The TREPP as alternative technique for recurrent inguinal hernia after Lichtenstein's repair: A consecutive case series

BACKGROUND: Recurrent inguinal hernias after initial repair with mesh are preferably treated via an alternative route (e.g. posterior after anterior). For recurrent inguinal hernias after an anterior repair such as Lichtenstein's, an endoscopic approach such as the total extraperitoneal or transabdominal preperitoneal technique (TEP or TAPP) is recommended if expertise is present. The TransREctus sheath PrePeritoneal (TREPP) technique is a promising open posterior technique and could be an alternative to endoscopic methods. This study aims to evaluate the results of the TREPP technique for recurrent inguinal hernia. MATERIALS AND METHODS: Consecutive patients who underwent a TREPP repair for recurrent hernia after initial operation according to Lichtenstein were included in a retrospective manner. A minimum of one year follow-up after the TREPP repair was maintained. Data retrieved from the patient files were combined with the findings at an outpatient department visit. RESULTS: Between January 2006 and December 2013 fifty-two patients were eligible for inclusion of which 38 patients were clinically evaluated. The mean follow-up of these thirty-eight patients was 65 months (range 17-108 months) in which 2 patients had developed a re-recurrence. One patient reported chronic postoperative inguinal pain (CPIP) since the TREPP and four patients experienced CPIP since the primary inguinal hernia repair. Peri-operative and <30 day complications were rare and no severe adverse events occurred. CONCLUSION: TREPP seems to be a feasible alternative for recurrent inguinal hernia repair after an initial operation according to Lichtenstein. It may yield extra advantages compared to endoscopic repairs, such as a short learning curve, spinal anesthesia and lower costs

Case series of recurrent inguinal hernia after primary TREPP repair: re-TREPP seems feasible and safe

Item does not contain fulltextINTRODUCTION: The Trans REctussheath PrePeritoneal (TREPP) mesh repair was introduced in 2006 to decrease the risk of postoperative inguinal pain in hernia surgery. For the repair of a recurrent inguinal hernia after a primary TREPP an alternative open anterior route (Lichtenstein) may seem the most logical option, but coincides with an increased risk of chronic postoperative inguinal pain. Therefore, this study aimed to evaluate the feasibility of a second TREPP procedure to repair a recurrent inguinal hernia after an initial TREPP repair. METHODS: Consecutive patients with a recurrent inguinal hernia after a primary TREPP, repaired by a re-TREPP were retrospectively included in the study. Data, retrieved from the electronic patient files, were combined with the clinical findings at the outpatient department where the patients were physically investigated according to a priorly written and registered protocol. RESULTS: Overall about 1800 TREPPs were performed between 2006 and 2013. Since the introduction of TREPP in 2006, 40 patients presented with a recurrence in our center. From this group 19 patients were re-operated with the TREPP technique. No intraoperative complications occurred. There was one conversion from re-TREPP to Lichtenstein and no re-recurrences occurred to date. Ten out of 19 patients could be clinically evaluated with a mean follow-up period of 37 months (range 11-95). None of these patients (n=10) complained of chronic postoperative inguinal pain. Two patients reported discomfort. One patient died non procedure related, three weeks after re-TREPP of sudden cardiac death. CONCLUSION: These first experiences with re-TREPP for secondary inguinal hernia repair are encouraging for the aspects of feasibility and safety, particularly in experienced surgical hands

Equatorial electron density measurements in Saturn’s inner magnetosphere

International audienceUpper hybrid resonance emissions detected by theRadio and Plasma Wave Science (RPWS) instrument on theCassini spacecraft are used to obtain electron densities onfive equatorial orbits of Saturn at radial distances rangingfrom 3 to 9 saturnian radii (RS). The electron density profilesfor these orbits show a highly repeatable radial dependencebeyond 5 RS, decreasing with increasing radial distanceapproximately as (1/R)3.63. Inside 5 RS, the electron densityprofiles are highly variable. We show that these radialvariations are consistent with a centrifugally-drivenoutward transport of plasma from a source inside 5 RS

Identification of electron field-aligned current systems in Saturn's magnetosphere

