Gallstone ileus- A rare presentation in the era of rampant cholecystectomies.

INTRODUCTION: Gallstone ileus is a rare but potentially dangerous complication of cholelithiasis and represents about 1 % of the total cases of small bowel obstruction (Balthazar and Schechter, 1978). PRESENTATION OF CASE: We report a case of 40 years old female who presented with signs and symptoms of bowel obstruction. On further investigation, a diagnosis of gallstone ileus was established. She was managed by laparoscopy-assisted enterolithotomy. DISCUSSION: Gallstone ileus, a form of mechanical intestinal obstruction, predominantly affects elderly females. Surgical management options includes enterolithotomy alone, two-staged enterolithotomy with delayed cholecystectomy and fistula repair, and single staged enterolithotomy and fistula repair. A laparoscopy-assisted enterolithotomy allows simultaneous direct diagnosis of gallstone ileus and assessment of pericholecystic adhesions along with cholecystoenteral fistula. CONCLUSION: Laparoscopy-assisted enterolithotomy was chosen for managing gallstone ileus in this patient, omitting cholecystectomy and fistula repair due to dense adhesions. The patient remained symptom free for 6 months post-surgery, suggesting potential spontaneous closure of the cholecystoduodenal fistula, affirming the viability of this less invasive approach.

Concentration- and Solvent-Induced Chiral Tuning by Manipulating Non-Proteinogenic Amino Acids in Glycoconjugate Supra-Scaffolds: Interaction with Protein, and Streptomycin Delivery.

We showed solvent- and concentration-triggered chiral tuning of the fibrous assemblies of two novel glycoconjugates Z-P(Gly)-Glu and Z-F(4-N)-Glu made by chemical attachment of Cbz-protected [short as Z)] non-proteinogenic amino acids L-phenylglycine [short as P(Gly)] and 4-Nitro-L-phenylalanine [short as F(4-N)] with D-glucosamine [short as Glu]. Both biomimetic gelators can form self-healing and shape-persistent gels with a very low critical gelator concentration in water as well as in various organic solvents, indicating they are ambidextrous supergelators. Detailed spectroscopic studies suggested ß-sheet secondary structure formation during anisotropic self-aggregation of the gelators which resulted in the formation of hierarchical left-handed helical fibers in acetone with an interlayer spacing of 2.4 nm. After the physical characterization of the gels, serum protein interaction with the gelators was assessed, indicating they may be ideal for biomedical applications. Further, both gelators are benign, non-immunogenic, non-allergenic, and non-toxic in nature, which was confirmed by performing the blood parameters and liver function tests on Wister rats. Streptomycin-loaded hydrogels showed efficacious antibacterial activity in vitro and in vivo as well. Finally, cell attachment and biocompatibility of the hydrogels were demonstrated which opens a newer avenue for promising biomedical and therapeutic applications.

To assess the feasibility and diagnostic accuracy of preoperative ultrasound and ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in patients of breast carcinoma.

Background: Metastasis of the lymph node is one of the most significant prognostic factors for breast cancer (BC). Aim: To predict positivity of the lymph node in BC patients with help of USG and USG-guided FNAC and thus to prevent unnecessary morbidity. Methods: 50 patients of incisional/true cut biopsy-proven BC patients were included. All were subjected to mammography, USG and FNAC of the lump breast. USG-guided FNAC of the axillary lymph node was done in 25 of these patients. These findings were assessed by histological examination following dissection of the axillary lymph node. Results: Axillary lymph node (ALN) metastasis was present in 42 patients on histopathology; 21 patients suspicious of malignancy on preoperative USG were confirmed by HPE. Out of 88 confirmed lymph nodes evaluated on ultrasonography, 4 were benign, 18 were indeterminate and 66 were suspicious. The most promising features were tumour length/depth ratio of <1.5 in 81, absent fatty hilum in 73% and hypoechoic cortex in 74%. Assessment of axilla with USG had a sensitivity of 50%, a specificity of 100%, a PPV of 100%, an NPV of 27.59% and a diagnostic accuracy of 58%. Preoperative USG-guided FNAC had a sensitivity of 91.67%, a specificity of 100%, a PPV of 100%, an NPV of 33.33% and a diagnostic accuracy of 92%. Conclusion: USG can detect non-palpable axillary lymph nodes and FNAC can increase the sensitivity and specificity of this technique, which makes this procedure very promising in detecting axillary metastases in BC patients.

Sutureless Appendectomy by Using Harmonic Scalpel: Is It Possible?

Introduction: Laparoscopic appendectomy is a commonly performed procedure. The base of appendix is secured by various techniques (suture, LigaSure, endoloop, or hamlock clip). Harmonic scalpel (HS) may be used to seal the base of the appendix. The study was conducted to assess the efficacy of HS in laparoscopic appendectomy for sealing the base of the appendix. Materials and Methods: The patients were divided into two groups: group 1 in which base was secured by endoloop and group 2 in which base of the appendix was sealed by HS in a stepwise manner. We made a record of patients' age and gender, and operative time. The patients were followed for a period of 3 months from the time of discharge. Results: During the study period of 4.5 years, 102 patients were in group 1 and 108 patients in group 2. Both groups were age and gender matched. Mean operating time for group 1 was 43.34 ± 6.7 minutes and that for group 2 was 28.46 ± 7.19 minutes (P < .0001). Complications included postoperative ileus (group 1 = 8, group 2 = 10) and surgical site infection (group 1 = 4, group 2 = 4, P > .05). Conclusion: It appears that use of HS for laparoscopic appendectomy is feasible and safe. Its results appear to be comparable with other methods of laparoscopic appendectomy. Complications are minimal. Further studies at other centers may substantiate our efforts.

