End-colostomy parastomal hernia repair: a systematic review on laparoscopic and robotic approaches

INTRODUCTION

Parastomal hernia (PSH) is the most common and challenging complication after stoma creation, with an estimated 50% incidence 2 years after the index surgery. Mesh repair is the treatment of choice. Laparoscopic and/or robotic approaches allow acceptable outcomes.

MATERIALS AND METHODS

A systematic literature review from January 2012 to November 2023 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Embase, PubMed, and Scopus search were performed to select articles dealing with minimally invasive surgical treatment for PSH after end colostomy.

RESULTS

603 studies were found, and 24 were chosen. When compared to open surgery, laparoscopy showed decreased postoperative complications and recurrence. The main laparoscopic approaches are the keyhole (KH), the Sugarbaker (SB), and the sandwich technique. Continuous improvement in surgery, mesh technology, and surgeons' expertise led to an amelioration of surgical outcome and recurrence rate after repair. Recent studies showed comparable outcomes for SB and KH techniques, while novel surgical approaches have been proposed in an attempt to further increase the operative and long-term results. Reports on PSH robotic repairs are scarce and describe small series results, suggesting a role of the initial learning curve as a risk factor for complications.

CONCLUSION

End-colostomy PSH surgical repair still represents a challenge for surgeons. Recent evidence has not shown a significant advantage in postoperative complications and recurrence with a specific repair among SB, KH, and sandwich technique. The paucity of data on robotic surgery does not allow to draw definitive conclusion. Further primary, multicentric, and larger cohort studies are needed.

[Diagnostic profile of young-onset dementia before 65 years. Experience of a French Memory Referral Center]

OBJECTIVE

The aim of the study was to compare the profiles of patients with young (age≤65 years) and late (age>65 years) onset of dementia in a memory clinic of a Memory Referral Center in Lyons (France), for the year 2008.

METHODS

A total of 746 demented patients were evaluated using clinical, neuropsychological and imaging information. For each patient, diagnoses of the dementing disorder used clinical criteria at the first visit. We examined the distribution of patients diagnosis and differences in sex and education between the young-onset dementia (YOD) and the late-onset dementia (LOD) groups.

RESULTS

From a total of 746 registered demented patients (300 men, 446 women), there were 91 patients (12.2%) with YOD (from 36.5 to 65 years) and 655 patients with LOD (from 66 to 92 years). Among the 91 YOD patients, the most frequent causes were Mild Cognitive Impairment (MCI) (18.7%), then Alzheimer's disease (AD), frontotemporal dementia and posterior cortical atrophy (14.3% each), followed by progressive aphasia (11.0%), dementia with Lewy bodies (DLD) (9.9%), semantic dementia (8.8%), other causes (3.3%), vascular dementia (2.2%), undetermined dementia (2.2%), AD+cerebrovascular disease (1.1%). Among the 655 LOD patients, AD was the most frequent cause of dementia (57.4%). Referred cases by a specialist doctor were 50.5% in the YOD group and 12.7% in the LOD group (P<0.0001). In the ACP group, 68.4% patients began before 65 years.

CONCLUSION

The number of YOD in our memory clinic was four-fold the number of expected patients in France. The characteristics of the Referral Center explain the high frequency of rare dementia such as progressive aphasia (5.2% of overall number), semantic dementia (3.6%) and posterior cortical atrophy (2.5%).

A human, compact, fully functional anti-ErbB2 antibody as a novel antitumour agent

A new human, compact antibody was engineered by fusion of a human, antitumour ErbB2-directed scFv with a human IgG1 Fc domain. Overexpression of the ErbB2 receptor is related to tumour aggressiveness and poor prognosis. This new immunoagent meets all criteria for a potential anticancer drug: it is human, hence poorly or not immunogenic; it binds selectively and with high affinity to target cells, on which it exerts an effective and selective antiproliferative action, including both antibody-dependent and complement-dependent cytotoxicity; it effectively inhibits tumour growth in vivo. Its compact molecular size should provide for an efficient tissue penetration, yet suitable to a prolonged serum half-life.

