Is laparoscopic inguinal hernia repair more effective than open repair?

To systematically review randomized controlled trials, [RCT] evidence comparing Lichtenstein to total extraperitoneal [TEP] hernia repair in terms of clinical and cost effectiveness. Case series. The study was conducted at University of Abderdeen, U.K. a comprehensive online literature search was undertaken using data bases such as MEDLINE, PubMed, EMBASE and Springerlink. Studies were then shortlisted according to the selection criteria [RCT with other 100 subject and English language publications from 1995 onwards] and appraised using the SIGN Methodology Checklist. A meta-analysis of the data was also performed using RevMan software. Analysis of reported data shows that TEP has less postoperative pain and return to work than Lichtenstein method. Operation time is shown to be longer in the TEP but this difference is shortened with increasing surgeon experience. The meta-analysis of the data on complications shows that there are no significant differences between the two types of procedures. TEP causes more short-term recurrences which are attributed to the learning curve effect. Long-term recurrence rates on the other hand show no significant differences. At present TEP is slightly more expensive than Lichtenstein repair. Both TEP and Lichtension repair are clinically effective procedures. The choice between them should be made on a case-by-case basis; which depends on the patients' preference and characteristics such as age, work and health status

Mode of detection of transvenous defibrillation lead malfunction in implantable defibrillators

To assess the clinical presentation and mode of detection of transvenous defibrillation lead failure and therefore enhance earlier diagnosis and prevent subsequent complications. Retrospective study. Electrophysiology outpatient clinic, Cardiology Division, Kuwait Heart Center Subjects: Four hundred and ninety-three patients who underwent first implantation of an implantable cardioverter-defibrllator [ICD] were enrolled and followed-up in the clinic. Intervention: Implantation of ICD Main Outcome Measures: ICD lead malfunction could be readily diagnosed by clinical presentation and device evaluation on an outpatient basis. Eight patients demonstrated clinical defibrillation lead failure on follow-up. It was diagnosed at a mean follow-up of 47.1 +/- 29.1 months after device implantation. Four patients presented with inappropriate shocks due to noise oversensing with an average of 4 +/- 6 shocks per patient. Lead malfunction was discovered during routine device follow-up in the remaining patients who were asymptomatic and ICD interrogation showed lead impedance out of normal range, increased chronic pacing threshold and /or sensing failure evidenced by drop in ventricular signal to less than two millivolts. All patients who sustained ICD lead failure had a new lead implanted. ICD lead malfunction requiring new lead implantation is not uncommon during long term follow-up and urge for continued close routine follow-up. Both old and new leads of different models are liable for malfunction. In asymptomatic patients lead failure can be readily diagnosed in most cases on an outpatient basis by finding abnormal measures of sensing / pacing parameters, lead impedance, stored electrograms and possibly radiographic data

Healing of a large periapical lesion with conventional treatment

Large cystic lesions of the maxilla and mandible that develop as a result of trauma to the teeth are generally surgically excised after the involved teeth have been endodontically treated or extracted. This article presents a case where conservative endodontic treatment alone resulted in complete resolution of a large periapical lesion of the maxilla