A systematic review on laparoscopic subtotal cholecystectomy for difficult gallbladders: a lifesaving bailout or an incomplete operation?

INTRODUCTION: Laparoscopic subtotal cholecystectomy (LSTC) is a bailout procedure that is undertaken when it is not safe to proceed with a laparoscopic total cholecystectomy owing to dense adhesions in Calot's triangle. The main aim of this review was to investigate the early (≤30 days) and late (>30 days) morbidity and mortality of LSTC. METHODS: A literature search of the PubMed® (MEDLINE®), Google Scholar™ and Embase® databases was conducted to identify all studies on LSTC published between 1985 and December 2020. A systematic review was then performed. RESULTS: Overall, 45 studies involving 2,166 subtotal cholecystectomy patients (51% female) were identified for inclusion in the review. The mean patient age was 55 years (standard deviation: 15 years). Just over half (53%) of the patients had an elective procedure. The conversion rate was 6.2% (n=135). The most common indication was acute cholecystitis (49%). Different techniques were used, with the majority having a closed cystic duct/gallbladder stump (71%). The most common closure technique was intracorporeal suturing (53%), followed by endoloop closure (15%). Four patients (0.18%) died within thirty days of surgery. Morbidity within 30 days included bile duct injury (0.23%), bile leak (18%) and intra-abdominal collection (4%). Reoperation was reported in 23 patients (1.2%), most commonly for unresolving intra-abdominal collections and failed endoscopic retrograde cholangiopancreatography to control bile leak. Long-term follow-up was reported in 30 studies, the median follow-up duration being 22 months. Late morbidity included incisional hernias (6%), symptomatic gallstones (4%) and common bile duct stones (2%), with 2% of cases requiring completion of cholecystectomy. CONCLUSIONS: LSTC is an acceptable alternative in patients with a "difficult" Calot's triangle.

Effect of physical exercise combined with shockwave therapy on erectile dysfunction in diabetic patients.

Introduction: The aim of the study was to evaluate whether physical exercise (PE) in addition to extracorporeal shockwave therapy (ESWT) is more effective in improving erectile function as compared to ESWT and PE alone in diabetic patients with erectile dysfunction (ED). Material and methods: Forty-five patients with type 2 diabetes mellitus (DM) and ED were divided into three equal groups: group 1 (ESWT group) received treatment with ESWT twice weekly for 6 weeks, comprising 3000 shockwaves at an energy density of 0.25 mJ/mm2 and an emission frequency of 6 Hz; group 2 (PE group) received treatment with physical exercise three times per week for 12 weeks; and group 3 (combined group) was treated using physical exercise in the form of the program followed by the PE group, plus ESWT in the form of the same parameter and protocol as that of the ESWT group. Treatment outcomes were measured by International Index of Erectile Function-5 (IIEF-5) score variations recorded at 4 and 12 weeks after the end of treatment with respect to the baseline. Results: The mean IIEF-5 scores significantly improved in all groups at the 4-week follow-up without intergroup differences. At the 12-week follow-up, the mean IIEF-5 improvement and durability were significantly higher among patients in combined groups. Conclusions: The combined approach of ESWT and PE provides significant advantages in erectile dysfunction improvement and durability as compared to ESWT or PE alone in diabetic patients with ED.

Eco-Friendly Recycling of Lithium Batteries for Extraction of High-Purity Metals.

The significant increase in lithium batteries consumption produces a significant quantity of discarded lithium-ion batteries (LIBs). On the one hand, the shortage of high-grade ores leads to the necessity of processing low-grade ores, which contain a low percentage of valuable metals in comparison to the discarded LIBs that contain a high percentage of these metals, which enhances the processing of the discarded LIBs. On the other hand, the processing of discarded LIBs reduces the negative environmental effects that result from their storage and the harmful elements contained in their composition. Hence, the current study aims at developing cost-effective and ecofriendly technology for cobalt and lithium metal ion recovery based on discarded LIBs. A novel synthesized solid-phase adsorbent (TZAB) was utilized for the selective removal of cobalt from synthetic solutions and spent LIBs. The synthesized TZAB adsorbent was characterized by using 13C-NMR, GC-MS, FT-IR, 1H-NMR, and TGA. The factors affecting the adsorption of cobalt and lithium ions from synthetic solutions and spent LIBs, including the sorbent dose, pH, contact time, temperature, and cobalt concentration were investigated. The conditions surrounding the recovery of cobalt and lithium from processing discarded LIBs, were investigated to optimize the maximum recovery. The Langmuir, Freundlich, and Dubinin-Radushkevich (D-R) isotherm models were used to study the kinetics of the adsorption process. The obtained results showed that high-purity CoC2O4 and Li3PO4 were obtained with a purity of 95% and 98.3% and a percent recovery of 93.48% and 95.76%, respectively. The maximum recovery of Co(II) from synthetic solutions was obtained at C0 = 500 mg·L-1, dose of 0.08 g, pH 7.5, T = 25 °C, and reaction time = 90 min. The collected data from Langmuir's isotherm and the adsorption processes of Co agree with the data predicted by the D-R isotherm models, which shows that the adsorption of Co(II) onto the TZAB seems to be chemisorption, and the results agree with the Langmuir and D-R isotherm models.

