Laparoscopic Rare Abdominal Hernia Treatment

Diaphragm and abdominal wall hernias are rare, and they may be congenital or acquired. Spiegel hernia incidence is between 0.1 and 2%. Morgagni hernia is comprising only 2–3% of all diaphragmatic hernias. Most Spiegel and Morgagni hernias are diagnosed late because of their non-specific symptoms and asymptomatic clinical presentation. The major symptoms are abdominal pain, vomiting, and dyspnea. Computed tomography (CT) shows the hernia sac content, strangulation or incarceration in the content, and detailed anatomical information about surrounding tissue. Surgery is the main treatment option except patients who have severe comorbidity. Spiegel hernia surgery can be performed open or laparoscopic. Intraperitoneal onlay mesh (IPOM), total extraperitoneal procedure (TEP), transabdominal preperitoneal (TAPP) procedure, or partial transabdominal laparoscopic methods are minimal invasive surgery options. In the repair of Morgagni hernia, surgical options may be laparoscopy, laparotomy, thoracotomy, or thoracoscopy

Laparoscopic Inguinal Hernia Repair: Technical Details, Pitfalls and Current Results

Expanding view of minimal invasive surgery horizon reveals new practice areas for surgeons and patients. Laparoscopic inguinal hernia repair is an example in progress wondered by many patients and surgeons. Advantages in laparoscopic repair motivate surgeons to discover this popular field. In addition, patients search the most convenient surgical method for themselves today. Laparoscopic approaches to inguinal hernia surgery have become popular as a result of the development of experience about different laparoscopic interventions, and these techniques are increasingly used these days. As other laparoscopic surgical methods, experience is the most important point in order to obtain good results. This chapter aims to show technical details, pitfalls and the literature results about two methods that are commonly used in laparoscopic inguinal hernia repair

Laparoscopic treatment of morgagni hernia: Two case reports

Morgagni hernias account for only 2–3% of all diaphragmatic hernias, and most of them (91%) are rightsided. Most Morgagni hernias are diagnosed in childhood, but rarely diagnosis may be late because they can be asymptomatic or present nonspecific-nonrespiratory symptoms. Thus, Morgagni hernia diagnosis is incidental in the majority of adulthood cases. The defect arises from a fusion failure of the diaphragm with the central arches. Surgery is the main treatment modality of the Morgagni hernia due to defect enlargement and strangulation- incarceration risks. In this paper, we present two Morgagni hernia cases treated with laparoscopic surgery. Minimal invasive techniques can be used in Morgagni hernia with all advantages

The combined S velocity achieved from tricuspid annulus and pulmonary annulus with tissue Doppler imaging could predict the proximal right coronary artery occlusion in patients with inferior myocardial infarction

Aim: To investigate if combined S velocity (CSV) calculated from tricuspid annulus and pulmonary annulus with tissue Doppler imaging in individuals with acute inferior myocardial infarction were linked to proximal RCA lesions. Methods: The study comprised 48 patient who had been diagnosed with acute inferior myocardial infarction and had culprit lesions in the right coronary artery. The RCA occlusion in Group A was proximal to the right ventricular branch, while the RCA occlusion in Group B was distant to the RV branch. The combined S velocity was tested, as well as other echocardiographic parameters. Results: In terms of metrics indicating right ventricular function, there were substantial disparities between the groups. A favorable association was established in the univariate correlation analysis between CSV and tissue Doppler imaging derived tricuspid annulus systolic velocity (St), pulmonary annulus motion velocity evaluated by TDI (PAMVUT), RV tricuspid annular plane systolic excursion (TAPSE), and fractional area change (FAC). CSV was identified as an independent predictor of proximal RCA occlusion in a multivariate logistic regression test. In the ROC analysis, CSV<18.3 cm/s and PAMVUT<8.6 cm/s indicated proximal RCA occlusion with 83 percent sensitivity and 71 percent specificity (AUC=0.83, p<0.001), and 85 percent sensitivity and 71 percent specificity (AUC=0.81, p<0.001), respectively. Conclusion: CSV measurements were revealed to be an important predictor of proximal RCA occlusions in this investigation

Analiza rezultata dijagnostičke ekscizijske biopsije limfnih čvorova: 12-godišnje iskustvo jednog centra

