Asklepios Fachklinikum Brandenburg

Current available outcome data following laparoscopic intraperitoneal onlay mesh repair (IPOM) for incisional hernia (IH) are comparable to a limited extent only because of a huge number of variability particulary in surgical technique and use of medical devices. In this prospective observational multicenter cohort study we evaluate the impact of a consensus driven standard protocol for IPOM, that is mesh fixation with absorbable tacks in double crown technique enforced by additional non-absorbable transfascial sutures at the edges of the mesh along with the use of Physiomesh™, on clinical and patient reported outcome measures. A total of 102 consecutive patients were screened for eligibility between September 2013 and October 2014. 85 patients (IH: EHS W1: n=39, W2: n=46) were included into the study. Clinical examination and PROM for pain and quality of life measure (Carolina Comfort Scale, CCS) were performed at baseline, during hospital stay and at 6 weeks, 6 months and 1 year follow-up. The follow-up rate was 87,1% for the primary endpoint. The Kaplan-Meier estimate for freedom-of-recurrence at 1 year was 95.9% (95%-CI: 87.9-98.7%), the cumulative recurrence rate at 1 year was 4.1% (95%-CI: 0.9-11.7%). There was no intraoperative complication. One seroma (type I; 1/84 (1,2%), 95%-CI: 0-7.1%) was diagnosed during hospital stay. 12 seroma (n=12/74 (16,2%), 95%-CI: 9.4-26.4%; n=10 type II and n=2 type IV) were diagnosed during follow-up requiring surgical intervention in 1 patient (1,4%, Clavien Dindo grade IIIb). Subcutaneous hematoma were found during follow-up in 8 patients (8/75 (10.7%); 95%-CI: 5.3-19.9) with need for surgical intervention in 2 patients (2,7%, Clavien Dindo grade IIIb). There were 3 superficial surgical site infections (3/74 (4,1%); 95%-CI: 0.9-11.7%, Clavien-Dindo grade I) without need for reoperation. Patient reported pain as measured by numeric rating scale at baseline was 1.36±1.53 and 0.35±1.04at 1 year follow-up. CCS total scores indicated a good outcome with a decrease to 2.80±6.47 (Min: 0, Q1: 0, Median: 0; Q3: 3.0; Max: 38.0) at 1 year follow-up. Subscore sensation of mesh decreased from 4.01±6.76 (min: 0, Q1: 0, Median: 0; Q3: 5.0; Max: 28.0) at 6 weeks to 1.67±3.99 (Min: 0, Q1: 0, Median: 0; Q3: 1.0; Max: 21.0) after 6 months and 0.90±2.69 (Min: 0, Q1: 0, Median: 0; Q3: 0; Max: 14.0) after 1 year follow-up. Subscores pain and movement limitation both decreased during follow-up and were significantly reduced at 1 year compared to preoperative assessment (p<0.001). This study showed favourable clinical and patient reported outcomes and a low rate of recurrences at 1 year follow-up after IPOM for elective IH applying a standardized surgical technique including the use of Physiomesh™. In view of the data leading to the market withdrawal of the Physiomesh™, one might conclude, that the described standard may have contributed to a compensation of the suspected delay in tissue integration of the Physiomesh™ resulting in a more proper mesh fixation compared to absorbable tack fixation with/without absorbable TFS. This may lead to the general appraisal, that the fixation technique has to be adapted to the individual characteristics of type of mesh and fixation devices and the planned anatomic landing zone of the mesh.

Atherosclerosis has been shown to alter vascular properties and predispose to injury. Blunt aortic trauma (BAT) is responsible for 20% of vehicle-related deaths. This work aims to demonstrate and better understand the biomechanics of the aorta with and without atherosclerotic changes during a frontal car crash using a finite element method (FEM). Secondarily, the influence of blood pressure was evaluated. A FEM model was created with an ANSYS system based on computed tomography images of 44 patients.The distribution of stress and deformation varies according to the stage of atherosclerotic disease. Finally, at a speed of 30 km/h, an aortic rupture occurs. The presence of a calcified atherosclerotic plaque in the thoracic aorta at an advanced and calcified stage increases its susceptibility to rupture during a car crash. No effect of blood pressure on aortic biomechanics was observed.

BackgroundPatients with somatoform pain experience physical pain that cannot be attributed to any underlying medical or physiological cause, and it is often thought to be related to psychological factors. Health professionals encounter difficulties identifying this specific type of chronic pain, leading to suboptimal treatment strategies. Therefore, we aimed to describe the characteristics of patients with somatoform pain, to support the identification of affected patients.MethodsWe collected and analyzed a cross‐sectional survey data from 200 patients with somatoform pain admitted to one of three psychosomatic centers in Germany between August 2013 and July 2014. The survey contains 10 different categories, all of them referring to pain‐related topics. Within the survey, we analyzed validated as well as non‐validated questionnaires. Here, we present the following five: Personal data, Body: Pain perception, Cognition: Pain processing, Pain behavior, and Physical complaints.ResultsOur results highlight that most patients with somatoform pain experience it in several body parts and as persisting, lasting >12 h/day (50%), and constantly changing (71%). Furthermore, patients indicate feelings of helplessness, by agreeing to the expressions the pain controls me (70%). Finally, we found that pain is predominantly seen as suffering, failing to convey emotional pain, despite cognitively acknowledging the dependency of emotional and physical pain.ConclusionThe study identified specific and distinctive characteristics in the emotional and behavioral responses of patients with somatoform pain, potentially distinguishing them from other patients with chronic pain.

Objective: The aim of this study was to clarify the link between experiencing cerebrovascular diseases (strokes as an explicit example) and fear of falling (FOF) among middle-aged and older adults in Europe. Methods: Longitudinal data were used from wave 5 to wave 7 of the representative Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported tools were used to quantify the key variables. Fear of falling was similarly assessed using a dichotomous yes or no question, "For the past six months at least, have you been bothered by any of the health conditions on this card", with fear of falling being one of the options. It was adjusted for various sociodemographic and health-related factors. In particular, to account for unobserved heterogeneity, conditional fixed effect regressions (FE) were used. Accordingly, change in an individual's FOF status over the included waves was analysed and correlated with the reported change of all the included time-varying independent variables within the same individual, including experiencing stroke or other cerebrovascular diseases. The final analytical sample equalled n = 22.071 observations. Results: Conditional logistic FE regressions showed that the onset of a stroke or other forms of cerebrovascular disease was not associated with an increased likelihood of experiencing fear of falling (OR = 1.25, p = 0.095). However, stratified by sex, such an association was present in men (OR = 1.79, p = 0.006), though not in women (OR = 0.94, p = 0.732). Conclusions: The onset of a stroke or other cerebrovascular diseases was associated with an increased likelihood of experiencing FOF in men but not women. Efforts are required to assist older men in avoiding FOF after the onset of stroke or other cerebrovascular pathologies.