Transmesosigmoid hernia: case report and review of literature.

Transmesosigmoid hernia has previously been considered as a rare condition. The clinical symptoms can be nonspecific. Here, we report a case of acute intestinal obstruction because of transmesosigmoid hernia. In addition, after a comprehensive review of PubMed and China National Knowledge Infrastructure, we present a review of 22 cases of transmesosigmoid hernia. We summarize several valuable clinical features that help early recognition of transmesosigmoid hernia. As a result of easy strangulation, in patients without a history of surgery or abdominal inflammation who present with symptoms of progressive or persistent small bowel obstruction (SBO), surgeons should consider the possibility of transmesosigmoid hernia. In addition, based on our data, in patients with SBO because of transmesosigmoid hernia, the defect is usually 2-5 cm in diameter. Furthermore, because of the high risk of strangulation with transmesosigmoid hernia, it is mandatory to reassess the condition timely and periodically when patients receive conservative treatment.

Effects of intensive glucose control on incidence of cardiovascular events in patients with type 2 diabetes: a meta-analysis.

BACKGROUND: The effects of intensive glucose control over conventional glucose control on cardiovascular outcomes of patients with type 2 diabetes remain uncertain. METHODS: We searched MEDLINE, EMBASE, and the Cochrane database to identify randomized controlled trials that compared the effects of intensive glucose control and conventional glucose control, on cardiovascular events in patients with type 2 diabetes. RESULTS: Seven trials involving 34,144 participants with type 2 diabetes were included. Intensive glucose control significantly reduced major cardiovascular events by 10% (relative risk (RR) 0.90, 95% CI 0.85-0.96; P = 0.0006), and non-fatal myocardial infarction by 16% (0.84, 95% CI 0.76-0.93; P = 0.0006) at the expense of increased incidence of severe hypoglycemia (2.30, 95% CI 1.74-3.03; P < 0.00001), while all-cause mortality, cardiovascular death, non-fatal stroke, and heart failure were similar between the two groups. Subgroup analyses showed that patients with longer follow-up duration, shorter diabetic duration, less glycosylated hemoglobin (HbA1c) reduction, higher HbA1c concentration at follow-up, and lower base-line HbA1c benefited more from intensive glucose control. CONCLUSION: An intensive glucose control strategy can effectively reduce the risk of major cardiovascular events but at the expense of a significantly increased risk of severe hypoglycemia in patients with type 2 diabetes.