Successful living donor liver transplantation in portomesenteric thrombosis.

Chronic portal vein thrombosis (PVT) is often considered a relative contraindication for living donor liver transplantation due to the risks involved and higher morbidity. In this report, we describe a surgical strategy for living donor liver transplant in patient with complete PVT using venovenous bypass from the inferior mesenteric vein (IMV) and then using a jump graft from the IMV for portal inflow into the graft. IMV is a potential source for portal inflow in orthotopic liver transplant.

Laparoscopic versus open ventral hernia mesh repair: a prospective study.

BACKGROUND: An incisional hernia develops in 3% to 13% of laparotomy incisions, with primary suture repair of ventral hernias yielding unsatisfactory results. The introduction of a prosthetic mesh to ensure abdominal wall strength without tension has decreased the recurrence rate, but open repair requires significant soft tissue dissection in tissues that are already of poor quality as well as flap creation, increasing complication rates and affecting the recurrence rate. A minimally invasive approach was applied to the repair pf ventral hernias, with the expectation of earlier recovery, fewer postoperative complications, and decreased recurrence rates. This prospective study was performed to objectively analyze and compare the outcomes after open and laparoscopic ventral hernia repair. METHODS: The outcomes for 50 unselected patients who underwent laparoscopic ventral hernia repair were compared with those for 50 consecutive unselected patients who underwent open repair. The open surgical operations were performed by the Rives and Stoppa technique using prosthetic mesh, whereas the laparoscopic repairs were performed using the intraperitoneal onlay mesh (IPOM) repair technique in all cases. RESULTS: The study group consisted of 100 patients (82 women and 18 men) with a mean age of 55.25 years (range, 30-83 years). The patients in the two groups were comparable at baseline in terms of sex, presenting complaints, and comorbid conditions. The patients in laparoscopic group had larger defects (93.96 vs 55.88 cm2; p = 0.0023). The mean follow-up time was 20.8 months (95% confidence interval [CI], 18.5640-23.0227 months). The mean surgery durations were 90.6 min for the laparoscopic repair and 93.3 min for the open repair (p = 0.769, nonsignificant difference). The mean postoperative stay was shorter for the laparoscopic group than for the open hernia group (2.7 vs 4.7 days; p = 0.044). The pain scores were similar in the two groups at 24 and 48 h, but significantly less at 72 h in the laparoscopic group (mean visual analog scale score, 2.9412 vs 4.1702; p = 0.001). There were fewer complications (24%) and recurrences (2%) among the patients who underwent laparoscopic repair than among those who had open repair (30% and 10%, respectively). CONCLUSIONS: The findings demonstrate that laparoscopic ventral hernia repair in our experience was safe and resulted in shorter operative time, fewer complications, shorter hospital stays, and less recurrence. Hence, it should be considered as the procedure of choice for ventral hernia repair.

Single stage bipolar exclusion of oesophagus in failed primary repair for perforation.

Perforation of the thoracic oesophagus is a serious clinical problem, associated with a high morbidity and mortality, especially if treated late. Primary repair with or without reinforcement is commonly recommended, if the patient presents within 24 hours. As the time to treatment increases, primary repair has a high rate of leakage and complications. A useful technique of temporary oesophageal exclusion and diversion with spontaneous recanalisation is presented. The technique obviates the need for thoracotomy and preserves the native oesophagus

Evaluation of Cases of Secondary Infertility by Hysterosalpingography and Hysteroscopy.

Hysterosalpingography (HSG) and hysteroscopy, two investigative modalities were performed on a group of 50 patients of secondary infertility and the results analysed. In this study, the infertile women were evaluated with HSG followed by hysteroscopy to evaluate the causes of secondary infertility and attempt a correlation between these investigative modalities. The complete agreement between HSG and hysteroscopy was established in 43 (86%) cases. HSG showed a false positive rate of 23% and false negative rate of 6%. The sensitivity of HSG was 77% and specificity 93% in diagnosing uterine conditions. The conditions missed were likely due to the overfilling of the uterus. HSG showed a good correlation with hysteroscopy and being a safe and simple procedure, it should be the preliminary Investigation in infertile patients. Thus, the two investigative modalities were found to be complementary to each other rather than being mutually exclusive.

Use of Chelex 100 in determination of bismuth in sulphide ores, concentrates, metals and alloys.

In the determination of bismuth, Chelex 100 has been successfully employed for reducing the concentration of matrix and interfering elements from sulphide ores and concentrates and for separation of the matrix elements from bismuth in the analysis of high-purity copper, silver and silver-cadmium alloy.

Use of zeo-karb 226 and dowex a-l in the analysis of high-purity zinc and zinc-base alloys for Tl and In.

Utility of Zeo-Karb 226 and Dowex A-l for the separation of Tl and In at 5-ppm level from high-purity zinc and zinc-base alloys has been investigated. With Zeo-Karb 226 (NH(4)(+)), T1(+) is conveniently separated from these materials and also from many other cations, with l.0M ammonium nitrate as the eluent. It is subsequently determined with Rhodamine B. This separation principle is also applied to the analysis of Pb-Tl alloys. Both Tl and In (along with Fe) are preconcentrated on Zeo-Karb 226(H(+)) from a solution of the sample at pH 3.0. Suitable methods of subsequent determination of Tl and In are described. In the case of Dowex A-1(H(+)), Tl(+), In(3+), Fe(3+) and Cu(2+) are retained from a solution of the sample at pH 2.0. An o-phenanthroline solution at pH 2.0 elutes all but traces of Cu(2+). In(3+) along with Fe(3+) is eluted with l.0M hydrochloric acid. Finally, Tl is eluted with 2.0M hydrochloric acid containing sulphurous acid.