Synthesized Zeolite Based on Egyptian Boiler Ash Residue and Kaolin for the Effective Removal of Heavy Metal Ions from Industrial Wastewater.

The increase of global environmental restrictions concerning solid and liquid industrial waste, in addition to the problem of climate change, which leads to a shortage of clean water resources, has raised interest in developing alternative and eco-friendly technologies for recycling and reducing the amount of these wastes. This study aims to utilize Sulfuric acid solid residue (SASR), which is produced as a useless waste in the multi-processing of Egyptian boiler ash. A modified mixture of SASR and kaolin was used as the basic component for synthesizing cost-effective zeolite using the alkaline fusion-hydrothermal method for the removal of heavy metal ions from industrial wastewater. The factors affecting the synthesis of zeolite, including the fusion temperature and SASR: kaolin mixing ratios, were investigated. The synthesized zeolite was characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), particle size analysis (PSD) and N2 adsorption-desorption. The SASR: kaolin weight ratio of 1:1.5 yields faujasite and sodalite zeolite with 85.21% crystallinity, which then shows the best composition and characteristics of the synthesized zeolite. The factors affecting the adsorption of Zn2+, Pb2+, Cu2+, and Cd2+ ions from wastewater on synthesized zeolite surfaces, including the effect of pH, adsorbent dosage, contact time, initial concentration, and temperature, have been investigated. The obtained results indicate that a pseudo-second-order kinetic model and Langmuir isotherm model describe the adsorption process. The maximum adsorption capacities of Zn2+, Pb2+, Cu2+, and Cd2+ ions onto zeolite at 20 °C were 12.025, 15.96, 12.247, and 16.17 mg·g-1, respectively. The main mechanisms controlling the removal of these metal ions from aqueous solution by synthesized zeolite were proposed to be either surface adsorption, precipitation, or ion exchange. The quality of the wastewater sample obtained from the Egyptian General Petroleum Corporation (Eastern Desert, Egypt) was highly improved using the synthesized zeolite and the content of heavy metal ions was significantly reduced, which enhances the utilization of the treated water in agriculture.

Superabsorbent Wound Dressing for Management of Patients With Moderate-to-Highly Exuding Chronic Leg Ulcers: An Early Stage Model-Based Benefit-Harm Assessment.

The aim of the research is to assess the benefit-harm of superabsorbent polymers wound dressings based on polyacrylate polymers (SAPs) compared with standard of care (SoC) dressing mix for patients with moderate-to-highly exuding hard-to-heal leg ulcers. The SoC dressings mix was composed of other superabsorbents in 29% of cases, antimicrobials 26%, foams 20%, alginates 5%, and other dressings 19% weighted according to their frequency. We have used the decision-analytic modeling method, Markov process, as an adequate analytical solution for medical prognosis. We have combined the systematic literature search to identify the most relevant inputs for the analysis, with available patient-level clinical data concerning benefits of superabsorbent to generate a robust prediction of patient-relevant outcomes, including healing rates and health-related quality of life. Besides, we have qualitatively described adverse events associated with those treatments. Our research indicates that SAPs when compared with SoC dressing mix in a patient with moderate-to-highly excluding leg ulcers are leading to an improved healing rate with an absolute risk difference of 2.20% in 6 months and a relative risk of 1.07 in favor of SAP dressings. The attributable fraction among those exposed to SAP dressings of 6.6%, meaning that 6.6% of the healed ulcers could be attributed to having had the SAP dressing treatment instead of the SoC dressing treatment. Besides, SAP dressings lead to improved quality of life measured as incremental quality-adjusted life weeks (QALWs) of 0.13 QALWs.

Vodder manual lymphatic drainage technique versus Casley-Smith manual lymphatic drainage technique for cellulite after thigh liposuction.

Introduction: Cellulite is one of the complications post liposuction. Cellulite causes changes in the lymphatic system. Manual lymphatic drainage is utilized as an effective treatment for enhancing cellulite. Aim: To compare between Vodder Manual Lymphatic Drainage (MLD) Technique and Casley-Smith MLD Technique for cellulite after liposuction. Material and methods: Thirty female patients with cellulite grade 3 after thigh liposuction participated in the study, and they were randomly divided into two equal groups: Group (A) that received Vodder MLD Technique and Bandage and Group (B) that received Casley-Smith MLD Technique and Bandage. The duration of the intervention was 8 weeks per participant, and each participant received 3 sessions per week. Results: The results revealed that there was a significant improvement in both groups by using two different methods of treatment (p < 0.001), but there was no significant difference between the two study groups (p > 0.05). Conclusions: Both Vodder technique and Casley-Smith technique are effective in treatment of cellulite after thigh liposuction but there is no difference between them, hence any technique of MLD is recommended to achieve better improvement in this case.