PVA-PDMS-Stearic acid composite nanofibrous mats with improved mechanical behavior for selective filtering applications.

In this work, we report a facile way to fabricate composite nanofibrous mats of polyvinyl alcohol (PVA), polydimethylsiloxane (PDMS), and stearic acid (SA) by employing the electrospinning-technique, with PDMS fraction ranging from 40w% to nearly 80w%. The results show that for a predetermined fraction of PVA and SA, incorporation of an optimal amount of PDMS is necessary for which the mats exhibit the best mechanical behavior. Beyond this optimal PDMS fraction, the mechanical properties of the composite mats deteriorate. This result has been attributed to the ability of the SA molecules to mediate binding between the PVA and PDMS long-chain molecules via van-der-Waals bonding. The morphological, structural, mechanical, and thermal characterizations respectively using SEM, XRD, DMA/tensile test, and DSC lend support to this explanation. By this method, it is possible to control the hydrophilicity/oleophilicity of the mats, and the mats show an excellent selective permeability to oil as compared to water and successfully filter water from a water-in-oil emulsion. Incorporation of SA not only serves to aid in electrospinning of a PDMS-rich nanofibrous mat with good mechanical strength and control over hydrophilicity/oleophilicity, but also has a potential use in fabricating sheets impregnated with phase change materials for thermal energy storage.

Ultrasound-guided transversus abdominis plane block: What are the benefits of adding dexmedetomidine to ropivacaine?

BACKGROUND: Ultrasound-guided transversus abdominis plane (TAP) block has recently come up as a modality to take care of postoperative pain. It can somewhat avoid the use of intravenous opioid analgesics and hence to avoid its complications. We have performed a prospective, double-blinded, randomized study to assess the analgesic effect of adding dexmedetomidine to local ropivacaine on TAP block for patients undergoing lower abdominal surgeries. AIM: The aim is to assess whether addition of dexmedetomidine to ropivacaine may bring some improvements to the analgesic efficacy of TAP blocks in patients undergoing lower abdominal surgeries. MATERIALS AND METHODS: The study was conducted on forty patients undergoing lower abdominal surgeries under general anesthesia. The patients were divided into two groups: one receiving plain ropivacaine (Group 1) and other receiving ropivacaine with dexmedetomidine (Group 2) during TAP block. The patients in the two groups were compared for age, sex, body mass index, incidence of postoperative nausea, and vomiting and pain as measured on visual analog scale (VAS). RESULTS: There was significantly lower pain score on VAS at 1, 3, 6, 12, and 18 h in Group 2 than in Group 1. CONCLUSION: The addition of dexmedetomidine to ropivacaine during TAP block improves analgesic effect of TAP block and prolongs the duration of analgesia as well.

Macroglossia: An Uncommon Manifestation of Primary Hypothyroidism due to Hashimoto's Thyroiditis in a Teenage Child.

Thyroid disorders are prevalent in the paediatric population and untreated hypothyroidism leads to several adverse consequences like mental retardation, neurological impairment, short stature, delayed puberty and increased morbidity. Owing to a wide range of non-specific clinical manifestations, one must have a high index of suspicion for timely diagnosis and treatment of primary hypothyroidism. We describe the case of an adolescent girl who presented with short stature, delayed puberty and feeding difficulties owing to undiagnosed and subsequently untreated hypothyroidism.

Macroglossia: An uncommon manifestation of primary hypothyroidism due to Hashimoto's Thyroiditis in a teenage child / Journal of the ASEAN Federation of Endocrine Societies

@#Thyroid disorders are prevalent in the paediatric population and untreated hypothyroidism leads to several adverse consequences like mental retardation, neurological impairment, short stature, delayed puberty and increased morbidity. Owing to a wide range of non-specific clinical manifestations, one must have a high index of suspicion for timely diagnosis and treatment of primary hypothyroidism. We describe the case of an adolescent girl who presented with short stature, delayed puberty and feeding difficulties owing to undiagnosed and subsequently untreated hypothyroidism.

Macroglossia: An uncommon manifestation of primary Hypothyroidism due to Hashimoto's Thyroiditis in a teenage child / Journal of the ASEAN Federation of Endocrine Societies

@#Thyroid disorders are prevalent in the paediatric population and untreated hypothyroidism leads to several adverse consequences like mental retardation, neurological impairment, short stature, delayed puberty and increased morbidity. Owing to a wide range of non-specific clinical manifestations, one must have a high index of suspicion for timely diagnosis and treatment of primary hypothyroidism. We describe the case of an adolescent girl who presented with short stature, delayed puberty and feeding difficulties owing to undiagnosed and subsequently untreated hypothyroidism.