[Anterior iliac bone grafts: techniques and sequelae. Report on 107 cases and review of the literature]

The anterior iliac crest is the harvest site preferred by many authors because of the quantity and quality of bone obtainable and the simplicity of harvesting techniques. The purpose of the present paper is to present a review of anterior iliac crest harvesting techniques and to illustrate the most serious sequelae reported in the literature. A clinical series is also presented in order to evaluate what is, in our experience, the degree of morbility connected with this donor site. We have controlled 107 patients who underwent bone harvesting from the anterior iliac crest between 1980 and 2000, investigating minor complications such as walking deficiency (immediate and long-term) the formation of seromas, haematomas, adynamic ileus and more serious complications such as retroperitoneal haemorrhages, abdominal hernias, ileus fractures, nervous lesions (immediate and long-term). From our survey it emerged that, among the major complications, incidentally rarely reported in the international literature, we found only a small percentage of cases involving damage to nervous structures. Minor complications were also limited and the only problem remains difficulty in walking after the operation which resolves fully in almost all cases. We can therefore state that the anterior iliac crest remains, to date, an excellent site for harvesting and there is no significant morbility and the surgeon has numerous techniques available for reducing the incidence of complications to the minimum.

Psychological aspects in orthognathic surgery. Body image and quality of life in postsurgical assessment. Body image and quality of life in postsurgical assessment

AIM

The aim of this study is to evaluate the psychological assessment of 20 patients after orthognathic surgery. Body image, anxiety levels, depression, somatic symptoms, aggressiveness and quality of life have been evaluated using 3 different questionnaires (BDDE, SQ, Q-LES-Q) during the postsurgical period. Analysis of the questionnaire has shown that the patients undergo orthognathic surgery mainly for esthetical reasons and, even if they could be considered normal, psychological evaluation followed by a proper support is a must. The present study has mainly developed and outlined this aspect.

METHODS

BDDE has been utilised to evaluate body image, self-estimation and social relationship. It was evident that the psychological impact after surgery represents a "revolution" for the patient. The "new face" may generate psychological problems for the patients. The SQ test has been used to evaluate the emotional profile. We also considered it essential for our study to evaluate several aspects of the quality of life of our sample group. The body image, particularly when others find it pleasing or displeasing may affect everyday life behaviour.

RESULTS

The study reports positive results in the psycho-emotional profiles and in several aspects of the quality of life, while the results of the self-perception of the body image could be considered average.

CONCLUSION

Reported data show that the corrections following orthognathic surgery have a positive impact on the assessment of the patients and on the personal and social attitude and behaviour, however suggesting, a long term psychological support to assure a satisfactory postoperative recovery.

[Cardiac troponin I in chronic hemodialysis. Comparison of methods and results after 3 months]

The laboratory and instrumental markers today in use for the determination of myocardial damage present limitations in dialysis patients due to interference patterns that tend to reduce prognostic evaluation. The aim of this study is to evaluate whether troponin I (cTnI), a recently established marker of myocardial damage, can help to identify, in asymptomatic patients too, minor ischemic lesions that could screen this patient population for future acute cardiac events. In our study of 103 patients undergoing chronic dialysis, instrumental measurements and serum dosages of cTnI were carried out at the onset and after three months, using first and second generation methods. Among the patients who tested positive using the above tests, 4 acute cardiac events were observed. A follow-up of the present study is due in one year's time.

Changes in pressure-pain thresholds of the jaw muscles during a natural stressful condition in a group of symptom-free subjects

AIMS

To investigate the effects of a natural emotional stressor on pressure-pain thresholds (PPTs) of the masticatory muscles of symptom-free subjects.

METHODS

Sixteen healthy dental students were selected before they undertook an academic examination. Sixteen gender-matched students who were not exposed to an examination served as controls. The 2 groups of students were monitored in parallel on 5 separate days over a 1-month period: 2 days before the examination (T1), on the day of the examination (T2), 2 days after (T3), 1 month after (T4), and again after another 2 days (T5). On the day of the examination (T2), the control students were only required to complete a brief, non-demanding questionnaire. On each day, the following parameters were assessed: PPTs of the masseter, the anterior temporalis, and the Achilles tendon; state anxiety; and present stress (measured on a visual analog scale [VAS]). Furthermore, in the students undergoing the examination, venous blood samples for assessment of beta-endorphin levels were obtained at T2 and T5.

