Surgical repair of parastomal hernia after Bricker procedure: consecutive experience of a tertiary center

peer reviewedBackground: Parastomal hernia (PH) is the most frequent surgical complication after radical cystectomy with ileal conduit urinary diversion (Bricker's procedure). There are few studies that specifically assess results of PH repairs after Bricker. The aim of this study was to review our experience of surgical repair of PH after Bricker. Methods: We retrospectively reviewed the medical files of a consecutive series of 23 patients (13 male, 10 females; median age 67) who underwent PH repair after Bricker's procedure between 2014 and 2020. Demographic characteristics, intraoperative data, postoperative complications and follow-up were collected. Pre et post CT imaging was specifically reviewed by a radiologist to confirm the PH stage and the CT follow-up according to the Moreno-Matias classification. Data are presented as median and ranges. Results: Preoperatively, all patients suffered from Moreno-Matias type III PH. 16 patients (70%) underwent Sugarbaker repair and 7 (30%) a “sandwich” technique combining Sugarbaker and keyhole repairs. 16 patients (70%) underwent laparoscopic repair (2 conversions). 9 patients underwent a repair of a midline incisional hernia during the same procedure. 4 patients developed severe (> Clavien 3a) complications (two 3b and two IVa). Median hospital stay was 4 days (1-25). Two patients required Bricker reoperation, one for acute ileal conduit ischemia due to peroperative vascular lesion, and one for mesh migration. One patient developed early recurrence after Sugarbacker repair due to mesh migration, and all other patients (n=22, 95.6%) did not develop clinical recurrence at follow-up. Within the no clinical recurrence group (n=22), 20 patients underwent at least one abdominal CT during the follow-up (median 36 months; 1-92). Two asymptomatic Moreno-Matias type Ia recurrences were detected on CT. Conclusions: This significant series confirm that repair of PH after Bricker is a challenging procedure that may be performed by minimal invasive techniques with intraperitoneal meshes and should be performed in experienced centres

How do I investigate... the vulnerability of a carotid artery plaque in 2024.

editorial reviewedCarotid artery atherosclerosis is one of the leading causes of stroke. Even though the association between the risk of stroke and the level of morphological stenosis of a carotid plaque has been known for a long time, growing evidence has since proven necessary to assess the composition of the plaque itself to identify vulnerability predictors. These vulnerable plaques, even more if non-stenosing, may be responsible for a significant - but hard to quantify - proportion of strokes so far classified cryptogenic. As a matter of fact, plaque composition may escape detection and characterisation with classical imaging. Several biomarkers associated with its vulnerability to destabilization and with the risk of stroke such as intraplaque hemorrhage and inflammation are now routinely assessable. After a few pathophysiological reminders and a critical reading of the historical literature concerning carotid artery atherosclerosis management, we will review in this article the imaging techniques that can be used in the routine work-up of a carotid atherosclerotic plaque, with a focus on vessel wall magnetic resonance imaging and contrast enhanced ultrasonography.L’athérosclérose carotidienne est une des causes les plus fréquentes d’accident ischémique cérébral (AIC). Si la dangerosité d’une plaque d’athérome est historiquement vue uniquement à travers le prisme de la sténose qu’elle engendre, l’évolution des connaissances nous pousse à considérer sa composition à la recherche de facteurs de vulnérabilité. Ces plaques à risque, a fortiori «non sténosantes», sont responsables d’une proportion difficilement quantifiable, mais probablement non négligeable d’AIC jusqu’ici considérés cryptogéniques. En effet, ces critères échappent pour beaucoup aux méthodes d’imagerie traditionnelle. Plusieurs propriétés associées à la vulnérabilité de la plaque et au risque d’AIC, principalement l’hémorragie intra-plaque et l’inflammation, sont désormais accessibles en pratique courante. Après quelques rappels physiopathologiques et une lecture critique de la littérature historique de la prise en charge de l’athérome carotidien, nous passerons en revue les différentes techniques d’imagerie utilisables en routine dans la mise au point de la plaque d’athérosclérose, avec un focus pratique sur l’imagerie pariétale vasculaire par résonance magnétique et, dans une moindre mesure, par échographie de contraste

Repair of parastomal hernia after Bricker procedure: retrospective consecutive experience of a tertiary center.

