homicide by drinking glass with peculiar findings let s create safer drinking environments to reduce alcohol related murders

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Ilioinguinal nerve neurectomy is better than preservation in lichtenstein hernia repair. A systematic literature review and meta-analysis

Objective This study aimed to evaluate the incidence of chronic groin pain (primary outcome) and alterations of sensitivity (secondary outcome) after Lichtenstein inguinal hernia repair, comparing neurectomy with ilioinguinal nerve preservation surgery. Summary background data The exact cause of chronic groin postoperative pain after mesh inguinal hernia repair is usually unclear. Section of the ilioinguinal nerve (neurectomy) may reduce postoperative chronic pain. Methods We followed PRISMA guidelines to identify randomized studies reporting comparative outcomes of neurectomy versus ilioinguinal nerve preservation surgery during Lichtenstein hernia repairs. Studies were identified by searching in PubMed, Scopus, and Web of Science from April 2020. The protocol for this systematic review and meta-analysis was submitted and accepted from PROSPERO: CRD420201610. Results In this systematic review and meta-analysis, 16 RCTs were included and 1550 patients were evaluated: 756 patients underwent neurectomy (neurectomy group) vs 794 patients underwent ilioinguinal nerve preservation surgery (nerve preser- vation group). All included studies analyzed Lichtenstein hernia repair. The majority of the new studies and data comes from a relatively narrow geographic region; other bias of this meta-analysis is the suitability of pooling data for many of these studies. A statistically significant percentage of patients with prosthetic inguinal hernia repair had reduced groin pain a 6 months after surgery at 8.94% (38/425) in the neurectomy group versus 25.11% (113/450) in the nerve preservatio group [relative risk (RR) 0.39, 95% confidence interval (CI) 0.28–0.54; Z = 5.60 (P 0.00001)]. Neurectomy did no significantly increase the groin paresthesia 6 months after surgery at 8.5% (30/353) in the neurectomy group versu 4.5% (17/373) in the nerve preservation group [RR 1.62, 95% CI 0.94–2.80; Z = 1.74 (P = 0.08)]. At 12 months afte surgery, there is no advantage of neurectomy over chronic groin pain; no significant differences were found in th 12-month postoperative groin pain rate at 9% (9/100) in the neurectomy group versus 17.85% (20/112) in the inguina nerve preservation group [RR 0.50, 95% CI 0.24–1.05; Z = 1.83 (P = 0.07)]. One study (115 patients) reported dat about paresthesia at 12 months after surgery (7.27%, 4/55 in neurectomy group vs. 5%, 3/60 in nerve preservatio group) and results were not significantly different between the two groups [RR 1.45, 95% CI 0.34, 6.21;Z = 0.5 (P = 0.61)]. The subgroup analysis of the studies that identified the IIN showed a significant reduction of the 6th mont evaluation of pain in both groups and confirmed the same trend in favor of neurectomy reported in the previous overal analysis: statistically significant reduction of pain 6 months after surgery at 3.79% (6/158) in the neurectomy grou versus 14.6% (26/178) in the nerve preservation group [RR 0.28, 95% CI 0.13–0.63; Z = 3.10 (P = 0.002)]. Conclusion Ilioinguinal nerve identification in Lichtenstein inguinal hernia repair is the fundamental step to reduce or avoid postoperative pain. Prophylactic ilioinguinal nerve neurectomy seems to offer some advantages concerning pain in the first 6th month postoperative period, although it might be possible that the small number of cases contributed to the insignificancy regarding paresthesia and hypoesthesia. Nowadays, prudent surgeons should discuss with patients and their families the uncertain benefits and the potential risk of neurectomy before performing the hernioplasty

The lymphatic drain of below-knee malignant melanoma. Is the popliteal fossa a ghost station?

