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Amoebiasis is an intestinal and tissue parasitic infection caused by the protozoan Entamoeba histolytica. Despite significant medical importance and worldwide dispersion, little is known about the epidemiology and distinct geographical distribution of various clinical forms of amoebiasis in the world. In this study, we present an amoebiasis case series referred to Avicenne Hospital (Bobigny, France) from 2010 to 2022 followed by an overview of the released literature to explore diverse clinico-pathology of amoebiasis and to update the actual epidemiological situation of this parasitosis worldwide. The referred patients underwent a combination of clinical and parasitological examinations and imaging. The study was followed by an overview of released literature performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. A total of 15 patients with amoebiasis were diagnosed with an average age of 48.5 years old at the occurrence time of infection. Men (78%) were the most affected patients. Most of the cases were reported following a trip to endemic regions, such as Mali, India, Nepal, Algeria, Cameroon or Congo. All of the processed patients exhibited a hepatic amoebiasis. Amoebic abscess was observed in all cases with an average size of 6.3 cm. Of these patients, seven cases (46.7%) benefited from drainage following a risk of rupture or superinfection of the abscess. A compilation of findings extracted from 390 scientific publications via seven major medical databases, allowed us to update the main epidemiological and clinical events that has led to the current worldwide expansion of amoebiasis. We presented a clinical and epidemiological overview of the amoebiasis accompanied with a worldwide illustrative map displaying the current distribution of known amoebiasis foci in each geographical ecozone of Asia, Europe, Africa, Americas, and Australia. Although Metropolitan France is not known as an endemic region of amoebiasis, amoebic liver abscess was the most frequent clinical form observed among our 15 patients processed. Most of infected patients had a history of travel to or lived-in endemic areas before arriving in France. [ABSTRACT FROM AUTHOR]

• It is unclear whether the sFlt-1/PlGF ratio is of added value to standard-of-care analyses performed in multiple pregnancies. • The sFlt-1/PlGF cut-off 38 in addition to urine PCr did not enhance pre-eclampsia prediction in multiple pregnancy. • The sFlt-1/PlGF ratio's impact on morbidity, cost-effectiveness in multiple pregnancies remains debatable. To assess the predictive accuracy of the sFlt-1/PlGF ratio cut-off 38 in addition to the standard-of-care spot urine protein/creatinine ratio (PCr) for multiple pregnancies in women with suspected pre-eclampsia. Post-hoc analysis of a prospective cohort study. Primary outcome was the occurrence of pre-eclampsia in one and four weeks after presentation with suspected pre-eclampsia. Test characteristics with 95% confidence intervals (CI) were calculated on pre-eclampsia development in one and four weeks. Twenty-three multiple pregnancies with suspected pre-eclampsia between 20 and 37 weeks gestation were included for analysis. Women who eventually developed pre-eclampsia had a significantly higher PCr (34.0 vs. 16.5, p = 0.015), sFlt-1 (17033 vs. 5270 pg/ml, p = 0.047) and sFlt-1/PlGF ratio (99 vs. 25, p = 0.033) at baseline. Furthermore, PCr ≥ 30 and sFlt-1/PlGF ratio > 38 was respectively seen in 1/16 (6.3 %) and 3/16 (18.8 %) of the women who did not develop pre-eclampsia. For predicting pre-eclampsia within one week the sFlt-1/PlGF ratio sensitivity was 75.0 % [95 % CI 19.4–99.4] and the negative predictive value 93.8 % [73.0–98.8], while no pre-eclampsia developed when PCr was < 30. Consequently, the combination of these tests did not lead to an improvement in test characteristics, with non-significant differences in positive predictive value (50.0 % [29.5–70.5] versus 80.0 % [37.3–96.4]) compared to PCr alone for pre-eclampsia development in one week. In addition to standard-of-care spot urine PCr measurements, this study has not been able to demonstrate that the sFlt-1/PlGF ratio cut-off 38 is of added value in the prediction of pre-eclampsia in multiple pregnancy. Trial registration: Netherlands Trial Register (NL8308). [ABSTRACT FROM AUTHOR]

Purpose: To compare 5-year outcomes among patients with and without unstable chondral lesions undergoing arthroscopic partial meniscectomy (APM).Methods: Using data from the Chondral Lesions And Meniscal Procedures (ChAMP) Trial, we compared outcomes for patients with unstable chondral lesions found at the time of APM and left in situ (CL-noDeb, N = 71) versus patients without unstable chondral lesions (NoCL, N = 47) at 5 years after APM. Outcomes included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog pain scale, Short-form Health Survey (SF-36), physical knee measurements, progressive joint space narrowing on radiographs, and the rate of additional knee surgery. Multivariate linear regression was used to obtain mean differences (MDs) with corresponding 95% confidence intervals (CIs) adjusted for age, body mass index, and preoperative score (for postoperative scores).Results: Compared with CL-noDeb, NoCL subjects had significantly greater improvement at 5 years in the KOOS score for function in sport and recreation (MD = 9.9 [95% CI, 0.7-19.1]), SF-36 pain (MD = 13.9 [95% CI, 5.5-22.3]), knee extension (MD = 0.8 [95% CI, 0.1-1.5]), and decreased quadriceps circumference at the mid-portion of the patella (MD = -1.5 [95% CI, -2.7 to -0.3). A greater proportion of patients in the NoCL group achieved the MCID for all outcome scores except for the WOMAC pain score (89% CL-NoDeb vs 87% NoCL) and SF-36 general (29% CL-NoDeb vs 23% NoCL). There were no significant group differences in measures of progressive radiographic joint space narrowing in any compartments of the operative knee and no significant difference in the rate of additional knee surgery within 5 years of the initial APM.Conclusions: Patients undergoing APM without unstable chondral lesions had statistically significantly better outcomes than patients with unstable chondral lesions at 5 years after surgery; however, there were no group differences in progressive radiographic joint space narrowing.Level Of Evidence: Level II, prospective comparative study. [ABSTRACT FROM AUTHOR]

