Results Participants were allocated to vitamin D 3 vs. placebo in equal numbers; 82% were vitamin D insufficient at baseline. Vitamin D 3 supplementation did not influence time to first severe exacerbation (aHR 1.02, 95% CI 0.69-1.53, P = 0.91) or time to first URI (aHR 0.87, 95% CI 0.64-1.16, P = 0.34). The influence of vitamin D 3 on co-primary outcomes was not modified by baseline vitamin D status or genotype. Of 16 pre-specified secondary outcomes, only one showed a difference between arms: vitamin D supplementation induced a modest improvement in respiratory quality of life as evidenced by a reduction in mean total score for the St George's Respiratory Questionnaire at 2 months (-3.9 points, p = 0.005), 6 months (-3.7 points, p = 0.038) and 12 months (-3.3 points, p = 0.060). Conclusions Vitamin D 3 supplementation did not influence time to exacerbation or URI in a population of adults with ICS-treated asthma with a high prevalence of baseline vitamin D insufficiency. Introduction Severe Asthma, characterised by persistent symptoms despite maximal medical therapy, represents 5% of asthma cases. Bronchial Thermoplasty (BT) is a novel therapy, NICE approved for Severe Asthma patients uncontrolled despite step 4/5 of British Guideline on Asthma Management. BT delivers radiofrequency thermal energy to airways distal to the main-stem bronchi, permanently reducing airway smooth muscle mass. It is unknown whether treatment of smooth muscle hypertrophy impacts persistently upon systemic signs of allergic inflammation. Peripheral blood eosinophils (PBEs) are a marker of allergic inflammation in asthma. We asked: does BT modify signs of allergic inflammation as measured by PBEs and if so, does this effect persist over time? Method A retrospective review of 15 consecutive Severe Asthma cases treated with BT was performed. Serial PBEs measured before and up to 1 year after BT were compared. Blood eosino-phil levels taken peri-procedure were excluded from analysis due to standard protocol concomitant steroid therapy. For time to first detectable high PBE all available post-BT PBE levels were assessed. Results 13 patients had PBE data before and after BT, with an average of 9 and 12 serial PBE levels pre and post-BT respectively. Mean PBE 1 year pre-BT was 0.33 Â 10 9 /L falling to a mean of 0.16 Â 10 9 /L 1 year post-BT (p < 0.05) (see Figure). 9 of 13 patients had a fall in mean PBE, in 2 of 13 levels rouse and 1 of 13 mean PBEs were unchanged post-BT. In 6 patients who converted from normal to high PBE post-BT, average time to first high PBE (>0.4 Â 10 9 /L) was 7 months (range 1-13 months). In 5 patients (38%) PBE remained within normal range persistently post BT. Conclusion Severe Asthma patients undergoing BT had a significant reduction in average peripheral blood eosinophil levels from baseline. In over 1/3 of cases this effect was persistent 1 year post procedure. These findings support the concept that BT not only reduces asthma-associated smooth muscle hypertrophy but impacts upon systemic markers of allergic i...

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BackgroundAlthough the repair of ventral abdominal wall hernias is one of the most commonly performed operations, many aspects of their treatment are still under debate or poorly studied. In addition, there is a lack of good definitions and classifications that make the evaluation of studies and meta-analyses in this field of surgery difficult.Materials and methodsUnder the auspices of the board of the European Hernia Society and following the previously published classifications on inguinal and on ventral hernias, a working group was formed to create an online platform for registration and outcome measurement of operations for ventral abdominal wall hernias. Development of such a registry involved reaching agreement about clear definitions and classifications on patient variables, surgical procedures and mesh materials used, as well as outcome parameters. The EuraHS working group (European registry for abdominal wall hernias) comprised of a multinational European expert panel with specific interest in abdominal wall hernias. Over five working group meetings, consensus was reached on definitions for the data to be recorded in the registry.ResultsA set of well-described definitions was made. The previously reported EHS classifications of hernias will be used. Risk factors for recurrences and co-morbidities of patients were listed. A new severity of comorbidity score was defined. Post-operative complications were classified according to existing classifications as described for other fields of surgery. A new 3-dimensional numerical quality-of-life score, EuraHS-QoL score, was defined. An online platform is created based on the definitions and classifications, which can be used by individual surgeons, surgical teams or for multicentre studies. A EuraHS website is constructed with easy access to all the definitions, classifications and results from the database.ConclusionAn online platform for registration and outcome measurement of abdominal wall hernia repairs with clear definitions and classifications is offered to the surgical community. It is hoped that this registry could lead to better evidence-based guidelines for treatment of abdominal wall hernias based on hernia variables, patient variables, available hernia repair materials and techniques.

Objective: The authors determined the prevalence of foreign body granulomas in intra-abdominal adhesions in patients with a history of abdominal surgery.Patients and Methods: In a cross-sectional, multicenter, multinational study, adult patients with a history of one or more previous abdominal operations and scheduled for laparotomy between 1991 and 1993 were examined during surgery.Patients in whom adhesions were present were selected for study. Quantity, distribution, and quality of adhesions were scored, and adhesion samples were taken for histologic examination.Results: In 448 studied patients, the adhesions were most frequently attached to the omentum (68%) and the small bowel (67%). The amount of adhesions was significantly smaller in patients with a history of only one minor operation or one major operation, compared with those with multiple laparotomies (p < 0.001).Significantly more adhesions were found in patients with a history of adhesions at previous laparotomy (p < 0.001), with presence of abdominal abscess, hematoma, and intestinal leakage as complications after former surgery (p = 0.01, p = 0.002, and p < 0.001, respectively), and with a history of an unoperated inflammatory process (p = 0.04).Granulomas were found in 26% of all patients. Suture granulomas were found in 25% of the patients. Starch granulomas were present in 5% of the operated patients whose surgeons wore starch-containing gloves. When suture granulomas were present, the median interval between the present and the most recent previous laparotomy was 13 months. When suture granulomas were absent, this interval was significantly longer-i.e., 30 months (p = 0.002). The percentage of patients with suture granulomas decreased gradually from 37% if the previous laparotomy had occurred up to 6 months before the present operation, to 18% if the previous laparotomy had occurred more than 2 years ago (p < 0.001).Conclusions: The number of adhesions found at laparotomy was significantly larger in patients with a history of multiple laparotomies, unoperated intraabdominal inflammatory disease, and previous postoperative intra-abdominal complications, and when adhesions were already present at previous laparotomy. In recent adhesions, suture granulomas occurred in a large percentage. This suggests that the intra-abdominal presence of foreign material is an important cause of adhesion formation. Therefore intra-abdominal contamination with foreign material should be minimized.

Adhesions cause bowel obstruction, chronic abdominal pain, and infertility. In this review, the incidence, clinical signs, diagnostic procedures, and treatment of these sequels of abdominal surgery are discussed. Laparoscopic treatment of bowel obstruction, chronic pain, and infertility is feasible in selected patients and has been reported to cause fewer newly formed adhesions. Randomized controlled trials to compare open and laparoscopic surgery for adhesions should be executed with long-term follow-up to assess the success rates of adhesiolysis and compare the morbidity and mortality.