Between 1993 and 1997, 28 girls with inguinal hernia were managed laparoscopically at our hospital. Their age ranged between 5 months and 10 years. Clinically, 15 of the hernias were on the right side, 9 were on the left, and 4 were bilateral. At laparoscopy, one of the suspected cases of bilateral hernia had a hernia only on one side. Two patients with a suspected left-sided unilateral hernia and one with a suspected right-sided unilateral hernia were found to have hernias on the contralateral side. All hernial sacs were ligated laparoscopically by applying endoscopie loops around the base of the inverted hernia sac. This procedure proves to be simple, safe, and effective.

Induction of acute pulmonary edema in anesthetized dogs causes a large fall in compliance. out of proportion to lung volume (1), and a sharp increase in venous admixture that can be reversed by forcible inflation of the lungs (2). This pattern of abnormal function suggested alveolar closure (1, 2).Since alveolar stability depends in large measure on the presence of normal pulmonary surface properties (3), altered surface forces were consiclered as an underlying mechanism. Cook and co-workers (1) reasoned that the decrease in alv'eolar diameter, resulting from the accumulation of intra-alveolar fluid, would account for an increase in total surface forces. We examined the possibility that pulmonary edema alters alveolar surface tension properties, in this way contributing to alveolar instability and to the failure of respiratory function. It can 1)e shown that for alveoli, as for spherical surfaces, total surface forces equal twice the surface tension divided by the radius of curvature (4).We induced pulmonary edema in anesthetized dogs by rapid intravenous infusion of dextran. Surface activity of lung extracts was measured and correlated with morphologic changes. There was a regional loss or impairment of surface activity in the edematous lung, associated with areas * Submitted for publication October 14, 1964; accepted November 27, 1964. Presented in part at the 47th Annual Meeting of the American Physiological Society, April 15, 1963, Atlantic City, N. J., and abstracted in Fed. Proc. 1963, 22, 339. Supported by U. S. Public Health Service research grant HE-04226 and by a research grant from the American Heart Association. MethodsProccdnarc. The experiments were conducted on 24 mongrel dogs weighing 7 to 33 kg. The dogs were tracheostomized and anesthetized with 30 mg per kg pentobarbital intravenously. They were supine and breathed spontaneously or with the assistance of a Starling respirator, set to deliver ventilation in the normal tidal range. To duplicate the conditions of an earlier study of gas exchange in pulmonary edema (2), we gave the animals 100% oxygen to breathe before the induction of pulmonary edema; the total period of oxygen breathing was generally 1 to 2 hours and did not exceed 5 hours. Pulmonary edema was induced by intravenous infusion of 6%o dextran solution in saline, at the rate of approximately 4 ml per kg per minute. The infusion was maintained until foam came out of the trachea. The animals were then killed with magnesium sulfate.Post-mortem, the lungs were weighed separately and their gross morphologic features noted. In every case, one sample was taken from a dark, depressed part of the lung and another from a pink, relatively unaltered part. The samples were examined for surface activity, as detailed below. In seven instances, portions of these samples were also fixed in Bouin's solution and stained with hematoxylin and eosin, toluidine blue, and with periodic acid Schiff reagent for microscopic examination.In ten experiments, a thoracotomy was performed, and the airway t...

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Both diagnostic and operative laparoscopy were used in the management of 68 impalpable testes. Twenty-three were either vanishing or atrophied, and were associated with a precarious blood supply. Two were found in the groin, 12 in the inguinal canal, and 32 at variable distances from the internal ring; of these, 2 were in a patient with persistent müllerian duct syndrome. Two atrophied abdominal testes were removed laparoscopically, 3 patients underwent a two-stage Fowler-Stephens procedure, and 28 underwent one-stage, laparoscopically assisted orchidopexy. An algorithm for surgical management of the impalpable testis based on laparoscopic findings is proposed.