Laparoscopic flip-flap technique versus conventional inguinal hernia repair in children.

BACKGROUND AND OBJECTIVES: Inguinal hernia repair is one of the most frequently performed pediatric surgical operations. Several pediatric laparoscopic inguinal hernia repair techniques have been introduced. But debate is unresolved regarding the feasibility of laparoscopy for treating pediatric inguinal hernias. METHODS: A retrospective cohort study enrolled 33 patients who underwent congenital inguinal hernia repair by either the new laparoscopic flip-flap technique or conventional open repair. Patients were divided into 2 groups according to the type of surgery: Group A included those who underwent the new laparoscopic technique, and Group B included those who underwent conventional open repair. RESULTS: Group A comprised 15 patients (mean age, 39 months), and group B comprised 18 (mean age, 44 months). Mean operative time was 47.5 minutes for Group A versus 27.5 minutes for Group B. Intraoperative complications for Group A included 1 case (7%) of vas deferens injury, and 3 cases (20%) in which the flaps were torn during suturing. In Group B, no intraoperative complications were encountered. In both groups, the mean postoperative hospital stay was 5.5 hours. Postoperative follow-up of 3 months revealed recurrence in 4 patients in Group A (27%), while there were no recurrences in Group B. CONCLUSION: Our preliminary experience shows unsatisfactory outcomes with laparoscopic flip-flap hernia repair in children. In spite of advancement in the application of laparoscopy in pediatric surgery, conventional open hernia repair is still the gold standard for children, in our experience. Future studies with more numbers and longterm follow-up should be conducted.     

Mechanisms of Tolerance Induced by Donor-Specific Transfusion and ICOS-B7h Blockade in a Model of CD4+ T-Cell-Mediated Allograft Rejection

The inducible co-stimulatory molecule (ICOS) has been shown to play a critical role in T-cell activation and differentiation, and the regulation of alloimmune responses in vivo. Using an MHC class II mismatched model of CD4(+) T-cell-mediated rejection, we found that treatment of mice with DST and ICOS-B7h blockade induced long-term skin allograft survival and donor-specific transplantation tolerance. ICOS blockade, either during antigen priming or during the effector phase, previously shown to alter the outcome of the immune response, had a similar effect on graft survival. DST and anti-B7h mAb reduced the frequency of IFN-gamma-producing allospecific cells but did not produce deviation to a T(H)2 phenotype. In an adoptive transfer model using ABM TCR transgenic mice directly reactive to I-A(bm12), DST and anti-B7h mAb reduced the number of allospecific CD4(+) T cells and increased CD4(+) T-cell apoptosis. These data demonstrate that DST and anti-B7h mAb induces transplantation tolerance to MHC class II mismatched skin grafts by a reduction of the alloreactive clone size that is, at least in part, dependent on apoptosis of host alloantigen-specific CD4(+) T cells.     

Bench-to-bedside review: Resuscitation in the emergency department

Over the past decade the practice of acute resuscitation and its monitoring have undergone significant changes. Utilization of noninvasive mechanical ventilation, goal-directed therapy, restricted fluid volume, blood transfusion and minimally invasive technology for monitoring tissue oxygenation have changed the practice of acute resuscitation. Early diagnosis and definitive treatment of the underlying cause of shock remains the mainstay for survival after successful resuscitation. Patient-centered outcome end-points, in addition to survival, are being utilized to appraise the effectiveness of treatment. Application of medical ethics to the ever changing practice of acute resuscitation has also become a societal expectation.     

The overlooked, retained double J stent

A series of 4 patients with long overlooked, retained ureteral stents is presented to illustrate the variable, unpredictable, and at times, hazardous course of such patients. These cases are cited to re-emphasize the need for careful documentation, observation, and follow-up of patients in whom stents are placed.     

The epidemiology of hypertension in family practice in Cape Town

A prevalence study of hypertension in 8 family practices in low socio-economic areas of Cape Town examined 1,046 patients over the age of 15 years. The crude prevalence rate of hypertension was 20.26%. There was no significant sex difference. Systolic pressure, diastolic pressure and hypertensive status increased with age and body mass index (BMI). There were complex relationships with regard to sex in that the female sex was predictive of hypertensive status after the age of 45 years unexplained by differences in BMI. After adjusting for age, BMI and sex differences, widowhood, poor education, obesity, a family history of hypertension or stroke and a past history of hypertension were significant predictors of hypertensive status. Smoking status, occupational social class or property ownership were not predictive. Fifty-one per cent of hypertensive subjects were treated. Of those receiving treatment, 30% were controlled resulting in a control prevalence of only 18%. Younger male subjects were better controlled by treatment. A strong need for improved diagnosis and treatment of hypertension in family practice exists in this region.     