Sentinel lymph node biopsy is fundamental in the staging of primary cutaneous melanoma (PCL), but reported lymphoscintigraphic patterns are very heterogeneous. In this systematic review, we evaluated the role of the popliteal station in below-knee PCL. A systematic search of literature through was conducted on the electronic databases PubMed, SCOPUS and Web of Science (WOS) to identify eligible studies. A total of 22 studies (n=5,673 patients) were included. The average Breslow thickness of PCL was 2.86 mm. During the analysis of the included articles, it was not possible to classify patients into the 3 Menes popliteal drainage pattern, obtained by lymphoscintigraphy. The analysis of lymphatic drainage in patients undergoing lymphoscintigraphy for melanoma of the lower extremities below the knee was reported in 5,637 patients and the lymphatic popliteal drainage was reported only in 5.64% (320 patients). The rate of popliteal lymph nodes melanoma metastases was 1.48%: they were located exclusively at the popliteal level in 0.60%, at the popliteal and inguinal levels in 0.39%, at the popliteal and iliac level in 0.02% and at the groin level in 0.48%. In conclusion, the most common lymphoscintigraphic pattern is represented by popliteal nodes in-transit or interval nodes, so metastases from below-knee melanomas commonly transit through popliteal nodes stations and arrive to inguinal nodes stations. The popliteal nodes are the primary station in about 5.64% of cases. Larger studies are needed to corroborate these findings

DERMATOME MAPPING TEST IN THE ANALYSIS OF ANATOMO- CLINICAL CORRELATIONS AFTER INGUINAL HERNIA REPAIR

Background: Nerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain. The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy and chronic postoperative inguinal pain (CPIP) after 6 months Material: A total of 115 patients, who underwent inguinal hernia mesh repair between July 2018 and January 2019, were included in this prospective observational study. The mean Age and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most of the hernias were direct (59.1%) and of medium dimension (47.8%). These patients were undergoing Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation. Results: Identification rates of the Iliohypogastric (IH), Ilioinguinal (II) And Genitofemoral (GF) nerves were 72.2%, 82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant higher in patients with BMI<25 than BMI ≥25 P (<0.05). After inguinal hernia mesh repair, eighteen patients (17.47%) had chronic postoperative inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome (14 patients, 13.59%). In eight patients’ pain was probably of neuropathic origin (33%). In the other ten patients (67%) pain was probably of neuropathic origin. The relation between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was not significant (p=0.542). Conclusion:The anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically significant higher IH nerve prevalence in patients with BMI<25; probably the identification of inguinal nerve is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is that the prevalence of chronic pain is higher when the nerves were not identified

Dermatome mapping test in the analysis of anatomo-clinical correlations after inguinal hernia repair

Abstract Background: Nerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain. The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy and chronic neuropathic postoperative inguinal pain (CPIP) after 6 months. Material: A total of 115 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh repair) between July 2018 and January 2019, were included in this prospective observational study. The mean age and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most of the hernias were direct (59.1%) and of medium dimension (47.8%). Furthermore, these patients were undergoing Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation. Results: Identification rates of the iliohypogastric (IH), ilioinguinal (II) and genitofemoral (GF) nerves were 72.2%, 82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant higher in patients with BMI < 25 than BMI ≥ 25 P (< 0.05). After inguinal hernia mesh repair, 8 patients (6.9%) had chronic postoperative neuropathic inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome. The relation between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was not significant (P = 0.542). Conclusion: The anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically significant higher IH nerve prevalence in patients with BMI < 25; probably the identification of inguinal nerve is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is that the prevalence of chronic pain is higher when the nerves were not identified. Keywords: Inguinal hernia, Inguinal nerves, Nerve identification, Pain, Follow-up © Th

AUTORITENZIONE DEL RISCHIO PROFESSIONALE IN UMBRIA: ESPERIENZA DELL\u2019AZIENDA OSPEDALIERA \u201cSANTA MARIA\u201d DI TERNI. STUDIO DI 310 CASI

