Laparoscopic inguinal hernia repair using an anatomically contoured three-dimensional mesh.

BACKGROUND: Laparoscopic inguinal hernia repair frequently is performed with mechanical fixation of a flat polypropylene mesh. Mechanical fixation is associated with pain syndromes, and mesh migration may occur without fixation of flat prostheses. An anatomically contoured mesh (3D Max; Davol, Cranston, RI, USA) using no or minimal fixation would avoid these problems. METHODS: A retrospective case study reviewed 212 transabdominal preperitoneal herniaplasties with 11 x 16-cm 3D Max mesh in 146 patients. Fixation with three helical tacks at the most was used early or with very large defects. RESULTS: Fixation was used in 19% of the cases, but only for 1 of the last 98 patients. As reported, 94% of the patients returned to normal activities by 3 weeks, 97% returned to unrestricted sports by 6 weeks, and 92% complete recovery from surgery by 9 weeks. Fixation or bilateral repair did not alter recovery. Four patients had minor pain or numbness. Symptomatic recurrence was 0%. One asymptomatic indirect recurrence was noted on examination, during a mean follow-up period of 23 months, yielding a 0.55% hernia rate and a 0.42% patient-year recurrence risk. CONCLUSIONS: An anatomically contoured mesh for transabdominal preperitoneal hernia repair often requires no fixation, with minimal risk of neuropathy and less than a 0.5% patient-year recurrence rate. Recovery is excellent even with bilateral repair or some fixation.

Radon in outdoor air in Nevada.

Measurements of radon at 50 sites with varying geology indicate that outdoor air in Nevada is comparable to that measured nationwide by Hopper et al. (1991). The statewide median of 15 Bq m-3 (0.4 pCi L-1) is essentially the same as the nationwide median. The range is considerable: from 2.6-52 Bq m-3 (0.07-1.40 pCi L-1). Variations in these measurements can generally be correlated with different concentrations of radon in soils and uranium and its progeny in rocks. Silica-rich igneous rocks (rhyolites and granites) appear to be the main sources of high levels of radon in outdoor air in Nevada. Concentrations of radon in outdoor air generally correlate with levels of radon in soil gas. Measurements taken from heights of 0.5, 1.0, and 2.0 m above the ground suggest that radon in outdoor air reflects the local geology throughout this range of heights. Towns for which > 20% of the homes have indoor-air radon concentrations > 48 Bq m-3 (4 pCi L-1) generally have relatively high soil-gas radon, relatively high outdoor-air radon, or both.

US-guided automated large-core breast biopsy.

To evaluate the efficacy of ultrasound (US)-guided automated large-core percutaneous needle breast biopsy, biopsy of 181 ultrasonographically suspicious breast lesions was performed by using a long-throw biopsy gun and 14-gauge needles with continuous US guidance. A "freehand" technique with either 5.0- or 7.5-MHz linear-array transducers was used. Needle core diagnoses were compared with surgical diagnoses in the 49 lesions subsequently surgically excised. The remaining 132 cases were followed for 12-36 months. Agreement between needle-core and surgical diagnoses in the 49 lesions was 100%. This group included 34 cancers (28 infiltrating ductal, two mucinous, one mixed infiltrating ductal and lobular, and one each of intraductal, infiltrating lobular, and tubular carcinoma). To date, no cancers have been found in the other 132 cases. The procedure time averaged 20 minutes, and no complications occurred. With an accuracy approaching that of excisional biopsy, US-guided needle core biopsy provides an alternative to surgery.

Communications with Kansas physicians.

The uneven geographic distribution of population, physicians and treatment facilities in Kansas may at times create difficulties in bringing unusual patient problems and needed medical expertise together. Technology currently exists for establishing communication links ranging from live, two-way, audio-video communication connections and computers to the common telephone. This survey indicates that the medical community has great interest in developing functional and cost-effective links. The two campuses of the medical school are working to provide better and broader communications access to the physicians of the state.

Obstetrical practices of members of the Kansas Academy of Family Physicians.

Data reported from this survey of the members of the Kansas Academy of Family Physicians indicate that members performing obstetrics are paying significantly higher professional liability premiums than members not providing such services. This difference, as well as the overall escalating costs of professional liability insurance, can be expected to result in loss of family physician-provided obstetrical services. As family physicians are providing the only readily available obstetrical services in a substantial number of rural areas, it seems likely that rural areas will experience a significant loss of access to obstetrical care. Although delivery fees have risen, they have not risen at the same rate as premiums. A net loss of family physicians providing obstetrical services has been noted during the period of 1985-88, and such losses appear to be an accelerating future trend.