Parastomal hernia repair: laparoscopic ventral hernia meshplasty with stoma relocation. The current state and a clinical case presentation.

BACKGROUND: Parastomal hernia is a frequent complication after performing an ostomy, and although different technical options have been described, it lacks an ideal intervention to resolve it. The use of meshes and the laparoscopic approach, has led to a significant advance in resolving this condition. However, the ideal technique should guarantee must ensure integral repair of the abdominal wall, taking into account the functionality of the stoma. In large parastomal eventrations the repairing of the ventral hernia with a mesh and relocating the stoma in another quadrant may be an intervention that fulfills both principles, and open approach being described. METHODS: We review the current state of surgical management of this condition and analyze the different technical options. Present the first description for using a laparoscopic technique with meshplasty and stoma relocation in an obese patient with a complex parastomal hernia, with results in the 18 month follow up. CONCLUSIONS: Surgical technique repair of the parastomal hernia is sometimes a complex issue, which possibly requires different solutions according to the characteristics of the hernia and patient. The technique described of meshplasty with stoma relocation by laparoscopic approach has been revealed as an affordable technique, with minor inconvenience to the patient, absence of complications and good functional results in the long term, benefiting from the advantages of minimally invasive surgery itself.

Effects of psychological stress and alprazolam on development of oral candidiasis in rats.

Psychological stress has been found to suppress cell-mediated immune responses that are important in limiting the proliferation of Candida albicans. Since anxiolytic drugs can restore cellular immunity in rodents exposed to stress conditions, we designed experiments conducted to evaluate the effects of alprazolam (1 mg/kg of body weight/day), a central benzodiazepine anxiolytic agonist, on the development of oral candidiasis in Sprague-Dawley rats exposed to a chronic auditory stressor. Animals were submitted to surgical hyposalivation in order to facilitate the establishment and persistence of C. albicans infection. Application of stress and treatment with drugs (placebo or alprazolam) were initiated 7 days before C. albicans inoculation and lasted until the end of the experiments (day 15 postinoculation). Establishment of C. albicans infection was evaluated by swabbing the inoculated oral cavity with a sterile cotton applicator on days 2 and 15 after inoculation, followed by plating on YEPD (yeast extract-peptone-dextrose) agar. Tissue injury was determined by the quantification of the number and type (normal or abnormal) of papillae on the dorsal tongue per microscopic field. A semiquantitative scale was devised to assess the degree of colonization of the epithelium by fungal hyphae. Our results show that stress exacerbates C. albicans infection of the tongues of rats. Significant increases in Candida counts, the percentage of the tongue's surface covered with clinical lesions, the percentage of abnormal papillae, and the colonization of the epithelium by fungal hyphae were found in stressed rats compared to those found in the unstressed rats. Treatment with alprazolam significantly reversed these adverse effects of stress, showing that, besides the psychopharmacological properties of this anxiolytic drug against stress, it has consequences for Candida infection.

PMA inhibits both spontaneous and glucocorticoid-mediated leptin secretion by human omental adipose tissue explants in vitro.

The activation of PKC by the acute administration of the phorbol ester PMA (1 microM, 2h) to omental adipose tissue explants in vitro resulted in a marked (about 75%) and persistent (up to at least 96 h) inhibition of leptin secretion. This PKC-mediated inhibition was not observed after the administration of an inactive phorbol ester (phorbol 12,13-dicecanoate). The inhibition by PMA of leptin secretion was not restricted to the spontaneous secretion, but blocked also effectively the leptin response to a powerful stimulus, such as the glucocorticoid dexamethasone. As the PKC activity has been shown to be elevated during fasting, the negative relation here described between PKC activity and leptin secretion could be of physiological relevance.

Effects of alprazolam on the development of Moloney sarcoma virus-induced tumors in stressed mice.

Experiments were conducted to evaluate the effects of alprazolam (1 mg/kg i.p.) on the development of autochthonous tumors induced by the Moloney sarcoma virus (MSV) in BALB/c female mice subjected to stress. Enhancement of MSV-induced tumor incidence and growth was observed, together with a delay in the usual prompt regression of the tumors, when programmed white sound anxiety-stress was administered immediately following MSV i.m. inoculation. However, a depressant effect on tumor size and incidence was observed when stress was administered before virus inoculation. Treatment with alprazolam was found to reverse partially the adverse effects of postinoculation stress, and also to inhibit the beneficial effects of the preinoculation administration of stress on tumor development. Pretreatment with Ro 15-1788 (10 mg/kg s.c.), a central benzodiazepine antagonist, resulted in a suppression on both effects of alprazolam in stressed mice.

Phagocytic activity in stressed mice: effects of alprazolam.

Mice exposed to a chronic auditory stressor and daily injected with alprazolam (1 mg/kg/day, s.c.) showed a reduction in stress-induced suppression of the in vitro and in vivo activity of phagocytosis, measured using the zymosan particle uptake method and the carbon clearance test, respectively. Pretreatment with Ro-15-1788 (10 mg/kg, s.c.), a central nervous system benzodiazepine antagonist, resulted in suppression of the effects of alprazolam in stressed mice.

[Double pyloric canal. Presentation of 3 new cases and review of the literature]. / Doble canal pilórico. Presentación de tres nuevos casos y revisión de la literatura.

We present three cases of double pylorus, one of them of iatrogenic origin, the latter entity being extremely rare. Likewise we review the etiopathogenic theories.

Santorinirrhage: hemosuccus pancreaticus in pancreas divisum.

We describe a previously unreported complication of pancreas divisum: severe and repeated episodes of gastrointestinal bleeding through the main pancreatic duct (hemosuccus pancreaticus) in a 34-yr-old woman over a period of 10 months. She had negative investigations, including a blank laparotomy, until an endoscopic retrograde cholangiopancreatography revealed a pancreas divisum with chronic pancreatitis and a small pseudocyst at the tail of the dorsal pancreas. During the procedure, bleeding through the papilla minor was observed coming from Santorini's duct. A corporocaudal pancreatectomy was done and the bleeding episodes have subsided.