Clinical Characteristics and Surgical Safety in Patients Older than 80 Years with Inguinal Hernia

BACKGROUND: Inguinal hernia repair is a common surgical intervention in the elderly. The aim of this study was to describe the clinical characteristics and treatment outcomes in patients over 80 years of age undergoing inguinal hernia repairs. METHODS: We retrospectively reviewed the medical records of 150 patients older than 65 years of age who had undergone an inguinal hernia repair between January 2006 and December 2010. Dividing our subjects by age into two groups, 65 to 79 years and 80 years and older, we compared their clinical features and surgical outcomes. RESULTS: There were 122 patients (81.3%) in the 65 to 79 years group and 28 (18.7%) in the over 80 years group. Average body mass index was 22.8 kg/m2 in the 65 to 79 group and 21.8 kg/m2 in the over 80 group. Comorbidities were present in 63.9% of the cases in the 65 to 79 group and 67.9% in the over 80 group. American Association of Anaesthetists score was significantly higher in the over 80 group (1.6+/-0.3 vs. 1.9+/-0.3, p=0.046). Comparisons of operative time for each operative method were statistically not different. Postoperative hospital stay and analgesic use also showed no significant differences between the groups. Among the postoperative complications, wound hematoma was most prevalent in both groups but was not statistically different. There was no surgery-related mortality in either group. CONCLUSION: Our results indicate that inguinal hernia repair can be done safely in those older than 80 years, unless there is high surgical risk per se.

Comparison of Particle Agglutination Assay and ELISA for Anti-thyroid Autoantibodies

BACKGROUND: Measurements of serum anti-thyroglobulin antibody (anti-Tg) and anti-thyroid peroxidase antibody (anti-TPO) are important for the diagnosis of autoimmune thyroid diseases. Although ELISA is most commonly used for the detection of anti-thyroid autoantibodies, other methods like particle agglutination assay (PA) or radioimmunoassay (RIA) are still being used in clinical laboratories. There are few studies about the comparison between PA and ELISA, and we evaluated the validity of these assays in this study. METHODS: We have used three methods, PA (Fujirebio Inc.), ELISA-1 (Zeus Scientific Inc.), and ELISA-2 (Orgentec Diagnostika) for the measurements of titers or concentrations of anti-thyroid autoantibodies. A total of 212 patients belonging to six different disease groups were tested: 40 patients for anti-Tg only, 64 for anti-TPO (or anti-microsome) only, and 108 for both antibodies. All test results were compared with each other in six disease groups. RESULTS: Concordance of positive or negative results was obtained in 78.5-97.3% of the samples tested, and positive rates of three methods were similar in autoimmume thyroid disease group. In the comparable concentration range, the correlation coefficients were 0.328-0.820 between the two ELISAs or between ELISA and PA. CONCLUSIONS: Positive or negative decisions by three assay systems have high concordance rates, and antibody levels measured by three methods correlate well in the comparable concentration range. The ELISA-1 shows less non-specific reactions, better discrimination in low level of autoantibodies, and the highest positive rate in autoimmume thyroid disease group.

Re-evaluation of the Anti-streptolysin O Test for Systemic Rheumatic Diseases

BACKGROUND: Anti-streptolysin O (ASO) test is usually used to diagnose group A streptococcal infection-related diseases, such as rheumatic fever, reactive arthritis, and various infectious diseases. Despite the recent declining incidence of these diseases, ASO test is still frequently performed as a screening test to diagnose rheumatic diseases. This study re-evaluated the clinical usefulness of ASO test in systemic rheumatic diseases (SRD). METHODS: ASO tests was performed in 825 patients between April and October in 2010. ASO levels were compared between SRD and non-SRD groups of patients. The results of ASO, C-reactive protein (CRP), and rheumatoid factor (RF) were compared among 6 subgroups of SRD: rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, Behcet disease, Sjogren's syndrome and others. RESULTS: Positive results in ASO test (>200 IU/mL) were observed in 15.3% (126/825) of the patients tested. None of the ASO positive patients was, however, diagnosed with rheumatic fever or reactive arthritis. There were no statistically significant differences in the mean value (P=0.688) or positive rate (P=0.835) of ASO test between SRD and non-SRD groups. Positive rates of ASO test were also not statistically significant different among six subgroups of SRD patients (all P>0.05), whereas those of CRP and RF tests were significantly different. CONCLUSIONS: The usefulness of ASO test is very low for diagnosing SRD, although it is frequently carried out as a screening test. We suggest that ASO test must be performed selectively when diseases from group A streptococcal infection are suspected.