Progress in monitoring methane emissions from landfills using drones: an overview of the last ten years.

Solid waste landfills are responsible for much of the anthropogenic methane emitted from the waste sector. The quantification of fugitive CH4 emissions from a landfill is to date characterised by high uncertainty and several methodologies have been devised to estimate emission fluxes. Unmanned Aerial Vehicles (UAVs, also known as drones) are revolutionising the way CH4 emission monitoring is conceived and offer new opportunities for quantifying emission fluxes from a landfill, mainly due to recent advances in sensor miniaturisation that make these instruments lighter and more suitable to be equipped on a drone. The paper analyses publications from the period 2014-2024 that illustrate UAV-based methods that can be used for this purpose, identifying experiences in the field and the current state of research. The review has highlighted a current research status characterised by a strong experimental focus, with few tests carried out in landfills under real emission conditions (33 % of the reviewed papers). Since 2018, there has been a growing interest in open-path sensors, tested in some controlled-release experiments according to different configurations which have given promising results, but experiences are limited and there are no experiments conducted directly in landfills. In general, the UAV-based methods identified by this systematic review are characterised by unclear uncertainties. Drones are a viable alternative to traditional monitoring methods at landfills and allow data to be acquired with a spatial and temporal resolution that can hardly be achieved by other low-cost methods. However, further studies and field trials are needed to better understand methodological aspects: especially the uncertainty of each step in the quantification process need to be properly analysed and quantified more precisely.

[Treatment practice in patients with isolated blunt splenic injuries. A survey of Swiss traumatologists]. / Die Behandlungspraxis bei Patienten mit isolierter stumpfer Milzverletzung. Eine Befragung der Schweizer Traumatologen.

BACKGROUND: The non-operative management (NOM) of blunt splenic injuries has gained widespread acceptance. However, there are still many controversies regarding follow-up of these patients. The purpose of this study was to survey active members of the Swiss Society of General and Trauma Surgery (SGAUC) to determine their practices regarding the NOM of isolated splenic injuries. MATERIALS AND METHODS: A survey of active SGAUC members with a written questionnaire was carried out. The questionnaire was designed to elicit information about personal and facility demographics, diagnostic practices, in-hospital management, preferred follow-up imaging and return to activity. RESULTS: Out of 165 SGAUC members 52 (31.5%) completed the survey and 62.8% of all main trauma facilities in Switzerland were covered by the sample. Of the respondents 14 (26.9%) have a protocol in place for treating patients with splenic injuries. For initial imaging in hemodynamically stable patients 82.7% of respondents preferred ultrasonography (US). In cases of suspected splenic injury 19.2% of respondents would abstain from further imaging. In cases of contrast extravasation from the spleen half of the respondents would take no specific action. For low-grade injuries 86.5% chose to admit patients for an average of 1.6 days (range 0-4 days) with a continuously monitored bed. No differences in post-discharge activity restrictions between moderate and high-grade splenic injuries were found. CONCLUSION: The present survey showed considerable practice variation in several important aspects of the NOM of splenic injuries. Not performing further CT scans in patients with suspected splenic injuries and not intervening in cases of a contrast extravasation were the most important discrepancies to the current literature. Standardization of the NOM of splenic injuries may be of great benefit for both surgeons and patients.

Life Cycle Assessment of a system for the extraction and transformation of Waste Water Treatment Sludge (WWTS)-derived lipids into biodiesel.

