Can ventral TAPP achieve favorable outcomes in minimally invasive ventral hernia repair? A systematic review and meta-analysis

PURPOSE

The concept of the transabdominal preperitoneal (TAPP) was transferred from the inguinal hernia repair to be adopted in minimally invasive ventral hernia repair (VHR) and since then it has been gaining popularity. However, there are minimal data supporting the ventral TAPP (vTAPP) technique which may lead to reticence in the adoption of this approach. The aim of this meta-analysis was to evaluate the outcomes of patients who received minimally invasive vTAPP for VHR.

STUDY DESIGN

A systematic search was performed of PubMed, Science Direct, Google Scholar and Cochrane Library until July 2022. We selected studies that compared the vTAPP technique with any of other minimally invasive techniques. A meta-analysis was done for the outcomes of perioperative characteristics and postoperative parameters.

RESULTS

A total of 9 studies (1429 patients) were identified. vTAPP was associated with considerable benefit when compared to IPOM. vTAPP was less painful (MD = - 1.01; 95% CI [- 1.39, - 0.64], p < 0.00001), of reduced average cost (MD = - 457.10; 95% CI [- 457.27, - 456.92], p < 0.00001) and decreased SSI (OR = 0.29; 95% [0.09, 0.96], p = 0.04). On the other hand, the vTAPP approach consumed less operative time (MD: - 31.01, 95% CI [- 33.50, - 28.51]), p < 0.00001) and shorter hospital stay than the e-TEP approach.

CONCLUSION

vTAPP appears to be safe and effective procedure for VHR, superior or similar to other minimally invasive techniques for perioperative characteristics and short-term outcomes.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Myxoid esophageal liposarcoma: A case report of a rare tumor

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Esophagealliposarcoma represent a rare cause of esophagealtumor.

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We present a case of liposarcomain the low oesophagus treated by surgical resection.

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There is no conventional treatment of this pathology.

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The curative treatment requires surgical resection orendoscopic approach for selected tumor.

Introduction

Esophageal liposarcoma represent a rare cause of esophageal tumor. According to the literature, since the first case reported in 1983, only 42 cases of esophageal liposarcoma were reported.

Presentation of case

We present a case of liposarcoma in the lower oesophagus treated by surgical resection.

Discussion

Liposarcoma in the oesophagus gastrointestinal tract is an uncommon. An analysis of the literature reports 42 cases.In many cases the diagnosis was established in postoperative period.Surgery is the standard treatment including polypectomy, total or subtotal oesophagectomy.

Conclusion

There is no conventional treatment of this pathology. The curative treatment requires surgical resection or endoscopic approach for selected tumor.

Characterization of genetic diversity of cactus species (Opuntia spp.) in Morocco by morphological traits and molecular markers

The genetic diversity within and among 124 accessions of Opuntia spp. collected from different regions of Morocco was assessed using morphological descriptors and molecular markers. Based on 10 morphological traits, the accessions were separated into 3 main clusters; each cluster was containing accessions from different regions and species. Polymerase chain reaction (PCR) was then performed on 22 accessions from different regions and species, with 10 inter-simple sequence repeat (ISSR) primers and one random amplified polymorphic DNA (RAPD) primer. ISSR primers produced 66 bands overall, 64 (96.9 %) of which were polymorphic while 6 bands were generated by the RAPD marker, all polymorphic. The polymorphic information content (PIC) values ranged from 0.62 to 0.97, with an average of 0.82. The dendrogram of genetic differences generated using the unweighted pair-group method using arithmetic averages (UPGMA) method showed 7 different clusters at a similarity of 0.76, which was confirmed by the principal component analysis (PCA). The main conclusion of our work is the high genetic similarity between Opuntia ficus indica and Opuntia megacantha species in Morocco. Our results will be useful for plant breeding and genetic resource conservation programs.

