bluuebunny/crossref_metadata_2025 huggingface dataset:
Ecología de la polinización de Syagrus smithii (Arecaceae), una palma cantarofila de la Amazonia Colombiana
Authors: Guerrero-Olaya Nilson Y. , Núñez-Avellaneda Luis A.
Published: April 2017

A partir de la evaluación de la morfología floral, la fenología reproductiva, la biología floral, los visitantes florales y determinación de polinizadores se describe la estrategia de polinización de una población de la palma Syagrus smithii de la Amazonia colombiana. Syagrus smithii es una palma solitaria de hasta 10 m de alto; produjo de una a tres inflorescencias bisexuales, con flores estaminadas y pistiladas agrupadas en tríadas, con una flor central femenina y dos laterales masculinas. Las inflorescencias abrieron de día y las flores estuvieron activas de noche. Una inflorescencia permaneció activa en promedio 28 días; la fase masculina se extendió durante los primeros 14 días, seguida de una fase inactiva de 10 días, y la fase final pistilada por cuatro días. En fase masculina, las inflorescencias fueron visitadas por 37 y en fase femenina por 21 especies de insectos, principalmente de los órdenes Coleoptera‚ Hymenoptera y Diptera. Los visitantes accedieron en busca de polen y lugar para reproducción. De todos los visitantes‚ pocas especies fueron polinizadores. Los valores de los índices (IVIP) e (IRP) indicaron que Mystrops sp. nov. 2 y Mystrops sp nov. 3 (Nitidulidae: Coleoptera) fueron los principales polinizadores, mientras que especies de coleópteros como Microstates sp.2 y Sibinia sp. 1 fueron polinizadores secundarios. Dado que los polinizadores desarrollaban sus ciclos de vida en las inflorescencias‚ sugerimos la existencia de un sistema de mutua dependencia entre polinizadores y la palma, el cual asegura la presencia de los polinizadores a lo largo del año y palmas con semillas viables.
Descripción de Thorichthys panchovillai sp. n., una nueva especie de cíclido (Actinopterygii: Cichlidae) de la cuenca del Río Coatzacoalcos, México
Authors: Del Moral-Flores Luis Fernando , López-Segovia Eduardo , Hernández-Arellano Tao
Published: April 2017

Thorichthys panchovillai, nueva especie, es descrita de los tributarios de la cuenca del Río Coatzacoalcos, México. La especie es diagnosticada por un conjunto de caracteres: radios de la aleta dorsal XVI, 8 – 9; radios de la aleta anal VII, 6 – 7; radios de la aleta pectoral, I, 11 – 12; branquiespinas totales en el primer arco branquial 11 – 12; mancha del subopérculo presente pero débilmente intensificada, en especial presenta un marcado dimorfismo sexual único y que le distingue del resto de sus congéneres: en la hembra se presenta una mancha negra entre la quinta y sexta espina dorsal.
Estatus y distribución en el Perú del Tucán Andino de Pico Negro Andigena nigrirostris (Waterhouse, 1839)
Authors: Salazar Sonia , Mena José Luis , Lane Daniel F. , Witt Christopher C.
Published: April 2017

En Perú Andigena nigrirostris es considerado hipotético al no existir registros publicados. A la fecha han sido colectados diez especímenes, se han obtenido dos grabaciones de sonido y la fotografía de un individuo. Siendo este último, el único registro dentro de un área natural protegida en Perú, el Santuario Nacional Tabaconas Namballe. Los registros indican que esta especie se distribuye en los bosques montanos de la vertiente oriental, al norte de la depresión de Huancabamba, entre ~ 2200 a 2900 m de altitud.
Plantas alimenticias de 19 especies de mariposas diurnas (Lepidoptera) en Loreto, Perú
Authors: Vásquez Bardales Joel , Zárate Gómez Ricardo , Huiñapi Canaquiri Percy , Pinedo Jiménez Julio , Ramírez Hernández Juan José , Lamas Gerardo , Vela García Pedro
Published: April 2017

El presente trabajo informa sobre las plantas alimenticias utilizadas por 19 especies de mariposas diurnas (Lepidoptera) que ocurren en el Centro de Investigaciones Allpahuayo-Mishana y la Comunidad Campesina de San Rafael, Loreto, Perú. Se reportan 23 especies y 1 híbrido de angiospermas empleadas por las mariposas investigadas. Veintiún plantas eran hospedadoras de las larvas y 5 nectaríferas de los adultos; Passiflora coccinea Aubl. y Passiflora edulis Sims eran a la vez hospederas y nectaríferas. Las familias de plantas más utilizadas por las mariposas en estado larval fueron Solanaceae, Passifloraceae, Fabaceae y Aristolochiaceae.
Ambiguities of “Insider-ness” in the Study of Religion
Authors: Debele Serawit
Published: April 2017

