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Background In the fight against the global tuberculosis epidemic, it is essential to ensure that patients adhere to the treatment prescribed. As the treatment is given for a minimum of 6 months it is common for patients not to take their drugs regularly. Strategies are therefore needed to assess adherence to treatment. One established method is to examine the patient's urine for the presence of drug metabolites. A rapid point-of-care test would overcome some of the drawbacks associated with currently available methods.

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This study compared the efficacy and acceptability of2 multidose corticosteroid powder inhalers in patients with chronic asthma. The multicentre study was ofa randomised, open, crossover design and began with a run-in period lasting 2 weeks during which patients used beclomethasone dipropionate from a pressurised aerosol (Becotide lOO®). This was followed by 2 periods each of 4 weeks duration when patients were treated with either budesonide (Pulmicort®) via Turbohaler® or beclomethasone dipropionate (Becodisks®) via Diskhaler®. The dose of inhaled corticosteroid used throughout was 400!,g twice daily. Patients recorded peak expiratory flow, inhaled bronchodilator use and adverse experiences in a diary. Lung function and inhaler technique was assessed at clinic visits made at the end of each treatment period. Patients completed an acceptability questionnaire at the end of the study.Of the 40 patients randomised, 37 received both treatments. Their mean age was 51 years (range 26 to 76) and their mean forced expiratory volume in I second (FEV () at study entry was 72% predicted normal value. There were no differences in efficacy between any of the treatment periods but patients preferred Pulmicort Turbohaler to Becodisks because it was more convenient to carry and easier to use. Both inhalers were well tolerated and no patient withdrew from the study because of adverse experiences.

PurposeInguinal hernia repair is one of the most frequently performed operations in general surgical practice. A variety of techniques have been used in the past with different results. The aim of the present study is to report our experience of inguinal hernia repair using the Kugel patch and to measure the frequency of postoperative recurrence and chronic groin pain. MethodologyData were recorded prospectively from a series of 333 inguinal hernia repairs performed between January 2004 to December 2006 using the Kugel patch technique. Wound infection, seroma, haematoma urinary retention, 6-month recurrence and chronic groin pain were the outcome measures. ResultsThe Kugel patch hernia repairs were performed in 284 patients during the 3-year period. There were no recurrences or chronic groin pain within 6 months of the 333 repairs. There was only one reported wound infection. The average operating time for bilateral hernia repair was 40.5 minutes (SD 8.8). Recurrent hernias took an average of 26 minutes (SD6.2) to repair whilst unilateral hernias took an average of 23 minutes (SD 6.8). 5 (1.8%) of the 284 patients had urinary retention. The average operating time for 136 direct procedures was 27 minutes compared with 25 minutes for the 148 indirect procedures (p = 0.096, t-test). ConclusionIn this prospective series the Kugel hernia repair is associated with no post hernia repair groin pain and no recurrence within 6 months of the procedure. It is inexpensive compared with laparoscopic repair, and allows the surgeon to cover all potential defects with one piece of mesh. PurposeTo review the experience with laparoscopic splenectomy, to determine it's efficacy for treating immune thrombocytopaenic purpura (ITP) and to highlight key technical issues with the operation. MethodologyAll splenectomies performed between 1992 and 2005 were identified from the Otago Surgical Audit and the clinical notes reviewed, including the laboratory records for follow-up data related to the haematologic cases. ResultsThere were 289 splenectomies performed over the 13 year period. The indications were trauma (111, 38%), haematologic disease (93, 32%), incidental (40, 14%) splenic malignancy (39, 13%), and other (8, 3%). Of the 68 patients with ITP, 49 (72%) had a lateral laparoscopic splenectomy (LLS) with no conversions, a 5% complication rate and one mortality. Based on platelet counts and the requirement for maintenance steroids there was a complete response in 44 (68%) patients at >6 months, a partial response in 16 (24%) and no response in 5 (8%) patients. A short video presentation will highlight the key steps for the safe and efficient performance of the LLS, including patient and port positioning, the use of ultrasonic dissection, splenic pedicle stapling, and morcellation. The indications for hand-port assisted laparoscopic and open splenectomy will be discussed. ConclusionsThe LLS is the preferred approach to splenectomy for all but massive splenomegaly and can be performed safely with careful attention to key technical issue...

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