The Effect of Pneumoperitoneum on the Ankle-brachial Index of the Patients Undergoing Laparoscopic Cholecystectomy: An Observational Study.

Background: Improvement in the perioperative care has led to increased use of minimally invasive surgeries. Multiple physiological changes during minimally invasive surgeries are attributed to the creation of pneumoperitoneum. Materials and Methods: One hundred and nine patients who underwent laparoscopic cholecystectomy at a tertiary care hospital in north India meeting the inclusion and exclusion criteria were enrolled. Results: Out of the total 109 patients, 13 were males and 96 females (M:F = 1:7.3), the mean basal metabolic rate was 28.95 kg/m2. The mean systolic and diastolic blood pressure of the upper limb were 134.33 + 17.545 and 80.69 + 11.59 respectively. The mean systolic and diastolic blood pressure in lower limb (LL) were 142.32 + 21.552 and 79.44 + 11.94, respectively. Significant rise in the SBP was noticed in LL at the time of creation of Pneumoperitoneum and after changing the position for surgery (P < 0.05). The diastolic pressure in the LL rises significantly in the LL after creation of pneumoperitoneum, at induction, after reverse Trendelenburg position and extubation (P < 0.05). The mean arterial pressure increased significantly in the LL after the creation of pneumoperitoneum and persisted till the extubation (P < 0.05). A significant rise of ankle-brachial index (ABI) was observed in the patients after the creation of pneumoperitoneum and it remained significant till 15 min into surgery (P < 0.05). There was no correlation of ABI with weight and age of the patients on Pearson correlation. Conclusion: There is rise in ABI of the patients undergoing laparoscopic cholecystectomy at the time of creation of pneumoperitoneum, after Trendelenburg position and 15 min into surgery.

In situ Hydrogels for Effective Treatment of Cancer: Strategies and Polymers Used.

Cancer is a worldwide health ailment with no known boundaries in terms of mortality and occurrence rates, thus is one of the biggest threats to humankind. Hence, there is an absolute need to develop novel therapeutics to bridge the infirmities associated with chemotherapy and conventional surgical methodologies including impairment of normal tissue, compromised drug efficiency and an escalation in side effects. In lieu of this, there's been a surge in curiosity towards development of injectable hydrogels for cancer therapy because local administration of the active pharmaceutical agent offers encouraging advantages such as providing higher effective dose at target site, prolonged retention time of drug, ease of administration, mitigation of dose in vivo ,improved patient compliance. Furthermore, due to its biocompatible nature such systems can significantly reduce the side effects that occur on long-term exposure to chemotherapy. The present review details the most recent advancements in in-situ gel forming polymers (natural and synthetic), polymeric cross-linking methodologies and in-situ gelling mechanisms, focusing on their clinical benefits in cancer therapy.

Emergency Focused Assessment with Sonography in Blunt Trauma Abdomen.

BACKGROUND: Focused assessment with sonography in trauma (FAST) being a rapid noninvasive examination is used primarily to evaluate for the evidence of traumatic free fluid suggestive of injury in the peritoneal, pericardial, and pleural cavities. It is widely recognized as a mainstream emergency skill in the management of trauma. AIM: The aim of the study is to evaluate the accuracy of FAST in patients presenting with blunt abdominal trauma. METHODS: Data were collected prospectively from FAST scans conducted in blunt trauma abdomen (BTA) patients. Positive and negative FAST scans were confirmed either with contrast-enhanced computed tomography (CECT) abdomen or with exploratory laparotomy, thus dividing it further into four groups, i.e., true-positive, false-positive, true-negative, and false-negative scans. After collecting the data, accuracy of FAST was calculated. RESULTS: In this study, a total of 104 patients were included. The mean age was 38.17 years. Most common cause of BTA was road traffic accident. The overall sensitivity, specificity, and accuracy of FAST were 69.8%, 92.1%, and 80.8%, respectively. CONCLUSION: This study showed that FAST is of paramount importance in patients who are hemodynamically unstable as it has a high positive predictive value. However, a FAST-negative result should always be confirmed by other modalities.

Methylmalonic acidemia mimicking diabetic ketoacidosis and septic shock in infants.

Methylmalonic acidemia (MMA) is most common inherited type of organic acidemia. It has diverse presentation in older infants without any initial apparent symptoms. MMA sometimes present with sudden metabolic decompensation, which may mimics common emergencies like septic shock and diabetic ketoacidosis (DKA) without early recognition can be fatal. In born error of metabolism especially organic acidemia should be suspected in any infant presented with severe high anion gap metabolic acidosis. We report two cases of MMA in infants presented acutely mimicking DKA and septic shock.

