Intestinal perforation after surgical treatment for incisional hernia. iatrogenic or idiopathic?

Intestinal perforation (IP) is a life-threatening gastroenterological condition requiring urgent surgical care, which may present itself as an uncommon complication following incisional hernia repair surgery, most often because of iatrogenic traumatism occurring during the procedure. However, we report a case where a spontaneous onset can be hypothesised. A 60-years-old patient underwent repair of an abdominal laparocele, through rectus abdominis muscle plasty, 5 years after development of an incisional hernia due to exploratory laparotomy for the treatment of acute appendicitis. Xipho-pubic scar was excised and umbilicus and supra-umbilical hernia sac dissected, a linear median incision was performed along the sub-umbilical linea alba, reaching preperitoneal plane to assess any intestinal loop adherence to the abdominal wall. After limited viscerolysis, abdominal wall defect was corrected by 'rectus abdominis muscle plasty' and umbilicus reconstruction by Santanelli technique. Postoperative course was uneventful until Day 29, with sudden onset of epigastric pain, fever and bulge. Sixty cubic centimeter pus was drained percutaneously and cavity was rinsed with a 50% H2O2 and H2O V-V solution until draining clear fluid. Symptoms recurred two days later, while during rinsing presented dyspnoea. X-Ray and CT scan diagnosed IP, and she underwent under emergency an exploratory laparotomy, leading to right hemicolectomy extended to last ileal loops and middle third of the transverse, right monolateral salpingo-ovariectomy and a temporary ileostomy by general surgeon. Twenty-three days later an ileostomy reversal surgery was performed and 8 days after she was discharged. At latest follow-up patient showed fair conditions, complaining abdominal pain and diarrhoea, attributable to the extensive intestinal resection. IP following incisional hernia repair, is reported as uncommon and early postoperative complication. In our case, the previous regular postoperative course with late onset lead us to hypothesise a possible idiopathic etiopathogenesis, because of a strangulation followed by gangrene and abscess formation, which might begin before the incisional hernia repair and unnoticed at the time surgery was performed

Morphology of low-redshift compact galaxy clusters I. Shapes and radial profiles

The morphology of clusters of galaxies may be described with a set of parameters which contain information about the formation and evolutionary history of these systems. In this paper we present a preliminary study of the morphological parameters of a sample of 28 compact Abell clusters extracted from DPOSS data. The morphology of galaxy clusters is parameterized by their apparent ellipticity, position angle of the major axis, centre coordinates, core radius and beta-model power law index. Our procedure provides estimates of these parameters by simultaneously fitting them all, overcoming some of the difficulties induced by sparse data and low number statistics typical of this kind of analysis. The cluster parameters were fitted in a 3 x 3 h^-2 sqMpc region, measuring the background in a 2 <R< 2.5 h^-1Mpc annulus. We also explore the correlations between shape and profile parameters and other cluster properties. One third of this compact cluster sample has core radii smaller than 50 h^-1 kpc, i.e. near the limit that our data allow us to resolve, possibly consistent with cusped models. The remaining clusters span a broad range of core radii up to 750 h^-1 kpc. More than 80 per cent of this sample has ellipticity higher than 0.2. The alignment between the cluster and the major axis of the dominant galaxy is confirmed, while no correlation is observed with other bright cluster members. No significant correlation is found between cluster richness and ellipticity. Instead, cluster richness is found to correlate, albeit with large scatter, with the cluster core radius.[abridged]Comment: 23 pages, 17 figures, accepted for publication in MNRAS. Full paper including full resolution figures 2 and 9 at http://www.eso.org/~vstrazzu/P/ME1030fv.pd

Intermittent and periodic fasting, hormones, and cancer prevention

The restriction of proteins, amino acids or sugars can have profound effects on the levels of hormones and factors including growth hormone, IGF-1 and insulin. In turn, these can regulate intra-cellular signaling pathways as well as cellular damage and aging, but also multisystem regeneration. Both intermittent (IF) and periodic fasting (PF) have been shown to have both acute and long-term effects on these hormones. Here, we review the effects of nutrients and fasting on hormones and genes established to affect aging and cancer. We describe the link between dietary interventions and genetic pathways affecting the levels of these hormones and focus on the mechanisms responsible for the cancer preventive effects. We propose that IF and PF can reduce tumor incidence both by delaying aging and preventing DNA damage and immunosenescence and also by killing damaged, pre-cancerous and cancer cells