In recent years, the demand for biofuels has been growing exponentially, as has the interest in biodiesel produced from organic matrices. Particularly interesting, due to its economic and environmental advantages, is the use of the lipids present in sewage sludge as a raw material for the synthesis of biodiesel. The possible processes of this biodiesel synthesis, starting from lipid matter, are represented by the conventional process with sulfuric acid, by the process with aluminium chloride hexahydrate and by processes that use solid catalysts such as those consisting of mixed metal oxides, functionalized halloysites, mesoporous perovskite and functionalized silicas. In literature there are numerous Life Cycle Assessment (LCA) studies concerning biodiesel production systems, but not many studies consider processes that start from sewage sludge and that use solid catalysts. In addition, no LCA studies were reported on solid acid catalysts nor on those based on mixed metal oxides which present some precious advantages, over the homogeneous analogous ones, such as higher recyclability, prevention of foams and corrosion phenomena, and an easier separation and purification of biodiesel product. This research work reports the results of a comparative LCA study applied to a system that uses a solvent free pilot plant for the extraction and transformation of lipids from sewage sludge via seven different scenarios that differ in the type of catalyst used. The biodiesel synthesis scenario using aluminium chloride hexahydrate as catalyst has the best environmental profile. Biodiesel synthesis scenarios using solid catalysts are worse due to higher methanol consumption which requires higher electricity consumption. The worst scenario is the one using functionalized halloysites. Further future developments of the research require the passage from the pilot scale to the industrial scale in order to obtain environmental results to be used for a more reliable comparison with the literature data.

The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: long-term results.

PURPOSE: To investigate the influence of the introduction of total mesorectal excision (TME) on local recurrence rate and survival in patients with rectal cancer. METHODS: A total of 171 consecutive patients underwent anterior or abdominoperineal resection for primary rectal cancer. When the TME technique was introduced, the clinical setting, including the surgeons, remained the same. Group 1 (1993-95, n =53) underwent conventional surgery and group 2 (1995-2001, n = 118) underwent TME. All patients were followed for 7 years or until death. RESULTS: Between the two groups, no statistically significant differences were present with regards to patient-, treatment-, or tumor-related characteristics apart from the time point of radiotherapy. The total local recurrence rates were 11 of 53 (20.8%) in group 1 and 7 of 118 (5.9%) in group 2, and the rates of isolated local recurrences were 6 of 53 (11.3%) in group 1 and 2 of 118 (1.7%) in group 2. Both differences were highly statistically significant. The disease-free survival in groups 1 and 2 was 60.4 and 65.3% at 5 years, and 58.5 and 65.3% at 7 years, respectively. Excluding patients with synchronous or metachronous distant metastasis from the analysis, both the disease-free survival and the cancer-specific survival were statistically significantly better in group 2 than in group 1. No statistically significant difference between the two groups was detected regarding the overall survival. CONCLUSIONS: The introduction of TME led to an impressive reduction of the local recurrence rate. Survival is mainly determined by the occurrence of distant metastasis, but TME seems to improve survival in patients without systemic disease.

Management of blunt injuries to the spleen.

BACKGROUND: Non-operative management (NOM) of blunt splenic injuries is nowadays considered the standard treatment. The present study identified selection criteria for primary operative management (OM) and planned NOM. METHODS: All adult patients with blunt splenic injuries treated at Berne University Hospital, Switzerland, between 2000 and 2008 were reviewed. RESULTS: There were 206 patients (146 men) with a mean(s.d.) age of 38.2(19.1) years and an Injury Severity Score of 30.9(11.6). The American Association for the Surgery of Trauma classification of the splenic injury was grade 1 in 43 patients (20.9 per cent), grade 2 in 52 (25.2 per cent), grade 3 in 60 (29.1 per cent), grade 4 in 42 (20.4 per cent) and grade 5 in nine (4.4 per cent). Forty-seven patients (22.8 per cent) required immediate surgery. Transfusion of at least 5 units of red cells (odds ratio (OR) 13.72, 95 per cent confidence interval 5.08 to 37.01), Glasgow Coma Scale score below 11 (OR 9.88, 1.77 to 55.16) and age 55 years or more (OR 3.29, 1.07 to 10.08) were associated with primary OM. The rate of primary OM decreased from 33.3 to 11.9 per cent after the introduction of transcatheter arterial embolization in 2005. Overall, 159 patients (77.2 per cent) qualified for NOM, which was successful in 143 (89.9 per cent). The splenic salvage rate was 69.4 per cent. In multivariable analysis age at least 40 years was the only factor independently related to failure of NOM (OR 13.58, 2.76 to 66.71). CONCLUSION: NOM of blunt splenic injuries has a low failure rate. Advanced age is independently associated with an increased failure rate.

