Trocar site hernia after gastric sleeve

BACKGROUND

Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position was found to be a reliable method for the detection of TSH following gastric bypass (LRYGB). In the present study, our aim was to examine the incidence of TSH after gastric sleeve, and further to investigate the proportion of symptomatic trocar site hernias.

METHODS

Seventy-nine patients subjected to laparoscopic gastric sleeve in 2011-2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey.

RESULTS

The incidence of trocar site hernia was 17 out of 79 (21.5%), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no significant correlation between patient symptoms and a TSH.

CONCLUSIONS

The incidence of TSH is high after laparoscopic gastric sleeve, a finding in line with several recent studies as well as with our first trial on trocar site hernia after LRYGB. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of a trocar site hernia can be serious, the proportion of symptomatic TSH needs to be more clarified.

P060 TROCAR SITE HERNIA AFTER GASTRIC SLEEVE

Aim

Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position upon a ring was found to be a reliable method for the detection of TSH in obese.

Our aim was to examine the incidence of TSH after gastric sleeve.

Material and Methods

79 patients subjected to laparoscopic gastric sleeve in 2011-2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey.

Results

The incidence of trocar site hernia was 17 out of 79 (21,5 %), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no clear correlation between symptomatic TSH and TSH on CT.

Conclusions

The incidence of TSH is high in this group of patients. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of trocar site hernia can be serious, the proportion of symptomatic TSH is unknown.

Inter-fraction movements of the prostate and pelvic lymph nodes during IGRT

Objectivities

The aim of this study was to evaluate inter-fraction movements of lymph node regions that are commonly included in the pelvic clinical target volume (CTV) for high-risk prostate cancer patients. We also aimed to evaluate if the movements affect the planning target volumes.

Methods

Ten prostate cancer patients were included. The patients underwent six MRI scans, from treatment planning to near end of treatment. The CTV movements were analyzed with deformable registration technique with the CTV divided into sections. The validity of the deformable registration was assessed by comparing the results for individual lymph nodes that were possible to identify in all scans.

Results

Using repetitive MRI, measurements showed that areas inside the CTV (lymph nodes) in some extreme cases were as mobile as the prostate and not fixed to the bones. The lymph node volumes closest to the prostate did not tend to follow the prostate motion. The more cranial lymph node volumes moved less, but still independently, and they were not necessarily fixed to the pelvic bones. In 95% of the cases, the lymph node motion in the R-L direction was 2–4 mm, in the A-P direction 2–7 mm, and in the C-C direction 2–5 mm depending on the CTV section.

Conclusion

Lymph nodes and prostate were most mobile in the A-P direction, followed by the C-C and R-L directions. This movement should be taken into account when deciding the margins for the planning target volumes (PTV).

Electronic supplementary material

The online version of this article (10.1007/s13566-018-0366-3) contains supplementary material, which is available to authorized users.

Comprehensive strategy for pesticide residue analysis through the production cycle of gilthead sea bream and Atlantic salmon

Plant ingredients and processed animal proteins are alternative feedstuffs for fish feeds in aquaculture. However, their use can introduce contaminants like pesticides that are not previously associated with marine Atlantic salmon and gilthead sea bream farming. This study covers the screening of around 800 pesticides by gas chromatography (GC) and liquid chromatography (LC) coupled to high resolution time-of-flight mass spectrometry in matrices throughout the entire marine food production chain. Prior to analysis of real-world samples, the screening methodology was validated for 252 pesticides to establish the screening detection limit. This was 0.01 mg kg^-1 for 113 pesticides (45%), 0.05 mg kg^-1 for 73 pesticides (29%) and >0.05 mg kg^-1 for 66 pesticides (26%). After that, a quantitative methodology based on GC coupled to tandem mass spectrometry with atmospheric pressure chemical ionization source (GC-APCI-MS/MS) was optimized for the pesticides found in the screening. Although several polar pesticides, of which pirimiphos methyl and chlorpyriphos-methyl were most dominant, were found in plant material and feeds based on these ingredients, none of them were observed in fillets of Atlantic salmon and gilthead sea bream fed on these feeds.