• The systematic review identified and assessed factors influencing LVAD adaptation. • Roy's adaptation model (RAM) is useful to organize the factors associated with LVAD adaptation. • The physiological-physical mode is the most researched influencing factor of LVAD adaptation. • The systematic review identified the need for additional research studies in each area of RAM. [ABSTRACT FROM AUTHOR]

the obesity survival paradox is an emergent issue in oncology, but its existence remains unclear particularly in older cancer patients. We aimed to assess the obesity survival paradox in older cancer patients. all consecutive cancer outpatients 65 years and older referred for geriatric assessment (GA) before a decision on cancer treatment between November 2013 and September 2016 were enrolled in the PF-EC cohort study. The main outcome was 6-month mortality. A Cox univariate and multivariate proportional hazard regression models were performed with baseline GA, oncological variables (cancer site, extension and treatment modalities) and C-reactive protein (CRP). We assessed the prognostic value of body mass index categories (i.e. malnutrition <21, 21 ≤ normal weight ≤24.9, 25 ≤ overweight ≤29.9 and obesity ≥30 kg/m2) in the whole study population and according to the metastatic status. 433 patients with a mean age of 81.2 ± 6.0 years were included, 51% were women, 44.3% had digestive cancers, 18% breast cancer and 14.5% lung cancer and 45% metastatic cancers. Eighty-eight of these patients (20.3%) were obese at baseline. Mortality rate was 17% during the 6-month follow-up period. After adjustment for sex, gait speed, Mini-Mental State Examination, cancer site and exclusive supportive care, obesity (compared to normal weight) was independently and negatively associated with 6-month mortality only in metastatic patients (aHR 0.17, 95% CI [0.03–0.92], P = 0.04). our study confirms the obesity survival paradox in older cancer patients only in the metastatic group. [ABSTRACT FROM AUTHOR]

In order to avoid consequences of total splenectomy (including severe postsplenectomy sepsis), partial splenectomy (PS) is increasingly reported. Without guidelines and indications concerning a rarely-indicated procedure, a review of literature should be an asset. A systematic review of all PSs from 1960 to December 2017 was performed, with special focus on surgical indications, sites of resection, approaches and techniques of vascular dissection and parenchymal section/hemostasis of the spleen, perioperative morbidity/mortality, including complications compelling to perform total splenectomy. Among 2130 PSs, indications for resection were hematological disease in 1013 cases and nonhematological conditions in 1078, including various tumors in 142 and trauma in 184. Parenchymal transection was performed using several techniques through the years, most frequently after having induced partial ischemia by splenic hilum vascular dissection/ligation. 371 laparoscopic/robotic PSs were reported. Rescue total splenectomy was required in 75 patients. Although good results are probably overestimated by such a retrospective review, PS should be considered as a procedure associated with a low morbidity/mortality. Nevertheless, severe complications are also reported, and the need of total splenectomy should not to be minimized. Laparoscopic/robotic procedures are increasingly performed, with good results and rare conversions. Systematic review. IV. [ABSTRACT FROM AUTHOR]

Objective Overt hypothyroidism confers an increased risk of non-alcoholic fatty liver disease (NAFLD). The liver plays a crucial role in the metabolism of cholesterol and triglycerides; thyroid hormones interact on hepatic lipid homeostasis. Thyroid function within the euthyroid range affects a number of health issues, including atherosclerosis development and biochemical markers of increased cardiovascular risk. However, the association of thyroid hormones with NAFLD in euthyroid subjects has not been unequivocally established. We therefore determined associations of thyroid hormone parameters with NAFLD among euthyroid subjects. Methods The study was conducted in the Lifelines Cohort Study, a population-based cohort study of participants living in the North of the Netherlands. Only euthyroid subjects (thyroid-stimulating hormone (TSH) 0.5–4.0 mU/L, free thyroxine (FT4) 11–19.5 pmol/L and free triiodothyronine (FT3) 4.4–6.7 pmol/L) older than 18 years were included. Exclusion criteria were participants with excessive alcohol use, known hepatitis or cirrhosis, liver functions ≥ three times the upper limit, current cancer, non-white ancestry, previous or current use of thyroid medication and current use of lipid or glucose lowering medication. A priori defined liver biochemistry, thyroid function parameters and metabolic syndrome (MetS) were studied. NAFLD was defined by using the validated Fatty Liver Index (FLI); FLI ≥ 60 was categorized as NAFLD. A P < 0.01 was considered significant. Results FLI ≥ 60 was found in 4274 (21.1%) of 20,289 individuals (62.1% male, median age 46 years) with increased prevalence of MetS ( P < 0.0001). In age- and sex-adjusted analysis FLI ≥ 60 was independently associated with a higher FT3 (OR 1.34, 95% CI 1.29–1.39, per SD increment, P < 0.0001) and a lower FT4 (OR 0.73, 95% CI 0.70–0.75, P < 0.0001) but not by TSH. The strongest association was found for the FT3/FT4 ratio (OR 1.44, 95% CI 1.39–1.49, P < 0.0001). These associations remained similar after additional adjustment for the presence of MetS. In subjects with enlarged waist circumference, TSH and FT4 were lower while FT3 was higher, resulting in an increased FT3/FT4 ratio ( P < 0.0001). Conclusions Euthyroid subjects with suspected NAFLD are characterized by higher FT3, lower FT4 and higher FT3/FT4 ratio, probably consequent to central obesity. [ABSTRACT FROM AUTHOR]

Background Colon cancer survivors experience physical and psychosocial problems that are currently not adequately addressed. This study investigated distress in patients after curative surgery for colon cancer and studied how this corresponds with the need for supportive care. Methods Prospective cohort of patients with stage I–III colon carcinoma, treated with curative intent, currently in follow-up at 6 different hospitals. A survey recorded symptoms, experienced problems, and (un)expressed needs. Satisfaction with supportive care was recorded. Results Two hundred eighty four patients were included; 155 males and 129 females, with a mean age of 68 years (range 33–95), and a median follow-up of 7 months. 227 patients completed the survey. Patients experienced a median of 23 symptoms in the week before the survey, consisting of a median of 10 physical, 8 psychological and 4 social symptoms. About a third of these symptoms was felt to be a problem. Patients with physical problems seek supportive care in one in three cases, while patients with psychosocial problems only seek help in one in eight cases. Patients who recently finished treatment, finished adjuvant chemotherapy, or had a stoma, had more symptoms and needed more help in all domains. Patients most frequently consulted general practitioners (GPs) and surgeons, and were satisfied with the help they received. Conclusion Colon cancer survivors experience many symptoms, but significantly fewer patients seek help for a psychosocial problem than for a physical problem. Consultations with supportive care are mainly with GPs or surgeons, and both healthcare providers are assessed as providing satisfying care. [ABSTRACT FROM AUTHOR]

Background: Various treatments are currently available for melasma. However, results are often disappointing.Objective: We sought to assess the efficacy and safety of nonablative 1550-nm fractional laser therapy and compare results with those obtained with triple topical therapy (the gold standard).Methods: Twenty female patients with moderate to severe melasma and Fitzpatrick skin types II to V were treated either with nonablative fractional laser therapy or triple topical therapy (hydroquinone 5%, tretinoin 0.05%, and triamcinolone acetonide 0.1% cream) once daily for 8 weeks in a randomized controlled observer-blinded study. Laser treatment was performed every 2 weeks for a total of 4 times. Physician Global Assessment was assessed at 3 weeks, 3 months, and 6 months after the last treatment.Results: Physician Global Assessment improved (P < .001) in both groups at 3 weeks. There was no difference in Physician Global Assessment between the two groups. Mean treatment satisfaction and recommendation were significantly higher in the laser group at 3 weeks (P < .05). However, melasma recurred in 5 patients in both groups after 6 months. Side effects in the laser group were erythema, burning sensation, facial edema, and pain; in the triple group side effects were erythema, burning, and scaling.Limitations: Limitations were: small number of patients; only one set of laser parameters; and a possible difference in motivation between groups.Conclusions: Nonablative fractional laser therapy is safe and comparable in efficacy and recurrence rate with triple topical therapy. It may be a useful alternative treatment option for melasma when topical bleaching is ineffective or not tolerated. Different laser settings and long-term maintenance treatment should be tested in future studies. [ABSTRACT FROM AUTHOR]

