Repair of small and medium size ventral hernias with a Proceed Ventral Patch: a single center retrospective analysis.

PURPOSE: Ventral hernias are common surgical targets. The Bard(®) Ventralex™ Hernia Patch was introduced for the repair of such hernias in the early 2000s. Ethicon (Johnson & Johnson) introduced the Proceed™ Ventral Patch (PVP™) in the late 2000s for the same indication. The effectiveness and safety of the Bard(®) Ventralex™ Hernia Patch has been proven in a series of studies. There are no medical studies on the PVP™ in humans. This study examines the effectiveness and safety of PVP™ in the closure of ventral hernias. METHOD: A single center retrospective analysis of patients' data was conducted. Fifty-seven patients with small and medium size ventral hernias were treated with patches in the period between May 2009 and December 2010. The charts of these patients were reviewed. Demographic data, diagnosis at surgery, duration of surgery, length of hospital stay, postoperative complications and recurrence were recorded. RESULTS: Fifty-seven patients were analyzed including 21 females and 36 males with a mean age of 56.7 years. The diagnosis at surgery included 36 cases of umbilical hernia, eight cases of epigastric hernia, seven incision hernias and six recurrent umbilical hernias. The mean duration of surgery was 30.7 min, and the mean length of hospital stay was 3.3 days. Four postoperative complications (7.1 %) and one case of hernia recurrence (1.7 %) were recorded. CONCLUSION: Ventral hernia closure with PVP™ is safe and effective. The rates of complication and recurrence are comparable to those of the Bard(®) Ventralex™ Hernia Patch.

Walls are thin 1 (WAT1), an Arabidopsis homolog of Medicago truncatula NODULIN21, is a tonoplast-localized protein required for secondary wall formation in fibers.

By combining Zinnia elegans in vitro tracheary element genomics with reverse genetics in Arabidopsis, we have identified a new upstream component of secondary wall formation in xylary and interfascicular fibers. Walls are thin 1 (WAT1), an Arabidopsis thaliana homolog of Medicago truncatula NODULIN 21 (MtN21), encodes a plant-specific, predicted integral membrane protein, and is a member of the plant drug/metabolite exporter (P-DME) family (transporter classification number: TC 2.A.7.3). Although WAT1 is ubiquitously expressed throughout the plant, its expression is preferentially associated with vascular tissues, including developing xylem vessels and fibers. WAT1:GFP fusion protein analysis demonstrated that WAT1 is localized to the tonoplast. Analysis of wat1 mutants revealed two cell wall-related phenotypes in stems: a defect in cell elongation, resulting in a dwarfed habit and little to no secondary cell walls in fibers. Secondary walls of vessel elements were unaffected by the mutation. The secondary wall phenotype was supported by comparative transcriptomic and metabolomic analyses of wat1 and wild-type stems, as many transcripts and metabolites involved in secondary wall formation were reduced in abundance. Unexpectedly, these experiments also revealed a modification in tryptophan (Trp) and auxin metabolism that might contribute to the wat1 phenotype. Together, our data demonstrate an essential role for the WAT1 tonoplast protein in the control of secondary cell wall formation in fibers.

Is laparoscopic cholecystectomy more challenging in male patients?

BACKGROUND: Laparoscopic cholecystectomy (LC) seems to be more challenging in males than in females. The surgery seems to be longer in male patients. There also seems to be an increased rate of conversion to open surgery in male patients. We sought to objectively verify this widespread belief. METHODS: We performed a retrospective analysis of laparoscopic cholecystectomies performed between January 2004 and November 2009 in our hospital. Within this period 1844 cholecystectomies were performed in our community-based hospital. After a strict inclusion procedure, 1571 cases of LC for symptomatic gallbladder disease were analyzed (501 males, 1071 females). The time for surgery, defined as the interval from placement of the Veress needle to wound closure in minutes, and the rate of conversion to open surgery were the main parameters considered. RESULTS: The time for surgery in male patients was significantly longer compared to that for females (p<0.0001). The male cohort was significantly older than the female cohort at the time of surgery (p<0.001). The rate of conversion to open surgery was significantly higher in male patients (5.6%) compared to 2.9% for females (p<0.0001). CONCLUSION: Based on our analysis, LC had a significantly longer duration of surgery in the male cohort. The rate of conversion to open surgery was also significantly higher in male cohort. Thus, LC could be more challenging in male patients.

Primary sarcoma of the pancreas, a rare histopathological entity. A case report with review of literature.

AIMS: primary pancreatic sarcomas represent an extremely rare histopathological entity accounting for less than 0.1% of all pancreatic malignancies. Pancreatic sarcomas tend to be more aggressive and have a poor prognosis. METHODS: the case of a 52 year old patient presenting with jaundice is presented and the available literature was reviewed. RESULTS: primary pancreatic sarcomas are extremely rare. Pancreatic sarcomas are more aggressive than other pancreatic neoplasms. CONCLUSION: primary sarcomas of the pancreas are extremely rare, are aggressive and are associated with very poor prognosis.

High resolution imaging of the equine cornea using the DUB®-SkinScanner v3.9. / Hochauflösende Darstellung der Hornhaut des Pferdes mit dem DUB®-SkinScanner v3.9.

