding evidence-based recommendations for the appropriate management of this heterogeneous group of tumors. Methods This S2k guideline was first published in 2015. The update published here is the result of the consensus of a representative interdisciplinary group of experts who carried out a systematic search of the literature on uterine sarcomas in the context of the guidelines program of the DGGG, OEGGG and SGGG. Members of the participating professional societies achieved a formal consensus after a moderated structured consensus process. Recommendations The consensus-based recommendations and statements include the epidemiology, classification, staging, symptoms, general diagnostic work-up and general pathology of uterine sarcomas as well as the genetic predisposition to develop uterine sarcomas. Also included are statements on the management of leiomyosarcomas, (low and high-grade) endometrial stromal sarcomas and undifferentiated uterine sarcomas and adenosarcomas. Finally, the guideline considers the follow-up and morcellation of uterine sarcomas and the information provided to patients.
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Präoperative Konditionierung und operative Strategien zur Therapie komplexer Bauchwandhernien. Chirurg 2019; 91:134-142. [DOI: 10.1007/s00104-019-01027-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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[Erratum to: Complexity of PEComas : Diagnostic approach, molecular background, clinical management]. DER PATHOLOGE 2019; 40:454. [PMID: 31263908 DOI: 10.1007/s00292-019-0636-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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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Das Verhalten der Laktatdehydrogenase (LDH) bei regelhaften und degenerierten Leiomyomen (LM) und in Abhängigkeit vom Alter der Patientin und der Tumorgröße. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Uterine Adenosarkome (AS) – Klinik, operative Primärtherapie und Einfluss des sarcomatous overgrowth (SO) auf die Rezidivrate und das Gesamtüberleben. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Uterine Karzinosarkome (UKS) – Klinik, Diagnostik und operative Primärtherapie – Effekt auf die Überlebensdaten. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Anwendung und Ergebnisse einer präoperativen CT- und MRT-Bildgebung bei uterinen Leiomyosarkomen (LMS). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Zum Einfluss des Menopausestatus, der Hormonrezeptoren und einer Ovarektomie auf die Prognose von uterinen Leiomyosarkomen (LMS). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Rezidivfreies und Gesamtüberleben nach Morcellement von 156 uterinen Leiomyosarkomen (LMS) im Stadium pT1. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Uterine Adenosarkome (AS) – adäquate Operation, Lymphonodektomie (LNE) und postoperative Therapien – Einfluss auf die Überlebensdaten. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Sonographische und Farbdopplerbefunde bei regelhaften und degenerierten Leiomyomen (LM). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Das Verhalten der Neutrophilen/Lymphozyten-Ratio (NLR) und der Lymphozyten/Monozyten-Ratio (LMR) bei Leiomyomen (LM). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Resistenzindex (RI) bei regelhaften und degenerierten Leiomyomen (LM). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Uterine Karzinosarkome (UKS) – totale versus radikale Hysterektomie, Lymphonodektomie und adjuvante Therapien – Effekt auf die Überlebensdaten. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Validierter Leiomyosarkom-Risiko-Score zur Prävention inadäquater Operationen und diagnostisches Fließschema. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Präoperative Diagnostik, Operationsindikationen und -methoden bei uterinen Leiomyosarkomen (LMS) unter Berücksichtigung adäquater und inadäquater Eingriffe. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Critical evaluation of an innovative mesh for bilateral transabdominal preperitoneal (TAPP) repair of inguinal hernias. Hernia 2018; 22:857-862. [PMID: 29869074 DOI: 10.1007/s10029-018-1786-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/31/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Transabdominal preperitoneal hernia mesh plasty (TAPP) offers significant benefits to patients undergoing bilateral inguinal hernia repair. We evaluated a novel pre-shaped, large-pored, titanium-coated, lightweight polypropylene mesh for bilateral placement as an alternative to two separate meshes. METHODS Thirty-six patients underwent elective surgical repair of bilateral inguinal hernias with the new mesh at three departments of surgery in Linz and Graz, Austria, between May 1, 2015 and June 30, 2017. RESULTS All operations were completed without intraoperative complications or conversion to open procedures. The mean operation time was 74 min. There were no postoperative procedure-related complications with the exception of one hematoseroma of the spermatic cord. Two symptomatic medial recurrences (2/36 patients = 5.6%, 2/72 hernia repairs = 2.8%, respectively) after supravesical and medial hernia repair with the bilateral mesh were seen at structured follow-up examinations 6 and 12 months postoperatively. CONCLUSION Treatment of bilateral inguinal hernias with the newly designed bilateral mesh for TAPP theoretically brings benefits in terms of resistance to forces acting on the mesh. The larger area may decrease the risk for mesh bulging and recurrence, and one large mesh might provide more stable support than two separate meshes overlapping at the midline. The results of our study do not confirm these theoretical benefits regarding a high recurrence rate (2.8%) after treatment of medial hernia defects. We recommend re-designing the mesh with only a small central slit, which would provide a broader mesh bridge with sufficient overlap for all types of inguinal and femoral hernias, including medial and supravesical defects. After the mesh has been re-designed, a new study should evaluate its real benefits before it is marketed.
