bluuebunny/crossref_metadata_2025 huggingface dataset:
Novelties in Costa Rican Stelis (Orchidaceae: Pleurothallidinae): two new species and a new record in the "Dracontia group"
Authors: Karremans Adam P. , Díaz-Morales Melissa
Published: July 2017

Stelis dies-natalis y Stelis aenigma, pertenecientes a un grupo de especies en su mayoría Centroamericanas colocadas alternativamente en el género Dracontia, son descritas e ilustradas basadas en material vivo. Ambas se encontraron en robledales de altura en diferentes picos de la Cordillera de Talamanca en Costa Rica. La primera, S. dies-natalis, se encontró en los Cerros Buena Vista y Urán, es similar a S. hydra pero se puede distinguir por la inflorescencia relativamente corta, las flores morado oscuro con un labelo amarillo cubierto por verrugas morado oscuro, los pétalos apiculados y el labelo con un apículo brevemente acuminado. La segunda, S. aenigma, que se pensaba inicialmente que se trataría un segundo espécimen de S. dies-natalis cuando se colectó en el Cerro Utyum, pero se puede distinguir fácilmente por las inflorescencias con pocas flores que apenas supera el tamaño de la hoja, las flores rojizas, el labelo sigmoideo y la antera obtusa y cuculada. Stelis platystylis, una especie previamente conocida de México a Nicaragua, es ilustraba basada en material vivo de Costa Rica.
A key to genera of Iranian lady beetles (Coleoptera: Coccinellidae) and species of subfamilies Chilocorinae, Coccinellinae, Epilachinae and Microweiseinae
Authors: Abdolahi R. , Nedvěd O. , Nozari J.
Published: July 2017

A key to genera of Iranian Coccinellidae, besides species of subfamilies Chilocorinae, Coccinellinae, Epilachinae and Microweiseinae is given.
The role of silicon (Si) in increasing plant resistance against insect pests review article
Authors: Sakr N.
Published: July 2017

Silicon (Si) is reported to improve plant resistance to a range of biotic and abiotic stresses, with consequent yield increases. Silicon plays an important role in providing defense for crops of great economic importance against insect pests attack. In this study, the interaction between plants treated with silicon and reduced insect damage was reviewed. The current review presents the agronomic importance of silicon in plants, the control of insect pests in different major crop plants by silicon treatment, the different mechanisms of silicon- enhanced resistance, and the absence of silicon effects on insect pests. By integrating the data presented in this paper, a good knowledge of the association between silicon treatment, increasing plant resistance, and decreasing insect pest damage could be attainted.
Az autológ idegtranszplantátumok helyett alkalmazott módszerek a kéz idegsérüléseinek helyreállításában
Authors: Bíró Vilmos
Published: July 2017

Abstract:

For a long time in the clinical practice the autologous nerve transplants are used in reconstruction of the segmental defects of injured hand nerves. The published outcomes, especially in case of the motor and mixed (sensory and motor) nerves, however, were not satisfactory. Hence, it remained a problem and in the focus of research. The author aimed to study this topic and drawing conclusions in his literary review publication. According to the recent results, the replacement of the autologous nerve transplants with other materials (e.g. nerve conduits, various allografts, etc.) has shown good outcomes in mixed nerves too, if the distance of the resected nerve ends do not exceed 6 mm and the diameter of the nerves were not more than 3–7 mm. The applications of these methods have shown poor results, if the defect and/or the nerve diameter were larger. So, in these cases the autologous nerve transplantation remains the optimal management in the future. Orv Hetil. 2017; 158(30): 1163–1167.
A kommunikáció nehézségei daganatos gyermekek szüleivel a palliatív ellátásra történő áttérés során
Authors: Nyirő Judit , Hauser Péter , Zörgő Szilvia , Hegedűs Katalin
Published: July 2017

Abstract:

Introduction: Adequate communication by medical personnel is especially important at certain points during the treatment of childhood cancer patients. Aim: To investigate the timing and manner of communication with parents concerning the introduction of palliative care in pediatric oncology. Method: Structured interviews, containing 14 questions, were carried out with physicians working in pediatric oncology (n = 22). Codes were generated inductively with the aid of Atlas.ti 6.0 software. Results: Interviews show a tendency of a one-step transition to palliative care following curative therapy. Another expert is usually involved in communication, most likely a psychologist. Regarding communication, there are expressions utilized or avoided, such as expressing clarity, self-defense and empathy. The communication of death and dying was the most contradictory. Conclusion: This was the first investigation regarding communication in pediatric palliative care in Hungary. Our results show that a modern perspective of palliative communication is present, but necessitates more time to become entrenched. Orv Hetil. 2017; 158(30): 1175–1181.
An Analytical Network Process on Financial Access of the Small and Medium Enterprise in Sharia Banking in Tasikmalaya City
Authors: Suryanto Asep , Nasution Fatimah Zahra
Published: July 2017

