A randomized controlled trial of extraperitoneal bupivacaine analgesia in laparoscopic hernia repair

BACKGROUND: This study was designed to determine the frequency of surgical site infection development after discharge from the hospital after abdominal or vaginal hysterectomy and the frequency of use of antimicrobial prophylaxis in this patient group. METHODS: A prospective cohort study was performed on patients undergoing abdominal or vaginal hysterectomy between February 1 and December 31, 1995. Surgeons were contacted 1 month after the operations to determine which patients had acquired surgical site infections. Surgical site infection rates were calculated according to procedure, surgeon, and National Nosocomial Infection Surveillance system risk categories. A retrospective pharmacy record review was conducted to determine antimicrobial prophylaxis use according to procedure and surgeon. RESULTS: A total of 763 cases were surveyed; 55 (7.2%) met criteria for postoperative surgical site infection (7.7% abdominal and 4.5% vaginal hysterectomy). National Nosocomial Infection Surveillance system moderate-risk patients had significantly higher infection rates than did low-risk patients for both abdominal (p = 0.045) and vaginal (p = 0.05) procedures. Most patients (71.1%) were not given antimicrobial prophylaxis. There was a wide range of antimicrobial prophylaxis use by surgeon (3.6% to 94.4% of patients, p < 0.01). CONCLUSION: Despite long-standing and widespread recommendations for antimicrobial prophylaxis before hysterectomy, most of our patients were operated on without such prophylaxis. Surveillance programs permit detailed review of patient care practices that may reveal opportunities for improvement.     

Prosthetic reinforcement of posterior cruroplasty during laparoscopic hiatal herniorrhaphy

Symptomatic gastroesophageal reflux after Nissen fundoplication may occur if the wrap herniates into the thorax. In an attempt to prevent recurrent hiatal hernia we employed polytetrafluoroethylene (PTFE) mesh reinforcement of posterior cruroplasty during laparoscopic Nissen fundoplication and hiatal herniorrhaphy. Three patients with symptomatic gastroesophageal reflux and a large (>==8 cm) hiatal defect underwent laparoscopic posterior cruroplasty and Nissen fundoplication. The cruroplasty was reinforced with a PTFE onlay. No perioperative complications occurred, and in follow-up (<==11 months) the patients are doing well. When repairing a large defect of the esophageal hiatus during fundoplication, the surgeon may consider reinforcement of the repair with PTFE mesh.     

Analgesic effect of bupivacaine on extraperitoneal laparoscopic hernia repair

BACKGROUND: Occurrence of cryptococcal endophthalmitis is rare and commonly is associated with widespread disseminated diseases. The authors report here a well-documented case of endogenous cryptococcal endophthalmitis without the preceding meningeal infection. METHODS: A 45-year-old female with a history of long-term use of systemic corticosteroid and cytotoxic drugs for systemic lupus erythematosus suffered from progressive visual loss in her left eye over 1 month. Large exudative retinal detachment and severe vitreous infiltration were observed. RESULTS: Histopathologic study of the retinal biopsy specimen established the diagnosis of cryptococcal endophthalmitis. Subsequent positive histopathologic study of the aspiration vitreous smear and epiretinal membrane confirmed the recurrence and persistence of the disease over 4 months after the initial presentation. Systemic amphotericin B-fluconazole and two doses of intravitreous amphotericin B injection eliminated the infection successfully. CONCLUSION: The authors report here a well-documented case of cryptococcal endophthalmitis and present the serial clinical and histopathologic pictures. The importance of retinal biopsy in diagnosis and the combined form of antifungal treatment also are shown.     

