bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of pelvic and para-aortic lymphadenectomy in epithelial ovarian cancers
Authors: Gupta Pankush , Kumar Sunesh , Singhal Seema , Meena Jyoti , Mathur Sandeep , Kumar Lalit
Published: December 2019

Background: Lymphadenectomy in epithelial ovarian cancers has remained a controversial subject. Lack of robust evidence on survival benefits and surgical morbidity associated questions its role in the era of adjuvant chemotherapy. The present study assessed pelvic and para-aortic lymph node removal in epithelial ovarian cancer in Indian women and tried to find clinicopathological correlation of nodal involvement and postoperative implications of lymphadenectomy.Methods: Thirty patients with diagnosis of epithelial ovarian cancer posted for primary debulking surgery were recruited and underwent staging laparotomy along with pelvic and para-aortic lymphadenectomy. Nodal involvement was confirmed on histopathology and various parameters which could predict nodal metastasis were assessed. Patients were followed up for 12 months post-surgery.Results: Nodal yield was ten for pelvic and four for paraaortic nodes. Pelvic node involvement was seen in 26.6% (8/30) of the patients and para-aortic in 15% (3/20) of the patients. Serous histology, higher grade, stage 3 and above, positive peritoneal cytology, omental involvement showed a higher lymph node involvement though not statistically significant. Para-aortic lymphadenectomy was associated with increased operating time, blood loss and longer hospital stay.Conclusions: Lymphadenectomy increases morbidity and decision should be based on predictors of nodal involvement.
Tramadol versus placebo for labor analgesia in low risk women: a randomized controlled trial
Authors: Raheja Aastha , Agarwal Krishna , Pachori Rini , Gandhi Gauri
Published: December 2019

Background: In low- and middle-income countries epidural analgesia is generally not available and practically no form of labor analgesia is given to the majority of the parturient. The purpose of study was to evaluate the safety and efficacy of tramadol as a labor analgesic during first stage of labor.Methods: Pregnant women admitted in the labor room satisfying the eligibility criteria were randomized to receive intramuscular injection of either 100 mg tramadol or 2 ml distilled water. Visual analogue score (VAS) was assessed at the beginning and every hour till 4 hours. Pain satisfaction, duration of second stage of labor, fetal heart rate, mode of delivery, and any maternal side effects of the study drug were recorded. Neonatal evaluation using Apgar score at 1 and 5 minutes was done. For statistical analysis Student t-test, Chi Square test and Fisher’s exact test were used.Results: Total of 86 women were included in the study. The VAS scores were significantly lower in the tramadol group at 1, 2 and 3 hours after the administration. Pain relief satisfaction was significantly higher in the tramadol group. Rate of cervical dilatation, duration of the second and the third stage, need for instrumental delivery or lower segment caesarean section, rate of fetal distress and Apgar score at one and five minutes were comparable in both the groups. Nausea was significantly higher in tramadol group.Conclusions: Tramadol is a safe and efficacious drug which is inexpensive, easily available and easy to administer with few minor side effects. It can be used as a labour analgesic as an alternative to epidural analgesia in settings where epidural analgesia is not available. Trial registration: Clinicaltrials.gov PRS registration number: NCT02999594.
The retina in hypertensive disorders of pregnancy: a study of the prevalence and association with severity of disease in a tertiary referral centre in India
Authors: Sharma Jasmine C. , Choudhary Bithi , Maru Laxmi , Mathur Poonam
Published: December 2019

Background: Hypertensive disorders of pregnancy remains to be a major cause of maternal and fetal morbidity and mortality. The retina offers the unique opportunity to directly observe changes in the vasculature due to preeclampsia. Fundoscopy can be used to prognosticate and assess the severity of disease and offer an optimum time of delivery to improve fetomaternal outcome. There are limited number of studies from northern India assessing the relationship between hypertensive disorders of pregnancy and retinopathy. This study was undertaken to bridge this gap.Methods: This was an observational cohort study undertaken in a tertiary hospital, 225 patients of preeclampsia coming to the department were identified and a structured proforma used to gather relevant information. All patients underwent fundoscopy and were classified into groups on the basis of fundal grade observed. The groups were compared in terms of clinicodemographic variables. Appropriate statistical tests were applied.Results: A total 68% patients had retinal changes of which the most common grade was grade 1 There was a significant rise in the mean systolic and diastolic blood pressure with increasing grade of fundal change. The (p-value 0.001). 65.5% of patients of preeclampsia without severe features (i.e. mild cases) had no retinopathy. None of these patients had grade 3 or 4 changes. In the patients of preeclampsia with severe features, 88.9% cases had varying degrees of retinopathy.Conclusions: As severity of preeclampsia increases, incidence of retinopathy also increases. Fundoscopy is a useful diagnostic aid and should be done to optimize fetomaternal outcome.
Huge Sertoli-Leydig cell tumor: a rare case report
Authors: Raghav Mridula , Anand Ashok R.
Published: December 2019