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Morphological and colour morph clines along an altitudinal gradient in the meadow grasshopper Pseudochorthippus parallelus. PLoS One 2017; 12:e0189815. [PMID: 29284051 PMCID: PMC5746220 DOI: 10.1371/journal.pone.0189815] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/02/2017] [Indexed: 11/19/2022] Open
Abstract
Many animals show altitudinal clines in size, shape and body colour. Increases in body size and reduction in the length of body appendices in colder habitats are usually attributed to improved heat conservation at lower surface-to-volume ratios (known as Bergmann’s and Allen’s rule, respectively). However, the patterns are more variable and sometimes reversed in small ectotherms that are affected by shortened growing seasons. Altitude can also affect colouration. The thermal melanism hypothesis predicts darker colours under cooler conditions because of a thermoregulatory advantage. Darker colours may also be favoured at high altitudes for reasons of UV protection or habitat-dependent crypsis. We studied altitudinal variation in morphology and colour in the colour-polymorphic meadow grasshopper Pseudochorthippus parallelus based on 563 individuals from 17 populations sampled between 450 and 2,500 m asl. Pronotum length did not change with altitude, while postfemur length decreased significantly in both sexes. Tegmen (forewing) length decreased in males, but not in females. The results indicate that while body size, as best quantified by pronotum length, was remarkably constant, extended appendices were reduced at high altitudes. The pattern thus follows Allen’s rule, but neither Bergmann’s nor converse Bergmann’s rule. These results indicate that inference of converse Bergmann’s rule based on measurements from appendices should be treated with some caution. Colour morph ratios showed significant changes in both sexes from lowland populations dominated by green individuals to high-altitude populations dominated by brown ones. The increase of brown morphs was particularly steep between 1,500 and 2,000 m asl. The results suggest shared control of colour in males and females and local adaptation along the altitudinal gradient following the predictions of the thermal melanism hypothesis. Interestingly, both patterns, the reduction of body appendices and the higher frequency of brown individuals, may be explained by a need for efficient thermoregulation under high-altitude conditions.
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Losers, winners, and opportunists: How grassland land‐use intensity affects orthopteran communities. Ecosphere 2016. [DOI: 10.1002/ecs2.1545] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Laparoscopic Supracervical Hysterectomy or Myomectomy With Power Morcellation: Risk of Uterine Leiomyosarcomas. A Retrospective Trial Including 35.161 Women in Germany. J Minim Invasive Gynecol 2015; 22:S2-S3. [DOI: 10.1016/j.jmig.2015.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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] [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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Rail or roll: a new, convenient and safe way to position self-gripping meshes in open inguinal hernia repair. Hernia 2015; 20:417-22. [PMID: 25989726 DOI: 10.1007/s10029-015-1389-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 04/19/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE In open inguinal hernia repair self-gripping meshes are currently commonly employed. Assumed benefits are saving of time, ease of handling and omission of fixation. Self-gripping meshes are, however, not as easy to handle and position as commonly stated. We describe a newly developed way of intra-operative mesh preparation and implantation and compare it to the conventional technique of insertion of self-gripping meshes. METHODS A two-armed, randomized trial with 64 patients was performed. For implantation of the self-gripping, light weight and partially absorbable mesh we used either a newly described rolling technique (group 1: n = 32) or the conventional way of insertion (group 2: n = 32). Primary endpoints of the study were feasibility with regard to actual implantation time and surgeons' satisfaction with the methods. Secondary endpoints were total operating time, length of hospital stay, postoperative pain, duration of pain medication intake and postoperative morbidity. In addition all patients were prospectively followed up according to the Hernia Med® registry's standards. RESULTS Implantation time (seconds) 140 ± 74 vs. 187 ± 84, p = 0.008, duration of pain medication intake (days) 3.6 ± 2.8 vs. 4.8 ± 2.6; p = 0.046 and postoperative morbidity 2 (6%) vs. 8 (25%) was significantly beneficial in group 1 (rolling technique) compared to group 2 (conventional method). Blinded questionnaire revealed that rolling the mesh is generally easier with less repositioning maneuvers than conventional placement. Neither overall procedure time, length of stay nor postoperative pain scores differed significantly between groups. CONCLUSION The newly introduced rolling technique for the actual placement of self-gripping meshes in open inguinal hernia repair is technically less demanding and therefore significantly faster when compared to the conventional way of insertion of the same product. In addition the rolling technique has shown to be safe for the patients and to also provide higher surgeons' satisfaction.
