The role of hernia sac ligation in postoperative pain in patients with elective tension-free indirect inguinal hernia repair: a prospective randomized study.

BACKGROUND: Tension-free inguinal hernia repair is one of the so-called painless operations. Mild or medium postoperative pain, however, even in the mesh repair era, is common and usually due to ilioinguinal nerve entrapment or mesh fixation in the periostium of the pubic tubercle. Especially in indirect inguinal hernia repair, however, hernia sac ligation and excision may be the cause of pain. The aim of this study was to conduct a single-center prospective randomized trial with a view to clarify this issue on a scientific basis. METHODS: In an 8-year period, all patients undergoing elective indirect inguinal hernia repair using a tension-free polypropylene mesh technique were randomized to induce high hernia sac ligation or not in a double blind manner. The main endpoint was to detect any difference in postoperative pain between the two groups. RESULTS: Between January 1999 and December 2006, 477 patients with indirect inguinal hernia entered the study and were randomized to have high hernia sac ligation and excision (group A, n = 238) or not (group B, n = 239). The two groups were comparable regarding demographic data. Postoperative pain was associated with statistically significantly more episodes in group 1, 27% (65/238), than in group 2, 10% (24/239), on day 1, 9% (22/238), compared to 3% (8/239) on day 7, 2% (5/238), compared to 0% (0/239), on day 30, respectively, and these results were statistically significant (P

Recombinant human erythropoietin for platinum-based chemotherapy-induced anaemia: A single-centre randomised study.

PURPOSE: Recombinant human erythropoietin (rHuEPO) represents an attractive alternative to red blood cell (RBC) transfusions for the treatment of chemotherapy-induced anaemia. This prospective, controlled study evaluated the safety and efficacy of rHuEPO in reducing RBC transfusion requirements in patients receiving platinum-based chemotherapy. PATIENTS AND METHODS: Patients with histologically proven malignancies, haemoglobin (Hb) values <10.5 g/dl, and receiving platinum-based chemotherapy were randomised to either 150 IU/kg of rHuEPO subcutaneously (s.c.) x3/week (group A), or simple follow-up plus RBC transfusions upon indication (group B). All patients received 200mg of elementary iron (Fe) daily. RESULTS: A total of 47 patients were randomised to either group A (n=24) or the control group B (n=23). There was a statistically significant increase of Hb (p <0.0002) and haematocrit (Ht) (p <0.002) in group A patients compared to the control group B. The levels of Hb in group A patients increased significantly with each chemotherapy cycle number. There was a statistically significant (p <0.04) difference in the number of transfusions between the two groups, with only 37.5% of group A patients requiring a RBC transfusion at any time during the study, compared to all patients (100%) in group B. CONCLUSIONS: Administration of rHuEPO is an effective intervention for the management of chemotherapy-induced anaemia, significantly reducing RBC transfusion requirements in patients receiving platinum-based chemotherapy. Hb and Ht levels proved reliable indicators for response to rHuEPO treatment.

Selective arterial embolization in the management of symptomatic renal angiomyolipomas.

Current management of renal angiomyolipomas (AMLs) include observation, transcatheter embolization and partial or total nephrectomy. Patients symptoms and size of the lesion are the determinants for the choice of the treatment. In general symptomatic or greater than 8 cm masses require intervention. A retrospective study of five patients presented with symptomatic lesions and treated with selective transcatheter embolization, over a 3 year period was performed in our hospital. A total of eight embolizations were performed, all on an emergency basis due to retroperitoneal bleeding or significant hematuria. Surgical intervention was necessary in one case, due to massive rebleeding on the fourth post-procedural day. Two patients rebled within 6 months and 2 years respectively, and were managed successfully with additional embolization. The remaining two patients are still asymptomatic 26 and 18 months after the successful initial result. Experience with this procedure is reported on with emphasis to the clinical outcome. It is believed that selective arterial embolization should be the standard initial therapy for symptomatic renal AMLs.