Laparoscopic transabdominal preperitoneal hernia repair (TAPP): stapling the mesh is not mandatory.

BACKGROUND: This report reviews our experience with 104 transabdominal preperitoneal (TAPP) hernia repairs, using a selective staple-free technique, over the period April 2003 to July 2007 (50 months). MATERIALS AND METHODS: Ninety-one patients underwent TAPP repair (13 bilateral). Eighty-one were males and 10 females. Mean age was 61 years. There have been 58 right inguinal hernias and 46 left. We had 47 indirect, 42 direct, 6 pantaloon, 4 supravesicular, 3 inguinal-scrotal, 2 sliding, and 1 femoral hernia. Twenty-three of the hernias we repaired were recurrences. We used a modified staple-free technique with the placement of a 15 x 10 cm polypropylene mesh in the preperitoneal space with sutured peritoneal closure. The mesh was stapled selectively only in very large defects (nine repairs; 9%). We used nondisposable instruments and trocars. RESULTS: We had no conversions. Mean operative time was 47 min/repair with a mean hospitalization of 1.2 nights. We had 1 recurrence (mean follow-up, 34 months). Postoperative complications were: preperitoneal hematoma 1, urinary retention 1, and inguinal seromas/hematomas 11. Mean return to normal activities was 7 days. CONCLUSIONS: TAPP repair is a technically demanding laparoscopic technique, but once mastered, is safe and effective with a high degree of patient satisfaction. Stapling the mesh is not necessary in most cases, thus resulting in a remarkably low cost. The rapid rehabilitation typically associated with laparoscopic surgery was seen in all our patients. The low recurrence rate (1% in our series) compares favorably to other tension-free techniques.

Is inflammation a significant predictor of bile duct injury during laparoscopic cholecystectomy?

BACKGROUND: Bile duct injuries (BDI) have been reported to occur more frequently during laparoscopic cholecystectomy (LC) compared to open cholecystectomy (OC). Several studies have demonstrated various potential predisposing factors for BDI. However, there is a controversy as to whether gallbladder inflammation is a significant predictor for BDI. Therefore, out primary aim was to investigate the relationship between inflammation and BDI at LC, and secondarily to present the management and clinical outcome of BDI. METHODS: We recorded all consecutive LC performed between 1993 and 2005 in our institution by nine staff surgeons. BDI were classified according to Strasberg's classification. Simple and multivariate logistic regression analysis was performed to evaluate the association between inflammation and BDI occurrence during LC. RESULTS: There were 2,184 patients. Among those, 344 had inflammation (16%). The conversion rate was 5% and was higher among male, elder patients, and those with inflammation. The BDI incidence was 0.69% (0.14% for major and 0.55% for minor injuries) and it was significantly higher in those with inflammation compared to those without inflammation (p = 0.01). In particular, the risk for BDI was almost 3.5 times higher in those with inflammation (OR = 3.61, 95% CI 1.27-10.21). Inflammation remained an independent risk factor for BDI even after adjustment for potential confounders. Among patients sustaining injury, one died and two have recurrent cholangitis. No association was observed between clinical outcome and management of BDI, time of diagnosis, sex, and inflammation. CONCLUSION: We revealed that inflammation is an independent predictor of BDI occurrence during LC. Therefore, it would be advisable for surgeons to not hesitate to convert a LC to an OC in the presence of inflammation.

CLIP-170/tubulin-curved oligomers coassemble at microtubule ends and promote rescues.

BACKGROUND: CLIP-170 is a microtubule binding protein specifically located at microtubule plus ends, where it modulates their dynamic properties and their interactions with intracellular organelles. The mechanism by which CLIP-170 is targeted to microtubule ends remains unclear today, as well as its precise effect on microtubule dynamics. RESULTS: We used the N-terminal part of CLIP-170 (named H2), which contains the microtubule binding domains, to investigate how it modulates in vitro microtubule dynamics and structure. We found that H2 primarily promoted rescues (transitions from shrinkage to growth) of microtubules nucleated from pure tubulin and isolated centrosomes, and stimulated microtubule nucleation. Electron cryomicroscopy revealed that H2 induced the formation of tubulin rings in solution and curved oligomers at the extremities of microtubules in assembly conditions. CONCLUSIONS: These results suggest that CLIP-170 targets specifically at microtubule plus ends by copolymerizing with tubulin and modulates microtubule nucleation, polymerization, and rescues by the same basic mechanism with tubulin oligomers as intermediates.

Rapid magnetic heating treatment by highly charged maghemite nanoparticles on Wistar rats exocranial glioma tumors at microliter volume.

One of the most significant challenges implementing colloidal magnetic nanoparticles in medicine is the efficient heating of microliter quantities by applying a low frequency alternating magnetic field. The ultimate goal is to accomplish nonsurgically the treatment of millimeter size tumors. Here, we demonstrate the synthesis, characterization, and the in vitro as well as in vivo efficiency of a dextran coated maghemite (gamma-Fe(2)O(3)) ferrofluid with an exceptional response to magnetic heating. The difference to previous synthetic attempts is the high charge of the dextran coating, which according to our study maintains the colloidal stability and good dispersion of the ferrofluid during the magnetic heating stage. Specifically, in vitro 2 mul of the ferrofluid gives an outstanding temperature rise of 33 degrees C within 10 min, while in vivo treatment, by infusing 150 mul of the ferrofluid in animal model (rat) glioma tumors, causes an impressive cancer tissue dissolution.