Comparison of long-term outcome and quality of life after laparoscopic repair of incisional and ventral hernias with suture fixation with and without tacks: a prospective, randomized, controlled study

Background

Technique of mesh fixation in laparoscopic incisional hernia repair is a matter of debate. Literature is lacking in randomized trials comparing various methods of mesh fixation. This study was designed to compare the cost-effectiveness and long-term outcomes following the two methods of mesh fixation.

Methods

A total of 110 patients were randomized to tacker mesh fixation or suture mesh fixation. Patients with nonrecurrent hernias with defect size ranging from 2 to 5?cm were included. The cost and incremental cost-effectiveness ratio was calculated. SF-36v2 health survey was used for quality-of-life analysis. Patients were followed up at regular intervals, and return to activity and satisfaction scores were recorded.

Results

Demographic profile and hernia characteristics were comparable between the two groups. Operation time was significantly higher (p?<?0) and early postoperative pain at 1?h, 6?h, and 1?month was significantly lower in the suture group. There was no significant difference in the incidence of chronic pain and seroma formation over a mean follow-up of 32.2?months. Cost of procedure was significantly higher in group I (p?<?0.001). Suture fixation was found to be more cost-effective than tacker fixation. Postoperative quality of life outcomes were similar in the two groups. Among return to activity parameters, time to resumption of daily activities and starting climbing stairs were significantly shorter in the suture group.

Conclusions

The suture fixation method is a cost-effective alternative to tacker fixation in patients with small- to medium-sized defects in laparoscopic incisional and ventral hernia repair. Suture fixation is better than tacker fixation in terms of early postoperative pain and return to activity. The two procedures are equally effective regarding the recurrence rates, complications, hospital stay, chronic pain, quality of life determinants, and patient satisfaction.     

Effectiveness of Bang and Ramm’s formulae in age assessment of Indians from dentin translucency length

Age assessment may be a crucial step in postmortem profiling leading to confirmative identification. Among the traditional dental parameters used for estimating age, root dentin translucency is considered to be least affected by external stimuli and most suitable for the purpose. Using this variable, Bang and Ramm in 1970 developed an elaborate method and formulae for predicting age in Norwegians, and its efficacy has been examined in Indians. A total of 100 tooth sections 250-μm thick were obtained from as many subjects, scanned on a flat-bed scanner and the translucency length measured using a commercially available image-editing software program. Since age estimates in Indians was less accurate compared to the original sample, translucency measurements were subjected to regression analysis, and India-specific formulae were derived. The new formula was applied to a control group (n = 18), and the estimated age was marginally better, validating to some extent the use of population-specific formulae in forensic age estimation. However, moderate correlation of translucency length to age inherent in Indians may undermine optimal age prediction.     

Bispectral index correlates well with Richmond agitation sedation scale in mechanically ventilated critically ill patients

Purpose  

The clinical sedation scores available for assessing sedation in the intensive care unit (ICU) have drawbacks and limit their usefulness in paralyzed and deeply sedated patients. An objective tool, the bispectral index (BIS), could prove beneficial in such circumstances. We evaluated the ability of BIS to assess the level of sedation and its correlation with the Richmond agitation sedation scale (RASS) in ICU.     

Overexpression of S100A4 as a biomarker of metastasis and recurrence in oral squamous cell carcinoma

S100A4, a biomarker of epithelial mesenchymal transition (EMT), plays an important role in invasion and metastasis by promoting cancer cell motility. In oral squamous cell carcinoma (OSCC), metastasis results in 90% of cancer associated mortality.

Objective

To investigate the role of S100A4 expression as an important component of the epithelial mesenchymal transition (EMT) program in oral squamous cell carcinoma (OSCC).

Material and Methods

S100A4 protein expression was assessed semi-quantitatively by immunohistochemistry in 47 histologically confirmed cases of oral squamous cell carcinoma (OSCC) and 10 normal oral mucosal biopsies. The association between the S100A4 overexpression and the aggressive features of OSCC were analyzed by X2 test.

Results

Moderate to strong cytoplasmic expression of S100A4 was observed in 30 out of 47 specimens of OSCC (64%). Overexpression of S100A4 was significantly associated with the clinical stage, lymph node involvement, metastases, pattern of invasion and recurrence (p<0.05).

Conclusion

S100A4 expression represents an important biomarker of prognostic significance that may be used to identify a subset of patients at high risk of invasion and metast