新疆维吾尔族、汉族儿童心脏径线的X线测量

作者测量了新疆地区７６８例３～７岁维吾尔族、汉族儿童心脏径线。心脏横径６岁组维吾尔族大于汉族。不分年龄组左心横径、心横径、心深径维吾尔族大于汉族，左侧位心膈交点至前胸膜面的距离维吾尔族女童大于汉族女童。两民族心横径与心脏体积的相关系数分别大于心脏深径与心脏体积的相关系数。本文提供了新疆地区３～７岁维吾尔族、汉族儿童各年龄组和不分年龄组心脏径线的正常数据。     

肝癌的介入放射治疗

作者对８６５例行介入放射治疗的肝癌（７７３例原发性，９２例转移性）进行放射形态学的观察。将病例分为三组：巨块型４５７例，结节型１２４例和弥散型２８４例。介入疗法包括：一次或重复化疗药物栓塞或肝动脉灌注，临床症状明显改善。术后平均存活期１４．８个月。同时也观察了因栓塞及各类不同栓塞剂而引起的明显并发症。同时讨论了患者存活期以及重复栓塞和肝转移性肿瘤的某些特性，并着重讨论过去认为单用化疗药物肝动脉灌注治疗效果不好的转移性肝癌与同时使用栓塞治疗的不同效果。     

Fusidic acid in infections of the external eye

Summary A newly developed 1% eye preparation of the potent antistaphylococcal antibiotic fusidic acid, showed an excellent clinical effect in 206 Egyptian children with external eye infections. The 248 patients included in the study were randomized, in the ratio 5:1, to either fusidic acid or chloramphenicol 0.5% eye drops. Both preparations were given four to six times daily for one week. Bacterial conjunctivitis was diagnosed in 56% of the children. Offending eye pathogens were mainlyStaphylococcus aureus (60%),Haemophilus aegyptius (10%),Streptococcus pneumoniae (13%) andNeisseria gonorrhoeae (6%). The overall clinical success rate in children with bacterial conjunctivitis was 85% with fusidic acid, compared to 48% with chloramphenicol (p < 0.001). The better effect of fusidic acid could be ascribed to a lower frequency ofin vitro resistance (16%) in comparison to chloramphenicol (55%). Both drugs were apparently well tolerated and no side-effects were observed.

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Fusidinsäure zur Behandlung von externen Augeninfektionen

Zusammenfassung Eine neuentwickelte 1%ige ophthalmologische Präparation des gegen Staphylokokken hochwirksamen Antibiotikums Fusidinsäure erwies sich bei 206 ägyptischen Kindern mit externen Augeninfektionen als hervorragend klinisch wirksam. Die im Rahmen der Studie behandelten 248 Kinder erhielten nach Randomverfahren im Verhältnis 5:1 entweder 1%ige Fusidinsäure- oder 0.5%ige Chloramphenicol-Augentropfen. Beide Präparate wurden eine Woche lang vier-bis sechsmal täglich verabreicht. Bei 56% der Kinder wurde eine bakterielle Konjunktivitis diagnostiziert. Die häufigsten pathogenen Erreger der Augeninfektionen warenStaphylococcus aureus (60%),Haemophilus aegyptius (10%),Streptococcus pneumoniae (13%) undNeisseria gonorrhoeae (6%). Mit Fusidinsäure wurde bei 85% der Kinder mit bakterieller Konjunktivitis ein Therapieerfolg erzielt, mit Chloramphenicol in 48% der Fälle (p < 0,001). Die therapeutische Überlegenheit von Fusidinsäure ließ sich darauf zurückführen, daß dieIn vitro-Resistenz der Erreger mit 16% der Isolate in der Fusidinsäure-Gruppe geringer war als in der Chloramphenicol-Therapiegruppe mit einer Resistenzrate von 55% der Isolate. Beide Medikamente wurden offensichtlich gut vertragen, Nebenwirkungen wurden nicht beobachtet.