Bibliothèque d'Agglomération du Pays de Saint-Omer

The use of open intra-peritoneal onlay mesh repairs (O-IPOMs) for treating medium/large incisional ventral hernias has come into question due to the development of minimally invasive and sublay procedures. This study aimed to identify factors that are associated with the use of O-IPOMs in France. We analysed prospectively collected data from the French Hernia Registry on incisional ventral hernia repairs (IVHR) for hernias ≥ 4cm in width. We obtained data for 2261 IVHR (from 11/09/2011 to 30/03/2020): 733 O-IPOMs and 1,528 other techniques. We found that the O-IPOMs were performed on patients with more patient-related risk factors compared with the other techniques. Specifically, there was a higher proportion of patients with ASA III/IV (40.47% vs. 28.02%; p < 0.00001) and at least one patient-related risk factor (66.17% vs. 58.51%; p = 0.0005). Of the 733 O-IPOMs, 195 used Ventrio ST™ (VST), the most commonly used mesh for such IPOMs in our database; the other 538 O-IPOMs used other meshes (OM). The VST subgroup had a higher proportion of patients with ASA III/IV (52.58% vs. 36.07%; p < 0.0001) and on anticoagulants (26.04% vs. 18.41%; p = 0.0229) compared with the OM subgroup; they also had a lower recurrence rate after 2years (5.83% vs. 15.41%; p = 0.008). However, large (≥ 10cm) or lateral defects were more common in the OM subgroup, and their mesh/defect area ratio was lower. O-IPOMs were performed on patients with more comorbidities and/or complex incisional hernias compared with other techniques.

In the studies on Ottoman demographical structure, avrz (an extraordinary tax) records took the place of cadastral record books, which are regarded as one of the important resources in 15 th and 16 th centuries, in 17 th and 18 th centuries. These records, which are taken as comprehensively and concisely as possible like cadastral record books, include valuable information on demographical structure of relevant places. The Karinabad town was captured as a result of invasions by I. Murad to the East Bulgaria in 1368. Located in the east of Bulgaria, it was an old city center termed as Karinabad or Karinovas in the archives. Today called as Karnobat, the city was mostly populated by Muslim Turks since the establishment of Ottoman management. The names of places were in Turkish and some of these were in close similarity with their counterparts in Anatolia.

Complete anastomotic obstruction secondary to a benign disease is rare, with only a few reports of endoscopic management in the literature [1] [2] [3]. We describe a case of the successful endoscopic management of a completely obstructed ileorectal anastomosis with the use of an endoscopic rendezvous technique. A 55-year-old man was admitted in September of 2009 for severe alcoholic pancreatitis. Organ necrosis developed, so that subtotal colectomy and lateral ileostomy were required. In May 2010, an ileorectal anastomosis was established, and ileostomy closure was postponed. After 3 months, the patient underwent a rectoscopy, which revealed complete obstruction of the anastomosis. At the same time, a second operator conducted an endoscopic procedure through the ileostomy. Transillumination was obtained from both sides. Fluoroscopy showed that the two endoscope tips were almost in contact with each other. We punctured the upper side of the anastomosis with a 19-gauge needle (Cook Endoscopy, Winston-Salem, North Carolina, USA) and passed a Metro II guidewire (Cook Endoscopy) through the needle ([Fig. 1]). A 10-Fr cystotome (Cook Endoscopy) was then passed from below upward over the guidewire, and dilation with a 10-mm Quantum Maverick balloon (Boston Scientific, Natick, Massachusetts, USA) was carried out ([Fig. 2]), followed by the placement of a fully covered self-expandable Wallstent (Boston Scientific) measuring 80 × 10 cm ([Video 1]). After 1 week, the stent was removed ([Fig. 3]), and the new orifice was further dilated to 15 mm. At 6 months after the procedure, the patient's bowel habits had returned to normal. Complete obstruction of an anastomosis presents a particular challenge because it requires a real recanalization. The technique of rendezvous was first proposed in the management of complex esophageal strictures [4]. The use of this therapeutic approach to treat complete obstruction of a colorectal anastomosis under fluoroscopic control [5], endoscopic ultrasound [6], or computed tomography [7] has been reported. Our case is, to our knowledge, the first one in which an ileorectal anastomosis was treated.

Blackouts from acute alcohol ingestion are defined as the inability to recall events that occurred during a drinking episode and are highly prevalent in both alcoholic and nonalcoholic populations. This article reviews the clinical manifestations, epidemiology, risk factors, cognitive impairment, and neurobiology associated with alcohol-induced blackout, with special emphasis on the neurochemical and neurophysiological basis, and gender differences. Two types of blackout have been identified: en bloc, or complete inability to recall events during a time period, and fragmentary, where memory loss is incomplete. The rapidity of rise in blood alcohol concentration is the most robust predictor of blackout. Alcohol impairs different brain functions at different rates, and cognitive and memory performance are differentially impaired by ascending versus descending blood alcohol concentration. Cognitive and memory impairment occurs before motor impairment, possibly explaining how a drinker appearing fully functional can have little subsequent memory. Blackouts are caused by breakdown in the transfer of short-term memory into long-term storage and subsequent retrieval primarily through dose-dependent disruption of hippocampal CA1 pyramidal cell activity. The exact mechanism is believed to involve potentiation of gamma-aminobutyric acid-alpha-mediated inhibition and interference with excitatory hippocampal N-methyl-d-aspartate receptor activation, resulting in decreased long-term potentiation. Another possible mechanism involves disrupted septohippocampal theta rhythm activity because of enhanced medial septal area gamma-aminobutyric acid-ergic neurotransmission. Women are more susceptible to blackouts and undergo a slower recovery from cognitive impairment than men, due in part to the effect of gender differences in pharmacokinetics and body composition on alcohol bioavailability.

Stress hyperglycaemia (SH) is associated with adverse outcome in patients with acute myocardial infarction (MI) but the mechanisms underlying this association are unknown. Our hypothesis was that SH on admission for acute MI may be associated with left ventricular (LV) remodelling. We analysed LV remodelling in 162 non-diabetic patients with anterior MI. SH was defined as a glycaemia on admission >or=7 mmol/L. Systematic echocardiographic follow-up was performed at 3 months and 1 year after MI. The changes in end-diastolic volume (EDV) and end-systolic volume (ESV) from baseline to 1 year were 11.4 +/- 16.5 and 6.4 +/- 12.4 ml/m(2), respectively, in patients with SH vs. 1.9 +/- 11.1 and 0.2 +/- 8.5 ml/m(2), respectively, in patients without SH (both P < 0.0001). When LV remodelling was defined as a >20% increase in EDV, it was observed in 46% patients in the SH group vs. 19% patients in the no SH group (P = 0.0008). By multivariable analysis, baseline wall motion score index (P = 0.001) and SH (P = 0.009) were independently associated with changes in EDV. SH was an independent predictor of LV remodelling [adjusted OR: 3.22 (1.31-7.94)]. SH is a major and independent predictor of LV remodelling after anterior MI in non-diabetic patients.