Single-blind randomized clinical trial of transinguinal preperitoneal repair using self-expanding mesh patch vs. Lichtenstein repair for adult male patients with primary unilateral inguinal hernia.

PURPOSE: The aim of the study was to compare proportions of chronic postoperative inguinal pain (CPIP) and other surgical outcomes between transinguinal preperitoneal repair with modified Kugel patch (MK) and Lichtenstein repair (LR). METHODS: Two-hundred adult male patients with primary unilateral inguinal hernia were randomized into MK or LR groups. The primary endpoint was CPIP, pain at 6 months after surgery. Secondary outcomes included recurrence rate, incidence of postoperative complications, time until return to activities, inguinal pain and sensory disturbances assessed at 1 week, 1 month, 3, 6, and 12 months after the operation using an 11-point numerical rating scale (NRS). The study was an intention-to-treat analysis. RESULTS: In comparison of MK (n = 100) and LR (n = 100) with similar backgrounds, proportions of CPIP were similar (7.2 vs. 11.1%, p = 0.3452). Favorable outcomes for MK were duration of operation (32 vs. 40 min, p < 0.0001), NRS of foreign body sensation at 1 year (0 [0-1] vs. 0 [0-2], p = 0.0067), and NRS of numbness at 1 month (0 [0-1] vs. 0 [0-3], p = 0.0078) after the operation. CONCLUSIONS: In regard to CPIP, the short-term results of MK and LR were similar.

Cranial ultrasound findings in well newborn Ugandan infants.

BACKGROUND: There has been no study assessing cranial ultrasound (cUS) scans in newborn infants born in equatorial Africa. OBJECTIVE: To assess the cUS scans of apparently well newborn term Ugandan infants and to correlate the findings with perinatal data. METHODS: An observational study of apparently healthy postnatal ward term Ugandan infants at Mulago Hospital, Makerere University Hospital, Kampala, Uganda. RESULTS: Data from 112 infants scanned at a median age of 1.4 postnatal days were analysed. Only 57 (51%) infants had scans considered normal, including 30 infants with isolated focal peritrigonal white matter (WM) echogenicity that was very common, occurring in 60 (53%) of infants. More extensive WM echogencities were seen in nine (7.5%) and focal unilateral central grey matter echogenicity in eight (6.5%) infants. Haemorrhage was not common. Subependymal pseudocysts (SEP) and choroid plexus cysts (CPC) occurred in 19.6% of infants each. Four infants only had lenticulostriate vasculopathy. No correlation was found between mode of delivery, birth weight, head circumference or gestational age, maternal HIV status and any cUS abnormality. CONCLUSIONS: Apparently well term-born Ugandan infants frequently have abnormalities on cUS. These are mainly increased WM echogenicity, SEP and CPC. These may relate to the reported high incidence of congenital infections in this population but this remains to be confirmed. The observations provide baseline data for comparison with scans from sick infants from similar communities and are also important for studies in which cUS will be used to assess progress.

Feasibility of percutaneous transabdominal portosystemic shunt creation.

Evaluation of the anatomic feasibility of the percutaneous transabdominal puncture of selected portal and hepatic veins in patients with cirrhosis was performed. This approach would become the framework for an image-guided robot-assisted needle drive mechanism for use in transjugular intrahepatic portosystemic shunt (TIPS) creation. Retrospective analysis of 10 CT and 14 MRI axial abdominal studies was carried out to determine whether single simultaneous transabdominal puncture of portal and hepatic veins was possible. A necessary modification of the TIPS procedure was tested in an ex vivo porcine model under fluoroscopy. Eighteen of 24 patients (75%) had intrahepatic vascular anatomy amenable to a single transabdominal puncture. Successful catheterization of portal and hepatic veins using a modified approach for TIPS was accomplished in two ex vivo porcine livers. A suitable anatomic approach for modified TIPS is present in a majority of patients with cirrhosis. Feasibility of the technique using this anatomic approach was confirmed in two ex vivo porcine models. This study serves as an initial step in a novel technical approach to TIPS using a new anatomic approach for this procedure.

Image-guided robotic delivery system for precise placement of therapeutic agents.