Controlled multicenter trial of laparoscopic transabdominal preperitoneal hernioplasty vs Shouldice herniorrhaphy. Early results

BACKGROUND: In February 1993 a prospective randomized multicenter trial was initiated to compare laparoscopic transabdominal preperitoneal hernioplasty to Shouldice herniorrhaphy as performed by surgeons of nonspecialized clinics. METHODS: Until January 1994, 87 patients with 108 hernias took part in the trial (43 Shouldice and 44 laparoscopic repairs). RESULTS: The laparoscopic procedure took significantly longer than did the open operation but caused less pain as measured by pain analogue score and consumption of paracetamol and narcotics. The postoperative complication rate was 26% in the open and 16% in the laparoscopic group. The patients in the laparoscopic group were discharged earlier and their convalescence was shorter than after open hernia repair. There has been one early recurrence in the laparoscopic and two in the open group to date with a mean follow-up of 201 days. CONCLUSIONS: Laparoscopic hernia repair causes less pain than the conventional operation and enables the patient to return to full work and usual activities earlier. The recurrence rate will not be known for 5 years.     

A comparison of patient recovery following unilateral and bilateral endoscopic preperitoneal herniorrhaphy

This study examined the effects of prenatal ethanol exposure on hippocampal theta activity in adult rats. Subjects were randomly selected from four prenatal treatment conditions: untreated, 0, 3, or 5 g/kg/day ethanol. At approximately 90 days of age, all subjects were surgically implanted with a bipolar electrode in the CA1 region of the hippocampus. Four epochs of hippocampal theta rhythm activity were recorded while the subjects were moving and four more while still, and a normalized theta score was computed and compared among groups. The 5 g/kg male group demonstrated a significantly higher theta score than controls, indicating either an increase in type I (movement-associated) theta and/or a decrease in type II (information-processing) theta activity. These results are consistent with prior reports that prenatal ethanol exposure alters hippocampal function and support clinical indications that monitoring the EEG of children may prove to be useful in the diagnosis of fetal alcohol syndrome and/or the detection of alcohol-related birth defects.     

Laparoscopic herniorrhaphy. A preperitoneal tension-free approach

At the present time laparoscopic herniorrhaphy appears to be successfully performed by utilizing a preperitoneal approach. The major indications are bilaterals hernia and the recurrent hernia. Other routine hernias may be done at the decision of the surgeon and patient depending upon the necessity of rapid return to work and desire to minimize pain. Utilizing this approach, the recurrence rate at the present time is less than 1%, which compares favorably with all other types of repair.     

Preliminary technique of laparoscopic extraperitoneal infrarenal paraaortic lymphadenectomy in the porcine model

The prevalence of Parkinson's disease (PD) is higher in whites than in nonwhites and it increases with advancing age. The pathological hallmarks of PD are loss of pigmented neurons in the substantia nigra pars compacta (SNpc) and presence of Lewy bodies. With increasing age, a similar loss of pigmented neurons in the SNpc has been reported. Hence, age and race possibly play a role in the pathogenesis of PD. The objectives of this study were to count the number of melanized neurons in the SNpc in normal human brains from India and study the change in neuronal count with advancing age and to compare the neuronal counts from this Indian population with counts reported in normal brains from the United Kingdom. Melanized neurons in the SNpc were counted in 84 normal human brains (age range, 5-84 years) in a single 7-microm section at the level of emergence of the oculomotor nerve. In the brains from India, there was no loss of melanized nigral neurons with advancing age. The absolute number of these melanized neurons was about 40% lower than the brains from UK. Despite a low number of melanized nigral neurons in the brains from India, individuals function normally and have dopamine levels comparable with their Western counterparts, suggesting that it is not the absolute number of melanized nigral neurons but the percent loss of nigral neurons that results in dopaminergic deficiency in PD. There is no significant loss of pigmented nigral neurons with age, suggesting that the loss seen in PD is exclusively due to the disease process itself. Indians have a lower prevalence of PD despite having a low count of melanized nigral neurons, suggesting that better protective mechanisms may be present in the Indians to prevent the loss of nigral neurons.     

A comparison of four warm-up techniques for initiating encounter groups.