Sertoli-Leydig cell tumors (SLCTs), constitute less than 0.5% of all ovarian tumors. SLCT are rare after menopause (less than10%), 75 years, unmarried, postmenopausal since 30 years, presented with complaints of abdominal swelling. On examination, abdominal mass of 36 weeks, hard, immobile felt. Ultrasonography of abdomen showed lobulated solid cystic lesion of size 22 x 15 x 27 cms with bilateral ovaries not separately visualized. Moderate free fluid in the abdomen, suggestive of malignant neoplastic etiology. CECT Abdomen + pelvis suggestive of primary ovarian malignancy with omental deposits and pelvic adenopathy. CA 125- 415.1 Patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy with huge tumour mass excision (weight 5.25 kg) with umbilical hernia repair. Frozen section suggestive of a huge mass of 30 x 20 x 15 cm, multilobulated, yellowish white tan in colour, solid-cystic in consistency, seen arising from right ovary. Omentum appears normal. Histopathology report s/o- Moderately differentiated Sertoli Leydig cell tumor. Reporting the first, this huge, in this age group with atypical presentation.
Giant angioleiomyoma of uterus masquerading as ovarian tumour: a case report
Authors: Bhandari Purnima , Humane Anil C. , Deshmukh Vaishali S.
Published: December 2019

Angioleiomyoma is a rare benign tumour of uterus. We are presenting an unusual case of 45-year-old female with 11 kg giant angioleiomyoma of uterus which was masquerading as ovarian tumour on imaging. Exploratory laparotomy was done which was suggestive of huge lobulated mass arising from the uterus. Hysterectomy with bilateral salpingo-oophorectomy was done. Histopathological examination of specimen was suggestive of uterine subserosal and broad ligament angioleiomyoma of cavernous type. This case is being reported because of its rarity and challenges in diagnosis and management.
Analysis of revision rhinoplasty; what is the problem and the management?
Authors: Alhadad Mohamed , El Sakka Dalia , Samy Medhat , Fergany Ahmed
Published: December 2019

Background: Revision rhinoplasty is reported to occur in 8% to 15%. Reoperation should be performed to correct deformities that were not diagnosed or addressed in previous surgeries, such as those from poor planning, performance and poor surgical healing. The aim of the study was to evaluate the problem of each case seeking revision rhinoplasty and different modalities for management to reach satisfactory results.Methods: This is a prospective study which was done in plastic surgery department, Menoufia University Hospitals over the period from December 2017 to December 2019. The study included 31 patients underwent previous rhinoplasty.Results: Patients were selected from the outpatient clinic, 31 patients who had varieties of nasal deformities. Mean age of the patients was 31.7 years. Female represent the majority of patients by 80.60% and males were 19.40% with significant difference in satisfaction (p=0.05). Patient satisfaction after surgery and it was excellent for 14 cases (45.20%), good for 9 cases (29 %) and it was fair in 8 cases (25.8%). Rhinoplasty outcome evaluation (ROE) score was correlated with patient satisfaction grades as mean of ROE score in excellent group was 67.5; in good group was 58.3; while in fair group was 38.8 with significant p value (0.001).Conclusions: Excellent patient satisfaction is related good planning, close follow up time, and less complication. Cartilage grafts especially rib cartilage is considered a lifeboat for revision rhinoplasty. We can link grades of patient satisfaction to ROE score.
Comparative study between assisted laparoscopic and open D2 distal gastrectomy for gastric cancer
Authors: Amer Naglaa Fathy , El Shakhs Soliman Abdelrahman , Mohamed Moharam Abdelsamie , Shahin Mahmoud
Published: December 2019

Background: Although laparoscopic gastrectomy has been in use for many years, there was great debate for its technical feasibility and oncological safety. However, with recent advancements of laparoscopic surgical instruments and the accumulation of operative experience, laparoscopic gastrectomy becomes more feasible, and laparoscopic D2 lymphadenectomy has been achieved. Methods: This study was prospectively conducted from April 2016 to September 2018 on 40 patients presenting with distal gastric cancer to the outpatient clinic of Menoufia University Hospitals. All patients in the study performed radical distal gastrectomy with D2 lymphadenectomy aiming for cure. The patients were divided into 2 groups: group A (20 patients operated upon with open gastrectomy (OG) technique) and group B (20 patients operated upon with the laparoscopic gastrectomy (LG) technique). Both groups were compared in this study regarding operative details, short term post-operative complications and pathological results.Results: The mean operative time in OG was shorter than LG (p value: 0.04), while there was significant difference between both groups regarding blood loss, mean blood loss in OG was 420.8±87.6 ml and in LG was 283.4±45.9ml, parenteral analgesic requirement was significantly less in LG than OG (p value: 0.04) while no significant difference regarding Intra-operative complications and pathological results.Conclusions: Assisted Laparoscopic distal gastrectomy with D2 lymphadenectomy is feasible and safe with less post-operative pain and short hospital stay.
Management modalities of isolated liver injury in blunt abdominal trauma
Authors: Mangukiya Lalji , Astik Hardik
Published: December 2019

