Inguinal pain without inguinal hernia: what could it be?

A number of unusual conditions was diagnosed in 6 patients with inguinal pain. A 30-year-old man had iliopectineal bursitis on the right as well as a recurrent left inguinal hernia; many years after a Pfannenstiel incision a woman aged 57 harboured an entrapment of the ilioinguinal nerve; a 26-year-old woman suffered from endometriosis in the round ligament; a man aged 65 had compression of the genitofemoral nerve caused by a left iliac aneurysm; a woman aged 38 demonstrated symptoms of an anterior snapping hip; and a man aged 42 had retroperitoneal compression of nerves caused by a sarcoma. All recovered following appropriate treatment. Knowledge of a variety of clinical entities with associated specific anamnesis and physical examination will lead to a correct diagnosis and treatment in most cases of inguinal pain. In instances of compression, imaging techniques may facilitate the diagnostic work-up.     

Which surgical technique for inguinal hernia is best?

There is an ongoing discussion about the best technique for repairing an inguinal hernia. In a study with a long follow-up period in which the endoscopic Total Extra Peritoneal (TEP)-approach and open-Lichtenstein repair procedures were compared, it was concluded that inguinal hernia should be repaired by experienced surgeons by means of TEP. The results of the study are consistent with the content of the European guidelines for inguinal hernia repair, but the above recommendation is not. The differences in postoperative pain and chronic pain in favour of TEP are small, and appear to diminish over time. There were more complications with TEP, the learning curve was longer and hospital costs were higher. The Lichtenstein repair procedure, on the other hand, was probably not performed well with its high pain scores. Both techniques had comparably high recurrence rates.     

Nanotechnology--what is it? Should we be worried?

This paper describes the origins of nanoscience from theoretical reasoning to its realization in terms of mechanical manipulation of atoms. The ability to visualize and manipulate matter at the nanoscale has led to a diverse technology that ranges from better and faster electronics and more efficient fuel usage to sensing, drug discovery and stronger, more resistant materials. It has the prospect of affecting the lives of all of us and already a number of applications are in the market-place. But in our development of these technologies, we need to take care to reduce the risks of the adverse consequences that usually attend new applications of science.     

Breast cancer screening: Should it be introduced and how?

Summary This brief discussion of the papers by Gästrin and Paccaud is looking at differences in the results of different study types. Introducing screening means changing unsystematic to systematic screening: only the latter has been shown to be effective. The comparison between randomized trials, and follow-up of acceptors only, suggests that the non-acceptors have much higher risks. Programmes should therefore concentrate on trying to reach non-acceptors. The combination of mammographic screening and self-examination in a randomized trial could add to the existing evidence.

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Zusammenfassung Die Diskussion der beiden Arbeiten von Gästrin und Paccaud befasst sich mit den Unterschieden zwischen systematischem und unsystematischem screening: Nur ersteres hat in der Vergangenheit Effekte gezeigt. Nachuntersuchungen von Frauen, welche Screening akzeptiert haben, zeigen bessere Resultate als die randomisierten Studien; dies weist darauf hin, dass Frauen, welche in unsystematischem Screening nicht erfasst werden, ein höheres Risiko haben. Neue Programme sollten deswegen unbedingt darauf achten, auch diejenigen Frauen für Screening zu gewinnen, welche sonst nicht kommen. Die Kombination der zwei Ansätze: Mammographie Screening und Selbstuntersuchung der Brust in einer randomisierten Untersuchung könnte wichtige Hinweise zur Ergänzung der bestehenden Evidenz geben.

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Résumé La brève discussion des articles de Gästrin et Paccaud porte sur la diversité des résultats obtenus lors d'études de types différents. En introduisant le dépistage, le dépistage non-systématique fait place à un dépistage systématisé, qui s'est révélé être efficace. La comparaison entre des essais randomisés et des études de suivi chez des femmes acceptant le dépistage suggère que les femmes nonsoumises au dépistage ont un risque plus élevé. Les nouveaux programmes devraient porter leur attention sur la motivation de ces femmes à haut risque. La combinaison du dépistage par mammographie et de la palpation du sein par la femme elle-même pourrait, dans le cadre d'un essai clinique randomisé, apporter des éléments complémentaires renforçant l'evidence déjà existante.

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Paper presented at a symposium on The Public Health Perspective of Social and Preventive Medicine, in celebration of the 20th anniversary of the Department of Social and Preventive Medicine, University of Berne, 25 June 1992 in Berne.     

Social marketing: Should it be used to promote evidence-based health information?

The implementation of public health knowledge is a complex process; researchers focus on organizational barriers but generally give little attention to the format and validity of relevant information. Primary and secondary papers and practice guidelines should represent valid and relevant sources of knowledge for clinicians and others involved in public health. However, this information is usually targeted at researchers rather than practitioners; it is often not completely intelligible, does not explain what it really adds to existing knowledge or which clinical/organizational context to place it in, and often lacks 'appeal' for those who are less informed. Moreover, this information is sometimes founded on biased research, shaped by sponsors to give scientific plausibility to market-driven messages. A "social marketing" approach can help public health researchers make evidence-based information clear and appealing. The validity and relevance of this information can be explained to target readers in light of their own knowledge levels and in terms of how this information could help their practice. In this paper we analyse the barriers to knowledge transfer that are often inherent in the format of the information, and propose a more user-friendly, enriched and non-research-article format.