Based on the author’s experience in conducting fieldwork on religion in Ethiopia, in this article she analyses the complexities of being an insider in a certain socio-political and economic context. Instead of ascribing an essence to insider-ness as a straightforward and definite category, it is argued that insider-ness is a product of dynamic and complex intersubjective interactions and processes. It is an ambiguous position marked by a continuous shift resulting from the researcher’s navigations between multiple identities at different times and environments in relation to research participants. As pointed out by Bourke (2014), the perpetual flux of one’s identity as an insider or an outsider stems from the researcher’s position: gender, class, ethnic background and religious as well as political persuasion. Furthermore, in as much as one enjoys the associated benefits thereof, the insider is faced with myriad challenges due to her or his variegated identities that in turn inform interlocutors’ perceptions, expectations and responses.
Non-ordained
Authors: Kraybill Jeanine
Published: April 2017

The Catholic Church, constructed on an all-male clerical model, is a hierarchical and gendered institution, creating barriers to female leadership. In interviewing members of the clergy and women religious of the faith, this article examines how female non-ordained and male clerical religious leaders engage and influence social policy. It specifically addresses how women religious maneuver around the institutional constraints of the Church, in order to take action on social issues and effect change. In adding to the scholarship on this topic, I argue that part of the strategy of women religious in navigating barriers of the institutional Church is not only knowing when to act outside of the formal hierarchy, but realizing when it is in the benefit of their social policy objectives to collaborate with it. This maneuvering may not always safeguard women religious from institutional scrutiny, as seen by the 2012 Doctrinal Assessment of the Leadership Conference of Women Religious, but instead captures the tension between female religious and the clergy. It also highlights how situations of institutional scrutiny can have positive implications for female religious leaders, their policy goals and congregations. Finally, this examination shows how even when women are appointed to leadership posts within the institutional Church, they can face limitations of acceptance and other constraints that are different from their female religious counterparts working within their own respective religious congregations or outside organizations.
A Bacterial Cause of Cancer: An Historical Essay
Authors: Lichtman Marshall A.
Published: April 2017

This article reviews the history of the discovery of microbes that increase the risk of cancer of some tissues with a special emphasis on the bacterium Helicobacter pylori and the role played by two Australian physicians, neither schooled in research, who had open minds about the shibboleth that mycobacteria (acid-fast organisms) can survive the acid environment of the stomach, but that other pathogenic bacteria cannot. They discovered one of the most important human pathogens, Helicobacter pylori, and showed it capable of inducing severe gastric inflammatory disease. Subsequently, others built on their observations and showed it capable of inducing two gastric neoplasms: carcinoma and lymphoma.
LAS ESTRATEGIAS DE MARKETING ECOLÓGICO EN CADENAS MINORISTAS, EN UNA PERSPECTIVA INTERNACIONAL
Authors: Pulido Novoa James , Cantillo Guerrero Ernesto Fidel
Published: April 2017

