Early strangulated recurrence of incisional hernia after laparoscopic repair: an old complication for a new technique

The introduction of laparoscopy in incisional hernia repair is giving rise to a new class of complications, specific of new techniques and materials. A case of early failure of incisional hernia laparoscopic repair complicated by the strangulation of a jejunal loop four months after surgery is reported. The use of inappropriate material (tacks) to fix the prosthesis to the abdominal wall, a sudden increase of intra-abdominal pressure caused by an episode of haematemesis four hours postoperatively (associated to its consequent endoscopic treatment), and the formation of rectus abdominis muscle hematoma are reported as the main factors determining the slippage of the mesh from the correct position and, ultimately, the early failure of the ventral hernia repair. Furthermore, the aetiology of early failure of laparoscopic incisional hernia repair, reported in literature, is reviewed.     

Acquired methemoglobinemia after hydroxocobalamin administration in a patient with burns and inhalation injury

Context: Hydroxocobalamin is an effective cyanide antidote. While erythema, hypertension, and chromaturia are recognized side effects, methemoglobinemia has not been reported. Methemoglobin levels are most accurately measured by co-oximetry. We describe an extensively burned patient who developed methemoglobinemia within an hour of hydroxocobalamin administration.

Case details: A 47-year old man without genetic deficiencies or abnormal hemoglobin variants presented with 61% body surface area thermal burns and grade 1 inhalation injury sustained during a tugboat engine explosion. On admission, lactate was 9.24?mmol/L, methemoglobin 1%, and carboxyhemoglobin 0.2% by blood gas analysis with co-oximetry. Despite large-volume resuscitation, lactate remained elevated (7–8?mmol/L). Intravenous hydroxocobalamin (5?g) was administered at postburn hour 19 for possible cyanide toxicity. Immediately thereafter, he became hypertensive with reflex bradycardia. Lactate decreased to 5.51?mmol/L, methemoglobin rose to 4.10%, and oxygen saturation by pulse oximetry decreased to 74–80% (despite arterial oxygen saturation of 95% by cooximetry). Methemoglobin concentration peaked at 13.40% at postburn hour 33. Methylene blue was not administered.

Conclusions: Methemoglobinemia in our patient was temporally associated with hydroxocobalamin administration.     

Thyroid cancer mortality and incidence: A global overview

In most areas of the world, thyroid cancer incidence has been appreciably increasing over the last few decades, whereas mortality has steadily declined. We updated global trends in thyroid cancer mortality and incidence using official mortality data from the World Health Organization (1970–2012) and incidence data from the Cancer Incidence in Five Continents (1960–2007). Male mortality declined in all the major countries considered, with annual percent changes around ?2/?3% over the last decades. Only in the United States mortality declined up to the mid 1980s and increased thereafter. Similarly, in women mortality declined in most countries considered, with APCs around ?2/?5% over the last decades, with the exception of the UK, the United States and Australia, where mortality has been declining up to the late 1980s/late 1990s to level off (or increase) thereafter. In 2008–2012, most countries had mortality rates (age‐standardized, world population) between 0.20 and 0.40/100,000 men and 0.20 and 0.60/100,000 women, the highest rates being in Latvia, Hungary, the Republic of Moldova and Israel (over 0.40/100,000) for men and in Ecuador, Colombia and Israel (over 0.60/100,000) for women. In most countries, a steady increase in the incidence of thyroid cancer (mainly papillary carcinomas) was observed in both sexes. The declines in thyroid cancer mortality reflect both variations in risk factor exposure and changes in the diagnosis and treatment of the disease, while the increases in the incidence are likely due to the increase in the detection of this neoplasm over the last few decades.     

Assessment of cardiovascular regulation after burns by nonlinear analysis of the electrocardiogram

Critical illness and hypovolemia are associated with loss of complexity of the R-to-R interval (RRI) of the electrocardiogram, whereas recovery is characterized by restoration thereof. Our goal was to investigate the dynamics of RRI complexity in burn patients. We hypothesized that the postburn period is associated with a state of low RRI complexity, and that successful resuscitation restores it. Electrocardiogram was acquired from 13 patients (age 55 +/- 5 years, total body surface area burned 36 +/- 6%, 11 +/- 5% full thickness) at 8, 12, 24, and 36 hours during postburn resuscitation. RRI complexity was quantified by approximate entropy (ApEn) and sample entropy (SampEn) that measure RRI signal irregularity, as well as by symbol distribution entropy and bit-per-word entropy that assess symbol sequences within the RRI signal. Data (in arbitrary units) are means +/- SEM. All patients survived resuscitation. Changes in heart rate and blood pressure were not significant. ApEn at 8 hours was abnormally low at 0.89 +/- 0.06. ApEn progressively increased after burn to 1.22 +/- 0.04 at 36 hours. SampEn showed similar significant changes. Symbol distribution entropy and bit-per-word entropy increased with resuscitation from 3.63 +/- 0.22 and 0.61 +/- 0.04 respectively at 8 hours postburn to 4.25 +/- 0.11 and 0.71 +/- 0.02 at 24 hours postburn. RRI complexity was abnormally low during the early postburn period, possibly reflecting physiologic deterioration. Resuscitation was associated with a progressive improvement in complexity as measured by ApEn and SampEn and complementary changes in other measures. Assessment of complexity may provide new insight into the cardiovascular response to burns.     

