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Clinical tools for predicting postoperative pain should be developed to provide better care for patients. The aims of this study were to evaluate preoperative magnetic resonance imaging (MRI) findings to reveal reasons for overwhelming pain in patients with inguinal hernia and to detect changes in quality-of-life (QoL) and pain scores preoperatively and following laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia.Twenty-two patients aged 18-50 years presenting with extremely painful inguinal hernias (highest pain scores50, scale 0-100) were examined with MRI prior to operative treatment with TEP repair. Postoperative follow-up lasted 6 months and consisted of questionnaires regarding functional status, pain, QoL and possible complications. Postoperative MRI scans were performed only in cases of preoperative findings on the MRI or prolonged inguinal pain persisting over 6 months.Prolonged postoperative pain could not be predicted from preoperative MRI scans, because no signs of the pain's origin such as pubic periostal irritation, bone marrow edema, pelvic bone or hip joint abnormalities, or lower abdominal muscle hemorrhage were detected in MRI. TEP repair of inguinal hernia significantly improved the patients' quality of life and relieved pain symptoms. High preoperative pain scores were major predictors of prolonged postoperative pain.Carefully evaluated preoperative pelvic MRI was usually normal in patients with high pain scores prior to operation. Preoperative pain scores may serve as indicators of development of prolonged inguinal pain.

Inguinal hernia repair is the most common elective procedure in general surgery. Therefore, the number of patients having complications related to inguinal hernia surgery is relatively large. The aim of this study was to compare complication profiles of inguinal open mesh (OM) hernioplasties with open non-mesh (OS) repairs and laparoscopic (LAP) repairs using retrospective nationwide registry data. The database of the Finnish Patient Insurance Centre (FPIC) was searched for complications of inguinal and femoral hernia repairs during 2002–2010. Complications of OM repairs were compared to complications of OS repairs and LAP repairs. Over 75 % of all inguinal hernia procedures during the study period in Finland were OM hernioplasties. FPIC received 245 complication reports after OM repairs, 40 after OS repairs, and 50 after LAP repairs. Reported complications were significantly more severe after LAP and OS repairs than OM surgery (p

Objective: To compare the Lichtenstein hernioplasty with a totally extraperitoneal preperitoneal laparoscopic technique (TEP) in treatment of recurrent inguinal hernias. Summary Background Data: Only a few studies thus far have compared an open and laparoscopic approach with the treatment of recurrent inguinal hernia in a prospective randomized study setting. Methods: Ninety-nine patients undergoing surgery for recurrent inguinal hernia were prospectively randomized into having either open or laparoscopic mesh repair. Pre, peri- and postoperative factors were recorded in addition to 3-year follow-up data at the outpatient clinic. At 5–10 years, the patients were interviewed via telephone for recurrent symptoms. The primary end-points chosen were hernia recurrence and chronic pain. Results: Preoperative factors did not differ between the 2 groups. Rerecurrence rates were 3 in the Lichtenstein group and none in the TEP group (6.4% versus 0.0%, respectively), but this difference was statistically not significant. Chronic pain was more prevalent in the Lichtenstein group compared with the TEP group (13 27.7% versus 4 8.2% patients, respectively, P 0.02). Postoperatively, the Lichtenstein group needed more pain medication than the TEP group (4.4 versus 3.0 doses, respectively, P 0.02) and returned to work later (17.9 versus 14.8 days, respectively, P 0.05). Conclusions: The laparoscopic technique with mesh in the treatment of recurrent inguinal hernia was proven superior to the open mesh repair in several important clinical aspects, with concomitant improvement in patient satisfaction. (Ann Surg 2009;249: 384 –387)