Patterns and predictors of hand functional recovery following pediatric burn injuries: Prospective cohort study.

PURPOSE: To describe the pattern of hand functional recovery in the first six months following the discharge of children with burn injury, and to identify the predictors affecting this recovery. MATERIALS AND METHODS: This was a prospective, comparative, follow-up cohort study in which hand functional outcome, was assessed during 9 months follow-up on 37 children with burn injuries involving the upper extremity with total body service area (TBSA<35%). Thirty-six matched healthy children were participated to compare the differences between children with burn and healthy children regarding the hand functional outcome. Hand function assessments included total active motion (TAM), grip strength and Jebsen Hand Function Test (JHFT) were conducted at hospital discharge, 3, and 6 months follow-up after discharge. RESULTS: We found a trend towards an increase in the TAM scores over time (P<0.001), and were excellent in 5.41%, at discharge and increased to 18.92% and 40.54% at 3 and 6-month following discharge. The hand grip strength and JHFT showed significant improvement over time after 6 months (P<0.001). Regression analysis revealed that time to surgery, engagement in rehabilitation services, hand dominance, age and TBSA were the predictors of hand functional recovery and accounted 74% for TAM, 0.79 and 0.86 for total JHFT scores and grip strength. CONCLUSIONS: the TAM, grip strength and JHFT were significantly improved after 3-month and these improvements were more evident at 6-month following discharge. Identification of the predictors may help therapists in the development of an effective rehabilitation programs.

Resistance Training Impact on Mobility, Muscle Strength and Lean Mass in Pancreatic Cancer Cachexia: A Randomized Controlled Trial.

OBJECTIVE: To determine the efficacy of a three-month resistance training programme on the mobility, muscle strength and lean body mass of patients with pancreatic cancer-induced cachexia. DESIGN: Randomized controlled trial. SETTING: Elsahel Teaching Hospital, outpatient clinic of the Faculty of Physical Therapy, Cairo, Egypt. PARTICIPANTS: Patients with pancreatic cancer-induced cachexia. INTERVENTIONS: Participants were randomized to the resistance training group (n = 20) and control group (n = 20). MAIN MEASURES: Outcomes including mobility, muscle strength and lean body mass were measured at baseline, three months after surgical resection and 12 weeks after intervention. RESULTS: The mean (SD) age was 51.9 (5.03) years and body mass index was 21.1 (1.13) kg/m²; 65% of patients were male. Compared to the control group, the resistance training group showed significant improvement in mobility: 400-m walk performance (270.3-256.9 seconds vs 266.4-264.2 seconds, respectively) and chair rise (13.82-12.53 seconds vs 13.77-13.46 seconds, respectively). Similarly, muscle strength was also significantly improved in the resistance training group than in the control group; we observed increase in peak torque of knee extensors (P = 0.004), elbow flexors (P = 0.001) and elbow extensors, improvement in lean mass of the upper limb (6.28-6.46 kg vs 6.31-6.23 kg, respectively) and lower limb (16.31-16.58 kg vs 16.4-16.31 kg, respectively). CONCLUSION: A three-month resistance training improved the mobility of patients with pancreatic cancer-induced cachexia. Muscle strength and lean body mass also improved.

Effect of radial shock wave on chronic pelvic pain syndrome/chronic prostatitis.

[Purpose] This study aimed to evaluate the effect of radial extracorporeal shock wave therapy (rESWT) on patients with chronic pelvic pain syndrome (CPPS). [Participants and Methods] Forty male CPPS patients were randomly assigned into either an rESWT group or a control group. The first group was treated with rESWT two times per week for four weeks with a protocol 3,000 pulse, 12 Hz at 3 to 5 bar. The control group was treated with the same protocol, but the device's probe had been turned off. The follow-up assessment was done using the National Institutes of Health-developed Chronic Prostatitis Symptom Index (NIH-CPSI) before treatment, as well as one week, four weeks, and 8 weeks after treatment. [Results] No significant difference was found in terms of age, sub-domain, or the total score of the NIH-CPSI between the rESWT group and the control group at the baseline. A statistically significant decrease was determined in the pain domain, urine score, quality of life, and the total NIH-CPSI score of the rESWT group at all post-treatment time points. All domains and the total score of the NIH-CPSI at all three follow-up time points decreased more significantly in the rESWT group as compared to the control group. [Conclusion] The findings of this study confirmed that rESWT is an effective method for treating CPPS.

