Changing the innate consensus about mesh fixation in trans-abdominal preperitoneal laparoscopic inguinal hernioplasty in adults: Short and long term outcome. Randomized controlled clinical trial.

INTRODUCTION: Inguinal hernioplasty is the standard treatment for inguinal hernia in adults. Mesh fixation was used to keep mesh in place for which various mesh fixation techniques have been used in laparoscopic inguinal hernia repair in adults, but their effectiveness has remained inconclusive. AIM OF THE WORK: to evaluate non fixation method of mesh laparoscopic inguinal hernioplasty as safe and effective as regard short and long term outcomes. PATIENTS AND METHODS: Over the period from July 2013 to July 2018, 798 patients with oblique inguinal hernias undergoing Trans abdominal preperitoneal technique (TAPP) were randomized into 3 groups: Group A; mesh non fixation 266 patients. Group B; tacker mesh fixation 266 patients Group C: Cyanoacrylic tissue glues (Histoacryl) mesh fixation 266 patients. Clinical effects were assessed by the following variables: intraoperative data, postoperative outcome as regard recurrence rate, postoperative pain [on visual analogue score (VAS)], analgesic consumption, operation time, hospital stay, and patient costs. Follow up was 18 months. RESULTS: There was no statistical difference between groups (A) and Group (C) regarding operative time, postoperative complications, and length of hospital stay and risk of chronic groin pain, postoperative pain score. In Group (B): the postoperative pain and complications were higher. There were 5 cases of hernia recurrence in all groups, but no significant differences among the three groups. CONCLUSION: Tacker Mesh fixation increased the risk of chronic groin pain. Pain score was higher with tacker mesh fixation. Laparoscopic TAPP inguinal hernia repair without tacker mesh fixation was safe and feasible with no significant increase in recurrence rates. Furthermore, mesh fixation with tacker procedure increased the risk of postoperative complications and patient costs. All ethical approval was given by our Faculty of Medicine medical ethical committee.

Characteristics of a Diverse Cohort of Stroke Patients with SARS-CoV-2 and Outcome by Sex.

BACKGROUND AND PURPOSE: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with stroke. The role of sex on stroke outcome has not been investigated. To objective of this paper is to describe the characteristics of a diverse cohort of acute stroke patients with COVID-19 disease and determine the role of sex on outcome. METHODS: This is a retrospective study of patients with acute stroke and SARS-CoV-2 infection admitted between March 15 to May 15, 2020 to one of the six participating comprehensive stroke centers. Baseline characteristics, stroke subtype, workup, treatment and outcome are presented as total number and percentage or median and interquartile range. Outcome at discharge was determined by the modified Rankin Scale Score (mRS). Variables and outcomes were compared for males and females using univariate and multivariate analysis. RESULTS: The study included 83 patients, 47% of which were Black, 28% Hispanics/Latinos, and 16% whites. Median age was 64 years. Approximately 89% had at least one preexisting vascular risk factor (VRF). The most common complications were respiratory failure (59%) and septic shock (34%). Compared with females, a higher proportion of males experienced severe SARS-CoV-2 symptoms requiring ICU hospitalization (73% vs. 49%; p = 0.04). When divided by stroke subtype, there were 77% ischemic, 19% intracerebral hemorrhage and 3% subarachnoid hemorrhage. The most common ischemic stroke etiologies were cryptogenic (39%) and cardioembolic (27%). Compared with females, males had higher mortality (38% vs. 13%; p = 0.02) and were less likely to be discharged home (12% vs. 33%; p = 0.04). After adjustment for age, race/ethnicity, and number of VRFs, mRS was higher in males than in females (OR = 1.47, 95% CI = 1.03-2.09). CONCLUSION: In this cohort of SARS-CoV-2 stroke patients, most had clinical evidence of coronavirus infection on admission and preexisting VRFs. Severe in-hospital complications and worse outcomes after ischemic strokes were higher in males, than females.

[On the effectiveness of the postsurgical mono- or combination therapy after cataract operations]. / Zur Wirksamkeit der postoperativen Mono- bzw. Kombinationstherapie nach Kataraktoperation.

BACKGROUND: In postoperative inflammatory diseases of the anterior segment of the eye the cause of the inflammation on the one hand and symptoms on the other hand have to be treated. Exactly this target can be reached by a combination of the active ingredients dexamethasone and gentamicin. In the present study we compared a fixed combination therapy with the consecutive application of the same substances. PATIENTS AND METHODS: We examined the effectiveness and handling of a fixed combination in a prospective, single-masked, randomised, comparing, controlled parallel group design study in comparison with a separate application of dexamethason and gentamicin sulfate in cataract patients. The main target criteria was the postoperative inflammation measured by of the laser-flare meter and clinical parameters. In addition different investigations were accomplished for the estimation of the compliance and the subjective tolerability. RESULTS: There was a significantly lower inflammation rate measured by the Tyndall value and the clinical examination on days 7 and 14 after cataract surgery on applying the combined medicinal product in comparison to applying the same active ingredients but in separate eye drops. CONCLUSIONS: Patients receiving the fixed combination will have advantages compared to those patients receiving the active ingredients as single agent therapy. A major advantage of a combined medicinal product is the lack of a wash-out effect with the combination therapy. Therefore, such a therapeutic possibility should chosen for ophthalmological patients.