peer reviewed[en] BACKGROUND: Ileal conduit parastomal hernias (ICPHs) are frequent after radical cystectomy with ileal conduit urinary diversion, but their management is debated. This study aimed to review the results of ICPH repair according to Sugarbaker or Sandwich techniques, with special interest in ICPH recurrence and urological complications. METHODS: The authors reviewed a consecutive series of patients undergoing ICPH repair between January 2014 and December 2020. Primary endpoints were ICPH recurrences at clinical exam and cross-sectional abdominal computed tomography (CT) scans. Secondary endpoints were any other complications possibly related to the ICPH repair. RESULTS: Twenty-three patients underwent ICPH repair surgery (16 Sugarbaker and 7 Sandwich techniques) during the study period. Sixteen patients underwent a primary laparoscopic approach. All but one patient underwent at least one abdominal CT during the follow-up. Median clinical and CT scan follow-up times were 57 and 50.5 months, respectively. Clinical and CT ICPH recurrence rates were 4.5% and 13% at 5 years, respectively. Eighteen patients (78%) suffered no urological complications during the follow-up period, but three patients (13%) needed redo surgery on the urinary ileal conduit. CONCLUSION: The modified Sugarbaker or Sandwich techniques might be considered as promising techniques for ICPH repair with a low rate of recurrence. The urological complications, and particularly the ileal conduit-related issues, need to be evaluated in further studies. Controlled and prospective data are required to compare the Sugarbaker and Sandwich techniques to the Keyhole approach for ICPH repairs

A microarray analysis of full depth knee cartilage of ovariectomized rats

<p>Abstract</p> <p>Background</p> <p>This short communication focuses the on articular cartilage and the subchondral bone, both of which play important roles in the development of osteoarthritis (OA). There are indications that estrogen-deficiency, as the post-menopausal state, accelerate the development of OA.</p> <p>Findings</p> <p>We investigated, which extracellular matrix (ECM) protein, proteases and different pro-inflammatory factors was up- or down-regulated in the knee joint tissue in response to estrogen-deficiency in rats induced by ovariectomy. These data support previous findings that several metalloproteinases (MMPs) and cysteine proteases are co-regulated with numerous collagens and proteoglycans that are important for cartilage integrity. Furthermore quite a few pro-inflammatory cytokines were regulated by estrogen deprivation.</p> <p>Conclusion</p> <p>We found multiple genes where regulated in the joint by estrogen-deficiency, many of which correspond well with our current knowledge of the pathogenesis of OA. It supports that estrogen-deficiency (e.g. OVX) may accelerate joint deterioration. However, there are also data that draw attention the need for better understanding of the synergy between proteases and tissue turnover.</p

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

CT scan in syncope : diagnostic yield and prescription habits.

editorial reviewedSyncope is a frequent reason for emergency department admission. Brain imaging is theoretically not recommended. After exclusion of features orienting towards non-syncopal events, we retrospectively included 206 patients who underwent head CT scans in the University Hospital of Liège for transient loss of consciousness between December 2020 and July 2021. We surveyed physicians involved in the emergency department concerning their imaging prescription habits and motivations. CT diagnostic yield is 1 %. The oncologic background is associated with pathological findings (odds ratio 84,1, p = 0,005). Cervical angio-CT scans only lead to incidental findings and increased dose exposure. Only a minority (6.6 %) of physicians systematically prescribe brain imaging. Radioprotection is an important notion for only 10 % of the less experimented physicians. Obligation of means is an occasional justification for resort to imaging. A prospective decisional rule based on the exclusion of features orienting towards non-syncopal loss of cousciousness, old age and oncologic history might reduce the number of useless scans. Radioprotection is too often neglected by less experimented physicians. Obligation of means should not be mingled with reassurance behaviors as part of defensive medicine.La syncope est un motif fréquent d’admission aux Urgences. La réalisation d’une imagerie encéphalique n’est, théoriquement, pas recommandée. Après exclusion de critères évocateurs d’une étiologie non syncopale, nous avons rétrospectivement inclus 206 patients ayant passé un CT cérébral entre décembre 2020 et juillet 2021 au CHU de Liège pour perte de connaissance brève. Nous avons sondé les médecins impliqués dans le service des Urgences concernant leur habitudes de prescription. L’apport diagnostique du CT est de 1 %. Un contexte oncologique est associé aux résultats iconographiques pathologiques (odds ratio 84,1; p = 0,005). L’angio-CT cervical ne permet que la mise en évidence d’incidentalomes au prix d’une majoration de l’irradiation. Une minorité (6,6 %) de prescripteurs a systématiquement recours à l’imagerie. La radioprotection est jugée importante par seulement 10 % des intervenants les moins expérimentés et l’obligation de moyens est parfois avancée comme justification de prescription. Des critères décisionnels prospectifs (exclusion d’éléments évocateurs de pertes de connaissance non syncopales, âge et contexte oncologique) permettraient de réduire le nombre d’examens inutiles. La radioprotection est trop souvent négligée par les prescripteurs les moins expérimentés. L’obligation de moyens ne doit pas être confondue avec des comportements de réassurance dans le cadre de la médecine défensive

Acute necrosis of the corpus callosum.

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