The effectiveness of conventional solid tumor treatment is limited by the systemic toxicity and lack of specificity of chemotherapeutic agents. Present treatment modalities are frequently insufficient to eliminate competent cancer cells without exceeding the limits of toxicity to normal tissue. The coming generation of cancer therapeutics depends on the precise targeting and sustained release of antitumor agents to overcome these limitations. We are developing an image-guided, robotic system for precise intratumoral placement of anticancer drugs and sustained release devices to advance this new treatment paradigm. The robotic system will use intraoperatively obtained computed tomographic (CT) images from a mobile CT scanner for guidance. The concept is to track patient anatomy and localize instruments using currently available optical tracking technology. Tracking will also be used to register patient anatomy with the images. The physician can then use the registered image to select an appropriate tumor target and entry location and to plan the instrument path. This path will then be transmitted to the robot, which orients and drives the instrument to the desired target under physician control. Achievement of the target is confirmed via intraoperative CT. This system will provide instrument guidance that is precise, direct, and controllable. Error due to poor target visualization and hand unsteadiness should be reduced greatly. The basic components of the system (robot, mobile CT, tracking) have been demonstrated in our laboratory, and the integration of the components is in progress. In future work, we plan to fuse preoperative PET imaging with intraoperative CT to allow functional as well as anatomic image guidance.

Limiting amino acids for a corn and soybean meal diet in weaned calves less than three months of age.

Holstein bull calves (n = 51) weaned at 6 wk of age were used in four N balance trials for 4 wk (Trials 1 to 3) or for 2 wk (Trial 4) from 8 wk of age to identify limiting amino acids for a corn and soybean meal diet. The calves were trained to maintain reflex closure of the reticular groove throughout the trials. In Trial 1, administration of .111 g of DL-methionine plus .333 g of L-lysine monohydrochloride/kg BW through the reticular groove increased N retention compared with the control that received isonitrogenous L-glutamine, but administration of .333 g L-lysine monohydrochloride/kg BW alone did not increase N retention in Trial 2. In Trial 3, administration of .111 g of DL-methionine/kg BW improved N balance compared with the control, although the improvement was not detected when DL-methionine was restricted to .022 g/kg BW. In Trial 4, administration of the mixture of .111 g of DL-methionine, .333 g of L-lysine monohydrochloride, and .055 g of L-tryptophan/kg BW increased N retention in calves compared with calves that received an isonitrogenous mixture of .111 g of DL-methionine and .274 g of L-glutamine/kg BW, or .111 g of DL-methionine, .055 g of L-tryptophan, and .234 g of L-glutamine/kg BW. The present results suggest that methionine was the first-limiting and that lysine was probably the second-limiting amino acid for the corn and soybean meal diet in weaned calves less than 11 wk of age, although tryptophan may be either co-limiting with lysine or third-limiting.

Shape and number of the roots of the permanent molar teeth.

One hundred ninety-eight mandibular first molars, 198 mandibular second molars, and 122 mandibular third molars, extracted from 99 Indian skulls were examined for the number of dental roots. The number of mandibular molar roots is increased by the appearance of the distolingual root, accessory lingual root, and bifurcation of the mesial root. The bifurcation of the mesial root was investigated in teeth in which it was more than 1/3 and less than 1/3 (apical bifurcation) of the root length. The following results were obtained. The numbers of the roots including apical bifurcation of the mesial root were 2, 3 and 4 in 72.7%, 26.8% and 0.5%, respectively, of the first molars; 1, 2 and 3 in 17.7%, 76.8% and 5.6%, respectively, of the second molars; and 1, 2 and 3 in 16.4%, 77.1% and 5.8%, respectively, of the third molars. The numbers of dental roots excluding apical bifurcation of the mesial root were 2 and 3 in 99.0% and 1.0%, respectively, of the first molars; 1, 2 and 3 in 17.7%, 81.8% and 0.5%, respectively, of the second molars; and 1, 2 and 3 in 16.4%, 77.1% and 5.8%, respectively, of the third molars.

Penis tuberculid (papulonecrotic tuberculid of the glans penis): treatment with a combination of rifampicin and an extract from tubercle bacilli (T.B. vaccine).

A case of penis tuberculid (papulonecrotic tuberculid of the glans penis) and its treatment with combination of oral rifampicin (RFP) and injection of an extract from tubercle bacilli (T.B. vaccine) were reported. We also examined the literature and discovered 37 cases of this disease in Japan in the last 10 years (between 1978 and 1987).