16 groups, composed of 3 male and 3 female community college evening students, experienced 1 of 4 warm-up conditions prior to a 45-min leaderless encounter group: (a) nonverbal exercises, (b) modeling of intensive group interaction using an edited tape recording of an encounter group, (c) autobiographical information exchanged among group members, (d) no warm-up . The nonverbal exercises seemed to promote the largest increases in self-ratings of extraversion. The modeling condition was most effective in fostering a group atmosphere rated as "active" and in stimulating intentions for further self-disclosures to the group. A correlational analysis of the dependent variables provided clues to the process components of the successful encounter group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized comparison of pulmonary function after the 'French' and 'American' techniques of laparoscopic cholecystectomy

The 'French' and 'American' techniques of laparoscopic cholecystectomy, which differ in the position of the surgeon and ports, have not been compared directly. The authors' hypothesis was that the 'French' technique results in better postoperative pulmonary function than the 'American' technique. Patients undergoing elective cholecystectomy were randomized, 25 patients to have the 'French' method and 24 the 'American' method. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured before operation, and 6, 24 and 48 h after surgery. Postoperative pain and fatigue were also measured. Both FVC and FEV1 at 6 h, 24 h and 48 h after operation were significantly less in the 'American' group (FVC at 24 h: 71 versus 86 per cent of preoperative value; P = 0.001, Student's t test; 95 per cent confidence interval 7-24). Two cases of atelectasis occurred in the 'American' group and none in the 'French' group. Differences in access to Calot's triangle were also noted. One patient in the 'French' group sustained a diathermy injury of the duodenum, related to defective equipment. It is concluded that the 'French' method leads to less impairment of pulmonary function.     

A comparison of replication techniques in the modification of minimal dating behavior.

Compared the effectiveness of 4 behavioral techniques in the treatment of 59 male undergraduate volunteers who reported minimal dating behavior. The techniques differed in type and amount of feedback which S received. Ss were divided into 2 control conditions; 2 intermediate treatment conditions which permitted either observation only or observation and rehearsal; and 2 conditions which permitted videotape self-observation of just-completed behavior. Those Ss receiving videotape self-observation were judged significantly higher on the basis of posttreatment changes on a simulated dating task than the control and intermediate-treatment groups. Results indicate that a realistic clinical problem can be modified by behavioral feedback techniques. Interactions between target behavior and choice of treatment are discussed. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of cotton dust sampling techniques

The standard high volume sampler, multistage cascade impactor, and modified vertical elutriators were evaluated for total cotton dust sampling. The effects of changes in performance parameters is reported. Mass median dust diameter found in four textile operations for several cotton grades are reported.     

A comparison of two depot injection techniques

In the study reported in this article, the researchers attempted to raise awareness among practitioners of the importance of intramuscular drug administration technique in reducing injection site complications following antipsychotic depot injections. They also aimed to improve and expand the scope of present practice by comparing the effect of two accepted techniques, the 'air bubble' and 'Z-track' on these complications, and demonstrate that the air bubbles technique is more effective in reducing seepage and causes less discomfort. A 'within subjects' design was used, and Likert scales for scoring subjective and objective assessment of complications were established and scored at each injection. The study showed that there was no significant difference between the effects of either technique.     

A comparison between ketorolac and diclofenac in laparoscopic sterilization

We compared ketorolac and diclofenac for the prevention and treatment of post-operative pain in patients undergoing laparoscopic sterilization. Fifty ASA I or II women were allocated randomly to receive either diclofenac 75 mg or ketorolac 30 mg intramuscularly 30-90 min before general anaesthesia. Pain scores were assessed half-hourly in the recovery room and then at 2 h and 4 h in the ward. In the recovery room, pain was treated with a second dose of the study drug, followed by parenteral pethidine if necessary. Four patients in the diclofenac group and five patients in the ketorolac group requested no analgesics after surgery. Fifteen patients from each group had satisfactory analgesia after the second dose of study drug. Pain scores were similar between groups at all times. The median (range) initial pain score in the recovery room was 5 (0-9.5) in the diclofenac group and 5 (1-9) in the ketorolac group. Pain at the injection site was more common after diclofenac than ketorolac (12 vs. 3, P < 0.05). In conclusion, both intramuscular diclofenac and ketorolac were relatively ineffective in controlling the pain after laparoscopic sterilization. The drugs were equally well tolerated, but more patients complained of pain at the injection site after diclofenac.     