Welfare indicators in laying hens in relation to nest exclusion

Consumer concerns about the welfare of laying hens are increasing, leading to increased interest in identifying reliable ways to assess welfare. The present study evaluated invasive and non-invasive welfare indicators in relation to a stressful challenge. The study included 126 Lohmann Selected Leghorn hens housed in furnished cages. Welfare indicators were measured between 61 and 70 wk of age in birds excluded from their nests for 5 consecutive d and control birds that had continuous access to nests. Baseline recordings were carried out in both groups prior to and post exclusion period. The assessed indicators were: corticosterone metabolites in droppings (FCM), corticosterone concentration in yolk, corticosterone concentration in plasma, irregularities of eggshells, heterophil to lymphocyte (H:L) ratio, tonic immobility duration, and feather cover. Behavioral observations showed that the birds had a clear preference for using the secluded nest sites, confirming that they were likely to perceive nest exclusion as an undesirable experience. Further, elevated levels of FCM in droppings, yolk corticosterone concentrations, H:L ratios and irregular eggshells were detected in both nest deprived and control birds during the exclusion. This suggests that these indicators were able to detect an increased stress response arising from nest deprivation, and it is hypothesized that the stress spread to birds in adjacent cages with access to nests. There was a positive and consistent correlation between FCM in droppings and eggshell irregularities, also supporting the use of eggshell irregularities as a potential non-invasive welfare indicator. However, the pattern of the stress response varied between indicators and correlations were generally few and inconsistent, highlighting the complexity of the relationship among welfare indicators.

Do gender differences in audio-visual benefit and visual influence in audio-visual speech perception emerge with age?

Gender and age have been found to affect adults' audio-visual (AV) speech perception. However, research on adult aging focuses on adults over 60 years, who have an increasing likelihood for cognitive and sensory decline, which may confound positive effects of age-related AV-experience and its interaction with gender. Observed age and gender differences in AV speech perception may also depend on measurement sensitivity and AV task difficulty. Consequently both AV benefit and visual influence were used to measure visual contribution for gender-balanced groups of young (20-30 years) and middle-aged adults (50-60 years) with task difficulty varied using AV syllables from different talkers in alternative auditory backgrounds. Females had better speech-reading performance than males. Whereas no gender differences in AV benefit or visual influence were observed for young adults, visually influenced responses were significantly greater for middle-aged females than middle-aged males. That speech-reading performance did not influence AV benefit may be explained by visual speech extraction and AV integration constituting independent abilities. Contrastingly, the gender difference in visually influenced responses in middle adulthood may reflect an experience-related shift in females' general AV perceptual strategy. Although young females' speech-reading proficiency may not readily contribute to greater visual influence, between young and middle-adulthood recurrent confirmation of the contribution of visual cues induced by speech-reading proficiency may gradually shift females AV perceptual strategy toward more visually dominated responses.

Welfare and performance in layers following temporary exclusion from the litter area on introduction to the layer facility

When introduced to the laying facility, pullets are sometimes temporarily excluded from the litter area in order to help them locate food and water, and to prevent floor-laid eggs. This procedure is not permitted in Sweden, because it involves denying access to both litter and space, which may have a negative effect on bird welfare. The present study investigated how the welfare and performance of layers were affected by this temporary exclusion on introduction of hens to the laying facility. The study included 600 floor-reared Dekalb White layers obtained at 16 wk age and housed in 6 groups of 100 in a conventional single-tier floor-laying system. Birds were either given full access to the litter area during the whole study or were excluded from the litter area during the first 2 wk after transfer to the laying facility. From 18 to 72 wk age, birds in both treatments had full access to the litter area. Excluding birds from the litter area for 2 wk resulted in better feather cover and reduced fearfulness, according to novel object and tonic immobility tests. Furthermore, birds initially excluded from the litter area produced eggs with a lower proportion of shell irregularities than birds with full access to the litter area throughout. No difference was found in corticosterone metabolites in droppings rate of lay, mortality, or proportion of floor-laid eggs. In conclusion, none of the parameters studied indicated that the welfare of laying hens was compromised by temporary exclusion from the litter area on introduction to the laying facility. In fact, some of the data suggested that bird welfare had improved.

Age mitigates the correlation between cognitive processing speed and audio-visual asynchrony detection in speech

Cognitive processing speed, hearing acuity, and audio-visual (AV) experience have been suggested to influence AV asynchrony detection. Whereas the influence of hearing acuity and AV experience have been explored to some extent, the influence of cognitive processing speed on perceived AV asynchrony has not been directly tested. Therefore, the current study investigates the relationship between cognitive processing speed and AV asynchrony detection in speech and, with hearing acuity controlled, assesses whether age-related AV experience mitigates the strength of this relationship. The cognitive processing speed and AV asynchrony detection by 20 young adults (20-30 years) and 20 middle-aged adults (50-60 years) were measured using auditory, visual and AV recognition reaction time tasks, and an AV synchrony judgment task. Strong correlations between audio, visual, and AV reaction times and AV synchrony window size were found for young adults, but not for middle-aged adults. These findings suggest that although cognitive processing speed influences AV asynchrony detection in speech, the strength of the relationship is seemingly reduced by AV experience.

