Long-term results with biosynthetic absorbable P4HB mesh in ventral abdominal wall repair: a multicentre analysis.

BACKGROUND: The aim of this multicentre study was to analyse the outcomes of biosynthetic absorbable poly-4-hydroxybutyrate (P4HB) prosthesis implantation in patients undergoing ventral hernia repair (VHR) in the context of different degrees of contamination. METHODS: From May 2016 to December 2021, a multicentre retrospective analysis of patients who underwent elective or urgent hernia repair with P4HB prosthesis was performed in seven hospitals in Spain and Portugal. Patients with a postoperative follow-up of less than 20 months and those within the theoretical period of prosthesis resorption were excluded from the study. Regarding the degree of contamination, patients were assessed according to the modified Ventral Hernia Working Group (VHWG) classification. Epidemiological data, hernia characteristics, surgical and postoperative variables (Clavien-Dindo classification) of these patients were analyzed. Risk factors related to long-term recurrence were studied by a multivariate analysis. RESULTS: In 236 cases of P4HB prosthesis implantation, repair in cases of Grade 3 was the most frequent (49.1%), followed by Grade 2 in 42.3% of cases and Grade 1 in 8.4%. The most frequent complications were Grade 1, with the majority occurring during the first year. The overall rate of surgical site occurrences (SSO) was 30%. The hernia recurrence rate was 14.4% (n = 34), with a mean postoperative follow-up time of 41 months (22-61). The multivariate analysis showed that the onlay location of the mesh (OR 1.07; CI 1.42-2.70, p = 0.004) was a significant independent risk factor for recurrence. CONCLUSIONS: The use of a P4HB bioresorbable mesh for the VHR with different degrees of contamination leads to favourable results overall, with an acceptable rate of hernia recurrence. The onlay location of the P4HB prosthesis is the main factor in recurrence in both elective and emergency settings.

[Giant renal angiomyolipoma]. / Angiomiolipoma renal gigante.

We present a case report of a renal angiomyolipoma with the special feature of its big size at the moment of the diagnosis. It is appreciated an important alteration of the kidney morphology and the repercussion produced in the rest of the abdominal organs. Due to this an exeresis with nefrectomy is performed. We do a bibliographic review and we analyzed the relevant aspects of this tumour.

[Leiomyosarcoma of the bladder. Report of a new case and review of the literature]. / Leiomiosarcoma de vejiga. Aportación de un nuevo caso y revisión de la literatura.

Contribution of a new case of bladder leiomyosarcoma due to the rarity of its presentation. There are barely one hundred cases reported in the medical literature. Clinico-pathological, therapeutic and prognostic assessment of this type of bladder sarcoma and discussion on the convenience of complementary therapy after surgery.

Differential effects of IL-1 beta and ibuprofen after endotoxic challenge in mice.

Interleukin-1 (IL-1) and ibuprofen modulate the host response in different models after endotoxic challenge. A comparative study was made between the two drugs, as they were jointly administered, to explore a potentiation of their therapeutic effects. Endotoxic challenge was provoked in CBA/H mice with lipopolysaccharide (LPS) from Escherichia coli (125 mg/kg), with administration of recombinant murine IL-1 beta (80 ng/mouse) 24 hr pre-LPS. Two doses of ibuprofen (1 mg/kg) were administered 1 hr before and 30 min after the septic challenge. Serum levels of IL-1 alpha, tumor necrosis factor-alpha (TNF alpha), and interleukin-6 (IL-6) were determined 1,2, and 4 hr, post-LPS, and prostaglandin E2 (PGE2) urine levels 4,8, and 12 hr post-LPS, and a comparative mortality study was performed. IL-1 beta treatment provoked a reduction of IL-1 alpha, TNF alpha, and IL-6 without affecting PGE2, while ibuprofen provoked a later increase of IL-1 alpha, TNF alpha, and IL-6, with a decrease of PGE2. Both drugs caused a notable enhancement of survival, with no difference between them, but their combined administration caused no improvement. We conclude that both drugs exert a similar therapeutic effect in endotoxic shock by different mechanisms.

Interleukin-1beta and ibuprofen effects on CD4/CD8 cells after endotoxic challenge.

Multiple-organ failure is considered a consequence of autodestructive inflammatory response during which a state of immunosuppression is produced. Alterations in CD4 and CD8 lymphocytes after experimental endotoxic challenge and their correlation with the protective effects of interleukin-1beta (IL-1beta) and ibuprofen pretreatment were investigated. CBA/H mice were injected with lipopolysaccharide (LPS) of Escherichia coli (125 mg/kg); 40 mice were pretreated with IL-1beta (80 ng/mouse, 24 hr pre-LPS), 40 with ibuprofen (1 mg/kg 1 hr pre-LPS, 1 mg/kg 30 min post-LPS), and 40 with both drugs (same doses and timing). Prostaglandin E2 (PGE2) urine levels were determined 4, 8, and 12 hr post-LPS (10 mice), CD4 and CD8 cells 24 hr post-LPS (10 mice), and mortality at 24, 48, 72, and 96 hr (20 mice). PGE2 decreased in ibuprofen-treated groups (P < 0.05 versus control, IL-1beta groups). CD4/CD8 ratio increased in groups treated with IL-1beta (11,9) and IL-1beta plus ibuprofen (11,2) compared with sham (3,4), LPS (4,2), and ibuprofen alone (4,1) (P < 0.05). Mortality decreased in all treated groups. A correlation was observed between IL-1beta treatment, CD4/CD8 ratio, and reduced mortality. In this model IL-1beta treatment improved survival after endotoxin challenge, preventing lymphocyte derangements and increasing CD4/CD8 ratio. This effect was not potentiated by ibuprofen administration.