Small and Medium Enterprise (SME) is one of the significant roles in national economic development. It is seemly followed by the rise of employment absorbent and equity in income distribution. The capital constraint and the impedance of banking financial access have become the main problem to the Small and Medium entrepreneurs. The objectives of this research are to identify the main factors as problems of Small and Medium Enterprises in having access to the financial institutions, and also to find out the solutions of the research problems. This research uses qualitative approach i.e. Analytic Network Process (ANP). Through applying this method, it is expected to help the researchers in making measurement and synthesis of some factors regarding on the topic analyzed as well as finding the solution for problems faced by the SMEs. The resources of the data is derived from questionnaires and in-depth interview with experts, practitioners, SMEs and regulators which then analyzed by the structure and hierarchy into homogen clusters of the SMEs problems and solutions, measuring into ratio scale and building synthesis. As the result, it becomes clear what factors impeding the financial access of the SMEs to banks. The results of this research show that the difficulties of SMEs in accessing financial support in Islamic financial institutions are internal problems of Islamic banking i.e. lack of financial assistance given to the SMEs, the functions of Islamic banking as business partners for SMEs is not optimal. Whereas the external problems in the SMEs are the disability in meeting the financial requirements asked by Islamic banking that are collateral and business history. The internal solutions are Islamic banking must give business mentoring to SMEs that have received financial supports to minimalize the bad credits level. The external solution is the government must also socialize Islamic financial mechanism to SMEs as part of education efforts.
“Islamic Moderation” in Perspectives: A Comparison Between Oriental and Occidental Scholarships
Authors: Islam Tazul , Khatun Amina
Published: July 2017

‘Islamic moderation’ has received a great deal of academic and media attention both in the West and in the East. Yet, the denotation of the very term still remains abundantly paradoxical as different regions and contexts provide different sheds of meanings. In the western scholarship, Islamic moderation is concerned with liberal social norms, hermeneutics, political pluralism, democratic process, organizational affinities, and views of state legitimacy over the monopoly of violence, some kind of adaptation, willingness to cooperate or compromise. However, it is by no means exhaustive as its definition in Islamic scholarship provides some unlike constituents. To define moderation, Muslim scholars, firstly explores to lexical meanings of its Arabic substitute “wasatiyyah”. Secondly, they explore the textual meanings of the word “wasatiyyah” used in the orthodox text i.e the Quran and traditions (Sunnah) of the Prophet Muhammad (pbuh). According to them, moderation is a best suited, justly balanced or middle position between two extremes i.e. extremism and laxity. Their use of the term, is contextualized in terms of counter-extremism, modest socio-religious behaviour and temperate legal position. This research finds out a considerable textual and contextual difference in the use of the term ‘Islamic moderation’ between the East and the West. Hence, this study aims to explore the lack of integration between both scholarships in this issue.
The Determinants and Consequences of District Partisan Change and Intactness in the Congressional Redistricting Process: An Integrative Model
Authors: Born Richard
Published: July 2017

In this study of redistricting from 1992 to 2012, we develop an integrative path analysis model that links together the two parts of the congressional redistricting process: the impact of political and environmental antecedent variables on district partisan change and constituency intactness, and the subsequent impact that partisan chance and intactness have on incumbent reelection margin. Environmental factors, most notably the extent of a district’s overor under-population prior to redistricting, are found to ultimately make more difference on safety than does party control of the redistricting plan. Furthermore, the pathways extending through partisan change are more important for members’ reelection margin than are the pathways extending through intactness. Since members typically end up with a sizable share of new constituents, however, whereas a fairly even balance exists between districts left with pro-incumbent or anti-incumbent partisan change, the average member actually has somewhat more to fear from the former product of the redistricting process.
The Newest Southerners: Generational Differences in Electoral Behavior in the Contemporary South
Authors: Prysby Charles
Published: July 2017

Young voters contributed disproportionately to Barack Obama’s presidential victory in 2012. In fact, if the electorate had been limited to those over 30 years old, Mitt Romney might be in the White House today. Obama captured 60 percent of the vote of those under 30, compared to 49 percent of those over 30, according to the national exit polls (Schier and Box- Steffensmeier 2013, 86). A similar pattern characterized the 2008 presidential election: Obama won 66 percent of the vote among those aged 29 or less, but under one-half of voters older than 45 (Pomper 2010, 53). The tendency for younger voters to be disproportionately Democratic emerged in the 2004 presidential election. Prior to that, Democratic presidential candidates did not consistently do better among younger voters. In 2000, for example, Al Gore did as well among older voters as he did among younger voters, and in 1992, Bill Clinton did his best among older voters, as did Walter Mondale in 1984 and Michael Dukakis in 1988 (Pomper 2001, 138; Pomper 1989, 133).
Presidential Agenda-Setting on the Economy during the “Great Recession”
Authors: Peake Jeffrey S.
Published: July 2017

Presidents are often identified as the most significant agenda-setter in the policy making process. However, agenda-setting theory indicates significant limitations to presidential leadership, particularly under certain policy contexts. In order to assess the presidency’s capacity to lead the systemic agenda in the context of an economic downturn, I analyze President Obama’s public relations efforts on the economy from January 2009 through May 2012. Specifically, I track the amount of attention given the economy in Obama’s public speeches and remarks and assess the degree to which they impacted or responded to media coverage of the economy and public concern for and confidence in the economy at both a weekly and monthly level. The findings suggest that the president’s attention to the economy was largely responsive to shifts in media attention and public opinion on the economy. This was especially the case with regard to the president’s attention to jobs and unemployment. However, Obama’s public leadership efforts on the topics of debt and spending directly impacted media coverage and indirectly affected public opinion on the economy.
Engineering expert witness work: what the lawyers require
Authors: Caiden David
Published: July 2017

