Open inguinal hernia repair with self-gripping Parietex ProGrip mesh: a retrospective study of 204 cases.

Chronic pain and recurrence rates are the main challenge in modern inguinal hernia surgery. Several trials have investigated the role of self-adhesive mesh repair for inguinal hernia, with special attention to the incidence of chronic postoperative inguinal pain and recurrence. The purpose of our study was to retrospectively evaluate the early and long-term results using a self-gripping mesh (Parietex Progrip® , Covidien) in our institution. A total of 204 patients, mean age 50.3 standard deviation (SD) 15.3, was included in the study. The repair was performed under local anaesthesia in 159 (78%) cases and locoregional anaesthesia in remaining 45 (22%). Mean operative time was 39 ± 20 minutes. The time for self-gripping mesh placement ranged from 5 to 9 minutes (mean 7 ± 2 minutes). There were no intraoperative complications. Clinical follow-up was performed at 1 month, 1 year and 2 years and consisted in the evaluation of complications, discomfort/pain and recurrence. One case of cutaneous infection and three cases of seroma were observed at one-month follow-up and were all treated conservatively. 8 patients were lost at one year follow-up, and another 4 were lost at 2 years. 3 patients died for other causes during follow-up. At 1 year and 2 years follow-up no cases of seroma, testicular complications or mesh infection were observed. Two cases of recurrence were recorded at 2 years follow up. No patient reported VAS score > 2 at one month, 1 year and 2 years follow-up. There were no readmissions, systemic complications or death during 2 years follow-up. Lichtenstein open repair using Parietex Progrip® mesh is a simple, rapid, effective and safe method for inguinal hernia repair. The main advantage of self-fixing mesh is the reduced operative time. A suturless fixation seems to prevent the development of postoperative chronic pain, without increasing recurrence rate in the majority of the trials.

Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition.

BACKGROUND: Interest in vegetarian diets is growing in Italy and elsewhere, as government agencies and health/nutrition organizations are emphasizing that regular consumption of plant foods may provide health benefits and help prevent certain diseases. METHODS AND RESULTS: We conducted a Pubmed search, up to September, 2015, for studies on key nutrients (proteins, vitamin B12, iron, zinc, calcium, vitamin D, and n-3 fatty acids) in vegetarian diets. From 295 eligible publications the following emerged: Vegetarians should be encouraged to supplement their diets with a reliable source of vitamin B12 (vitamin-fortified foods or supplements). Since the plant protein digestibility is lower than that of animal proteins it may be appropriate for vegetarians to consume more proteins than recommended for the general population. Vegetarians should also be encouraged to habitually consume good sources of calcium, iron and zinc - particularly vegetables that are low in oxalate and phytate (e.g. Brassicaceae), nuts and seeds, and calcium-rich mineral water. Calcium, iron, and zinc bioavailability can be improved by soaking, germination, and sour-dough leavening that lower the phytate content of pulses and cereals. Vegetarians can ensure good n-3 fatty acid status by habitually consuming good sources of a-linolenic acid (walnuts, flaxseeds, chia seeds, and their oils) and limiting linoleic acid intake (corn and sunflower oils). CONCLUSIONS: Well-planned vegetarian diets that include a wide variety of plant foods, and a reliable source of vitamin B12, provide adequate nutrient intake. Government agencies and health/nutrition organizations should provide more educational resources to help Italians consume nutritionally adequate vegetarian diets.

Atividade antifúngica de extratos de Momordica charantia L. sobre Colletotrichum musae / Antifungal activity of Momordica charantia L. extracts against Colletotrichum musae

Os objetivos do presente trabalho foram avaliar os efeitos de extratos de Momordica charantia sobre o crescimento micelial e a germinação de conídios de Colletotrichum musae, e a eficiência destes extratos no controle da antracnose, causada por C. musae, em bananas. Extratos aquoso e hidroetanólico, obtidos de folhas e ramos, na concentração de 50 por cento em relação ao volume adicionado, em meio sólido, proporcionaram 71 e 65 por cento de inibição do crescimento micelial, respectivamente, enquanto que em meio líquido, a inibição do crescimento micelial foi de 86 e 81 por cento, respectivamente. Somente o extrato aquoso e o tiofanato metílico, nas concentrações de 50 por cento e 1000 µg mL-1 respectivamente, proporcionaram 100 por cento de inibição da germinação de esporos de C. musae. Os extratos metanólico e aquoso inibiram em 80 e 70 por cento, respectivamente, o desenvolvimento das lesões em bananas, quando aplicados até dois dias antes da inoculação do fungo. Estes resultados foram semelhantes ao tratamento com tiofanato metílico, que inibiu 80 por cento do desenvolvimento das lesões. Confirma-se a presença de substância antifúngica nos extratos de M. charantia e outros estudos devem ser realizados para viabilizar seu uso no controle da antracnose da banana.