El objetivo del presente artículo de investigación consistió en identificar, desde una perspectiva internacional, las distintas estrategias de mercadeo ecológico, aplicadas por un grupo de cadenas comerciales minoristas. La técnica de investigación fue la revisión documental y se utilizó el método analítico. El trabajo se desarrolló en tres etapas: en la primera, se seleccionaron 50 fuentes de información; posteriormente, se construyó un mapeo con los términos claves pertinentes al objeto de estudio; por último, se redactó este artículo. Se estudiaron las estrategias de comunicación dirigidas a los consumidores y clientes, con relación a la oferta de productos y servicios amigables para el medio ambiente. Como resultado de investigación, se determinó que las cadenas minoristas internacionales con sede en Colombia realizan una labor de mercadeo ecológico mediante una estrategia clara de comunicación con los consumidores. Se concluyó que las cadenas comerciales minoristas asumen las tendencias del mercadeo afines a los intereses del Estado colombiano (Plan estratégico nacional de mercados verdes de la república de Colombia), y que dichas cadenas juegan un papel fundamental como intermediarios comerciales de productos y servicios amigables para el medio ambiente. ABSTRACTThe aim of this research article was to identify different green marketing strategies implemented by a group of retail chains, from an international perspective. A documentary review was the technique used, along with the analytical method. This article was developed in three stages; in the first stage 50 sources of information were selected; thereafter, a mapping was built with the key terms relevant to the subject matter; and finally, the draft article. The strategies focused on the communication to consumers and clients regarding the offer of products and/or amicable services to the environment, were studied. As a result of this research, it was determined that retail chains with headquarters in Colombia carry out green marketing work through a clear communication strategy with consumers. It was concluded that market trends that agree with the interests of the Colombian government (plan estratégico nacional de mercados verdes de la república de Colombia) converge with the commercial retail chains, which play an essential role as commercial intermediaries of products and/or amicable services to the environment.
HERRAMIENTAS COMPUTACIONALES COMO APOYO A LA GERENCIA EN LA ESTIMACIÓN DEL VALOR DE FINANCIACIÓN PARA UNA UTILIDAD NETA DE CAPITAL DESEADA.
Authors: Jiménez Sánchez Jorge Iván , Castaño Giraldo Nelson Eduardo
Published: April 2017

El presente artículo de reflexión de una investigación, cuyo objetivo consistió en resaltar la importancia y utilidad que tienen las herramientas computacionales, como alternativa en el análisis y optimización de las utilidades netas de capital. Utilizando como técnica de investigación la revisión documental y el método de análisis, El proceso se desarrolló a partir de selección de casos, analizando los estados de resultados y aplicándolos al software GeoGebra, con el fin de calcular el endeudamiento requerido para incrementar las utilidades netas de capital, teniendo en cuenta la capacidad y costo de producción. Este trabajo propone a la pymes el uso de una herramienta Computacional que apoye a la gerencia a determinar la necesidad de endeudamiento y medir la capacidad de pago de las obligaciones financieras. Se concluye que en un mercado competitivo como el actual las pymes deberán prepararse para incorporar herramientas computacionales que les facilite tomar decisiones financieras oportunas y que les permita extenderse y permanecer en el mercado. ABSTRACTThe aim of this research article of reflection was to highlight the importance and utility of computational tools as an alternative in the analysis and optimization of net income assets. A documentary review and the analytical method were the research techniques used. The process was developed from case selection, analyzing income statements and applying them to software GeoGebra, in order to calculate the budget required to increase net income from assets taking into account the capacity and cost of production. This paper proposes to Small and Medium-sized enterprises (PYMES) to use a computational tool to calculate the budget required and measure the ability to pay financial obligations. It was concluded that in the current competitive market, Small and Medium-sized enterprises should be prepared to incorporate computational tools, which facilitate appropriate financial decision making, help them extend and remain on the market.
MODELO DE GESTIÓN ESTRATÉGICA DE RESPONSABILIDAD SOCIAL ORGANIZACIONAL
Authors: Díaz Arrieta Ana María , Bolívar Córdoba Miguel Ángel
Published: April 2017

El objetivo del presente artículo de investigación consistió en diseñar un modelo de un sistema de gestión, que permitiera mejorar la calidad en una organización, desde la perspectiva de la responsabilidad social. El método utilizado fue el interpretativo analítico, bajo un enfoque mixto y con un corte propositivo. La muestra fue estratificada con 178 elementos (entre empresas y personas naturales). Las técnicas de investigación utilizadas fueron: la observación participante; encuestas y entrevistas a trabajadores, directivos y clientes. El resultado obtenido fue la creación de un modelo de sistema de gestión y de responsabilidad social, basado en la teoría de los stakeholders y fundamentado en la teoría del bien común. Aparte de su utilidad especifica, se concluye que el modelo diseñado se puede replicar en otras organizaciones con características similares, adecuándose a sus contextos. ABSTRACTThis research paper aimed to design the model of a management system, which allow improve in an organization, from the perspective of social responsibility. The analytical-interpretative method was applied, under a mixed approach of propositive nature. The sample was stratified with 178 elements (between companies and natural persons). The research techniques used were: participatory observation; surveys and interviews to employees, directors or customers. The result of this research project was the creation of a model of a management system and social responsibility, based on the theory of stakeholders, as well as the theory of the common good. It was concluded that the designed model can be repeated in other organizations with similar characteristics, being adapted to their contexts.
Single incision laparoscopic appendicectomy versus conventional laparoscopic appendicectomy- a prospective study
Authors: Kumar Rohit , Vaithianathan Rajan , Sundaresan Vinoth
Published: April 2017