The author is a civil engineer who has lived and worked in different countries where he has undertaken numerous engineering expert roles. This has included roles concerned with litigations and disputes, forensic investigations of engineering failures and accidents as well as insurance claims advisory roles. Some advice is given about what is expected of an expert witness, and it is intended that this paper will be a useful primer for engineers being engaged as expert witnesses, particularly if that work is in the UK or the USA.
SITUAÇÃO EPIDEMIOLÓGICA DO TRACOMA NO PIAUÍ, NORDESTE BRASILEIRO
Authors: Paiva Miguel Henrique Pereira de , Costa Maria Amélia de Oliveira , Luz Rogério Ferreira , Souza Renato Douglas e Silva , Miranda Junior Adelmo Barbosa de , Melo Filho Francisco Rogério de Araújo , Reis Mayara Rafaela dos
Published: July 2017

Este estudo objetivou apresentar a epidemiologia do tracoma no Piauí com enfoque no número de casos positivos, formas clínicas e locais de ocorrência. Tratou-se de um estudo exploratório de abordagem quantitativa, realizado a partir da análise de dados de acesso restrito sobre a situação epidemiológica do tracoma no Piauí. Casos positivos de tracoma foram notificados em 34 municípios piauienses nos últimos nove anos, a maioria localizada na região Sudoeste do Estado e apresentando baixo índice de desenvolvimento humano. O município de Uruçuí apresentou o maior número de casos. foram notificados 593 casos de tracoma, sendo o tracoma folicular a forma clínica mais frequente, além de casos raros de tracoma inflamatório intenso e um caso de tracoma cicatricial. Considerando dados do último inquérito nacional do tracoma no Piauí, houve redução de municípios afetados, corroborando com a meta da Organização Mundial de Saúde de eliminação de tracoma até 2020.
INFLUÊNCIA DOS FATORES BIOLÓGICOS E SOCIOECONÔMICOS NO DESENVOLVIMENTO NEUROPSICOMOTOR DE PRÉ-ESCOLARES
Authors: Pereira Juliana Fernandes , Formiga Cibelle Kayenne Martins Roberto , Vieira Martina Estevam Brom , Linhares Maria Beatriz Martins
Published: July 2017

O objetivo do estudo foi caracterizar as variáveis socioeconômicas e psicossociais de crianças que frequentam creches públicas e avaliar a influência destes fatores no desenvolvimento neuropsicomotor. Realizou-se um estudo analítico-observacional transversal com 61 crianças, de ambos os sexos, com idade de quatro a seis anos, frequentadoras das creches públicas na cidade de Goiânia (GO). O desenvolvimento infantil foi avaliado pelo teste de triagem de Denver II e foi aplicado questionário socioeconômico, classificação ABEP e questionários sobre os dados biológicos e clínicos da criança com os pais. Verificou-se que 77% das crianças avaliadas apresentaram risco na classificação global do teste de Denver II, sendo típicas nas áreas psicossocial, motor fino, motor amplo e linguagem. A análise da influência dos fatores revelou que a renda familiar (até R$2.000,00) esteve associada com maior porcentagem de risco no desenvolvimento da linguagem (64%). Os demais fatores não tiveram diferença estatisticamente significativa. Conclui-se que crianças aparentemente normais possam apresentar risco em seu desenvolvimento e a necessidade de novos estudos que apontem a influência significativa dos fatores socioeconômicos e psicossociais sobre o desenvolvimento neuropsicomotor.
EFEITOS DOS ANTI-INFLAMATÓRIOS NÃO ESTEROIDAIS DURANTE A GESTAÇÃO E AMAMENTAÇÃO EM RATOS WISTAR
Authors: Nomellini Giovana Alice Faggion , Vicari Denise Foresto , Furtado Viviana Bernardes , Crisci Ana Rosa
Published: July 2017

Avaliar as possíveis alterações fetais, o comprimento e peso, da prole após a indução de dois tipos de AINES em ratos Wistar, durante a gestação e amamentação. Foram utilizados 24 animais, perfazendo-se com isso três grupos de oito animais, para comparar os resultados dos AINES; os animais receberam esses AINEs por gavagem a cada 24 horas durante o período de gestação e amamentação. A seguir foi realizada antropometria dos filhotes. Ao se analisar os valores médios de peso e comprimento ao nascer, verificou-se que existe diferença significativa entre seus pesos e comprimentos médios (p
PERFIL SOCIODEMOGRÁFICO ASSOCIADO EM NÍVEL DE APTIDÃO FÍSICA RELACIONADA À SAÚDE EM ESCOLARES
Authors: Sehn Ana Paula , Reuter Cézane Priscila , Kern Deise Graziela , Silva Cristiane Fernanda da , Barbian Cláudia Daniela , Welser Letícia , Burgos Miria Suzana
Published: July 2017

Este estudo teve como objetivo verificar se existe associação entre fatores sociodemográficos e níveis de aptidão física relacionada à saúde em escolares. Foram sujeitos deste estudo transversal 1.000 crianças e adolescentes, de sete a 17 anos de idade, de Santa Cruz do Sul-RS. Analisou-se o nível socioeconômico, o perfil nutricional, a flexibilidade, a resistência abdominal e a aptidão cardiorrespiratória. Todas as análises foram realizadas no programa estatístico SPSS v. 23.0, considerando um nível de significância de p
Reproducibility of preclinical data: one man's poison is another man's meat
Authors: Bespalov Anton , H. Emmerich Christoph , Gerlach Björn , C. Michel Martin
Published: July 2017

