Laparoscopic slit mesh repair of parastomal hernia using a designated mesh: long-term results

BACKGROUND

Parastomal hernia (PH) is a frequent complication of colorectal surgery, which incidence reaches 55% of all stoma formation. Currently, there is no definitive strategy for its repair. This study was designed to assess the outcome in patients who underwent laparoscopic PH repair using a slit mesh/keyhole technique.

METHODS

We undertook a retrospective case review of all patients who underwent laparoscopic PH repair with a designed slit mesh/keyhole between 2005 and 2010. Three ports were placed opposite the stoma site, and careful adhesiolysis and hernia content reduction were performed. The parastomal fascial defect was measured and covered with a designated mesh. Fixation of the mesh was achieved with concentric tacks and transcutaneous Prolene suture. Recurrence was diagnosed after examination of patients by two surgeons or by imaging demonstrating an indolent hernia.

RESULTS

Twenty-nine laparoscopic PH mesh repairs were performed with an average age of 63.5 (range 42-81, median 64) years to treat paracolostomy hernia in 18 of 29 cases (62.1%), para-ileostomy hernia in 10 of 29 cases (34.5%), and for an ileal conduit site hernia in 1 of 29 cases (3.4%). The average operative time was 179 (range, 80-300; median, 180) min. Two operations (6.9%) were converted to an open approach. Early postoperative complications were documented in four patients (13.8%), including one elderly patient with severe comorbidities who died from postoperative sepsis (mortality rate, 3.4%). Only one late complication was recorded (3.4%). The average hospital stay was 4.7 (range, 1-19; median, 3) days. Average follow-up time was 28 (range, 12-53; median, 30) months. Recurrence of the hernia was found in 13 of 28 patients (46.4%).

CONCLUSIONS

Laparoscopic slit mesh/keyhole repair is feasible, although it is a complex surgery reflected by extended operative time. The high recurrence rate suggests that technical improvement of the method is essential.

Metastatic angiosarcoma presenting as diffuse alveolar hemorrhage

Angiosarcoma is a rare malignant neoplasm of the vascular or lymphatic endothelium. Diffuse alveolar hemorrhage is a rare presenting manifestation of angiosarcoma. We describe a case of pulmonary metastasis of angiosarcoma who presented with diffuse alveolar hemorrhage as initial manifestation.

Effect of the number of stacking layers on the characteristics of quantum-dash lasers

A theoretical model is evaluated to investigate the characteristics of InAs/InP quantum dash (Qdash) lasers as a function of the stack number. The model is based on multimode carrier-photon rate equations and accounts for both inhomogeneous and homogeneous broadenings of the optical gain. The numerical results show a non monotonic increase in the threshold current density and a red shift in the lasing wavelength on increasing the stack number, which agrees well with reported experimental results. This observation may partly be attributed to an increase of inhomogeneity in the active region.

A new approach to simulate characterization of particulate matter employing support vector machines

This paper, for the first time, applies the support vector machines (SVMs) paradigm to identify the optimal segmentation algorithm for physical characterization of particulate matter. Size of the particles is an essential component of physical characterization as larger particles get filtered through nose and throat while smaller particles have detrimental effect on human health. Typical particulate characterization processes involve image reading, preprocessing, segmentation, feature extraction, and representation. Of these various steps, knowledge based selection of optimal image segmentation algorithm (from existing segmentation algorithms) is the key for accurately analyzing the captured images of fine particulate matter. Motivated by the emerging machine-learning concepts, we present a new framework for automating the selection of optimal image segmentation algorithm employing SVMs trained and validated with image feature data. Results show that the SVM method accurately predicts the best segmentation algorithm. As well, an image processing algorithm based on Sobel edge detection is developed and illustrated.

Multidrug resistant Vibrio cholerae O1 El Tor carrying classical ctxB allele involved in a cholera outbreak in South Western India

Cholera is a fatal diarrheal disease characterized with enormous fluid loss through stools. A total of 41 Vibrio cholerae isolates collected from a recent cholera outbreak in Solapur, South Western India were found to belong to serogroup O1, biotype El Tor and serotype Ogawa. Molecular analysis revealed the prevalence of different toxigenic and pathogenic genes in the isolates. All the isolates harboured rstR(El)(Tor) allele indicating the presence of CTXΦ(El)(Tor). However, cholera toxin (ctxB) gene sequencing and a ctxB allele specific PCR of the isolates confirmed the presence of ctxB of classical biotype. The antibiogram profile revealed the resistance for several antibiotics including nalidixic acid, polymyxin B, streptomycin, sulfamethoxazole, trimethoprim, rifampicin and vibriostatic agent 2,4-diamino-6,7-diisopropylpteridine (O/129). All the isolates were PCR positive for class 1 integron and SXT elements also. Fingerprinting analysis revealed the clonal relationship among the outbreak isolates. The results suggested the involvement of multidrug resistant V. cholerae El Tor biotype isolates having ctxB gene of classical biotype in the cholera outbreak.