Background: The advent of Single incision laparoscopic appendicectomy (SILA) has encouraged surgeons to compare its benefits over conventional laparoscopic appendicectomy (CLA). We conducted a prospective study comparing SILA with CLA, evaluating parameters like operative time and complications, post-operative pain, duration of stay and the cosmetic outcome.Methods: A prospective, comparative study of 94 consecutive patients was conducted at our institution between December 2014 and May 2016. The data regarding the various parameters were documented in both groups of patients.Results: Among the 94 patients, 30 underwent SILA and 64 underwent CLA. We found statistically significant outcomes for SILA over CLA in variables such as operative time (p=0.0018), duration of hospital stay (p≤0.0001) and cosmetic outcome (p≤0.0001). Almost all patients in the SILA category showed no evidence of a scar after a three month follow up.Conclusions: SILA was found to have a better outcome than CLA with regard to operative time, hospital stay and cosmesis. We conclude that this technique of SILA can be a better alternative to CLA.
Predicting difficulty of thyroidectomy preoperatively
Authors: Oommen Alex , Remin Vaisagh
Published: April 2017

Background: Today, thyroidectomy is a common operation used to treat various thyroid disorders. Nowadays, many high-volume thyroid surgeons are discharging patients on the same day of thyroidectomy. The incidence of complications following thyroidectomy is directly linked to the difficulty of the procedure. So, if we can predict the difficulty of thyroidectomy preoperatively, we can anticipate complications and decide on which patients will require in-patient care.Methods: A thyroidectomy difficulty scale was developed by Schneider and colleagues. This scale was used in our study to classify patients in to difficult thyroidectomy group and non-difficult thyroidectomy group. The association between preoperative variables and difficulty of thyroidectomy was studied.Results: Statistical analysis revealed that there was a significant association between hyperthyroidism and difficult thyroidectomy. Similarly, there was a significant association between positive anti-thyroid peroxidase antibody (which defines Hashimoto’s thyroiditis) and difficult thyroidectomy. Also, there was a significant association between positive anti-thyroglobulin antibody and difficult thyroidectomy. Difficult thyroidectomy was found to have a significant association with postoperative hypocalcemia. Statistical analysis also showed duration of surgery to have a significant association with difficulty of thyroidectomyConclusions: Patients with hyperthyroidism, positive anti-thyroid peroxidase antibodies, positive anti-thyroglobulin antibodies have a high probability of a difficult thyroidectomy, associated with longer operative times and increased complications. This information can improve preoperative risk counseling and lead to more efficient scheduling of the operating room.
Thoracic approaches in atrial septal defect closure a comparative study
Authors: Gupta Manju , Mishra Pankaj Kumar , Bathla Amit , Shoeb Mohd , Prasad Jagdish
Published: April 2017

Background: Atrial septal defects (ASD) are one of the most common cardiac malformations. Being asymptomatic, diagnosis is not always made in childhood and may be delayed to adolescence or adulthood. The incidence of ASD in female is twice that of male, so greater emphasis has been placed on the cosmetic results of the operation.Methods: In this study, we retrospectively compare results 100 patients of ASD closure through a right anterolateral thoracotomy incision and median sternotomy incision. Between August 2011 to August 2016, out of total 100 patients with ostium secundum ASD, 50 patients operated by right anterolateral thoracotomy have mean age 16.74 yrs, mean weight 28.77 kg, mean Height 122.06 cm and 50 patients with midline sternotomy have mean age 17.07 year, mean weight 29.24 kg, mean height 122.20cm.Results: There was no mortality in both groups. Per operatively mean operating time, mean CPB time, mean cross clamp time in thoracotomy was 130.08±8.16min, 48.68±5.10min, 29.70±4.21 min while in sternotomy was 121.34±8.30 min, 45.62±4.10 min, 28.28±2.82 min respectively. When compared, there is significant increased duration in operating and CPB time in thoracotomy while cross clamp time was non-significant. Mean duration of ICU and Hospital stay in thoracotomy group was 1.78±0.58days and 6.74±1.77 days when compared to sternotomy group in which it was 2.40±0.495 days and 7.66±1.40 days which is significantly less when compared. Postoperatively and in follow up thoracotomy group have better cosmesis when compared.Conclusions: Surgical treatment of osteum secondum ASD using right anterolateral thoracotomy approach has low operative risk better cosmetic results and patient satisfaction.
Clinical study of hernia in females
Authors: Kappikeri Vijaykumar S. , Thalasta Puneeth
Published: April 2017

