Preperitoneal bilateral inguinal herniorrhaphy evolution of a technique from conventional to laparoscopic.

BACKGROUND: Simultaneous repair of bilateral inguinal hernia remains controversial. METHODS: Seventy-two consecutive patients underwent a preperitoneal prosthetic repair of bilateral groin hernia; 25 via laparoscopy. ASA classification, Nyhus type, hospitalization, convalescence time, and cost were examined. Mean follow-up was 36 and 12 months for the conventional and laparoscopic group respectively. RESULTS: Sixty-nine patients were available for long-term follow-up. Average hospital stay, recurrence rate, perioperative urinary retention, transient thigh neuralgia, and return to normal activities were 48 hours, 5%, 9%, 6%, and 22 days as compared to 4 hours, 6%, 20%, 12%, and 9 days for the conventional and laparoscopic group respectively. The cost for laparoscopic repair was $500 greater. CONCLUSIONS: The preperitoneal approach to repair of bilateral hernias demonstrates an acceptable recurrence rate with low long-term morbidity. Experience with conventional preperitoneal technique greatly facilitates transition to laparoscopic repair.

The effect of lasers, electrocautery, and sharp dissection on cutaneous flaps.

This study evaluated the technical ease and wound-healing response of cutaneous flaps constructed on dogs using Nd:YAG laser, CO2 laser, electrocautery, and sharp dissection. Four flaps were constructed on the dorsum of 16 dogs using each of the four modalities. Parameters examined included drainage after both 48 hours and 1 week, time of dissection, bursting strength, and semiquantitative assessments of fibroblast, polymorphonuclear leukocyte, monocyte, and collagen content. Significantly less time was required to construct flaps with electrocautery as compared with CO2 laser, Nd:YAG laser, and sharp dissection (15 versus 18, 20, and 26 minutes, respectively; p < 0.01). Significantly fewer suture ligatures were necessary to obtain hemostasis for electrocautery, CO2 laser, and Nd:YAG laser as compared with sharp dissection (0, 2, and 2 versus 15 sutures, respectively; p < 0.01). Drainage was significantly less for flaps constructed using sharp dissection as compared with both CO2 and Nd:YAG lasers at 48 hours (12 versus 26 cc, p < 0.01, and 20 cc, p < 0.05, respectively). Significantly less drainage was observed after 48 hours for flaps created using electrocautery as compared with CO2 laser (14 versus 26 cc; p < 0.05). Bursting strength of flaps constructed using sharp dissection was significantly greater than that of those constructed using electrocautery, Nd:YAG laser, and CO2 laser (1086 versus 638 gm, p < 0.05, 714 gm, and 571 gm, p < 0.01, respectively). Semiquantitative histologic evaluation revealed a higher collagen content and fibroblast infiltration and less polymorphonuclear leukocyte infiltration in wounds created using sharp dissection as compared with CO2 laser, Nd:YAG laser, and electrocautery.(ABSTRACT TRUNCATED AT 250 WORDS)

Documenting the activity and effectiveness of a regional drug information center.

The methods of data collection, storage, and retrieval used by the Rocky Mountain Drug Consultation Center (RMDCC) are described. To substantiate that drug information services provided by RMDCC are clinically useful and have a beneficial effect on therapy, data on medication-related problems and case outcomes, as well as demographic data, are stored in an IBM PC-XT using a system that allows searching and linkage of any number of recorded categories. Data were compiled on 28,081 inquiries from health-care professionals and consumers during 1985 and 1986. Analysis revealed that (1) medication-related problems are common (involving 34% of consumer inquiries), especially among the elderly; (2) a positive effect on therapy was made in the majority (76%) of problem cases; and (3) consumers were given drug information by their physician or pharmacist in fewer than half of the cases in which medications were prescribed and dispensed. A computer-based system to assist in analyzing information can be an important asset in documenting the activity and effectiveness of a regional drug information center.

Clinical effects of accidental levothyroxine ingestion in children.

Forty-one children, aged 1 to 5 years, who accidentally ingested levothyroxine sodium were studied. Symptoms possibly associated with the ingestion occurred in 11 patients (27%). These symptoms (tachycardia, hyperactive behavior, fever, vomiting, diarrhea, diaphoresis, and flushing) were categorized as minor and all resolved without treatment. Because observed effects were generally mild and often unrelated to either estimated amounts of hormone consumed or serum thyroxine levels, a conservative approach to patient treatment is recommended in cases of levothyroxine ingestion in children.

New filter compositions for the analysis of airborne particulate and trace metals.

Characteristics are presented of various new filter materials of polyvinyl chloride--polyacrylonitrile, polyimide, polyaromatic, and of quartz fibers. These filters have been specifically developed for air sampling applications. Included in the presentation are comparative performance characteristics such as: infrared and ultraviolet spectra, inorganic and trace metals analyses, chemical compatibilities and reactivities with various liquids and gases, moisture pick-up, mass per unit area, mechanical properties (tensile strength and elongations), air flows/pressure drops, and particle retention efficiencies. Examples are presented of the increased acceptance of membrane filters in air analyses due to their simplifying tedious conventional procedures and their improvement of sensitivity, precision, and accuracies. Included are the ability of specific synthetic filters to impart optical transparency for analyses of asbestos and other fibers by transmission techniques using oil immersion or dispersion staining, the direct determination of silica on an acrylonitrile membrane by infrared, the direct determination of atmospheric particulate types and the concentrations of each. Other examples given are trace metal analyses by X-ray fluorescence, and gravimetric procedures and scanning electron microscopy techniques for analyses of suspended particulate matter.

High purity fibrous air sampling media.

Interest in measurement of low concentrations of metal levels in suspended particulate matter has generated needs for high purity, low background filters. Several new types of filters are discussed with high purity compositions including glass fiber filters, fluorocarbon membranes and fabric-supported membrane filters. Air collection efficiencies are presented along with comparative analysis.