Laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernia (IH) is broadly accepted in recent years because of its cosmetic superiority. In March 2011, we introduced LPEC for IH in girls. We compared LPEC with conventional herniorrhaphy (Potts procedure) to find the benefit of LPEC. Between March 2011 and July 2012, eleven girls with IH with a mean age of 3.6 years (range, 0-9 years) underwent LPEC (unilateral vs. bilateral = 7 : 4 cases). Thirty girls with IH with a mean age of 4.5 years (range, 0-11 years) underwent Potts procedure (unilateral vs. bilateral = 20 : 10 cases) between September 2008 and January 2012. The medical charts were retrospectively reviewed in terms of operating time and operative complications. Median operating time of uni-/bilateral IH in LPEC was 53 ± 21.7/58 ± 7.6min. Median operating time of uni-/bilateral IH in Potts procedure was 22 ± 4.1/37 ± 6.2min. No postoperative complications were encountered both in LPEC and Potts procedure. Although the operating time was significantly longer in LPEC, LPEC was safely performed the same as Potts procedure. Since the operating time could be reduced by operatorʼs experience, LPEC will be a useful procedure for IH in girls.
Methotrexate (MTX) is the standard drug for rheumatoid arthritis. However, MTX is considered to be a risk factor for the development of malignant lymphoma. It is classified among other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD) in the WHO classifications. We report a case of OIIA-LPD diagnosed as cervical lymph node metastasis from adenocarcinoma by fine-needle aspiration cytology. A 52-year-old female with RA had been treated with MTX for two years. She noticed an elastic hard mass of 30mm in diameter in her left neck. Fine-needle aspiration cytology diagnosed it as lymph node metastasis from adenocarcinoma. Ultrasonography of thyroid, lung CT and GI tract examination showed no abnormal findings. A massive abnormal uptake was found on FDG-PET examination. Open biopsy was performed to detect the primary lesion. Pathological and immunohistochemical findings led to a diagnosis of OIIA-LPD, which was anaplastic large cell lymphoma histopathologically. The incidence of OIIA-LPD may increase in head and neck surgical practice because MTX therapy is the standard treatment for RA. It is important to take OIIA-LPD into consideration for lymphadenopathy of a patient taking MTX.
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