The aims of the present work were to evaluate the effects of Momordica charantia extracts on mycelial growth and conidial germination of Colletotrichum musae, as well as the efficiency of these extracts in controlling anthracnose caused by C. musae in bananas. Water and hydroethanol extracts were obtained from leaves and branches at 50 percent concentration relative to the added volume. In solid medium, extracts led to 71 and 65 percent mycelial growth inhibition, respectively, whereas in liquid medium the mycelial growth was inhibited at 86 and 81 percent, respectively. Only water extract and thiophanate-methyl, at 50 percent and 1000 µg mL-1, respectively, resulted in 100 percent inhibition of C. musae spore germination. Methanol and water extracts inhibited by 80 and 70 percent, respectively, the development of lesions in bananas when applied until two days before fungal inoculation. These results were similar to those of the treatment with thiophanate-methyl, which inhibited 80 percent development of lesions. The presence of antifungal substance was confirmed in M. charantia extracts. Future studies must be performed to make its use viable for the control of anthracnose in bananas.

Antifungal activity of extracts from Brazilian Cerrado plants on Colletotrichum gloeosporioides and Corynespora cassiicola / Atividade antifúngica de extratos de plantas do Cerrado brasileiro sobre Colletotrichum gloeosporioides e Corynespora cassiicola

This study aimed to determine the antifungal activity of leaf aqueous and hydroethanolic extracts of 10 plants from the Brazilian Cerrado on Colletotrichum gloeosporioides and Corynespora cassiicola. Antifungal activity was measured through the incorporation of each extract in a culture media or spore suspension, at 50 percent concentration relative to the volume, determining respectively the mycelial growth and the spore germination. Then, the percentages of mycelial growth inhibition and spore germination inhibition were obtained based on the comparison with the control. The extracts had a variable action on the phytopathogens, from mycelial growth stimulation for Aristolochia esperanzae and Byrsonima verbascifolia extracts to complete inhibition of mycelial growth and spore germination for Myracrodruon urundeuva and Lafoensia pacari extracts. M. urundeuva, L. pacari and Caryocar brasiliense leaf extracts had antifungal activity against Colletotrichum gloeosporioides and Corynespora cassiicola; the hydroethanolic extracts presented more antifungal activity than the aqueous extracts, and spore germination of both phytopathogens was more affected than their mycelial growth.

O objetivo deste trabalho foi determinar a atividade antifúngica de extratos aquosos e extratos hidroetanólicos de folhas de 10 plantas do Cerrado brasileiro sobre Colletotrichum gloeosporioides e Corynespora cassiicola. A determinação da atividade antifúngica foi realizada pela incorporação do extrato em meio de cultura ou na suspensão de esporos, na concentração de 50 por cento em relação ao volume, determinando-se, respectivamente, o crescimento micelial e a germinação de esporos. Em seguida, pela comparação com a testemunha, foram obtidas as percentagens de inibição do crescimento micelial e da germinação dos esporos. Foi constatado comportamento variável dos extratos sobre os fitopatógenos, desde o estímulo no crescimento micelial para os extratos de Aristolochia esperanzae e Byrsonima verbascifolia, até a inibição completa do crescimento micelial e dagerminação dos esporos para os extratos de Myracrodruon urundeuva e Lafoensia pacari. Extratos de folhas de L. pacari, de M. urundeuva e de Caryocar brasiliense apresentaram atividade antifúngica sobre Colletotrichum gloeosporioides e Corynespora cassiicola; os extratos hidroetanólicos proporcionaram mais atividade antifúngica que os extratos aquosos, e a germinação de esporos de ambos os fitopatógenos foi mais afetada que o crescimento micelial.

Generalized eruptive keratoacanthoma (Grzybowski variant).

We describe a patient with generalized eruptive keratoacanthoma (KA) of Grzybowski showing the characteristic features of this extremely rare condition. Since the first description by Grzybowski in 1950, only 28 additional cases (including the present one) have been reported. This variety of KA most commonly affects patients during the fifth to seventh decade of life and appears as a generalized eruption of hundreds to thousands of follicular papules. The small pruriginous papules often have a keratotic centre and show microscopic features of KA. Marked facial involvement is characteristic and can lead to masked facies with ectropion, as in our patient. The course of the disease is chronic and the response to therapy is poor.

Regional hyperthermic perfusion with cisplatin following surgery for malignant melanoma of the extremities.