BACKGROUND: Enzymatic breakdown of the extracellular matrix, and possibly local inflammation, contributes to intervertebral disc degeneration. We investigated whether polymorphisms within the IL-1 gene locus are associated with lumbar disc degeneration and whether the effect of occupational physical load on disc degeneration is modified by the polymorphisms. METHODS: Genotypes were determined from 133 middle-aged men who underwent magnetic resonance imaging of the lumbar spine. The participants represented 3 occupations: 40 were machine drivers, 42 carpenters, and 51 office workers. We evaluated decreased signal intensity of the nucleus pulposus, disc bulges, and decreased disc height as signs of degeneration in the L2/L3-L5/S1 discs. RESULTS: The odds ratio for disc bulges was 2.4 (95% confidence interval = 1.2-4.8) and 1.9 (1.0-3.7), in carriers of the IL-1alphaT or IL-1betaT alleles, respectively. The TT genotype of the IL-1alpha gene carried more than 3-fold risk of disc bulges as compared with the CC genotype. CONCLUSIONS: IL-1 gene cluster polymorphisms could affect the risk of disc degeneration. The effect of physical workload seems to be modified by the IL-1 gene polymorphisms.

Background Few studies prospectively assessed risk factors for ventricular fibrillation (VF) during a first myocardial infarction (MI). We designed a nation-wide study aiming to identify clinical and genetic characteristics associated with primary VF; and report here about clinical features. Methods PREDESTINATION (PRimary vEntricular fibrillation and suDden dEath during a firST myocardIal iNfArcTION) is an Italian case-control, prospective multicentre study. Cases are patients aged 18–80years with a first MI and at least one VF episodes occurring within 24h of symptoms onset, before reperfusion. Cases and controls are paired 1: 2 by gender and age (±5years). Results Among 1026 patients enrolled between 2007 and 2017, 970 entered the primary analysis: 375 cases and 595 controls (mean age 59years, 85% males). Multivariable analysis identified 5 independent predictors of primary VF: systolic blood pressure (OR 0.982, 95% CI: 0.98–0.99 for each mmHg) and K+ levels + levels obtained after VF, the OR associated with K+ levels Conclusions The present study identified 5 independent predictors of primary VF: familiarity, anterior MI, low systolic blood pressure, physical inactivity and hypokalaemia. Importantly, the last two risk factors are modifiable and, especially in the presence of a family history of sudden death, they should be avoided as much as possible.

A quasi-experimental pilot study was performed to determine the feasibility and safety of an Adapted Physical Activity (APA) protocol and its effect on health-related quality of life (HRQOL), fear of falling, pain, and physical performance in women with osteoporosis-related vertebral fractures. Forty-four post-menopausal women (mean age: 67.6 &plusmn, 4.6) with osteoporotic vertebral fractures were assigned to an exercise group (APA group = 26) who attended a six-month exercise protocol that included postural and muscular reinforcement exercises, and a control group (CG = 18) who was asked to maintain their current lifestyle. At baseline and six months after baseline, HRQOL was measured as primary outcome by the Assessment of Health Related Quality of Life in Osteoporosis (ECOS-16) questionnaire. Secondary outcomes were fear of falling (Fall Efficacy Scale International, FES-I), lumbar back pain (Visual Analogue Scale-VAS), functional exercise capacity (Six Minutes Walking Test-6MWT, Borg scale), balance and gait (Tinetti Scale), and flexibility of the column (Chair Sit-and-Reach). The effects of the intervention were analyzed by comparison within groups and between groups. Effect sizes (ES) were calculated using Cohen&rsquo, s d. All the outcomes significantly improved in the APA group, while they remained unchanged in the CG. After adjustment for unbalanced variables, the comparison between groups showed significant effects of the intervention for ECOS-16-score, functional exercise capacity, balance, and gait. The exercise program had big effect sizes on HRQOL (ES = 1.204), fear of falling (ES = 1.007), balance (ES = 0.871), and functional exercise capacity (ES = 1.390). Good adherence (75.8%) and no injuries were observed. Due to its feasibility, safety, and effectiveness, the proposed exercise protocol can be adopted in APA programs addressed to patients with osteoporosis-related vertebral fractures.