To collate and summarize the current international literature on the transplant recipient outcomes of organs from Medical Assistance in Dying (MAiD) donors, as well as the actual and potential impact of organ donation following MAiD on the donation and transplantation system. The provision of organ donation following MAiD can impact the donation and transplantation system, as well as potential recipients of organs from the MAiD donor, therefore a comprehensive understanding of the potential and actual impact of organ donation after MAiD on the donation and transplantation systems is needed. Scoping review using the JBI framework. We searched for published (MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Academic Search Complete), and unpublished literature (organ donation organization websites worldwide). Included references discussed the actual and potential impact of organ donation following MAiD on the donation and transplantation system. All references were screened, extracted and analysed by two independent reviewers. We included 78 references in this review and our finding were summarized across three categories: (1) Impact in the donor pool: (2) statistics on organ donation following MAiD; and (3) potential and actual impact of MAiD on the donation and transplant system. The potential impact of the MAiD donor on the transplant waiting list is relatively small as this process is still rare, however, due to the current organ shortage worldwide the contribution of this procedure should not be disregarded. Additionally, despite being limited, the existing research provided scanty evidence that organs retrieved from MAiD donors are associated with satisfactory graft function and survival rates and that outcomes from transplant recipients are comparable to those of organs from donation following brain death and may be better than those of organs from other types of donation after circulatory determined death. Still, further studies are required for comprehensive and reliable evidence. • Organ donation following Medical Assistance in Dying (OD-MAiD) has the potential to improve the organ shortage. • There is a lack of evidence that outcomes from OD-MAiD may have similar outcomes from other types of deceased donation. • Evidence from this review informs about outcomes from OD-MAiD, and support research work building on existing knowledge. [ABSTRACT FROM AUTHOR]

Life as a family caregiver of patients with cancer can be emotionally and practically challenging. Little is known of whether home-based chemotherapy of patients with acute myeloid leukemia places excessive pressure on family caregivers or decreases their burden. To explore the significance of home-based portable pump chemotherapy for family caregivers of patients newly diagnosed with acute myeloid leukemia. An explorative qualitative design using dyadic and individual semi-structured interviews with family caregivers and patients were followed by thematic analysis. Purposive sampling was used regarding gender, age, and distance to the hospital. At each interview, we were teams of one researcher and one clinical nurse specialist from the hematology department. The derived themes were predominately descriptive, based on patterns in the data. Five couples participated, (aged 39–72 years). Three themes were identified: 1) Going home. 2) Responsibilities due to the pump and leukopenia. 3) The shadow of the life-threatening disease. The pump was a minor concern to the family caregivers seen in the light of the life-threatening disease. Home-based treatment was a relief but the responsibilities due to leukopenia demanded the caregivers' resources. The fear of losing the patient and the burdens of dealing with leukopenia suppressed the family caregivers' sense of load due to the portable pump treatment. The findings underline the importance of healthcare professionals recognizing family caregivers' sense of burden and prioritizing sufficient support and education in order to enhance the everyday life of both patient and family caregiver. • Home-based chemotherapy requires preparation for the consequences of leukopenia. • Home-based chemotherapy decreases the burden of family caregivers. • Programmable portable pump chemotherapy eases the acute myeloid leukemia trajectory. • The fear of losing the patient overshadows the worries related to the portable pump. [ABSTRACT FROM AUTHOR]

Colorectal cancers are common in elderly patients. However, cancer screening is poorly used after 75. Elderly patients form a heterogeneous population with specific characteristics. Standards of care cannot therefore be transposed from young to elderly patients. Tumour resection is frequently performed but adjuvant chemotherapy is rarely prescribed as there are no clearly established standards of care. In a metastatic setting, recent phase III studies have demonstrated that doublet front-line chemotherapy provided no survival benefit. Moreover, several studies have established the benefit of bevacizumab in association with chemotherapy. There is a lack of evidence for the efficacy of anti-epidermal growth factor antibodies in elderly patients. Geriatric assessments could help to select the adequate treatment strategy for individual patients. Geriatric oncology is now the challenge we have to face, and more specific trials are needed. [ABSTRACT FROM AUTHOR]

Aims: To investigate the impact of the UKPDS risk engine on management of CHD risk in T2DM patients.Methods: Observational study among 139 GPs. Data from 933 consecutive patients treated with a maximum of two oral glucose lowering drugs, collected at baseline and after twelve months. GPs estimated the CHD risk themselves and afterwards they calculated this with the UKPDS risk engine. Under- and overestimation were defined as a difference >5 percentage points difference between both calculations. The impact of the UKPDS risk engine was assessed by measuring differences in medication adjustments between the over-, under- and accurately estimated group.Results: In 42.0% the GP accurately estimated the CHD risk, in 32.4% the risk was underestimated and in 25.6% overestimated. Mean difference between the estimated (18.7%) and calculated (19.1%) 10 years CHD risk was -0.36% (95% CI -1.24 to 0.52). Male gender, current smoking and total cholesterol level were associated with underestimation. Patients with an subjectively underestimated CHD risk received significantly more medication adjustments. Their UKPDS 10 year CHD risk did not increase during the follow-up period, contrary to the other two groups of patients.Conclusions: The UKPDS risk engine may be of added value for risk management in T2DM. [ABSTRACT FROM AUTHOR]

Indoor air in homes contains a variety of organic agents such as bacteria, endotoxin and fungi. Epidemiological studies have shown links between these components and respiratory problems and the development of allergies. Twenty-eight dwellings located in the Greater Copenhagen area in Denmark were investigated in this study. Temperature, relative humidity and air exchange rate were measured. Dwelling characteristics including floor area, volume of the living room, floor material, year of construction of buildings and floor level were collected. The microbial exposure was measured by quantifying fungi, bacteria and endotoxin concentration in airborne dust collected by Electrostatic Dust fall Collectors (EDCs). The Total Inflammatory Potential (TIP) of the dust was also measured. Significantly higher concentrations of fungi were found in dwellings with high relative humidity (p = 0.03), larger room volume (p = 0.03) and in dwellings located on the second floor or higher (p = 0.02). Small floor area per person and low air exchange rate were significantly associated with increased concentrations of bacteria (both p < 0.01). Spring season (p = 0.01), buildings constructed before the 20th century (p = 0.09) and wooden floor (p = 0.03) were associated with high TIP. In conclusion, people living in smaller dwellings or in dwellings on upper floors are at higher risk of microbial exposure. While TIP was affected by some dwelling characteristics, it was mainly influenced by season. [ABSTRACT FROM AUTHOR]

