Functional outcomes in symptomatic versus asymptomatic patients undergoing incisional hernia repair: Replacing one problem with another? A prospective cohort study in 1312 patients

Background: Incisional hernias can be associated with pain or discomfort. Surgical repair especially mesh reinforcement, may likewise induce pain. The primary objective was to assess the incidence of pain after hernia repair in patients with and without pre-operative pain or discomfort. The secondary objectives were to determine the preferred mesh type, mesh location and surgical technique in minimizing postoperative pain or discomfort. Materials and methods: A registry-based prospective cohort study was performed, including patients undergoing incisional hernia repair between September 2011 and May 2019. Patients with a minimum follow-up of 3–6 months were included. The incidence of hernia related pain and discomfort was recorded perioperatively. Results: A total of 1312 patients were included. Pre-operatively, 1091 (83%) patients reported pain or discomfort. After hernia repair, 961 (73%) patients did not report pain or discomfort (mean follow-up = 11.1 months). Of the pre-operative asymptomatic patients (n = 221), 44 (20%, moderate or severe pain: n = 14, 32%) reported pain or discomfort after mean follow-up of 10.5 months. Of those patients initially reporting pain or discomfort (n = 1091), 307 (28%, moderate or severe pain: n = 80, 26%) still reported pain or discomfort after a mean follow-up of 11.3 months postoperatively. Conclusion: In symptomatic incisional hernia patients, hernia related complaints may be resolved in the majority of cases undergoing surgical repair. In asymptomatic incisional hernia patients, pain or discomfort may be induced in a considerable number of patients due to surgical repair and one should be aware if this postoperative complication

Traitement conservateur de l'hematome surrenalien unilateral

The objective was the evaluation of the conservative treatment in the management of the unilateral adrenal gland hemorrhage (UAGH). By retrospective study, we analysed the files of 11 patients of UAGH medically treated between January 1994 and December 2003. The UAGH has been diagnosed by imaging then the adrenal gland corticosteroid and medulla have been explored by lab test. 10 patients had haematoma at the right side. The symptom was marking by a sudden acute abdominal pain. Bybiological plan, all the lesions were non secreting. All the patients have been followed-up for one year at least and all became asymptomatic. 50% of the size of the masses regressed after the first 6 months on CT scan control. The morphology permits by the follow-up the elimination of silent tumour. L’objectif de l’étude était d’évaluer le traitement conservateur dans la prise en charge de l’hématome surrénalien unilatéral (HSU). Par une étude rétrospective, nous avons étudié les dossiers de 11 patientstraités médicalement entre janvier 1994 et décembre 2003 pour un HSU. L’HSU était diagnostiqué par des examens d’imagerie puis des dosages biologiques ont permis d’explorer la corticosurrénale et lamédullosurrénale. 10 patients avaient un hématome à droite. La symptomatologie était marquée par la survenue brutale d’une douleur abdominale. Au plan biologique toutes les lésions étaient nonsécrétantes. Le suivi était d’au moins une année et tous les patients sont devenus asymptomatiques. On notait une régression de 50% de la taille au scanner de l’HSU au terme des 6 premiers mois. L’imagerie permet avec le suivi d’éliminer une tumeur sous jacente

Technique du prélèvement pancréatique pour l'isolement des îlots de Langerhans

The allograft of pancreatic islets represents a potential alternative to insulin therapy in patients suffering from the most severe forms of Type 1 diabetes. Here we report our experience of pancreatic procurement for isolation and islet allograft

Lack of vegetation exacerbates exposure to dangerous heat in dense settlements in a tropical African city

Both climate change and rapid urbanization accelerate exposure to heat in the city of Kampala, Uganda. From a network of low-cost temperature and humidity sensors, operational in 2018-2019, we derive the daily mean, minimum and maximum Humidex in order to quantify and explain intra-urban heat stress variation. This temperature-humidity index is shown to be heterogeneously distributed over the city, with a daily mean intra-urban Humidex Index deviation of 1.2 degrees C on average. The largest difference between the coolest and the warmest station occurs between 16:00 and 17:00 local time. Averaged over the whole observation period, this daily maximum difference is 6.4 degrees C between the warmest and coolest stations, and reaches 14.5 degrees C on the most extreme day. This heat stress heterogeneity also translates to the occurrence of extreme heat, shown in other parts of the world to put local populations at risk of great discomfort or health danger. One station in a dense settlement reports a daily maximum Humidex Index of >40 degrees C in 68% of the observation days, a level which was never reached at the nearby campus of the Makerere University, and only a few times at the city outskirts. Large intra-urban heat stress differences are explained by satellite earth observation products. Normalized Difference Vegetation Index has the highest (75%) power to predict the intra-urban variations in daily mean heat stress, but strong collinearity is found with other variables like impervious surface fraction and population density. Our results have implications for urban planning on the one hand, highlighting the importance of urban greening, and risk management on the other hand, recommending the use of a temperature-humidity index and accounting for large intra-urban heat stress variations and heat-prone districts in urban heat action plans for tropical humid cities

SOFFCO-MM guidelines for the resumption of bariatric and metabolic surgery during and after the Covid-19 pandemic

International audienceBariatric/metabolic surgery was paused during the Covid-19 pandemic. The impact of social confinement and the interruption of this surgery on the population with obesity has been underestimated, with weight gain and worsened comorbidities. Some candidates for this surgery are exposed to a high risk of mortality linked to the pandemic. Obesity and diabetes are two major risk factors for severe forms of Covid-19. The only currently effective treatment for obesity is metabolic surgery, which confers prompt, lasting benefits. It is thus necessary to resume such surgery. To ensure that this resumption is both gradual and well-founded, we have devised a priority ranking plan. The flow charts we propose will help centres to identify priority patients according to a benefit/risk assessment. Diabetes holds a central place in the decision tree. Resumption patterns will vary from one centre to another according to human, physical and medical resources, and will need adjustment as the epidemic unfolds. Specific informed consent will be required. Screening of patients with obesity should be considered, based on available knowledge. If Covid-19 is suspected, surgery must be postponed. Emphasis must be placed on infection control measures to protect patients and healthcare professionals. Confinement is strongly advocated for patients for the first month post-operatively. Patient follow-up should preferably be by teleconsultation