[Contralateral transinguinal laparoscopy in unilateral inguinal hernia]. / Laparoscopie controlatérale transinguinale dans la hernie inguinale unilatérale.

BACKGROUND: Indication for surgical exploration of the contralateral groin during unilateral herniorraphy in children is the subject of a worldwide debate. Routine exploration based on the likelihood of a patent processus vaginalis (PV) according to age, gender or side to some extent leads to unnecessary procedures, while routine abstention may leave a peritoneal sac, likely to later induce a symptomatic hernia in about 10% of cases. METHODS AND PATIENTS: One hundred and twenty-five children aged from 1 month to 15 years underwent transinguinal laparoscopic assessment of the contralateral groin, using a 3 mm trocar and a 70 degrees telescope gently introduced through the exposed PV. Surgical exploration was performed only in those patients who exhibited a patent PV, and in patients where the groin was poorly visualized due to technical problems. RESULTS: Regardless of age, contralateral surgery was not considered in 88 (70%) of the 125 children. Among the 37 patients that were operated upon, eight had a negative exploration due to an erroneous endoscopic evaluation. Surgery was avoided in 35 (56%) of the 62 infants aged less than 2 years, including nine of the 13 prematures who were previously routinely operated upon. Conversely, in the 63 older patients who were readily spared from surgical exploration, the videoscopic evaluation allowed appropriate selection for contralateral surgery in six. CONCLUSION: A routine policy, either of surgery or observation, is no longer indicated as a quick, safe and cost-effective method is available to detect a patent PV. The transinguinal laparoscopy is safe and could be easily performed by surgeons already skilled in pediatric herniorraphy. Therefore, the videoscopic transinguinal contralateral evaluation is worth being promoted to ensure an appropriate surgery tailored to the anatomical features.

[Results of surgical treatment of persistent or recurrent pneumothorax]. / Résultats du traitement chirurgical des pneumothorax persistants ou récidivants.

From 1st January 1988 to 31st December 1991, 107 patients were operated on for spontaneous idiopathic (N = 69) or secondary pneumothorax (N = 38). Surgery was performed for recurrence (63.6%) or failure to respond to management by tube drainage (36.4%). Ninety seven patients underwent pleural abrasion, and 10 underwent parietal pleurectomy. Prolonged continuous epidural analgesia was performed in 57 cases. Postoperative complications occurred in 15 patients (14%). Overall morbidity was significantly higher in patients with chronic lung disease (26.3%) than in patients without chronic lung disease (7.2%) (p < or = 0.01). As far as postoperative hospital stay was concerned, the same significant difference was observed (16.8 days versus 12.7 days) (p < or = 0.005). In patients with idiopathic pneumothorax, postoperative hospital stay was significantly shorter in those with epidural pain relief (11.7 days) than in the others (13.6 days) (p < or = 0.025). No recurrence was observed with a mean follow-up of 27 months. We conclude that: 1) surgery is the most efficient treatment of persistent or recurrent pneumothorax; 2) operative morbidity is related to the underlying lung disease and not to the procedure itself; 3) epidural analgesia is beneficial in this surgery.

[Hematocolpometra and local estrogen therapy: an overdose of promestriene?]. / Hématocolpométrie et estrogénothérapie locale: surdosage au Promestriène?

We report a case of hyperestrogenisation which showed itself by the presence of a haematocolpometra in an elderly lady which could be attributed to prolonged and continuous treatment with Promestriene cream. Haematocolpometra is due to intra-uterine haemorrhage (itself due to hyperplastic endometrial polyps) with vaginal stenosis caused by vaginal atrophy that existed before local treatment was started. The Pomestriene is an estrogenic substance which works locally and does not seem to cause much in the way of general effects when used for short courses. If when it is used in large doses over a prolonged period of time, however, it is necessary to look for generalised hyperestrogenisation. Further studies are needed to confirm these finding.