Illness cognitions and health-related quality of life in liver transplant patients related to length of stay,comorbidities and complications

Quality of Life Research - Illness cognitions regarding helplessness and acceptance are known to play a role in health-related quality of life (HRQoL). Our study examined the evolution of these...     

Persistent reversed end diastolic flow in the fetal middle cerebral artery: an ominous finding

Fetal persistent middle cerebral artery reversed end diastolic flow is a rare and ominous finding. Previous cases have been associated with intracranial hemorrhage, growth restriction, anaemia, and hepatic anomaly. Intrauterine demise or early neonatal death is a common outcome. We report the case of persistent middle cerebral artery reversed end diastolic flow in a well-grown fetus at 32 weeks’ gestation resulting from acute, severe anaemia due to a large feto-maternal hemorrhage. An emergency cesarean section was performed and the neonate required advanced resuscitation and immediate blood transfusion. Postnatal magnetic resonance imaging confirmed a hemorrhagic parietal infarct and bilateral ischaemic changes in the basal ganglia. This provides further evidence that persistent middle cerebral artery reversed end diastolic flow in any fetus is an ominous finding warranting urgent diagnostic evaluation and/or delivery.     

Why Did it Take so Long to Start a Non-Heart-Beating Donor Program in Belgium ?

Ischemia-reperfusion injury of the liver causes severe organ dysfunction after both extended liver resections and liver transplantation. In experimental models, ischemic preconditioning has repeatedly been shown to protect the liver from injury after warm and cold ischemia-reperfusion. Herein, we summarize the experimental and clinical evidence considering protection of tissue by ischemic preconditioning and we conclude that it is now time to initiate prospective randomized multicenter trials, in order to confirm the benefit of ischemic preconditioning for the patients undergoing major liver surgery and liver transplantation.     

Open preperitoneal mesh repair of inguinal hernias using a mesh with nitinol memory frame

Purpose

To prospectively evaluate the use of a continuous Nitinol containing memory frame patch during a TIPP-technique in the open repair of inguinal and femoral hernias.

Methods

Over a 3-year period all consecutive adult patients that needed treatment for an inguinal or femoral hernia were treated by the TIPP repair using the Rebound Shield mesh. Intra-operatively the type and size of the hernia were evaluated according to the EHS classification, as well as the size of the mesh used. Baseline characteristics for all patients were evaluated considering age, gender, BMI and American society of Anesthesiologists score. Standard X-ray was performed to evaluate mesh position. All patients were evaluated for post-operative pain using the visual analogue scale (VAS 0–10 scale).

Results

In total 289 groin hernias were operated using a nitinol containing patch in 235 patients. The mean operating time was 38 min for unilateral hernias and 59 min for bilateral hernias. The median follow-up is 21.2 months (14–33 months) during which three patients died, unrelated to the groin hernia repair. At the time of re-evaluation 12 patients (5.0 %) complained of chronic pain, with a VAS score higher than 3 after 3 months (range 3–10). Two of these patients already had severe pain pre-operatively. A total of 3 recurrences (2.9 %) were noted with strong correlation with X-ray findings.

Conclusion

A nitinol memory frame containing mesh is a valuable tool to achieve complete deployment of a large pore mesh in a TIPP repair for inguinal hernias with acceptable morbidity and a low recurrence rate.     

Trocar Injuries in Laparoscopy: Techniques,Tools, and Means for Prevention. A Systematic Review of the Literature

Trocar injuries are a possible cause for severe morbidity and mortality when performing laparoscopic surgery. This systematic review investigates the differences in the incidence of complications depending on the method of entry. A meta-analysis of the medical literature was performed. Search results were limited to clinical trials and the following languages: English, French, German, or Dutch. All results that compared the Veress, Hasson, and direct entry technique or compared sharp, blunt, and radially expanding trocars (RET) were included (n = 19). Studies involving pediatric and pregnant patients were excluded. When comparing the Veress needle to direct trocar insertion (DTI), pooled analysis showed a borderline significant reduction for major complications (p = 0.04) based on five events in 2 RCT’s (n = 978) and a reduction in minor complications (p < 0.001) in favor of DTI. RCT’s comparing the Hasson and Veress techniques showed no significant reduction in major complications (p = 0.17), but the Hasson technique showed significantly less minor complications (p = 0.01) and failed entries (p = 0.002). CO₂ leakage was far more common when using the Hasson technique (p < 0.001). Our search method did not reveal any studies comparing the Hasson technique to DTI. When comparing bladed to RET, three studies (n = 408) showed less minor complications when using a RET (p = 0.003) and a qualitative analysis showed a trend toward pain reduction when using RET. This meta-analysis concludes that there are less minor complications and failed attempts when using the Hasson or direct entry technique when compared to the Veress method, but there is limited evidence regarding major complications. RET reduce minor vascular complications when compared to bladed trocars.     

Association between surgical hernia repair techniques and the incidence of seroma: a systematic review and meta-analysis of randomized controlled trials

Hernia - Ventral hernia repair (VHR) includes the surgical reconstruction of the abdominal wall (AW) using different surgical techniques. Although such procedures are usually devoid of...