Background: Abdominal wall hernia is the most commonly encountered clinical problem in the surgical setting and also the incidence of various types of hernias are known to have gender variations. This study was done to analyse the pattern of different types of hernia and their incidence in female patients.Methods: This was a retrospective study done at Basaveshwara Teaching and General Hospital, Kalaburagi, Karnataka, India from January 2012 to December 2014. All the female patients who presented with different types of hernia like inguinal, umbilical, ventral, congenital and diaphragmatic hernias irrespective of the age have been included in the study from January 2012 to December 2014.Results: In this study total of 87 cases of different types of hernias were studied including ventral, inguinal, umbilical and diaphragmatic hernias. Among which ventral hernias were the most common including 42 cases and among them one case presented as obstructed hernia and the most common age of incidence was 31-40 years. The next most common presentation was inguinal hernia with total of 29 cases and the paediatric age group (0-10 years) was the most common presentation. The next common hernia was umbilical hernia and the most common age of presentation was 21-40 years. The least common presentation was that of diaphragmatic hernia with only 4 cases, age of the patients being 60 and above.Conclusions: In present study, most commonly encountered hernia was ventral hernia followed by inguinal, then umbilical and lastly diaphragmatic hernias.
A clinico pathological study of acute appendicitis with special reference to ultrasonography
Authors: Inamdar Mohammed Faheem , Manjappa Sali , Inamdar N. M.
Published: April 2017

Background: Acute appendicitis is one of the commonest conditions treated at emergency, despite of advances in diagnostic medicine and therapeutics, the diagnosis of appendicitis remains essentially clinical, requiring clinical acumen and surgical knowledge. Maximum incidence noted in second and third decade of life with male predominance. Ultrasonograpy is shown to be effective in the diagnosis of acute appendicitis with a sensitivity of 84 to 89% and specificity of 92 to 98%. Objectives of the study was to study the clinical features of acute appendicitis regarding Alvarado score. Role of USG and HPE Examination in supporting the clinical diagnosis of acute appendicitis and the morbidity, mortality of emergency appendicectomy.Methods: 100 patients who were admitted to VIMS hospital, Bellary, from November 2004 to April 2006 with a clinical suspicion of acute appendicitis were included in the present study. Ultrasonography and Histopathological Examination was done in all cases and results were correlated with final analysis. Results were analyzed using 'Z’ test, Chi-squire test, sensitivity and specificity.Results: In present study of 100 cases 77 were males and 23 Females patient. Out of which 60 are in 15 to 30 years, 21 patients are 10 to 15 years followed by 13 in the age group of 30-40 years. All are undergone appendicectomy. 11 patents undergone Elective, and 89 emergency appendicectomy. Ultrasound was coming positive in 92 cases and negative in 8 cases. The sensitivity and specificity of 95.7% and 80% Respectively. HPE was done in all 100 cases 95 were positive 5 were negative with sensitivity of 96.8% and specificity of 80%.Conclusions: Appendicitis is commonest in 2nd and 3rd decade followed by 4th decade with a male preponderance, Ultrasonography is useful in females to rule out any gynecological pathology. Patients who come early within 2 to 3 days of symptoms of acute appendicitis, emergency appendicectomy is the treatment of the choice and were will be less morbidity and mortality, post operatively.
Modified Graham’s repair for peptic ulcer perforation: reassessment study
Authors: Arora Bhavinder K. , Arora Rachit , Arora Akshit
Published: April 2017

