The effect of complexation with cyclodextrins on the antioxidant and antimicrobial activity of ellagic acid.

PURPOSE: The aim of the paper was to develop the simple procedures for preparation of inclusion complexes of ellagic acid (EA) with cyclodextrins (CDs) and to investigate their antioxidant and antimicrobial activity. METHODS: The structural characterization was carried out using Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and nuclear magnetic resonance (NMR) methods. The phase solubility technique was used to investigate the interactions between 'host' and 'guest' molecules and to estimate the molar ratio between them. The antioxidant and antimicrobial activity of EA and inclusion complexes were determined. RESULTS: The apparent stability constants were found to be 117 dm3 mol-1 for the complex with ß-CD and 161 dm3 mol-1 for the complex with (2-hydroxypropyl)-ß-cyclodextrin (HP-ß-CD). The results of phase-solubility studies showed that EA formed the inclusion complexes with CDs in the molar ratio of 1:1. The calculated half-maximal inhibitory concentration was 41.18 µg cm-3 for butyl hydroxy toluene, 1.96 µg cm-3 for EA, 0.88 µg cm-3 for inclusion complex with HP-ß-CD, and 1.27 µg cm-3 for inclusion complex with ß-CD. CONCLUSION: The stability constants indicated the rapid release of EA from the inclusion complexes in the aqueous medium at 25 °C. The antioxidant activity of EA was increased, while the antimicrobial activity was preserved after complexation with CDs.

Intraperitoneal onlay mesh reinforcement of the abdominal wall: a new surgical option for treatment of anterior cutaneous nerve entrapment syndrome-a retrospective cohort analysis of 30 consecutive patients.

BACKGROUND: The aim of the study was to introduce a new surgical treatment for anterior cutaneous nerve entrapment syndrome, a frequently unrecognised disorder in the general population responsible for chronic abdominal wall pain with limited treatment options to date. We hypothesised that intraperitoneal onlay mesh reinforcement could dissipate excessive increases in intra-abdominal pressure and prevent entrapment of the neurovascular bundle. METHODS: Retrospective cohort analysis was performed between September 2002 and March 2014. All consecutive patients diagnosed with anterior cutaneous nerve entrapment syndrome refractory to conservative treatment (n = 30) underwent laparoscopic intraperitoneal onlay mesh reinforcement of the painful area in the abdominal wall. Planned follow-up took place at 2, 6 and 12 weeks after surgery and at time of analysis (March 2015). Primary outcome was patients' satisfaction after treatment at short and long term (last follow-up) using a verbal rating score as measurement (1 = I am very satisfied; I never experience pain, 2 = I am satisfied; I occasionally experience some pain, 3 = I have improved but experience pain on a regular basis, 4 = I have had no result on this treatment, 5 = my pain is worse after treatment). Scores 1 and 2 were classified as success, and scores 4 and 5 as failure of the treatment. RESULTS: Thirty patients underwent laparoscopic intraperitoneal onlay mesh reinforcement. None were lost to follow-up (mean 54 ± 44 months, range 12-122, median 38). Short- and long-term success rates were 90 and 71 %, respectfully. CONCLUSIONS: Intraperitoneal onlay mesh reinforcement of the abdominal wall seems to be a promising option for the treatment of intractable anterior cutaneous nerve entrapment syndrome.

Laparoscopic repair of primary and incisional ventral hernias: the differences must be acknowledged: a prospective cohort analysis of 1,088 consecutive patients.

BACKGROUND: Interpretation of the outcome after laparoscopic repair (LR) of ventral hernias presented in the literature often is based on pooled data of primary ventral hernias (PVH) and incisional ventral hernias (IVH). This prospective cohort study was performed to investigate whether this pooling of data is justified. METHODS: The data of 1,088 consecutive patients who underwent LR of PVH or IVH were prospectively collected and reviewed for baseline characteristics, operative findings, and postoperative complications classified as Clavien grade 3 or higher. RESULTS: The PVH group consisted of 662 patients, and the IVH group comprised 426 patients. The mean Association of American Anesthesiologists classification was higher in IVH group (1.92 vs 1.68; P ≤ 0.001), as was rate of conversion to open surgery (7 vs 0.5 %; P < 0.001). The IVH group required more adhesiolysis (76 vs 0.9 %; P < 0.001), a longer procedure (73 vs 42 min; P < 0.001), and a longer hospital stay (4.53 vs 2.43 days; P < 0.001). The recurrence rate was higher in the IVH group (5.81 vs 1.37 %; P < 0.001), as was total complication rate (18.69 vs 4.55 %; P < 0.001). CONCLUSIONS: This study showed significant differences in baseline characteristics and operative findings between patients undergoing PVH repair and those undergoing IVH repair. Continued pooling of data on LR of IVH and PVH combined, commonly found in the current literature, seems incorrect.

