Feasibility of a Local Anesthesia Program for Inguinal Hernia Repair at a Veteran Affairs Hospital.

BACKGROUND: Local anesthesia (LA) for open inguinal hernia repair (OIHR) is not widely used in the United States. An LA program for OIHR was initiated at the Dallas Veteran Affairs Medical Center in 2015. We hypothesize that outcomes under LA for OIHR are similar to general anesthesia with adequate patient satisfaction. METHODS: A total of 1422 groin hernias were performed by a single surgeon using a standardized technique at the Dallas Veteran Affairs Medical Center (2015-2019). Only unilateral, primary, elective, OIHRs were included (n = 1092). LA was used in 26.0% (n = 285) and compared with patients undergoing general anesthesia. Univariate analysis was performed by the Student t-test for continuous variables and χ2 test (or the Fisher exact test) for categorical variables. RESULTS: OIHR performed with LA increased from 15.5% in 2015 to 76.6% in 2019. Patients undergoing LA were older and had significantly more comorbidities. Holding time to operating room (OR), OR to start of the operation, skin-to-skin time, and end of the operation to out of the OR were all reduced with LA (all P values <0.05). Inguinodynia, recurrence, and overall complications were similar. Patients undergoing LA indicated that they were comfortable (93.0%), rated their worst pain as 2.03 ± 2.2 (of 10), and would undergo LA if they had to do it again (94.0%). CONCLUSIONS: LA was associated with decreased OR times and had good patient satisfaction. Overall complication rates were similar despite a higher burden of comorbid conditions in patients undergoing LA.

The relationship between dioxin congeners in the breast milk of Vietnamese women and sister chromatid exchange.

The aim of this study was to clarify the relationship between dioxin concentrations in breast milk and the sister chromatid exchange (SCE) frequency in women from herbicide-sprayed and non sprayed areas. Blood samples were taken from 21 women with high TCDD (tetrachlorodibenzo-p-dioxin) levels from sprayed areas, 23 women with moderate TCDD levels from sprayed areas, and 19 women from non sprayed areas to determine their SCE frequency. The SCE frequencies for the high and moderate TCDD groups from the sprayed area and for the non sprayed area group were 2.40, 2.19, and 1.48 per cell, respectively. Multiple regression analysis showed that the standardized ß values for 1,2,3,6,7,8-hexaCDD (ß = 0.60), 1,2,3,4,6,7,8-heptaCDD (ß = 0.64), and octaCDD (ß = 0.65) were higher than those for TCDD (ß = 0.34) and 1,2,3,7,8-pentaCDD (ß = 0.42). The adjusted R² value for polyCDDs (R² = 0.38) was higher than that for polyCDD toxic equivalents (TEQ (toxic equivalents); R² = 0.23). This study therefore shows that levels of hexa-, hepta-, and octaCDD, which were previously regarded as being less toxic than TCDD, are closely related to SCE frequency and that the level of dioxin (pg/g lipid) is potentially more useful as an indicator than TEQ value for explaining SCE frequency.

Organophosphate Pesticide Exposure: Effect on Farmers' Sperm Quality in the Mekong Delta, Vietnam.

OBJECTIVES: Using pesticides in the An Giang province is widespread. However, studies on the health effect of organophosphate pesticide have not been updated within the past 12 years. This study aimed to assess exposure to organophosphate pesticides and their effects on sperm quality among farmers in the An Giang Province, Mekong Delta, Vietnam. METHODS: During the winter - spring crop season of December 2021 to February 2022, a cross-sectional study was conducted on farmers aged 18 to 60 years-old based on seven communes' health checkup programs. The pesticide spray group included farmers who had sprayed pesticides in the previous week and had a history of working in agriculture for more than 2 years. The control group was defined as those who lived in the same community, had not worked in agriculture, and had never sprayed pesticides. Demographic characteristics and blood, urine, and semen samples were collected and analyzed. RESULTS: Data for 184 eligible participants were analyzed, including 116 farmers in the pesticide spray group and 68 non-farmers in the control group. Pesticide spray contributed to a decrease in the sperm quality index of 6.253 units (95% CI, 4.472-8.749). Increasing each pseudocholinesterase (PChE) unit (kIU/L) was associated with an increase of 1.181 units in the sperm quality index (95% CI, 0.757-0.947). CONCLUSIONS: Preventive methods for organophosphate pesticide exposure, such as administrative controls, engineering controls, substitution, and personal protective equipment should be applied to control health risks. In the An Giang setting, personal protective equipment is feasible, but most types of equipment are not used. The immediate priority is to determine the cause of personal protective equipment not being used and to find solutions to encourage people to use them.

Feasibility of Umbilical Hernia Repair Under Local Anesthesia and Monitored Anesthesia Care at a Veteran Affairs Hospital.

