Bilateral Morgagni Hernia: Primary Repair without a Mesh

We present a case of bilateral Morgagni hernia in a 68-year-old male with an intermittent history of progressive onset of breath shortness and occasional cardiac arrhythmias. Diagnosis was made by clinical examination and the findings in a plain chest radiograph and was confirmed by computed tomography scan. The patient was operated electively and subjected to a transabdominal approach. A bilateral subcostal incision revealed a large right side anterior diaphragmatic defect with a hernia containing the ascending colon, the majority of the transverse colon and a huge amount of omentum. Also a second smaller defect was found on the left side with no hernia inside. After large bowel and omentum had been taken down to the peritoneal cavity, both defects were primarily closed using interrupted nylon sutures without the use of a mesh. The patient recovered very well, had an uneventful postoperative course and was released on the 5th postoperative day. 15-month follow-up failed to reveal any signs of recurrence

Laparoscopic para-aortic lymphadenectomy for metastatic colon cancer in a patient with left-sided inferior vena cava: a case report

Transposition of inferior vena cava, or, left-sided inferior vena cava (LS-IVC) is a rare clinical entity, in which the inferior vena cava ascends along the left side of the abdominal aorta. Literature contains mainly clinical case reports. Although it is usually not associated with clinical symptomatology, this anomaly should be detected during preoperative planning to avoid iatrogenic injuries intraoperatively. We present a case of left-sided inferior vena cava encountered during laparoscopic lymphadenectomy in a 45-year-old man with previous laparoscopic hemicolectomy due to colon adenocarcinoma. Preoperative CT abdomen revealed the left-sided location of infrarenal IVC and laparoscopic trans-peritoneal aortic lymphadenectomy was decided. Intraoperatively, transposition of inferior vena cava was confirmed in accordance with the CT findings. Resection of lymph node block was conducted with no complications and with minimal blood loss. The postoperative course was uneventful, and the patient was discharged from the hospital the day following surgery. In conclusion, transposition of the inferior vena cava, although rare, constitutes an anatomical variant that should be identified preoperatively to decrease intraoperative risks. Several anatomical variants have been associated with left-sided inferior vena cava

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The role of interleukin-18 and interleukin -18 binding protein in hepatic ischemia/reperfusion injury: experimental study

Background: Inflammation-associated oxidative stress contributes to hepaticischemia/reperfusion (I/R) injury. Detrimental inflammatory event cascades largelydepend on activated Kupffer cells and neutrophils, as well as proinflammatorycytokines, including tumor necrosis factor-a (TNF-α) and interleukin (IL)-18. The aim ofour study was to evaluate the effects of IL-18 binding protein in hepaticischemia/reperfusion injury of mice.Methods: Thirty C57BL/6 mice were allocated into three groups. Sham operation, I/R,and I/R with intravenous administration of IL-18 binding protein. Hepatic ischemia wasinduced for 30 min by Pringle's maneuver. After 120 min of reperfusion, mice wereeuthanized and the liver and blood samples were collected for histological,immunohistochemical, molecular and biochemical analyses.Results: I/R induced typical liver pathology and upregulated IL-18 in the liver of mice.Binding of IL-18 with IL-18Bp reduced significantly the histopathological indices of I/Rliver injury and Kupffer cell apoptosis. The I/R-induced increase of TNF-a, MDA, ASTand ALT levels, was prevented in statistically significant levels due to the pretreatmentwith IL-18Bp. Likewise, blocking of IL-18 ablated the I/R-associated elevation of NF-κB,c-Jun, MPO and IL-32 and the upregulation of neutrophils and T-helper lymphocytes.Conclusions: Administration of IL-18Bp protects the mice liver from I/R injury by intervening in critical inflammation-associated pathways and Kuppfer cell apoptosis.Πλαίσιο: Το με τη φλεγμονή σχετιζόμενο οξειδωτικό stress συμβάλλει στην ηπατική βλάβη ισχαιμίας/επαναιμάτωσης. Τα καταστροφικά αποτελέσματα του καταρράκτη της φλεγμονής σχετίζονται σε μεγάλο βαθμό με τα ενεργοποιημένα κύτταρα Kupffer και τα ουδετερλόφιλα, καθώς και με προφλεγμονώδεις κυτοκίνες, συμπεριλαμβανομένων του παράγοντα νέκρωσης του όγκου α(TNF-α) και της ιντερλευκίνης -18 (IL-18). Ο σκοπός της μελέτης μας ήταν να αξιολογήσουμε τα αποτελέσματα της δεσμευτικής πρωτείνης της ιντερλευκίνης 18, στην ηπατική βλάβη ισχαιμίας / επαναιμάτωσης σε μύες.Μέθοδος: Τριάντα C57BL/6 μύες χωρίστηκαν σε τρείς ομάδες. Την ομάδα εικονικής επέμβασης, την ομάδα ισχαιμίας/επαναιμάτωσης και την ομάδα ισχαιμίας / επαναιμάτωσης αλλά με ενδοφλέβια χορήγηση της δεσμευτικής πρωτείνης της ιντερλευκίνης 18. Η ηπατική ισχαιμία προκλήθηκε για 30 λεπτά με το χειρισμό Pringle. Μετά επαναιμάτωση 120 λεπτών οι μύες θυσιάστηκαν και το ήπαρ καθώς και δείγματα αίματος συγκεντρώθηκαν για ιστολογικές, ανοσοιστοχημικές, μοριακές και βιοχημικές αναλύσεις.Αποτελέσματα: Η ισχαιμία /επαναιμάτωση προκάλεσε τυπική ιστοπαθολογική βλάβη του ήπατος και αύξησε την έκφραση ιντερλευκίνης 18 στο ήπαρ των μυών. Η δέσμευση της ιντερλευκινης 18 απο τη δεσμευτική της πρωτείνη, ελάττωσε σημαντικά τους ιστοπαθολογικούς δείκτες της ηπατικής βλάβης ισχαιμίας/επαναιμάτωσης και την απόπτωση των κυττάρων Kupffer. Η αύξηση των επιπέδων των TNF-α, MDA, AST και ALT, μπορούσε να προληφθεί σε στατιστικά σημαντικά επίπεδα, όταν στα πειραματόζωα χορηγείτο δεσμευτική πρωτείνη της ιντερλευκίνης 18, πριν από την πρόκληση της ισχαιμίας. Ομοίως η δέσμευση της ιντερλευκίνης 18, ελάττωνε την αύξηση του NF-κB, της c-Jun, MPO και της ιντερλευκίνης 32, που προκαλούντο από την ισχαιμία/επαναιμάτωση, καθώς και την αύξηση των ουδετερόφιλων και Τ βοηθητικών λεμφοκυττάρων.Συμπεράσματα: Η χορήγηση της δεσμευτικής πρωτείνης της ιντερλευκίνης 18 προστατεύει το ήπαρ μυών από βλάβη ισχαιμίας/επαναιμάτωσης, επεμβαίνοντας ε σημαντικές οδούς πού σχετίζονται με την φλεγμονή και την απόπτωση των κυττάρων Kupffer

