Comparison of Stoppa and Lichtenstein techniques in the repair of bilateral inguinal hernias

Summary The feasibility of tension-free repairs in bilateral inguinal hernias has not been well documented. In this prospective randomized study patients' characteristics, intra- and postoperative parameters including pain, return to daily activity and work, were assessed in patients undergoing bilateral hernia repair by means of either the Stoppa or the Lichtenstein techniques. A total of 45 patients having bilateral inguinal hernia repairs were randomly assigned to one of the two treatment groups. Patients in Group I had operations with the simultaneous Lichtenstein technique (n23) and were further randomized to either spinal (n11) or local anesthesia (n12) subgroups. Those in Group II underwent a Stoppa hernioplasty (n22). Complications and recurrences were sought for two years postoperatively. Patients with bilateral Lichtenstein repairs under local anesthesia had lower pain scores at rest and leg-raising test, and returned to pain-free normal daily activity and work on the 15th and 30th days, respectively. Although smaller than those of other groups, none of these parameters were statistically significant. The only prominent difference was seen in the operating time. The Stoppa repair took significantly less time than the Lichtenstein repairs (51 vs. 65 min, p < 0.01). In this study we were unable to demonstrate the superiority of either technique or type of anesthesia used in the repair of bilateral hernias. Both techniques were capable of producing favorable postoperative results, and were well accepted by most of the patients.     

Renal salvage procedure for synchronous bilateral Wilms' tumor

This report describes a renal salvage procedure performed in a 2-year-old girl with bilateral renal tumors comprising a multilocular, cystic tumor of the right kidney and a solid and cystic nephroblastoma of the left kidney after chemotherapy. Surgery was performed because the right kidney became hydronephrotic due to compression by the enlarged cysts, while the left tumor showed only minimal shrinkage even after three courses of chemotherapy. The right-sided cysts were simply unroofed and the left-sided tumor was extirpated by partial nephrectomy. Her postoperative course was uneventful with considerable recovery of the function of each kidney. This procedure should be considered if the pathological features of the tumor are relatively favourable. Accepted: 20 January 1999     

Paradoxical vocal cord movement in newborn and congenital idiopathic vocal cord paralysis: two of a kind?

The second most common cause of stridor reported in the newborn is bilateral vocal cord paralysis (BVCP) and one-third of the cases have been categorized as idiopathic. During the last year four children with stridor since birth were referred to our department for examination. Videotaped flexible laryngoscopy, carried out with the patient awake or under general anaesthesia with a spontanous respiration, revealed instead of abduction of the vocal cords during inspiration, rather an active adductory movement. Consequently instead of BVCP, we made the diagnosis paradoxical vocal cord movement (PVCM). One of the twins required a tracheostomy, the three other patients have been observed without the need of further treatment. No previous publications have described PVCM in newborn. However, our observations and video recordings clearly show that the stridor in our four patients is due to PVCM. This is possibly the same condition as earlier reported as congenital, idiopathic BVCP where incoordinated vocal cord movement or dyskinesia has been a part of the laryngoscopic findings. The mechanism behind PVCM in this age group or site of lesion is unclear.     

The value of protruding extraperitoneal fat in predicting contralateral inguinal hernia

The high incidence of bilateral inguinal hernias in the pediatric population and the fact that most of these children undergo contralateral hernia repair months or years after the first intervention for a clinically unilateral inguinal hernia have resulted in numerous examinations aimed at finding a contralateral hernia. We have found that the presence of protruding extra-peritoneal fat on the operated side could be considered a predictor of bilaterality after observing this finding in a large number of children operated upon months or years before for a unilateral inguinal hernia. Correspondence to: M. Kovalivker     

Malignant neoplasms after treatment for metachronous bilateral Wilms' tumor: a literature review

Information regarding malignant neoplasms after treatment for metachronous bilateral Wilms' tumor is limited. A MEDLINE search was performed of all English-language articles from 1950 to 1997 pertaining to metachronous bilateral Wilms' tumor. A total of 108 different cases were identified and analyzed. Mean follow-up was 5.8 years after initial diagnosis of Wilms' tumor (range, 1 month to 25.6 years). Eleven of 63 evaluable children (17.5%) had a congenital anomaly. Four patients (3.7%) developed a malignant neoplasm after treatment of a metachronous bilateral Wilms' tumor. Three of 18 patients followed for at least 10 years developed a solid tumor, including two sarcomas in the irradiated areas. Two of the 4 children who developed a malignant neoplasm had a congenital anomaly. Malignant neoplasms after treatment for metachronous bilateral Wilms' tumor can occur. Health-care professionals caring for these patients should be aware of this late sequelae of treatment.     