Background: The liver is one of the most commonly injured organ in blunt abdominal trauma. Management of liver injury due to blunt abdominal trauma has been dramatically evolved in recent years. Dramatic change from operative management to non-operative management has improved survival in these patients, becoming the standard of care for most liver injuries.Methods: A retrospective study of the patients admitted with the diagnosis of isolated liver injury due to blunt abdominal trauma between 2013-2018. Data collected of 30 patients of isolated liver injury who either treated conservative management of operative management. Variable analyzed included demographic data, mechanism of injury, associated injury, conservative treatment, operative treatment, morbidity, mortality, and hospital stay.Results: A total of 30 patients were analyzed of isolated liver injury due to blunt abdominal trauma, 27 patient sustained minor liver injury (grade I, II and III), whereas 3 patients had major liver injury (grade IV, V and VI). 25 cases due to road traffic accident and 5 cases were due to falls from a height. 27 patients with American Association for the surgery of trauma grade I, II, III and 2 patients with grade IV, V managed conservatively, surgical intervention required in 1 patient with grade V, mortality occurred in 1 patient out of 29 who were treated conservatively.Conclusions: Isolated liver injury is common in the blunt abdominal trauma patient. Most of the patients with the liver injury with hemodynamically stable treated conservatively. Only a few of them require surgical management if they are hemodynamically unstable.
Management and overview of postoperative chylothorax after congenital cardiothoracic surgery
Authors: Bansal Dhananjay , Chugh Vaibhav , Bhushan Rahul , Banday Javed M. , Jhajhria Narender S. , Grover Vijay , Gupta Vijay K.
Published: December 2019

Background: The aim of the study was to determine the incidence, risk factors, and outcomes for chylothorax in patients undergoing cardiothoracic surgery, with special emphasis on its management.Methods: Total of 24 patients with post-operative chylothorax, operated from September 2015 to December 2018, was included in the study. Medical records were maintained, including daily records of drainage volumes and management.Results: From September 2015 to December 2018, there were 24 cases of chylothorax in 600 congenital cardio-thoracic surgeries-an incidence of 4.0%. Overall mortality rate was similar, but cases had longer postoperative hospital stays (median, 22 versus 8 days). Incidence of chylothorax was significantly higher with congenital cardiac procedures. Diagnosis was made at a median of 6 days after surgery. Duration of drainage was a median of 15 days, with 11 patients draining more than 30 days. Longer duration of drainage was associated with cavopulmonary anastomosis procedure. Nutritional management included low fat diet, enteral feeds enriched with medium-chain triglycerides, and parenteral nutrition. Three patients were treated with octreotide, 4 with thoracic duct ligation, and 1 with pleurodesis. Octreotide was associated with a variable effect on drainage. Thoracic duct ligation reduced, but did not stop drainage.Conclusions: Chylothorax increases duration of hospitalization after cardiovascular surgery in children. Early diagnosis may reduce the duration of chylothorax. Nutritional strategies remain the cornerstone for management of postoperative chylothorax. The impact of octreotide and surgical intervention is limited when reserved for patients with severe or prolonged drainage.
Percutaneous nephrolithotomy in the pediatric age group: a study from North Karnataka
Authors: Kagalkar Suresh , Agarwal Surendra Kumar
Published: December 2019

Background: Nephrolithiasis is major problem in India. It is more prevalent in northern states of India and Karnataka is not an exception to this. Percutaneous nephrolithotomy (PCNL) has been accepted globally as a safe procedure with great success rate with less complication, and it is safe, effective, and suitable for pediatric cases. The aims and objectives of the study were to evaluate the indication of PCNL in children, to identify the complication, prevention and treatment of complication and to evaluate the efficacy and safely, management of kidney stones in children.Methods: Study period Aug 2015 July 2018, total 56 cases of renal stones in pediatric age group admitted in our Hospital, a tertiary care centre. All the patients evaluated for complete urine analysis, urine culture and sensitivity, complete hemogram, renal parameter, X ray KUB (kidney, ureter, and bladder), ultrasound KUB etc.Results: Small-stone (<2 cm) seen in 21.4% and large stone 64.2%. Following complications were noted- Pelvic perforations (3.5%), fever (7.1%) and hematuria (7.1%).Conclusions: PCNL is safe and effective procedure for the managements of renal stones in children with acceptable morbidity.
Skin closure after ileostomy reversal: comparative study between conventional linear versus purse-string suturing
Authors: Tiwari Deepak , Silodia Ashutosh
Published: December 2019

Background: Wound infection and scarring are relatively common complication after stoma reversal. Immediate skin closing by conventional linear closure technique is associated with varying percentage of wound infection ranging from 2 to 41%. Delayed skin closure is associated with prolonged healing time and poor scar cosmesis. In order to overcome these problems, an alternative method of skin closure during stoma reversal has been suggested. It involves taking purse-string subcuticular absorbable sutures to close the skin during Ileostomy reversal. Our study is a comparative study between conventional linear skin closure and this alternative form skin closure in stoma closure procedures for the assessment of surgical site infection and scar cosmesis.Methods: 40 patients were enrolled for the study, divided in two groups, one undergoing purse-string skin closing (n=20) and the other undergoing linear skin closure (n=20) during stoma reversal. All the data was analysed using IBM SPSS version 21.0 taking p value less than 0.05 was taken as level of significance.Results: Surgical site infections were seen in 3 out of 20 patients in whom purse-string skin closure was done, while it was 9 out of 20 patients in primary linear closure during stoma reversal group. Post-operative pain was found significantly lesser in purse-string group compared to linear closure group on same and first post-operative day. Scar cosmesis was assessed using patient and observer scar assessment scale and was observed better in purse-string group of patients.Conclusions: Purse-string skin closure is a better alternative surgical option to consider during stoma reversal surgeries as compared to conventional linear closure.
Correlation of pre-operative vitamin D3 levels with post-operative hypocalcemia in patients undergoing total thyroidectomy
Authors: M. N. Mallikarjuna , Kumar Arun , M. V. Ramya , C. S. Santhosh
Published: December 2019