Intraperitoneal administration of apigenin in liver ischemia/reperfusion injury protective effects

Background/Aims: Hepatic injury caused by ischemia/reperfusion (I/R) is a clinical problem associated with major liver surgery. Among other flavonoids, apigenin has shown a promising effect on I/R cases. In this study, we have investigated the effects of apigenin after liver I/R injury in rats. Materials and Methods: Forty eight rats were randomized into the following eight groups: (1) Control-sham group: rats subjected to the surgical procedure, except for liver I/R; (2) DMSO group: rats subjected to surgery, except for liver I/R given the apigenin solvent dimethyl-sulfoxide intraperitoneally; (3) C60 group; (4) C120 group; (5) C240 group: rats underwent liver ischemia for 45 min followed by reperfusion for 60 min, 120 min, and 240 min; (6) AP60 group; (7) AP120 group; (8) AP240 group: rats underwent liver ischemia for 45 min, and then given apigenin (5 mg) intraperitoneally followed by reperfusion for 60 min, 120 min, and 240 min. Reverse transcription polymerase chain reaction was performed on liver tissues to measure BCL-2/BAX expression, enzyme-linked immunosorbent assay to measure M30/M65 and ICAM-1. Immunohistochemistry was used to identify M30 biomarker in liver tissues. Statistical Analysis: Quantitative variables were tested by Kolmogorov–Smirnov test, repeated measures analysis of variance/Friedman test. Gene levels were assessed by Student's t-test/Mann–Whitney U-test. Results: BCL-2 levels were significantly higher in I/R apigenin groups than in I/R control groups. BAX levels were lower in the AP240 group than in C240 group. Prolongation of reperfusion resulted in increased activation of M30. ICAM-1 levels were lower in the AP240 group than in C240 group. Conclusions: Apigenin seems to inhibit the process of apoptosis and ameliorate the hepatic I/R injury

Laparoscopic para-aortic lymphadenectomy for metastatic colon cancer in a patient with left-sided inferior vena cava: a case report

Transposition of inferior vena cava, or, left-sided inferior vena cava (LS-IVC) is a rare clinical entity, in which the inferior vena cava ascends along the left side of the abdominal aorta. Literature contains mainly clinical case reports. Although it is usually not associated with clinical symptomatology, this anomaly should be detected during preoperative planning to avoid iatrogenic injuries intraoperatively. We present a case of left-sided inferior vena cava encountered during laparoscopic lymphadenectomy in a 45-year-old man with previous laparoscopic hemicolectomy due to colon adenocarcinoma. Preoperative CT abdomen revealed the left-sided location of infrarenal IVC and laparoscopic trans-peritoneal aortic lymphadenectomy was decided. Intraoperatively, transposition of inferior vena cava was confirmed in accordance with the CT findings. Resection of lymph node block was conducted with no complications and with minimal blood loss. The postoperative course was uneventful, and the patient was discharged from the hospital the day following surgery. In conclusion, transposition of the inferior vena cava, although rare, constitutes an anatomical variant that should be identified preoperatively to decrease intraoperative risks. Several anatomical variants have been associated with left-sided inferior vena cava

The Combined Use of Platelet-Rich Plasma and Adipose-Derived Mesenchymal Stem Cells Promotes Healing. A Review of Experimental Models and Future Perspectives

Wound healing and tissue regeneration are a field of clinical medicine presenting high research interest, since various local and systematic factors can inhibit these processes and lead to an inferior result. New methods of healing enhancement constantly arise, which, however, require experimental validation before their establishment in everyday practice. Platelet-rich plasma (PRP) is a well-known autologous factor that promotes tissue healing in various surgical defects. PRP derives from the centrifugation of peripheral blood and has a high concentration of growth factors that promote healing. Recently, the use of adipose-derived mesenchymal stem cells (ADMSCs) has been thoroughly investigated as a form of wound healing enhancement. ADMSCs are autologous stem cells deriving from fat tissue, with a capability of differentiation in specific cells, depending on the micro-environment that they are exposed to. The aim of the present comprehensive review is to record the experimental studies that have been published and investigate the synergistic use of PRP and ADMSC in animal models. The technical aspects of experimentations, as well as the major results of each study, are discussed. In addition, the limited clinical studies including humans are also reported. Future perspectives are discussed, along with the limitations of current studies on the long-term follow up needed on efficacy and safety