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

Effects of a 12-week exercise training programme on aerobic fitness, body composition, blood lipids and C-reactive protein in adolescents with obesity

<p><b>INTRODUCTION</b>Developing effective exercise programmes for the paediatric population is a strategy for decreasing obesity and is expected to help in eventually limiting obesity-associated long-term health and societal impact. In this study, the effects of a 12-week twice weekly additional exercise training, which comprised a combination of circuit-based resistance training and aerobic exercises, in additional to typical physical education sessions, on aerobic fitness, body composition and serum C-reactive protein (CRP) and lipids were analysed in 13- to 14-year-old obese boys contrasted with a control group.</p><p><b>MATERIALS AND METHODS</b>Both the exercise group (EG, n = 12) and control group (CG, n = 12) participated in the typical 2 sessions of 40-minute physical education (PE) per week in schools, but only EG participated in additional 2 sessions per week of 45 to 60 minutes per session of exercise training, which comprised a combination of circuit-based resistance training and aerobic exercises maintained at 65% to 85% maximum heart rate (HRmax = 220 - age). Body composition was measured using dual energy X-ray absorptiometry (DEXA). Fasting serum CRP and blood lipids were analysed pre- and postexercise programme. Aerobic fitness was measured by an objective laboratory submaximal exercise test, PWC170 (Predicted Work Capacity at HR 170 bpm).</p><p><b>RESULTS</b>Exercise training significantly improved lean muscle mass, body mass index, fitness, resting HR, systolic blood pressure and triglycerides in EG. Serum CRP concentrations were elevated at baseline in both groups, but training did not result in a change in CRP levels. In the CG, body weight increased significantly at the end of the 12-week period.</p><p><b>CONCLUSION</b>This study supports the value of an additional exercise training programme, beyond the typical twice weekly physical education classes, to produce physiological benefits in the management of obesity in adolescents, including prevention of weight gain.</p>