Systematic review of atraumatic splenic rupture.

BACKGROUND: Atraumatic splenic rupture (ASR) is an ill defined clinicopathological entity. METHODS: The aim was to characterize aetiological and risk factors for ASR-related mortality in order to aid disease classification and treatment. A systematic literature review (1980-2008) was undertaken and logistic regression analysis employed. RESULTS: Some 632 publications reporting 845 patients were identified. The spleen was normal in 7.0 per cent (atraumatic-idiopathic rupture). One, two or three aetiological factors were found in 84.1, 8.2 and 0.7 per cent respectively (atraumatic-pathological rupture). Six major aetiological groups were defined: neoplastic (30.3 per cent), infectious (27.3 per cent), inflammatory, non-infectious (20.0 per cent), drug- and treatment-related (9.2 per cent) and mechanical (6.8 per cent) disorders, and normal spleen (6.4 per cent). Treatment comprised total splenectomy (84.1 per cent), organ-preserving surgery (1.2 per cent) or conservative measures (14.7 per cent). The ASR-related mortality rate was 12.2 per cent. Splenomegaly (P = 0.040), age above 40 years (P = 0.007) and neoplastic disorders (P = 0.008) were associated with increased ASR-related mortality on multivariable analysis. CONCLUSION: The condition can be classified simply into atraumatic-idiopathic (7.0 per cent) and atraumatic-pathological (93.0 per cent) splenic rupture. Splenomegaly, advanced age and neoplastic disorders are associated with increased ASR-related mortality.

[Intestinal stomas--indications, stoma types, surgical technique]. / Der künstliche Darmausgang--Indikationen, Stomaformen, chirurgische Technik.

The formation of an intestinal stoma is one of the most frequent operations in visceral surgery. Despite new operative techniques and a more restrictive use of the stoma, the stoma formation remains an often necessary surgical procedure, which results to a dramatic change in the patients' life. The stoma formation and its later closure are associated with a high morbidity. Many complications, such as stoma necrosis, stoma retraction or stoma prolapse, are related to surgical mistakes made during stoma formation. These complications are therefore largely avoidable. The stoma formation needs careful planning together with a professional stoma nursing team. Moreover, it is mandatory that the stoma formation is made with great care and that it meticulously follows the well established surgical principles. A perfectly placed, technically correctly fashioned and easy to care for stoma is essential for a good patients'quality of life.

[Acute "difficult" gastrointestinal bleeding]. / Die akute "schwierige" gastrointestinale Blutung.

Gastrointestinal bleeding with its point of origin outside the reach of conventional gastro- and colonoscopy represents an extraordinary diagnostic and therapeutic challenge. Bleeding may originate from the small bowel distal to the duodenojejunal junction (middle gastrointestinal bleeding) or from the biliary tree (haemobilia) or from the pancreatic ductal system (haemosuccus pancreaticus). This particular type of gastrointestinal bleeding is often intermittend and caused by a variety of different pathologies. Angiography is the diagnostic method of choice for further investigation. It allows precise localization of the bleeding site and simultaneous interventional therapy (embolization/coiling). The importance of further diagnostic modalities such as scintigraphy, capsule endoscopy, push-enteroscopy and double-balloon-enteroscopy is discussed.

Laparoscopic management of nonparasitic symptom-producing solitary hepatic cysts.

BACKGROUND: In 1991, the first laparoscopic treatment of a nonparasitic solitary hepatic cyst was published. We now report a series of eight cases and describe a standardized minimally invasive technique. STUDY DESIGN: Between October 1992 and December 1995, eight patients underwent laparoscopic surgical treatment for nonparasitic solitary hepatic cysts. Patients with polycystic hepatic disease were not included in our study. RESULTS: Cyst diameters varied from 12 to 15 cm. The mean operation time was 114 minutes, and the mean postoperative hospital stay was 8.5 days. There was no morbidity or mortality. During the mean follow-up time of 12.6 months, one asymptomatic recurrence was noted. CONCLUSIONS: The treatment of choice for solitary hepatic cysts that produce symptoms is laparoscopic fenestration and wide resection (deroofing) of the external part of the cyst followed by the transposition of an omental flap into the remaining cyst cavity to prevent recurrences. Laparoscopic deroofing of solitary hepatic cysts is a safe and effective procedure. This technique allows ample access for surgical treatment of solitary cysts in segments II, III, IVb, V, and VIII of the liver; however, the posterior segments, VI and VII, and segment IVa are difficult to approach laparoscopically. Hemorrhage and bile leakage can be controlled by applying a running suture to the resection margin. A cholecystectomy should be performed if gallstones are present or if the cyst is located in the right hepatic lobe adjacent to the gallbladder wall.

