Choice of technique in "difficult" inguinal hernias. Personal experience

The authors refer on their positive results in the treatment of so-called difficult inguinal hernias (relapsing or multiple hernias) with the use of prosthetic prolene mesh according to Stoppa's procedure (partly modified) through a preperitoneal approach after a Pfannenstiel's incision. On the other hand recurrent hernias in risky patients as well as gross hernias are treated by Rives' method which consists in a prolene mesh placement through the inguinal approach.     

High-level linguistic disturbances subsequent to childhood closed head injury

High-level language functioning was assessed in a group of 11 children with severe closed head injury (CHI). Performance was examined on measures of figurative language, oral expression, inferencing, and interpretation of ambiguous sentences, and was compared with that of a control group matched for age, gender, and handedness. The children with CHI demonstrated inferior performance on the oral expression, ambiguous sentences, and figurative language tests; however, performance on the inferencing task appeared intact. These findings are discussed with respect to the underlying nature of the observed impairments. Both linguistic and cognitive factors are considered. It is concluded that a complex interaction of cognitive and linguistic impairments experienced by children with CHI may underlie the performance deficits identified in the current study.     

Outcome for patients colonised with Burkholderia cepacia in a Birmingham adult cystic fibrosis clinic and the end of an epidemic.

BACKGROUND: There has been increasing concern since 1979 about the emergence of Pseudomonas cepacia (Burkholderia cepacia) in patients with cystic fibrosis in the UK and elsewhere. Colonisation of the sputum has been shown to be associated with increased morbidity and mortality. Evidence suggests person to person transmission and some centres have segregated those colonised with B cepacia from other patients with cystic fibrosis. The outcome of patients colonised by B cepacia has been studied, together with the effects of strict segregation. METHODS: The outcome in 18 patients with sputum colonised by B cepacia was compared with that in age, sex, and severity matched controls with no evidence of B cepacia colonisation by a retrospective case note study. RESULTS: No difference between cases or controls were found in the 24 month period prior to colonisation by B cepacia in lung function, number of days in hospital, or outpatient visits. Colonisation led to an increased rate of loss of lung function and utilisation of hospital services. There was an increase in the numbers of transplants and deaths amongst the cases. Since 1992 there have been only three new cases of B cepacia colonisation and the incidence and prevalence of the organism has fallen dramatically since segregation commenced. CONCLUSIONS: B cepacia appears to be linked to the decline in colonised individuals. There was no evidence that colonisation occurred in patients declining for other reasons. B cepacia colonisation confers a worse prognosis than Pseudomonas aeruginosa alone. Segregation appears to limit the spread of the organism from infected individuals to other patients with cystic fibrosis.     

Lateral cervical puncture as a new method for collecting cerebrospinal fluid. Experience in Recife and its metropolitan area

200 cervical lateral punctions (CLP) were performed in comatose patients without psychomotor trouble proving this new system to be an alternative for suboccipital punction. This procedure was successful in 90% of the cases. Low importance venous accidents happened but they did not bring any injury or serious consequences to the patients or to cerebrospinal fluid examination results. Vertebral artery injury was not observed. Punctions in corpses showed us that this artery is one cm far from the needle trajectory during the realization of the CLP.     

The CT findings of acute thyroiditis and acute suppurative thyroiditis

Although acute thyroiditis often has a distinctive clinical presentation, this relatively uncommon entity can occasionally be confused with other inflammatory processes. In general, the earlier the diagnosis of acute thyroiditis is established, the lower is the frequency and severity of its attendant complications. Computed tomography (CT) is an extremely useful modality in establishing the diagnosis early because it can evaluate iodine content of the thyroid gland and provides more accurate mapping than ultrasound and nuclear medicine techniques. Three patients with acute thyroiditis--two with suppuration--are presented and the CT findings and clinical aspects of this disease are reviewed.