The VAWCM method provided a high fascial closure rate after long-term treatment of OA. Technique-related complications were few. No patient was left with a large planned ventral hernia.

This study addressed the interaction between short-term adaptation to apneas with face immersion and erythrocyte release from the spleen. Twenty healthy volunteers, including ten splenectomized subjects, participated. After prone rest, they performed five maximal-duration apneas with face immersion in 10 degrees C water, with 2-min intervals. Cardiorespiratory parameters and venous blood samples were collected. In subjects with spleens, hematocrit and hemoglobin concentration increased by 6.4% and 3.3%, respectively, over the serial apneas and returned to baseline 10 min after the series. A delay of the physiological breaking point of apnea, by 30.5% (17 s), was seen only in this group. These parameters did not change in the splenectomized group. Plasma protein concentration, preapneic alveolar PCO2, inspired lung volume, and diving bradycardia remained unchanged throughout the series in both groups. Serial apneas thus triggered the hematological changes that have been previously observed after long apneic diving shifts; they were rapidly reversed and did not occur in splenectomized subjects. This suggests that splenic contraction occurs in humans as a part of the diving response and may prolong repeated apneas.

Background: Partial splenic embolization (PSE) was introduced in the 1980s. We studied the longterm follow-up results of a PSEtreated patient cohort. Patients and methods: Twenty-six severely ill patients (median age 63.5 years) were treated with a graded PSE a total of 52 times, mainly due to bleeding esophageal varices and thrombocytopenia. The aggregated follow-up time was 1715 months. Results: The mean values of hemoglobin, leukocytes and thrombocytes increased significantly after PSE. The frequency of bleeding episodes from esophageal varices was significantly reduced. No effect was observed concerning blood liver parameters in cirrhotic patients. The integrated PSE effect was judged as improvement in 19 patients, status quo in 5, and dete-rioration in 2. Median survival time was 50.5 months (range 0.5-272 months). Two patients underwent liver transplantation. Complications consisted mainly of fever, atelectasis, and abdominal pain. Two patients died of PSE-related complications. Conclusions: A standardized and graded PSE is reasonably safe even in patients with advanced disease in whom it is hazardous to splenectomize. It gives a long-term effect on the hematological parameters, bleedings from esophageal varices and good palliation, and improved clinical status contributing to symptomatic control.

Chronic hepatitis C virus infection is frequently complicated by cirrhosis and hypersplenism, which together with several other factors, such as reduced thrombopoietin synthesis in the liver, cause cytopenia. The antiviral combination therapy with pegylated interferon and ribavirin itself is impaired by haematological toxicity. Partial splenic embolization (PSE) by the injection of microspheres via a catheter comprising approximately 30-70% of the splenic parenchyma is now a safe method, which significantly reduces the cytopenia induced by hypersplenism, especially thrombocytopenia. The effect is long lasting up to 20 years and has been documented in a variety of disorders. PSE is now carefully described in a combination modality as a pretreatment to reduce cytopenia in hepatitis C virus-induced cirrhosis patients with hypersplenism, making antiviral therapy possible per se at higher dosages with a sustained duration.

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Objective: Routine antibiotic treatment of acute uncomplicated diverticulitis (AUD) has been shown ineffective. In this study, the adherence to a new treatment protocol for uncomplicated diverticulitis was evaluated and the incidence of complications in patients treated with and without antibiotics was investigated. Materials and methods: A retrospective study of in-patients diagnosed with AUD at Helsingborg Hospital, Sweden between 01 January 2013 and 06 January 2015 was performed. Antibiotics were routinely administrated until 01 May 2014. Thereafter, a new antibiotic-free treatment protocol for uncomplicated diverticulitis was introduced. All the patients were followed regarding complications for minimum one year. Results: A total of 50 patients were studied after the new protocol implementation and, 60% (n ¼ 31) of the patients were treated without antibiotics. Specialists initiated antibiotic therapy significantly more often than registrars (p¼.03). More patients in the antibiotic group had comorbidities (p¼.03), apart from that, no significant differences in baseline characteristics were noted between treatment groups. Patients treated with antibiotics after introduction of the new protocol had significantly higher C-reactive protein than patients managed without antibiotics (median 117 mg/L vs. 70, p¼.005). The hospital stay was shorter in the non-antibiotic group (three days vs. two days; p¼.008). No significant differences in complications were observed. Conclusions: Protocol compliance was lower than expected, indicating that implementation of new treatment regimens is challenging. This study confirms that complications are rare in AUD treated without antibiotics. However, the selection of the sickest patients to the treatment with antibiotics limits the interpretation of the results.

High-risk patients older than 65 years with haematological disorders can safely undergo splenectomy with a low mortality rate and a reasonable rate of morbidity. The long-term course demonstrates a fair response rate, minimal surgically related complications, but thromboembolic and infectious events, and the majority of deaths unrelated to late effects of the splenectomy.