Limited reproducibility of preclinical data is increasingly discussed in the literature. Failure of drug development programs due to lack of clinical efficacy is also of growing concern. The two phenomena may share an important root cause — a lack of robustness in preclinical research. Such a lack of robustness can be a relevant cause of failure in translating preclinical findings into clinical efficacy and hence attrition, and exaggerated cost in drug development. Apart from the study design and data analysis factors (e.g., insufficient sample sizes, failure to implement blinding, and randomization), heterogeneity among experimental models (e.g., animal strains) and the conditions of the studyused between different laboratories is a major contributor to the lacking of robustness of research findings. The flipsideof this coin is that the understanding of the causes of heterogeneity across experimental models may lead to the identification of relevant factors for defining the responder populations. Thus, this heterogeneity within preclinical findings could be an asset, rather than an obstacle, for precision medicine. To enable this paradigm shift, several steps need to be taken to identify conditions under which drugs do not work. An improved granularity in the reporting of preclinical studies is central among them (i.e., details about the study design, experimental conditions, quality of tools and reagents, validation of assay conditions, etc.). These actions need to be discussed jointly by the research communities interested in preclinical data robustness and precision medicine. Thus, we propose that a lack of robustness due to the heterogeneity across models and conditions of the study is not necessarily a liability for biomedical research but can be transformed into an asset of precision medicine.
Validation of novel multiplex technologies
Authors: Akyüz Levent
Published: July 2017

The parallel analysis of multiple factors, such as cytokines, from small sample size is an interesting approach for assessment of in vivo activation signatures and functionality after ex vivo stimulation. One interesting application is for therapy monitoring, such as safety data, pharmacodynamics, evidences for mode-of-action and side effects, particularly useful for accompanying early phase clinical trials. There are different platforms for Multiplex analysis of ligands available. We compared in this study the performance of three different platforms (Luminex Bio-Plex® 200, MesoScale Discovery®, Ella®) which use different ways of achieving parallel measurements of biomarkers from small liquid sample size. We show examples of in house assessment of intra- and inter-assay variations, determination of range and recovery for classical immunological serum markers and discuss advantages and disadvantages for these three platforms in relation to the question addressed.
Delayed appendicectomy in patients with non-perforated acute appendicitis
Authors: B. N. Anandaravi , S. R. Krishna , H. D. Pradeep Kumar , Garg Mayank
Published: July 2017

Background: Appendicitis remains one of the most common diseases encountered by the surgeon in practice. Appendicectomy is the most common urgent or emergency general surgical operation performed. Emergency appendicectomy is believed to be the standard treatment protocol for patients with acute appendicitis. This study was conducted to verify whether acute non-perforated appendicitis requires immediate surgery or can be delayed to be taken up on elective basis.Methods: This is a retrospective study of all the cases undergoing appendicectomy for acute appendicitis over the period of January 2016 to December 2016 in K. R. hospital, Mysuru, Karnataka, India. The cases were divided into two comparison groups: emergency group (operated within 12 hours of admission) and delayed group (operated between 12-72 hours). Parameters like age, sex, duration of symptoms, total leucocytes count, temperature, haemoglobin, radiological investigations, operative procedure, operative time, length of hospital stay, length of post-operative stay were collected and the end points for comparison were: Operative time, perforation rate, post-operative complication, length of hospital stay, readmission rate. Cases of perforated appendicitis in preoperative diagnosis, interval appendicectomy and appendicectomy done in association with other abdominal conditions were excluded from the study.Results: During this one-year period 283 patients have undergone appendicectomy. Out of this 189 (66.8%) patients have undergone surgery within 12 hours of admission and 94 (33.2%) have undergone surgery between 12 to 72 hours of admission. There was no significant difference between the two groups in operative time, per operative perforation rate, post-operative complication rate, readmission rate. Length of the hospital stay was greater in delayed group as compared to emergency group. But there was no significant difference between the post-operative length of hospital stay.Conclusions: Acute appendicitis can be treated surgically in a delayed elective basis without increasing morbidity.
Pure mucinous (colloid) carcinoma of gall bladder: a rare entity
Authors: Rawal Gireesha , Ahluwalia Charanjeet , Yadav Amit Kumar , Dhawan Indrani
Published: July 2017

In the biliary tract, ‘mucinous’ carcinomas in which extracellular mucin constitutes more than 50% of the tumour volume, are very rare. Those tumours in which the mucinous pattern comprises of at least 90% of the tumour are called ‘pure mucinous’ carcinomas and are exceedingly rare in the gallbladder. We describe the case of a 55 years old female, who presented with the complaints of jaundice and dull aching pain in right hypochondriac region. USG abdomen was suggestive of carcinoma along with cholelithiasis, following which cholecystectomy was performed. Grossly, a large grey-white tumour was identified whose cut surface was variegated. Sections showed a tumour which was entirely composed of pools of extracellular mucin, in which clusters of tumour cells were floating. Based on morphology and immunohistochemistry, a final diagnosis of ‘pure mucinous (colloid) adenocarcinoma’ of the gallbladder was given. This case is described owing to the rarity of this neoplasm. The clinical features, natural history and prognosis of mucinous carcinoma of GB are not very well known, due to their extreme rarity. These have been discussed in this case report. Histopathological examination is vital for a decisive diagnosis of such cases.
Treatment for hepatocellular carcinoma in the caudate lobe: a report of 13 cases
Authors: Zhang Wei , Wu Yakun , Li You , Gong Jianping , Long Hao
Published: July 2017

