Transabdominal pre-peritoneal mesh in inguinal hernia repair in elderly: end point of our experience

BACKGROUND: Aim of this study is to present our standardized laparoscopic transabdominal preperitoneal hernia repair (TAPP) technique, and to study our experience in the elderly as far as concerns preoperative and postoperative variables. METHODS: We described our standardized TAPP technique according with Stuttgart technique [1], and we evalutated our team's experience in TAPP inguinal hernia repair in elderly (> 65 yrs) and in young patients (< 65 yrs). RESULTS: We retrospectively reviewed our Surgery Division's experience about TAPP; we included in our study 185 patients. The sample was subdivided in two groups: TAPP Group (< 65 years patients) and TAPPe Group (> 65 years patients). TAPP Group was composed by 154 patients and TAPPe Group of 31 patients. According with literature, in this subgroup recurrence rate (3,2%), early and delayed complications and mean operative time (86 min). There were no major vascular or intestinal complications. At the moment follow-up is 31 months. There were no incisional hernias on umbilical trocar. Mean satisfaction rate was excellent also in elderly patients. CONCLUSIONS: According with literature, in our experience TAPP technique is a safe and feasible procedure, even in elderly patients

Anal sphincter dysfunction in multiple sclerosis: An observation manometric study

Constipation, obstructed defecation, and fecal incontinence are frequent complaints in multiple sclerosis. The literature on the pathophysiological mechanisms underlying these disorders is scant. Using anorectal manometry, we compared the anorectal function in patients with and without multiple sclerosis. 136 patients referred from our Center for Multiple Sclerosis to the Coloproctology Outpatient Clinic, between January 2005 and December 2011, were enrolled. The patients were divided into four groups: multiple sclerosis patients with constipation (group A); multiple sclerosis patients with fecal incontinence (group B); non-multiple sclerosis patients with constipation (group C); non-multiple sclerosis patients with fecal incontinence (group D). Anorectal manometry was performed to measure: resting anal pressure; maximum squeeze pressure; rectoanal inhibitory reflex; filling pressure and urge pressure. The difference between resting anal pressure before and after maximum squeeze maneuvers was defined as the change in resting anal pressure calculated for each patient. RESULTS: Group A patients were noted to have greater sphincter hypotonia at rest and during contraction compared with those in group C (p=0.02); the rectal sensitivity threshold was lower in group B than in group D patients (p=0.02). No voluntary postcontraction sphincter relaxation was observed in either group A or group B patients (p=0.891 and p=0.939, respectively). CONCLUSIONS: The decrease in the difference in resting anal pressure before and after maximum squeeze maneuvers suggests post-contraction sphincter spasticity, indicating impaired pelvic floor coordination in multiple sclerosis patients. A knowledge of manometric alterations in such patients may be clinically relevant in the selection of patients for appropriate treatments and for planning targeted rehabilitation therapy

Ejection of Supermassive Black Holes from Galaxy Cores

[Abridged] Recent numerical relativity simulations have shown that the emission of gravitational waves during the merger of two supermassive black holes (SMBHs) delivers a kick to the final hole, with a magnitude as large as 4000 km/s. We study the motion of SMBHs ejected from galaxy cores by such kicks and the effects on the stellar distribution using high-accuracy direct N-body simulations. Following the kick, the motion of the SMBH exhibits three distinct phases. (1) The SMBH oscillates with decreasing amplitude, losing energy via dynamical friction each time it passes through the core. Chandrasekhar's theory accurately reproduces the motion of the SMBH in this regime if 2 < ln Lambda < 3 and if the changing core density is taken into account. (2) When the amplitude of the motion has fallen to roughly the core radius, the SMBH and core begin to exhibit oscillations about their common center of mass. These oscillations decay with a time constant that is at least 10 times longer than would be predicted by naive application of the dynamical friction formula. (3) Eventually, the SMBH reaches thermal equilibrium with the stars. We estimate the time for the SMBH's oscillations to damp to the Brownian level in real galaxies and infer times as long as 1 Gyr in the brightest galaxies. Ejection of SMBHs also results in a lowered density of stars near the galaxy center; mass deficits as large as five times the SMBH mass are produced for kick velocities near the escape velocity. We compare the N-body density profiles with luminosity profiles of early-type galaxies in Virgo and show that even the largest observed cores can be reproduced by the kicks, without the need to postulate hypermassive binary SMBHs. Implications for displaced AGNs and helical radio structures are discussed.Comment: 18 pages, The Astrophysical Journal, in press. Replaced with revised versio

Laparoscopic appendectomy in the elderly: our experience

BACKGROUND: Laparoscopic appendectomy for acute appendicitis is one of the most common surgical procedures performed in the world. We aimed to compare laparoscopic and open appendectomy in the elderly in our experience. METHODS: We performed a retrospective review of elderly patients who underwent appendectomy for acute appendicitis from 1st of January 2006 to the 31st of July 2012. We analyzed 39 appendectomies in elderly patients: 20 procedures were performed using open technique (Group O) and 19 using laparoscopic technique (Group L). RESULTS: In the analysis of intraoperative variables there was no statistically significant difference. In this study there was no statistically significant difference also in peri-operative variables. CONCLUSION: Laparoscopic appendectomy is a safe and feasible technique in acute appendicitis also in the elderly