Job-seeking interview skills training: A comparison of four instructional techniques.

56 prison inmates aged 18–47 yrs in 3 prerelease training cycles were randomly assigned to 1 of 4 treatment conditions or to a waiting-list control condition. The 4 instructional techniques were model exposure (MOD), role playing (RP), model exposure plus role playing (MRP), and model exposure and role playing with videotape feedback (VIDEO). Judges' ratings of videotaped simulated pre- and posttreatment interviews and personnel interviewers' ratings of follow-up interviews served as criterion measures. Posttest results indicate that both the MRP and VIDEO treatments were significantly more effective than the control procedure on all dependent variables; the RP treatment was more effective than the control on 2 criteria, and the MOD group was inferior to the MRP group on 1 criterion. On follow-up ratings, the MRP group differed significantly from the control group on 1 variable, while the VIDEO group differed significantly on 3 areas of behavior and on probability of hire. The use of numerous types of training components is superior to the use of single components in developing complex types of abilities and behavior. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of high-energy oblique lung irradiation techniques

The present studies investigate the effects of early nerve growth factor (NGF) administration on the ontogenetic profile of learning and retention capacities in mice. The learning paradigm used required the animals to withhold an escape response from a vibrating platform to avoid a punishment (step-down passive avoidance). In Experiment 1, acquisition of step-down passive avoidance was essentially the same in 11- and 15-day-old mice whereas only the latter showed significant retention after 24 h. In younger animals, data pointed to a facilitating effect of familiarization with the test environment. In Experiment 2 ICV NGF treatment on postnatal day 9 increased step-down latencies in both reinforced and nonreinforced pups on day 11. Moreover, NGF mice exposed in nonreinforcement condition on day 11 failed to acquire the avoidance response 24 h later, suggesting that the treatment anticipated the appearance of latent inhibition. Results of Experiment 3, investigating the effects of different durations of preexposure to the test apparatus on passive avoidance acquisition 24 h later, supported the specificity of NGF effects on the emergence of latent inhibition. These findings suggest that neural populations responsive to NGF trophic effect are involved in the maturation of early learning and retention capacities in rodents.     

A case controlled comparison of open and laparoscopic splenectomy in children

BACKGROUND: This case controlled study compares the efficacy, safety, and cost of laparoscopic splenectomy (LS) and open splenectomy (OS) for hematologic disorders in children. METHODS: The records of 82 consecutive children and adolescents undergoing splenectomy for hematologic disorders between August 1994 and September 1997 were reviewed retrospectively. RESULTS: Fifty patients underwent LS by a lateral approach and 32 underwent OS through a left subcostal incision. Mean age was 7.76 years for LS and 6.9 years for OS. Patient weights were similar: (LS, mean 30.5 kg; OS, mean 27.6 kg). Hematologic indications included hereditary spherocytosis in 43 children (LS 26, OS 17), sickle cell anemia with sequestration in 13 (LS 7, OS 6), immune thrombocytopenic purpura in 14 (LS 8, OS 6), and 12 with other disorders (LS 9, OS 3). Concomitant cholecystectomy was performed in 10 of 50 LS and 6 of 32 OS cases. Accessory spleens were identified in 8 of 32 (25%) OS and 9 of 50 (18%) LS cases (P = .578). No LS procedures required conversion to OS. The mean estimated blood loss was 54.4 mL for LS and 49.0 mL for OS (P = .233). LS required a longer operative time (115 vs 83 minutes, P = .002), less need for postoperative intravenous narcotic (51% vs 100%, P < .0001), lower total narcotic doses (0.239 vs 0.480 mg/kg morphine, P = .006), shorter length of hospital stay (1.4 +/- 0.97 vs 2.5 +/- 1.43 days, P = .0001), and lower average total hospital charges ($5713 vs $6564) than OS. There were no deaths or major complications in either group. CONCLUSIONS: Laparoscopic splenectomy is a safe and effective procedure in children with hematologic disorders resulting in longer operative times, less narcotic administration, shorter length of stay, and lower total hospital charge.     