Based on the analysis of 7 years of Cassini electron plasma spectrometer data near Saturn's equatorial plane, we computed the average directional electron current in the Northern and the Southern hemispheres separately. We determined the net current density by subtracting the downward electron current density (equator to the ionosphere) from the upward electron current density (ionosphere to the equator). From the symmetric analysis (no separation in local time), we identified: (1) layers of net upward current carried by the thermal electrons (1–10 eV) in both hemispheres inside 5–8 RS (Saturn Radius = 60,268 km) (region A) and (2) layers of net downward current carried by a population of warmer electrons (10–400 eV) inside 8–10 RS (region B). From the analysis of the currents organized by local time (dayside and nightside parsing), new features were identified such as (1) a day-night asymmetry of the current carried by the warm and hot (400 eV–26,000 eV) electrons beyond 10 RS (region C), and (2) the possible existence of inter-hemispheric currents directed from the Southern to the Northern hemisphere inside 4 RS (region A) and oppositely directed at about 13–15 RS (region C). Our interpretation is that the observed current system results from the superimposition of (1) a current system associated with the corotation enforcement, (2) a current system linked to the presence of the newly identified noon-to-midnight convection electric field and (3) a system of inter-hemispheric currents driven by the thermosphere-ionosphere. We finally discuss the relation of the observed currents with the newly identified Saturn's secondary auroral emissions

Development of a clinical practice guideline for orthodontically induced external apical root resorption

Contains fulltext : 220428.pdf (Publisher’s version ) (Open Access)OBJECTIVES: To develop a clinical practice guideline on orthodontically induced external apical root resorption (EARR), with evidence-based and, when needed, consensus-based recommendations concerning diagnosis, risk factors, management during treatment, and after-treatment care. MATERIALS AND METHODS: The Appraisal of Guidelines for Research and Evaluation II instrument and the Dutch Method for Evidence-Based Guideline Development were used to develop the guideline. Based on a survey of all Dutch orthodontists, we formulated four clinical questions regarding EARR. To address these questions, we conducted systematic literature searches in MEDLINE and Embase, and we performed a systematic literature review. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. After discussing the evidence, a Task Force formulated considerations and recommendations. The drafted guideline was sent for comments to all relevant stakeholders. RESULTS: Eight studies were included. The quality of evidence (GRADE) was rated as low or very low. Only the patient-related risk factors, 'gender' and 'age', showed a moderate quality of evidence. The Task Force formulated 13 final recommendations concerning the detection of EARR, risk factors, EARR management during treatment, and after-treatment care when EARR has occurred. Stakeholder consultation resulted in 51 comments on the drafted guideline. After processing the comments, the final guideline was authorized by the Dutch Association of Orthodontists. The entire process took 3 years. LIMITATIONS: The quality of the available evidence was mainly low, and patient-reported outcome measures were lacking. CONCLUSIONS/IMPLICATIONS: This clinical practice guideline allows clinicians to respond to EARR based on current knowledge, although the recommendations are weak due to low-quality evidence. It may reduce variation between practices and aid in providing patients appropriate information

Drifting field-aligned density structures in the night-side polar cap.

Spatio-temporal properties of density irregularities inthe night-side polar cap are inferred from multi-pointobservations of auroral hiss at a radial distance of 5 Earthradii. In this case study, we use high resolution data ofthe wave instruments onboard the four Cluster spacecraftto estimate the local plasma density, obtaining valuesclose to 1 cm3 with density depletions decreasing downto 0.15 cm3. Combined analysis in different points inspace conclusively shows for the first time that thesedensity structures are field-aligned and that theypredominantly drift in the anti-sunward direction at speedsof a few km/s. This corresponds to a dawn-to-dusk convectionelectric field of approximately 1 mV/m. The transversedimension of the observed density depletions, mapped downto the ionospheric heights, is of the order of a few tens of km.Their lifetime is probably longer than tens of seconds

