ABSTRACT
A 5-month-old, intact male, yellow Labrador retriever was presented with a 24-hour history of anorexia and vomiting. Abdominal imaging revealed the presence of a mechanical obstruction in the jejunum and peritoneal effusion. Cytologic evaluation and culture of the effusion prior to surgery identified a suppurative exudate with bacteria consistent with septic peritonitis and suspected to be related to the intestinal lesion. An exploratory laparotomy was performed, and a segment of jejunum was circumferentially severely constricted by an off-white, fibrous band of tissue. Resection and anastomosis of the strangulated segment of jejunum and excision of the constricting band provided resolution of the clinical signs. The dog made a complete recovery. Histologic evaluation revealed the band to be composed of fibrovascular and smooth muscle tissue, consistent with an idiopathic anomalous congenital band. No other gastrointestinal lesions were observed, either grossly at surgery or histologically in the resected segment of intestine. To our knowledge, a similar structure has not been reported in the veterinary literature.Copyright © 2022 Canadian Veterinary Medical Association. All rights reserved.
ABSTRACT
Background: Anastomotic leak (AL) after minimally invasive esophagectomy (MIE) is a well-described source of morbidity for patients undergoing surgical treatment of esophageal neoplasm. With improved early recognition and endoscopic management techniques, the long-term impact remains unclear. Method(s): A retrospective review was conducted of patients who underwent MIE for esophageal neoplasm between January 2015 and June 2021 at a single institution. Cohorts were stratified by development of AL and subsequent management. Baseline demographics, perioperative data, and post-operative outcomes were examined. Result(s): During this period, 172 MIEs were performed, with 35 of 172 (20.3%) complicated by an AL. Perioperative factors independently associated with AL were post-operative blood transfusion (leak rate 52.9% versus 16.8%;p = 0.0017), incompleteness of anastomotic rings (75.0% vs 19.1%;p = 0.027), and receiving neoadjuvant therapy (18.5% vs 30.8%;p < 0.0001). Inferior short-term outcomes associated with AL included number of esophageal dilations in the first post-operative year (1.40 vs 0.46, p = 0.0397), discharge disposition to a location other than home (22.9% vs 8.8%, p = 0.012), length of hospital stay (17.7 days vs 9.6 days;p = 0.002), and time until jejunostomy tube removal (134 days vs 79 days;p = 0.0023). There was no significant difference in overall survival between patients with or without an AL at 1 year (79% vs 83%) or 5 years (50% vs 47%) (overall log rank p = 0.758). Conclusion(s): In this large single-center series of MIEs, AL was associated with inferior short-term outcomes including hospital length of stay, discharge disposition other than to home, and need for additional endoscopic procedures, without an accompanying impact on 1-year or 5-year survival. Key message: In this large, single-center series of minimally invasive esophagectomies, anastomotic leak was associated with worse short-term outcomes including hospital length of stay, discharge disposition other than to home, and need for additional endoscopic procedures, but was not associated with worse long-term survival. The significant association between neoadjuvant therapy and decreased leak rates is difficult to interpret, given the potential for confounding factors, thus careful attention to modifiable pre- and peri-operative patient factors associated with anastomotic leak is warranted.Copyright © 2022 The Authors
ABSTRACT
Introduction: The bispectral index monitors the unawareness component of balanced anaesthesia and gives us the depth of Anesthesia.It reflects the response of the brain to a variety of hypnotic and inhaled anaesthesia agents. The aim of this study was to see the effect of different MAC values of isoflurane on the bispectral index and hemodynamic variations at different MAC values. Material(s) and Method(s): This prospective study was conducted on 20 patients at tertiary care center for 6 months. After induction of Anesthesia, following parameters were recorded: noninvasive blood pressure measurement, heart rate, oxygen saturation, ETCo2 and BIS values. The BIS was continuously monitored and when the MAC values of isoflurane were 0.5, 0.7, 1, 1.2 and 1.5 corresponding BIS values and all the other haemodynamic parameters were noted. Result(s): In 11 patients