Drain tube use in incisional hernia repair: a national survey.

PURPOSE: There is debate regarding the use of drain tubes in incisional hernia repair. This has become topical in Australia, with a court judge suggesting that drain tubes are mandatory. There continues to be a lack of evidence to support generalised decision-making regarding the use of drain tubes. METHODS: The general surgeon membership of General Surgeons Australia (GSA) were surveyed regarding incisional hernia repair, their use of drains, and the decision-making behind their use. RESULTS: A total of 196 surgeons' survey responses were analysed. Most surgeons perform less than 20 incisional hernia repairs per year (78%), prefer an open approach (78%), and preferably perform a pre-peritoneal (sub-lay) repair (53%). There was a variety of approaches to leaving a drain, with the most common answer being "sometimes" (31.28%) and an equal number of surgeons claiming to always or never leaving a drain (11.79% each). There was also no consensus in the duration the drain should stay in, with most surgeons averaging less than 5 days. Interestingly, there was a range of views on the effects of drain tubes, with some surgeons believing drains decreased infections and more believing they increased infections. Most surgeons felt seromas were decreased, but there was increased post-operative pain. The majority of surgeons agreed there was no evidence to support their beliefs. CONCLUSION: Placement of drain tubes is not universally practiced by the general surgeons who participated in the survey. The lack of evidence is reflected by a varied approach to incisional hernia repair and the use of drain tubes.

Minocycline-induced serum sickness.

Minocycline, a semisynthetic derivative of tetracycline, has become a commonly prescribed medication for the treatment of persistent acne. It has been associated with a variety of adverse reactions, including one published case of serum sickness. We describe two additional cases of serum sickness reactions due to minocycline, characterized by erythematous rash, arthropathy, and in one case, angioedema. Both patients recovered fully after treatment with an antihistamine in combination with a brief course of corticosteroids. Although these represent only the second and third cases in the literature of minocycline-induced serum sickness, it may be reported more frequently in the future with the increased use of minocycline.

Management of asthma in the geriatric population.

Asthma remains an important cause of morbidity and mortality for patients of all ages, but it may be of particular concern in geriatric patients as the aging population increases. Asthma may vary in severity from mild to such severity that ventilatory support is required. However, with proper medical management, asthma of most patients can be adequately controlled. Although there are similarities in managing younger patients with asthma, special problems occur in the geriatric population.

Recurrent anaphylaxis due to unrecognized latex hypersensitivity in two healthcare professionals.

BACKGROUND: Anaphylaxis is a potentially fatal immediate-type reaction and intense effort may be required to identify the allergen responsible. In some cases, a "hidden" allergen may be responsible that is not apparent in spite of careful clinical assessment. OBJECTIVES: This report describes the assessment of two cases of anaphylaxis in which a search for an allergen was initially not conclusive and the diagnosis of idiopathic anaphylaxis was considered. METHODS: Two patients were evaluated by various physicians for anaphylaxis with no clear indication of a responsible allergen. Persistence in evaluation led to the identification of the allergen responsible. RESULTS: In two health care workers latex was identified as the "hidden" cause of anaphylaxis. This allergen had not been considered in either case in initial evaluations. Neither patient has had a recurrence of anaphylaxis since latex was identified as the cause of anaphylaxis. CONCLUSIONS: Although latex is widely recognized as a cause of anaphylaxis, it can still be unrecognized in some cases of recurrent anaphylaxis. Latex must be considered as a "hidden" cause of anaphylaxis, particularly in health care workers.

Hypersensitivity pneumonitis from residential composting: residential composter's lung.

Hypersensitivity pneumonitis results when a susceptible individual is exposed to sufficient airborne material capable of inducing a systemic and pulmonary immune response. We describe a man who had all the classic manifestations of hypersensitivity pneumonitis but in whom the circumstances of sensitization, residential yard work with composted yard clippings, has not previously been reported. We call this new entity residential composter's lung.