Assessment of behavioral determinants influencing success of supervised exercise therapy in patients with intermittent claudication: A cross sectional survey.

BACKGROUND: Supervised exercise therapy is the first step in treatment of intermittent claudication. However, adherence to supervised exercise therapy is low. Limited access and reimbursement issues are known reasons, though lack of motivation is often leading. Behavioral determinants influencing motivation and thus adherence to supervised exercise therapy remain to be investigated. In this study we sought to determine which behavioral determinants would be of influence on the long-term adherence of supervised exercise therapy. METHODS: 200 patients, newly diagnosed with peripheral arterial disease Rutherford classification II-III, were sent a questionnaire to assess motivation and behavior with regard to supervised exercise therapy. The questionnaire was constructed using the I-CHANGE model for explaining motivational and behavioral change. Baseline characteristics were acquired from medical records. Alpha Cronbach's was calculated to test reliability of the questionnaire. RESULTS: 108 (54%) patients returned their questionnaire. A total of 79% patients followed supervised exercise therapy. Patients who increased their walking distance after supervised exercise therapy have significantly greater knowledge (p = 0.05), positive attitude (p = 0.03) and lower negative attitude (p = 0.01). Patients with a higher self-efficacy remained significantly more active after participating in supervised exercise therapy (p = 0.05). CONCLUSION: Increasing the determinants knowledge, attitude and self-efficacy will improve adherence to supervised exercise therapy and result in delayed claudication onset time.

A rare complication of colonic diverticulosis: giant diverticulum. Case report and overview of pathophysiology, diagnosis and therapeutic options.

A rare complication of diverticulosis of the colon is giant colonic diverticulum, an entity first described by Bonvin in 1946. The experience of any surgeon with this problem is at the most still small and reported management in the literature has been varied. We present the case of a 84-year-old woman presenting with a painless abdominal mass and constipation. A 30 x 10 cm gas-filled cyst was discovered on abdominal X-ray and CT examination. Furthermore, we provide an overview of pathophysiology, diagnosis and therapeutic options.

Duplex-guided percutaneous transluminal angioplasty in iliac arterial occlusive disease.

BACKGROUND: Chronic renal insufficiency (CRI) is a growing global problem. PTA can be performed without nephrotoxic contrast, utilizing Doppler-ultrasound (Duplex) guidance. Duplex-guided infra-inguinal interventions and access-related interventions have been reported. Duplex-guided iliac interventions have not been performed to any extent because of the anatomic location. In our study we evaluated the safety and efficacy of Duplex-guided percutaneous transluminal angioplasty (DuPTA) in iliac arteries. METHODS: From June 2012 until February 2013, 31 patients (35 iliac lesions), underwent DuPTA. Indications ranged from Rutherford 3 to 5. Preoperative evaluation included Ankle Brachial Index (ABI), Duplex and MRA. Procedural success was defined as crossing the lesion with a guidewire and dilating or stenting the lesion. Clinical success was defined as 50% reduction in peak systolic velocity (PSV) or clinical improvement. PSV was evaluated after PTA, then at 2 weeks. Clinical results were assessed 2 weeks after the procedure. RESULTS: Procedural success was achieved in 94% of patients (33/35), all of whom also had clinical success. Post-procedural PSV reduction showed an average improvement of 63% (431 cm/s to 153 cm/s). Mean preoperative ABI was 0.72 and improved to 0.88 postoperatively. CONCLUSIONS: PTA using Duplex-guidance in significant iliac stenosis is a safe method with major advantages in patients at high risk for developing contrast-induced nephropathy.

The creation of the optimal dedicated endovascular suite.