Reduction of autonomic arousal in alcoholics: A comparison of relaxation and meditation techniques.

Investigated and compared the effects of progressive relaxation training and meditation training on autonomic arousal in alcoholics with 30 Ss (mean age, 45.1 yrs) who were selected from a hospital substance-abuse program. The Ss were randomly assigned to 1 of the following 3 experimental conditions: (a) progressive relaxation training group, (b) meditation training group, or (c) quiet rest control group. All groups met for 3 wks during which state anxiety (State-Trait Anxiety Inventory), blood pressure, heart rate, and spontaneous GSRs were measured. The measures were designed to assess the treatment effects following the 1st training session and at the end of the total training period. Results indicate that both progressive relaxation training and medication training are useful for reducing blood pressure in alcoholics. In addition, significant differences between the groups in the effectiveness of the relaxation procedures were found. Meditation training induced blood pressure decreases at an earlier point in the 3-wk training period and affected decreases in systolic blood pressure that progressive relaxation training did not. Results support the idea of considerable specificity of response to relaxation techniques. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Video-laparoscopic staging of gastric cancer. A prospective multicenter comparison with noninvasive techniques

BACKGROUND: The high proportion of gastric carcinomas present in an unresectable stage, together with the emergence of multimodal treatments, increases the usefulness of objective staging methods that avoid unnecessary laparotomies. METHODS: A prospective evaluation of the accuracy of laparoscopy in the staging of 71 patients with gastric adenocarcinoma is presented. Serosal infiltration, retroperitoneal fixation, metastasis to lymph nodes, peritoneal and liver metastasis, and ascites were determined in the staging workup. Sensitivity, specificity, and predictive values were calculated and compared with those obtained with ultrasonography (US) and computed tomography (CT). RESULTS: The diagnostic accuracy of laparoscopy in the determination of resectability was 98.6%. Consequently, over 40% of patients were spared unnecessary laparotomies. Laparoscopy yielded diagnostic indices superior to US and CT for all the tumoral attributes studied. Our technique permits accurate assessment and pathologic verification of liver and the peritoneal and retroperitoneal extent of tumor invasion in the majority of patients. CONCLUSIONS: Laparoscopy in gastric adenocarcinoma is a reliable technique that provides accurate assessment of resectability and stage, thus avoiding unnecessary laparotomies in patients in whom surgical palliation is not indicated. A stepwise diagnostic workup combining imaging and minimally invasive techniques is proposed.     

A comparison of ventilation techniques in ARDS. Volume controlled vs pressure regulated volume control

OBJECTIVE: Comparison between effects of a new method of mechanical ventilation (PRVC) and Volume Controlled ventilation in the ARDS treatment. DESIGN: Prospective study from March 1995 to March 1997. PLACE: Intensive Care Unit of Sanremo Hospital. PATIENTS: Nine patients, six males and three females, average age 49.2 years, average SAPS 35.5, with moderate to severe ARDS related to various etiologies. INTERVENTIONS: Patient were first ventilated with Siemens Servo Ventilators 300 in Volume controlled. They were then ventilated with Pressure-regulated Volume Control maintaining the same ventilation parameters (TV, RR, FiO2, PEEP and I:E ratio). MEASUREMENTS: After a 60 minute stabilisation period in each method, Peak inspiratory pressure, Static Compliance, PaO2, PaCO2, AaDO2 and cardiovascular parameters were measured. RESULTS: With the PRVC ventilation an important decrease of PIP and an improvement of PaO2 and SaO2 were observed. CONCLUSIONS: Although it is not possible to draw any conclusion on morbidity and mortality in patients treated with PRVC versus VC, for gas exchange and compliance improvement and for inspiratory pressure decrease with consequent reduction of barotrauma, it may be affirm that PCRV seems to be the best ventilation methods in the ARDS treatment.