Background: To investigate therapies of hepatocellular carcinoma in the caudate lobe, surgical approach and method, surgical outcome of hepatic caudate lobotomy.Methods: Clinical data of 13 patients with hepatocellular carcinoma in the caudate lobe who received surgical treatment in the Department of Hepatobiliary Surgery of the Second Affiliated Hospital of Chongqing Medical University from Jan 2010 to Jan 2014 was retrospectively analyzed.Results: Two patients selected TACE therapy. However, tumor metastasis was observed on them in short term, and the therapeutic effect was poor after several times of treatment. Nine patients received surgical treatment. Surgical approaches included left approach, right approach and combined approaches from the left and right side; surgical method was part or complete caudate lobe resection combining with other liver segments. The operation time was 220.0-350.0 minutes, with the average value of 259.4 minutes. The vascular clamping time was 21.0-45.0 minutes, with the average value of 30.2 minutes. The bleeding volume was 400.0-1800.0 ml, with the average value of 844.4 ml. In all patients, there was no perioperative death and no postoperative liver failure happened, and 4 patients who suffered from interrelated complications were cured or got better by conservative treatments. All patients were followed up for 24 months. The recurrent rates of 1 and 2-year were 44.4%, 88.9% respectively, and the survival rates of 1 and 2 year were 66.7%, 44.4% respectively after surgical resection.Conclusions: Resection is still the preferred therapeutic method for hepatocellular carcinoma in the caudate lobe. However, long-term outcomes of the therapy for hepatocellular carcinoma in the caudate lobe need further improvement.
Clinico-bacteriological study of vesical calculus: a prospective study
Authors: Tekam Vijay Kumar , Choube Abhishek
Published: July 2017

Background: The incidence of primary bladder calculi in developed countries has been steadily and significantly declining since the 19th century because of improved diet, nutrition and infection control. In these countries, vesical calculi affect adults. However, bladder calculi remain common in developing and less developed countries. Despite the presence of several studies in countries with a high incidence of the disease, no complete uniformity in the reporting of data exists.Methods: The present study was carried out in 76% admitted patient of vesical calculus, investigated and treated by spcl. Some stones were subjected to bacteriological culture.Results: Incidence of vesical calculus was 1.01% of the total surgical admission and 14.87% out of total genito-urinary disease cases.Maximum number of patients were in the age group 0-10 years. Males predominated the females with a 12:1 ratio. E.coli was the commonest organism covering 22.3% of infection. All the cases were managed by spcl.Conclusions: It was concluded from our study that were common in children with low socio-economic status. Metabolic, infective, stasis and vitamin a deficiency (MISA) remained the important factor in its formation. They are usually single and commonly of mixed variety.
Sutureless, bloodless, safe new circumcision technique
Authors: Mohamed Wael Barakaat Ahmed , Ahmed Ahmed Eisa
Published: July 2017

Background: Several techniques of circumcision are available such as conventional surgical technique, the device (Gomco, Plastibell), mono and bipolar diathermy and sutureless methods such as fibrin glue. Our knowledge, the first report of using harmonic scalpel in circumcision was published by Peng et al, in the Asian journal of andrology but the study was done on dogs, this one of the little studies describe the use of the harmonic scalpel in male circumcision in humans. Aim was to describe the technique of the harmonic scalpel circumcision and report its outcomes in the term of safety and efficacy.Methods: This was a prospective observational study performed in the general surgery department at Sohag university hospital, Sohag, Egypt from 1st January 2015 to 31 December 2016.Results: 90 male patients were included in this study. Their age ranged between 3 and 18 years. The most common indication was religious circumcision 50%. No intraoperative blood loss or a postoperative bleeding. One case of wound infection and three cases of a postoperative edema respond to conservative treatment. No injury to the surrounding structure.Conclusions: The result of this study determines that the harmonic scalpel circumcision not associated with intraoperative blood loss or postoperative bleeding and a good postoperative cosmetic result, with a minimal complication. So, it is an appropriate alternative to the traditional scalp and suture technique.
Changing trends in elective splenectomy at a tertiary hospital in North India - a 10year study.
Authors: Rehmani Babar , Kumar Navin , Pathak Priyank
Published: July 2017

Background: Spleen is the meeting ground of medicine and surgery and most patients for elective splenectomy are primarily evaluated by physicians and then referred to the surgeons. Both physicians and surgeons need to be aware of the utility of splenectomy as a therapeutic option in various medical conditions. This study looks at the indications for elective splenectomy and the outcomes over a decade at a tertiary care centre in North India. It also evaluates the adherence to protocols recommended for prevention of OPSI in adults.Methods: A hospital based prospective observational study was conducted at a tertiary care hospital situated in Uttarakhand, North India, over a duration of 10 years from October 2006 to October 2016. The inclusion criteria for the study were all the patients undergoing splenectomy for the non-traumatic indications.Results: Sixty-one patients underwent splenectomy in the 10 years’ duration. The age range of patients was from 17-79 years with twenty-six males and rest females. Hypersplenism was the commonest indication for splenectomy. There were eleven cases of primary hypersplenism and there were twenty-five cases of secondary hypersplenism. Portal hypertension was the main cause of secondary hypersplenism requiring splenectomy.Conclusions: The major indications of elective splenectomy were hypersplenism secondary to portal hypertension due to EHPVO and haematological disorders mainly ITP. Mortality is 2.4% and morbidity is 21.4%. Vaccination rates of 75% were seen in planned splenectomy however, no case of OPSI recorded in this series.
Effective diagnosis for the management of gall stone: a clinical study
Authors: Rathod Vinod , Chavhan Nishant , Dahake Tushar
Published: July 2017