[Trans-hepatico cystic coledochostomy for the opening hydatid cyst in the biliary tract: Indications and outcome evaluation of 25 cases]

The treatment of hydatid cysts of the liver opened in the bile ducts is sometimes difficult and complex. The trans-hepaticocystic coledochostomy (CTHK) is one of these processes. We conducted a review of the indications for this surgical procedure and its perioperative outcomes through a series of 25 patients and then we analyzed predictor factors of complications. During the period's study, 909 patients with liver hydatid cyst went under the surgery. Ninety two (92, i.e. 10.1%) of them had an opening in the bile ducts through a large fistula. Twenty five (25, i.e. 27%) had a trans-hepaticocystic coledochostomy. The sex ratio was 0.6. The population was young with an average age of 47 years. The trans-hepaticocystic coledochostomy was performed because of a thick pericyst associated with a nonsutured fistula in 18 cases, a voluminous residual cavity with a soft pericyst but the fistula was unexposed in six cases and in a case where the pericyst was thick, fistula was exposed. Its suture was associated with a high risk of bile duct stenosis. Specific morbidity was 20% due to a length of the intraductal coledochostomy under 2 cm (P = 0.016), the absence of an epiploplasty (P = 0.004) and the existence of a leak of contrast material outside the fistula on the cholangiography (P = 0.005). The trans-hepaticocystic coledochostomy is a safe and reliable technique, often indicated when other conservative methods are failing. The application of its technical requirements and avoidance of mounting errors allow reducing its morbidity.

Theoretical study of phenylene-thiophene oligomers: structure-properties relationship

Theoretical results including geometrical characteristics, electronic structures, photophysical parameters (lowest excitation energies, electron affinities (EAs), ionization potentials (IPs), maximum of absorption and emission) and vibrational modes of some new oligomers, based on phenylene-thiophene motives, are investigated using Density Functional Theory DFT/B3LYP/6-31G(d) approach. The electronic and optical properties of phenylene-based derivatives can be tuned through the insertion of thiophene in the main oligomers backbone as well as the addition of alkoxy-substituent groups on 2 and 5 positions on phenylene groups. It can be noticed, that different conformational behaviors and steric effects take place. Then, an increase in conjugation length induces a decrease in the gaps energy and a bathochromic shift of absorption/emission spectra. Based on these computed results, which are consistent with the available experimental data, the correlation structure-properties is better understood, where these nanostructures show a great potential for opto-electronic devices.

A Combined Experimental and Theoretical Study on the Effect of Doping and Interface Formation on Ppv−ether Copolymer

We present a detailed optoelectronic and vibrational study devoted to the transformation from neutral to doped PPV-ether copolymer in both powder and thin film states. The full geometries were optimized with the density functional theory (DFT) for neutral and doped states, where a comparative geometric study was established. The lowest singlet excited-state geometries have been investigated by using the configuration interaction single (CIS/3-21G(d)) method. The absorption spectra are then calculated respectively on the basis of the ground- and excited-state geometries. Our calculation results are in close agreement with those available from experiments. The charge distribution and excitation energies of singly charged PPV-ether are calculated, where two subgap absorption features are found to dominate the optical spectrum correlated with the polaron picture. These theoretical results are compared to experimental optical data illustrated by iodine-doped PPV-ether. Next, we have performed a simulation to model the conformations and the electronic structure modifications of interface formation of PPV-ether copolymer thin film with calcium (Ca), magnesium (Mg), and aluminum (Al) metal as a cathode and indium tin oxide (ITO) as anode in polymer LEDs. By providing the optical parameter obtained and the chemical reaction at the interface, we present the energetic diagram near the interface and the energy position of the lowest occupied molecular orbital with respect to the electrode Fermi level.

[Ectopic pregnancy: interest and value of clinical examination in management policy]

Clinical examination (history and physical examination) is not considered to be a useful tool in the diagnosis of ectopic pregnancy (EP). In this systematic review we aimed to evaluate its value when ancillary tests are not readily available or when they are equivocal. Suspicion of EP is based on the presence of one or more of the following signs: vaginal bleeding, acute pelvic pain, or any risk factors for EP occurring in a pregnant woman. Detection of early pregnancy by urinary or serum hCG testing must be systematic because neither medical history nor physical examination can rule out early pregnancy with a high level of confidence. No isolated sign has sufficient diagnostic accuracy to rule out EP. In presence of vaginal bleeding without pain and if abdominal and pelvic examination are normal the risk of EP is very low. The presence of spontaneous pain moderate to severe, peritoneal signs, or definite pain during digital cervical mobilization increase the probability of EP. Absence of these signs does not rule out EP but tend to eliminate tubal rupture. In the presence of these signs one may consider an emergency transfer in a specialized center. In their absence, suspicion of EP may have outpatient diagnosis procedures.

