Nárahaular (groin hernia) eru algengust kviðslita og valda útbungun á nárasvaeði en geta auk þess valdið verkjum og jafnvel garnastíflu. 1,2 Aðgerðir á nárahaulum eru á meðal algengustu aðgerða í almennum skurðlaekningum 3 , en víða á Vesturlöndum eru framkvaemdar um 130-160 aðgerðir á 100.000 íbúa árlega. 4,5 Algengast er að aðgerð sé gerð vegna einkenna en einnig til að fyrirbyggja fylgikvilla, til daemis garnastíflu. Þetta er örugg aðgerð en helstu vandamálin eru endurtekin kviðslit og langvinnir verkir. 8-12 Þessi grein fjallar aðallega um greiningu og meðferð nárakviðslita, en einnig er fjallað um líffaerafraeði nárans, meingerð nárakviðslita og klíníska birtingamynd þeirra. Greinin byggir á nýjustu heimildum, þar á meðal nýlegum íslenskum rannsóknum. Flokkun, faraldsfraeði og líffaerafraeði Kviðslit er útbungun á lífhimnu, lífhimnufitu eða kviðarholslíffaeri í gegnum meðfaedd eða áunnin göt á kviðveggnum. Algengustu kviðslitin eru nárahaular, naflakviðslit og kviðslit í öri. Nárahaular skiptast í tvennt; eiginleg nárakviðslit og laeriskviðslit en þau síðarnefndu eru aðeins 4% nárahaula og hlutfallslega miklu algengari hjá konum. 3 Nárakviðslitum er síðan skipt í tvennt: miðlaeg og hliðlaeg kviðslit sem hafa mismunandi meingerð og líffaerafraeðilega afstöðu (sjá Box 2). Hjá körlum eru hliðlaeg kviðslit tvisvar sinnum algengari en miðlaeg (60% miðað við 30%), 1
Background and Aims The aim of this prospective single-center study was to evaluate the outcome of inguinal hernia repair. Materials and Methods A total of 485 inguinal hernias (452 patients and 33 patients with bilateral hernias) were operated between January 2004 and December 2010. Mean age was 56 years, and 93% were male. Patient demographics and operative data were collected, and the operating surgeon assessed the technical difficulty of the operation. Five years after surgery, a questionnaire evaluated recurrence and chronic discomfort according to the Cunningham scale. 372 responded (82%), and mean follow-up was 5.5 years. Results There were 390 repairs for a primary and 62 for a recurrent hernia. Totally extraperitoneal (TEP) operation was most frequently performed (56%), transabdominal preperitoneal (TAPP) operation in 31%, and Lichtenstein and Shouldice in 12% and 2%, respectively. At 5-year follow-up, the primary outcome of chronic discomfort was 19.5%. The independent positive predictors were young age and operation for a recurrent hernia (OR: 3.7), with TEP operation reducing the risk of chronic discomfort (OR: 0.5). The secondary outcome was the recurrence rate of 2.5%. Risk factors were strenuous work (OR: 13.7), technically difficult repairs (OR: 7.2), and chronic discomfort (OR: 6.7). Conclusions Every fifth patient had chronic discomfort in long-term follow-up. The recurrence rate was 2.5%, and a technically difficult procedure was a risk factor.
The majority of patients diagnosed with advanced gastrointestinal stromal tumor (GIST) are successfully treated with a combination of surgery and tyrosine kinase inhibitors (TKIs). However, it remains challenging to monitor treatment efficacy and identify relapse early. Here, we utilized a sequencing strategy based on molecular barcodes and developed a GIST-specific panel to monitor tumor-specific and TKI resistance mutations in cell-free DNA and applied the approach to patients undergoing surgical treatment. Thirty-two GIST patients were included, and 161 blood plasma samples were collected and analyzed at routine visits before and after surgery and at start, during, and end of surgery. Patients were included regardless of their risk category. Our GIST-specific sequencing approach allowed detection of tumor-specific mutations and TKI resistance mutations with mutant allele frequency < 0.1 %. Circulating tumor-DNA (ctDNA) was detected in at least one timepoint in 9 out of 32 patients, ranging from 0.04% to 93% in mutant allele frequency. High-risk patients were more often ctDNA-positive than other risk groups (p < 0.05). Patients with detectable ctDNA also displayed higher tumor cell proliferation rates (p < 0.01) and larger tumor sizes (p < 0.01). All patients who were ctDNA-positive during surgery became negative after surgery. Finally, in two patients who progressed on TKI treatment, we detected multiple resistance mutations. Our data show that ctDNA may become a clinically useful biomarker in monitoring treatment efficacy in high-risk GIST patients and can assist in treatment decision making.
The results of cholecystectomies in AH are very good and comparable to the results of national and international studies. Key words: laparoscopic cholecystectomy, intra-operative cholangiography, choledocholithiasis, endoscopic retrograde cholangiopancreatography, complications. Correspondence: Marta Ros Berndsen, mrberndsen3@gmail.com.
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