Laparoscopic treatment of large paraesophageal hernia with totally intrathoracic stomach.

BACKGROUND: Once paraesophageal hernia has been diagnosed, it should be repaired immediately because of life-threatening complications such as bleeding, ischemia, and perforation when intrathoracic strangulation or volvulus occurs. We describe our surgical strategy for treating this rare type of hiatal hernia with regard to early and late postoperative complications. STUDY DESIGN: This was a retrospective case series from a university hospital. Twelve patients (seven women and five men) with a mean age of 64 years (range, 50-76 years) and a completely intrathoracic stomach underwent laparoscopic paraesophageal hernia repair. Seven patients had a type 2 hernia, and five patients had a type 3 hernia. Additional organoaxial volvulus was present in three patients. All patients underwent reduction of the stomach and the greater omentum, excision of the hernia sac, closure of the hiatal defect, and a floppy Nissen fundoplication. RESULTS: Because of severe adhesions, one patient needed an open stomach reduction (conversion rate, 8%). The mean operating time was 161 minutes (range, 110-200 minutes), blood loss was minimal, and the mean postoperative hospital stay was 6 days (range, 4-7 days). There were no intraoperative complications, but early postoperative complications occurred in three patients (25%; one with dysphagia, 1 reoperation due to organoaxial gastric rotation with gastroduodenal obstruction, and one with deep venous thrombosis). No deaths occurred. Followup in all patients is complete, with a mean followup time of 21 months (range, 3-40 months). The complication rate after long-term followup was 8%, and reflux esophagitis symptoms in one patient were completely relieved by medical therapy. CONCLUSIONS: Laparoscopic paraesophageal hernia repair was feasible and safe with low morbidity and mortality rates in this elderly patient group. To achieve good long-term results, standard surgical treatment should include reduction of the stomach, complete excision of the hernia sac, closure of the hiatal defect, floppy Nissen fundoplication, and anterior gastropexy.

[Bacteria of the genus Bacillus in chicken carcasses and hamburgers]. / Bacterias del género Bacillus en canales y hamburguesas de pollo.

The incidence of mesophilic aerobic sporulate bacteria in chicken carcasses and hamburgers was studied and the species of isolated sporulate bacteria were identified. Forty seven eviscerated carcasses from a processing plant of Entre Ríos province (Argentina) were analyzed together with fifty samples of hamburgers from two supermarkets of Santa Fe city. All carcasses resulted in contamination with aerobic mesophilic bacteria in the range from 6 x 10(3) to 1.2 x 10(6) CFU/ml liquid washed, and 94% them with sporulate bacteria, the threshold being under 100 CFU/ml (Figure 1). Hamburgers from both places resulted with aerobic mesophilic bacteria in 100% of the cases, in the range of 1 x 10(5)-3.3 x 10(6) CFU/g for supermarket A and 2.2 x 10(5) to 1.7 x 10(7) CFU/g for supermarket B; the incidence of sporulate bacteria was between 4.3 x 10(2) and 1.2 x 10(4) CFU/g for A, while the range for B was 6.2 x 10(2) and 3.8 x 10(4) CFU/g (Figure 2). Two hundred and fourteen Bacillus Genus strains were isolated and purified from the carcasses and five hundred and ninety five from hamburgers. B. subtilis and B. megaterium were most involved in carcasses; while B. licheniformis, B. subtilis and B. pumilus were in hamburgers from supermarket A and B. subtilis and B. pumilus were found in supermarket B (Table 1). The presence of B. cereus was also found, although in low levels, in all the samples (Table 1). Pollution levels with aerobic mesophilic bacteria are high in both kinds of samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Thiazolide-induced apoptosis in colorectal cancer cells is mediated via the Jun kinase-Bim axis and reveals glutathione-S-transferase P1 as Achilles' heel.

