Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis

Background

The aim of this article is to analyze laparoscopic versus open repair of incisional/ventral hernia (IVH).

Methods

A systematic review of the literature was undertaken to analyze clinical trials on IVH.

Results

Five randomized controlled trials involving a total of 366 patients were analyzed. There were 183 patients in each group. Open repair of IVH was associated with significantly higher complication rates and longer hospital stays than laparoscopic repair. There was also some evidence that surgical times may be longer for open repair of IVH. However, statistically there was no difference in wound pain or recurrence rates.

Conclusions

Laparoscopic repair of IVH is safe, with fewer complications and shorter hospital stays, and possibly a shorter surgical time. However, postoperative pain and recurrence rates are similar for both techniques. Hence, the laparoscopic approach may be considered for IVH repair if technically feasible, but more trials with longer follow-up evaluations are required to strengthen the evidence.     

The Study of Acute Leukemia Cells by Means of Acridine Orange Staining and Flow Cytometry

The studies described here explored the staining of acute leukemia cells with acridine orange (AO). The red fluorescence curve of AML specimens was usually bimodal, suggesting the presence of subpopulations of cells which have different RNA contents. In almost every AML specimen, small leukemic blast cells comprised at least part of the “low RNA content” sub-population. Residual granulocytes and lymphocytes also contributed to this population. Frequently, the green fluorescence, indicative of the binding of A0 to DNA, was slightly less in these cells than in the majority of cells present. There was no evidence however, that the leukemia cells with these characteristics represented a G₀ or kinetically quiescent population of cells. In ALL specimens, the presence of multiple cytogenetically distinct clones was easily detectable in AO stained specimens. The red fluorescence curve of G₀/G₁ ALL cells was unimodal.     

Management of unanticipated difficult intubation: a survey of current practice in the Oxford region

BACKGROUND AND OBJECTIVE: Unanticipated difficulty in tracheal intubation in an anaesthetized patient has always been a cause of concern to anaesthesiologists. This difficulty may lead to morbidity and mortality. This survey was carried out to determine the technique commonly favoured in centres in the Oxford region in the UK for the management of unanticipated difficult intubation. METHODS: We conducted a clinical scenario-based questionnaire survey of 181 anaesthesiologists in the Oxford region. In this scenario, difficulty in endotracheal intubation is recognized only after induction of anaesthesia. A number of options were available to deal with this situation. We used this scenario as a tool to gain insight into the training and the training needs of anaesthesiologists at various levels of training. RESULTS: Of the 181 questionnaires sent, we received 143 (79%) completed replies. The vast majority (141/143 (99%)) of anaesthesiologists would use a gum-elastic bougie together with head and neck positioning and optimal external laryngeal manipulation to gain the best attempt at intubation. If intubation still failed, overall 129/143 (90%) had a back-up plan, while 14/143 (10%) had no plan. Flexible fibreoptic techniques were more commonly planned by 92/143 (64%) anaesthesiologists compared to blind techniques which were less commonly planned by 37/143 (26%) anaesthesiologists. Differences in choice of technique among anaesthesiologists in teaching and district general hospitals were not significant (P = 0.87). Overall, trainees were less likely to choose fibreoptic techniques compared to consultants (P = 0.0009) and would use blind techniques or ask a more experienced colleague to take over. The main reason for the choice was previous experience with the technique. CONCLUSIONS: Although fibreopric techniques were most commonly planned, these were less often chosen by trainees than consultants due to lack of experience/training, while unavailability of intubating laryngeal mask airway (Intavent) was an additional issue precluding its use as an adjunct to intubation.     

The first clinical experience with a peripheral,self-expanding nitinol stent in the treatment of saphenous vein graft disease: angiographic evidence of late expansion

The ideal intervention for degenerated saphenous vein grafts (SVG) is still controversial. We report the first use of a peripheral, self-expanding nitinol stent in the treatment of a patient with symptomatic SVG disease. The procedure was well tolerated, without any short- or long-term complications. Quantitative coronary analysis of a 3-month follow-up angiogram revealed a continued expansion of the nitinol stent. Larger scale trials are warranted to evaluate whether the self-expanding nitinol stents can be used alone or in adjunct to other modalities for the treatment of SVG disease. The case report is followed by a literature review of SVG stenting.     

Prevalence of smoking between the doctors, nurses and medical faculty students at some health facilities in Turkey

Smoking is an important behaviour among health professionals who are role models for the public. For this reason 22 studies are selected which are smoking behaviours among doctors, nurses and students of medical school in Turkey. Smoking prevalence is found 32.6-66.2%, 40.3-68.6% and 15.1-36.6% among doctors, nurses and students of the medical faculties respectively. Smoking is fairly widespread among health professionals. Health professionals who are assumed to be role models for the public have to be considered primarily in cigarette control programs.     

Risk factor management in stable,insulin-treated patients with Type 2 diabetes: the Diabetes Outcomes in Veterans Study

OBJECTIVES: Describe the methodologies and study population of the Diabetes Outcomes in Veterans Study (DOVES). RESEARCH DESIGN AND METHODS: Prospective, multicenter, observational study of Southwestern veterans with stable, insulin-treated Type 2 diabetes. Subjects were randomly selected from pharmacy records and were required to be using at least one long-acting insulin preparation daily. Baseline psychosocial evaluations included psychological status, social and cultural barriers to care, self-care behaviors, and vascular disease risk factors. Clinical measurements included self-reported vascular disease, hemoglobin A1c (HbA1c), blood pressure, blood lipids, and body mass index (BMI). A subset of subjects completed a protocol of four times daily self-monitored blood glucose testing for 8 weeks. Subjects were followed for 12 months. Principal endpoints included glycemic control, the occurrence of hypoglycemia, and control of vascular disease risk factors. RESULTS: We enrolled 338 subjects. The mean (+/-S.D.) age was 65.1+/-9.7 years and 3.8% were women. At baseline, over two-thirds of subjects reported vascular disease complications. Nearly three-quarters had limited physical activity. Among subjects younger than 65 years, 53% considered themselves disabled for work. Despite the high prevalence of vascular disease, 43.8% had an HbA1c >/=8.0%. Many subjects were sedentary, 62.1% had a BMI of 30 kg/m(2) or above, and 22.2% were still smoking. CONCLUSIONS: Detailed measurements of psychological status, self-care behaviors, and risk factor control are feasible in this elderly, debilitated population. Although the prevalence of complications and self-rated disability was high, vascular disease risk factors were poorly controlled in a substantial proportion of subjects.