Postoperative convalescence after inguinal hernia surgery: Prospective randomized multicenter study of laparoscopic versus Shouldice inguinal hernia repair in 1042 patients

Interest in inguinal hernia surgery has increased significantly with the introduction of new operating techniques during the past decade. This multicenter study compared short-term results in patients treated by the laparoscopic transabdominal preperitoneal patch technique (TAPP; n=518) and the Shouldice technique (n=524). We evaluated demographics, operative data, complications, hospital stay, postoperative pain, use of analgesics, functional status, sick leave, and complaints up to 3 months postoperatively. The median operating time was shorter in the Shouldice group (55 vs. 65 min), but there were no significant differences in complication rates, and major complications were rare. The hospital stay was 1 day or less in over 98% of cases in both groups, but more operations were performed on outpatient basis in the Shouldice group. In the TAPP group postoperative pain and analgesic consumption were less, postoperative functional status was better, and sick leave was shorter (10 vs. 14 days). These results show that the two methods are equally safe and have few major complications. The TAPP operation is associated with less postoperative pain, better postoperative functional status, and shorter sick leave, but at the price of a longer operating time. Electronic Publication     

Regulation of the delayed hypersensitivity reaction in the lung reflected as mononuclear, mast cell and mucus cell appearance after T helper cell depletion and adoptive transfer

Epicutaneous sensitization with picrylchloride (PiCl) induced a strongly delayed hypersensitivity (DH) reaction in mice. Local challenge in the airways of these mice resulted in increased numbers of mononuclear cells, mast cells and mucus cells. Depletion of T helper cells in vivo by treatment with monoclonal antibody (GK 1.5) inhibited the DH reaction. This treatment also resulted in a decrease in the number of mononuclear and mucus cells in the lung after intranasal challenge. The DH reaction was transferred to recipients with immune lymph node cells and spleen cells from mice sensitized epicutaneously with PiCl. The recipient mice also showed a slight increase in the number of mononuclear cells in the lung after intranasal challenge. These results indicate that T cells are not only involved in the DH reaction but also in the accompanying lung reaction.     

Regulation by T cells of delayed hypersensitivity reaction in mouse lung as reflected by mononuclear cells, mast cells and mucus-producing cells

The appearance of mononuclear cells, mast cells and mucus-producing cells in the lung and their linkage to the development of delayed hypersensitivity (DH) reactions were studied. Adoptive transfer of immune lymph node cells, spleen cells and serum and in vivo treatment with monoclonal antibodies to L3T4-positive T cells in Balb/c mice were performed to investigate the cellular regulation of the number of mononuclear cells, mast cells and mucus-producing cells in the lung. Immune lymph node cells and, to a lesser extent, immune spleen cells from mice sensitized epicutaneously with picrylchloride transferred DH reactions to the recipients as assessed by ear thickness increase after challenge. Serum from sensitized mice was not able to transfer a DH reaction. Cyclophosphamide treatment of donor mice increased the DH reaction in the recipient mice. Adoptive transfer of immune lymph node cells and spleen cells gave a slight increase in the number of mononuclear cells in the lung of recipient mice compared with controls. This weak accumulation of mononuclear cells in the lungs of recipient mice, however, was not accompanied by a consistent increase in the number of mucus-producing cells and mast cells. The number of spleen cells expressing the L3T4 antigen decreased after in vivo treatment with the monoclonal GK1.5 (anti-L3T4) antibody as assessed by immunohistochemistry. This antibody treatment also resulted in an inhibition of the DH reaction and a decrease in the number of mononuclear cells and mucus-producing cells, but not in mast cells in the lung of sensitized and challenged mice.(ABSTRACT TRUNCATED AT 250 WORDS)     

A new radioimmunoassay for human mast cell tryptase using monoclonal antibodies

A solid phase immunoradiometric assay was developed for the quantitation of tryptase released from activated human mast cells. Tryptase exhibits a linear dose-response curve over the standard range of 2-50 micrograms/l in buffer, serum, and plasma. The dose-response curve approached a plateau at a tryptase concentration of 100 micrograms/l and exhibited partial inhibition at concentrations above 10,000 micrograms/l. The sensitivity of the assay was 0.2-0.4 micrograms/l, and the intra-assay and interassay coefficients of variation were below 4% at 2 micrograms/l or higher tryptase concentrations. The recovery of known amounts of purified tryptase added to serum ranged from 91 to 115%. Detection of tryptase was evaluated with several body fluids and was accurate in sera, plasma, bronchoalveolar lavage fluid, nasal lavage fluid, and saliva. The concentration of tryptase was examined in serum samples from 100 healthy controls; in each case the level was less than 2 micrograms/l. The immunoassay also was utilized to examine serum levels of tryptase after the onset of a hypotensive reaction in one patient receiving general anesthesia. A maximally elevated level of tryptase (25 micrograms/l) was detected at the first time point, 0.5 h, and elevated levels persisted to 6 h before a return to normal levels was documented at 24 h. Thus, the involvement of mast cell activation in hypotensive subjects can be ascertained by this new tryptase radioimmunoassay.     

