Omental whirl associated with bilateral inguinal hernia: a case report

INTRODUCTION: Torsion of the omentum is a rare cause of abdominal pain. It is clinically similar to common causes of acute surgical abdomen and is often diagnosed during surgery. Inguinal hernia is a common condition but not frequently related with torsion of the omentum. CASE PRESENTATION: A 40-year-old Caucasian man came to our emergency department with abdominal pain of the left quadrant and abdominal distension for 2 days. His medical history included an untreated left inguinal hernia in the last year. Computed tomography revealed densification of mesocolon with left omentum "whirl" component and other signs of omental torsion. During an exploratory laparoscopy, a wide twist of his omentum with necrotic alterations that extended to the bilateral inguinal hernial content was observed. Omentectomy and surgical repair of bilateral inguinal hernia were performed. CONCLUSIONS: Torsion of the omentum is a rare entity and usually presents a diagnostic challenge. The use of abdominal computed tomography can help diagnosing torsion of the omentum preoperatively and, thus, prevents a surgical approach. Nonetheless, some cases of torsion of the omentum require surgical repair. Accordingly, a laparoscopic approach is minimally invasive and efficient in performing omentectomy.(undefined

EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair

Background Although the repair of ventral abdominal wall hernias is one of the most commonly performed operations, many aspects of their treatment are still under debate or poorly studied. In addition, there is a lack of good definitions and classifications that make the evaluation of studies and meta-analyses in this field of surgery difficult. Materials and methods Under the auspices of the board of the European Hernia Society and following the previously published classifications on inguinal and on ventral hernias, a working group was formed to create an online platform for registration and outcome measurement of operations for ventral abdominal wall hernias. Development of such a registry involved reaching agreement about clear definitions and classifications on patient variables, surgical procedures and mesh materials used, as well as outcome parameters. The EuraHS working group (European registry for abdominal wall hernias) comprised of a multinational European expert panel with specific interest in abdominal wall hernias. Over five working group meetings, consensus was reached on definitions for the data to be recorded in the registry. Results A set of well-described definitions was made. The previously reported EHS classifications of hernias will be used. Risk factors for recurrences and co-morbidities of patients were listed. A new severity of comorbidity score was defined. Post-operative complications were classified according to existing classifications as described for other fields of surgery. A new 3-dimensional numerical quality-of-life score, EuraHS-QoL score, was defined. An online platform is created based on the definitions and classifications, which can be used by individual surgeons, surgical teams or for multicentre studies. A EuraHS website is constructed with easy access to all the definitions, classifications and results from the database. Conclusion An online platform for registration and outcome measurement of abdominal wall hernia repairs with clear definitions and classifications is offered to the surgical community. It is hoped that this registry could lead to better evidence-based guidelines for treatment of abdominal wall hernias based on hernia variables, patient variables, available hernia repair materials and techniques

Increasing vegetable intakes: rationale and systematic review of published interventions

Purpose While the health benefits of a high fruit and vegetable consumption are well known and considerable work has attempted to improve intakes, increasing evidence also recognises a distinction between fruit and vegetables, both in their impacts on health and in consumption patterns. Increasing work suggests health benefits from a high consumption specifically of vegetables, yet intakes remain low, and barriers to increasing intakes are prevalent making intervention difficult. A systematic review was undertaken to identify from the published literature all studies reporting an intervention to increase intakes of vegetables as a distinct food group. Methods Databases—PubMed, PsychInfo and Medline—were searched over all years of records until April 2015 using pre-specified terms. Results Our searches identified 77 studies, detailing 140 interventions, of which 133 (81 %) interventions were conducted in children. Interventions aimed to use or change hedonic factors, such as taste, liking and familiarity (n = 72), use or change environmental factors (n = 39), use or change cognitive factors (n = 19), or a combination of strategies (n = 10). Increased vegetable acceptance, selection and/or consumption were reported to some degree in 116 (83 %) interventions, but the majority of effects seem small and inconsistent. Conclusions Greater percent success is currently found from environmental, educational and multi-component interventions, but publication bias is likely, and long-term effects and cost-effectiveness are rarely considered. A focus on long-term benefits and sustained behaviour change is required. Certain population groups are also noticeably absent from the current list of tried interventions