Glutathione-S-transferase of the Pi class (GSTP1) is frequently overexpressed in a variety of solid tumors and has been identified as a potential therapeutic target for cancer therapy. GSTP1 is a phase II detoxification enzyme and conjugates the tripeptide glutathione to endogenous metabolites and xenobiotics, thereby limiting the efficacy of antitumor chemotherapeutic treatments. In addition, GSTP1 regulates cellular stress responses and apoptosis by sequestering and inactivating c-Jun N-terminal kinase (JNK). Thiazolides are a novel class of antibiotics for the treatment of intestinal pathogens with no apparent side effects on the host cells and tissue. Here we show that thiazolides induce a GSTP1-dependent and glutathione-enhanced cell death in colorectal tumor cell lines. Downregulation of GSTP1 reduced the apoptotic activity of thiazolides, whereas overexpression enhanced it. Thiazolide treatment caused strong Jun kinase activation and Jun kinase-dependent apoptosis. As a critical downstream target of Jun kinase we identified the pro-apoptotic Bcl-2 homolog Bim. Thiazolides induced Bim expression and activation in a JNK-dependent manner. Downregulation of Bim in turn significantly blocked thiazolide-induced apoptosis. Whereas low concentrations of thiazolides failed to induce apoptosis directly, they potently sensitized colon cancer cells to TNF-related apoptosis-inducing ligand- and chemotherapeutic drug-induced cell death. Although GSTP1 overexpression generally limits chemotherapy and thus antitumor treatment, our study identifies GSTP1 as Achilles' heel and thiazolides as novel interesting apoptosis sensitizer for the treatment of colorectal tumors.

Colon cancer cells produce immunoregulatory glucocorticoids.

Glucocorticoids (GC) have important anti-inflammatory and pro-apoptotic activities. Initially thought to be exclusively produced by the adrenal glands, there is now increasing evidence for extra-adrenal sources of GCs. We have previously shown that the intestinal epithelium produces immunoregulatory GCs and that intestinal steroidogenesis is regulated by the nuclear receptor liver receptor homolog-1 (LRH-1). As LRH-1 has been implicated in the development of colon cancer, we here investigated whether LRH-1 regulates GC synthesis in colorectal tumors and whether tumor-produced GCs suppress T-cell activation. Colorectal cancer cell lines and primary tumors were found to express steroidogenic enzymes and regulatory factors required for the de novo synthesis of cortisol. Both cell lines and primary tumors constitutively produced readily detectable levels of cortisol, as measured by radioimmunoassay, thin-layer chromatography and bioassay. Whereas overexpression of LRH-1 significantly increased the expression of steroidogenic enzymes and the synthesis of cortisol, downregulation or inhibition of LRH-1 effectively suppressed these processes, indicating an important role of LRH-1 in colorectal tumor GC synthesis. An immunoregulatory role of tumor-derived GCs could be further confirmed by demonstrating a suppression of T-cell activation. This study describes for the first time cortisol synthesis in a non-endocrine tumor in humans, and suggests that the synthesis of bioactive GCs in colon cancer cells may account as a novel mechanism of tumor immune escape.

[Colorectal surgery--an integral part of general surgery!]. / Kolorektale Chirurgie--ein integraler Bestandteil der Allgemeinchirurgie!