[Diagnosis of holoprosencephalia. Report of 17 cases]

OBJECTIVE

To establish the epidemiologic profile of holoprosencephalia and determine benefits of ultrasound and foetopathologic examination to the diagnostic. METHODS AN MATERIAL: [corrected] Retrospective study about 17 cases of holoprosencephalia observed in CMNT between Janaury 1992 and September 2000.

RESULTS

Ultrasound diagnosis was made in 13 cases (75%). Ultrasound criteria were; absence of median structure of the brain and unique ventricule. The prognosis was always bad. Foetopathologic examination revealed 7 cases of lobar holoproencephalia and 10 of semi lobar. Fascial dysmorphia were noted in 82% of cases.

CONCLUSION

The foetopathology and genetic counselling looking for fascial, dysmorphia in family's members gives a good evaluation of recurrences.

[Value of ambulatory diagnostic hysteroscopy. A review of a series of 292 cases]

This is a retrospective study including 292 ambulatory diagnostic hystéroscopies realised during a period of 1 year and a half. The mid age of our patients is 44 years. The main indications are haemorrhage, infertility and abnormal ultrasound findings. The exams are carried out under analgesia. Its sensibility is good concerning the endométrial pathology. As a matter of fact, it equals 100% for adénocarcinomas, it varies from 56.5 to 77.3% for hyperplasia, 100% for endométrial polyps and from 88 to 90% for endométrial atrophy. In contrast, it is worse for the myométrial pathology such as adénomyose and sub mucosal myomas. Besides its sensibility, the tolerance of this exam allows its ambulatory realisation permitting a considerable economy.

Kerosene stove as a cause of burns admitted to the Ain Shams burn unit

Kerosene stoves are in widespread use for cooking and warming water in underprivileged areas in Cairo. These stoves are dangerous and lack safety measures; they are often a cause of fire incidents and burn injuries. During the period from May 1995 to December 1996 the number of patients who presented to the burn unit of Ain Shams University, Cairo, Egypt was 759, of whom 304 (40%) sustained the injury as a consequence of kerosene stove fires. Efforts to inform the public about the danger of these stoves are recommended to minimize the incidence, morbidity, mortality and cost of this relatively common and preventable type of injury.

Palliative balloon valvoplasty of the pulmonary valve in tetralogy of Fallot

Balloon dilation of the pulmonary valve was performed in 54 patients with tetralogy of Fallot with severe cyanosis, high haematocrit and severe valvar pulmonary stenosis. Clinical, echocardiographic, angiographic, and haemodynamic data were analyzed before and after the procedure. After balloon dilation, the systemic oxygen saturation increased from a mean value of 66% to 85%. The mean value of the haematocrit before dilation was 55 + 13, and decreased to 47 after dilation (p < 0.002) in 2 months follow-up. Balloon dilation increased the size of the pulmonary valvar orifice from a mean value of 9 + 5 mm to 11.5 + 2 mm (p < 0.005). The mean Z score of the pulmonary valves, which was -3 + 1.3 before dilation, increased to -1.1 + 1.1 immediately after the procedure (p < 0.05). The size of the right and left pulmonary arteries increased after dilation from 9 mm to 10 mm, and from 8.7 + 2.4 mm to 9.8 + 2.3 mm, respectively (p < 0.05). The comparable mean Z scores increased from -2.8 + 1.9 SD to -1.8 + 1.4 SD, and from -2.4 + 1.9 SD to -1.5 + 1.6 SD for the right and left branches, respectively (p < 0.05). In patients with stenosis at the bifurcation of the pulmonary trunk and hypoplasia of the left artery, successful dilation of the pulmonary valve lead to an increase of flow and improvement in size of the hypoplastic segment. In conclusion, initial balloon dilation of the pulmonary valve in tetralogy of Fallot resulted in increase of the Z score for the pulmonary valve and improved antegrade pulmonary blood flow, inducing growth of the pulmonary arteries and ameliorating the anatomic and physiologic preoperative condition.