Prevalence of rectus diastasis is higher in patients with inguinal hernia.

PURPOSE: To determine the prevalence of rectus diastasis (RD) in patients with inguinal hernia. MATERIAL AND METHODS: Multicenter, cross-sectional study. Patients with inguinal hernia were included in the study group (IH) and those with benign proctologic complaints created the control group (CG). Age, gender, BMI, family history for inguinal hernias, comorbid diseases, alcohol use, smoking, constipation, malignancy, chemotherapy, number of births, multiple pregnancies and prostate hypertrophy history of all patients in both groups were recorded. All patients were evaluated for RD and umbilical hernias by physical examination. RESULTS: A total of 528 consecutive patients were included in the study (292 IH / 236 CG). Overall prevalence of RD was 35.6% and it was significantly higher in IH than in CG (46.9% vs 21.6%, p < 0.001). Also, umbilical hernia was more frequently detected in the patients with inguinal hernia. Other risk factors for RD were age, BMI, DM, BPH and smoking. The mean inter-rectus distance for 528 patients was 18.1 mm; it was 20.71 ± 10.68 mm in IH and 14.88 ± 8.82 in CG (p < 0.001). It was determined that the increase in age and BMI caused an increase in the inter-rectus distance, and that the presence of DM, inguinal hernia and umbilical hernia increased the inter-rectus distance quantitatively. CONCLUSIONS: The prevalence of RD seems to be higher in patients with inguinal hernia comparing to that in general population. Increased age, high BMI and DM were found to be independent risk factors for RD development.

Internet search by the patients undergoing hernia surgery about the disease and surgeon selection.

AIM: To find out the current status of the internet use of patients who undergo surgery for repair of their hernias. MATERIALS AND METHODS: The patients who were diagnosed with abdominal wall hernia and scheduled for elective hernia repair were requested to answer a questionnaire. The questions were directed face-to-face by the surgeons themselves. The age, gender, education status, American Society of Anesthesiologists (ASA) physical status, place of living, health insurance, access to the Internet, surgical method, the person who did the search, previous hernia surgery, recurrence of previous hernia surgery, surgery other than hernia, and the hernia type were the recorded parameters at the first stage. Then, the answers for three main questions were taken: "Did you make a search about your hernia?", "Did you make a search about your surgeon?", "Would you prefer another surgeon if you could?" RESULTS: A total of 200 patients were included in the study (146 male/54 female). 55.5% of the patients made an Internet search about their hernias. 58.5% of the patients made a search to find a proper surgeon. 12.5% of the patients stated that they would like to go to another surgeon for the hernia repair if it was possible. Internet search rate was significantly higher in younger patients in comparison with older patients. The higher the education level of the patients, the higher the rate of making Internet searches about the hernias and surgeons. Patients who live in the cities more frequently made Internet searches in comparison with those living in towns or villages. Internet searches about the hernias were similar in patients who had a history of hernia surgery (n = 23, 52%), and were even operated for recurrence of the same hernia (n = 30, 60%), compared to other patients (p = 0.569). Similarly, the rates of conducting surgeon research of the patients in these two groups (66.7%, 56.5%, respectively) were statistically similar (p = 0.450). The effect of ASA classification of patients on the Internet researches conducted about the disease and about the surgeons was not statistically significant (p = 0.799, p = 0.388, respectively). It was found that the rates of researching about the disease and about the surgeon on the Internet were significantly higher in patients who had undergone a minimally invasive surgery (p < 0.001, p < 0.001, respectively). CONCLUSIONS: Less than two-thirds of the hernia patients make Internet search about their disease. Higher education level, younger age, patient's preference for minimally invasive surgery and living in a city positively affect Internet search rates.

Unbiased estimation of the calcaneus volume using the Cavalieri principle on computed tomography images.

The size and shape of tarsal bones are especially relevant when considering some orthopedic diseases such as clubfoot. For this reason, the measurements of the tarsal bones have been the subject of many studies, none of which has used stereological methods to estimate the volume. In the present stereological study, we estimated the volume of calcaneal bone of normal feet and dry bones. We used a combination of the Cavalieri principle and computer tomographic scans taken from eight males and nine dry calcanei to estimate the volumes of calcaneal bones. The mean volume of dry calcaneal bones was estimated, producing mean results using the point-counting method and Archimedes principle being 49.11+/-10.7 or 48.22+/-11.92 cm(3), respectively. A positive correlation was found between anthropometric measurements and the volume of calcaneal bones. The findings of the present study using the stereological methods could provide data for the evaluation of normal and pathological volumes of calcaneal bones.

Penetration of second-, third-, and fourth-generation topical fluoroquinolone into aqueous and vitreous humour in a rabbit endophthalmitis model.

