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  • Inguinal hernia  (2)
  • Life and Medical Sciences  (1)
  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Hernia 4 (2000), S. 1-5 
    ISSN: 1248-9204
    Keywords: Inguinal hernia ; Daycase ; Ambulatory ; Cost-savings
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A Hernia Service (HS) was commenced in Derriford Hospital, Plymouth, UK in May 1996 to improve patient outcome following a poor star rating for overall hospital performance in daycase hernia surgery. Between 1996 and December 1998, 576 patients, median age 65 years (range 24–88) with unilateral or bilateral inguinal hernias underwent surgical repair on the HS. During the same time period on the General Surgical Service (GSS) 1722 patients underwent surgical repair. On the HS, patients operated under local anaesthesia (LA) increased from 78.0 to 90.5%, and on the GSS use of LA increased from 7.6 to 22.4%. The percentage of daycases on the HS increased from 53.0 to 81.4% and on the GSS from 2.9 to 28.0%. The actual number of inpatient hospital days saved by the HS was 236 days in 1997 and 284 days in 1998. The potential saving was greater: in 1998 if the GSS daycase rate (28.0%) had been the same as the HS daycase rate (81.4%) 605 inpatient days would have been saved. A hernia satisfaction questionnaire was sent to a ran dom sample of 50 patients who had had their hernia repaired by the HS and 50 patients who had been treated by the GSS. HS patients experienced a mean pain score of 4,7 (range 1–10) compared to 5.7 (range 0–10) (p=0.07) for the GSS. Similarly, HS patients required less post-operative analgesia (mean 2.8 days compared to 5.9 days for the GSS group, p〈0.01) and resumed normal activity at an earlier stage (mean 10.8 days compared to 17.6 days for the GSS patients, p〈0.01). Instigation of a dedicated HS has improved patient outcome and substantially increased the use of local anaesthesia and the number of daycase hernia repairs on both the HS and the GSS, with substantial cost savings.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1248-9204
    Keywords: Inguinal hernia ; Plug ; Mesh ; Groin pain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Background The 14 day results of this study reported elsewhere demonstrated that the Perfix® plug-and-patch was as effective as the Lichtenstein patch but not as cost-effective. The present analysis looks at the results at one year to measure quality of life between the two groups. Patients and Methods 141 patients were randomly allocated in a doubleblind manner to receive either a Lichtenstein patch (patch) or a Perfix® plug- and-patch (plug-and-patch) for primary inguinal hernia. Quality of life at 6 months and one year was assessed by the short-form 36 (SF36). On a 3 point scale patients were asked at one year to rate groin, wound and testicular discomfort. Results Physical function by SF36 was similar in the 2 groups at 6 months, but at one year in the patch group (95.11 +/-20.07) was significantly better (p 〈 0.05) than physical function in the plug-and-patch group (82.5 ± 20.98). At one year the number of patients with wound discomfort limiting work or social activities was significantly greater in patients receiving the plug-and-patch (n = 12) compared with patients receiving the patch (n = 4), p 〈 0.031. At one year, 4 of 70 patients receiving the plug-and-patch had required reoperation to remove the preformed plug-and-patch device and replace it with a flat Lichtenstein patch, because of wound pain which was limiting activity. Conclusion A significant proportion of patients suffer chronic pain after placement of a Perfix® plug-and-patch for primary inguinal hernia repair. Removal of the Perfix® device is required in approximately i in 20 patients (5.6% in this series).
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    New York, NY [u.a.] : Wiley-Blackwell
    Journal of Cellular Physiology 155 (1993), S. 399-407 
    ISSN: 0021-9541
    Keywords: Life and Medical Sciences ; Cell & Developmental Biology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Biology , Medicine
    Notes: Regulation of polyamine transport in murine L1210 leukemia cells was characterized in order to better understand its relationship to specific intracellular polyamines and their analogs and to quantitate the sensitivity by which it is controlled. Up-regulation of polyamine uptake was evaluated following a 48-hr treatment with a combination of biosynthetic enzyme inhibitors to deplete intracellular polyamine pools. The latter declined gradually over 48 hr and was accompanied by a steady increase in spermidine (SPD) and spermine (SPM) transport as indicated by rises in Vmax to levels ∼4.5 times higher than control values. Restoration of individual polyamine pools during a 6-hr period following inhibitor treatment revealed that SPD and SPM uptake could not be selectively affected by specific pool changes. The effectiveness of individual polyamines in reversing inhibitor-induced stimulation of uptake was as follows: putrescine 〈 SPD 〈 SPM = the SPM analog, N1, N12-bis(ethyl)spermine (BESPM). In contrast to stimulation of transport, down-regulation by exogenous polyamines or analogs occurred rapidly and in response to subtle increases in intracellular pools. Following a 1-hr exposure to 10 μM BESPM, Vmax values for SPD and SPM fell by 70%, whereas the analog pool increased to only 400-500 pmol/106 cells - about 15-20% of the total polyamine pool (∼2.8 nmol/106 cells). SPM produced nearly identical regulatory effects on transport kinetics. Both BESPM and SPM were even more effective at down-regulating transport that had been previously stimulated four to fivefold by polyamine depletion achieved with enzyme inhibitors. A dose response with BESPM at 48 hr revealed a biphasic effect on uptake whereby concentrations of analog 〈 3 μM produced an increase in SPD and SPM Vmax values, whereas concentrations 3 μM and higher produced a marked suppression of these values. Cells treated with 3 μM BESPM for 2 hr and placed in analog-free medium recovered transport capability in only 3 hr. Thus, whereas stimulation of polyamine transport is a relatively insensitive and slowly responsive process that tends to parallel polyamine depletion, down-regulation of polyamine transport by exogenous polyamines and analogs and its reversal are rapidly responsive events that correlate with relatively small (i.e., 15-20%) changes in intracellular polyamine pools.
    Additional Material: 5 Ill.
    Type of Medium: Electronic Resource
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