Background: Total thyroidectomy (TT) is a commonly performed procedure for various  thyroid disorders, with parathyroid insufficiency manifesting as hypocalcaemia being a well-known complication. Albeit, vitamin D is well implicated in calcium homeostasis, the association between hypovitaminosis D and postoperative hypocalcaemia is yet to be concluded. The aim of our study is to evaluate the correlation of preoperative serum vitamin D3 levels  with occurrence of post-operative hypocalcemia in patients undergoing TT.Methods: A prospective  study  was conducted on 50 patients  undergoing TT for benign thyroid diseases from November 2016 to May 2018. Pre-operative vitamin D3 levels were estimated. Serum calcium levels was measured pre‑ and post‑operatively at 24hours, 1st week and 4th week. Serum calcium level ≤8.5 mg/dl was considered as biochemical hypocalcemia. A data of demographic, clinical, biochemical and intraoperative findings were documented and analysed.Results: Statically 14 (28%) patients developed symptomatic hypocalcemia. Out of these, 11 (78.5%) patients had preoperative vitamin D levels of <30 ng/dl (p=0.034). 24 hours postoperative serum calcium level was significantly  lesser in patients with  lower preoperative vitamin D levels (p=0.015), suggesting that postoperative  hypocalcemia (24 hr) is statistically related to pre-operative vitamin D3 levels.Conclusions: It could be concluded from our study that preoperative serum vitamin D3 levels can predict post-operative occurrence of symptomatic and/or biochemical hypocalcemia. Thus, it could be hypothesized that supplementing vitamin D preoperatively could curb the incidence of hypocalcaemia following TT. However, further relevant trials are needed to attest to this.
Thoracodorsal artery perforator flap in immediate breast reconstruction: a series of twenty cases
Authors: Reddy Thyagaraj , Dikshit Vashisht , Tilak Balgangadhara , M. S. Ganesh
Published: December 2019

Background: The management of breast cancer has shown a progressive change, from radical ablative surgery, to breast conserving techniques. Traditionally, the mini latissimus dorsi flap has been used for reconstruction; which is associated with donor site morbidity. Vascular research has now allowed the use of perforator-based flaps for reconstruction, which reduce donor site morbidity.Methods: Twenty thoracodorsal perforator flaps in twenty early breast cancer patients were studied between January 2018 and December 2018. Parameters studied were adequacy of volume, ease and time taken for flap elevation, and final aesthetic outcome.Results: Flap volume was adequate to fill defect. One of twenty cases had flap loss due to venous congestion secondary to pedicle kinking. Average time taken for flap elevation was 70.45 minutes. All patients were satisfied with cosmetic outcome.Conclusions: The TDAP flap is a safe and reliable flap which provides adequate volume for partial breast reconstruction.
Role of diagnostic laparoscopy in chronic abdominal pain
Authors: Hussain Sajid , Haideri Safia
Published: December 2019

Background: Chronic abdominal pain is a common disorder both in general practice and in hospitals. Although patients with this type of pain may have undergone numerous diagnostic workups, including surgery, their pain remains a challenge to all known diagnostic and treatment methods. Laparoscopy can identify abnormal findings and improve the outcome in patients with chronic abdominal pain, as it allows surgeons to see and treat many abdominal conditions that cannot be diagnosed otherwise.Methods: A prospective longitudinal study was conducted from August 2016 to September 2017 in the Surgery Department of Vinayaka Missions Kirupananda Variyar Medical College, Salem. 50 patients with abdominal pain for 3 months and above were included in the study. Detailed history was recorded from patients and thorough clinical examination was performed. The findings were recorded in the proforma.Results: The most common laparoscopy finding among the study subjects was dense adhesions (26%) followed by abdominal TB (18%) and mesenteric lymphadenopathy (16%). 88% of the study subjects had a total relief of their abdominal pain and 6% of the patients felt that the pain was reduced and for the remaining 6% the pain was still persistent.Conclusions: The efficacy of diagnostic laparoscopy was 90% in the current study. Laparoscopy has an effective diagnostic role in evaluating patients with chronic abdominal pain, in whom conventional methods of investigations have failed to elicit a certain cause. The therapeutic value of diagnostic laparoscopy is also accepted, well-appreciated, and it cannot be underestimated.
Study on incidence of oesophageal carcinoma in patients undergoing upper gastrointestinal endoscopy for upper gastrointestinal symptoms in a secondary care hospital
Authors: Puttaraju Shashidhara , Gnanakumar Deva Keerthana Yesudian
Published: December 2019

