A meta-analysis of outcomes after open and laparoscopic Nissen's fundoplication for gastro-oesophageal reflux disease in children

The objective of this study is to meta-analyse the published literature comparing outcomes after open (ONF) versus laparoscopic Nissen fundoplication (LNF) for gastro-oesophageal reflux disease in children. Electronic databases were searched from January 1993 to October 2009. A systematic review was performed to obtain a summative outcome. Six comparative studies were analysed. There were 466 patients in the laparoscopic group and 255 in the open group. There was no significant difference in operative time between LNF compared with ONF (p = 0.35). Children stayed in hospital for less time after undergoing LNF compared with ONF [random effects model: SMD = 0.93, 95% CI (0.41, 1.44), z = 3.53, p < 0.01]. Children feed earlier after LNF [random effects model: SMD = 4.13, 95% CI (1.00, 7.27), z = 2.58, p < 0.001] and had less morbidity [fixed effects model: RR = 3.22, 95% CI (1.98, 5.25), z = 4.71, p < 0.01; random effects model: RR = 2.90, 95% CI (1.49, 5.66), z = 3.12, p < 0.01]. No difference in recurrence at 12 months was highlighted (p = 0.29). In conclusion, the laparoscopic Nissen's fundoplication in children may be considered a safe and effective alternative to open surgery; however, careful case selection is required.

Profile of drug users in Karachi City, Pakistan

Drug use has been identified as a major public issue in Pakistan. A descriptive questionnaire survey in Karachi city was made to identify the socioeconomic profile and beliefs and practices of 500 drug users The most commonly used drugs were cocaine (19.0%) and crack-cocaine (15.0%), followed by amphetamine, (11.0%), alcohol, caffeine, barbiturates and benzodiazepines (10.0% each). Key psychological factors leading tc drug use were problems with parental or marital relations or break-up of a relationship (45.0%). Drugs were seer as an escape from stressful life events (28.0%) or feelings of failure (18.2%). Many drug users blamed the origin of their drug use on bad social influences (47.0%) or socioeconomic problems (23.4%). Preventive measures are needed to decrease the rate of drug addiction in Karachi.

Treatment-related toxicities in patients with squamous cell carcinoma of the head and neck (SCCHN)

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Background: Although treatment effects and toxicities have been reported from randomized clinical trials of patients with squamous cell carcinoma of the head and neck (SCCHN), little information is available from real-world clinical practice where heterogeneous treatment patterns and patient populations may lead to different estimates than those observed in clinical trials. Methods: Using a population-based tumor registry at a large, Midwestern integrated health system, we identified all cases of stage III or IV SCCHN diagnosed 2000–2006. The incidence/severity of acute and late toxicities associated with SCCHN treatment was obtained from detailed medical record review of health system encounters, including physician notes. Grading of toxicities (using CTCAE3 criteria), distinction between acute and late toxicity, and analyses by treatment are ongoing. The incidence and severity of toxicities will be presented by treatment regimen, tumor location and tumor stage. We presented here an interim analysis. Results: Among the target population of 194 patients that will ultimately be included in this study, 137 medical record reviews have been completed to date. The percentages of patients with toxicities, including 95% confidence intervals are presented in the table , below. Conclusions: Toxicity in patients with advanced SCCHN is common. Data from clinical practice quantifying the incidence are lacking, these data from an observational real-world study provide important baseline information on the incidence of toxicities in patients with advanced SCCHN and also call for safer effective treatment for SCCHN.

[Table: see text]

[Table: see text]

Human papillomaviruses do not play an aetiological role in Müllerian adenosarcomas of the uterine cervix

AIM

To determine if human papillomaviruses (HPVs) play a role in the histogenesis of adenosarcomas of the uterine cervix.

METHODS

Nine archival cases of primary cervical adenosarcoma were studied. The HPV status of the nine histologically proven tumours was investigated by non-isotopic in situ hybridisation (NISH) and PCR. NISH was performed using digoxigenin labelled probes to HPV types 6, 11, 16, 18, 31 and 33. PCR used GP5+/GP6+ primers to the HPV L1 gene.

RESULTS

Neither the benign epithelial components nor the malignant stromal components of the 9 neoplasms harboured nuclear NISH signals for the HPV types investigated. Amplimers of the HPV L1 gene were not detected by PCR in any of the tumours studied.

CONCLUSION

HPVs do not appear to play an aetiological role in cervical adenosarcomas. This suggests that a different histogenetic pathway for this rare tumour type must exist.

Position of the acetabular component determines the fate of femoral head autografts in total hip replacement for acetabular dysplasia

We have reviewed 54 patients who had undergone 61 total hip replacements using bulk femoral autografts to augment a congenitally dysplastic acetabulum. There were 52 women and two men with a mean age of 42.4 years (29 to 76) at the time of the index operation. A variety of different prostheses was used: 28 (45.9%) were cemented and 33 (54.1%) uncemented. The graft technique remained unchanged throughout the series. Follow-up was at a mean of 8.3 years (3 to 20). The Hospital for Special Surgery hip score improved from a mean of 10.7 (4 to 18) pre-operatively to a mean of 35 (28 to 38) at follow-up. The position of the acetabular component was anatomical in 37 hips (60.7%), displaced less than 1 cm in 20 (32.7%) and displaced more than 1 cm in four (6.6%). Its cover was between 50% and 75% in 34 hips (55.7%) and less than 50% in 25 (41%). In two cases (3.3%), it was more than 75%. There was no graft resorption in 36 hips (59%), mild resorption in 21 (34%) and severe resorption in four (6%). Six hips (9.8%) were revised for aseptic loosening. The overall rate of loosening and revision was 14.8%. Overall survival at 8.3 years was 93.4%. The only significant factor which predicted failure was the implantation of the acetabular component more than 1 cm from the anatomical centre of rotation of the hip.

A new method for intrathoracic anastomosis in laparoscopic esophagectomy

The benefits of laparoscopic procedures over the traditional open technique for esophagectomy in the management of esophageal cancer are well documented. A disadvantage of the laparoscopic technique is longer surgery, particularly in the early part of a surgeon's "learning curve." In a two-stage (Ivor-Lewis) procedure, performance of the esophagogastric anastomosis within the chest can be a "rate-limiting step." A circular stapler is used, which requires placement of a purse-string suture or a manually-tied knot around in the transected proximal esophagus to secure the anvil in place. This is technically demanding and time-consuming in the laparoscopic setting. The authors have devised a method that obviates the need for a purse string or knot, simplifying the intrathoracic esophagogastric anastomosis while still achieving a safe anastomosis.

Visceral leishmaniasis control in Thi Qar Governorate, Iraq, 2003

Since 1991, visceral leishmaniasis has extended to new areas rarely affected before in Iraq, such as the southern governorates. In 2003, in the aftermath of the invasion of the Coalition Forces, Thi Qar Governorate was at high risk for an outbreak of visceral leishmaniasis. This paper describes the cooperation of an international nongovernmental organization and a district primary health care department to restore the visceral leishmaniasis control programme in Thi Qar in 2003 and prevent a major outbreak of visceral leishmaniasis. It also discusses the lessons learned and presents recommendations for the future.