Objective Myotonic dystrophy type 1 (DM1) is the most frequent muscular dystrophy in adults. DM1 is a multisystem disorder also affecting the heart with an increased incidence of sudden death, which has been explained with the common impairment of the conduction system often requiring pacemaker implantation; however, the occurrence of sudden death despite pacemaker implantation and the observation of major ventricular arrhythmias generated the hypothesis that ventricular arrhythmias may play a causal role as well. The aim of the study was to assess the 2-year cumulative incidence and the value of noninvasive and invasive findings as predictive factors for sudden death, resuscitated cardiac arrest, ventricular fibrillation, sustained ventricular tachycardia and severe sinus dysfunction or high-degree atrioventricular block. Methods/design More than 500 DM1 patients will be evaluated at baseline with a clinical interview, 12-lead ECG, 24-h ECG and echocardiogram. Conventional and nonconventional indications to electrophysiological study, pacemaker, implantable cardioverter defibrillator or loop recorder implantation have been developed. In the case of an indication to electrophysiological study, pacemaker, implantable cardioverter defibrillator or loop recorder implant at baseline or at follow-up, the patient will be referred for the procedure. At the end of 2-year follow-up, all candidate prognostic factors will be tested for their association with the endpoints. Trial registration ClinicalTrials.gov ID NCT00127582. Conclusion The available evidence supports the hypothesis that both bradyarrhythmias and tachyarrhythmias may cause sudden death in DM1, but the course of cardiac disease in DM1 is still unclear. We expect that this large, prospective, multicenter study will provide evidence to improve diagnostic and therapeutic strategies in DM1.

Background— The role of structural heart disease and sodium channel dysfunction in the induction of electrical instability in Brugada syndrome is still debated. Methods and Results— We studied 18 consecutive patients (15 males, 3 females; mean age 42.0±12.4 years) with clinical phenotype of Brugada syndrome and normal cardiac structure and function on noninvasive examinations. Clinical presentation was ventricular fibrillation in 7 patients, sustained polymorphic ventricular tachycardia in 7, and syncope in 4. All patients underwent cardiac catheterization, coronary and ventricular angiography, biventricular endomyocardial biopsy, and DNA screening of the SCN5A gene. Biopsy samples were processed for histology, electron microscopy, and molecular screening for viral genomes. Microaneurysms were detected in the right ventricle in 7 patients and also in the left ventricle in 4 of them. Histology showed a prevalent or localized right ventricular myocarditis in 14 patients, with detectable viral genomes in 4; right ventricular cardiomyopathy in 1 patient; and cardiomyopathic changes in 3. Genetic studies identified 4 carriers of SCN5A gene mutations that cause in vitro abnormal function of mutant proteins. In these patients, myocyte cytoplasm degeneration was present at histology, whereas terminal dUTP nick end-labeling assay showed a significant increase of apoptotic myocytes in right and left ventricle versus normal controls ( P =0.014 and P =0.013, respectively). Conclusions— Despite an apparently normal heart at noninvasive evaluation, endomyocardial biopsy detected structural alterations in all 18 patients with Brugada syndrome. Mutations in the SCN5A gene, identified in 4 of the 18 patients, may have induced concealed structural abnormalities of myocardiocytes that accounted for paroxysmal arrhythmic manifestations.

The follow-up of 1440 consecutive post-MI patients (68.9±10.9 years) with an LVEF≤40% was analyzed in 19 Italian hospitals to evaluate how many patients with clinical nonsustained VT and inducible sustained VT or VF underwent post-discharge risk assessment (RA). During 38 (range, 4–76) months follow-up, 611 patients (42.4%) qualified for and 294 (20.4%) effectively underwent RA combining LVEF assessment and Holter monitoring, 29 (2.0%) subsequently underwent programmed electrical stimulation and 19 (1.3%) received an ICD.