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BACKGROUND: The tension-free hernioplasty as introduced by Lichtenstein has gained increasing acceptance during the last decade although the technique has not been evaluated in a randomized trial. METHODS: This randomized study compares the 2-year follow-up results after 102 tension-free hernioplasties with implantation of a prolene mesh in all groin hernias to 53 Cooper ligament repairs in direct hernias and 53 abdominal ring repairs in indirect hernias. RESULTS: After tension-free repairs five hernias recurred (5%), and after either Cooper ligament or abdominal ring repair, 16 recurrences were found (15%) (P = 0.025). No indirect hernias recurred after a tension-free repair; 2 recurred after abdominal ring repair (4%; NS). The recurrence rate after tension-free repairs for primary direct inguinal hernias was 7% as compared with 30% after Cooper ligament repair (P = 0.0081). No difference in complication rate between the tested methods was found. CONCLUSION: Recurrence rate is reduced to one-third after tension-free herniotomies as compared with the conventionel herniotomies without increase in complication rate.

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Nd-YAG laser treatment was employed as palliative treatment in 47 patients with colorectal cancer. Thirty-eight patients (81%) experienced good symptomatic effect from the treatment. Four complications occurred: three cases of perforation and one case of moderate bleeding. There was no mortality. It is concluded that laser treatment is a good palliative method in patients with colorectal cancer, especially in elderly patients with complicating diseases and in patients with local recurrence or symptoms from nonresected tumours.

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Disseminated peritoneal leiomyomatosis (DPL) is a rare disorder, characterized by the occurrence of multiple leiomyomas scattered throughout the peritoneal cavity. Until this report DPL had been observed only in women and there is only one previous case with malignant change. A case of DPL in a male, complicated by sarcomatous transformation is reported. DPL has a definite malignant potential; patients with the disease should be followed closely for signs of progression.

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It has been suggested that dilatation of the ureter seen in pregnancy is caused by progesterone. Twenty-four patients with ureteral calculi, therefore, were given an intramuscular injection of 250 mg hydroxyprogesterone in order to facilitate the discharge of the stones. Irrespective of the duration of symptoms there was a potential effect of treatment in up to 66% of the patients. In patients with symptoms of less than three weeks duration the stones were discharged within three weeks after the first symptom in 75% of the cases, which is a much higher incidence rate than that stated in the literature for spontaneous stone discharge (18-30%). In patients with longstanding symptoms 50% of the stones had passed, as compared to 39% reported in the literature. Especially concrements with a diameter larger than 4 mm had a better discharge rate. As the treatment is simple, cheap and without side effects, it seems worthwhile trying it in order to avoid surgery.

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In 22 patients with anterior bladder suspension defect as judged by colpocysto-urethrography (CCU) a vaginal repair was undertaken. In 14 patients urinary stress or urge and stress incontinence was the indication for operation, and in 8, genital prolapse. At follow-up more than 6 months postoperatively the CCU was repeated and a clinical evaluation undertaken. A normalization of the CCU was obtained in only 6 patients and 10 showed a less severe suspension defect. Nine of 14 patients were cured of incontinence. Only 3 of these had a normal follow-up CCU. Improvement of bladder suspension defect was not the sole responsible factor for postoperative continence. Urinary incontinence developed postoperatively in 2 of 8 patients operated on solely because of symptomatic genital prolapse. Very high cure rates for urinary incontinence have been reported following a colposuspension operation. A vaginal repair is not recommended as first-choice operation in incontinent females with anterior bladder suspension defects, if a CCU may be undertaken and the colposuspension technique is mastered.

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Eighteen patients with ascites, 9 with cirrhosis of the liver and 9 with malignant disease, were subjected to the ammonia tolerance test by instillation of ammonia transrectally . Arterial blood samples were taken before and 15 and 30 min after the instillation to determine the plasma ammonia concentrations. The results show a significant difference in the plasma ammonia concentration between the two groups of patients after instillation of ammonia. Since the method is non-invasive, it is recommended as a screening test in the differentiation between ascites of cirrhotic and malignant genesis.

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Partial cystectomy was performed for urothelium-derived bladder carcinoma in 55 patients in the period 1958-78. Ureteral re-implantation was done in 14 cases. The operative mortality was 7.3%. The five-year and ten-year survival rates were, respectively, 47.1 and 35.4%. The series was subdivided according to grade and T-stage of the tumours. The patients with a grade I or II tumour had significantly better survival rates than those with a grade III or IV tumour. T1 tumours had a more favourable outcome than T2 or T3 tumours, though the difference was not statistically significant. The ten-year prognosis was best when the tumour measured less than 1 cm, but tumour size did not otherwise influence the result. The tumour recurred in 32 (58%) of the patients, in 25 of them within 2 years of operation. The attractions of partial cystectomy include avoidance of urinary diversion and possibility of later, more radical surgery. Prophylactic antibiotic treatment is recommended in order to reduce the operative mortality and morbidity.

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Sixty-one patients presenting with hemorrhage from esophageal varices were treated with sclerotherapy by means of a fiberoptic endoscope. Twenty-nine had acute bleeding, which was stopped in 90%. Thirty-two were treated after recent bleeding. The hospital mortality was 31%. Re-bleeding occurred in 55% of those discharged but was easily controlled. Fatal complications occurred in 5%. The calculated 4-year survival was 35%. Two thirds of this mortality could be attributed to liver failure. The intellectual function of the patients appeared to be unaffected.

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In 7 patients with a catheter in the portal vein and a T tube in the common bile duct, the concentration of unhydrolyzed pivampicillin and of ampicillin was measured simultaneously in portal and peripheral blood and in bile after oral administration of 700 mg pivampicillin. In both portal and peripheral circulation of concentration of unhydrolyzed pivampicillin was always less than 1% of the levels of ampicillin, indicating the effectiveness of the intestinal mucosa in the hydrolysis of pivampicillin. Evidence for the ability of the liver to excrete ampicillin against a concentration gradient into the bile was established by direct measurements. Only about 1% of the dose given could be recovered in the bile. There was an unexplained reduction of about 70% in the absorption of the drug induced by the catheter itself.

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