Purpose A classification for primary and incisional abdominal wall hernias is needed to allow comparison of publications and future studies on these hernias. It is important to know whether the populations described in different studies are comparable. Methods Several members of the EHS board and some invitees gathered for 2 days to discuss the development of an EHS classification for primary and incisional abdominal wall hernias. Results To distinguish primary and incisional abdominal wall hernias, a separate classification based on localisation and size as the major risk factors was proposed. Further data are needed to define the optimal size variable for classification of incisional hernias in order to distinguish subgroups with differences in outcome. Conclusions A classification for primary abdominal wall hernias and a division into subgroups for incisional Hernia (2009) 13:407-414 DOI 10.1007 abdominal wall hernias, concerning the localisation of the hernia, was formulated.

Hypertrophic olivary degeneration (HOD) is a unique form of transneuronal degeneration caused by a disruption of the dentato-rubro-olivary pathway, also known as the triangle of Guillain-Mollaret. The triangle of Guillain-Mollaret is involved in fine voluntary motor control and consists of both the inferior olivary nucleus and the red nucleus on one side and the contralateral dentate nucleus. Clinically, patients classically present with symptomatic palatal myoclonus. Typical magnetic resonance imaging findings include T2-hyperintensity and enlargement of the inferior olivary nucleus evolving over time to atrophy with residual T2-hyperintensity. In this article, we provide a case-based illustration of the anatomy of the Guillain-Mollaret-triangle and the typical imaging findings of hypertrophic olivary degeneration.

Color-flow duplex scanning of infrainguinal vein bypasses was used to identify failing grafts. Several duplex parameters were compared to determine their value in identifying and quantifying the degree of stenosis. Intraarterial digital subtraction angiography was used as the "gold standard" to determine the severity of the stenosis. The goal of this study was to identify specific color-flow duplex criteria for grading stenotic lesions. After a retrospective analysis some of these parameters were prospectively validated. The surveillance protocol required a color-flow duplex scan every 3 months for the first year and every 6 months during the second year. One hundred sixteen vein grafts in 112 patients were studied. Forty-three stenoses were identified and classified into categories from 30% to 49%, 50% to 69%, and 70% to 99% diameter reduction. These stenoses were identified in either the bypass graft or adjacent inflow or outflow arteries. Failing grafts were evaluated further by intraarterial digital subtraction angiography. Patients with normal appearing bypasses (without suspected stenotic lesions) had intravenous digital subtraction angiography. The five duplex parameters that were studied included the following: (1) graft peak systolic velocity (PSV-graft), (2) the maximum peak systolic velocity (at the site of a stenosis or in normal grafts at the narrowest segment of the bypass) (PSV-max), (3) the ratio between PSV-graft and PSV-max, (PSV-index), (4) end-diastolic velocity (EDV) at a stenosis or from narrowest graft segment, (5) color-flow image diameter measurements. For discrimination of different degrees of stenosis, threshold values of these parameters were calculated by receiver operating characteristic analysis. Diameter reduction measured by color-flow imaging was best to identify all stenotic lesions greater than 29% (sensitivity 88%, specificity 99%). Peak systolic velocity-index proved optimal identification of stenoses greater than 49% (sensitivity 89%, specificity 92%), and 70% to 99% stenoses were associated with increased EDV (sensitivity 91%, specificity 100%). The PSV-index criteria were then validated prospectively in a separate group of vein grafts. The data support the value of surveillance of femorodistal vein grafts and demonstrate that calculation of the degree of graft stenosis is feasible.

This transinguinal minimally invasive preperitoneal mesh repair is reproducible, easy to perform and safe with acceptable mid-term results. These elements, together with a minimal superficial dissection in the inguinal canal, preperitoneal mesh placement and the absence of fixation, are possible elements to reduce acute and chronic postoperative pain compared to other open and also laparoscopic techniques that have to be proven in larger (randomised) trials.

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