Complications of inguinal herniotomy are comparable in term and premature infants.

PURPOSE: Inguinal hernias are common, and prevalence is highest in premature males. Recognised complications include recurrence, iatrogenic cryptorchidism and testicular atrophy. We reviewed complication rates following inguinal herniotomy (IH), comparing premature (gestation <36 weeks) and term infants. METHODS: A retrospective case note review of infants aged 0-12 months undergoing IH between January 2006 and December 2010. Data collected included demographics, side of hernia, incarceration, complications, duration of follow-up and need for further surgery. Comparison was made using unpaired student t test and Fishers exact test. RESULTS: Four hundred and eight patients underwent IH (365 male, 42 female, 1 complete androgen insensitivity); 197 were premature (prem), mean weight 3.81 kg (1.02-9.4); 211 were term (gestation ≥36 weeks), mean weight 5.85 kg (2.4-11.7), p = 0.0001 versus prem. Total herniotomies performed = 472 (131 Left, 213 Right, 64 bilateral); 89 hernias were incarcerated at presentation (60 prem vs. 29 term, p = 0.0001). Bowel resection was required in six patients (5 prem vs. 1 term, p = 0.1109), and 14 had simultaneous orchidopexy (12 prem vs. 2 term, p = 0.0049). Early post-operative complication rate 2.8 % (8 prem vs. 5 term; p = 0.4037). Two hundred and forty patients attended follow-up; 58.8 % (125 prem, 115 term). This group accounted for 279 IH (264 male, 15 female). Mean follow-up = 5 months (0.5-36). Complication rates: recurrence 2.7 %, metachronous hernia 7.5 %, iatrogenic cryptorchidism 3.8 % and testicular atrophy 0.7 %. CONCLUSION: No significant difference was found in complication rates between premature and term infants despite significantly more premature infants presenting with incarcerated hernias.

Measurement of the turnover of glycogen phosphorylase by GC/MS using stable isotope derivatives of pyridoxine (vitamin B6).

The majority of vitamin B6 in the body is in skeletal muscle, bound as the cofactor pyridoxal 5'-phosphate to one abundant protein, glycogen phosphorylase. Previous work has established that radiolabelled vitamin B6 can be used as a turnover label for glycogen phosphorylase. In this study, a stable isotope derivative of pyridoxine {dideuterated pyridoxine; 3-hydroxy-4-(hydroxymethyl) -5-[hydroxymethyl-2H2]-2-methylpyridine} ([2H2]PN) has been used as a metabolic tracer to study the kinetics of labelling of the body pools of vitamin B6 in mice. A non-invasive method was developed in which the isotope abundance of the urinary excretory product of vitamin B6 metabolism, 4-pyridoxic acid, was analysed by GC/MS. The change in isotope abundance of urinary 4-pyridoxic acid following administration of [2H2]PN reflects the kinetics of labelling of the body pools of vitamin B6, and yields, non-invasively, the rate of degradation of glycogen phosphorylase.

Application of gas chromatography-mass spectrometry with selected ion monitoring to the urinanalysis of 4-pyridoxic acid.

An analytical protocol has been developed for the analysis of urinary 4-pyridoxic acid (4-PA) by gas chromatography-mass spectrometry (GC-MS) for use in metabolic studies. Aliquots of urine were deproteinised and fractionated by isocratic reversed-phase high-performance liquid chromatography. The eluent fraction containing the 4-PA was collected, freeze-dried and silylated using N-methyl-N-(tert.-butyldimethylsilyl)trifluoroacetamide. Derivatisation produced the mono-tert.-butyldimethylsilyl derivative of 4-PA lactone. This derivative was readily amenable to GC-MS analysis in the electron ionisation (70 eV) mode, yielding a prominent fragment ion at m/z 222 ([M-57]+; base peak). A heavy isotope-labelled derivative of pyridoxine [dideuteriated pyridoxine; 3-hydroxy-4-(hydroxymethyl)-5-[hydroxymethyl-2H2]-2-methylpyridine] has been synthesised and is being employed to determine the kinetics of labelling of the body pools of vitamin B6. Kinetic measurements are based on the determination of the relative proportions of metabolically produced deuterium-labelled and non-labelled 4-PA in urine, obtained from stable isotope ratios determined by low-resolution selected ion monitoring using a bench-top quadrupole GC-MS system.

The expression of glycogen phosphorylase in normal and dystrophic muscle.

Specific cofactor labelling was employed to determine the degradation rate of glycogen phosphorylase in normal adult C57BL/6J mice and their dystrophic counterparts (C57BL/6Jdy/dy). The rate constant for the decay of phosphorylase-bound label was 0.125 day-1 in normal muscle and 0.49 day-1 in dystrophic muscle, i.e. a lower rate of catabolism of phosphorylase in dystrophic muscle. Quantitative Northern-blot analyses of total RNA isolated from normal and dystrophic muscle indicated that the abundance of phosphorylase mRNA as a percentage of total RNA was approx. 40% lower in dystrophic muscle. The specific activity of phosphorylase in dystrophic muscle is approx. 60% lower than in normal muscle, and is elicited by a lower rate of turnover of the enzyme, i.e. both synthesis and degradation are decreased.

Effect of denervation on the expression of glycogen phosphorylase in mouse skeletal muscle.

After sciatectomy of the left hind-limb of C57BL/J mice, a denervation-induced muscular atrophy ensued and was accompanied by a decrease in the specific activity of glycogen phosphorylase to approx. 25% of control values. The cofactor of phosphorylase, pyridoxal 5'-phosphate, was used as a specific label in the determination of the degradation rate of the enzyme following nerve section. After a delay of 3-4 days, phosphorylase was degraded approx, twice as rapidly in the denervated gastrocnemius (0.20 day-1) as in the control muscle (0.12 day-1). The effect of denervation on phosphorylase mRNA was measured by quantitative Northern-blot analysis using a rat skeletal-muscle phosphorylase cDNA probe. After an initial rapid decline, phosphorylase mRNA levels stabilized in denervated muscle at 50% of the value measured in the contralateral control muscle.

Screening of asymptomatic bacteriuria in a disadvantaged school population.

In the Pose-Robbins School Health Project, 314 seventh grade students were screened for asymptomatic bacteriuria. A multiple dipstrip detection method was used for nitrite, glucose, and protein. Where one or more of the dipstrip tests was positive, urine cultures were performed on clean voided specimens. A child whose urine culture showed a colony count of greater than 100,000 colonies/ml was defined as having asymptomatic bacteriuria. Of the female students, 5.4 percent were found to have asymptomatic bacteriuria. None of the male students had asymptomatic bacteriuria. The percentage of schoolgirls in this age group who demonstrated infection was higher than previously reported. The school population screened in this study was from a poverty area disadvantaged according to most demographic parameters.