Aims Colorectal cancer (CRC) occurs mostly in the elderly. However, the biology of CRC in elderly has been poorly studied. This study examined the prevalence of deficient mismatch repair phenotype (dMMR) and BRAF mutations according to age. Patients and Methods MMR phenotype was prospectively determined by molecular analysis in patients of all ages undergoing surgery for CRC. BRAF V600E mutation status was analysed in a subset of dMMR tumours. Results A total of 754 patients who underwent surgery between 2005 and 2008 were included in the study. Amongst them, 272 (36%) were ≥ 75 years old. The proportion of women < 75 was 38% and that ≥ 75 was 53% ( p < 0.0001). The prevalence of dMMR was 19.4% in patients ≥ 75 and 10.7% in patients < 75 ( p = 0.0017). For patients ≥ 75, the prevalence of dMMR was significantly higher in women than in men (27% vs 10.2%, respectively; p = 0.003) but was similar in women and men < 75 (12.5% vs 9.7%, respectively; p = 0.4). We examined BRAF mutation status in 80 patients with dMMR tumours. The V600E BRAF mutation was significantly more frequent in patients ≥ 75 than in patients < 75 (72.2% vs 11.4%, respectively; p < 0.001). In patients ≥ 75, there was no difference in the prevalence of the BRAF V600E mutation according to sex (78% in women and 70% in men, p = 0.9). Conclusions The prevalence of dMMR in CRC is high in patients over 75. In elderly patients, dMMR tumours are significantly more frequent in women than in men. The BRAF mutation is frequent in elderly patients with CRC. [ABSTRACT FROM AUTHOR]

Background & Aims: The combination of peginterferon and ribavirin with telaprevir or boceprevir is the standard treatment of hepatitis C virus (HCV) genotype 1 infection. However, these drugs are not well tolerated because of their side effects and suboptimal virologic responses. In a phase 2a, open-label study, we examined the safety and efficacy of an interferon-free, ribavirin-free regimen of direct-acting antivirals, comprising daclatasvir (an NS5A replication complex inhibitor), asunaprevir (an NS3 protease inhibitor), and BMS-791325 (a non-nucleoside NS5B inhibitor), in patients with chronic HCV infection. Methods: We analyzed data from 66 treatment-naive patients with HCV genotype 1 infection without cirrhosis who were assigned randomly to groups given daclatasvir (60 mg, once daily), asunaprevir (200 mg, twice daily), and BMS-791325 (75 or 150 mg, twice daily) for 12 or 24 weeks. The primary end point was an HCV-RNA level less than 25 IU/mL at 12 weeks after treatment (sustained virologic response at 12 weeks [SVR12]). Results: In 64 patients, HCV-RNA levels were less than 25 IU/mL by week 4 of treatment (including 48 of 49 patients with HCV genotype 1a infection and 45 of 46 patients with the non-CC interleukin 28B genotype). Sixty-one patients (92%) achieved SVR12, based on a modified intention-to-treat analysis. Virologic responses were similar between 12 and 24 weeks of treatment. During the study, 2 patients experienced viral breakthrough and 1 patient relapsed. There were no grade 3–4 increases in levels of alanine or aspartate aminotransferases or bilirubin; there were no deaths or discontinuations resulting from serious adverse events or adverse events related to the treatment regimen. The most common adverse events were headache, asthenia, and gastrointestinal symptoms. Conclusions: In a phase 2a study, the all-oral, interferon-free, and ribavirin-free regimen of daclatasvir, asunaprevir, and BMS-791325 was well tolerated and achieved high rates of SVR12 in patients with HCV genotype 1 infection. Further studies of this regimen are warranted. ClinicalTrials.gov, number NCT01455090. [Copyright &y& Elsevier]

Summary: Background: Despite the prevalence of complex ventral hernias, there is little agreement on the most appropriate technique or prosthetic to repair these defects, especially in contaminated fields. Our objective was to determine French surgical practice patterns among academic surgeons in complex ventral hernia repair (CVHR) with regard to indications, most appropriate techniques, choice of prosthesis, and experience with complications. Methods: A survey consisting of 21 questions and 6 case-scenarios was e-mailed to French practicing academic surgeons performing CVHR, representing all French University Hospitals. Results: Forty over 54 surgeons (74%) responded to the survey, representing 29 French University Hospitals. Regarding the techniques used for CVHR, primary closure without reinforcement was provided in 31.6% of cases, primary closure using the component separation technique without mesh use in 43.7% of cases, mesh positioned as a bridge in 16.5% of cases, size reduction of the defect by using aponeurotomy incisions without mesh use in 8.2% of cases. Among the 40 respondents, 36 had experience with biologic mesh. There was a strong consensus among surveyed surgeons for not using synthetic mesh in contaminated or dirty fields (100%), but for using it in clean settings (100%). There was also a strong consensus between respondents for using biologic mesh in contaminated (82.5%) or infected (77.5%) fields and for not using it in clean setting (95%). In clean-contaminated surgery, there was no consensus for defining the optimal therapeutic strategy in CVHR. Infection was the most common complication reported after biologic mesh used (58%). The most commonly reported influences for the use of biologic grafts included literature, conferences and discussion with colleagues (85.0%), personal experience (45.0%) and cost (40.0%). Conclusions: Despite a lack of level I evidence, biologic meshes are being used by 90% of surveyed surgeons for CVHR. Importantly, there was a strong consensus for using them in contaminated or infected fields and for not using them in clean setting. To better guide surgeons, prospective, randomized trials should be undertaken to evaluate the short- and long-term outcomes associated with these materials in various surgical wound classifications. [Copyright &y& Elsevier]

Invasive histoplasmosis is the most common AIDS-defining event in endemic regions such as South America. In non-endemic regions, less familiar to the diagnosis, invasive histoplasmosis can be mistakenly diagnosed as miliary tuberculosis leading to a high mortality rate. Here we present the case of an invasive histoplasmosis mistakenly diagnosed as tuberculosis. The diagnosis of histoplasmosis was considered later on, in light of patient's clinical deterioration and positive Aspergillus galactomannan antigens. This case highlights the importance of considering other opportunistic infections when facing a culture-negative miliary tuberculosis without clinical improvement despite anti-tuberculosis therapy. It also draws our attention to the tools available in non-endemic regions that can be helpful in the diagnosis of invasive histoplasmosis. [ABSTRACT FROM AUTHOR]