The radiologic appearance of prosthetic materials used in hernia repair and a recommended classification.

OBJECTIVE: This article analyzes radiopaque properties of meshes currently used in hernia surgery. A search was conducted using PubMed and a combination of the terms "hernia repair," "mesh," "laparoscopy," "CT," "MRI," "radiopaque," and "high-resolution techniques." CONCLUSION: The visibility of meshes varies from not visible at all (e.g., Ultrapro), to hardly discernible (Prolene), to readily seen (Composix), and finally to the always visible (Dualmesh). Radiopaque properties of meshes have been insufficiently recognized by both the manufacturers and clinicians.

Impact of the number of tacks on postoperative pain in laparoscopic repair of ventral hernias: do more tacks cause more pain?

BACKGROUND: The main source of postoperative pain after laparoscopic repair of ventral hernia is thought to be fixation of implanted mesh. This study aimed to analyze whether a relation exists between the number of tacks used for fixation and postoperative pain. METHODS: To reduce the number of prognostic variables, only patients with primary umbilical hernia who underwent laparoscopic repair with double-crown mesh fixation were enrolled in this study. Two groups differing only in the manner of tacking were compared. Group 1 (n = 40), collected from previous studies, showed no specific efforts to minimize the number of tacks. Group 2 was a cohort of 40 new patients who underwent double-crown fixation using the minimal number of tacks considered to provide adequate mesh fixation. To eliminate systematic and random errors, the study analyzed only for postoperative pain. The severity of the patients' pain was assessed preoperatively and then 2, 6, and 12 weeks postoperatively using a visual analog scale (VAS) ranging from 0 to 100. RESULTS: The mean number of tacks used differed significantly between the two groups: group 1 (45.4 ± 9.6) vs group 2 (20.4 ± 1.4) (p = 0.001). Postoperative pain differed significantly only at the 3-month postoperative assessment: group 1 VAS (5.78) vs group 2 VAS (1.80) (p = 0.002). CONCLUSIONS: Although postoperative pain differed significantly at the 3-month follow-up assessment, both VAS scores were so low that from a clinical point of view, this difference seems irrelevant. Fewer tacks do not create less pain, nor do more tacks create more pain. This absence of a correlation between the number of tacks used and postoperative pain may indicate that pain after laparoscopic repair of at least small ventral hernias possibly is generated according to some "threshold" principle rather than according to a cumulative effect created by more points of fixation.

Pregnancy following laparoscopic mesh repair of ventral abdominal wall hernia.

BACKGROUND: There are no data on laparoscopic repair of ventral and incisional hernias (LRVIH) in fertile women who intend to have further pregnancies. A unique series is described of 8 women who got pregnant and gave birth after LRVIH. METHODS: Medical records of 875 consecutive patients who underwent LRVIH were reviewed. Women who gave birth after LRVIH were identified. At follow-up, patients answered a questionnaire on pain, discomfort, recurrence, and problems during pregnancy and delivery and underwent a physical examination. RESULTS: Eight patients were identified; all agreed to inclusion. Four women received LRVIH for incisional hernia; 4 were operated on for primary ventral hernia. Median age at LRVIH was 29 years (range, 24 to 34). No postoperative complications occurred. Median time between LRVIH and delivery was 22.5 months (range, 12 to 44). Median follow-up after delivery was 23.5 months (range, 2 to 40). Five patients experienced a tearing pain in the area of hernia repair during the last months of pregnancy. This pain was not continually present and disappeared after delivery in all patients. All infants were born healthy at full term. Seven patients had a vaginal birth and one had a caesarean delivery. There were no major complications during pregnancy or delivery. At control examination, all patients were asymptomatic and, with one exception, without signs of recurrence. One patient had a swelling in the repaired area indicating either recurrence or mesh bulging. Being asymptomatic, she refused any further diagnostics. CONCLUSION: LRVIH in fertile women who intend to have further pregnancies is an acceptable therapeutical option that causes no significant problems during pregnancy or delivery.

Chronic Polyhydramnios: A Medical Entity Which Could Be a Model of Muscle Development in Decreased Mechanical Loading Condition.