Corticosterone metabolites in laying hen droppings-Effects of fiber enrichment, genotype, and daily variations

There is growing interest and concern for animal welfare in commercial poultry production. To evaluate stress and welfare in an objective and noninvasive way, fecal corticosterone metabolites (FCM) in droppings can be analyzed. However, the influence of diet, genotype, and daily variations in FCM and production of droppings in laying hens has been poorly investigated. This study examined the effect of insoluble fiber by adding 3% ground straw pellets to the feed to Lohmann Selected Leghorn (LSL) and Lohmann Brown (LB) hens housed in furnished cages between 20 and 40 wk of age. In total, 960 hens were included in the study. Droppings were collected 4 times per day for 3 consecutive days and analyzed by corticosterone immunoassay. Biological validation confirmed the ability of the assay to detect changes in FCM levels. Inclusion of straw pellets in the feed increased FCM concentration in both hen genotypes and increased excretion rate of FCM in LB hens. The LB hens also produced greater amounts of droppings than LSL hens. Both FCM levels and production of droppings varied during the day, although no distinct diurnal rhythm was found. These findings demonstrate that when using FCM to evaluate stress and welfare in laying hens, many factors (e.g., diet, genotype used, and so on) need to be taken into account to allow accurate interpretation of the results. In addition, under certain conditions, excretion rate of FCM might be more appropriate to use compared with FCM concentration.

Audio-visual speech experience with age influences perceived audio-visual asynchrony in speech

Previous research indicates that perception of audio-visual (AV) synchrony changes in adulthood. Possible explanations for these age differences include a decline in hearing acuity, a decline in cognitive processing speed, and increased experience with AV binding. The current study aims to isolate the effect of AV experience by comparing synchrony judgments from 20 young adults (20 to 30 yrs) and 20 normal-hearing middle-aged adults (50 to 60 yrs), an age range for which a decline of cognitive processing speed is expected to be minimal. When presented with AV stop consonant syllables with asynchronies ranging from 440 ms audio-lead to 440 ms visual-lead, middle-aged adults showed significantly less tolerance for audio-lead than young adults. Middle-aged adults also showed a greater shift in their point of subjective simultaneity than young adults. Natural audio-lead asynchronies are arguably more predictable than natural visual-lead asynchronies, and this predictability may render audio-lead thresholds more prone to experience-related fine-tuning.

[Combined transvaginal and transumbilical approach for cholecystectomy with no visible scarring]

The use of natural orifices for operations in the abdominal cavity (natural orifice transluminal endoscopic surgery, or NOTES) could be a conclusive development in the field of minimally invasive surgery. Early in the 1990s we had experiences with posterior colpotomy for removal of specimens in laparoscopic surgery. This is why we use the transvaginal approach in NOTES and combine it with a trocar hidden in the umbilicus. With this technique we could perform cholecystectomy without a visible scar. The operation could become routine also because of the use of our well-known rigid optics and instruments. From June 2007 until April 2008 we operated on 57 patients using this method. All operations finished successfully, and the mean operation time was 54 min. There was one complication. An abscess in the Douglas room had to be evacuated laparoscopically. All other postoperative courses were uneventful. After a minimum follow-up of 3 months, none of the patients had symptoms in the vagina or during sexual intercourse.

Audio-visual identification of place of articulation and voicing in white and babble noise

Research shows that noise and phonetic attributes influence the degree to which auditory and visual modalities are used in audio-visual speech perception (AVSP). Research has, however, mainly focused on white noise and single phonetic attributes, thus neglecting the more common babble noise and possible interactions between phonetic attributes. This study explores whether white and babble noise differentially influence AVSP and whether these differences depend on phonetic attributes. White and babble noise of 0 and -12 dB signal-to-noise ratio were added to congruent and incongruent audio-visual stop consonant-vowel stimuli. The audio (A) and video (V) of incongruent stimuli differed either in place of articulation (POA) or voicing. Responses from 15 young adults show that, compared to white noise, babble resulted in more audio responses for POA stimuli, and fewer for voicing stimuli. Voiced syllables received more audio responses than voiceless syllables. Results can be attributed to discrepancies in the acoustic spectra of both the noise and speech target. Voiced consonants may be more auditorily salient than voiceless consonants which are more spectrally similar to white noise. Visual cues contribute to identification of voicing, but only if the POA is visually salient and auditorily susceptible to the noise type.