The controversy, whether colorectal surgery should be performed by the general surgeon or the specialist colorectal surgeon, is gaining increasing importance in Europe. The short and long term results in colorectal surgery as well as in other subspecialties are largely determined by the annual case load and the surgical training in colorectal surgery. If both conditions are met, colorectal surgery can be just as safely and successfully performed in a district hospital by a general surgeon. The following advantages support the treatment of colorectal lesions by a general surgeon: the capacity to cope with unforeseen intraoperative problems thanks to the broad surgical experience of the general surgeon, the ability and authorisation to perform multivisceral resections and the ability through the daily training in abdominal surgery to perform emergency interventions since about 30% of all colorectal operations are performed in an emergency setting. Against colorectal specialisation can be argued: increased costs through the need of specialised colorectal surgeons, the establishment of independent units for colorectal surgery, impairment of surgical training and sometimes loss of enthusiasm through the daily routine of the highly specialised surgeon. The common colorectal surgery should remain an integral part of general surgery, given the conditions of an sufficient annual case load of at least 30 colorectal resections and of an adequate surgical training in colorectal surgery.

Illi intracranial pressure monitoring and fixation device. A new fixation system for intracranial pressure monitoring in children and adolescents in paediatric neurotraumatology, hydrocephalus and craniofacial surgery.

Fixation and positioning of intracranial pressure (ICP) monitoring devices in small children with very thin skull bones pose serious problems. We present a new ICP fixation device with two movable components compressing the skull bone from in- and outside. This new fixation system, designed by PD Dr. O.E. Illi and licensed by White Spot AG, Surgical Tools and Research, Baar, Switzerland, guarantees far greater stability and reliability than conventional screws or bolts. It is fully compatible with a range of fiberoptic or pneumatic transducer systems. We have applied this new device successfully in 10 patients.

[Interdisciplinary evaluation for liver transplantation: the Bern concept]. / Interdisziplinäre Abklärung zur Lebertransplantation: Das Berner Konzept.

Orthotopic liver transplantation (OLT) is the therapy of choice for a variety of end-stage liver diseases. The 5 year survival rate for electively operated patients with non malignant liver disease is exceeding 70%. Crucial for patient management is the early referral of the patient to a liver transplant center where an interdisciplinary evaluation of the patient is undertaken during a short hospital stay. The diagnosis will be confirmed, the operability assessed, contraindications excluded and the conservative treatment improved. A timely operation is of extreme importance and is based on an estimation of the severity and the dynamics of the liver disease. The liver transplantation should be performed early in a patient with a preserved liver function in order to achieve the best results.

Laparoscopic partial hepatectomy in the rat: a new resectional technique.

BACKGROUND: Rats are widely used for basic research in laparoscopic surgery. We have developed a new technique of laparoscopic partial hepatectomy in the rat. METHODS: 40 American Cancer Institute rats were randomized into 3 groups. Group A (n = 14) underwent laparoscopic liver resection using a CO2 pneumoperitoneum. Group B (n = 14) was operated on with a gasless laparoscopic technique using a lifting device. A control group C (n = 12) underwent conventional open liver resection. In each group half of the animals underwent single lobectomy and the other half bilobectomy. RESULTS: The liver resection was performed successfully in all 40 rats. No conversion to open surgery was necessary. No mortality or morbidity was observed. CONCLUSIONS: This new technique of laparoscopic partial hepatectomy proved to be feasible and safe. It is the first description of a laparoscopic hepatic resection in the rat that could prove valuable in further investigations of liver physiology and pathology.

[Peritonitis in diverticulitis: the Bern concept]. / Peritonitis bei Divertikulitis: Das Berner Konzept.