AIMS: This study was designed to investigate the penetration of second-, third- and fourth-generation topical fluoroquinolone into aqueous and vitreous humour in a rabbit endophthalmitis model. METHODS: Thirty New Zealand white rabbits were divided into six groups. Left eye was infected with an intravitreal inoculum of Staphylococcus aureus. Groups 1, 2, 3, 4, and 5 received topical ofloxacin, ciprofloxacin, lomefloxacin, levofloxacin, or moxifloxacin treatment 24 h after the inoculation, respectively. No treatment was given to group 6 as the control group (n=5). Aqueous and vitreous samples were obtained 30 min after the last drop. High-performance liquid chromatography was used to determine the fluoroquinolone concentration. RESULTS: In the normal and inflamed eyes, mean aqueous concentrations of ofloxacin were 1.90 and 2.69 mug/ml, ciprofloxacin were 2.16 and 3.65 mug/ml, lomefloxacin were 3.54 and 1.19 mug/ml, levofloxacin were 2.89 and 9.41 mug/ml, and moxifloxacin were 4.92 and 43.33 mug/ml, respectively. Mean vitreous concentrations of ofloxacin were 0.25 and 0.07 mug/ml, ciprofloxacin were 0.08 and 0.32 mug/ml, lomefloxacin were 0.001 and 0.03 mug/ml, levofloxacin were 0.03 and 0.09 mug/ml, and moxifloxacin were 0.28 and 2.68 mug/ml, in normal and inflamed eyes, respectively. Moxifloxacin achieved a significantly higher concentration in aqueous and vitreous humour of infected eyes compared with ofloxacin (P<0.01), ciprofloxacin (P<0.05), lomefloxacin (P<0.01), and levofloxacin (P<0.05). CONCLUSION: This study demonstrated that fourth-generation fluoroquinolone, moxifloxacin, seems to have better penetration to inflamed ocular tissues in rabbit.

The short -term effects of an exercise programme as an adjunct to an orthosis in neuromuscular scoliosis.

The purpose of this study was to investigate the effects of a 4 week physiotherapy programme on patients who were given a spinal orthosis for neuromuscular scoliosis. This study was planned as a single group pre- and post-intervention repeated measures design. All patients were given a polyethylene spinal orthosis with an anterior opening. Fifteen (15) patients with neuromuscular diseases and a mean age of 12.46 years were evaluated. An exercises programme consisting of postural training, muscle strengthening and stretching exercises with special emphasis on respiratory exercises was given as an adjunct to orthotic treatment. The degree of impairment in forced vital capacity was 17.56% upon wearing an orthosis, it decreased to 9.28% following therapy (p < 0.05). There was also a statistically significant increase in muscle strength, balance duration and a significant decrease in limitation of range of motion. The results of the study imply that the conservative treatment of neuromuscular scoliosis should include an exercise programme as an adjunct to an orthosis, both to reduce the compromising effect of an orthosis on respiratory function and to support the patient's physical capacities.

Surveillance of antimicrobial resistance among gram-negative isolates from intensive care units in eight hospitals in Turkey.

With the participation of eight major reference hospitals in Turkey, 749 aerobic Gram-negative isolates obtained from 473 intensive care patients in 1997 were tested for their susceptibility to 13 commonly employed antibacterial agents. The frequency with which species were isolated and resistance rates were compared with data from the previous 2 years. Imipenem was the most active agent against the majority of isolates (75%), followed by ciprofloxacin, cefepime and amikacin. The per cent susceptibility to all antibiotics declined from 1995 to 1996. With the exception of imipenem, for which there was no change in resistance, the per cent susceptibility somewhat increased in 1997. However, it was still lower than in 1995.

Use of cholecystokinin to prevent the development of parenteral nutrition-associated cholestasis.

BACKGROUND: Neonates are at high risk for the development of parenteral nutrition-associated cholestasis when receiving a prolonged course of total parenteral nutrition (TPN). Although this cholestasis is of unknown etiology, it may result from a lack of gastrointestinal hormone formation, including cholecystokinin, which normally occurs after enteral feedings. METHODS: Two groups of neonates were studied. The treatment group consisted of 21 consecutive, prospectively enlisted neonates receiving TPN for > 14 days. The nontreatment group consisted of 21 infants from the 2 years preceding the study who were matched to the treatment group by gestational age, diagnosis, and duration of TPN. The major outcome determinant was direct bilirubin. Cholestasis was defined as a direct bilirubin > 2.0 mg/dL and was considered severe if the direct bilirubin was > 5.0 mg/dL after other causes were ruled out. RESULTS: The mean direct bilirubin levels in the nontreated group progressively rose over time, whereas the mean direct bilirubin the treated group remained level. The incidence of infants with a direct bilirubin > 2.0 mg/dL was 24% and 43% in the CCK+ and CCK- groups, respectively, and was not significant (p = .14). The percentage of infants with a direct bilirubin > 5.0 mg/dL was 9.5% and 38% in the treatment and nontreatment groups, respectively, and was significant, p = .015. CONCLUSIONS: Levels of direct bilirubin were lower in the treated compared with the nontreated group. These findings suggest that cholecystokinin prophylaxis in high-risk neonates may help prevent the development of parenteral nutrition-associated cholestasis.