Outcome and cost comparison of laparoscopic transabdominal preperitoneal hernia repair versus Open Lichtenstein technique

Laparoscopic hernia repair has all the advantages of a tension free repair. This study compares the laparoscopic transabdominal preperitoneal (TAPP) approach with tension-free open hernia repair in terms of operative time, postoperative pain, hospital stay, complications, and cost. Open and TAPP repairs using polypropylene mesh were performed in two groups of 25 male patients. The difference in operative times between the groups was not significant. Mean pain scores (0-100) for the open group were 54.12 +/- 13.06 at 12 hours and 37.24 +/- 11.38 at 24 hours, significantly higher than the corresponding scores of 38.36 +/- 8.21 at 12 hours and 20.92 +/- 8.73 at 24 hours for the TAPP group (P < 0.05). The mean postoperative analgesic dose was 6.72 +/- 2.72 in the TAPP group, which was insignificantly lower than 7.52 +/- 2.00 in the open group. Mean hospital stay was 2.24 +/- 0.97 days in the open group and 1.52 +/- 0.51 in the TAPP group, which was significant (P < 0.05). Twenty patients (80%) in the TAPP group rated themselves highly satisfied with the surgery as compared to 11 patients (44%) in the open group (P < 0.05). There was no recurrence in either group during a mean followup period of 13.5 months (range, 8-28 months). Laparoscopic hernia repair was significantly more expensive than open (1100 US dollars versus 629 US dollars). TAPP repair is superior to open repair in terms of shorter hospital stay, lower postoperative pain, and better patient satisfaction. It is also safe, with no recurrence in a short-term period. This technique will be the operation of choice for the treatment of groin hernia after long-term results have been established in our center.     

Prevention of adhesions by sodium chromoglycate, dexamethasone, saline and aprotinin after pelvic surgery

BACKGROUND: The purpose of the present paper was to assess the efficacy of saline, sodium chromoglycate, dexamethasone and aprotinin, in single or in combined use in reducing postoperative pelvic adhesion formation in a rabbit model. METHODS: A standard lesion was performed to induce adhesion formation. Forty-five rabbits were divided into nine study groups. Group 1 was the non-treatment group. In group 2, 3 cm(3) of the rabbits' own serum was instilled i.p. In group 3, 5 mg/kg sodium chromoglycate and 3 cm(3) of the rabbits' own serum were administered i.p. The group 4 rabbits were instilled with 5 mg/kg sodium chromoglycate, 3 cm(3) rabbits' own serum and 1 mg/kg dexamethasone i.p. The group 5 rabbits were injected with 5000 units aprotinin i.m. 2 h before operation and 5 mg/kg sodium chromoglycate, 3 cm(3) of rabbit serum, 1 mg dexamethasone and 5000 units aprotinin instilled i.p. In group 6, 3 cm(3) saline was instilled i.p. Groups 7, 8 and 9 were a repeat of groups 4, 5 and 6 with the exception of replacement of the rabbit serum by 3 cm(3) saline. Animals were evaluated for adhesions 10 days after operation. RESULTS: Macroscopic adhesion scores of all the groups (2-9) were significantly less than scores of the control group (group 1). The macroscopic adhesion scores of group 9 and group 8 were significantly less compared to that of group 7. CONCLUSION: Intraperitoneal instillation of saline and sodium chromoglycate decreased pelvic adhesion formation significantly in a rabbit model. Addition of aprotinin and dexamethasone to these agents gave a further advantage in decreasing pelvic adhesion formation.     

Blood pool MR angiography of aortic stent-graft endoleak

OBJECTIVE: The purpose of our research was to investigate the value of a blood pool contrast agent in detecting endoleaks on MR angiography after endoluminal stent-graft repair of infrarenal aortic aneurysms. CONCLUSION: Blood pool MR angiography using Ferumoxytol reveals more aortic stent-graft endoleaks than does CT angiography and depicts more endoleaks 24 hr after administration than during the immediate arterial phase because of a 50-fold increase in the volume of enhancement in the aneurysmal sac outside the stent-graft.     