Background: Oesophageal carcinoma is one of the leading causes of cancer related deaths worldwide and is also associated with high morbidity. Hence early diagnosis and treatment are the only effective way to improve survival and quality of life in oesophageal carcinoma patients. Early-stage oesophageal carcinoma are often asymptomatic and may also present with common upper gastrointestinal symptoms hence diagnosis of early oesophageal carcinoma is only based on detection of suspicious lesions through endoscopy and histopathological evaluation of biopsies from these suspicious lesions. The study is designed to see whether using alarming upper gastrointestinal symptoms, risk of oesophageal carcinoma in patients can be predicted.Methods: Present study comprises of 200 patients presenting with upper gastrointestinal symptoms at JSS Hospital, Chamarajanagar (both out patients and referred patients) during the period of October 2018 to December 2019, who underwent upper gastrointestinal endoscopy.Results: Out of 200 patients, 135 patients were males and 65 patients were females. According to the study, dysphagia was found to be a significant predictive factor and in contrary to the global statistics this study showed females aged more than 60 years were significantly at higher risk of developing oesophageal carcinoma.Conclusions: We recommend to do an early endoscopy for any patient presenting with upper gastrointestinal symptoms and to take multiple biopsies from any suspicious lesion especially for male gender older than 50 years and female gender older than 60 years presenting with dysphagia.
Can preoperative serum lactate dehydrogenase levels predict postoperative pulmonary complication following an emergency abdominal surgery? An observational study
Authors: Murugavel Ananthakumar , Kanth Vishnu , Palanivelu Elamurugan Thirthar
Published: December 2019

Background: Postoperative pulmonary complications (PPC) are one of the commonest complications following gastrointestinal surgery. They lead to increase in morbidity and mortality. Lactate dehydrogenase (LDH) is an enzyme present in essentially all major organ systems. Studies have shown measurement of its activity levels and its isoenzyme pattern may provide additional information about lung and pulmonary endothelial cell injury. The objectives of the present study were to study the levels of serum LDH in patients with and without post-operative pulmonary complications following emergency abdominal surgery.Methods: The study was designed as an observational study. All patients ≥18 years of age undergoing gastrointestinal surgery, excluding those with prior lung pathology were included in the study. The demographic parameters, clinical parameters and laboratory parameters along with details of pulmonary complications were recorded. Serum LDH level were assessed on admission. Levels of serum LDH were compared between patients with and without post-operative pulmonary infections and were assessed for significance.Results: Incidence of PPC was 28% in our study. There was significant difference in the mean age in the group with and without PPC (p=<0.001). Smoking habit, serum albumin total protein and upper abdomen incision surgery were associated with increased incidence of PPC. Pleural effusion was the commonest PPC seen in patients. Serum LDH was not significantly associated with the incidence of PPC.Conclusions: Pre-operative serum LDH level is not a predictive factor for occurrence of postoperative pulmonary complication. Age, smoking, total protein, serum albumin, upper abdomen incision were found to associated with increased risk of PPCs.
A comparative study of laparoscopic trans abdominal pre peritoneal ventral hernia repair versus open pre peritoneal ventral hernia repair
Authors: Shingade Pravin N. , Rawat Anshu , Sooraj Rizhin
Published: December 2019

Background: Ventral hernias are defined as a protrusion of abdominal contents through the abdominal wall muscle. It can be categorised as spontaneous or acquired or by their location on the abdominal wall like epigastric hernia, umbilical hernia, para umbilical hernia etc. This original article reveals that laparoscopic trans abdominal pre peritoneal (TAPP) mesh placement for ventral hernia usually follows the current principle of hernia surgery and give better results from open pre peritoneal ventral hernia repair.Methods: A prospective study conducted in Dr. D. Y. Patil Medical College and Hospital, Pune for the period of 2017-2019 comparing laparoscopic TAPP vs. open preperitoneal ventral hernia repair. Total of 25 patients for laparoscopic TAPP repair and 25 patients for open preperitoneal repair were compared.Results: Total 50 cases were studies in which 25 for laparoscopic and 25 for open repair. Majority of patients were female than males. Incidence of para umbilical (56%) was found to be more. Intra operative, post-operative complications were found to be more in open repair than laparoscopic TAPP repair.Conclusions: Laparoscopic TAPP ventral hernia repair is safe with fewer complications. Therefore, offers successful treatment for ventral hernia repair with added benefits of laparoscopy such as better visualization and magnification of the hernia defects which are not clinically apparent and less chances of injury which is not possible by open technique. Laparoscopic TAPP ventral hernia repair gives equal results in terms of recurrence and less complications than open ventral hernia repair.
Lithobezoar: a case report
Authors: Chowksey Sanjeev , Deshmukh Satish , Kalbande Samrudhi
Published: December 2019

We present a unique case of a colonic lithobezoar in a relatively healthy, young male with no history of psychological or psychiatric disorders. Furthermore, unlike previously reported cases, this patient had no history of gastric surgery. The mode of presentation and the rariety of disease pose difficulties in diagnosis of lithobezoar. The different modalities of treatment, both surgical and nonsurgical, were thought of and discussed. The diagnosis of a lithobezoar in a healthy patient requires a high index of suspicion, as it presents with nonspecific symptoms. The standard treatment for bezoars is discussed but lithobezoar needs special mention due to its rariety and no specific surgery guidelines.
Rare case of midgut volvulus with malrotation in an elderly patient
Authors: Raleng Mezhuneituo , Pore Anant Prakash , Katheria Vickey , Khamrang Worshim , Wungramthing R. S.
Published: December 2019

