Pediatric femoral hernia.

Pediatric femoral hernias account for less than 1% of all groin hernias. Pediatric femoral hernias are rather uncommon more so in males, often overlooked, misdiagnosed and treated as inguinal hernia. Femoral hernia masquerading as inguinal hernia in a seven year old male is reported along with review of relevant literature.

Iliopsoas abscess: analysis and perspectives from an endemic region of Eastern Nepal.

OBJECTIVE: To evaluate the clinical profile and outcome in patients with iliopsoas abscess. METHODS: A descriptive study was carried out in B.P. Koirala Institute of Health Science, Dharan, Nepal from February 2005 to March 2006. The medical records of all thirty six patients admitted in surgery ward with diagnosis of iliopsoas abscess during the study period were analyzed. RESULTS: Thirty six patients were included the study. There were 22 (61.1%) males and 14 (38.9%) females with a mean age of 24.33 +/-19.19 years. Demographic distribution of the patients revealed the highest number 13 (36.1%) from Sunsari district, eastern part of the country. Right sided unilateral involvement was the most common presentation and only 2 cases had bilateral involvement. In none of our patients the dorsolumbar spine radiograph revealed any involvement of the bone. The most common complaints were pain in lower abdomen and lump in iliac fossa with flexion deformity at hip joint. All the patients underwent open surgical drainage and their outcomes were analyzed in term of cure, morbidity and mortality. Staphylococcus aureus was the most common organism 24 (61.5%) isolated. Twenty two (91.66%) of Staphylococcus aureus samples were sensitive to ciprofloxacin. There was one mortality in the group who died of septicaemia secondary to necrotizing fascitis. Six patients had wound infection, which were cured by regular dressing. CONCLUSION: On the basis of our experience and review of available relevant literature, we can conclude that a high index of suspicion and awareness of the varying clinical picture are required to diagnose this condition properly. Ultrasonography should still be the preferred imaging modality as it is cheap, safe, cost effective and readily available. Ciprofloxacin should be used as a first line drug. Image guided aspiration may be practical in selected cases having little pus and traditional open drainage should be considered without hesitation.

Humoral immune responses to the Plasmodium falciparum antigen Pf155 RESA in adults with differential clinical conditions from an Indian zone where malaria is endemic.

Ring infected erythrocyte surface antigen of Plasmodium falciparum (Pf155/RESA) has been considered as a vaccine candidate. However, the relative immunogenicity of this antigen has not been studied in Indian populations. Pf155/RESA was investigated for its immunogenicity by studying humoral immune responses against Pf155/RESA and Pf155/RESA derived peptides (P1, P2 representing immunodominant epitopes from the 3' and P3 from the 5' repeat regions) by erythrocyte membrane immunofluorescence (EMIF) assay and by enzyme linked immunosorbent assay (ELISA) in P. falciparum primed donors living in hyperendemic malarious areas (Orissa State, India) where P. falciparum infections are highly prevalent. Subjects of different clinical status namely acute (A), clinically immune (CI) and acute with history of repeated P. falciparum infections (R) were included in this study. All the donors were seropositive against the crude antigen. There was considerable variation in the responses among the donors. While humoral responses in the plasmas against the P2 peptide (EENV)4 were significantly higher in magnitude and in frequency in the CI donors than in the A donors, no positive response was seen in the R donors. The responses to the peptides P1 (EENVEHDA)2 and P3 (DDEHVEEPTVA)2 were poor both in the A and in the CI groups. Whereas, most of the R donors were seropositive against the P3. The present results indicate that Pf155/RESA contains B cell epitopes which were recognized differently by the immune system of individuals living in malaria-hyperendemic areas of India who have been primed by natural infection. Our studies also suggest that in order to investigate the possible functional role of a given antigen, study of immune responses against the antigen in donors of different clinical status may be useful.