Background: Gallstones also known as cholelithiasis, is one of the most occurring and costly gastrointestinal disorder. Management of acute biliary cholelithiasis mainly involves pain control with non-steroidal anti-inflammatory drugs or narcotic pain relievers. However, surgical procedures like laparoscopic and mini-laparotomy cholecystectomy is also use for the management of it.Methods: Present clinical study gives an account of the diagnostic criteria for the effective management of acute biliary cholelithiasis, the diagnosis of gallstones was done by ultrasonography (USG).Results: Present study indicated females more (73.33 %) prone to occurrence of gallstone compared to males (26.67 %). Abdominal pain was the common feature in all the patients, with majority complaining (40 %) pain in right hypochondrium and epigastrium. Dyspepsia along with Nausea and vomiting was associated in 70 % and 66.66 % patients respectively. Tenderness and tenderness of hypochondrium were reported in 70 % and 30 % patients respectively. Ultrasonography served to be the major technique in diagnosing gallstones in the present study with success rate of 98.33 %.Conclusions: The present study concludes male-female ratio for occurrence of gallstones 1:2.75. Pain in the abdomen with nausea/vomiting and dyspepsia is the major clinical feature along with the occurrence of tenderness with elevated leucocytes count as one of the prime diagnostic criteria’s. Present study concluded ultrasonography (USG) as the correct technique in diagnosing gallstones.
Role of FNAC in soft tissue tumors and its histopathological correlation
Authors: Jain Veenu , Agarwal Tarun
Published: July 2017

Background: Soft tissue tumours are very rare. They are diagnosed initially by Fine needle aspiration cytology (FNAC). The present study was conducted with the aim to study the acceptability and diagnostic accuracy of cytodiagnosis in soft tissue lesions, to evaluate the reliability of cytodianosis as compared conventional histological paraffin section and to assess nuclear grade in various soft tissue lesions.Methods: The present study was conducted on 140 patients of soft tissue tumours during the period from August 2002 to July 2003 in the Department of pathology and microbiology, LLRM medical college, Meerut. FNAC was done in 132 cases and histopathology was conducted in 86 cases and correlation of those results was done.Results: Diagnosis of STT by FNAC was done in 132 cases. In benign tumours maximum number of cases (28) was in the age group of 20-29 years and in malignant tumours maximum number of cases (7) was in the age group of 40-49 years. 110 (83.3%) cases were benign and 22 (16.7%) cases were found to be malignant. Maximum number of STT was observed in trunk followed by limb extremities. Male preponderance was observed in the study. The overall accuracy of the present study was 97.7%. Accuracy for diagnosing benign soft tissue tumours was 100% and for malignant STT was 94.5%. The sensitivity, specificity and predictive value of the present study was 100%, 98.6% and 93.3%.Conclusions: FNAC plays a very important role in initial diagnosis of soft tissue tumours. It provided acceptable diagnostic accuracy when supported by histopathology.
Comparative evaluation of laparoscopic versus open appendicectomy in cases of acute appendicitis
Authors: Gupta Atul Kumar , Chawda Vishal , Gupta Shalabh , Goel Apoorv , Bhagat Tripta S. , Agarwal Ayush
Published: July 2017

Background: Conventional open appendicectomy is a common emergency surgical procedure being used for more than a century. Despite continuously increasing popularity of minimal access surgery, laparoscopic appendicectomy has not gained enough popularity.Methods: A prospective randomized study to compare laparoscopic and open appendicectomy for the treatment of appendicitis was carried out from April 2015 to October 2016. Thirty patients each were randomized to two groups. Decision to operate was taken on clinical grounds.Results: Twenty-five patients in each group were confirmed to be suffering from appendicitis. While alternative diagnosis could be established in 4 out of remaining 5 patients in laparoscopic group, in only 1 out of 5 patients from open appendicectomy definitive diagnosis for pain could be established. There was no significant difference in operative time between two groups. Patients in laparoscopic group had lesser postoperative pain scores and wound complications. They also got discharged and returned to normal activity earlier than those in open appendicectomy group.Conclusions: Laparoscopic appendicectomy has lesser postoperative morbidity and improves diagnosis in nonappendicitis patients.
Is hypothyroidism a risk for gall stone disease? a study to assess the association
Authors: Watali Yawar Zahoor , Jain Rahul , Bali Rajandeep Singh , Mittal Ankul
Published: July 2017