Immediate effects of total visual deafferentation on single unit activity in the visual cortex of freely behaving cats. I. Tonic excitability changes

Summary Effects of total visual deafferentation (eye enucleation) on maintained and evoked single unit activity in the cat visual cortex (VC) were studied. Three recording states were distinguished: resting arousal (RA), light sleep (LS) and deep sleep (DS). Two characteristic discharge patterns were noted in deafferented units. One was characterized by rhythmic synchronous firing of several units which was accompanied by high-amplitude slow wave bursts in the EEG (6–8/sec) during RA. Another was the abrupt occurrence of long-lasting spike trains which appeared unpredictively irrespective of vigilance levels. The overall discharge rate tended to decrease after deafferentation in both RA and DS while in LS tended to increase slightly. Three types of VC units were distinguished, as in intact ones, on the basis of the correlation function between the mean discharge rate in RA and its changes in LS. The relative incidence for the three types were different in the deafferented VC. The largest group (47.2%) had a sequence of mean discharge rate DS相似文献   

The impact of bilateral breast cancer on the prognosis of breast cancer: a comparative study with unilateral breast cancer

BACKGROUND: The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. We assessed the impact of synchronous and metachronous bilateral breast cancer on the prognosis compared with unilateral breast cancer. METHODS: Between January 1, 1960 and December 31, 2001, 1,214 women were treated for primary operable breast cancers. Thirteen (1.1%) had synchronous bilateral breast cancer; 33 (2.7%) had a metachronous contralateral breast cancer. We compared age at operation, menopausal status, clinical stage, tumor size and histology, lymph node status, hormone receptor status, and use of adjuvant chemotherapy or hormone therapy, and we analyzed the impact of these factors on recurrence and survival in the 46 patients with bilateral breast cancer and the 1,168 patients with unilateral breast cancer. RESULTS: The 5-and 10-year disease-free survival rates, respectively, were 65% and 65% in metachronous cases, 85.7% and 64.3% in synchronous cases, and 77.9% and 72.1% in unilateral cases. There was no significant difference in overall survival among the three groups. On multivariate analysis, metachronous bilaterality, tumor size, lymph node status and adjuvant hormone therapy were each independent risk factors for recurrence, whereas bilaterality of breast cancer did not influence overall survival. CONCLUSIONS: Our data suggest that metachronous bilateral breast cancer is associated with shorter disease-free survival than synchronous bilateral or unilateral breast cancer, although overall survival does not differ among the 3 groups. Patients with metachronous bilateral breast cancer should be followed particularly closely in order to detect recurrence early and maximize quality of life.     

Kimura’s disease presenting as bilateral parotid masses

Kimuras disease, a unique angiolymphoid proliferative disorder with unknown cause, is apparently more prevalent in a young Oriental males, but also occurs rarely in Western people. It has occasionally been misdiagnosed as malignant tumor or other serious diseases, leading to unnecessary radical surgery. Hence, clinicians should be made aware of this disease. The most common presentation is a unilateral soft-tissue mass in the head and neck region. Kimuras disease of bilateral parotid involvement has been reported rarely. We encountered a rare case of Kimuras disease presenting as bilateral parotid region masses and treated it successfully with surgery.     

Bilateral otosyphilis in a patient with HIV infection

Otosyphilis is a rare but important cause of sensorineural hearing loss and dizziness, because this hearing loss can be reversed by early diagnosis and aggressive treatment. Moreover, HIV may alter the course of otosyphilis and hasten the development of otosyphilis by reducing host cellular immunity. We report the case of a 35-year-old HIV-infected patient with bilateral fluctuating sensorineural hearing loss and bilateral total vestibular loss caused by otosyphilis. We include a discussion of the relationship between otosyphilis and HIV infection.     

Bilateral congenital lobar emphysema: how should we proceed?

We report a case of a 4-week-old male infant who presented with increasing respiratory distress and was diagnosed to have bilateral congenital lobar emphysema on chest x-ray. Our approach to the surgical management in two sequential operations of left upper lobectomy followed by right middle lobectomy is discussed.