Therapeutic hypothermia translates from ancient history in to practice

Acute postasphyxial encephalopathy around the time of birth remains a major cause of death and disability. The possibility that hypothermia may be able to prevent or lessen asphyxial brain injury is a “dream revisited”. In this review, a historical perspective is provided from the first reported use of therapeutic hypothermia for brain injuries in antiquity, to the present day. The first uncontrolled trials of cooling for resuscitation were reported more than 50 y ago. The seminal insight that led to the modern revival of studies of neuroprotection was that after profound asphyxia, many brain cells show initial recovery from the insult during a short “latent” phase, typically lasting ~6 h, only to die hours to days later during a “secondary” deterioration phase characterized by seizures, cytotoxic edema, and progressive failure of cerebral oxidative metabolism. Studies designed around this conceptual framework showed that mild hypothermia initiated as early as possible before the onset of secondary deterioration, and continued for a sufficient duration to allow the secondary deterioration to resolve, is associated with potent, long-lasting neuroprotection. There is now compelling evidence from randomized controlled trials that mild induced hypothermia significantly improves intact survival and neurodevelopmental outcomes to midchildhood

Case Report- Evaluation of the mesh fixation technique in laparoscopic incisional hernioplasty

The laparoscopic repair of incisional hernias still has controversial aspects, among which is the technique for mesh fixation to the posterior abdominal wall. Whereas some authors advocate single fixation with mechanical suture, others recommend a combined fixation of transmural sutures and staples. Case history: We report the case of a recurrent incisional hernia, which was treated via the laparoscopic approach and found to be caused by a failure in mesh fixation. The re-operation was completed via laparoscopy and 12 months after surgery she remains asymptomatic with no apparent recurrence. Conclusion: (1) \u2032Ideal mechanical fixation\u2032 does not yet exist and must always be tested before the operation can be considered completed and (2) folds or creases in double-layer meshes must be avoided as they seem to favour the formation of visceral adhesions