Plasmasphere dynamics in the duskside bulge region: a new look at an old topic

Data acquired during several multiday periods in 1982 at ground stations Siple, Halley, and Kerguelen and on satellites DE 1, ISEE 1, and GEOS 2 have been used to investigate thermal plasma structure and dynamics in the duskside plasmasphere bulge region of the Earth. The distribution of thermal plasma in the dusk bulge sector is difficult to describe realistically, in part because of the time integral manner in which the thermal plasma distribution depends upon the effects of bulk cross-B flow and interchange plasma flows along B. While relatively simple MHD models can be useful for qualitatively predicting certain effects of enhanced convection on a quiet plasmasphere, such as an initial sunward entrainment of the outer regions, they are of limited value in predicting the duskside thermal plasma structures that are observed. Furthermore, use of such models can be misleading if one fails to realize that they do not address the question of the formation of the steep plasmapause profile or provide for a possible role of instabilities or other irreversible processes in plasmapause formation. Our specific findings, which are based both upon the present case studies and upon earlier work, include the following: (1) during active periods the plasmasphere appears to become divided into two entities, a main plasmasphere and a duskside bulge region. The latter consists of outlying or outward extending plasmas that are the products of erosion of the main plasmasphere; (2) in the aftermath of an increase in convection activity, the main plasmasphere tends (from a statistical point of view) to become roughly circular in equatorial cross section, with only a slight bulge at dusk; (3) the abrupt westward edge of the duskside bulge observed from whistlers represents a state in the evolution of sunward extending streamers; (4) in the aftermath of a weak magnetic storm, 10 to 30% of the plasma ''removed'' from the outer plasmasphere appears to remain in the afternoon-dusk sector beyond the main plasmasphere. This suggests that plasma flow from the afternoon-dusk magnetosphere into the boundary layers is to some extent impeded, possibly through a mechanism that partially decouples the high altitude and ionospheric-level flow regimes; (5) outlying dense plasma structures may circulate in the outer duskside magnetosphere for many days following an increase in convection, unless there is extremely deep quieting; (6) a day-night plasmatrough boundary may be identified in equatorial satellite data; (7) factor-of-2-to-10 density irregularities appear near the plasmapause in the postdusk sector in the aftermath of weak magnetic storms; (8) during the refilling of the plasmatrough from the ionosphere at L = 4.6, predominantly bidirectional field aligned and equatorially trapped light ion pitch angle distributions give way to a predominantly isotropic distribution (as seen by DE 1) when the plasma density reaches a level a factor of about 3 below the saturated plasmasphere level; (9) some outlying dense plasma structures are effectively detached from the main plasmasphere, while others appear to be connected to that body

The electron density of Saturn's magnetosphere

International audienceWe have investigated statistically the electron density below 5 cm−3 in the magnetosphere of Saturn (7–80 RS, Saturn radii) using 44 orbits of the floating potential data from the RPWS Langmuir probe (LP) onboard Cassini. The density distribution shows a clear dependence on the distance from the Saturnian rotation axis (√X2+Y2) as well as on the distance from the equatorial plane (|Z|), indicating a disc-like structure. From the characteristics of the density distribution, we have identified three regions: the extension of the plasma disc, the magnetodisc region, and the lobe regions. The plasma disc region is at LS. The magnetodisc is located beyond L=15, and its density has a large variability. The variability has quasi-periodic characteristics with a periodicity corresponding to the planetary rotation. For Z>15 RS, the magnetospheric density distribution becomes constant in Z. However, the density still varies quasi-periodically with the planetary rotation also in this region. In fact, the quasi-periodic variation has been observed all over the magnetosphere beyond L=15. The region above Z=15 RS is identified as the lobe region. We also found that the magnetosphere can occasionally move latitudinally under the control of the density in the magnetosphere and the solar wind. From the empirical distributions of the electron densities obtained in this study, we have constructed an electron density model of the Saturnian nightside magnetosphere beyond 7 RS. The obtained model can well reproduce the observed density distribution, and can thus be useful for magnetospheric modelling studies

The inner magnetosphere of Saturn: Cassini RPWS cold plasmaresults from the first encounter

We present new results from the inner magnetosphereof Saturn obtained by the Radio and Plasma Wave Science(RPWS) investigation onboard Cassini around the period ofthe Saturn orbit injection (July 1, 2004). Plasma waveelectric field emissions, voltage sweeps by the Langmuirprobe (LP) and radio sounder data were used to infer thecold plasma (<100 eV) characteristics within 20 RSofSaturn. A dense (<150 cm3) and cold (<7 eV) plasma toruswas found just outside the visible F-ring. This torus ofpartly dusty plasma does not perfectly co-rotate with Saturn,which suggests the cold plasma is electro-dynamicallycoupled to the charged ring-dust particles. The spacecraftpotential was a few volts negative above the E- and G-rings,indicating the dust-particles were likewise negativelycharged. The cold ion characteristics changed near themagnetically conjugate position of Dione, indicating releaseof volatile material from this icy moon