OBJECTIVE: The aim was to describe the use of the DUB®-SkinScanner v3.9 (taberna pro medicum GmbH, Lueneburg, Germany) for the examination of the equine cornea. MATERIAL AND METHODS: Using the DUB®-SkinScanner v3.9 various pathological corneal conditions were pictured in the A- and B-mode at a frequency of 22 and/or 50 MHz in nine eyes of eight horses. Scans were obtained from standing horses or from horses under general anesthesia non-related to image acquisition. RESULTS: The examination allowed real time imaging and measurement of the equine cornea in vivo. Compared to slit-lamp biomicroscopy additional information was obtained in seven of nine eyes regarding the corneal thickness, in four of nine eyes regarding the epithelium, in five of nine eyes regarding the stroma and in five of nine eyes regarding the endothelium. CONCLUSION AND CLINICAL RELEVANCE: The DUB®-SkinScanner v3.9 is a valuable high-resolution imaging tool for the evaluation of the equine cornea under practice conditions. The image acquisition does not depend on corneal transparency and provides additional diagnostic information to the standard slit-lamp biomicroscopy.

Is the male gender an independent risk factor for complication in patients undergoing laparoscopic cholecystectomy for acute cholecystitis?

This paper was designed to investigate the gender dependent risk of complication in patients undergoing laparoscopic cholecystectomy for acute cholecystitis. Laparoscopic cholecystectomy is the standard procedure for benign gallbladder disorders. The role of gender as an independent risk factor for complicated laparoscopic cholecystectomy remains unclear. A retrospective single-center analysis of laparoscopic cholecystectomies performed for acute cholecystitis over a 5-year period in a community hospital was performed. Within the period of examination, 1884 laparoscopic cholecystectomies were performed. The diagnosis was acute cholecystitis in 779 cases (462 female, 317 male). The male group was significantly older (P = 0.001). Surgery lasted significantly longer in the male group (P = 0.008). Conversion was done in 35 cases (4.5%). There was no significant difference in the rate of conversion between both groups. However the rate of conversion was significantly higher in male patients > 65 years (P = 0.006). The length of postoperative hospital stay was significantly longer in the male group (P = 0.007), in the group > 65 years (P = 0.001) and following conversion to open surgery (P = 0.001). The male gender was identified as an independent risk factor for prolonged laparoscopic cholecystectomy on multivariate analysis. The male gender could be an independent risk factor for complicated or challenging surgery in patients undergoing laparoscopic cholecystectomy for acute cholecystitis.

Esophageal motility and reflux symptoms before and after bariatric surgery.

BACKGROUND: Surgical treatment is the most effective method for weight reduction in morbid obesity. The most common operations are gastric banding and gastric bypass. The effect of these interventions on esophageal function and gastroesophageal reflux symptoms has not been adequately investigated. METHODS: Patients undergoing obesity surgery were prospectively included in an observational study. Before surgery, each of the 53 patients underwent pulmonary function tests, esophageal manometry, and gastroscopy. Drug medication and esophageal symptoms were recorded. "Non-sweet eater" patients with good compliance underwent laparoscopic adjustable gastric banding (LAGB). In "sweet-eating" or non-compliant patients, gastric bypass (GBP) was carried out. RESULTS: Between July 1997 and April 2000, 53 patients (9 males and 44 females) were consecutively operated on. 32 patients (median BMI 46.4 kg/m2 +/- 5.4 SD) received LAGB, and 21 patients (BMI 54.0 kg/m2 +/- 10.7) GBP. Median follow-up was 22 months, and only 3 patients were lost to yearly follow-up. Preoperatively, 6 LAGB patients had reflux symptoms, which postoperatively resolved in 3 of them, while the other 3 noted no change. Three patients who had no preoperative reflux symptoms developed them after LAGB. In the GBP group, no patient had esophageal dysmotility or incompetent esophageal sphincter function pre- or postoperatively. The incidence of postoperative esophageal symptoms was independent of operative technique (Wilcoxon U-Test: p = 0.75). CONCLUSION: The present results do not show any effect of gastric reduction surgery on postoperative esophageal function or gastroesophageal reflux symptoms.

Micromechanics of plant tissues beyond the linear-elastic range.

We investigated the relation between cell wall structure and the resulting mechanical characteristics of different plant tissues. Special attention was paid to the mechanical behaviour beyond the linear-elastic range, the underlying micromechanical processes and the fracture characteristics. The previously proposed model of reorientation and slippage of the cellulose microfibrils in the cell wall [H.-CH. Spatz et al. (1999) J Exp Biol 202:3269-3272) was supported and is here refined, using measurements of the changes in microfibrillar angle during straining. Our model explains the widespread phenomenon of stress-strain curves with two linear portions of different slope and sheds light on the micromechanical processes involved in viscoelasticity and plastic yield. We also analysed the velocity dependence of viscoelasticity under the perspective of the Kelvin model, resolving the measured viscoelasticity into functions of a velocity-dependent and a velocity-independent friction. The influence of lignin on the above-mentioned mechanical properties was examined by chemical lignin extraction from tissues of Aristolochia macrophylla Lam. and by the use of transgenic plants of Arabidopsis thaliana (L.) Heynh. with reduced lignin content. Additionally, the influence of extraction of hemicelluloses on the mechanical properties was investigated as well as a cell wall mutant of Arabidopsis with an altered configuration of the cellulose microfibrils.