Abstract: Allogeneic blood transfusions remain common in primary total knee arthroplasty. We reviewed our experience with 2269 consecutive primary total knee arthroplasties in 2069 patients over a 3.5year period. In our cohort, 1838 received no TXA, 330 received TXA via IV infusion, and 130 had TXA applied topically. The need for blood transfusion, as well as hematocrit levels immediately after surgery in the recovery room and the day of discharge were recorded. Tranexamic acid infusion demonstrated a statistically significant decrease in blood transfusion (P =0.001), as did topical application of TXA (P =0.019). The transfusion rate without TXA was 6.5% (120/1839) but only 0.3% (1/330) with TXA infusion. There were no transfusions (0/130) with topical TXA. Statistical differences were also noted in both immediate post operative and day of discharge hematocrit levels in patients having TXA infusion while those values for patients with TXA irrigation failed to obtain statistical significance. No significant change in the rate of symptomatic deep venous thrombosis or pulmonary embolism was noted. [Copyright &y& Elsevier]

Abstract: Introduction: Follow-up to detect recurrence is an important feature of care after colon cancer treatment. Currently, follow-up visits are surgeon-led with focus on recurrence. To date, there is increasing interest for general practitioners (GPs) providing this care, as GPs might provide more holistic care. The present study assessed how surgeons, GPs, and patients evaluate current surgeon-led colon cancer follow-up and to list their views on possible future GP-led follow-up. Methods: The study consists of a cross-sectional survey including colorectal surgeons, patients who participate or recently finished a follow-up programme, and GPs in the Netherlands. Results: Eighty-seven out of 191 GPs, 113 out of 238 surgeons, and 186 out of 243 patients responded. Patients are satisfied about current surgeon-led follow-up, especially about recurrence detection and identification of physical problems (94% and 85% respectively). However, only 56% and 49% of the patients were satisfied about the identification of psychological and social problems respectively. Only 16% of the patients evaluated future GP-led follow-up positively. Regarding healthcare providers, surgeons were more positive compared to GPs; 49% of the surgeons, and only 30% of the GPs evaluated future GP-led follow-up positively (P = 0.002). Furthermore, several reservations and principle requirements for GP-led follow-up were identified. Discussion: The results suggest an unfavourable view among patients and healthcare providers, especially GPs, regarding a central role for GPs in colon cancer follow-up. However, low satisfaction on psychosocial aspects in current follow-up points out a lack in care. Therefore, the results provide a justification to explore future GP-led care further. [Copyright &y& Elsevier]

Abstract: Obscure gastrointestinal bleeding has long been a diagnostic challenge because of the relative inaccessibility of small bowel to standard endoscopic evaluation. Intraoperative enteroscopy indications have been reduced by the development of deep enteroscopy techniques and video capsule endoscopy. In light of the current advances, this review aimed at evaluating the intraoperative enteroscopy technical aspects, study results and an ongoing role for intraoperative enteroscopy in obscure gastrointestinal bleeding management. Intraoperative enteroscopy allows complete small bowel exploration in 57–100% of cases. A bleeding source can be identified in 80% of cases. Main causes are vascular lesions (61%) and benign ulcers (19%). When a lesion is found, intraoperative enteroscopy allows successful and recurrence-free management of gastrointestinal bleeding in 76% of cases. The reported mortality is 5% and morbidity is 17%. The recurrence of bleeding is observed in 13–52% of cases. With the recent development of deep enteroscopy techniques, intraoperative enteroscopy remains indicated when small bowel lesions (i) have been identified by a preoperative work-up, (ii) cannot be definitively managed by angiographic embolization, endoscopic treatment or when surgery is required and (iii) cannot be localized by external examination during surgical explorations. Surgeons and endoscopists must exercise caution with intraoperative enteroscopy to avoid the use of a low yield, highly morbid procedure. [Copyright &y& Elsevier]

Abstract: Objective: About 15% of colorectal adenocarcinomas have a deficient DNA mismatch repair phenotype. The frequency of deficient DNA mismatch repair tumours increases with age due to the hypermethylation of hMLH1 promoter. The study aimed to determine the prognostic value of deficient DNA mismatch repair phenotype in elderly patients. Design: Mismatch repair phenotype was retrospectively determined by molecular analysis in consecutive resected colorectal adenocarcinoma specimens from patients over 75 years of age from 4 Oncology centres. Results: 231 patients (median age: 81, range: 75–100) were enrolled from 2005 to 2008. Mean prevalence of deficient DNA mismatch repair phenotype was 22.5%, and 36% for patients over 85 years. Deficient DNA mismatch repair status was significantly associated with older age, female sex, proximal colon primary and high grade tumour. For stage II tumours no deficient DNA mismatch repair tumours had a recurrence at end of follow-up compared to 17% for tumours with proficient phenotype. The proficient phenotype status was significantly associated with worse age-adjusted overall survival [HR 2.60; 95% CI 1.05–6.44; p =0.039]. For stage III tumours a trend for less recurrence was observed for deficient DNA mismatch repair phenotype (16%) compared to proficient phenotype (36%). Conclusion: deficient DNA mismatch repair phenotype is a prognostic factor in stage II colorectal tumour in elderly patients. Our results suggest that mismatch repair phenotype should be taken in consideration for adjuvant chemotherapy decision in elderly patients. [Copyright &y& Elsevier]

Research Question: How are spiritual experiences described by participants of an energy based healing session? Theoretical Framework: A taxonomy of spiritual experiences (TSE), developed from previous research, provided a linguistic tool to explore and describe spiritual experiences. Methodology: A secondary qualitative analysis was conducted on a subset of existing data. Context: Original data was from accounts of spiritual experiences from participants in Healing Touch classes. Sample Selection and Data Collection: A purposive sample of accounts of spiritual experiences that occurred during giving or receiving an energy based healing session (n=56) was drawn from the existing data base of spiritual experience accounts. Analysis and Interpretation: A top down deductive analysis using the TSE as a coding schema was applied to this sample. Comparisons were made between this subset who described their spiritual experience specifically occurring during a healing session and the original dataset of more general descriptions of a spiritual experience. Comparisons were also made between this subset and the original data as well as between giving and receiving a healing. Main Results: The components of the taxonomy were well represented and richly described as occurring during a healing session. Notable similarities between giving and receiving a healing were apparent in the descriptions of sensate experiences, ecstasy, and experiences of encounters with disincarnate guides. Healing activities are a rich context for spiritual experiences. The taxonomy provides a useful linguistic and cognitive structure for exploring spiritual experiences. [Copyright &y& Elsevier]