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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] [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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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] [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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420 Analysis of genomic alterations in Ewing sarcoma (German cohort) reveals cooperating mutations and novel therapy targets. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70546-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Effects of habitat structure and land-use intensity on the genetic structure of the grasshopper species Chorthippus parallelus. ROYAL SOCIETY OPEN SCIENCE 2014; 1:140133. [PMID: 26064535 PMCID: PMC4448891 DOI: 10.1098/rsos.140133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/25/2014] [Indexed: 06/04/2023]
Abstract
Land-use intensity (LUI) is assumed to impact the genetic structure of organisms. While effects of landscape structure on the genetics of local populations have frequently been analysed, potential effects of variation in LUI on the genetic diversity of local populations have mostly been neglected. In this study, we used six polymorphic microsatellites to analyse the genetic effects of variation in land use in the highly abundant grasshopper Chorthippus parallelus. We sampled a total of 610 individuals at 22 heterogeneous grassland sites in the Hainich-Dün region of Central Germany. For each of these grassland sites we assessed habitat size, LUI (combined index of mowing, grazing and fertilization), and the proportion of grassland adjoining the sampling site and the landscape heterogeneity (the latter two factors within a 500 m buffer zone surrounding each focal site). We found only marginal genetic differentiation among all local populations and no correlation between geographical and genetic distance. Habitat size, LUI and landscape characteristics had only weak effects on most of the parameters of genetic diversity of C. parallelus; only expected heterozygosity and the grasshopper abundances were affected by interacting effects of LUI, habitat size and landscape characteristics. The lack of any strong relationships between LUI, abundance and the genetic structure might be due to large local populations of the species in the landscape, counteracting local differentiation and potential genetic drift effects.
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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] [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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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] [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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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] [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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Routine versus no drain placement after elective laparoscopic cholecystectomy: meta-analysis of randomized controlled trials. MINERVA CHIR 2014; 69:185-194. [PMID: 24970306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Routine drainage of the subhepatic space has been a surgical trend of open cholecystectomy, carried on to the era of laparoscopic surgery without substantial evidence. Avoiding the potentially devastating sequelae of an undetected bile leakage is the main rationale behind this practice. Aim of this meta-analysis was to compare evidence on routine drain placement after laparoscopic cholecystectomy versus no drainage. A meta-analysis of randomized controlled trials was conducted; outcome variables included postoperative pain, subhepatic collection, 30-day morbidity, wound-related complications, and drainage interventions. The fixed- and random effects models were used in order to calculate combined overall effect sizes of pooled data. Data are presented as the odds ratio (OR) or difference in means with 95% confidence interval (CI). Six randomized trials including 1167 patients were identified. Pain scores were significantly higher in the drainage group both at 6-12h (mean difference 1.12, 95% CI 1.01-1.24, P<0.0001) and at 12-24h after surgery (mean difference 1.12, 95% CI 0.86-1.39, P<0.0001). No difference was found with regard to the incidence of subhepatic collection and drainage procedures. A trend in favor of the no drain approach with regard to 30-day morbidity and wound infection was registered, although this was less pronounced after sensitivity analysis. The possible clinical benefit of routine use of abdominal drainage in uncomplicated laparoscopic cholecystectomies requires larger study populations. The approach is however not encouraged on the basis of the present analysis, as it results in increased postoperative pain and overall morbidity.