Background: Gall stones are one of the most common problems affecting the digestive tract requiring hospitalization. The disease frequently occurs in young, otherwise healthy people with a prevalence of 11-36 % on autopsy report. Thyroid diseases are, arguably, among the commonest endocrine disorders worldwide. In the present study, we have tried to determine an association between gall stone disease, and previously diagnosed and undiagnosed hypothyroidism in patients presenting to our hospital for treatment. The aim of this study was to determine association between gallstones and hypothyroidism and to study the prevalence of previously undiagnosed hypothyroidism in all patients of gallstones.Methods: The study was a hospital based cross sectional, observational study conducted on 200 patients with upper abdominal pain attending the Surgery OPD and Emergency over a period of 1 years. Patients were divided into 2 groups: Case group (100 patients) with gall stones on ultrasound and Control group (100 patients) without gall stones on ultrasound. Thyroid profile along with other biochemical investigations was done and both the groups were compared for the parameters.Results: Both groups were comparable for age and sex of the patients. On considering the thyroid profile of the patients in both the groups we observed that 14% of patients were hypothyroid in case group and 8% of the patients in control group. On comparing the two groups, there was no statistically significant difference in the prevalence of hypothyroidism (p value 0.175) between the two groups. There was a significant difference when serum cholesterol and bilirubin levels were compared between the two groups. 7 patients out of 100 cholelithiasis had Choledocolithiasis too, these patients had significantly raised cholesterol and deranged liver function tests.Conclusions: No significant relation between gallstones and hypothyroidism was found in this study (p value=0.175) and need further evaluation. Among the hypothyroid patients the incidence of gall stones was highest among 51-60 years of age so we recommend that TSH level should be measured for every patient with gallstone disease in this age range.
Thoracotomy and decortication in chronic empyema (fibrothorax), in the era of video assisted thoracic surgery
Authors: Nichkaode Prabhat B. , Agrawal Rajendra , Patel Sachin Kumar
Published: July 2017

Background: Traditionally, open thoracotomy and decortication with or without pleurectomy is the treatment of chronic empyema in the stage of fibrothorax. Some recent reports have claimed similar clinical results by video assisted thoracoscopic surgery (VATS) with less morbidity and mortality than open surgery. Our experience with thoracotomy and decortication with or without pleurectomy for fibrothorax is reviewed, in this study. Aim was to evaluate results of the results of open thoracotomy and decortication with or without pleurectomy in patients with chronic empyema in the stage of fibrothorax.Methods: From September 2007 to March 2012, 126 patients with diagnosis of empyema thoracic were treated at institute. Diagnosis of chronic empyema was based on-duration of signs and symptoms before definitive treatment and imaging findings- such as constriction of thoracic cage and lungs. 56 patients fulfilled the criteria for chronic empyema and then underwent open thoracotomy and decortication.Results: 39 patients (69.6 %) were males, 17 patients (30.35 %) were females. Mean age of study group was 31.4 years. Etiology was synpneumonic effusion in 49 patients (87.5 %) sub pleural malignancy in 3 patients, traumatic haemothorax in 2 patients and ruptured hydatid cyst in 2 patients. The mean duration of symptoms and signs before definitive treatment averaged 42 days. All patients had chronic empyema (Fibrothorax), as confirmed by imaging and operative findings. There were 3 patients (5.4 %) with complications and one mortality. The postoperative length of stay averaged 11.2 days. There were no recurrences of empyema. Complete expansion of lung was confirmed by imaging in 53 patients at the end of 3 months on follow up.Conclusions: Treatment for chronic empyema thoracic with Fibrothorax can be achieved with open thoracotomy and decortication with low complication rates and low mortality with satisfactory results.
Offloading of diabetic foot wounds using Amit Jain’s offloading system: an experience of 23 cases
Authors: Dath Roshan , Rao U. Venkatkrishna , Kumar Kishore , Kumar Harish , Kumar Suresh
Published: July 2017

Background: It is a well-known fact that around 15% of patients with diabetes are likely to be affected by foot ulcers during their lifetime. The aim of this study was to evaluate and analyze Amit Jain’s offloading system used in diabetic foot wounds.Methods: A cross-sectional, retrospective study was done at 3 centres namely Brindhavvan Areion Hospital, Synergy Centre for Diabetes and South City hospital in Bangalore, India. The study period was for 1 year from April 2016 to March 2017.Results: 23 cases were included in the study. 16 patients (69.57%) had right foot involved whereas 7 patients (30.43%) had left foot involved. Majority of the patients had foot problems located at forefoot (86.96%). The most common condition where Amit Jain’s offloading was used was in trophic ulcer (61%). In 22 patients (95.65%), the microcellular rubber and ethyl vinyl acetate combination was used whereas in one patient (4.35%), 7 mm of single layered EVA was used. 9 patients (39.13%) had their wounds healed within 8 weeks whereas 11 patients (47.83%) had their wounds healed within 8-16 weeks.Conclusions: Amit Jain’s offloading device is a new offloading device that can be effectively used as an alternative to felted foam. It is based on deflective technique just like felted foam. In this series, 86.98% of the wounds had healed by 16 weeks with this new offloading device. The Amit Jain’s offloading device, which has a scientific rationale based on the deflective offloading as well as usage of visco-elastic material that is accepted worldwide, produces effective wound healing without any complication and without inhibiting patient’s mobility. Amit Jain’s offloading is a level one recommendation for diabetic foot wounds.
Comparative study on association between serum TSH concentration and Thyroid cancer
Authors: C. Prasad , Kumar Supreet , Y. Tej Tej
Published: July 2017