Lymph node biopsy is indicated in patients with suspected malignancy or lymphadenopathy due to unclarified reasons. Lymph node biopsy can be performed as fine needle aspiration biopsy, core biopsy, or excisional lymph node biopsy. In particular, the diagnosis of malignant lymphoma is considered insufficient for oncological treatment unless classified into subgroups. Core biopsy and excisional biopsy can be performed to diagnose lymphoma and classify it into subgroups. Core biopsy may also be limited in some cases for the diagnosis of lymphoma. Therefore, patients are referred to surgical departments for excisional lymph node biopsy. It was aimed herein to analyze the results of excisional lymph node biopsies performed for diagnostic purposes in our department. Data on 73 patients having undergone diagnostic excisional lymph node biopsy at Sakarya University Medical Faculty Training and Research Hospital between January 2008 and January 2020 were retrospectively analyzed. Patients were evaluated in terms of age, gender, biopsy site, pathological diagnosis, number and diameter of lymph nodes excised. Patients younger than 18 years of age, those with sentinel lymph node biopsies, and lymph node dissections performed for any known malignancy were excluded from the study. Statistical data analysis was done using SPSS statistical software. There were 37 (50.7%) female and 36 (49.3%) male patients, mean age 52.07 (18-90) years. Axillary lymph node biopsy was performed in 32 patients, inguinal lymph node biopsy in 29 patients, cervical lymph node biopsy in 3 patients, intra-abdominal lymph node biopsy in 6 patients, mediastinal lymph node biopsy in 1 patient, and supraclavicular lymph node biopsy in 2 patients. All of the lymph node biopsies were performed as excisional biopsy. Malignancy was detected in 36 (49.3%) patients. In 37 (50.3%) patients, the causes of lymphadenopathy were found to be benign pathologies. When the causes of malignant disease were examined, it was observed that 23 (31.5%) patients were diagnosed with lymphoma. Hodgkin lymphoma was detected in 5 patients diagnosed with lymphoma, and non-Hodgkin lymphoma was found in 18 patients. Metastatic lymphadenopathy was observed in 13 (17.8%) patients. Reactive lymphoid hyperplasia (26%) and lymphadenitis (20.5%) were found among the causes of benign lymphadenopathy. The number of excised lymph nodes was between 1 and 4, and their diameter was between 9 and 75 mm (mean: 29.53±15.56 mm). There was no statistically significant difference between benign and malignant patients according to gender, age, lymph node diameter, number of lymph nodes excised, and excisional lymph node biopsy site. For diagnostic lymph node biopsy, fine-needle aspiration biopsy and core biopsy should be performed primarily. If lymphoma is suspected in the diagnosis, fine-needle aspiration biopsy is not necessary. In this case, it is believed that it is more appropriate to perform core biopsy first. If the core biopsy is insufficient for diagnosis, it is more appropriate to perform surgical biopsy in order to cause no delay in diagnosis and treatment. Excisional biopsy is a method that can be safely performed and does not cause severe morbidity in palpable peripheral lymphadenopathies. Although it does not cause severe morbidity because it is an invasive procedure, excisional biopsy should be performed in a selected patient group.Biopsija limfnih čvorova indicirana je u bolesnika sa sumnjom na zloćudnu bolest ili s limfadenopatijom nejasnog uzroka. Biopsija limfnih čvorova može se izvesti kao tankoiglena aspiracijska biopsija, širokoiglena biopsija ili ekscizijska biopsija limfnih čvorova. Dijagnoza zloćudnog limfoma smatra se naročito nedostatnom za onkološko liječenje ako nije provedena klasifikacija u podskupine. Širokoiglena biopsija i ekscizijska biopsija mogu se provesti kako bi se dijagnosticirao limfom i klasificirao u podskupine. Širokoiglena biopsija može se također u nekim slučajevima pokazati ograničenom u dijagnosticiranju limfoma. Zato se bolesnici upućuju u kirurške odjele na ekscizijsku biopsiju limfnih čvorova. Cilj ovoga istraživanja bio je analizirati rezultate ekscizijskih biopsija limfnih čvorova izvedenih u dijagnostičke svrhe