Effect of low-pressure pneumoperitoneum on pain and inflammation in laparoscopic cholecystectomy: a randomized controlled clinical trial.

OBJECTIVE: We aim to assess the effect of low-pressure pneumoperitoneum on post operative pain and ten of the known inflammatory markers. BACKGROUND: The standard of care pneumoperitoneum set pressure in laparoscopic cholecystectomy is set to 12-14 mmHg, but many societies advocate to operate at the lowest pressure allowing adequate exposure of the operative field. Many trials have described the benefits of operating at a low-pressure pneumoperitoneum in terms of lower post operative pain, and better hemodynamic stability. But only few describe the effects on inflammatory markers and cytokines. METHODS: A prospective, double-blinded, randomised, controlled clinical trial, including patients who underwent elective laparoscopic cholecystectomy. Patients randomised into low-pressure (8-10 mmHg) vs. standard-pressure (12-14 mmHg) with an allocation ratio of 1:1. Perioperative variables were collected and analysed. RESULTS: one hundred patients were allocated, 50 patients in each study arm. Low-pressure patients reported lower median pain score 6-hour post operatively (5 vs. 6, p-value = 0.021) in comparison with standard-pressure group. Eight out of 10 inflammatory markers demonstrated better results in low-pressure group in comparison with standard-pressure, but the effect was not statistically significant. Total operative time and surgery difficulty was not significantly different between the two groups even in the hands of inexperienced surgeons. CONCLUSION: low-pressure laparoscopic cholecystectomy is associated with less post operative pain and lower rise of inflammatory markers. It is feasible with comparable complications to the standard of care. Registered on ClinicalTrials.gov (NCT05530564/ September 7th, 2022).

Neutron and high energy photon fluence estimation in CLINAC using gold activation foils.

AIM: The thermal neutron, epithermal neutron and high-energy photon fluence were measured in this work around the Varian 21EX 23 MV CLINAC, which is operated in Albairouni hospital in Damascus, Syria. BACKGROUND: Photoneutron measurements around medical CLINAC aim to protect both patients and staff from unwanted radiation. MATERIALS AND METHODS: Neutron and photon activation techniques were applied using gold foils. RESULTS: It was found that high-energy photons fluence has practically a constant value in the field size. The thermal and epithermal neutron fluence along ox and oy axes has the same order of magnitude. CONCLUSION: Gold foils have been used successfully to measure neutron flux and high-energy photons simultaneously using activation techniques.

MONITORING OF HIGH-ENERGY PHOTON FLUENCE IN CLINAC USING Zn AND Cr PHOTOACTIVATION.

Monitoring of high-energy photon dose in radiation therapy is crucial for radiation protection, as well as to estimate the radiation effects in the operating microelectronic devices. The aim of this work was to investigate the possibility of using the photoactivation technique to monitor the high-energy photon fluence in the Varian 21EX 23MV CLINAC. The 52Cr(γ,n)51Cr and 66Zn(γ,n)65Zn reactions were used. It was found that 51Cr and 65Zn can be used successfully to monitor the fluence for short term (80 days) and long term (110 days), respectively.

Determination of 226Ra Contamination Depth Around Phosphogypsum Pit Using In-Situ Gamma Spectrometer.

The feasibility of applying multiple photopeak method (MPM) and peak to valley ratio (PVRM) method to determine Radium-226 contamination depth (226Ra hc) has been investigated. Gamma spectra in eight positions around phosphogypsum disposal pit has been measured using portable NaI(Tl) gamma spectrometer. MPM was investigated by calculating the ratio [Formula: see text] of 609 keV gamma line net counts to the corresponding value of 352 keV. PVRM was investigated by calculating the ratio [Formula: see text] of net counts of 609 keV gamma line to the corresponding valley counts. 226Ra hc in the positions has been determined using traditional soil coring. It was found that, [Formula: see text] and [Formula: see text] have good linear correlations with 226Ra hcTherefore, 226Ra hc can be determined by MPM and PVRM. These methods save a lot of time, costs and efforts in comparison with the traditional one.

Rare bone infections "excluding the spine".

Bone infections are usually due to haematogenous spread from distant infected organs. Spread of local sepsis or contamination of open wounds are less frequent routes of infection. The commonest cause of osteomyelitis is Staphylococcus aureus. The term rare bone infections refers to diseases where only a few percent affect bone or diseases which are essentially rare; these include bacteria, fungi, parasites and non-specific conditions. Common examples are tuberculosis, salmonellosis, brucellosis, hydatidosis, madura, actinomycosis, aspergillosis and American fungal infections. Certain bone infections have become exceedingly rare, particularly atypical mycobacteria, viral embryopathies and spirochaetes. Rare bone infections are encountered in many parts of the world commonly in the tropics and in the U. S. Immunocompromise and ease of travel can lead to increased incidence. A high index of clinical suspicion is necessary for diagnosis. Specific laboratory diagnosis is not always possible. Radiographs, computed tomography, isotope studies and magnetic resonance are useful but may not make the diagnosis. Aspiration or biopsy is necessary. Rare bone infections may simulate non-infective bone lesions.

Needle track seeding following percutaneous ethanol injection for treatment of hepatocellular carcinoma.

We report two cases of needle track seeding in the subcutaneous tissue and intercostal muscles following percutaneous ethanol injection for the treatment of hepatocellular carcinoma. In one patient, tumor seeding was observed 11 months after a total of 12 alcohol injections, and in the other patient, tumor seeding was observed 30 months after a total of 18 alcohol injections. The cases reported in the literature are discussed.

Water enhanced "non-paralytic" transcutaneous ultrasound of the normal gastric wall layers (WETCUS).

BACKGROUND/AIMS: Barium studies, endoscopies and endoscopic ultrasound are the usual methods for gastrointestinal tract examinations. Endoscopic ultrasound was the only accurate equipment used for imaging the various layers of the stomach wall distinctly. METHODOLOGY: Twenty patients undergoing renal ultrasound were given 600 cc of water to drink. Gastric wall layers were demonstrated in all patients, namely mucosa; submucosa, musculosa and serosa. The echogenic layer of the water-mucosa interface was not included in gastric wall thickness measurement. RESULTS: The normal wall measurement varied from 3-5 mm. This is lower than in previous reports. CONCLUSIONS: Water enhanced "non-paralytic" transcutaneous ultrasound is a simple, safe, non-invasive, and accurate test for visualizing gastric wall layers.

Case report: radiological and endoscopic management of bile leak following laparoscopic cholecystectomy.

Due to the ever increasing popularity of laparoscopic cholecystectomy (LC), many radiologists and gastroenterologists have noticed an epidemic of bile duct injuries due to subsequent complications. We report on five cases of post-LC minor bile duct injuries and document our preliminary experience in their management. Although the majority of minor bile leaks resolve spontaneously, particularly if a surgical drain has been left in situ, percutaneous drainage (PD) can be used alone or in addition to endoscopic management to treat symptomatic bile leaks and biloma formation. Bile leaks without associated abdominal collections should be first identified by endoscopic cholangiography followed by sphincterotomy and/or stenting. Surgery should only be reserved for cases of major bile duct injury if PD and endoscopic management have failed initially.