Abstract: Background: The objective of this study was to detect and quantify circulating tumour cells (CTC) in peripheral and portal blood of patients who had open or laparoscopic surgery for primary colonic cancer. Methods: Patients in the laparoscopic-group were operated on in a medial to lateral approach (“vessels first”), in the open-group a lateral to medial approach was applied. The enumeration of CTC was performed with the CellSearch System. Intra-operative samples were taken paired-wise (from peripheral and portal circulation) directly after entering the abdominal cavity (T1), after mobilisation of the tumour baring segment (T2), and after tumour resection (T3). Ploidy of both the CTC and tissue of the primary tumour was determined for chromosome 1, 7, 8 and 17. Results: Thirty-one patients were included; 18 patients had open surgery, 13 patients were operated on laparoscopically. The percentage of samples with CTC at T1 was 7% in peripheral blood and 54% in portal blood (p =0.002). At T2, 4% and 31% respectively (p =0.031). And at T3, 4% and 26% respectively (p =0.125). The cumulative percentage of samples with CTC was significantly higher during open surgery as compared to the laparoscopic approach. Both the CTC and tissue of the primary tumour were diploid for chromosome 1, 7, 8 and 17. Conclusion: The detection rate and quantity of CTC is significantly increased intra-operatively and is significantly higher in portal blood compared to peripheral blood. Significantly less CTC were detected during laparoscopic surgery probably as result of the medial to lateral approach. [Copyright &y& Elsevier]

Purpose: To rank Knee Injury and Osteoarthritis Outcome Score (KOOS) questions from most to least improvement after arthroscopic partial meniscectomy (APM) and compare improvement of meniscal versus mechanical symptoms.Methods: A secondary analysis of the Chondral Lesions and Meniscus Procedures (ChAMP) Trial was performed. Inclusion criteria were age 30 years or older with degenerative meniscal tear failing nonoperative management, with or without associated unstable chondral lesions. No chondral debridement was performed. Responses to the 42 KOOS questions ranged from 0 (extreme problems) to 4 (no problems), and were answered preoperatively and at 1 year after isolated APM. The 1-year mean change, or delta (Δ), was calculated for each KOOS question and the Δ for meniscal and mechanical symptoms were statistically compared.Results: Greatest improvement in 135 eligible patients was observed for questions about (1) awareness of knee problems (Δ = 1.93, standard deviation [SD] = 1.38), (2) frequency of knee pain (Δ = 1.93, SD = 1.29), (3) degree of difficulty while twisting/pivoting on the injured knee (Δ = 1.88, SD = 1.13), (4) degree of difficulty while running (Δ = 1.67, SD = 1.30), and (5) being troubled by lack of confidence in the knee (Δ = 21.67, SD = 1.11). Least improvement was observed for questions about: (1) degree of difficulty while getting on/off the toilet (Δ = 0.94, SD = 0.96), (2) feel grinding or hear clicking when the knee moves (Δ= 0.90, SD = 1.25), 3) degree of difficulty while getting in/out of the bath (Δ= 0.88, SD = 1.00), (4) knee catches/hangs up during movement (Δ= 0.80, SD = 1.09), and (5) the ability to straighten the knee fully (Δ= 0.54, 1.44). There was greater improvement for the KOOS questions pertaining to meniscal versus mechanical symptoms (P < .00001).Conclusions: KOOS symptoms as reported by subjects' responses to the questions pertaining to the frequency of knee pain, twisting/pivoting, running, squatting, and jumping showed the most improvement 1 year after isolated APM, whereas those relating to mechanical symptoms improved the least. Focusing on meniscal rather than mechanical symptoms may help surgeons better identify patients expected to benefit from APM.Level Of Evidence: IV, retrospective analysis of prospectively collected data. [ABSTRACT FROM AUTHOR]

Abstract: Gouttebarge V, Wind H, Kuijer PP, Sluiter JK, Frings-Dresen MH. Construct validity of functional capacity evaluation lifting tests in construction workers on sick leave as a result of musculoskeletal disorders. Objectives: To assess the construct (discriminative and convergent) validity of 5 Ergo-Kit (EK) functional capacity evaluation (FCE) lifting tests in construction workers on sick leave as a result of musculoskeletal disorders (MSDs). Design: Cross sectional within-subject design. Setting: Occupational health service for the construction industry. Participants: Male construction workers (N=72) on 6-week sick leave as a result of MSDs. Interventions: Not applicable. Main Outcome Measure: After being assessed on 5 EK FCE lifting tests, participants were asked to complete the Von Korff questionnaire on pain intensity and disability as a result of MSDs and the instrument for disability risk assessing the risk for work disability. Discriminative validity was evaluated by comparing the results of the EK FCE lifting test scores between the 2 groups of participants based on the instrument for disability risk scores (high risk for work disability compared with low risk for work disability). Convergent validity was evaluated by assessing the associations between the results of the EK FCE lifting tests and Von Korff questionnaire self-reported pain intensity and disability as a result of MSDs. Results: The hypothesized differences between both instrument for disability risk groups on the 5 EK FCE lifting tests were found in the expected direction but were not statistically significant (1 test exhibited a trend). Pearson correlation coefficients showed a poor convergent validity between the scores of the Von Korff questionnaire and the EK FCE lifting tests (–.29≤r≤.05). Conclusions: Poor construct validity of the 5 EK lifting tests was found: discriminative validity was not statistically established, and convergent validity with self-reported pain intensity and disability was poor. [Copyright &y& Elsevier]

Context: Spinal cord injury often results in chronic pain syndromes that conventional pain management is unable to resolve. Healing Touch (HT) is a biofield therapy that involves using the hands to promote healing and mediate the perception of pain by affecting the energy field of the person. The practice of HT is based on the premise that the energy field has the ability to provide valuable information about the person''s physical, emotional, mental, and spiritual condition and can influence the dense matter of physical form. Objective: This secondary analysis using case study reviews describes two different experiences of receiving a HT session for management of chronic neuropathic pain and its sequelae, utilizing energy field data and reports of participants and their HT practitioners. Design: Qualitative case study approach was used. Setting: Data were obtained from 42 HT sessions that took place within the homes of seven veterans with spinal cord injury. Method: Two cases involving the most common patterns of response were selected from seven cases to represent the participants'' and practitioners'' experiences. A descriptive qualitative approach informed the results. Results: The findings indicate that a variety of experiences can exist in individuals with chronic pain due to spinal cord injury; experiences will also vary with their healing touch practitioners. There are commonalities in the perception of the practitioners in the damage to the energy field and energy centers, with individualized and consistent resolution of the field over time. [Copyright &y& Elsevier]

