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The insights of Modigliani and Miller (Am Econ Rev 53:433–443, 1963) and Miles and Ezzell (15:719–730, https://doi.org/10.2307/2330405, 1980) on the cost of capital of firms rank among the most important results in financial theory. The underlying assumptions regarding the financial policy, however, can hardly be reconciled with empirical findings. We investigate the implications of an alternative approach that is characterized by a fixed payout ratio. By introducing additional assumptions about investment opportunities, we find relationships between the cost of equity of levered and unlevered firms. The results contribute to explaining empirical findings and open the possibility to base valuation techniques on realistic and yet practicable assumptions.

Aim “Sublay mesh placement is the gold standard in the treatment of incisional hernias. In open surgery, high rates of wound complications are reported. Various minimal invasive procedures with extraperitoneal mesh placement (MIPEX) are currently under evaluation in order to improve the clinical results. We report our experience with an increased use of MIPEX techniques” Material and Methods “The perioperative results of all consecutive patients from 1/2018 to 4/2021with incisional hernia surgery were reviewed. For the purpose of this study, the results of patients with MIPEX were compared to STANDARD treatment (open surgery and/or intraperitoneal mesh). All patient data were registered prospectively in the Herniamed database. ” Results “103 out of 170 patients were treated with MIPEX and 67 with STANDARD. MIPEX were MILOS/E-MILOS (n = 48), TAPP (n = 15), laparoscopic sublay (n = 5), ETEP (n = 17) and other (n = 18) with additional TAR in (n = 16). Five procedures were performed robotically. Mean duration of surgery (DOS) was 150 minutes in MIPEX and 116 minutes in STANDARD (n.s.). Morbidity was 7% in MIPEX and 19% in Standard (p Conclusions “MIPEX included a broad spectrum of procedures. With the implementation of MIPEX, DOS increased significantly in large hernias. Morbidity and LHS were significantly reduced in all patients.”

Aim Parastomal hernias are complex findings with a high recurrence rate. Various methods were described for surgical repair. A new method for the treatment of parastomal hernias with extraperitoneal mesh placement was published in 2016 (Pauli et al.). Recently, open retromuscular repair has been shown to be safe, effective and durable (Beffa et al. 2017). Still, there are concerns regarding mesh related complications (Tastaldi et al. 2017). Material and Methods All patients who underwent an open or laparoscopic modified retromuscular Sugarbaker parastomal hernia repair at our institution were identified. We describe the patient characteristics, operative details, perioperative results and the follow-up. Results Between January 2018 to May 2021 14 patients received surgical repair for parastomal hernia at our institution. Eight of these patients received retromuscular extraperitoneal mesh placement (4 open, 4 laparoscopic) in the aforementioned technique. The median age was 72 years (65 – 85) and the median BMI was 31 kg/m² (26 – 34). Six patients had a urostomy and two had a colostomy. One patient had a recurrent parastomal hernia after previous intraabdominal mesh repair. The median operating time was 223 minutes (144 – 425). Median Mesh size was 300 cm² (225 – 750). Two minor complications (Clavien-Dindo Classification Grade II) demanding pharmacological treatment. The median hospital stay was 8 days (4 – 17). Median follow up was 17 month (range 1 – 26). Recurrence rate was 25 %. Conclusions The modified retromuscular sugerbaker technique seems to be safe and feasible as shown by our data. Due to the extraperitoneal mesh position, we see fundamental methodological advantages. Further studies are necessary for long-term results.

Aim Repair of inguinal hernia is one of the most common operations in general surgery in industrialized countries. Isolated spermatic cord liposarcoma is a very rare soft tissue tumor. Despite standardized diagnostic algorithms for inguinal hernia, it could be difficult to predict such a rare finding. Material and Methods We report a case of inadvertent inguinal liposarcoma excision during hernia surgery in a 72-year-old male patient. Except for polyposis coli there were no further illnesses. Results After a minimal invasive transabdominal preperitoneal (TAPP) repair of a symptomatic inguinal hernia last year a persistent scrotal swelling developed. Computed tomography (CT) showed a protrusion of fatty tissue into the scrotal sac. Diagnosis of scrotal hernia was made. We performed an open Lichtenstein procedure. The final pathologic examination revealed a highly differentiated liposarcoma. Staging was completed and the case was presented to a multidisciplinary sarcoma tumor board at our institution. As recommended, a inguinal reoperation was performed with wide excision. Conclusions Although a very rare condition, spermatic cord liposarcoma should be considered as a possible differential diagnosis for inguinal hernia surgery.

A systematic investigation of the coordination behavior of Pn complexes towards the main group Lewis acids Tl+ and In+ is presented. While the reaction of the tetrahedral P2 complex [{CpMo(CO)2}2(μ,η2:η2-P2)] (A1) with Tl[TEF] ([TEF] = [Al{OC(CF3)3}4]-) leads to the formation of the dicationic complex [Tl2(A1)6]2+ (1) with a central six-membered Tl2P4 ring, the analogous reaction with In[TEF] leads instead to a tetranuclear [In4(A1)8]4+ complex (3) exhibiting a weak InI-InI interaction in the solid state. When the Cp*-analogous P2 complex [{Cp*Mo(CO)2}2(μ,η2:η2-P2)] (A2) is reacted with Tl[TEF] the dinuclear complex [Tl2(A2)4]2+ (2) is formed, containing only four P2 ligands but also featuring a six-membered Tl2P4 ring motif. From the reactions of the cyclo-P3 complexes [CpM'(CO)2(η3-P3)] (M' = Cr (B1), Mo (B2)) with In[TEF] and Tl[TEF], a series of four isostructural one-dimensional coordination polymers (4a-d) are obtained which exhibit a novel bridging coordination mode of the cyclo-P3 ligands in the solid state. Additionally, the mixed PmSn ligand complex [(Cp*Mo)2(μ,η3:η3-P3)(μ,η2:η2-PS)] (C) was reacted with Tl[TEF] to afford a novel one-dimensional coordination polymer (5), which shows an unprecedented bridging s-1,3-coordination mode of ligand C towards Tl+. The compounds were analyzed by single-crystal X-ray structure determination, elemental analysis, and mass spectrometry, as well as by multinuclear NMR and IR spectroscopy. All products are readily soluble in CH2Cl2, despite in many cases being polymeric in the solid state. Multinuclear NMR spectroscopy suggests a highly dynamic coordination behavior in solution, including fast equilibria between different monomeric species, which is also supported by DFT calculations. The one-dimensional polymers 4c and 4d reveal a triplet in the 31P{1H} MAS NMR spectrum at room temperature, which could be explained by fast rotation of the P3 rings in the solid state.

In a radiotherapy department having more than one linear accelerator, it is rather common to match the dose output of all machines. In particular, the recently developed flattening filter free mode requires new investigations regarding the feasibility of matching and the consequences for quality assurance and workload. This refers also to the beam model of the radiotherapy treatment planning system. Our results show that matching is possible not only for flat beams but also for flattening filter free mode. Therefore, the machines can substitute each other in the case of breakdown or service without new treatment planning even in the case of complex intensity-modulated radiotherapy or volumetric-modulated arc therapy. The quality assurance is reduced to only one data set for both the linear accelerators and the radiotherapy treatment planning system.