Bilateral total extraperitoneal inguinal hernia repair (TEP) has outcomes similar to those for unilateral TEP: population-based analysis of prospective data of 6,505 patients

Background  

Whether bilateral total extraperitoneal (TEP) inguinal hernia repair is associated with worse outcomes than unilateral TEP continues to be a matter of debate. This study aimed to compare different outcomes of large cohorts of patients undergoing bilateral versus unilateral TEP.     

The effect of positive semen bacterial and Ureaplasma cultures on in-vitro fertilization success

A total of 342 couples planning to undergo in-vitro fertilization(IVF) were examined for the presence of bacteria in semen priorto and during the procedure. Pregnancy rates were analysed retrospectivelyto ascertain any adverse affects if >10 000 colony formingunits (CFU)/ml bacteria were detected in the semen sample. Themost common bacteria isolated from semen were Enterococcus spp.(73%). The presence of these bacteria did not affect the pregnancyrate of the patients with positive cultures prior to (32%) orduring (37%) the IVF procedure compared with those patientsin whom no bacteria were detected (32%). Those patients withsemen cultures positive for Escherichia coli prior to the IVFprocedure, but which cleared after treatment had a higher pregnancyrate (60%) compared with those patients who were positive forE.coli at the time of the attempt The group of patients withStaphylococcus aureus in the semen at the time of IVF also demonstrateda low pregnancy rate (17%). Of the patients, 36 (11%) had positiveUreaplasma cultures from the screening test carried out on thesemen and 22% became pregnant after successful treatment Noneof the three patients with persistently positive cultures becamepregnant in conclusion, the presence of Enterococcus in semendoes not affect pregnancy rates following IVF. E.coli, S.aureusand Ureaplasma urea-lyticum may have a negative effect and shouldbe treated.     

Immunochemical Definition of the New Dr Specificity 8WDRw13

Using two alloantisera produced by planned immunization of blood donor volunteers, a new specificity was defined residing on human Ia molecules. The specificity is possessed by the following human lymphoid cell lines: Reh, NALM-1, B89, KM-3 and BJAB, and appears to be the same as the DRw13 specificity discovered in the 8th International Histocompatibility Workshop. A radioimmunoassay for typing w13 on peripheral blood lymphocytes was established. A population and family study supports the genetic control by the HLA-DR locus. The phenotypic frequency in an Italian population was 3.7 percent. The relationship between w13 and the MT2 supertypic specificity was confirmed at the molecular level and the papain sensitivity of w13-carrying molecules was determined.     

Different patterns of cell proliferation and death and oncogene expression in cutaneous malignant melanoma

Ninety-six cutaneous melanomas (CMs) were investigated aiming at finding differences, if any, among tbe main four chnicopatho-logical types, for Bcl-2. c-myc and p53 protein expression, and for tumor cell proliferation and death indices. Proliferation was assessed by calculating die mitotic index (MI, number of mitoses) and the MIBl labelling index (M-LI, number of MIBI+ nuclei), and tumor cell death by calculating tbe apoptotic index (AI, number of apoptoses) among 1000 tumor cells. CMs were subdivided into thin (<1 mm) and intermediate thickness (1-4 mm) tumors. Bcl-2 expression did not significantly change among different types, c-myc Expression decreased expecially in thicker superficial spreading (SSM) and lentigo maligna melanoma (LMM) types. p53 Expression was higher in nodular melanoma (NM) and in acral lentigiuous melanoma(ALM), which also showed the highest degrees of proliferation. AI was significantly higher in thin rather than in intermediate thickness SSMs, LMMs and ALMs (8.4 vs. 2; 6.1 vs. 2.3. and 5.8 vs. 3.6, respectively). AI was low in thin (1.7) and intermediate thickness (1.9) NMs. Which also showed high MI (3.9 and 4.5, respectively), and M-LI (16.7 and 2.9, respectively). Thin and intermediate thickness ALMs also showed high MI and M-LI (4.1 vs. 5.2 and 11.3 vs. 14.6, respectively). Bcl-2 is among genes which inhibit apopiotic death, whereas c-myc and p-53 genes promote this process. In CMs. no relation was found between BcI-2 expression, MI, PI, and AI. All SSMs, LMMs, and ALMs with a high AI showed a high c-myc expression and were negative for p53. c-myc, Although highly expressed, did not promote a significant apoptotic death in NM type. Bc12, c-myc, and p53 were not equally expressed nor equally related to tumor cell turnover in all CMs, suggesting their different influence on the various types and stages, and the role of other factors in CM growth control.     