Polyhydramnios is a condition related to an excessive accumulation of amniotic fluid in the third trimester of pregnancy and it can be acute and chronic depending on the duration. Published data suggest that during muscle development, in the stage of late histochemical differentiation decreased mechanical loading cause decreased expression of myosin heavy chain (MHC) type 1 leading to slow-to-fast transition. In the case of chronic polyhydramnios, histochemical muscle differentiation could be affected as a consequence of permanent decreased physical loading. Most affected would be muscles which are the most active i.e., spine extensor muscles and muscles of legs. Long-lasting decreased mechanical loading on muscle should cause decreased expression of MHC type 1 leading to slow-to-fast transition, decreased number of muscle fiber type I especially in extensor muscles of spine and legs. Additionally, because MHC type 1 is present in all skeletal muscles it could lead to various degrees of hypotrophy depending on constituting a percentage of MHC type 1 in affected muscles. These changes in the case of preexisting muscle disorders have the potential to deteriorate the muscle condition additionally. Given these facts, idiopathic chronic polyhydramnios is a rare opportunity to study the influence of reduced physical loading on muscle development in the human fetus. Also, it could be a medical entity to examine the influence of micro- and hypogravity conditions on the development of the fetal muscular system during the last trimester of gestation.

Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques.

BACKGROUND: Persistent, activity-limiting pain after laparoscopic ventral or incisional hernia repair (LVIHR) appears to be related to fixation of the implanted mesh. A randomized study comparing commonly used fixation techniques with respect to postoperative pain and quality of life has not previously been reported. METHODS: A total of 199 patients undergoing non-urgent LVIHR in our unit between August 2005 and July 2008 were randomly assigned to one of three mesh-fixation groups: absorbable sutures (AS) with tacks; double crown (DC), which involved two circles of tacks and no sutures; and nonabsorbable sutures (NS) with tacks. All operations were performed by one of two experienced surgeons, who used a standardized technique and the same type of mesh and mesh-fixation materials. The severity of the patients' pain was assessed preoperatively and at 2 weeks, 6 weeks and 3 months postoperatively by using a visual analogue scale (VAS). Quality of life (QoL) was evaluated by administering a standard health survey before and 3 months after surgery. Results in the three groups were compared. RESULTS: The AS, DC, and NS mesh-fixation groups had similar patient demographic, hernia and operative characteristics. There were no significant differences among the groups in VAS scores at any assessment time or in the change in VAS score from preoperative to postoperative evaluations. The QoL survey data showed a significant difference among groups for only two of the eight health areas analyzed. CONCLUSION: In this trial, the three mesh-fixation methods were associated with similar postoperative pain and QoL findings. These results suggest that none of the techniques can be considered to have a pain-reduction advantage over the others. Development of new methods for securing the mesh may be required to decrease the rate or severity of pain after LVIHR.

Bulging of the mesh after laparoscopic repair of ventral and incisional hernias.

BACKGROUND AND OBJECTIVES: To investigate the prevalence, diagnosis, clinical significance, and treatment strategies for bulging in the area of laparoscopic repair of ventral hernia that is caused by mesh protrusion through the hernia opening, but with intact peripheral fixation of the mesh and actually a still sufficient repair. METHODS: Medical records of all 765 patients who underwent laparoscopic ventral hernia repair were reviewed, and all patients with a swelling in the repaired area were identified and analyzed. RESULTS: Twenty-nine patients were identified. They all underwent a computed tomography assessment. Seventeen patients (2.2% of the total group) had a hernia recurrence; in an additional 12 patients (1.6%), radiologic examinations indicated only bulging of the mesh but no recurrence. Bulging was associated with pain in 4 patients who underwent relaparoscopy and got a new, larger mesh tightly stretched over the entire previous repair. Eight asymptomatic patients decided on "watchful waiting." All patients remained symptom free during a median follow-up of 22 months. CONCLUSION: Symptomatic bulging, though not a recurrence, requires a new repair and must be considered as an important negative outcome of laparoscopic ventral hernia repair. In asymptomatic patients, "watchful waiting" seems justified.

Recurrences after laparoscopic repair of ventral and incisional hernia: lessons learned from 505 repairs.