Emotional and risk seeking behavior after prepuberal subchronic or adult acute stimulation of 5‐HT7‐Rs in naples high excitability rats

We report here the results of studies aimed to investigate the involvement of serotonin receptor 7 subtype (5‐HT7‐R) in the modulation of emotional response in Naples High‐Excitability (NHE) rat, a validated model for hyperactivity and impaired attention. A range of dosages (0.0, 0.125, 0.250, or 0.500 mg/kg) of LP‐211, a selective agonist of 5‐HT7‐Rs, has been evaluated in animals at different age (adolescence and adulthood). Male NHE and random bred (NRB) control rats were tested in an Elevated Zero‐Maze (EZM) after LP‐211 treatment in two different regimens: at the issue of adolescent, subchronic exposure (14 intraperitoneal [i.p.] injections, once/day, pnd 31–44, tested on pnd 45—Exp. 1) or as adult, acute effect (15 min after i.p. injection—Exp. 2). Adolescent, subchronic LP‐211 at 0.500 mg/kg dosage increased the frequency of head‐dips only in NHE rats. Drug effect on time spent and entries in open EZM quadrants were revealed with adult, acute administration of 0.125 mg/kg LP‐211 (both strains), indicating a tendency toward anxiolytic effects. In conclusion, data demonstrate that subchronic stimulation of 5‐HT7‐Rs during prepuberal period increases novelty‐seeking/risk‐taking propensity in NHE adults. These sequels are revealing increased disinhibition and/or motivation to explore in the NHE rats, which are characterized by a hyperactive dopaminergic system. These data may open new perspectives in studying mechanism of risk‐seeking behavior. Synapse 68:159–167, 2014 . © 2013 Wiley Periodicals, Inc.     

Melatonin Treatment Alters Biological and Immunomodulatory Properties of Human Dental Pulp Mesenchymal Stem Cells via Augmented Transforming Growth Factor Beta Secretion

IntroductionMelatonin is an endogenous neurohormone with well-reported anti-inflammatory and antioxidant properties, but the direct biological and immunomodulatory effects of melatonin on human dental pulp stem cells (hDPSCs) has not been fully elucidated. The aim of this study was to evaluate the influence of melatonin on the cytocompatibility, proliferation, cell migration, odontogenic differentiation, mineralized nodule formation, and immunomodulatory properties of hDPSCs.MethodsTo address the melatonin biological effects on hDPSCs, the cytocompatibility, proliferation, cell migration, odontogenic differentiation, mineralized nodule formation, and immunomodulatory properties of hDPSCs after melatonin treatment were evaluated. The statistical differences were evaluated using 1-way analysis of variance with the Tukey multiple comparison test.ResultsWe found that melatonin did not alter hDPSC immunophenotype or cell viability, even at the highest concentrations used. However, using intermediate melatonin concentrations (10–300 μmol/L), a significantly higher proliferation rate (P < .05 and P < .01) and migration of hDPSCs (P < .01) were observed. Importantly, melatonin treatment (100 μmol/L) significantly increased the secretion of the anti-inflammatory cytokine transforming growth factor beta (P < .05 and P < .01) and provoked a more robust antiproliferative effect on mitogen-stimulated T cells (P < .05). Finally, and unlike previous results found with mesenchymal stem cells from other sources, melatonin fails to induce or accelerate the spontaneous osteogenic differentiation of hDPSCs.ConclusionsTogether, these findings provide key data on the bioactivity of melatonin and its effects on hPDSC biological and immunomodulatory properties.     

Reconstruction of a degloved thumb

We present two cases of degloving injuries of the thumb with amputation of the distal phalanx. The first one was treated with an osteocutaneous flap from the first toe, giving effective function to the thumb, and the second by a fasciocutaneous interosseous flap around the segment of the exposed thumb, with a satisfactory result.