[Refractive long-term results after piggyback intraocular lens implantation]. / Refraktive Langzeitergebnisse nach Huckepackimplantation.

BACKGROUND: Piggyback lens implantation is an alternative to exchange of the original intraocular lens (IOL) to treat high anisometropia in pseudophakic eyes. We present our results. PATIENTS AND METHOD: A second IOL (piggyback) was implanted in 27 patients from 2000 to 2006. Nineteen patients were clinically investigated late postoperatively, and data for the other eight patients were evaluated from the patients' files. RESULTS: The patients were 65+/-9 years old. Follow-up time was 38+/-25 months. The mean preoperative spherical equivalent (SE) in the myopic eyes was -7.86+/-3.82 D and in the hyperopic eyes was 1.64+/-0.74 D. After surgery, the mean SE in the myopic eyes was -1.77+/-1.82 D and in the hyperopic eyes was -0.09+/-0.51 D. Postoperative anisometropia was reduced from 4.64+/-3.3 D. to 0.9+/-0.82 D. CONCLUSION: Piggyback lens implantation is a safe and effective surgical procedure and is less traumatic than exchange of the original IOL.

[Therapy refractory blepharoconjunctivitis in a 90 year old patient]. / Therapierefraktäre Blepharokonjunktivitis bei einer 90-jährigen Patientin.

Sebaceous gland carcinoma can clinically mimic benign conditions such as chalazion and blepharoconjunctivitis. This carcinoma should be histologically excluded for every unilateral, recalcitrant chalazion and every unilateral, therapy refractory blepharitis. Autosomal dominant Muir-Torre syndrome should be considered in patients who develop sebaceous gland carcinoma of the ocular adnexa. In this case, the sebaceous gland carcinoma is combined with visceral carcinoma.

Drainage devices in glaucoma surgery.

Glaucoma drainage devices, also termed aqueous shunts (AS), are widely used in the USA. Indications for AS include excessive conjunctival scarring diminishing the success of another filtration surgeries, abnormalities of the iridocorneal angle, neovascular glaucoma, presence of corneal grafts, and inflammatory glaucoma. Qualified success has been achieved for many years in 50 to 100 % of the treated eyes, depending on the patient selection. An AS consists of a silicone tube that is inserted into the anterior chamber and a plate (explant) made of silicone or polypropylene. The latter is positioned between the recti muscles. Within some weeks the surrounding tissue forms a fibrous bleb around the plate. This serves as a permanent filtration reservoir. The most serious complication is postoperative hypotonia, that can lead to serious choroidal detachment, suprachoroidal hemorrhage, anterior chamber flattening, and corneal decompensation. To avoid this complication some devices, e.g. the Ahmed Glaucoma valve and the Krupin valve, have integrated mechanisms to sustain a residual intraocular pressure. With other devices such as the Molteno and the Baerveldt devices the tube has to be temporarily ligated until a scar area forms around the explant. On the other hand, fibrous infiltration of the wall of the bleb often leads to a reversible rise in intraocular pressure about one to four months after surgery which can be treated by massaging the bulb, needling the bleb, or injection of antimetabolites. There are no obvious differences between the different AS regarding the success of pressure control. With appreciation of indications and therapy of complications, AS are an useful option in the management of complicated glaucoma, where conventional filtration surgery is considered to carry a high risk of failure.

Physico-chemical and technological studies on sugar beet roots.

The morphological and chemical characteristics of ten varieties of sugar beet roots were evaluated during the season of 1996-1997. The best morphological characteristics were found in Top, Ito and Pamela varieties. The highest expected technological yield of sugar was found in Pamela and Top. The chemical constituents of different varieties of sugar-beet roots showed significant differences. The suitability of sugar beet juice for preparing beet syrup as a new product was also evaluated and compared with sugar cane syrup. Purified beet-syrups concentrated under vacuum or under atmospheric pressure showed more stability during storage than sugar cane syrup. The effect of storage conditions (at cold storage and at room temperature) and packaging materials (glass and polyethylene high-density bottles) on properties of beet-syrup and sugar cane syrup were also studied.

[Combined orthognathic surgery for fractures reduction, in mandibular prognathic patients]. / Eundyasmene orthognathike epembase gia anataxe katagmaton se kato prognathikous astheneis.

Fractures of the facial skeleton require immediate reduction, in order to avoid functional and esthetic disorders. But in cases where the patient had already a facial deformity such as prognathism, a combination with sagittal splitting osteotomy operation is indicated, for reduction of the fracture and the deformity as well, in one stage. We present two such cases, with satisfactory results.