A 70 year old male who was under treatment for lymphoma, presented with a 2 day old history of not passing stool, flatus, associated with vomiting and abdominal distension. Patient was diagnosed as subacute intestinal obstruction and put on conservative management. However since his condition worsen exploratory laparotomy was performed. On laparotomy a midgut volvulus was detected and subsequently de-rotation of small gut was done. Through this paper we would like to stress out the difficulties in diagnosis and the challenges that we faced.
Proving Properties of Discrete-Valued Functions Using Deductive Proof: Application to the Square Root
Authors: Todorov Vassil , Taha Safouan , Boulanger Frederic , Hernandez Armando
Published: December 2019

For many years, automotive embedded systems have been validated only by testing. In the near future, Advanced Driver Assistance Systems (ADAS) will take a greater part in the car’s software design and development. Furthermore, their increasing critical level may lead authorities to require a certification for those systems. We think that bringing formal proof in their development can help establishing safety properties and get an efficient certification process. Other industries (e.g. aerospace, railway, nuclear) that produce critical systems requiring certification also took the path of formal verification techniques. One of these techniques is deductive proof. It can give a higher level of confidence in proving critical safety properties and even avoid unit testing.

In this paper, we chose a production use case: a function calculating a square root by linear interpolation. We use deductive proof to prove its correctness and show the limitations we encountered with the off-the-shelf tools. We propose approaches to overcome some limitations of these tools and succeed with the proof. These approaches can be applied to similar problems, which are frequent in the automotive embedded software.
Features of the Computational Implementation of the Algorithm for Estimating the Lyapunov Exponents of Systems with Delay
Authors: Goryunov Vladimir E.
Published: December 2019

We consider the computational implementation of the algorithm for Lyapunov exponents spectrum numerical estimation for delay differential equations. It is known that for such systems, as well as for boundary value problems, it is not possible to prove the well-known Oseledets theorem which allows us to calculate the required parameters very efficiently. Therefore, we can only talk about the estimates of the characteristics in some sense close to the Lyapunov exponents. In this paper, we propose two methods of linearized systems solutions processing. One of them is based on a set of impulse functions, and the other is based on a set of trigonometric functions. We show the usage flexibility of these algorithms in the case of quasi-stable structures when several Lyapunov exponents are close to zero. The developed methods are tested on a logistic equation with a delay, and these tests illustrate the “proximity” of the obtained numerical characteristics and Lyapunov exponents.
Gaven Kerr, O.P., On Creation with Its Philosophical Corollaries
Authors: Burrell David
Published: December 2019

Author endorses the study by Gaven Kerr, O.P., for the way it shows the centrality of Aquinas’ metaphysics of creation: showcasing the ‘real distinction’ between esse and essentia, followed by Aquinas’ unique treatment of each, as well as a deep consideration of esse tantum. At the end he states the ‘proof’ which Gaven Kerr has articulated so deftly reflects the manner in which the Creator ‘appears’ in creation, thereby ‘showing’ what cannot be ‘said’ (Wittgenstein).
Choosing between emotion regulation strategies to appear cool, calm, and collected: Does emotional stimulus intensity matter?
Authors: Szczygieł Dorota , Baryła Wiesław
Published: December 2019

The present study examined the effect of negative emotional stimulus intensity (low versus high) on the choice of emotion regulation (ER) strategy when a person wants to control their emotional expression, and the impact of this choice on how the information accompanying emotional stimuli is remembered. The effects of emotional stimulus intensity on the choice of ER strategy were examined in two studies. In both studies, the participants (unaware of the differences in the intensity of stimuli) were asked to view images inducing negative emotions of high and low intensity and to choose which strategy (cognitive reappraisal or expressive suppression) they would use in order to control their emotional expression. In addition, in Study 2, the authors tested the memory of the verbal content accompanying the emotional stimuli that appeared during the ER period. As expected, the participants chose reappraisal over suppression when confronted with low-intensity stimuli. In contrast, when confronted with high-intensity stimuli, they chose suppression over reappraisal. The results of Study 2 revealed that memory accuracy was higher for those images that the participants chose to use reappraisal rather than suppression.
Bedah mayat (autopsi) ditinjau dari perspekif hukum positif Indonesia dan hukum Islam
Authors: Hatta Muhammad
Published: December 2019

Dalam hukum positif Indonesia, autopsi forensik diatur dalam Kitab Undang-Undang Hukum Pidana, Undang-Undang No. 8 Tahun 1981 tentang Kitab Undang-Undang Hukum Acara Pidana dan Undang-Undang Nomor 36 Tahun 2009 Tentang Kesehatan. Ketiga undang-undang tersebut membenarkan melakukan tindakan autopsi dengan tujuan untuk menegakkan keamanan, dan keadilan bagi masyarakat. Hasil pemeriksaan autopsi forensik akan tertuang dalam sebuah laporan tertulis dalam bentuk visum e repertum dapat digunkan sebaga alat bukti di pengadilan. Dalam hukum islam, autopsi forensik dilarang karena dapat merusak mayat dan melanggar kehormatan mayat. Namun, ada beberapa ulama membenarkan autopsi forensik dengan alasan untuk mewujudkan kemaslahatan ummat (mashalih mursalah) baik di bidang keamanan, keadilan, dan kesehatan. Berdasarkan Fatwa Majelis Ulama Indonesia Nomor 6 Tahun 2009 tentang Autopsi Jenazah menyebutkan bahwa pada dasarnya autopsi dilarang atau haram, namun dalam keadaan Darurat atau mendesak maka diperbolehkan. In Indonesia positive law, a autopsy is regulated in the Criminal Code, Law No. 8 of 1981 concerning the Criminal Procedure Code and Law Number 36 of 2009 concerning Health. The three laws justify carrying out autopsy actions with the aim of enforcing security, and justice for the community. The results of a forensic autopsy examination will be contained in a written report in the form of a post mortem report that can be used as evidence in court. In Islamic law, forensic autopsies are prohibited because they could damage a corpse and violate the honor of a corpse. However, there are some scholars who justify the forensic autopsy on the grounds of realizing the benefit of the ummah (mashalih mursalah) in the fields of security, justice and health. Based on the Fatwa of the Indonesian Ulema Council Number 6 of 2009 concerning the Body Autopsy states that basically autopsies are prohibited or haram, but in an emergency or urgent condition it is permissible.
Short-Term Environmental Conditioning Enhances Tumorigenic Potential of Triple-Negative Breast Cancer Cells
Authors: Eckley Samantha S. , Buschhaus Johanna M. , Humphries Brock A. , Robison Tanner H. , Luker Kathryn E. , Luker Gary D.
Published: December 2019