INTRODUCTION: The colon is the most frequent origine for a diffuse peritonitis and diverticular perforation is again the most common source of a spontaneous secondary peritonitis. This paper first focuses on the treatment of peritonitis and secondly on the strategies of source control in peritonitis with special emphasis on the tactics (primary anastomosis vs. Hartmann procedure with colostomy) for surgical source control. PATIENT AND METHODS: Prospective analysis of 404 patients suffering from peritonitis (11/93-2/98), treated with an uniform treatment concept including early operation, source control and extensive intraoperative lavage (20 to 30 liters) as a standard procedure. Other treatment measures were added in special indications "on demand" only. Peritonitis was graded with the Mannheim Peritonitis Index (MPI). Tactics of source control in peritonitis due to diverticulitis were performed according to "general condition" respectively the MPI of the patient. RESULTS: The 404 patients averaged a MPI of 19 (0-35) in "local" peritonitis and a MPI of 26 (11-43) in "diffuse" peritonitis. The colon as a source of peritonitis resulted in MPI of 16 (0-33) in the case of "local" respectively 27 (11-43) in "diffuse" peritonitis. From 181 patients suffering from diverticulitis 144 needed an operation and in 78 (54%) peritonitis was present. Fourty-six percent (36) of the patients suffered from "local", 54% (42) from "diffuse" peritonitis. Resection with primary anastomosis was performed in 26% (20/78) whereas in 74% (58/78) of the patients a Hartmann procedure with colostomy was performed. The correlating MPI was 16 (0-28) vs. 23 (16-27) respectively. The analysis of complications and mortality based on the MPI showed a decent discrimination potential for primary anastomosis vs Hartmann procedure: morbidity 35% vs. 41%; reoperation 5% vs. 5%; mortality 0% vs. 14%. CONCLUSION: In case of peritonitis due to diverticulitis the treatment of peritonitis comes first. Thanks to advances in intensive care and improved anti-inflammatory care, a more conservative surgical concept nowadays is accepted. In the case of diverticulitis the MPI is helpful to choose between primary anastomosis vs. Hartmann procedure with colostomy as source control. The MPI includes the "general condition" of the patient into the tactical decision how to attain source control.

Experimental study of adhesion formation in open and laparoscopic fundoplication.

BACKGROUND: The extent of adhesion formation following both open and laparoscopic surgery remains unclear. This study aimed to evaluate the extent of postoperative adhesion formation after laparoscopic and open fundoplication in a rat model. METHODS: Fifty-two male Sprague-Dawley rats were randomized into four groups: laparoscopic fundoplication (n = 20), open fundoplication (n = 20), laparoscopy (n = 6) and laparotomy (n = 6). Blood as well as intraperitoneal fluid was sampled for tumour necrosis factor (TNF) alpha measurement by enzyme-linked immunosorbent assay. All the rats were killed 3 weeks after operation, and adhesion formation was evaluated using a standardized scoring system. RESULTS: There were no intergroup differences in body-weight gain after surgery. The overall mortality rate was 19 per cent and death was observed only in the fundoplication groups. Animals that had open fundoplication developed significantly more adhesions than those that underwent laparoscopic fundoplication (34 versus 21). Laparoscopic surgery induced predominantly parietal adhesions, whereas open surgery was more associated with visceral adhesions. The adhesions observed in the laparoscopic groups were significant thinner than those after open surgery and the tenacity of adhesions was decreased in laparoscopic compared with open surgery. The peak plasma level of TNF-alpha was reached during laparoscopic fundoplication, whereas the peak level was observed 3 h after open fundoplication. Intraperitoneal TNF-alpha levels showed no significant differences at 3 h. CONCLUSION: These findings indicate that laparoscopic fundoplication in rats leads to less severe adhesions of a different type (parietal) compared with those seen in the open controls.

Preoperative Nyhus classification of inguinal hernias and type-related individual hernia repair. A case for diagnostic laparoscopy.

The goal of this prospective study was to determine the clinical value (sensitivity and specificity) of preoperative hernia classification (Nyhus classification) using three distinct methods: clinical examination, Doppler ultrasonography, and diagnostic laparoscopy. Thirty patients with 35 suspected groin hernias were included. Definitive hernia classification was achieved by laparoscopic peritoneal incision and dissection of the inguinal floor. Twenty-eight laparoscopic hernia repairs followed. Sensitivity and specificity were calculated for each preoperative evaluation method. Clinical examination was found to be more accurate than Doppler ultrasonography. The highest scores for sensitivity (0.93) and specificity (1.00) were achieved, however, by diagnostic laparoscopy. Therefore, the authors consider diagnostic laparoscopy to be a valuable preoperative tool for assessing hernia type. An accurate preoperative hernia classification will allow an individualized type-related hernia repair (open: anterior, posterior approach, or laparoscopic: transabdominal preperitoneal, total preperitoneal, inner-ring closure, mesh insertion).