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Poor adherence to medication is one of the most important determinants in the treatment of patients with chronic disorders. e-Health-based interventions may be able to improve treatment adherence. This article gives an overview of the available e-Health interventions and the extent to which they can improve adherence. We searched in the PubMed, Cinahl, PsycInfo, and Embase databases for e-Health interventions that aimed at improving adherence to treatment. Of the 16 included studies, 15 used a website and one used an app. Ten studies showed a significant improvement in treatment adherence by using the intervention. e-Health interventions were generally complex. Simple interventions were the most successful in improving treatment adherence.

The main complication of surgery for inguinal hernia is chronic postoperative pain. This is often reported following the Lichtenstein procedure. A new, open surgical technique for the repair of inguinal hernia has been developed. This procedure is called the transrectus sheath preperitoneal procedure (TREPP). At TREPP a lightweight mesh with a ring made of memory metal is introduced into the preperitoneal space through the transrectus sheath. The first results of this operative technique are very promising: short operation time, short learning curve and not many patients with chronic postoperative pain. In a randomised, multi-centre study which will start mid-2013 (ISRCTN18591339), the TREPP procedure is compared with the transinguinal preperitoneal procedure. The primary outcome measure of this study is chronic postoperative pain.

Objective: To evaluate whether enteral prophylaxis with probiotics in patients with predicted severe acute pancreatitis prevents infectious complications., Design: Multicentre, randomised, double-blind, placebo-controlled trial., Method: A total of 296 patients with predicted severe acute pancreatitis (APACHE II score > or = 8, Imrie score > or = 3 or C-reactive protein concentration > 150 mg/l) were included and randomised to one of two groups. Within 72 hours after symptom onset, patients received a multispecies preparation of probiotics or placebo given twice daily via a jejunal catheter for 28 days. The primary endpoint was the occurrence of one of the following infections during admission and go-day follow-up: infected pancreatic necrosis, bacteraemia, pneumonia, urosepsis or infected ascites. Secondary endpoints were mortality and adverse reactions. The study registration number is ISRCTN38327949., Results: Treatment groups were similar at baseline with regard to patient characteristics and disease severity. Infections occurred in 30% of patients in the probiotics group (46 of 152 patients) and 28% of those in the placebo group (41 of 144 patients; relative risk (RR): 1.1; 95% CI: 0.8-1.5). The mortality rate was 16% in the probiotics group (24 of 152 patients) and 6% (9 of 144 patients) in the placebo group (RR: 2.5; 95% CI: 1.2-5.3). In the probiotics group, 9 patients developed bowel ischaemia (of whom 8 patients died), compared with none in the placebo group (p = 0.004)., Conclusion: In patients with predicted severe acute pancreatitis, use of this combination of probiotic strains did not reduce the risk of infections. Probiotic prophylaxis was associated with a more than two-fold increase in mortality and should therefore not be administered in this category of patients.

Objective: To estimate the prevalence of polyps in the stomach and duodenum in patients with familial adenomatous polyposis (FAP), and to examine the relationship between age and severity of duodenal adenomatosis., Design: Retrospective., Method: Using the FAP-registry of the Netherlands Foundation for the Detection of Hereditary Tumours, data were obtained from patients who had undergone a gastroduodenoscopy before 1 July 1999. The endoscopic and histological findings were used to classify the duodenal adenomas according to the Spigelman classification., Results: 224 patients had undergone at least one gastroduodenoscopy: 117 men and 107 women with a mean age at the time of the first endoscopy of 37 years (range: 13-78). Fundic gland polyposis was detected in 79 patients (35%), stomach adenomas in 6 patients (3%) and duodenal adenomas in 92 patients (41%). A total of 21 patients (9%) had severe duodenal adenomatosis (Spigelman III or IV). Duodenal adenomatosis was often more severe if the patient was older. Ten patients were known to have duodenal cancer; the mean age at diagnosis was 50.3 years (range: 39-67)., Conclusion: Nearly 10% of the patients with FAP had developed severe duodenal adenomatosis. The severity of duodenal adenomatosis was related to the patient's age.

Objective: To describe the surgical treatment of distal oesophageal perforation and its results., Design: Retrospective., Methods: From patient records data were collected on 11 patients, 6 men and 5 women (median age: 54 years; range: 21-76) who underwent surgery for distal oesophageal perforation in Utrecht University Medical Centre. There were 7 iatrogenic perforations, 3 after vomiting and 1 perforation was based on an oesophageal stricture. Four patients had a delay < 24 h and 7 > 24 h (range: 6-27 days). Nine presented with sepsis, mediastinitis and empyema. Seven underwent primary repair: 5 in combination with a hemifundoplication, 2 with omentomplasty. In the group of other surgical treatment, 2 had drainage with extension and diversion, 1 had an oesophageal resection and gastric conduit and 1 had only surgical drainage., Results: Primary repair resulted in 7/7 survival. The median period of hospital stay was 24 days (range: 10-62), and the median stay on the ICU was 14 days (range: 0-21). Four patients underwent reoperation. Four patients with primary repair presented no functional complaints, 1 had reflux complaints and 2 dysphagia. Two out of four within other surgery survived the perforation.

