Wound Failure in Laparotomy: New insights

__Abstract__ Wound failure is a common complication of abdominal surgery. Its clinical presentation can vary from superficial wound dehiscence to burst abdomen with intraabdominal organs protruding through the wound. In long term, incisiona

Being in Transit: Life, Death, and the Politics of Migrant Journeys from Central America to the United States

Every year, hundreds of thousands of migrants from El Salvador, Guatemala, Honduras, and Nicaragua risk their lives traveling to and toward the U.S. Long before reaching the U.S.-Mexico border, however, they travel thousands of miles across Central America and Mexico, often stopping off in migrant shelters scattered along the way. Whether travelling by foot or riding atop large freight trains known as “the Beast,” migrants spend weeks, months, and even years in transit, navigating a dense landscape of hardening borders and immigration enforcement in Mexico and the U.S. while encountering incredible dangers along the way, such as assault, extortion, kidnapping, robbery, and murder. This dissertation argues that migration journeys and the places between origin and destination are now key to making sense of the migration process and of migrants’ experiences with displacement, governance, mobility, and violence, as these dynamics increasingly play out in such spaces and as migrants spend more time in transit. Previous journalistic and scholarly accounts of these journeys have typically been framed around tragedy and violence, diminishing migrants’ agency and reducing them to individuals incapable of experiencing anything but tragedy and violence. Deviating from these accounts, this dissertation examines violence and insecurity along migrants’ journeys, as well as their resiliency and resourcefulness, to show that there is much more to migration journeys and to thereby shed light on forms of agency, resistance, and meaning-making that emerge in and through the act of transit. In doing so, it attempts to humanize migrants and to recognize the complexity of their journeys, thus adding depth and nuance to understandings of migrants and of the migration process often rendered lifeless, overly-simplistic, and one-dimensional by journalists and scholars alike

Intraperitoneal chemotherapy for peritoneal metastases : an expert opinion

Introduction: The rationale for intraperitoneal (IP) drug delivery for patients with peritoneal metastases (PM) is based on the pharmacokinetic advantage resulting from the peritoneal-plasma barrier, and on the potential to adequately treat small, poorly vascularized PM. Despite a history of more than three decades, many aspects of IP drug delivery remain poorly studied. Areas covered: We outline the anatomy and physiology of the peritoneal cavity, including the pharmacokinetics of IP drug delivery. We discuss transport mechanisms governing tissue penetration of IP chemotherapy, and how these are affected by the biomechanical properties of the tumor stroma. We provide an overview of the current clinical evidence on IP chemotherapy in ovarian, colorectal, and gastric cancer. We discuss the current limitations of IP drug delivery and propose several potential areas of progress. Expert opinion: The potential of IP drug delivery is hampered by off-label use of drugs developed for systemic therapy. The efficacy of IP chemotherapy for PM depends on cancer type, disease extent, and mode of drug delivery. Results from ongoing randomized trials will allow to better delineate the potential of IP chemotherapy. Promising approaches include IP aerosol therapy, prolonged delivery platforms such as gels or biomaterials, and the use of nanomedicine

Intramyocardial Bone Marrow Cell Injection: Clinical and Functional Effects in Ischemic Heart Disease

Coronary artery disease is a major cause of mortality and morbidity in the western world. Despite successive revascularization procedures, a large number of patients ends up with end-stage coronary artery disease, not amenable for conventional revascularization. These patients often have stress-inducible myocardial ischemia, resulting in disabling complaints of angina, refractory to medical treatment. Intramyocardial bone marrow cell injection is currently under investigation as a new therapeutic option for these patients. This treatment aims to improve myocardial perfusion and contractile function (and decrease anginal complaints) through administration of bone marrow cells into ischemic myocardium. In the current thesis, the use of intramyocardial bone marrow cell injection for the treatment of chronic myocardial ischemia is evaluated several studies. First, the results of a randomized, placebo controlled, double-blinded trial are described, demonstrating that bone marrow cell injection is associated with a reduction in angina complaints, improved myocardial perfusion and increased left ventricular function. Furthermore, the effects of intramyocardial bone marrow cell injection were further explored by evaluating changes in diastolic function, cardiac innervation, and left ventricular synchronicity. In addition, the long term effects of bone marrow cell injection are described.Financial support by Abbott Vascular, Chipsoft BV, Orbus International BV, Medis medical Imaging systems BV and Biosense Webster Inc. (a Johnson and Johnson Medical Company) for the publication of this thesis is gratefully acknowledgedUBL - phd migration 201

Aneurysm of the Superior Posterior Pancreatic-Duodenal Artery Presenting with Recurrent Syncopes

We present a 61-year-old woman with hypovolemic shock due to a ruptured aneurysm of the superior posterior pancreatic-duodenal artery in whom recurrent syncopes were the first presenting sign of pancreatic-duodenal artery aneurysm (PDAA). PDAA is a rare but life-threatening condition. The widely varying symptomatology may lead to a delay in diagnosis and treatment. Patients with atypical symptoms, such as vague abdominal pain, recurrent dizziness or syncope, may actually suffer from a sentinel bleeding of the vascular malformation. Radiological imaging, especially selective angiography, may provide a diagnostic as well as a therapeutic tool in these patients

Patient awareness and symptoms from an incisional hernia

Incisional hernia is a common postoperative complication following open abdominal surgery with incidence varying between 3% and 20%.1 Approximately half of all incisional hernias are diagnosed within 1 year following surgery. In the United Kingdom alone, about 10,000 incisional hernia repairs are performed annually. Incisional hernia repairs are generally elective with emergency repair due to incarceration or strangulation constituting about 15% of repairs.1 Incisional hernia repair is not a low-risk operation and generally has relatively poor results due to chronic postoperative pain and high recurrence rates.2−3 Little has been published on patients' awareness of incisional hernia following open abdominal surgery. Moreover, there are very few publications on indications for incisional hernia repair and on the natural course of such hernias. The literature suggests that symptoms and complaints usually presented by patients include pain, discomfort, cosmetic complaints, skin problems, incarceration, strangulation, functional disability, and pulmonary dysfunction.4−6 The aim of this study was to investigate whether patients were aware that they had a hernia. In addition, we sought to determine symptoms for those who knew that they had an incisional hernia

A case of split notochord syndrome: a child with a neuroenteric fistula presenting with meningitis

The authors describe a case of split notochord syndrome with a neuroenteric fistula in a newborn presenting with meningitis. Associated anomalies included agenesis of the corpus callosum, short colon, malrotation, epispadias, and an abnormally high bifurcation of the abdominal aorta and inferior vena cava. The embryological mechanisms and etiologic theories are discussed in short