Systematic evaluation of radiological findings in the assessment of resectability of peri-ampullary cancer by CT using different contrast phase protocols.

AIMS: To determine the relative significance of radiological signs in determining the resectability of peri-ampullary cancer (PC) and to assess the value of multi-phase imaging in detecting these findings. MATERIALS AND METHODS: Blinded, double re-reporting of preoperative imaging from five hospitals was undertaken of 411 patients undergoing surgery for PC over an 8-year period, of whom 119 patients were found to be inoperable at the time of surgery. RESULTS: The median tumour size was 26.7 mm and the proportion of patients reported to have regional lymphadenopathy (RL), venous (VI) and arterial involvement (AI) was 24.7%, 11.5%, and 3.9%, respectively and was similar regardless of the number of contrast phases undertaken. Significant associations were, however, noted between individual risk factors: VI was closely associated with tumour size (p=0.002) and AI (p<0.0001). In multivariate analysis AI, VI, and RL were independently associated with resectability (relative risk of resection=0.05, 0.31, and 0.51, respectively). Tumour size, however, was not associated with resectability when VI was included in the multivariate model. CONCLUSIONS: The use of multiple vascular contrast phases has no measureable impact on the rate of determination of tumour resectability of PC. In preoperative staging, AI is the most significant adverse finding for resectability. Large tumour diameter is not an adverse finding in isolation from other risk factors.

The operating room case-mix problem under uncertainty and nurses capacity constraints.

Surgery is one of the key functions in hospitals; it generates significant revenue and admissions to hospitals. In this paper we address the decision of choosing a case-mix for a surgery department. The objective of this study is to generate an optimal case-mix plan of surgery patients with uncertain surgery operations, which includes uncertainty in surgery durations, length of stay, surgery demand and the availability of nurses. In order to obtain an optimal case-mix plan, a stochastic optimization model is proposed and the sample average approximation method is applied. The proposed model is used to determine the number of surgery cases to be weekly served, the amount of operating rooms' time dedicated to each specialty and the number of ward beds dedicated to each specialty. The optimal case-mix selection criterion is based upon a weighted score taking into account both the waiting list and the historical demand of each patient category. The score aims to maximizing the service level of the operating rooms by increasing the total number of surgery cases that could be served. A computational experiment is presented to demonstrate the performance of the proposed method. The results show that the stochastic model solution outperforms the expected value problem solution. Additional analysis is conducted to study the effect of varying the number of ORs and nurses capacity on the overall ORs' performance.

Management and outcomes of appendicular neuroendocrine tumours: Retrospective review with 5-year follow-up.

BACKGROUND: Neuroendocrine (NEN) tumours are the commonest type of tumours affecting the appendix. The majority of cases are diagnosed incidentally on post-operative histopathological examination of the resected appendicectomy specimen. Preoperative diagnosis remains a challenge, unless the patient presents with obvious features of carcinoid syndrome or signs of metastatic disease. Hence, the authors present our five-year experience in diagnosing and managing NEN tumours of the appendix. METHODS: Retrospective review of all patients underwent an emergency appendicectomy with intention to treat clinically suspected appendicitis at Derriford Hospital (Plymouth, Devon, UK) was undertaken. Patients with diagnoses other than NEN of the appendix were excluded. For patients with appendicular NEN, demographic data, pre-operative inflammatory markers, post-operative histology results as well as follow-up investigations were obtained using patients' electronic records. Case notes were reviewed for clinical presentation, operative details and follow-up information. RESULTS: 2724 patients underwent emergency appendicectomy between January 2009 and May 2014. Carcinoid tumours were identified in 17 histologically examined appendicectomy specimens. Clinically, all patients presented with acute appendicitis with raised inflammatory markers in 58.5% of patients. Median tumour size was 5 (1-20) mm. Median postoperative follow up was 2.9 (0.92-5.8) years. All patients remained tumour free with no evidence of metastasis or recurrence during the entire study period. CONCLUSION: Appendicular NEN are rare and usually diagnosed incidentally; hence precise examination of routine appendicectomy specimens is fundamental in the diagnosis. Simple appendicectomy is sufficient for tumours less than 1 cm for adequate clearance, whilst right hemi-colectomy is recommended for larger tumours.

Ophthalmomyiasis externa caused by Oestrus ovis L. in the Ajloun area of northern Jordan.

During the years 1990-1991 17 cases of ophthalmomyiasis externa due to the sheep nasal botfly, Oestrus ovis, were reported from the Ajloun area in northern Jordan. Symptoms included mild to severe conjunctivitis, cellulitis, lacrimation and conjunctival hyperaemia. All cases were among males, and they occurred either from April to July or from September to November.