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[Median incisional hernias and coexisting parastomal hernias : new surgical strategies and an algorithm for simultaneous repair]. Chirurg 2014; 85:697-704. [PMID: 24823998 DOI: 10.1007/s00104-014-2746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The co-occurrence of incisional and parastomal hernias (PSH) remains a surgical challenge. Standardized treatment guidelines are missing, and the patients concerned require an individualized surgical approach. The laparoscopic techniques can be performed with incised and/or stoma-lateralizing flat meshes with intraperitoneal onlay placement. The purely laparoscopic and laparoscopic-assisted approaches with 3-D meshes offer advantages regarding the complete coverage of the edges of the stomal areas and the option of equilateral or contralateral stoma relocation in cases of PSH, which are difficult to handle due to scarring, adhesions, and large fascial defects > 5 cm with intestinal hernia sac contents. A relevant stoma prolapse can be relocated by tunnel-like preformed 3-D meshes and shortening the stoma bowel. The positive effect on prolapse prevention arises from the dome of the 3-D mesh, which is directed toward the abdominal cavity and tightly fits to the bowel. In cases of large incisional hernias (> 8-10 cm in width) or young patients with higher physical demands, an open abdominal wall reconstruction in sublay technique is required. Component separation techniques that enable tension-free ventral fascial closure should be preferred to mesh-supported defect bridging methods. The modified posterior component separation with transversus abdominis release (TAR) and the minimally invasive anterior component separation are superior to the original Ramirez technique with respect to wound morbidity. By using 3-D textile implants, which were specially designed for parastomal hernia prevention, the stoma can be brought out through the lateral abdominal wall without increased risk of parastomal hernia or prolapse development. An algorithm for surgical treatment, in consideration of the complexity of combined hernias, is introduced for the first time.
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Abstract
Using the usual diagnostic tools like barium swallow examination, endoscopy, and manometry, we are able to diagnose a hiatal hernia, but it is not possible to predict the size of the hernia opening or, respectively, the size of the hiatal defect. At least a correlation can be expected if the gastroesophageal junction is endoscopically assessed in a retroflexed position, and graded according to Hill. So far, it is not possible to come to a clear conclusion how the hiatal closure during hiatal hernia repair should be performed. There is no consensus on using a mesh, and when using a mesh which type or shape should be used. Further studies including long-term results on this issue are necessary. However, it seems obvious to make the decision depending on certain conditions found during operation, and not on preoperative findings.
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Abstract
Despite multimodal therapeutic options, esophageal cancer is still among the most deadly malignancies. In the past decade, targeted therapy has shown great potential in other cancers, but data on esophageal carcinoma are still rare. Five potential new molecular targets in esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) were investigated for their expression characteristics: vascular endothelial growth factor receptor (VEGFR)-3, human epidermal growth factor receptor-2, stem cell growth factor receptor, tissue inhibitors of metalloproteinase (TIMP)-4 and TIMP-3. One hundred seventy-one EAC and ESCC tissue samples obtained from patients undergoing esophagectomy from 2000 to 2008 were included. Clinical data were evaluated retrospectively. Immunohistochemical staining was performed using tumor tissue with and without neoadjuvant treatment and healthy tissue. For samples without neoadjuvant treatment, expression of all targets was higher in tumor tissue than in healthy tissue except for VEGFR-3 (>98% expression in both tissues). For TIMP-4, TIMP-3 and stem cell growth factor receptor, trends to higher expression in tumor tissue were also found in EAC and ESCC that had received neoadjuvant treatment. Using Matched-pair analysis, we compared target expression in tumor tissue with and without neoadjuvant treatment. Only TIMP-3 had significantly lower expression in neoadjuvant treated tumor tissue (EAC: P = 0.059, ESCC: P = 0.006). TIMP-4, TIMP-3 and VEGFR-3 appear to qualify for targeted therapy in esophageal cancer because of their high expression in neoplastic tissue. TIMP-3 appears to be downregulated in neoadjuvantly treated esophageal cancer, and VEGFR-3 shows high expression in healthy mucosa leading to severe side effects by molecular targeting. Thus, TIMP-4 seems the most promising target.
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