Pregnancy aggravates proteinuria in subclinical glomerulonephritis in the rat

Because subclinical renal disease may be aggravated during pregnancy-as reflected in the occurrence of proteinuria, for example-we investigated whether a subclinical glomerulonephritis (SG) in the non-pregnant rat (passive Heymann nephritis), a condition without proteinuria, is aggravated when the animals become pregnant and, if so, whether this is associated with a glomerular inflammatory reaction. SG was induced in non-pregnant rats 8 days before pregnancy. On day -1, part of the group of rats became pregnant. Three experiments were performed. In experiment 1,4-hour urine albumin excretions and blood pressure (tail cuff) were measured. In experiment 2, the glomerular filtration rate (GFR) was measured with the chromium 51-labeled ethylenediaminetetraacetic acid method, while in experiment 3, parameters characteristic of a glomerular inflammation were studied. Experiment 1 revealed that non-pregnant rats with SG did not exhibit proteinuria. However, after the rats became pregnant, a significant proteinuria occurred, without an increase in systolic blood pressure. Experiment 2 revealed that the GFR did not increase in pregnant rats with SG, while experiment 3 showed that only pregnant animals exhibited a significant glomerular inflammation; this glomerular inflammation was characterized by intraglomerular influx of polymorphonuclear cells and monocytes. The results suggest that an SG in the rat may flare up during pregnancy. This exacerbation is characterized by proteinuria and coincides with a glomerular inflammatory reaction. It is suggested that proteinuria and the glomerular inflammatory reaction are causally related and promoted by the pregnant condition

Environmental health guideline for Municipal Health Services. Assessment of air exchange and ventilation capacity in dwellings

Het RIVM heeft in samenwerking met GGD'en een richtlijn ontwikkeld die beschrijft hoe ventilatie en ventilatievoorzieningen van bestaande woningen beoordeeld kunnen worden. Voorbeelden zijn: hoeveel kubieke meter verse lucht komt er per uur een woning binnen en hoeveel binnenlucht wordt er afgevoerd? Hoeveel kan er hoogstens afgevoerd worden? Is dat voldoende om de binnenlucht gezond te houden en hoe valt dat te meten? De luchtverversing in woningen schiet vaak tekort, wat gevolgen kan hebben voor de kwaliteit van het binnenmilieu en voor de gezondheid. Het kabinet heeft plannen om de kwaliteit van het binnenmilieu te verbeteren. De richtlijn biedt GGD-medewerkers basisinformatie over ventilatie en ventilatievoorzieningen van woningen. Ook is beschreven welke relaties tussen ventilatie en gezondheidsrisico's er bekend zijn. Te weinig ventilatie kan leiden tot bijvoorbeeld vochtproblemen, en hoge concentraties van verbrandingsproducten en het gas radon. Dit kan gepaard gaan met onder andere geurhinder, verergering van astma of een verhoogde kans op longkanker. Daarnaast is op basis van de wettelijke voorschriften en andere maatstaven een selectie gemaakt van methoden, technieken en criteria die GGD'en kunnen hanteren om de ventilatiecapaciteit en de ventilatie te beoordelen. Om het instrumentarium compleet te maken zijn de methoden, technieken en criteria op onderdelen aangevuld. Hiermee zijn ze meer gericht op het aantal personen dat aanwezig is of doorgaans aanwezig is in de betreffende ruimten. Verder is beschreven wat de taken van de GGD'en zijn en hoe zij het beoordelingsproces van ventilatie en ventilatievoorzieningen kunnen indelen. De beoordeling kan plaatsvinden in de betreffende woning of vanaf de werkplek.The National Institute for Public Health and the Environment (RIVM) has drawn up a guideline, together with the Municipal Health Services (GGD) that describes how the air exchange rate and ventilation capacity of existing dwellings can be assessed. Examples of assessment points are: how many cubic metres of fresh air enter a dwelling per hour and how much indoor air is removed? What is the maximum volume flow that can be achieved? Is that flow sufficient to keep the indoor air at a healthy level and how can this be measured? Good ventilation in dwellings is often inadequate which can have consequences for the quality of the indoor environment and for people's health. Therefore, the Dutch government is planning to improve the indoor environmental quality. The guideline will provide GGD professionals with basic information regarding the air exchange rate and ventilation capacity of dwellings. It also outlines what is already known about the relationship between indoor air exchange and associated health risks. For example, too little ventilation can lead to dampness and high concentrations of combustion products and radon gas. This can cause: odour nuisance, exacerbation of asthma or even an increased risk of lung cancer. In addition, based on legal requirements and other standards, a selection of methods has been made of techniques and criteria that GGD departments can use to assess the ventilation capacity and air exchange rate of dwellings. In order to complete the range of instruments used, the methods, techniques and criteria have been supplemented wherever necessary. This change ensures more focus to be placed on the number of people actually present or usually present in the indoor area(s) concerned. In addition, the guideline outlines the specific tasks of the GGD departments as well as how they can approach the assessment process for air exchange rate and ventilation capacity. The assessment can take place in the dwelling itself or at the place of work.VW