Tumor microenvironments expose cancer cells to heterogeneous, dynamic environments by shifting availability of nutrients, growth factors, and metabolites. Cells integrate various inputs to generate cellular memory that determines trajectories of subsequent phenotypes. Here we report that short-term exposure of triple-negative breast cancer cells to growth factors or targeted inhibitors regulates subsequent tumor initiation. Using breast cancer cells with different driver mutations, we conditioned cells lines with various stimuli for 4 hours before implanting these cells as tumor xenografts and quantifying tumor progression by means of bioluminescence imaging. In the orthotopic model, conditioning a low number of cancer cells with fetal bovine serum led to enhancement of tumor-initiating potential, tumor volume, and liver metastases. Epidermal growth factor and the mTORC1 inhibitor ridaforolimus produced similar but relatively reduced effects on tumorigenic potential. These data show that a short-term stimulus increases tumorigenic phenotypes based on cellular memory. Conditioning regimens failed to alter proliferation or adhesion of cancer cells in vitro or kinase signaling through Akt and ERK measured by multiphoton microscopy in vivo, suggesting that other mechanisms enhanced tumorigenesis. Given the dynamic nature of the tumor environment and time-varying concentrations of small-molecule drugs, this work highlights how variable conditions in tumor environments shape tumor formation, metastasis, and response to therapy.
Laser technology
Authors: Mandra Yuliya , Abdulkerimov Khiyir , Svetlakova Elena , Griroriev Sergey , Gegalina N. , Semencova Elena , Vlasova Maria , Boldyrev Yuriy , Kotikova Anastasiya , Ivashov Aleksandr , Legkih Aleksandr , Abdulkerimov Timur , Diomidov Il'ya
Published: December 2019

The manual is intended for students of the Faculty of Dentistry, residents, practicing dentists of various specialties. Dedicated to current issues of laser dentistry. Developed taking into account world scientific and clinical practice, experimental, laboratory and clinical data obtained by the authors. This manual presents materials relating to modern ideas about the use of laser technology in dentistry, highlights modern methods of diagnosis and treatment, clinical cases are given.
Features of the Piston Engine Working Process when Working on Kerosene
Authors: Khryashchov Yu.E. , Sokolov O.N.
Published: December 2019

For aircraft in light multi-purpose aviation, piston engines are considered more efficient than gas turbine. The main technical requirement for such engines is to ensure trouble-free operation with the best possible fuel efficiency. At the same time, there are no requirements to emission of harmful substances in exhaust fumes except for the absence of visible smoke. When developing multi-purpose aircraft piston engines, it is important to ensure their multi-fuel operation, including opera-tion on TS-1 kerosene and diesel fuel. But the issues associated with setting engine control algo-rithms for operation on TS-1 kerosene are practically unexplored. In order to refine the control algo-rithms, the flow of the working process using such fuel was studied in this work. The effect of se-quencing the working process stages on the formation of the ignition delay period was shown. Based on the analysis of the factors affecting the ignition delay period, a map of the fuel injection advance angle values was generated. According to the experimental data, the activation energy of pre-flame reactions was adopted, which for kerosene TS-1 was 23–28 kJ/mol.
Designing frames of integrated cfrp solar panels for spacecraft
Authors: Galinovsky A.L. , Denisov A.V. , Gavrilova E.A. , Denisova M.A. , Chertov V.G. , Eremin S.A.
Published: December 2019

This article deals with the problem of ensuring the competitiveness of space systems by increasing the energy and mass efficiency of solar panels. It provides a review of modern designs of the solar panel frames intended for use in spacecraft, and a choice of design and technological solutions for the creation of integrated structures of the solar panel frames with a low specific weight. A model of a composite integrated frame is developed that ensures the bearing capacity of the solar panel at a given static gravitational load at the time of launch and in operation. The results of the selection of rational parameters for the elements of the integrated solar panel frame are given. The results obtained in the framework of the adopted assumptions and the initial characteristics of the polymer composite materials warrant the possibility of realization of the specific gravity in the range of 0.55–0.65 kg/m2, with a regulated load bearing capacity and stiffness, thereby complying with the world trends for objects of this class. Using the proposed design, it is possible to place lens concentrators over the photovoltaic converters installed on the frame, which in turn can significantly increase the specific power of the solar cell.
Determining the Quality of the Surface Layer of Low-Stiff Cylindrical Products after Straightening with Transverse Burnishing with Smooth Plates
Authors: Zaides S.A. , Hong Quang Le
Published: December 2019

