Frequency of contralateral patent processus vaginalis in children presenting with unilateral hernias

To determine the frequency of contralateral patent processus vaginalis [PPV] in children who presented with unilateral inguinal hernias. A Descriptive Study. Department of Paediatric Surgery, Military Hospital Rawalpindi, from November 2006 to November 2007. All children under the age of 6 years and presenting with unilateral inguinal hernia were included. Those children who had a hernia on the contralateral side, or a history of swelling in the past, previous operations on the contralateral side, associated conditions like connective tissue disorders, ascites or VP shunts were also excluded. A standard Rehbein procedure was carried out for hernia repair on both sides. The results were analyzed and presented as mean [range] or mean +/- SD. There were 76 patients who underwent bilateral inguinal explorations. Males were 66 [86.8%] and 10 [10.8%] were female. Almost two thirds [n=52, 68.4%] were children younger than two years of age [mean age 1 year and 9 months]. There was a preponderance of left sided hernias [45 vs. 31, 59.2% vs. 40.8%]. The asymptomatic contralateral side exploration showed the presence of a definite PPV in 5 [6.6%] patients. The mean operating time was 35 + 10.4 minutes. The risk of contralateral hernia, in children presenting with one sided inguinal hernia is quite low. This does not justify routine exploration of the contralateral groin to prevent only a few clinical hernia developments later on

War casualties: recent trends in evacuation, triage and the 'golden hour'

Prompt medical treatment and early evacuation is the goal of military medicine in the battlefield. 'Triage' is a process of sorting the casualties according to the severity of injury and the prioritization of treatment. In trauma management 'Golden Hour' is the first sixty minutes or so after injury; this emphasizes that the chances of the victim's survival are the greatest if definitive care is given as early as possible. Our evacuation protocols follow the triage but the time to treatment is beyond sixty minutes. Many Armies have developed evacuation systems which allow the casualty to be seen within this specified time. This has been achieved by streamlining the evacuation chain, extensive incorporation of air transport and training of paramedics in advanced life support measures. In line with the modern trends we need to modernize our own system of casualty evacuation and treatment