Background: In India, thyroid cancer accounts for less than 1% of all malignancies (2% of women and 0.5% of men). Thyroid cancer is responsible for 6 deaths per 1 million persons annually. Serum TSH is a well-established growth factor for thyroid nodules, however its role in thyroid malignancy is inconclusive hence this study was conducted with the objective to determine the association between serum Thyroid stimulating hormone (TSH) concentrations with thyroid carcinoma.Methods: Case control study was conducted in a tertiary care centre. 120 Benign and malignant thyroid subjects respectively were included in the study. Newly diagnosed and record based data collection was done. Measurements of serum TSH concentrations were performed by automated immune chemiluminescent assay. Data was analyzed using SPSS 22 version software, Chi-square test was used as test of significance for qualitative data, p value of <0.05 was considered as statistically significant.Results: Majority of them were females in the age group 26 to 40 years in both the groups and were diagnosed to have solitary thyroid nodule. In malignant thyroid nodules 51.7% were diagnosed to have follicular carcinoma, 46.7% had papillary carcinoma and 1.7% were diagnosed to have Hurthle cell carcinoma. Significant association was observed between TSH levels and diagnosis of thyroid lesions. TSH was raised (>4mIU/L) in 46.6% of malignant nodules and in 15% of benign nodules. Raised TSH had an odds ratio of 4.958 for Thyroid malignancy compared to benign nodulesConclusions: Higher TSH levels were associated with Thyroid malignancy and the risk of malignancy rises in parallel with serum TSH within normal range, and high levels of serum TSH concentrations was associated with advanced stage of thyroid cancer.
Study on outcome of laparoscopic donor nephrectomy
Authors: S. K. Subha Kanesh , P. Govindarajan
Published: July 2017

Background: Laparoscopic donor nephrectomy is being performed in increasing numbers since 1995. Now laparoscopic donor nephrectomy has been accepted as good alternate to open procedure as seen in various other abdominal surgeries. This was the basis of the present study. So, the present study was designed to analyse and compare the outcome of Laparoscopic donor nephrectomy and Open donor nephrectomies.Methods: The prospective and observational study was conducted at Stanley Medical College in Department of Urology in 61 Patients aged between 25-50 years who underwent left donor nephrectomy The Mean operating time, warm ischemic time, blood loss, analgesic requirement and duration of hospital stay were recorded and analysed statistically.Results: Out of 61 donor nephrectomies, 16 kidneys harvested by laparoscopic method with only 2 (12%) conversion to open due bleeding. Mean operating time was 179.9±47.6 minutes. Present study showed mean blood loss of (163±93 ml). Analgesic requirement of the LDN (mean 1.25 days) was significantly lower when compared to open group (mean 3.75 days). The present study shows duration of hospital stay was lower in LDN (mean 5.1days).Conclusions: Laparoscopic donor nephrectomy is an effective, safe and rewarding though it is time consuming and technically challenging. The analgesic requirement, duration of hospital stay and the blood loss were less with the laparoscopic surgery. Results of graft functioning of kidneys in both procedures were equivalent. So laparoscopic donor nephrectomy can be made as the procedure of choice in future.
Urachal Diverticulum presenting as abdominal pain: a surprise at surgery
Authors: J. Chaithanya , B. K. Srinivas , K. S. Hanumanthaiah , S. Rajagopalan
Published: July 2017

A urachal diverticulum is one of the spectrum of presentation of urachal pathology, all of which are very rare in adulthood. This report describes the experience of a urachal diverticulum in adult. Urachal abnormalities result from incomplete regression of the fetal urachus. They are more common in children than in adults, due to urachal obliteration in early infancy.
A case of chronic mesenteric ischemia managed by ascending aorta to superior mesenteric and hepatic artery bypass
Authors: Nambiar Harilal V. , Manappallil Robin George , Aikot Sylesh , V. Pramod
Published: July 2017

Chronic mesenteric ischemia is a rare and life-threatening condition which occurs due to occlusion of two or more mesenteric arteries following atherosclerosis. Multi-vessel revascularization forms the mainstay of treatment. This is a case of a middle-aged smoker who presented with abdominal angina and was diagnosed to have chronic mesenteric ischemia due to atherosclerotic occlusive aortic disease with coeliac artery and superior mesenteric artery occlusion. He was successfully managed with extra anatomic bypass from the ascending aorta to superior mesenteric and hepatic artery.
Tumour forming Pseudoangiomatous stromal hyperplasia: a case report
Authors: R. Vasuki , N. B. Thanmaran , Devi A. K. Kalpana , Moothedath Rajesh Menon , M. Satheesh Kumar
Published: July 2017

Tumor-forming Pseudoangiomatous stromal hyperplasia (PASH) is a rather uncommon breast lesion and only very few cases of tumor-forming PASH were reported from 1986, since the lesion was originally described. In contrast, focal, non-tumor forming PASH may be an incidental microscopic finding in up to 23% of breast biopsies. PASH is a benign proliferative lesion of the breast stroma that is characterized by slit-like pseudovascular spaces lined by endothelial-like spindle cells. It is indeed rare for a discrete breast mass to have PASH as the main pathological feature on histopathology. The breast mass, typically unilateral, was usually diagnosed clinically as a fibroadenoma.When found in tumour form, PASH most commonly manifests as a single, circumscribed, palpable mass in a premenopausal female. The main differential diagnosis histologically are fibroadenoma, phyllodes tumor and angiosarcoma. However, PASH is a benign condition with very good prognosis. Hence possibility of PASH in nodular or tumour form has to be considered when approaching a case of breast lump whose management is different. We report here a case of PASH in tumour form from our Institute.