BACKGROUND: Local anesthesia (LA) for open umbilical hernia tissue repair (OUHTR) is not widely utilized in academic centers in the United States. We hypothesize that LA for OUHTR is feasible in a veteran patient population. METHODS: From 2015 to 2019, 449 umbilical hernias were repaired at our institution utilizing a standardized technique in veteran patients. OUHTR was included in this analysis (n = 283). Since 2017, 18.7% (n = 53) UH were repaired under LA. We compared outcomes and operative times between general anesthesia and LA in patients undergoing OUHTR. Univariable and multivariable analyses were performed to determine significance. RESULTS: The entire cohort was composed of older (56.3 ± 12.1 years), White (75.5%), obese (body mass index [BMI] = 32.3 ± 4.6 kg/m2) men (98.0%). The average hernia size for the entire cohort was 2.42 ± 1.2 cm. The groups were similar in age and BMI. Patients with higher American Society of Anesthesiologists (ASA) (Odds ratio [OR] 3.1; 95% CI 1.5-6.8) and cardiovascular disease (OR 2.7; 95% CI 1.0-7.2) were more likely to receive LA. Recurrence (0.0% vs 6.0%; P = .9) and 30-day complications (6.0% vs 13%; P = .9) were similar between LA and GA after correcting for hernia size. Operating room times were reduced in the LA group (17.7 minutes; P < .05). None of the patients with LA required postanesthesia care unit for recovery. The patients who received LA reported being comfortable (78.9% of patients), with the worst reported pain being 2.4 ± 2.4 (out of a scale of 10), and 94.7% would elect to receive LA if they had another hernia repair. CONCLUSION: Patients who received LA had more cardiac disease and a higher ASA. Complications were similar between both groups. LA reduced operating room times. Patients were satisfied with LA.

Association between dioxin concentrations in breast milk and food group intake in Vietnam.

OBJECTIVES: To clarify the association between dioxin concentrations in breast milk and food group intake in herbicide-sprayed and nonsprayed areas in Vietnam. METHODS: This survey was conducted in August 2007 in sprayed and nonsprayed areas, respectively. The interviews were performed using a questionnaire to obtain information on personal characteristics and usual dietary intake. Eighty mothers of sprayed area and 42 mothers of nonsprayed area participated in the study. Breast milk was analyzed for concentration of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). RESULTS: Multiple regression analysis showed that location (sprayed or nonsprayed area) has the highest association with the toxic equivalents (TEQ)-PCDDs, TEQ-PCDFs, and TEQ-Total rather than other factors. In the sprayed area, the adjusted R (2) values of regression were approximately 0.1. On the other hand, the adjusted R (2) values in the nonsprayed areas were higher than those in the sprayed area, i.e., between 0.2 and 0.3, and showed that there were significant associations with body mass index (BMI) in all models. CONCLUSIONS: Dioxin exposure was less affected by usual dietary intake in the sprayed area than in the nonsprayed area in Vietnam. It was clear that past exposure rather than present dietary intake may affect present dioxin concentrations in breast milk in the sprayed area in Vietnam. This study suggests that present dioxin concentrations in breast milk were maintained by continuous past exposure even after 30-40 years had passed.

Local VS. other forms of anesthesia for open inguinal hernia repair: A meta-analysis of randomized controlled trials.

BACKGROUND: There is variation in the anesthetic technique for open inguinal hernia repair (OIHR) worldwide. Factors determining the anesthetic technique remains equivocal. We hypothesize that outcomes and operative room times are superior with local anesthesia (LA) compared to AO [all others (general and spinal anesthesia)]. METHODS: Following PRISMA guidelines and set inclusion and exclusion criteria, various databases were reviewed and 18 RCT's were isolated. Using ReviewManager 5.3, multiple parameters were used to test for overall effect between the included studies. RESULTS: Overall complication rate was similar in LA vs. AO (p = 0.06). Wound infection and hematomas were similar between LA vs. OA, but urinary retention was significantly decreased in LA (p = 0.0002). Patient satisfaction was not inferior with LA (p = 0.10). Surgical time was similar in LA vs. AO (p = 0.86), but operating room time was significantly decreased with LA (p < 0.0001). The literature review also showed a decrease in the LOS and cost when LA was used. CONCLUSION: This meta-analysis demonstrates that LA is a well-tolerated for OIHR with OR times and urinary retention being significantly decreased.

Dioxin reservoirs in southern Viet Nam--a legacy of Agent Orange.

In the isolated Aluoi Valley of central Viet Nam, very high levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) were measured in soil, fish fat, duck fat, pooled human blood and breast milk samples collected from A So village between 1996 and 1999. The village was situated on a former military base occupied by US Special Forces between 1963 and 1966. TCDD was a contaminant of the herbicide "Agent Orange", aerially sprayed in the valley between 1965 and 1970, and stored at the A So base. Measured levels were lower near the sites of two other former US bases in the valley which had been occupied for shorter periods of time. In areas where Agent Orange had been applied by low-flying aircraft, levels of TCDD in soil, food and human samples were elevated, but lower than those near the three former US bases. We confirm the apparent food chain transfer of TCDD from contaminated soil to cultured fish pond sediments to fish and duck tissues, then to humans as measured in whole blood and breast milk. We theorize that the Aluoi Valley is a microcosm of southern Viet Nam, where numerous reservoirs of TCDD exist in the soil of former military installations south of the former demilitarized zone. Large quantities of Agent Orange were stored at many sites, used in ground and aerial applications, and spilled. TCDD, through various forms of soil disturbance, can be mobilized from these reservoirs after decades below the surface, and subsequently, introduced into the human food chain.