Inguinal hernia in girls: A retrospective analysis of over 1000 patients

Background: In girls with inguinal hernia, timing of surgical repair to prevent ovarian strangulation and screening for Androgen Insensitivity Syndrome (AIS) remain controversial. This study assesses the incidence of ovarian strangulation and AIS, and its associated risk factors. Methods: Electronic patient records were used to study girls aged 0–15 years who underwent inguinal hernia repair between 2000 and 2017. Patients with incomplete data were excluded. Risk factors were identified using logistic regression. Results: This study includes 1084 girls (median (IQR) age: 133.5 (14–281) weeks) who underwent 1132 hernia repairs (1015 unilateral, 117 bilateral) within a median (IQR) time interval of 12 (6–23) days following diagnosis. Hernia sac intraoperatively contained ovary in 235 (21.7%) patients, ovary was strangulated in 14 (6%). Risk factors for ovarian strangulation were younger gestational age (OR 0.49), higher birthweight (OR 32.18), and first presentation at the emergency department (OR 13.07). However data were partly missing. Ectopic testis was found in seven (0.6%) patients. Metachronous contralateral inguinal hernia and ipsilateral recurrence developed in 6.1% and 0.3%, respectively. Conclusions: Ovarian hernia was diagnosed in 21.7%, and ovary was strangulated in 6%. No definite conclusions can be drawn regarding risk factors for strangulation and timing of surgery in girls with irreducible ovarian hernia. Level of Evidence: Level III

Increased Pro-inflammatory Cytokine Production in Down syndrome Children Upon Stimulation with Live Influenza A Virus

Purpose Children with down syndrome (DS) have an increased susceptibility to infections, due to altered humoral and/or cellular immunity. The aim of this study was to determine the cytokine production in whole blood of children with DS upon stimulation with live influenza A virus. Methods Whole blood of 61 children with DS and 57 of their healthy siblings was stimulated with 2.5x10(4) TCID50/ml influenza A virus during 6, 24, and 48 h. TNF-alpha, IL-1 beta, IL-6, IL-8, IL-10, IL-12p70, IFN-alpha, IFN-gamma concentrations, and viral load were measured at all time points. Results At most of the time points, TNF-alpha, IL-1 beta, IL-6, and IL-8 concentrations were significantly higher in children with DS following stimulation with live influenza A virus. IFN-alpha and IFN-gamma levels were also significantly higher in the DS group. Viral clearance, however, was equal in both groups. Conclusions Children with DS have an altered immune response to influenza A virus. The production of higher levels of pro-inflammatory cytokines may be responsible for a more severe clinical course of viral disease in these childre