BACKGROUND: All hernia recurrences in a series of 505 patients who underwent laparoscopic repair of a ventral hernia (n=291) or incisional hernia (n=214) were analyzed to identify factors responsible for the recurrence. METHODS: In all laparoscopic repairs, an expanded polytetrafluoroethylene prosthesis overlapping the hernia margins by >or=3 cm was fixed with a double ring of tacks alone (n=206) or with tacks as well as sutures (n=299). During the mean follow-up time of 31.3 +/- 18.4 months, nine patients (1.8%) had a recurrence, eight of which were repaired laparoscopically. Operative reports and videotapes of all initial repairs and repairs of recurrences were analyzed. RESULTS: All recurrences followed an incisional hernia repair (p<0.001). Five recurrences developed after mesh fixation with both tacks and sutures and four after mesh fixation with tacks alone (p=1.0). All recurrences were at the site of the apparently sufficient original incision scar: in eight patients, the recurrent hernia was attached to the mesh; in one, it developed in another part of the scar. All initial repairs had been performed without technical errors. Upon repair of the recurrences, a new, larger mesh was placed over the entire incision, not just the hernia. There were no re-recurrences during follow-up (mean 19.8+/-10.3 months). CONCLUSIONS: Recurrence after incisional hernia repair appears to be due primarily to disregard for the principle that the whole incision--not just the hernia--must be repaired. Our experience supports the idea that the entire incision has a potential for hernia development. Insufficient coverage of the incision scar is a risk factor for recurrence after laparoscopic repair of ventral and incisional hernia.

Computed tomographic measurements of mesh shrinkage after laparoscopic ventral incisional hernia repair with an expanded polytetrafluoroethylene mesh.

BACKGROUND: The potential for shrinkage of intraperitoneally implanted meshes for laparoscopic repair of ventral and incisional hernia (LRVIH) remains a concern. Numerous experimental studies on this issue reported very inconsistent results. Expanded polytetrafluoroethylene (ePTFE) mesh has the unique property of being revealed by computed tomography (CT). We therefore conducted an analysis of CT findings in patients who had previously undergone LRVIH with an ePTFE mesh (DualMesh, WL Gore, Flagstaff, AZ, USA) in order to evaluate the shrinkage of implanted meshes. PATIENTS AND METHODS: Of 656 LRVIH patients with DualMesh, all patients who subsequently underwent CT scanning were identified and only those with precisely known transverse diameter of implanted mesh and with CT scans made more than 3 months postoperatively were selected (n = 40). Two radiologists who were blinded to the size of the implanted mesh measured in consensus the maximal transverse diameter of the meshes by using the AquariusNET program (TeraRecon Inc., San Mateo, CA, USA). Mesh shrinkage was defined as the relative loss of transverse diameter as compared with the original transverse diameter of the mesh. RESULTS: The mean time from LRVIH to CT scan was 17.9 months (range 3-59 months). The mean shrinkage of the mesh was 7.5% (range 0-23.7%). For 11 patients (28%) there was no shrinkage at all. Shrinkage of 1-10% was found in 16 patients (40%), of 10-20% in 10 patients (25%), and of 20-24% in 3 patients (7.5%). No correlation was found regarding the elapsed time between LRVIH and CT, and shrinkage. There were two recurrences, one possibly related to shrinkage. CONCLUSION: Our observations indicate that shrinkage of DualMesh is remarkably lower than has been reported in experimental studies (8-51%). This study is the first to address the problem of shrinkage after intraperitoneal implantation of synthetic mesh in a clinical material.

Preparation, characterization and antimicrobial activity of inclusion complex of biochanin A with (2-hydroxypropyl)-ß-cyclodextrin.

OBJECTIVES: An inclusion complex of biochanin A (BCA) with (2-hydroxypropyl)-ß-cyclodextrin (HP-ß-CD) was prepared in the ethanol solution to improve its water solubility. METHODS: Using the FTIR, 1 H-NMR, XRD, DSC and SEM methods, the structural characterization of the prepared complex was analysed. KEY FINDINGS: The phase-solubility study has shown that the solubility of BCA was increased twofold in 42% (v/v) ethanol solution after complexation with HP-ß-CD. The complex between BCA and HP-ß-CD was prepared in the molar ratio of 1 : 1. The antibacterial activity of the inclusion complex was investigated against the various bacteria, fungus and yeast using the microdilution method. The minimal inhibitory concentration values for the analysed strain of bacteria were in the range of 0.84-1.69 mg/cm3 , whereby the prepared inclusion complex exhibited less effect on the reduction of the number of Escherichia coli and Klebsiella pneumoniae species compared to pure BCA. The inclusion complex of BCA was significantly more active against Candida albicans than pure BCA. Biochanin A and its inclusion complex has not expressed the activity against Aspergillus niger. CONCLUSIONS: Based on the obtained results, it can be concluded that the antimicrobial activity of BCA was remained unchanged after complexation.

Removal of transabdominal sutures for chronic pain after laparoscopic ventral and incisional hernia repair.