Owing to the spectacular progress in imaging techniques, cystic lesions of the pancreas are detected more often than previously, and this leads to therapeutic dilemmas. Of the cystic lesions of the pancreas, 80% are found to be pseudocysts and 10-15%, neoplastic cysts. The definition of a pseudocyst is: 'an accumulation of pancreatic juice surrounded by a wall of connective tissue or granulation tissue, developed as the result of acute pancreatitis, pancreatic injury or chronic pancreatitis'. In cases of asymptomatic pseudocyst, an expectative policy suffices; growth and symptomatic pseudocysts justify intervention. In addition to surgical internal drainage (cystojejunostomy) there are new therapeutic techniques: external drainage guided by ultrasonography or CT, and internal drainage guided by endoscopy. Endoscopic drainage is the treatment of choice, but it requires experienced hands. The cystic tumours are subdivided into two groups: serous and mucinous cystadenomas. The group of mucinous tumours is subdivided into mucinous cystadenomas and intraductal papillary mucinous tumours. The mucinous or macrocystic adenoma is potentially malignant and should be treated as a malignancy.

Reconstructive surgery for ulcerative colitis and familial adenomatous polyposis nowadays usually takes the form of an ileoanal pouch, involving making a reservoir of the terminal portion of the ileum which subsequently is anastomosed to the anal canal. This method results in definite cure in many cases, but is associated with a morbidity of 15-30% and fails in 10%. A new surgical treatment includes complete removal of the affected large bowel mucosa, guaranteeing oroanal intestinal continuity, limiting complications and providing good function of the reservoir or of the new rectum. In creation of an ileoneorectal anastomosis, complete removal of the affected mucous membrane is followed by preparing a functional 'neorectum' by means of pedicle grafting of ileal mucous membrane on to the uncovered muscular wall of the rectum. This operation gave good results in a small-scale clinical trial.

A 35-year-old man developed bilateral compartment syndrome in the lower legs after prolonged colorectal surgery in the lithotomy position. This complication of a prolonged non-physiological operation position is a rare event and the diagnosis is therefore often delayed, with sometimes serious irreversible neuromuscular damage. In this case the complication was successfully treated by four-compartment fasciotomy and forced diuresis (to prevent renal insufficiency caused by myoglobin nephrosis).

Objective: Evaluation of the long-term results of protocolled treatment of ankle fractures in childhood., Setting: St Elisabeth Hospital, Tilburg, the Netherlands., Design: Retrospective long-term follow-up study., Method: All 78 children with an ankle fracture and an open epiphyseal plate in the period 1985-1989 were treated according to a protocol which specified the indications for conservative or surgical therapy depending on the particular fracture type according to Salter and Harris. After a median follow-up period of 3.42 years (range: 2.08-7.67 years) in 48 patients the treatment results could be evaluated in 92% of these patients. Thirty patients had an isolated fracture of the distal part of the fibula., Results: A clinically 'good' or 'excellent' result was achieved in 100% of the patients, and an 'excellent' result in 68%., Conclusions: Growth disturbances after an ankle fracture in children with an open epiphyseal plate can now be restricted to the very rare fractures with severe damage to the germinative layer of the epiphyseal plate. In general, conservative treatment should be used in Salter and Harris I and II fractures and operative treatment in displaced Salter and Harris III and IV fractures.

Objective: Evaluation of the long-term results of protocol treatment of adult patients with ankle fractures., Setting: St Elisabeth Hospital, Tilburg, the Netherlands., Design: Retrospective long-term follow-up study., Method: All patients (n = 579) with an ankle fracture (580 fractures) in the period 1985-1989, who had not died soon after the injury and in whom the morbidity was not caused mainly by other conditions (n = 30) were treated according to a protocol which specified the indications for conservative or surgical therapy depending on the particular fracture type. After a median follow-up period of 5 years (range: 2.25-8.17 years) the treatment results could be evaluated in 92% of the patients., Results: Clinically "good' or "excellent' results ranging from 79-90.5% types A, B and C fractures (according to the Swiss Arbeitsgemeinschaft für Osteosynthesefragen) were achieved., Conclusions: A broad indication for conservative, even functional (tape bandaging) treatment and restricted use of implants during osteosynthesis appear justified considering the results obtained.

Ruptures of the tendon of the biceps muscle usually occur spontaneously because of degeneration and almost always in the proximal tendon of the long head. Experiences of 13 patients with a rupture of the long head are described. Ten patients were treated by operation, the results of simple transposition of the tendon are excellent as long as ruptures have not existed for more than 6 weeks. The indication to operate ruptures of the long head is relative.