Abstract: Aims: In colonic cancer the prognostic significance of extracapsular lymph node involvement (LNI) is not established and is therefore the objective of this study. Methods: Between January 1994 and May 2005, all patients who underwent resection for primary colonic cancer with lymph node metastasis were reviewed. All resected lymph nodes were re-examined to assess extracapsular LNI. In uni- and multivariate analysis disease-free survival (DFS) was correlated with various clinicopathologic factors. Results: One hundred and eleven patients were included. In 58 patients extracapsular LNI was identified. Univariate analysis revealed that pN-stage (5-year DFS pN1 vs. pN2: 65% vs. 14%, p <0.001), extracapsular LNI (5-year DFS intracapsular LNI vs. extracapsular LNI: 69% vs. 41%, p =0.003), and lymph node ratio (5-year DFS <0.176 vs. ≥0.176: 67% vs. 42%, p =0.023) were significant prognostic indicators. Among these variables pN-stage (hazard ratio 3.5, 95% confidence interval [CI]: 1.72–7.42) and extracapsular LNI (hazard ratio 1.98, 95% CI: 1.00–3.91) were independent prognostic factors. Among patients without extracapsular LNI, those receiving adjuvant chemotherapy had a significantly better survival (p =0.010). In contrast, chemotherapy did not improve DFS in patients with extracapsular LNI. Conclusion: Together with pN2 stage, extracapsular LNI reflects a particularly aggressive behaviour and has significant prognostic potential. [Copyright &y& Elsevier]

Summary: Background: The characteristics, incidence and risk factors for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) may depend on definitions and geography. Methods: A prospective, 3-day point-prevalence study was performed by a survey of all intensive care units (ICU) in the Netherlands (n=96). Thirty-six ICU''s responded (37%), reporting on 266 patients, of whom 151 were mechanically ventilated. The questionnaire included criteria and potential risk factors for ALI/ARDS, according to the North American–European Consensus Conference (NAECC) or the lung injury score (LIS⩾2.5). Results: Agreement between definitions was fair (κ 0.31–0.42, P=0.001). ALI/ARDS was characterized, regardless of definition, by radiographic densities, low oxygenation ratios, high inspiratory O2 and airway pressure requirements. Depending on definitions, ALI and ARDS accounted for about 12–33% and 7–9% of ICU admissions per year, respectively, constituting 21–58% (ALI) and 13–16% (ARDS) of all mechanically ventilated patients. The annual incidences of ALI and ARDS are 29.3 (95%CI 18.4–40.1) and 24.0 (95%CI 14.2–33.8) by NAECC, respectively, and are, respectively, 83.6 (95%CI 65.3–101.9) and 20.9 (95%CI 11.7–30.1) by LIS per 100,000. Risk factors for ALI/ARDS were aspiration, pneumonia, sepsis and chronic alcohol abuse (the latter only by NAECC). Conclusion: The effect of definitions of ALI/ARDS on mechanical ventilation in the Netherlands is small. Nevertheless, the incidence of ALI/ARDS may be higher than in other European countries but lower than in the USA, and the incidence of ALI by LIS may overestimate compared to that by NAECC. Aspiration, pneumonia, sepsis and chronic alcohol abuse are major risk factors, largely independent of definitions. [Copyright &y& Elsevier]

Objective: To review the evidence for the effectiveness of exercise therapy and to estimate the additional effect of supervision on exercise therapy in patients with intermittent claudication. Materials and methods: A systematic review was performed of all randomised controlled trials (RCTs) comparing supervised exercise therapy to unsupervised exercise regimens or observation in patients with intermittent claudication. Main endpoints were pain free walking distance (PWD) and absolute walking distance (AWD). Quality assessment and data extraction were performed independently by two observers. Results: Fifteen manuscripts, published between 1990 and May 2006, were eligible for analysis, evaluating 761 patients. In the studies comparing supervised exercise to standard care the weighted mean difference in pain free walking distance (PWD) and absolute walking distance (AWD) was 81.3meters (95% CI; 35.5–127.1) and 155.8meters (95% CI; 80.8–230.7), respectively. In the studies comparing supervised to unsupervised exercise therapy, the weighted mean difference in PWD and AWD was 143.8meters (95% CI; 5.8–281.8) and 250.4meters (95% CI; 192.4-308.5). Conclusion: Exercise therapy increases the PWD and AWD in patients with intermittent claudication. Supervised exercise therapy increases the PWD and AWD more than standard care. However, the additional value of supervision over unsupervised exercise regimens needs further clarification. [Copyright &y& Elsevier]

Abstract: Aims: The impact of extracapsular lymph node involvement (LNI) has been studied for several malignancies, including gastrointestinal malignancies. Aim of this study was to assess the current evidence on extracapsular LNI as a prognostic factor for recurrence in gastrointestinal malignancies. Methods: The Cochrane Database of systematic reviews, the Cochrane central register of controlled trials, and MEDLINE databases were searched using a combination of keywords relating to extracapsular LNI in gastrointestinal malignancies. Primary outcome parameters were incidence of extracapsular LNI and overall five-year survival rates. Findings: Fourteen manuscripts were included, concerning seven oesophageal, three gastric, one colorectal, and three rectal cancer series with a total of 1528 node positive patients. The pooled incidence of extracapsular LNI was 57% (95% CI: 53–61%) for oesophageal cancer, 41% (95% CI: 36–47%) for gastric cancer, and 35% (95% CI: 31–40%) for rectal cancer. In nine of the 14 studies a multivariate analysis was performed. In eight of these nine studies extracapsular LNI was identified as an independent risk factor for recurrence. Conclusion: Extracapsular LNI is a common phenomenon in patients with gastrointestinal malignancies. It identifies a subgroup of patients with a significantly worse long-term survival. This systematic review highlights the importance of assessing extracapsular LNI as a valuable prognostic factor. Pathologists and clinicians should be aware of this important feature. [Copyright &y& Elsevier]

Keywords: Laparoscopic gastrectomy; Aberrant hepatic artery; Gastric cancer EN Laparoscopic gastrectomy Aberrant hepatic artery Gastric cancer 159 160 2 04/11/20 20200401 NES 200401 There is nowadays a new trend towards laparoscopic approach in surgical oncology for gastric cancer. This video shows a laparoscopic distal gastrectomy with hepatic pedicle nodes dissection for gastric cancer in a patient presenting with aberrant left hepatic artery arising from the left gastric artery. This video will be usefull for all surgeons needing to perform a transperitoneal laparoscopic distal gastrectomy with lymphadenectomy of the hepatic pedicle and gastro-jejunal anastomosis (Figs. [Extracted from the article]