Negli anni recenti si \ue8 assistito ad un considerevole incremento delle richieste di risarcimento per med-mal. Questo incremento ha causato un aumento dei premi assicu- rativi, fino a divenire insostenibili da parte del SSN. In seguito a questa situazione le Regioni hanno adottato metodi assicurativi alternativi in ambito sanitario, come ad esempio il sistema di autoritenzione. Il presente studio si \ue8 posto come obiettivo l\u2019analisi delle richieste di risarcimento per med-mal pervenute all\u2019Azienda Ospedaliera Santa Maria di Terni dal 27 ottobre 2013 (data di entrata in vigore del sistema autoritentivo in Umbria) al 31 dicembre 2018, al fine di studiare l\u2019andamento del contenzioso, i reparti pi\uf9 sinistrosi, il tipo di errore pi\uf9 frequente, i tempi e i costi del sistema autoritentivo. Ne sono emersi numerosi ed interessanti risultati

L\u2019omicidio volontario a TERNI dal 2010 al 2018: casistica autoptica e comparazione con precedente studio.

l presente studio si \ue8 posto come obiettivo quello di esaminare il fenomeno dell\u2019omicidio volontario nella citt\ue0 di Terni nel periodo che va dal 2010 al 2018, integrando poi i dati ottenuti con quelli di un analogo studio condotto in precedenza dall\u2019Istituto di Medicina Legale di Terni relativo al periodo 1984-2009. I dati analizzati sono stati estrapolati a partire da sopralluoghi giudiziari, ispezioni cadaveriche esterne, autopsie giudiziarie, sentenze del GIP, della Corte d\u2019Appello, della Suprema Corte di Cassazio- ne. Ai fini dello studio sono stati individuati un totale di 11 casi di omicidio volontario perpetrati in questo periodo di 9 anni, con una media di 1,07 omicidi/anno/100.000 abitanti, maggiore rispetto alla media nazionale, che si attesta a 0,79 omicidi/anno/ 100.000 abitanti. L\u2019integrazione con lo studio precedente ha mostrato inoltre un trend in crescita nel numero di omicidi volontari a Terni, che \ue8 passato da 0,5 omicidi/anno/ 100.000 abitanti del quinquennio 1994-1998 a 1,4 omicidi/anno/100.000 del quinquennio 2014-2018. Le vittime sono risultate soprattutto di sesso maschile (55%); nei casi di omicidi perpetrati contro donne l\u2019omicidio ha avuto luogo prevalentemente in un\u2019abitazione privata, mentre nel caso degli uomini, in una pubblica via. Gli autori del delitto sono risultati uomini nella totalit\ue0 dei casi, sottolineando per\uf2 che in 2 casi l\u2019autore risulta ad oggi sconosciuto. Si \ue8 registrato inoltre, gi\ue0 a partire dai primi anni 2000, un aumento sia di vittime che di assassini di nazionalit\ue0 straniera, che, in quest\u2019ultimo caso, sono risultati in numero superiore rispetto a quelli di nazionalit\ue0 italiana; dato assolutamente coerente con l\u2019incremento dei flussi migratori che hanno riguardato anche la citt\ue0 di Terni. Le armi principalmente utilizzate sono state armi da punta e da taglio, seguite da armi da fuoco e mezzi contundenti, mentre il ricorso all\u2019asfissia meccanica \ue8 stato infrequente. Il teatro dell\u2019omicidio \ue8 rappresentato soprat- tutto da abitazioni ad uso privato, e il movente \ue8 stato prevalentemente di natura passionale; tali riscontri, se consideriamo anche che nella maggior parte dei casi la vittima conosceva il proprio assassino, sono fortemente suggestivi della dimensione \u201cdomestica\u201d del reato di omicidio volontario, e permette di affermare come Terni sia una citt\ue0 a basso di tasso di criminalit\ue0 violenta

Media-Based Research on Selfie-Related Deaths in Italy

The incidence of taking selfies and sharing them on social media as well as selfie-related dangerous behaviors is increasing, particularly among young people, also leading to selfie-related trauma and death. This study was performed to obtain epidemiological characteristics of selfie-related mortality in Italy