Indirect evidence of bronchial inflammation assessed by titration of inflammatory mediators in BAL fluid of patients with asthma

Bronchial inflammation is a characteristic of asthma that may be examined indirectly by bronchoalveolar lavage (BAL). Nine normal individuals were compared with 38 age-matched adults with asthma of variable severity to appreciate the importance of cell activation in the severity of asthma. The severity of asthma was appreciated by the clinical score of Aas and the pulmonary function of the patients. FEV1 ranged between 35% and 130% of predicted. The indirect activation of eosinophils (EOSs), mast cells, fibroblasts, and neutrophils was examined by the titration of eosinophil cationic protein (ECP), tryptase, hyaluronan (HA), and myeloperoxidase (MPO) by radioimmunoassay in BAL fluid (BALF) and cytology of BALF. In the adults with asthma, there was a significantly increased number of EOSs and a significantly increased level of all mediators but MPO. MPO levels were increased in seven patients only; three of these patients were previous smokers. Only ECP and HA levels were significantly correlated with the severity of asthma. These results demonstrate EOSs, mast cells, and fibroblasts are activated in asthma, whereas the involvement of neutrophils is less clear. There was a significant correlation between ECP and HA levels, suggesting a common activation of EOSs and fibroblasts.     

Inflammatory processes in asthma

Bronchial inflammation is a characteristic of asthma, but, although postmortem and rare bronchoscopic studies had been performed, it is only after 1980 that many experiments were done. Electron microscopy, immunohistochemistry and molecular biology have enhanced our knowledge. As bronchial biopsies and bronchoalveolar lavage present drawbacks, it is favorable to combine both to obtain the best insights into inflammation. The epithelium is rarely intact in asthmatic patients, the cells being both 'fragile' and activated. Eosinophil inflammation is highly important and likely involved in the damage of the epithelium and submucosa. Airway macrophages and monocytes are present in greater amounts and are activated in the bronchi, and they are certainly involved in the pathogenesis of asthma. Mast cells are activated and some emphasis has been put on lymphocytes. Therefore, asthma appears to be a desquamative bronchitis with mixed cell infiltrate.     

Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer

BACKGROUND:: In certain patients with pancreatic and biliary cancer, chemotherapymay relieve tumour-related symptoms, improve quality of lifeand possibly prolong survival. The extent of these improvementsis not completely known in spite of the extensive use of thistreatment modality. The aim of this study was to estimate anygain in the quantity and quality of life produced by chemotherapyin patients with pancreatic and biliary cancer. PATIENTS AND METHODS:: Between January 1991 and February 1995, 90 eligible patientswith pancreatic or biliary cancer were randomized to eitherchemotherapy in addition to best supportive care or to bestsupportive care. Chemotherapy was allowed in the latter groupif the supportive measures did not lead to palliation. Chemotherapywas either sequential 5-fluorouracil/leucovorin combined withetoposide (FELv) or, in elderly and poor performance patients,the same regimen without etoposide (FLv). Quality of life wasevaluated with the EORTC-QLQ-C30 instrument. RESULTS:: Mean scale scores in the QLQ-C30 improved more often/deterioratedless frequently in the chemotherapy group than in the best supportivecare group. More patients in the chemotherapy group (36%, 17/49)had an improved or prolonged high quality of life for a minimumperiod of months compared to those in the best supportive caregroup (10%, 4/41, p <0.01). Overall survival was significantlylonger in the chemotherapy group (median 6 vs. 2.5 months, p<0.01). Also, the quality-adjusted survival time was longerfor patients randomized to chemotherapy (median 4 vs. 1 months,p <0.01). The effects were seen both in pancreatic and biliarycancer. CONCLUSION:: The results show that chemotherapy can add to both quantityand quality of life in advanced pancreatic and biliary cancer.The number of patients who benefit from treatment is, however,still limited; for this reason careful selection before, andclose monitoring during, treatment are necessary. biliary cancer, chemotherapy, palliation, pancreatic cancer, randomized study