Transvaginal NOTES hybrid cholecystectomy: feasibility results in 68 cases with mid-term follow-up

BACKGROUND AND STUDY AIMS

Natural orifice transluminal endoscopic surgery (NOTES) has been tested in the animal model for a multitude of procedures including cholecystectomy. Clinical experience using flexible endoscopes is, however, very limited. Transvaginal cholecystectomy has been shown to be the most feasible approach in which rigid instruments can be used. We report our experience in all patients treated over a 1-year period.

PATIENTS AND METHODS

Between June 2007 and June 2008, 68 patients (mean age 50 years) underwent transvaginal cholecystectomy with an additional 5-mm umbilical trocar using rigid laparoscopic instruments. Data about symptoms, operation, and postoperative course were prospectively collected, as were findings of a gynecological follow-up examination 1 week after surgery and the results of an interview at least 3 months after surgery.

RESULTS

All 68 operations were finished successfully without conversion, with a mean operation time of 51 minutes; in three additional cases severe pelvic adhesions prevented further transvaginal progress. There were no intraoperative or immediately postoperative complications, but one patient presented with a Douglas pouch abscess 3 weeks after surgery. Gynecologic follow-up exams 1 week after surgery were unremarkable. All patients were interviewed 3-10 months after surgery and had no abdominal or gynecological complaints including in relation to sexual intercourse.

CONCLUSION

Transvaginal NOTES cholecystectomy with rigid instruments can be safely and effectively performed in daily routine.

Clinical evaluation of seating in persons with complete thoracic spinal cord injury

STUDY DESIGN

Consecutive male patients studied with photographic measurement of a combination of clinical methods.

OBJECTIVES

To describe seating in individuals with complete thoracic spinal cord injury (SCI) by using a combination of clinical methods.

SETTING

Spinalis SCI unit, Stockholm, Sweden.

METHODS

Wheelchair specifications were documented. Measurements of posture from photographs in 30 male subjects with complete thoracic SCI, sitting in a relaxed and an upright position on a standardized surface and in a wheelchair were calculated. A comparison was made between positions and seating surfaces. An examiner's classification of lower trunk position in wheelchair was compared to subjects' evaluations. SCI subjects reported sitting support, satisfaction, and wishes for improvement.

RESULTS

Most SCI subjects used similar wheelchair specifications. None of the backrests were custom designed. Relatively small differences were found between the relaxed and upright position in the wheelchair regarding measurements of posture and according to the examiner's classification of the lower trunk position. Only 13/30 SCI subjects were sitting with the lower trunk centered relative to the backrest in the upright position. The examiner's classification and the subjects' evaluation of asymmetric sitting were not always in agreement. Only 12/30 SCI subjects were satisfied with their way of sitting.

CONCLUSION

Current wheelchair specifications and adjustments seem to inhibit a postural correction towards upright sitting and fail to provide sufficient lateral support. Findings indicate an inability for SCI subjects to vary their sitting position in a wheelchair to a large extent. Both an examiner's classification and subjects' evaluation of asymmetric sitting are necessary to obtain a sufficient knowledge base for subsequent adjustment. By using methods regarding different aspects of seating, a more comprehensive view of seating was achieved. The combination of clinical methods seems to be useful in order to describe seating in individuals with complete thoracic SCI.

Criminality and platelet monoamine oxidase activity in former juvenile delinquents as adults

Platelet monoamine oxidase (MAO) activity was estimated in 70 former delinquent boys and 40 controls now aged 38-46 years. Platelet MAO activity was compared with their early criminal behaviour (before the age of 15) and their late registered criminality from the age of 15). Mean platelet MAO activity in subjects with both early and late criminality was significantly lower than that in former delinquents without late criminality. There was no significant difference in mean platelet MAO activity between controls and delinquents with early but no late criminality. When delinquents with early criminality were divided into a low and a high MAO group, the relative risk to be registered for late criminality was about 3.1 times higher for the subjects in the low MAO group. Thus, individuals with low platelet MAO activity run an increased risk of continued criminal behaviour.