out of 20 patients satisfactory BIS of 40-60 was achieved at MAC 0.5. In 16 out of 20 patients satisfactory BIS 40-60 was achieved at 0.7 MAC. In all the 20 patients satisfactory BIS was achieved at 1 MAC.In 2 out of 20 patients we couldn't proceed beyond 1.0 MAC because of the fall in MAP to <65mm of Hg. In 4 out of 20 patients we couldn't proceed beyond 1.2MAC because of the fall in MAP to <65mm of Hg. Conclusion(s): Isoflurane produced satisfactory BIS of 40-60 in 16 patients at 0.7 MAC and in all the 20 patients at 1 MAC.Use of BIS in our study helped in better titration of Isoflurane according to patient's individual needs thereby we avoided light plane of anaesthesia or deep hypnosis and the adverse effects associated with it. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Background: Preoxygenation using a bag valve mask (BVM) with a filter is recommended to reduce the risk of viral transmission. Preoxygenation in hypoxaemic patients may require a positive end-expiratory pressure (PEEP) valve. Applying a filter to a BVM with or without a PEEP valve can increase resistance and work of breathing. Objective(s): To evaluate the efficacy of proximal oxygen added to BVM with mechanical filter in healthy volunteers. Material(s) and Method(s): The present study was a crossover trial that randomized 48 volunteers to receive four preoxygenation techniques: BVM with a filter as group F, BVM with a filter and proximal oxygen as group FO, BVM with a filter and PEEP valve as group FP, and BVM with a filter, PEEP valve, and proximal oxygen as group FPO. Fraction of expired oxygen (FEO2) and continuous positive airway pressure (CPAP) were measured. Comfort was assessed using a numerical rating scale (NRS). The primary outcome was FEO2 at five minutes. Result(s): Data from 46 volunteers were analyzed. Adding oxygen proximal to the filter in the FO group increased FEO2 at five minutes by 7.07% (95% CI 4.87 to 9.26) and decreased the time to reach FEO2 90% by 301.74 seconds (95% CI 282.82 to 320.66) compared with the times in group F. Similarly, supplemental proximal oxygen including a PEEP valve increased FEO2 at five minutes by 6.07% (95% CI 3.87 to 8.26) and decreased the time to reach FEO2 90% by 242.13 seconds (95% CI 223.21 to 261.05). CPAP was 2.27, 3.61, 11.65, and 13.14 mmHg in group F, FO, FP, and FPO, respectively. The NRS score was 6.51 and 6.07 in groups F and FO, and 3.15 and 3.70 in groups FP and FPO, respectively. Conclusion(s): Adding proximal oxygen to a BVM with a filter improved the efficacy of preoxygenation. Copyright © 2023 JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND.
ABSTRACT
Aim: The aim of this study is to evaluate the results of laparoscopic reversal of Hartmann’s procedure assisted by transanal circular stapler as a primary treatment modality. Materials and methods: About 32 patients presenting with an end colostomy due to various elective and emergency surgical, gynecological, and obstetric indications were selected for this study, from April 2010 to March 2016. All the patients were subjected to ultrasonography of the abdomen and pelvis, a colostogram and contrast enema, and colonoscopy. Patients selected for the study were subjected to all routine workup. Pre-anesthetic evaluation was done. Parameters such as operative time, conversion rates, intraoperative blood loss, postoperative complications, return of bowel movements, starting on oral feed, anastomotic leak, port-site infection, and hospital stay were studied. Results: About 32 patients, including both male (12) and female (20), were included in the study. The age ranged between 30 years and 65 years (mean 47.5 years). The mean operative time was 150.6 ± 20.4 minutes. Four cases were converted to open. Oral feeds were started on 2 ± 1 postoperative day. Patients tolerated solid soft diet 96 hours after surgery. Postoperative hospital stay was 7 days (range 6–8 days). No patients had anastomotic leak or required revision surgery. Three patients had port-site infections. Conclusion: We conclude that transanal stapler-assisted laparoscopic Hartmann reversal can be considered as a primary modality of treatment in the hands of an experienced surgeon though having a steeper learning curve and a higher difficulty score compared with other laparoscopic colorectal surgeries with benefits of lesser intraoperative time, early return of bowel movements, faster initiation of oral solid feeds, decreased incidence of anastomosis leak, and lesser hospital stay. © The Author(s). 2022.