BACKGROUND: The study was undertaken to review our experience in the treatment of extremity melanoma with hyperthermic isolated limb perfusion (HILP), using cisplatin as the chemotherapeutic agent. We also evaluated the best timing for regional lymph node dissection in relation to the perfusion. PATIENTS AND METHODS: Sixty patients with advanced malignant melanoma of the limbs were treated with HILP used mainly as an adjuvant treatment. There were 56 lower- and 4 upper-limb HILPs. Cisplatin was used at a dose of 20 mg/L of limb volume. Temperature at the tumor site was 39 degrees C to 40 degrees C. Postoperative complications, disease-free period, and time to recurrence were recorded. RESULTS: There were no deaths related to the procedure. Forty-seven percent of the patients developed local complications; most complications were minor and resolved within 60 days. The local complication rate was higher when HILP was performed shortly after or simultaneously with regional lymph node dissection. None of the patients had systemic complications. Mean survival time from treatment was 87.2 months. Currently, 35 patients (58%) are alive and free of disease 52.7 +/- 22.5 months after HILP. Twelve patients (20%) are alive with recurrent disease, of which 5 recurred locally. The average time (+/- standard error of the mean) to recurrence was 24.5 +/- 13.8 months after perfusion. CONCLUSIONS: HILP with cisplatin is a relatively safe procedure, which seems to increase locoregional control of advanced malignant melanoma of the extremity. Separating the timing of lymph node dissection from HILP by 6 to 8 weeks reduces the complication rate.

The effect of anesthesia type on needle localization breast biopsy: another point of view.

BACKGROUND: Efforts directed at early detection of breast cancer have resulted in an increased incidence of nonpalpable mammographic lesions that warrant excisional biopsy. The most common localization method is by use of the hook wire technique, or needle localization biopsy. Although much has been written about the localization technique, the impact of the method of anesthesia on the accuracy of the biopsy and especially on the completeness of the excision has not been clarified. PATIENTS AND METHODS: We studied 450 needle localization breast biopsies to determine whether the type of anesthesia (local versus general) influenced the accuracy and completeness of the biopsy. We compared 153 biopsies performed under local anesthesia to 297 done under general anesthesia. RESULTS: The use of local versus general anesthesia did not affect accuracy; however, it did determine the inability to achieve clean margins (27.6% versus 7.3%, respectively, P <0.02). It was more difficult to excise completely specimens located deeper than 3 cm in the breast, when the localizing needle travelled more than 3 cm, and when the lesions were of the microcalcification mammographic pattern. CONCLUSIONS: For lesions mammographically suspicious for malignancy, mainly those located deeper than 3 cm, general anesthesia is preferred.

Acute effects of nisoldipine, propranolol, and their combination in patients with chronic stable angina: a double-blind, randomized, cross-over, placebo-controlled study.

We studied the short-term effects of oral administration of nisoldipine (10 mg) and propranolol (80 mg) alone and in combination in 14 patients with chronic exertional angina pectoris in a double-blind, randomized, cross-over study. The 14 patients (13 men and 1 woman, mean age 56 +/- 7 years) performed symptoms-limited bicycle exercise stress test 3 h after placebo or active substance administration. Maximal work load, exercise duration, and time to 1-mm ST segment depression were significantly increased and ST depression at peak exercise was significantly decreased by drugs alone and in combination. Propranolol and nisoldipine alone improved exercise duration similarly and as well as the combination; however, a different response to the three pharmacologic interventions was found in patients treated with single drugs. The improvement in exercise tolerance was associated with rate-pressure product values at peak exercise, unchanged after nisoldipine and significantly reduced after both propranolol alone and in combination. After placebo, all patients had exercise-induced angina, in 9, 8, and 4 patients after nisoldipine, propranolol, and the combination of the two drugs, respectively. Nisoldipine is effective in the treatment of effort angina and its combination with propranolol may be useful and superior in patients who show poor response to monotherapy.

[Comparative evaluation using an ergometric test of the efficacy of the 3 major calcium antagonists on exertion stable angina]. / Valutazione comparativa mediante test ergometrico dell'efficacia dei tre maggiori calcio-antagonisti sull'angina stabile da sforzo.

Nifedipine, diltiazem and verapamil are three effective calcium-antagonists in the treatment of angina pectoris. We compared their effects on effort angina to evaluate whether one of them is more efficacious. The data were collected from 42 patients (37 males, 5 females; mean age 51 +/- 4) entering one of 3 different trials; the beginning of all trials comprised a two-week, single blind, placebo run-in phase. An exercise stress test was performed at the end of this period and it was considered as basal test for the statistical analysis. Then the 42 patients were divided in 3 groups of 14 and entered a double-blind, randomized phase of drug treatment. The 3 groups started 3 parallel trials: 1) placebo/nifedipine 60 mg/day; 2) placebo/verapamil 360 mg/day; 3) placebo/diltiazem 240 mg/day. The duration of each trial was of 6 weeks (3 weeks of treatment with placebo and 3 weeks with active substance). Exercise stress tests were performed at the end of each phase of the trials, and the resulting data were compared with the data of the test performed at the end of run-in period. Parameters evaluated were: heart rate, blood pressure and rate pressure product at basal conditions, at submaximal and peak exercise; moreover we considered workload, maximal ST segment depression, total exercise duration and frequency of exercise-induced angina. Verapamil reduced rate pressure product at basal condition; all three drugs reduced rate pressure product at submaximal exercise, but a significant statistical difference was found only for verapamil and diltiazem.(ABSTRACT TRUNCATED AT 250 WORDS)