Mcleod syndrome: Report of an Indian family with phenotypic heterogeneity

The present report deals with the clinical phenomenology of three members (brothers) of one family with McLeod syndrome (MLS). In two, the clinical pictures were of choreiform disorders with amyotrophy, which were found to be neurogenic in origin by detailed electrophysiological study. The index case had peripheral acanthocytosis; immunohematological and molecular genetic studies confirmed diagnosis of MLS. However, one brother only had a slowly progressive motor neuron disease like picture but no abnormal movement disorder. He had peripheral acanthocytes as well. The inheritance seems to be X-linked recessive in nature. The affected family members exhibited much phenotypic heterogeneity. This appears to be the first report of MLS from India.

Unilateral paravertebral block: an alternative to conventional spinal anaesthesia for inguinal hernia repair

BACKGROUND

Inguinal herniorrhaphy can be successfully performed using general, regional or local anaesthesia. Paravertebral block (PVB) has been used for unilateral procedures such as thoracotomy, breast surgery, chest wall trauma, hernia repair or renal surgery.

METHODS

We compared unilateral lumbar PVB with conventional spinal anaesthesia (SA) in 60 consenting ASA I and II males aged 18-65 years, scheduled for unilateral inguinal hernia repair. Patients were randomly assigned into two groups, P (n=30) or S (n=30) to receive either PVB or SA, respectively. Two patients (7%) in group P had to be converted to general anaesthesia due to block failure. During surgery, patients of both groups received intravenous infusion of propofol titrated to light sedation.

RESULTS

The time to first post-operative analgesic requirement (primary outcome measure) as 342 +/- 73 min in group P and 222 +/- 22 min in group S (P<0.0001). Time to ambulation was 234 +/- 111 min in group P and 361 +/- 32 min in group S (P<0.0001). Urinary retention requiring catheterization were found in zero (0%) patients in group P compared with five (16%) in group S (P=0.024).

CONCLUSION

It can be concluded that unilateral PVB is more efficacious than conventional SA in terms of prolonging post-operative analgesia and reducing morbidities in patients undergoing elective unilateral inguinal hernia repair.

Hyperpolarized MR imaging: neurologic applications of hyperpolarized metabolism

Hyperpolarization is the general term for a method of enhancing the spin-polarization difference of populations of nuclei in a magnetic field. No less than 5 distinct techniques (dynamic nuclear polarization [DNP]; parahydrogen-induced polarization-parahydrogen and synthesis allow dramatically enhanced nuclear alignment [PHIP-PASADENA]; xenon/helium polarization transfer; Brute Force; (1)H hyperpolarized water) are currently under exhaustive investigation as means of amplifying the intrinsically (a few parts per million) weak signal intensity used in conventional MR neuroimaging and spectroscopy. HD-MR imaging in vivo is a metabolic imaging tool causing much of the interest in HD-MR imaging. The most successful to date has been DNP, in which carbon-13 ((13)C) pyruvic acid has shown many. PHIP-PASADENA with (13)C succinate has shown HD-MR metabolism in vivo in tumor-bearing mice of several types, entering the Krebs-tricarboxylic acid cycle for ultrafast detection with (13)C MR imaging, MR spectroscopy, and chemical shift imaging. We will discuss 5 promising preclinical studies: (13)C succinate PHIP in brain tumor; (13)C ethylpyruvate DNP and (13)C acetate; DNP in rodent brain; (13)C succinate PHIP versus gadolinium imaging of stroke; and (1)H hyperpolarized imaging. Recent developments in clinical (13)C neurospectroscopy encourage us to overcome the remaining barriers to clinical HD-MR imaging.

Airway management of two patients with penetrating neck trauma

SUMMARY

Direct trauma to the airway is a rare injury which can lead to disastrous consequences due to compounding effect of bleeding, aspiration of blood, airway obstruction and severe sympathetic stimulation. Here we are presenting two cases of open tracheal injury in two adult males following assault with sharp weapon. Two different techniques of securing the airways were employed depending upon the severity and urgency of the situation. In the first case, orotracheal intubation helped the surgeon to repair airway around the endotracheal tube whereas in the second patient this stenting effect was absent as he was intubated through the distal cut-end of trachea in the face of airway emergency.

Optical polarization modulation and gain anisotropy in an electrically injected spin laser

The effects of spin-induced gain anisotropy on output polarization and threshold current reduction of electrically pumped spin-polarized lasers have been studied. Analytical forms of these parameters are derived by considering diffusive transport from the spin injector to the active region. The calculated values of the parameter are in excellent agreement with values obtained from measurements made at 200 K on an InAs/GaAs quantum dot spin-polarized vertical cavity surface-emitting laser. Electrical modulation of the output polarization of the laser is demonstrated with a peak modulation index of 0.6.