The efficacy of laparoscopic examination of the internal inguinal ring in children.

The ability of physicians to identify a patent processus vaginalis by laparoscopic examination of the internal ring is now well established, but the efficacy on patient outcome is not. The authors reviewed their experience to determine the effect of diagnostic laparoscopy of the internal ring on the management of children with inguinal hernias. The records of 150 children who underwent inguinal surgery were reviewed--75 before (group 1) and 75 after (group 2) pediatric laparoscopy was introduced into the authors' practice. The children in group 1 were selected for unilateral or bilateral surgery based on history, age, sex, side of presentation, and parental preference. For group 2, laparoscopy was an additional option offered to appropriate patients. Laparoscopy was performed in 43 group 2 patients, using an infraumbilical site. The minimum follow-up period was 2 years for group 1 and 1 year for group 2. The mean ages for groups 1 and 2 were 41.2 and 39.7 months, respectively. There were 61 boys and 14 girls in each group. The percentages of right (R), left (L), and bilateral (B) findings, based on clinical observation, were 56.0 (R), 29.3 (L), and 14.7 (B) for group 1, and 58.7 (R), 26.6 (L), and 14.7 (B) for group 2. The incidence of bilateral surgical exploration was similar for the two groups (group 1, 58.6%; group 2, 61.3%). The addition of laparoscopy significantly lowered the incidence of negative explorations (group 1, 16.0%; group 2, 2.6%; P < .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Laparoscopic incidence of contralateral patent processus vaginalis in boys with clinical unilateral inguinal hernias.

In 38 boys with clinical unilateral inguinal hernias (CUIH), the contralateral processus vaginalis was examined laparoscopically before surgical manipulation at the time of elective inguinal herniorrhaphy. General anesthesia was used in each case, and a 30 degrees, 2.7-mm laparoscopic was introduced using standard techniques. Positive laparoscope findings prompted surgical exploration. The age range was 2 to 134 months. Twenty-four had a right CUIH, and 14 had a left CUIH. Overall, the contralateral processus vaginalis was patent in 52.6%, with 58.3% and 42.8% patency on the nonclinical left and right sides, respectively. In boys under 2 years of age, 50% of those with a right CUIH had a contralateral patent processus vaginalis, as did 60% of those with a left CUIH. In two of these 38 patients in whom there was no clinically proven hernia, the only patent processus vaginalis was on the side opposite the one with a clinical history. Laparoscopic examination of the internal inguinal ring provided accurate information useful in determining the need for contralateral inguinal exploration in these 38 children.

Giant sacrolumbar meningioma. Case report.

A case of giant sacral meningioma with presacral and lumbar extension is presented. The difficulties in diagnosis and management are emphasized including the staged multidisciplinary surgical approaches and preoperative tumor embolization.

The eradication of smallpox: organizational learning and innovation in international health administration.

PIP: The WHO smallpox eradication campaign represents perhaps the best example of a successful international health administration. In the 1st year of the campaign (1967), the guiding strategy was to vaccinate people en masse over a 2-3 year period in countries where smallpox was epidemic thereby conquering the disease. In Western Nigeria where 90% of the population had been vaccinated, a smallpox outbreak occurred in a religious sect resisting vaccinations and a delay in delivery of supplies forced a change in strategy. Campaign staff learned to rapidly isolate infected persons and swiftly vaccinate the uninfected in an outbreak area in order to break the transmission of smallpox, even where 1/2 the population had been vaccinated. Technological advancements also contributed to the campaign's success. For example, the jet injector vaccinated 1000 people/hour with efficient, reliable, mass produced potent, stable freeze dried vaccines (often produced in target countries) or the less costly and virtually maintenance free bifurcated needle was used. The most significant contribution to the success of the campaign, however, was the flexible mode of management adopted by the campaign staff at WHO which provided an appropriate environment for organizational learning and innovation. Although management was open and flexible, the campaign did depend on careful planning and setting of goals, continual assessment, and rapid response to field requests for assistance or advice. Trends in the incidence of smallpox was chosen as the indicator of success as opposed to the number of vaccinations. The campaign demonstrated the need for cultural adaptations as it operated in each country and region. This evaluation of the success of the smallpox campaign presents conclusions that serve as guidelines to the organization and administration of international programs designed to solve other health problems.^ieng

Role of the pineal gland in ovine photoperiodism: regulation of seasonal breeding and negative feedback effects of estradiol upon luteinizing hormone secretion.

In this study we determined whether the pineal is required for the photoperiodic control of reproduction in ewes and, if so, whether its effect is mediated via negative feedback effects of estradiol on LH. Two groups of Suffolk ewes were pinealectomized and challenged with 90-day alternations between long (16 h of light, 8 h of darkness) and short (8 h of light, 16 h of darkness) photoperiods for 2 yr. One group of pinealectomized ewes had intact ovaries; the other was ovariectomized and implanted with estradiol to monitor feedback inhibition of LH. Reproductive effects of pinealectomy were correlated with elimination of the nighttime rise of serum melatonin. In pineal-intact control ewes, reproductive function was readily manipulated by photoperiod. Long days inhibited ovarian cyclicity and increased the negative feedback potency of estradiol regardless of time of year; short days had stimulatory effects on both variables. In most animals, pinealectomy abolished both the inductive effects of short days and the inhibitory effects of long days, and eliminated the nighttime rise in serum melatonin. Although seasonal changes in reproductive function persisted after pinealectomy, the timing of these changes coincided most closely with that of pineal-intact animals housed outdoors. With the passage of time after pinealectomy, however, these seasonal fluctuations became progressively damped. These results document pineal mediation of the photoperiodic control of seasonal breeding in ewes and indicate that the pineal exerts its effect, at least in part, by changing the capacity of estradiol to inhibit LH secretion. Furthermore, the pineal mediates the response to both stimulatory and inhibitory photoperiods. Finally, ewes that are unresponsive to photoperiod remain seasonal, either in response to other environmental cues or owing to the expression of an endogenous circannual rhythm of reproduction.

Rubidium (potassium) uptake by Arabidopsis: a comparison of uptake by cells in suspension culture and by roots of intact seedlings.

Experiments are reported in which the uptake of (86)Rb(+), used as an analog of K(+), into cultured cells of Arabidopsis thaliana is investigated. A single transport system is found with K(m) = 0.34 millimolar and V(max) = 14 nmoles per milligram of protein per hour. This system is blocked by the metabolic inhibitor carbonyl cyanide m-chlorophenyl hydrazone (CCCP) and by cold. At high concentrations of external K(+) (above 1 millimolar), a significant fraction of total uptake is energy-independent. No evidence is found for more than one energy-dependent uptake system or for concentration-dependent modifications of a carrier as postulated in multiphasic transport models.Rb(+) uptake was also examined in cultured cells derived from an "osmotic mutant" of Arabidopsis. The system closely resembles that found in wild type cells with the exception that the Michaelis-Menten constants are higher: K(m) = 1 millimolar and V(max) = 32 nanomoles per milligram of protein per hour.The possibility that these results are artifacts associated with use of cultured cells was checked by examining (86)Rb(+) uptake by roots of intact seedlings of wild type Arabidopsis. A single energy-dependent transport system is found with K(m) = 0.42 millimolar which is not significantly different from the K(m) of cultured cells. There is also energy-independent uptake at high external ion concentration.