Some patients who have undergone laparoscopic repair of ventral and incisional hernia have persistent postoperative pain, assumed to be caused by the presence of transabdominal sutures (TAS). We investigated whether removal of these sutures relieves discomfort. Of 375 patients who underwent laparoscopic repair of ventral and incisional hernia, 6 patients (1.6%) had persistent pain resistant to conservative therapy. These patients underwent relaparoscopy and removal of TAS at all apparent pain sites. Postoperatively, 3 patients had complete pain relief. Two patients had some improvement but moderate, less localized, pain remained. The sixth patient experienced no change at all. Removal of TAS deemed responsible for pain may occasionally provide relief, but the results of removal seem unpredictable and less effective than previously assumed.

Postoperative Pain After Laparoscopic Repair of Primary Umbilical Hernia: Titanium Tacks Versus Absorbable Tacks: A Prospective Comparative Cohort Analysis of 80 Patients With a Long-term Follow-up.

We investigated if a novel fixation device with absorbable tacks (Securestrap) causes less early and chronic postoperative pain after laparoscopic repair with a double-crown mesh fixation of ventral abdominal wall hernia when compared with the standard fixation device with nonabsorbable titanium tacks (Protack). The primary outcome measure was early postoperative pain at 2, 6, and 12 weeks postoperatively. The secondary outcome measure was chronic postoperative pain measured ≥18 months after surgery. Pain levels were assessed using a visual analog scale ranging from 0 (no pain) to 100 mm (excruciating pain). Early postoperative pain was significantly lower in group 2 (absorbable tacks) at 6 (2 vs. 5; P=0.008) and 12 weeks (1 vs. 2; P=0.008) but not at follow-up (6 vs. 11; P=0.21). Given the very low visual analog scale scores in both groups, the clinical significance of these finding remains open to discussion.

[Complications of laparoscopic correction of abdominal wall and incisional hernias]. / Complicaties na laparoscopische correctie van buikwand- en littekenbreuken.

AIM: To give an overview of all negative outcomes of laparoscopic ventral hernia repair. DESIGN: Retrospective cohort study METHODS: Data from all consecutive patients who underwent laparoscopic ventral or incisional hernia repair from January 2000 - May 2010 were summarized in a database. All operative and postoperative complications requiring invasive surgical or radiological intervention were analysed. RESULTS: A total of 803 patients underwent laparoscopy for hernia repair. Conversion to an open operation (n=24; 3%) was needed in 15 cases due to severe adhesions and in 9 due to enterotomy. Laparoscopic repair was completed in 779 patients (97%). Mean follow-up was 35.6 months (SD: 20.3). There were 17 recurrences (2.2%). Other adverse events were: enterotomies (n = 14; 1.8%: 9 recognized intraoperatively and 5 presented postoperatively); postoperative death due to myocardial infarction (n = 1); death due to mesenteric ischemia (n = 1); intra-abdominal bleeding (n = 3); postoperative ileus (n = 2); ileus long after laparoscopy (n = 2); chronic pain (n = 12; 1.6%); trocar-site hernia (n = 7); late mesh infection (n = 5); symptomatic mesh bulging (n = 4); chronic seroma (n = 1). CONCLUSION: Laparoscopic correction is an effective method of treating hernias of the abdominal wall and recurrence is low. A total of 8.9% of patients had complications requiring re-intervention. Of these only a quarter were recurrences. On its own, the percentage of recurrences is therefore an inadequate indicator of the outcomes of this operation.

Tamponade of presacral hemorrhage with hemostatic sponges fixed to the sacrum with endoscopic helical tackers: report of two cases.

Presacral venous hemorrhage is a severe complication in low rectal surgery. This complication was encountered in 5 of 165 patients (3 percent) who underwent a presacral dissection for rectal mobilization. Conventional hemostatic measures often are ineffective to arrest this hemorrhage, and a number of alternative hemostatic techniques have been proposed. We report the successful tamponade of presacral hemorrhage with absorbable hemostatic sponges fixed to the sacrum with endoscopic helical tackers.

A comparison of the results of transhiatal versus transthoracic resection for squamous cell carcinoma of the esophagus

A escolha da terapeutica cirurgica para o carcinoma do esofago e controversa. Foram revistos os resultados de 169 pacientes consecutivamente submetidos a esofagectomia por cancer epidermoide, por via transtoracica ou transhiatal, em periodo de 11 anos. A mortalidade geral foi de 17,8 por cento significativamente maior nos enfermos submetidos a esofagectomia por via toracica. Foi obtido indice de sobrevida de 5 anos de 9,1 por cento. As diferencas entre incidencia de complicacoes pulmonares, fistula de anastomose e taxa de sobrevida nao foram significantes. O indice de fistula anastomotica foi significativamente maior quando usado o estomago, para substituicao esofagica, em relacao ao colon, sem influencia sobre a mortalidade. Os resultados analisados comparativamente recomendam que a escolha da tecnica fique particularmente ligada a cada caso.