Incisional hernias – results of present therapy options

Sp. Sf. Pantelimon, București, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere: Hernia incizională este cea mai frecventă complicație după operațiile abdominale. Este dificil de estimat exact costul acestei patologii pentru societate. Dacă adăugam la costul intervenției chirurgicale și costul spitalizării, dificultățile operațiilor de recidivă multiplă, costul protezelor, morbiditățile pacienților neoperați, afectarea capacității de muncă și a calității vieții, vom avea magnitudinea problemei dezvoltate de această complicație redutabilă a tuturor intervențiilor chirurgicale. Material și metodă: Am analizat rezultatele mai multor studii de prestigiu ale unor colective românești și internaționale în domeniul herniilor incizionale. Rezultate: Din nefericire rezultatele globale ale tratamentului în hernia incizională oscilează între 12-63% pentru procedeele tisulare și între 2-36% pentru procedeele allopalstice. Abordul chirurgical este cel mai adesea bazat pe traditie si pe liberul arbitru, decat pe evidențe statistice sau ghiduri de tratament. Nu este deloc surprinzător faptul că, în ciuda noilor cuceriri în domeniul defectelor parietale și a folosirii explozive a protezelor, rata de re-operații pentru recidiva incizională se situează la același nivel. Concluzii: Componența operatorie ca unică etiologie în hernia incizională este supraestimată. Datorită faptului că și alți factori etiologici, cunoscuți sau nu, concura la apariția herniei incizionale și la re-recidivă, și datorită faptului că acești “factori” nu sunt deocamdată influențabili de tratamentul medical nu ne rămțne decât să analizăm lucid și responsabil factorii chirurg-dependenți. Greselile de tactică/tehnică chirurgicală trebuie evidențiate, explicate, și înlăturate. Soluția nu este o abordare pur tehnică, ci una fiziologică, în termeni de elasticitate, complianța și rezistența a întregului perete abdominal, deseori modificat profund de marile defecte incizionale.Introduction: incisional hernia is the most common complication after abdominal surgery. It is difficult to estimate the exact cost to society of this pathology. If we add to the cost of surgery and hospitalization costs, the difficulties of relapse multiple operations, the cost of prostheses, unoperated patient morbidity, impaired work capacity and quality of life, the magnitude of the problem we have developed this redoubtable complication of all surgical procedures. Methods: We analyzed the results of several studies of prestigious romanian and international collectives about incisional hernias. Results: Unfortunately, the overall results of treatment in incisional hernia procedures vary between 12-63% for tissular procedures and between 2-36% for allopalstic procedures. Surgical approach is most often based on tradition and the free will, rather than obvious statistical treatment guidelines. Not surprisingly, despite the new advancements in the field of herniology and the use of new parietal prosthesis, the rate of re-operations for recurrent incisional fall at the same level. Conclusions: Surgery as the only component in etiology of incisional hernias is overestimated. Due to the fact that other etiological factors, known or not compete in the emergence and re-incision hernia recurrence, and because these “factors” are not influenced by medical treatment for now, we are just lucid and analyze the factors responsible - surgeon dependent. Mistakes tactics/surgical technique must be highlighted, explained and removed. The solution is not a purely technical approach, but a physiological, in terms of elasticity, compliance and resistance of the entire abdominal wall

A monoclonal antibody specific for prophase phosphorylation of histone deacetylase 1 : a readout for early mitotic cells

Histone deacetylases (HDACs) are modification enzymes that regulate a plethora of biological processes. HDAC1, a crucial epigenetic modifier, is deregulated in cancer and subjected to a variety of post-translational modifications. Here, we describe the generation of a new monoclonal antibody that specifically recognizes a novel highly dynamic prophase phosphorylation of serine 406-HDAC1, providing a powerful tool for detecting early mitotic cells

Multi-Omic, Histopathologic, and Clinicopathologic Effects of Once-Weekly Oral Rapamycin in a Naturally Occurring Feline Model of Hypertrophic Cardiomyopathy: A Pilot Study

Hypertrophic cardiomyopathy (HCM) remains the single most common cardiomyopathy in cats, with a staggering prevalence as high as 15%. To date, little to no direct therapeutical intervention for HCM exists for veterinary patients. A previous study aimed to evaluate the effects of delayed-release (DR) rapamycin dosing in a client-owned population of subclinical, non-obstructive, HCM-affected cats and reported that the drug was well tolerated and resulted in beneficial LV remodeling. However, the precise effects of rapamycin in the hypertrophied myocardium remain unknown. Using a feline research colony with naturally occurring hereditary HCM (n = 9), we embarked on the first-ever pilot study to examine the tissue-, urine-, and plasma-level proteomic and tissue-level transcriptomic effects of an intermittent low dose (0.15 mg/kg) and high dose (0.30 mg/kg) of DR oral rapamycin once weekly. Rapamycin remained safe and well tolerated in cats receiving both doses for eight weeks. Following repeated weekly dosing, transcriptomic differences between the low- and high-dose groups support dose-responsive suppressive effects on myocardial hypertrophy and stimulatory effects on autophagy. Differences in the myocardial proteome between treated and control cats suggest potential anti-coagulant/-thrombotic, cellular remodeling, and metabolic effects of the drug. The results of this study closely recapitulate what is observed in the human literature, and the use of rapamycin in the clinical setting as the first therapeutic agent with disease-modifying effects on HCM remains promising. The results of this study establish the need for future validation efforts that investigate the fine-scale relationship between rapamycin treatment and the most compelling gene expression and protein abundance differences reported here. © 2023 by the authors.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]