Epigenetic inactivation of 14-3-3 sigma in oral carcinoma: association with p16(INK4a) silencing and human papillomavirus negativity

In vitro studies have identified 14-3-3sigma as a regulator of senescence in human keratinocytes. To assess its contribution to squamous neoplasia, we have analyzed genetic and epigenetic changes in this gene in squamous cell carcinomas (SCCs) and dysplastic lesions of the oral cavity. No mutations were detected in the coding sequence of 14-3-3sigma in 20 oral carcinomas, and there was loss of heterozygosity in only 7 of 40 informative cases. In contrast to the absence of genetic change, aberrant methylation within 14-3-3sigma was detected in 32 of 92 squamous cell carcinomas and in 3 of 6 oral dysplasias and was associated with reduced or absent expression at both mRNA and protein levels. Methylation was not detected in matched, normal epithelial tissue controls. Carcinomas in which 14-3-3sigma was methylated were significantly more likely to lack DNA sequences from human papillomavirus and to have coincident methylation of p16(INK4a) than cases that expressed 14-3-3sigma. Methylation was detected in SCC, both wild-type and mutant for p53, but was more commonly detected in cancers with wild-type p53. These results implicate coincident epigenetic abrogation of function in both sigma and p16(INK4a) in a subset of SCCs of the oral cavity.     

Lens of the eye: radiation dose in balloon dacryocystoplasty

PURPOSE: To evaluate the absorbed radiation dose to the lens of the eye, which is the critical organ in the primary beam during fluoroscopically guided transluminal balloon dilation of the lacrimal drainage system (balloon dacryocystoplasty) for obstructive epiphora and to evaluate the possibility of deterministic radiation effect on the lens. MATERIALS AND METHODS: The radiation dose to the lens of the eye during balloon dacryocystoplasty (which includes pre- and postintervention dacryocystography) was measured in 10 consecutive patients by using thermoluminescent dosimeters on the lids of both eyes as close as possible to the lenses. A C-arm angiographic unit coupled with a digital imaging system was used, with similar exposure and geometric parameters in all cases. RESULTS: The mean radiation dose to the lens of the treated eye was 4.6 mGy +/- 2.2 (dose range, 1.9-9.1 mGy) and to that of the untreated eye was 38.5 mGy +/- 17.5 (dose range, 14.7-67.8 mGy). CONCLUSION: The lens of the untreated eye receives a higher dose than that of the treated eye because of its closer proximity to the x-ray tube in a lateral projection. In the lens, even the highest measured radiation dose (67.8 mGy) still was well below the deterministic threshold for lens opacity and cataract formation.     

Malignant solid tumors associated with congenital immunodeficiency disorders

This objective of this study was to evaluate patients with immunodeficiency syndromes who had developed malignant solid tumors and to examine survival rates and prognosis with respect to type of immunodeficiency disease. Twenty-two patients who were diagnosed with malignant solid tumors and immunodeficiency syndromes between January 1972 and February 2003 were analyzed retrospectively. There were 12 (55%) patients with non-Hodgkin lymphoma, 8 (37%) with Hodgkin disease, 1 (5%) with mucinous adenocarcinoma of the colon, and 1 (5%) with brain stem glioma. Fifteen (68%) patients had ataxia-telangiectasia, 3 (14%) had common variable immunodeficiency disease, 2 (9%) had Bloom syndrome, 1 (5%) had combined immunodeficiency, and 1 (5%) had selective immunoglobulin A deficiency. Out of the 15 patients with ataxia-telangiectasia 9 patients had non-Hodgkin lymphoma, 5 had Hodgkin disease, and 1 had brain stem glioma. Two patients with common variable immunodeficiency disease had non-Hodgkin lymphoma and 1 had Hodgkin disease. One of the patients with Bloom syndrome had Hodgkin disease and 1 had colon carcinoma. The overall survival for the whole group was 24%. Overall survival rates in non-Hodgkin lymphoma, Hodgkin disease, colon carcinoma, and brain stem glioma were 17, 44, 0, and 0% (p =.25), respectively. Overall survival in ataxia-telangiectasia patients was 20%. In this series, most of the patients had ataxia-telangiectasia (68%). The survival rates of the malignant diseases were very poor in immunodeficiency. Overall survival in non-Hodgkin lymphoma patients was relatively worse than Hodgkin disease patients.