To restore the shape of low-stiff cylindrical parts such as shafts and axles, straightening by transverse bending with the subsequent processing of workpieces by the method of surface plastic deformation based on the transverse burnishing with smooth plates is proposed. The experimental and calculated results are presented to determine the effect of absolute compression on the main characteristics of the quality of the surface layer of parts such as surface roughness and residual stresses. The analysis of experimental data for the evaluation of the parts after straightening by transverse burnishing showed the following positive changes: a sharp decrease in the initial roughness, the formation of equilibrium residual compressive stresses in the surface layers and ensuring stabilization of the accuracy of the processed part in size and shape. Depending on the magnitude of the absolute reduction, the surface quality increases by 2–3 classes, and rather large compressive residual stresses are formed (up to 375 MPa). The results of the work justify recommending the proposed method of straightening by transverse burnishing with smooth plates for implementation into the technology of machine part restoration.
Effects of Glycosaminoglycan from Urechis Unicinctus on the P2Y12 Receptor Signaling Pathway in Rat Platelets
Authors: Yuan Chunying , Miao Fei , Li Jinghong , Cui Qingman
Published: December 2019

This study aims to investigate the effects of glycosaminoglycan (GAG) from Urechis unicinctus on the P2Y12 receptor signaling pathway in rat platelets. The concentrations of cyclic adenosine monophosphate (cAMP), thromboxane B2 (TXB2) and glycoprotein IIb/IIIa (GPIIb/IIIa) in rat platelets were determined using enzyme-linked immunosorbent assay (ELISA) kits. The phosphorylation levels of protein kinase A (PKA) and vasodilator-stimulated phosphoprotein (VASP) in rat platelets were detected through Western blot. The expression of P2Y12 gene in rat platelets was analyzed via real-time fluorescence quantitative PCR and reverse-transcription PCR. It was observed that GAG significantly increased the cAMP content (plessthan 0.05, plessthan 0.01) and decreased the TXB2 and GPIIb/IIIa concentrations (plessthan 0.05,plessthan 0.01) in rat platelets. GAG significantly enhanced the phosphorylation levels of PKA and VASP in rat platelets plessthan 0.01) and had a synergistic effect with the P2Y12 receptor blocker. GAG significantly reduced the expression level of P2Y12 gene in rat platelets (plessthan 0.01). We speculated that GAG from U. unicinctus inhibited platelet aggregation in rats through the P2Y12 receptor signaling pathway.
Renal Damage Induced by Myocardial Ischemia Reperfusion in Mouse: Role of Oxidative Stress
Authors: Tong Xue , Zhao Hong , Lu Xiaomei
Published: December 2019

The aim of this study was to investigate whether oxidative stress has a role in myocardial ischemia reperfusion induced renal damage. The 30 male C57 mice were divided into control group, myocardial ischemia reperfusion (MIR) group and MnTBAP treatment group. In MIR group, the left coronary artery was occluded for 45minutes and reperfusion for 4 weeks. The same procedure was used for the MnTBAP group, with the additional step of MnTBAP (10mg/kg) administered intraperitoneally for 28 days. Before surgery and 4 weeks later, transthoracic echocardiography was performed and urine protein and albumin were measured. At the end of the time, mice were sacrified and kidneys collected for ROS and fibrosis analysis. The plasma was collected for BUN and SCR determination. It was observed that MIR decreased renal function and increased production of ROS, compelled with renal fibrosis. Administration of MnTBAP reduced production of ROS and renal fibrosis and increased renal function. These findings suggest that the MIR plays a causal role in causing renal injury and the MnTBAP exerts renal-protective effects, probably by its antioxidant activities.
In Vitro Susceptibility Testing of Different Antimycotics and Disinfectants against Microsporum canis Isolated from Clinical Cases of Feline Dermatophytosis
Authors: Matloob Khizar , Mahmood Asim Khalid , Durrani Uzma Farid , Mushtaq Muhammad Hassan , Hussain Rashid , Akhtar Raheela , Anees Muhammad
Published: December 2019

Dermatophytosis is a common fungal condition of skin having zoonotic importance. Unconventional use of antimycotics and persistence in environment due to improper disinfection often leads to resistance and treatment failure. The purpose of this study was to observe in-vitro efficacy of different antimycotics and disinfectants against Microsporum canis. Skin scraping samples from affected cats were cultured and purified. Conidia were harvested from cultured colonies and count of 1.0 x 106/mL was adjusted by hemocytometer. Harvested conidial suspensions were inoculated on Mueller Hinton Agar (MHA) with antimycotic disks and incubated, then inhibition zone diameters were measured. Same conidial suspensions were inoculated with each disinfectant separately on Dermatophyte Test Medium (DTM) petri plates and colonies were enumerated after incubation. The data suggested that Itraconazole had maximum in-vitro effect followed by Miconazole, Clotrimazole and Ketoconazole, whereas Fluconazole demonstrated resistance. On the other hand, 5% phenol, 3% Hydrogen Peroxide, 1:10 sodium hypochlorite solutions were equally effective against M. canis spores.