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.     

Physical training increases osteoprotegerin in postmenopausal women

The purpose of this study was to explore whether mechanical loading by exercise over a 1–year period in postmenopausal women had an effect on the receptor activator for nuclear factor kappa B ligand/osteoprotegerin (RANKL/OPG) system or the levels of the Wnt-signaling antagonist sclerostin. A total of 112 postmenopausal were randomized to either sedentary life (controls) or physical activity (training group). Ninety-two women fulfilled the study protocol. The training program consisted of three fast 30-min walks and one or two 1-h aerobic training sessions per week. The effect on the bone mineral density of the hip assessed with dual X-ray absorptiometry was positive as reported earlier. Blood samples were taken from participants at baseline and after 1 year and serum levels of OPG, RANKL and sclerostin were quantified together with the bone metabolism markers C-terminal telopeptide of collagen type I (CTX) and bone-specific alkaline phosphatase (BALP). The results were analyzed using an analysis of covariance model using baseline values as the covariate. The training group displayed a clear mean increase of OPG +7.55 pg/ml compared to controls (p = 0.007). The mean changes for RANKL +0.19 pg/ml (square-root transformed data) and sclerostin +0.62 pmol/l were non-significant (p = 0.13 and p = 0.34). The changes in bone turnover markers CTX and BALP showed a tendency to decrease in the training group versus controls but the changes were small and non-significant. Although our study is limited in number of participating women, we have been able to show an OPG-associated, and RANKL- and sclerostin-independent, training-induced inhibition of postmenopausal bone loss.     

Cellular expression and genetic control of ABH antigens in primary sensory neurons of marmoset, baboon and man

ABH antigens have been demonstrated in the posterior root ganglia (PRG) of 3 primate species (marmoset, baboon and man). Their expression corresponded to the ABO phenotype of the individual and was independent of the secretor gene. In marmosets more cells were positive for H (33 +/- 9%) than for A (19 +/- 6%). In baboons A or B antigens were more easily detected (66 +/- 9%) than the H antigens (48 +/- 5%). In humans more than two-thirds of PRG cells were positive for H but only a small proportion of these were positive for A or B. The ABH antigens were found mainly in the small and intermediate-size neurons whose central processes project to lamina II of the spinal cord posterior horn. Unipolar neurons of the Gasserian ganglion, neurons of the mesencephalic nucleus of the trigeminal nerve and of some visceral ganglia have also been shown to express these antigens which are also present in the fibre layer and glomeruli of the olfactory bulbs.     

The value of monitoring arterial oxygenation saturation by pulse oximetry in neuroleptanalgesia

Anaesthesia can induce hypoxaemia. Pulse oximetry gives continuous non invasive monitoring of arterial oxygen saturation. No arterial puncture is needed. Ninety-four patients were monitored by pulse oximetry during neuroleptanalgesia for colonoscopy. Eighteen patients showed desaturation episodes of less than 90%, eight linked to opioid-induced respiratory depression. In all patients, pulse oximetry gave clinicians an immediate awareness of the incident. Treatment was facilitated. Pulse oximetry made anaesthesia safer.     

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.     

Plasma glutamic acid levels in premature newborn

24 premature, newborn infants were investigated for plasma glutamic acid (GA) levels before and after a normal milk feed, to ascertain if the ingestion of GA present in the milk could result in an increase of its plasma level. No increases were detected in plasma between 5 and 90 min after the feed. These results may be important in respect to the problem of the possible toxicity of monosodium glutamate (MSG) added to baby foods.     

The Fanconi-Bickel syndrome: a case of neonatal onset.

A male newborn infant was recognized having Fanconi-Bickel syndrome (FBS) in the neonatal period. The presenting clinical findings were hyperglycemia and polyuria detected during an episode of acute enteritis. Physical examination was normal, biochemical analyses were suggestive of FBS: glycosuria, proteinuria, phosphaturia, generalized aminoaciduria, and increased levels of urinary beta 2-microglobulin, serum glucose and serum alkaline phosphatase. The molecular genetic analysis showed homozygosity for mutations within the gene of the glucose transporter 2 (Glut 2), 1213 C>T. The patient demonstrated improved clinical and metabolic status following institution of diet with frequent small meals and galactose-free-milk as well as pharmacological treatment with phosphate and vitamin alpha-OH-D3. In conclusion, infants showing hyperglycemia and polyuria may be considered having FBS also in the neonatal period. Early institution of adequate caloric intake and replacement of electrolytes and vitamin D may avoid or reduce metabolic complications.