na našem odjelu. Retrospektivno su analizirani podaci za 73 bolesnika podvrgnutih dijagnostičkoj ekscizijskoj biopsiji limfnih čvorova u Sveučilišnoj bolnici Sakarya između siječnja 2008. i siječnja 2020. godine. Analizirani su sljedeći podaci: dob, spol, mjesto gdje je izvedena biopsija, patološka dijagnoza, broj i promjer ekscidiranih limfnih čvorova. Iz istraživanja su bili isključeni bolesnici mlađi od 18 godina, oni s biopsijom sentinel limfnih čvorova te oni s disekcijom limfnih čvorova zbog bilo kakve poznate zloćudne bolesti. Statistička analiza podataka provedena je pomoću statističkog programa SPSS. Bilo je 37 (50,7%) ženskih i 36 (49,3%) muških bolesnika srednje dobi od 52,07 (18-90) godina. Biopsija aksilarnih limfnih čvorova izvedena je u 32, ingvinalnih limfnih čvorova u 29, cervikalnih limfnih čvorova u 3, intra-abdominalnih limfnih čvorova u 6 bolesnika, mediastinalnih limfnih čvorova u 1 bolesnika i supraklavikularnih limfnih čvorova u 2 bolesnika. Sve biopsije limfnih čvorova izvedene su kao ekscizijske biopsije. Malignitet je otkriven u 36 (49,3%) bolesnika, dok su u 37 (50,3%) bolesnika uzroci limfadenopatije bile dobroćudne patologije. Ispitivanje uzroka zloćudne bolesti pokazalo je da je limfom bio dijagnosticiran u 23 (31,5%) bolesnika. Hodgkinov limfom otkriven je u 5 bolesnika u kojih je dijagnosticiran limfom, dok je ne-Hodgkinov limfom utvrđen u 18 bolesnika. Metastatska limfadenopatija zabilježena je u 13 (17,8%) bolesnika. Među uzrocima dobroćudne limfadenopatije nađeni su reaktivna limfoidna hiperplazija (26%) i limfadenitis (20,5%). Broj izvađenih limfnih čvorova bio je od 1 do 4, a njihov promjer bio je od 9 do 75 (srednja vrijednost 29,53±15,56) mm. Nije bilo statistički značajne razlike između bolesnika s dobroćudnom i zloćudnom limfadenopatijom u dobi, spolu, promjeru limfnih čvorova, broju izvađenih limfnih čvorova i mjesta izvođenja ekscizijske biopsije limfnih čvorova. Za dijagnostičku biopsiju limfnih čvorova treba najprije napraviti tankoiglenu aspiracijsku biopsiju i širokoiglenu biopsiju. Ako se dijagnostički posumnja na limfom tada tankoiglena aspiracijska biopsija nije potrebna. U tom slučaju smatra se da je primjerenije najprije napraviti širokoiglenu biopsiju. Ako se širokoiglena biopsija pokaže nedostanom za postavljanje dijagnoze tada je primjerenije napraviti kiruršku biopsiju kako ne bi došlo do kašnjenja u dijagnozi i liječenju. Ekscizijska biopsija je metoda koja se može sigurno izvoditi i ne uzrokuje teži pobol kod palpabilnih perifernih limfadenopatija. Iako ne uzrokuje teži pobol s obzirom na to da je invazivni postupak, ekscizijsku biopsiju treba izvoditi u odabranoj skupini bolesnika

Towards a Platform-Independent Cooperative Human Robot Interaction System: III. An Architecture for Learning and Executing Actions and Shared Plans

Robots should be capable of interacting in a cooperative and adaptive manner with their human counterparts in open-ended tasks that can change in real-time. An important aspect of the robot behavior will be the ability to acquire new knowledge of the cooperative tasks by observing and interacting with humans. The current research addresses this challenge. We present results from a cooperative human-robot interaction system that has been specifically developed for portability between different humanoid platforms, by abstraction layers at the perceptual and motor interfaces. In the perceptual domain, the resulting system is demonstrated to learn to recognize objects and to recognize actions as sequences of perceptual primitives, and to transfer this learning, and recognition, between different robotic platforms. For execution, composite actions and plans are shown to be learnt on one robot and executed successfully on a different one. Most importantly, the system provides the ability to link actions into shared plans, that form the basis of human-robot cooperation, applying principles from human cognitive development to the domain of robot cognitive systems. © 2009-2011 IEEE

It is time to define an organizational model for the prevention and management of infections along the surgical pathway : a worldwide cross-sectional survey

Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.Peer reviewe