RESULTS

In the stressed students, the PPTs of the masticatory muscles and the Achilles tendon were significantly lower (analysis of variance [ANOVA], P < or = 0.02) on the day of the examination (T2) and on the days nearest the exam (T1, T3), and state anxiety and present stress were significantly higher (ANOVA, P < or = 0.003). No significant change was found in beta-endorphin plasma levels (P > 0.05). In the control group, PPTs, state anxiety, and present stress did not change significantly (ANOVA, P > 0.05).

CONCLUSION

The results support a relationship between psychologic stress and pressure-pain sensitivity of the masticatory muscles.

[Treatment of aneurysm of the inferior pancreaticoduodenal artery associated with celiac axis occlusion]

A case of the inferior pancreaticoduodenal artery aneurysm, associated with occlusion of the celiac axis is reported. The aneurysm seemed to be related to a high-flow state secondary to the associated occlusion of the celiac axis. The occlusion was typical of the atheromatous disease. The aneurysm was atherosclerotic in origin and was treated with resection and PTFE patching. Eighty months later an angiogram was performed, demonstrating a normal patency of the pancreaticoduodenal arcades. The treatment of these aneurysms is discussed, and the literature on this uncommon disease is reviewed.

The role of chemical engineering in pharmaceutical chemical process development

The task of chemical process development in the pharmaceutical industry has grown into a multidisciplinary endeavor requiring years to complete. Increased competition in the pharmaceutical Additionally, the ever-tightening regulatory environment further compromises the business objective (ultimately, profits). This has required careful analysis of the activities within development. This work discusses the results of this analysis, which shows how a balance between minimal resource utilization and phased development achievements can be reached. The cycle of development, from inception to completion, is examined. Special emphasis is placed upon the role of chemical engineering and its appropriate deployment. Simple examples of the synergies that are possible between chemistry and chemical engineering are also given.

Duodenal ulcer and Sjogren's syndrome in patients with primary biliary cirrhosis: a casual association?

Peptic ulcer has been reported in patients with primary biliary cirrhosis (PBC), but its frequency and pathogenesis are still poorly defined. We have analyzed the occurrence of duodenal ulcer in 37 female patients affected by PBC and in 35 with chronic liver disease of various etiologies. An active ulcer was found in seven patients with PBC and in one with chronic autoimmune hepatitis. The presence of an exocrine gland defect, as indicated by clinical signs of Sjogren's syndrome (SS), was found in six patients with PBC and duodenal ulcer (85%), but in only eight (26.6%) of those without ulcer (p less than 0.02). Therefore, in our patients, duodenal ulcer occurs more often in PBC than in other types of chronic liver disease. The association of SS with PBC, significantly higher in patients with than without ulcer, supports the hypothesis that the underlying exocrine gland defect is involved in the development of duodenal ulcer.

[Gastric leiomyoblastoma. Description of a clinical case]

The paper describes a case of gastric myoblastoma, a rare tumour of the smooth musculature most commonly found in the stomach but also encountered outside the digestive tract. The tumour is potentially malignant and the occasional malignant forms feature histologically a large number of clearly atypical mitoses and clinically an aggressive pattern often involving even widespread metastasis. The case presented is that of a 73 year old woman given a Billroth I gastric resection who was in perfect health 7 months later despite the findings of a myoblastoma with some signs of enhanced mitosis.

[Adenocarcinoma of the cecal appendix. Presentation of 2 cases and a review of the literature]

Two cases of adenocarcinoma of the vermiform appendix are described. The literature on these rare cancers which are almost always diagnosed at routine histology and whose prognosis is related to Duke grading and staging, is reviewed. The stable cure observed in one patient after 13 years after straightforward caecal resection for cancer of the appendix extending beyond the base of the implant (which today would be handled with hemicolectomy) and then treated for multiple polyps, two of them in a stage of malignant degeneration, suggests a difference of biological behaviour compared to tumours of the other colon districts. In the second case, stress is laid on the unusual extension of the tumour-related inflammation to the skin of the gluteal region.

Arginine thiazolidinecarboxylate in the treatment of chronic active hepatitis: double-blind comparison with placebo

Forty-four patients with chronic active hepatitis were given arginine thiazolidinecarboxylate (800 mg/day per os for 40 days) or placebo in a randomized, double-blind trial. The most important liver function parameters were measured in each patient at the beginning of the trial, after 20 days, and at the end of the trial. The active drug lessened the parameters of necrosis and cholestasis while protein synthesis improved in liver cells. The differences between ATCA and placebo groups were highly significant. No treatment-related side-effects were reported.