BACKGROUND: During the last decade endovascular therapy has been established as an alternative treatment for a variety of vascular diseases. Neither the classic operating room (OR), nor the conventional angiography suite is optimal for both open surgery and endovascular procedures. Important issues include: quality of the imaging equipment, radiation burden, ease of use of the equipment, need for specially trained personnel, ergonomics, ability to perform both open and percutaneous procedures, sterile environments, as well as quality and efficiency of patient care. METHODS: A literature search identified articles pertinent to the key issues during the decision-making process of creating the optimal endovascular suite. Manual cross-referencing also was performed. RESULTS AND CONCLUSION: The most important feature of working in a dedicated endovascular suite should be the ability to attain best treatment of vascular patients. Whether the interventional radiologist or the vascular surgeon uses the facilities is of less importance. A fixed fluoroscopy unit is preferred, above a portable C-arm. Establishment of an endovascular operating room suite has the benefit of a sterile environment, the possibility of performing hybrid procedures and conversions when necessary. Moreover, angiography immediately before treatment gives contemporary anatomical information, and after treatment provides quality control. As a consequence, better quality and service can be provided to the individual patient.

Adhesion formation and reherniation differ between meshes used for abdominal wall reconstruction.

Incisional hernia is a common surgical problem, frequently requiring prosthetic mesh repair. The demands of the ideal mesh seem conflicting; ingrowth at the mesh-fascia interface, without development of adhesions at the visceral mesh surface. Various antiadhesives combined with macroporous mesh and composite meshes were studied for prevention of adhesions to mesh and ingrowth into the fascia. In 60 rats an abdominal wall defect was created and repaired with underlay mesh. Rats were divided into six groups and treated with polypropylene mesh (PPM, control), PPM with auto-cross-linked polymers (ACP) gel, PPM with fibrinogen glue (FG), polypropylene/expanded polytetrafluoroethylene (ePTFE) mesh, polypropylene/sodium hyaluronate/carboxymethylcellulose (HA/CMC) mesh, and polypropylene-collagen/polyethylene-glycol/glycerol (CPGG) mesh. Mesh infection was assessed in the postoperative period, adhesions and reherniations were scored at sacrifice 2 months after operation, and tensile strength of the mesh-tissue interface was measured. Six rats developed mesh infection, half of them were treated with PPM/ePTFE. The PPM/HA/CMC group showed a significant reduction in the amount and severity of adhesions. In animals treated with PPM/ACP and PPM/FG, severity of adhesions was reduced as well. Reherniation rate in the PPM/ACP group was 50% and significantly higher than that in other groups. Rats in the PPM/HA/CMC had the highest tensile strength. PPM/HA/CMC approaches the demands of the ideal mesh best, having superior antiadhesive properties, no reherniation and no infection in this rat model of incisional hernia.

Hyaluronan-based antiadhesive membrane has no major effect on intraperitoneal growth of colonic tumour cells.

BACKGROUND: A relationship between post-surgical adhesion formation and peritoneal tumour implantation has been proposed. Hyaluronan (HA)-based agents reduce adhesion formation, but the effect on peritoneal tumour is not established. This study investigated the influence of a HA-containing agent on intraperitoneal tumour in an experimental model. METHODS: 66 Balb/c mice underwent laparotomy and damage was inflicted to the parietal peritoneum. The animals were randomized into five groups. Groups 1 and 2 received HA-carboxymethylcellulose bioresorbable membrane and no treatment, respectively. Mice in groups 3-5 were injected intraperitoneally with 10(5) colon 26-B cells after the laparotomy. Treatment consisted of HA membrane, no HA agent and placement of HA membrane on the non-traumatized peritoneal wall, respectively. Animals were killed after 14 days; adhesions were scored in groups 1 and 2, and the tumour mass in groups 3-5. 45 Wag/Rij rats underwent the same procedures and treatment as mice in groups 3-5. In rats, 10(6) CC-531 cells were injected. Rats were killed after 3 weeks and the tumour mass was scored. RESULTS: HA membrane resulted in a significant reduction of adhesions, but had no major effect on the intraperitoneal tumour mass in mice and rats. CONCLUSION: HA-carboxymethylcellulose bioresorbable membrane has no major effect on intraperitoneal tumour implantation and growth in an experimental model.