Relationship between periodontal diseases and preterm birth: Recent epidemiological and biological data.

Preterm infants are born prior to completion of 37 weeks of gestation. These patients are seen on the rise despite the efforts put in to control them. Global incidence of preterm birth is around 9.6% of all birth representing 12.9 million births with regional disparities: From 12% to 13% in USA, from 5% to 9% in Europe, and 18% in Africa. First reported by Offenbacher et al. in 1996 relationship exist between maternal periodontal disease and delivery of a preterm infant. This article reviews the recent epidemiological and biological data. The articles were searched on Google, PubMed recent articles were selected. Mainly, three hypotheses by which periodontal bacteria can affect the outcome of pregnancy. Biological hypothesis: (a) Bacterial spreading, (b) Inflammatory products dissemination, (c) Role of fetomaternal immune response against oral pathogens. The promotion of the early detection and treatments of periodontal disease in young women before and during pregnancy will be beneficial especially for women at risk.

Infected pseudoaneurysms in intravenous drug abusers: Ligation or reconstruction?

BACKGROUND: Infected pseudoaneurysm in intravenous (IV) drug abusers is a serious clinical problem, with difficult and controversial management. With existing controversies regarding their optimal management, we present the results of simple ligation and local debridement for treatment of infected pseudoaneurysms. PATIENTS AND METHODS: Records of 72 consecutive patients with pseudoaneurysms in IV drug abusers over the last 20 years were reviewed retrospectively. RESULTS: Ligation and excision of pseudoaneurysm was done in all patients with delayed revascularization in only two patients. Four patients had amputations because they had gangrenous limbs on presentation. All other patients had healthy limbs at the time of discharge. There were three deaths, two due to sepsis with multiorgan dysfunction and one with hemorrhagic shock. CONCLUSION: Infected pseudoaneurysm should be managed by simple ligation of involved artery with delayed revascularization, if required.

HSV-sr39TK positron emission tomography and suicide gene elimination of human hematopoietic stem cells and their progeny in humanized mice.

Engineering immunity against cancer by the adoptive transfer of hematopoietic stem cells (HSC) modified to express antigen-specific T-cell receptors (TCR) or chimeric antigen receptors generates a continual supply of effector T cells, potentially providing superior anticancer efficacy compared with the infusion of terminally differentiated T cells. Here, we demonstrate the in vivo generation of functional effector T cells from CD34-enriched human peripheral blood stem cells modified with a lentiviral vector designed for clinical use encoding a TCR recognizing the cancer/testes antigen NY-ESO-1, coexpressing the PET/suicide gene sr39TK. Ex vivo analysis of T cells showed antigen- and HLA-restricted effector function against melanoma. Robust engraftment of gene-modified human cells was demonstrated with PET reporter imaging in hematopoietic niches such as femurs, humeri, vertebrae, and the thymus. Safety was demonstrated by the in vivo ablation of PET signal, NY-ESO-1-TCR-bearing cells, and integrated lentiviral vector genomes upon treatment with ganciclovir, but not with vehicle control. Our study provides support for the efficacy and safety of gene-modified HSCs as a therapeutic modality for engineered cancer immunotherapy. Cancer Res; 74(18); 5173-83. ©2014 AACR.

Spinal epidural abscess following epidural cannulation for flail chest analgesia: a case report.

Epidural abscess after epidural catheterization is a rare complication. Neurological manifestations vary and the patient described here presented with complete paraplegia. He was managed by surgical decompression and did well postope-ratively. We present a case report and review of the literature of thoracic epidural abscess following catheterization for epidural analgesia with near total neurological recovery.

Prophylactic antibiotic usage in patients undergoing inguinal mesh hernioplasty - A clinical study.

BACKGROUND: There is ambiguity about the use of antibiotic prophylaxis in inguinal mesh hernioplasty. We have tried to assess the efficacy of antibiotic prophylaxis in this procedure. MATERIALS AND METHODS: A randomized double blind placebo controlled study was conducted which included 55 patients who underwent an inguinal mesh hernioplasty over a 2 year period. The patients were evaluated for the status of the suture line as well as the presence of wound infection. RESULTS: Out of 55 patients 29 were randomized to the antibiotic arm and 26 to the placebo group. The groups were well matched for all variables studied excluding wound infections, which occurred at a rate of 10.34% (n = 3) in the antibiotic group and 15.38% (n = 4) in the placebo arm, (p > 0.01). CONCLUSION: This study did not document any statistically significant difference observed between those who received antibiotics and those receiving placebo in terms of any of the prognostic end points evaluated for Lichtenstein mesh hernioplasty.