Abstract: Gouttebarge V, Wind H, Kuijer PP, Sluiter JK, Frings-Dresen MH. Reliability and agreement of 5 Ergo-Kit functional capacity evaluation lifting tests in subjects with low back pain. Objective: To assess interrater reliability and agreement of 5 Ergo-Kit functional capacity evaluation lifting tests in subjects with low back pain (LBP). Design: Within-subjects design, with 2 repeated measurements. Setting: Academic medical center in The Netherlands. Participants: Twenty-four subjects (10 men, 14 women) with LBP. Interventions: Not applicable. Main Outcome Measure: Five Ergo-Kit lifting tests (2 isometric, 3 dynamic) were assessed on 2 occasions (t1, t2), by 2 different raters (R1, R2). The interval between the test sessions was 3 days. Interrater reliability level was expressed with the intraclass correlation coefficient (ICC), and the level of agreement between raters with the standard error (SE) of measurement. Results: ICCs means (reliability) of isometric and dynamic Ergo-Kit lifting tests ranged from .94 to .97, and SE of measurement values (agreement) ranged from 1.9 to 8.6kg. Conclusions: There was good reliability and agreement between raters of the isometric and dynamic Ergo-Kit lifting tests in subjects with LBP, which supports the use of these tests to assess functional lifting capacity. [Copyright &y& Elsevier]

Abstract: Gouttebarge V, Wind H, Kuijer PP, Sluiter JK, Frings-Dresen MH. Intra- and interrater reliability of the Ergo-Kit functional capacity evaluation method in adults without musculoskeletal complaints Objective: To evaluate the intra- and interrater reliability of tests from the Ergo-Kit (EK) functional capacity evaluation method in adults without musculoskeletal complaints. Design: Within-subjects design. Setting: Academic medical center in the Netherlands. Participants: Twenty-seven subjects without musculoskeletal complaints (15 men, 12 women). Interventions: Not applicable. Main Outcome Measures: Seven EK tests (2 isometric, 3 dynamic lifting, 2 manipulation tests) were each assessed 3 times (over 4 days), twice by 1 rater (R1) and once by another rater (R2). Intrarater reliability was calculated using the EK test scores assessed by R1. Interrater reliability was calculated using the EK test scores assessed by both raters. Counterbalancing the rater order made possible the calculation of 2 interrater reliability levels (at time intervals of 4 and 8d). All reliability levels were expressed as intraclass correlation coefficients (ICCs). Results: Intrarater and interrater reliability (8-d time interval) was high (ICC, >.80) for the isometric lifting tests, moderate (ICC range, .50–.80) for the dynamic lifting tests, and low (ICC, <.50) for the manipulation tests. The interrater reliability of the isometric and dynamic lifting tests (4-d time interval) was high (ICC, >.80), and it was moderate (ICC range, .50–.80) for both manipulation tests. Conclusions: The isometric and dynamic lifting tests of the EK have a moderate to high level of reliability; the manipulation tests have a low level of reliability. [Copyright &y& Elsevier]

Obtaining detailed in vivo metabolic information has been identified as key elements of better understanding the efficacy and toxicity of new therapies. A new nuclear magnetic resonance (NMR) technology called LOCMAT is reported in this paper that yields substantially increased spectral resolution in spatially localized in vivo 1H NMR metabolite spectra, as illustrated by measurements in the liver of a live mouse. LOCMAT promises to significantly enhance the utility of NMR spectroscopy for biomedical research. [Copyright &y& Elsevier]

Résumé: Introduction. – La hernie diaphragmatique est une complication rare après œsophagectomie pour cancer. Le but de ce travail a été de rapporter une série de sept patients et de préciser les caractéristiques de cette entité. Patients et méthodes. – Sept patients (six hommes et une femme) âgés de 61 à 68 ans ont été opérés d’une hernie diaphragmatique à distance d’une chirurgie pour cancer œsophagien (adénocarcinome n = 4, carcinome épidermoïde n = 3). Tous ces patients avaient eu une œsophagectomie par voie abdominale trans-hiatale quatre fois et par voie trans-thoracique trois fois, avec dans tous les cas un agrandissement de l’orifice hiatal. Résultats. – Trois patients, tous symptomatiques, ont été réopérés en urgence dans les deux années suivant l’œsophagectomie. Parmi les quatre patients opérés entre deux et sept ans après l’œsophagectomie, deux étaient asymptomatiques. Le caractère symptomatique ou non de la hernie diaphragmatique n’était lié ni à la technique de l’œsophagectomie, ni au type de phrénotomie (antérieure ou section du pilier). La hernie était toujours symptomatique quand elle contenait du grêle. Tous les patients ont été opérés par voie abdominale. La hernie contenait du colon trois fois, du grêle une fois, et était mixte trois fois. Une phrénotomie d’agrandissement était nécessaire six fois pour réduire la hernie. Deux patients ont eu une colectomie pour traiter une ischémie colique transverse peropératoire. L’orifice diaphragmatique était calibré autour de la plastie gastrique par suture simple six fois ou par prothèse ... [Copyright 2005 Elsevier]

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Floristic and structural data of oak dune forests in western Jutland (Kaerga˚rd and Bla˚bjerg) were collected in 1998 and compared with previous studies of Danish oligotrophic oak forests.A hierarchical divisive clustering resulted in four main clusters, containing two coastal oak vegetation types, Quercus robur–Carex arenaria and Q. robur–Pleurozium schreberi communities, both restricted to the oak dune forest areas in western Jutland, and two more widespread oak forest types, Q. robur–Vaccinium myrtillus and Q. robur–Holcus mollis communities.The low-growing Q. robur–C. arenaria shrub and forest vegetation occurs primarily in the outer dunes, with the tallest trees on the leeward sides of the dunes, while a Q. robur–P. schreberi community is found in the inner parts of the dune system. The similarity to a considerable number of the acidophilous vascular plant species closely relates the Danish oak dune forest communities to the Pinus sylvestris or P. sylvestris–Q. robur vegetation described in neighbouring countries, suggesting that P. sylvestris probably had a prominent role in the Danish oak dune forests before human exploitation caused its extinction in the 18th century.The low-growing oak shrub in the outer dunes, aged between 52 and 85 years, generally seems to have remained unchanged in floristic composition and structure since 1964 when the previous study on the shrub was performed.In the dune valleys, oak stand-level dieback is widespread and was latest recorded in 1985. Such retrogressive processes are probably due to a combination of low winter temperatures and other adverse climatic conditions. In the central parts of the oak dune forest, the oak trees, aged between 55 and 73 years, grow to a higher stature, but also here stand-level dieback is widespread leading to retrogression. Only in the innermost parts, a regular forest cover seems to prevail with trees of 68–104 years of age and the development of the field vegetation cover progresses into a typical forest community. This is exemplified by the decrease of light-demanding species and the establishment of true forest species like Oxalis acetosella and Dryopteris dilatata.The structure and poor-species diversity make the oak dune forest unique both in Denmark and on an international scale. We recommend further studies of the remnants of the original, and in the past probably more widespread dune forests in Denmark, and drawing up of a detailed management and conservation plan. The possibility of permitting the native and now reintroduced P. sylvestris to re-colonise the oak dune forest area and be part of the natural vegetation succession processes should be seriously considered. [Copyright &y& Elsevier]