Improving initial management of lower urinary tract symptoms in primary care: costs and patient outcomes

OBJECTIVE: Guidelines for primary care management of lower urinary tract symptoms in older men recommend shared decision making regarding the choice of treatment. In this study we aimed to determine the costs and patient outcomes of an implementation strategy designed to enhance uptake of these guidelines. MATERIAL AND METHODS: The intervention comprised a distance learning programme for general practitioners, comprising evidence-based information, assessment of learning needs, a knowledge test and patient education materials. The control group only received the written guidelines. A cluster randomized trial in 187 older male patients compared costs and outcomes in the two study groups. A healthcare perspective was taken in the economic evaluation, with a 3-month time horizon. The primary health outcome was patient-reported urinary symptoms at 3 months. Costs relating to the distance learning package and the healthcare provided were considered, using undiscounted standardized prices. RESULTS: Patient-reported urinary symptoms at 3 months did not differ between the study groups: 66% and 61% with moderate symptoms and 7% and 11% with severe symptoms in the intervention and control groups, respectively. The mean total costs per patient were euro28.15 lower in the intervention group (euro93.11) compared to the control group (euro121.26), mainly because of a lower number of referrals to the urologist. A bootstrap analysis showed an incremental cost-effectiveness ratio of euro111.98 (95% CI -euro423 to +euro329). CONCLUSIONS: The distance learning programme did not change health outcomes, but it reduced costs in the first 3 months after an initial consultation compared to written guidelines. Studies with a longer follow-up period are needed.     

Acute limb ischemia associated with type B aortic dissection: clinical relevance and therapy

BACKGROUND: The goal of the current study is to characterize the presentation, therapy, and outcomes of acute limb ischemia (ALI) associated with type B aortic dissection (AoD). METHODS: The prospective/retrospective International Registry for Acute Aortic Dissection (IRAD) database and a single institutional database were queried for all patients with type B AoD from 1996 to 2002. Univariate and multivariate statistics were used to delineate factors associated with morbidity and mortality outcomes. RESULTS: According to the IRAD data (n = 458), the mean age of patients was 64 years, and 70% were men. The overall mortality was 12%; of these, 6% had ALI. Pulse (3-fold) and neurologic deficits (5-fold) were more common in those with ALI (P < .001). Endovascular, but not surgical therapy, was more commonly performed in patients with ALI compared with those without ALI (31% vs 10%, P = .004). No difference in age, race, gender, or origin of dissection was observed. ALI was associated with acute renal failure (odds ratio [OR] = 2.7; 95% confidence interval [CI] 1.1-7.1; P = .048) and acute mesenteric ischemia/infarction (OR = 6.9; 95% CI 2.5-20; P < .001). Adjusting for patient characteristics, ALI was associated with death (3.5; 95% CI 1.1-10; P = .02). The single institution analysis revealed similar patient demographics and mortality in 93 AoD patients, of whom 28 had ALI. Aortic fenestration or aorto-iliac stenting was the primary therapy in 93%; surgical bypass was used in 7%. Limb salvage was 93% in those with ALI at a mean of 18 months follow-up. The number of organ systems with malperfusion was 2-fold higher at aortography than suspected preprocedure (P = .002). By stepwise regression modeling, mortality was greater in those not taking a beta-blocker (OR = 19; 95% CI 3.1-111; P = .001). CONCLUSIONS: ALI secondary to AoD is predictive of death and visceral ischemia. Endovascular therapy confers excellent limb salvage and allows diagnosis of unsuspected visceral ischemia.