Air exposure triggered a higher transmigration rate of PMNs from the blood compartment into the peritoneal cavity and decreased PMN apoptosis, as compared with CO2. The lower proportion of PKH26-positive peritoneal macrophages in the air group might have been attributable to a higher inflammatory stimulation than in the CO2 group, leading to increased emigration of PMo to draining lymph nodes. All the findings underscore a complex cell-specific regulation of cell recruitment and clearance in the peritoneal compartment.
Reduced phagocytosis 1 h after surgical interventions suggests a contribution of PMo to the altered immune function. When exposed to CO2, PMo show a decreased basal TNF-alpha release. However, PMo also show an increased TNF-alpha release after a second immune stimulation (E. coli), suggesting a greater competency of interaction in an immune defense reaction after CO2 exposure.
Controversy continues whether exploration of the contralateral, asymptomatic side should routinely be performed since Rothenberg and Barnett stated in 1955 that a contralateral hernia is present in three out of four children presenting with a symptomatic unilateral inguinal hernia (IH). In our institution, hernia operations are performed on the symptomatic side only, the exception being male infants under 1 year of age with a left-sided IH. To verify our concept and to evaluate the frequency of contralateral hernial development, the medical records of all infants under 1 year of age operated upon between 1984 and 1988 were reviewed and the children followed through December 1996. Included in the study were 882 infants, 616 boys (70%) and 266 girls (30%); 148 (17%) were born prematurely. Seventy percent were operated upon before the end of the 3rd month of life. In 761 infants clinical signs of a unilateral hernia were present, and in 121 symptomatic hernias were found on both sides; 665 infants were operated upon unilaterally. A second operation on the opposite side was necessary in 38 cases (5.7%). The highest incidence of contralateral hernial development was found in premature boys (11.5%). We conclude that even in infants below 1 year of age, IH is usually a unilateral disease and does not require routine exploration of the asymptomatic side.
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