BackgroundProspective studies demonstrate that over one‐third of patients undergoing standard suture closure of laparotomy wounds will develop incisional hernias (IHs). Whilst prophylactic mesh has been demonstrated to decrease IH rates in clean laparotomy wounds, mesh has been associated with high rates of seroma formation (>30%), infection (>10%) and pain, discouraging many surgeons from using mesh, especially combined with intestinal surgery. The aim of this study is to review the experience of a single colorectal surgeon who, after noting high IH rates in his own patients, started placing prophylactic mesh routinely in patients judged to be at high risk of IH.MethodsThe records of all patients undergoing bowel resections and ileostomy closure by one surgeon from 2008 to 2018 were independently retrospectively analysed.ResultsOf the 935 procedures identified, 662 patients underwent midline laparotomy with bowel resection and 273 patients underwent closure of loop ileostomy. Mesh was placed prophylactically in 221 (23.6%) of 935 procedures. Comparing the mesh and non‐mesh groups, wound infections occurred in nine (4.1%) versus 23 (3.2%) (P = 0.53), seromas occurred in nine (4.1%) versus six (0.8%) (P = 0.003) and chronic pain was noted in 12 (5.4%) versus 17 (2.4%) (P = 0.04). The mean follow‐up was 33 months in both the mesh and non‐mesh groups. IHs have occurred in three (1.3%) of the mesh group compared to 95 (13.3%) of the non‐mesh group procedures (P = 0.0001).ConclusionIn colorectal operations, prophylactic mesh decreases the risk of IH without prohibitive complications.

Background Cardiac magnetic resonance feature tracking (CMR-FT) and speckle tracking echocardiography (STE) are well-established strain imaging modalities. Multilayer strain measurement permits independent assessment of endocardial and epicardial strain. This novel and layer specific approach to evaluating myocardial deformation parameters may provide greater insight into cardiac contractility when compared to whole-layer strain analysis. The aim of this study is to validate CMR-FT as a tool for multilayer strain analysis by providing a direct comparison between multilayer global longitudinal strain (GLS) values between CMR-FT and STE. Methods We studied 100 patients who had an acute myocardial infarction (AMI), who underwent CMR imaging and echocardiogram at baseline and follow-up (48 ± 13 days). Dedicated tissue tracking software was used to analyse single- and multi-layer GLS values for CMR-FT and STE. Results Correlation coefficients for CMR-FT and STE were 0.685, 0.687, and 0.660 for endocardial, epicardial, and whole-layer GLS respectively (all p < 0.001). Bland Altman analysis showed good inter-modality agreement with minimal bias. The absolute limits of agreement in our study were 6.4, 5.9, and 5.5 for endocardial, whole-layer, and epicardial GLS respectively. Absolute biases were 1.79, 0.80, and 0.98 respectively. Intraclass correlation coefficient (ICC) values showed moderate agreement with values of 0.626, 0.632, and 0.671 respectively (all p < 0.001). Conclusion There is good inter-modality agreement between CMR-FT and STE for whole-layer, endocardial, and epicardial GLS, and although values should not be used interchangeably our study demonstrates that CMR-FT is a viable imaging modality for multilayer strain

Background: Multilayer strain measurement with cardiac magnetic resonance feature tracking (CMR-FT) allows independent assessment of endocardial and epicardial strain. This novel method of layer-specific quantification of myocardial deformation parameters provides greater insight into contractility compared to whole-layer strain analysis. The clinical utility of this technique is promising. The aim of this study is to investigate the intra-and inter-observer reproducibility of CMR-FT derived multilayer global longitudinal strain (GLS) and global circumferential strain (GCS) parameters in the setting of normal cardiac function, cardiac pathology, and differing MRI field strengths. Methods:We studied 4 groups of 20 subjects, comprising of patients with dilated cardiomyopathy, ischemic heart disease, and patients without cardiac pathology at both 1.5 and 3 T. Quantitative measures of wholelayer and multi-layer longitudinal and circumferential strain were calculated using CMR-FT software.Results: Intraclass correlation coefficients (ICC) for intraobserver reproducibility of endocardial, epicardial, and whole-layer measurements of GLS were 0.979, 0.980, and 0.978 respectively, and those for GCS were 0.986, 0.977, and 0.985. ICCs for inter-observer reproducibility of endocardial, epicardial, and whole-layer measurements of GLS were 0.976, 0.970, and 0.976, and those for GCS were 0.982, 0.969, and 0.981. Bland Altman analysis showed minimal bias and acceptable limits of agreement (LOA) within each patient subgroup and the overall cohort. Circumferential and longitudinal strain parameters were equally reproducible in the overall cohort.Conclusions: CMR-FT derived multilayer measurements of longitudinal and circumferential strain demonstrate high intra-and inter-observer reproducibility, with suitability for use in clinical practice.

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The floor of the maxillary sinus is partly formed by the alveolar process of the maxilla, and this anatomical relationship forms an interface for collaboration between rhinologists, maxillofacial and dental surgeons, and dentists. Odontogenic maxillary sinusitis (ODMS) occurs secondary to infectious processes of the maxillary molar and premolar teeth or following complications from dental procedures. Extruded dental foreign bodies within the sinus can cause chronic mucosal irritation leading to mucociliary dysfunction and sinogenic symptoms. Anteriorly placed foreign bodies are difficult to access via the conventional endoscopic maxillary antrostomy. Endoscopic approaches to access the anterior maxillary sinus involve extended resection of the medial maxillary wall, potentially with the removal of the inferior turbinate and nasolacrimal duct mobilisation. The prelacrimal window approach (PLWA) is a favourable modification that provides excellent visualisation of the maxillary sinus with minimal tissue resection and displacement. We describe the case of an extruded distobuccal 27 tooth root into the anterior maxillary sinus, presenting with acute sinusitis. The patient was successfully managed via a PLWA. This case represents the importance of recognition of ODMS with early referral to otorhinolaryngologists.