Background: Peptic perforation is an emergency and requires urgent surgical treatment. Many modalities of treatment are available ranging from conservative treatment to laparoscopic repair. There is no consensus on treatment of perforated pylorodudenal ulcer which can be treated with conservative treatment, simple closure of ulcer, closure of ulcer with free omentum, closure of perforation with use of pedicled omentum, definitive treatment with truncal vagotomy and drainage procedures or parietal cell vagotomy. However best treatment is still to be decided.Methods: This study was conducted in department of surgery 60 patients presenting with peptic perforation in last three years. All patients with duodenal perforation in first part (D1) were included in the study. Pyloric perforations, multiple perforations, traumatic perforations and severe co-morbid condition were excluded from study. A pedicled omentum was used in the repair of duodenal perforation. Immediate and late postoperative complications were recorded. The patients were followed for three months.Results: Out of 60 cases there were 50 male patients and 10 female patients. The majority of male patients were in the middle age group between 35 to 45 years of age and the female patients were of older age group between 40 to 65 years of age. These patients presented with history of acute pain abdomen in the epigastric region. All the patients underwent modified Graham’s patch repair. In postoperative period, two patients had burst abdomen on fourth postoperative day. Biliary fistula formation occurred in 2 patients. Wound infection occurred in 4 patients and the hospital stay was 5 to 9 days. There was no mortality recorded in this series.Conclusions: In summary, the surgery for perforated peptic ulcer should use modified Graham’s repair using pedicled omentum giving excellent results in terms of healing, morbidity and mortality.
Stapled haemmorhoidopexy versus open haemorrhoidectomy: our initial experience
Authors: Ahmad Mir Mujtaba , Nadeem Raja , Husain Musharraf , Nazir Irfan , Ahmad Manzoor
Published: April 2017

Background: Haemorrhoids or ‘Piles’ is a frequently observed disease in surgical practice. Various non-surgical and surgical treatments are available. Open haemorrhoidectomy (Milligan-Morgan) is a widely-used procedure. A recent novel technique called ‘Stapled haemorrhoidopexy’, first described and performed by Italian surgeon Antonio Longo is gaining worldwide recognition for its benefits.Methods: A total of 155 patients between the age group of 20 and 65 years, diagnosed to have grade III or IV haemorrhoids were included in the study, divided into 2 groups, Group 1 undergoing Open haemorrhoidectomy (30 patients) and Group 2 undergoing Stapled haemorrhoidectomy (25 patients). Post operatively patients of both groups were reviewed at the time of discharge, at 7 days after discharge, at 1 month and 3 months post-surgery. The significant difference of the percentages between the two groups was tested using the Chi Square test. The significant difference in the mean values between the 2 groups was tested using the Student’s t- independent test. For all the tests, level of significance was taken as 0.05.Results: In present study, the mean operating time for stapled haemorrhoidopexy was 34.96±7.38 minutes with an average of 20-50 minutes, while with open haemorrhoidectomy, the mean operating time was 44.67±11.83 minutes (p<0.001). The mean VAS scores at 6, 12 and 24 hours with stapled haemorrhoidopexy were 1.79±0.76; 1.83±0.61 and 1.47±0.66, respectively, and with open haemorrhoidectomy, the mean VAS scores at 6, 12 and 24 hours were 2.88±0.88; 2.13±0.82 and 1.91±0.83, respectively. The mean hospital stay for patients with stapled haemorrhoidopexy was 1.96±0.55 days in comparison to the open group where the mean hospital stay was 3.51±0.72 days (P-value<0.001). The time for resumption to routine work was shorter in stapled group 8.61±2.76 as compared to 15.34± 2.12 which was statistically significant (P value <0.001). The mean amount of blood loss during stapled hemorrhoidectomy was statistically less than in open surgery.Conclusions:Stapled Haemorrhoidectomy is less painful with shorter duration of hospital stay and resumption of daily activity is faster than the open haemorrhoidectomy. However, long term follow-up is required to know the recurrence rate in stapled haemorrhoidectomy.
Lumbodorsal flap for repair of meningomyelocele- a procedure matched controlled study
Authors: Prasad Gungi Raghavendra , Sharma Deepak , Rao J. V. Subba , Kumar P. Siva , Aziz Amtul
Published: April 2017

Background: Open neural tube defects have been approached by innumerable surgical techniques. Hitherto, excision of the exposed neural tube component, water tight closure of dura, approximation of paraspinal soft tissue and skin closure repair was stressed. Support of vertebral defect was not adequately addressed. Objectives were to introduce lumbodorsal/thoraco dorsal fascial flap as an effective answer to the vertebral defect component of MMC. To compare conventional paraspinal soft tissue closure with lumbodorsal/ thoracodorsal fascial flap.Methods: This was a procedure matched controlled study conducted from 1984-2015. A total of 121 procedures were performed by the same team formed the cohort of the study. Conventional muscle mobilization group A (n=50) and lumbodorsal flap group B (n=71) were the two groups. Demographic data, CSF leak, CSF collection, wound dehiscence, duration of drain and duration of surgery were the parameters evaluated with statistically blinded method.Results: The series mostly constituted lumbar (28%) and lumbo-sacral meningomyelocele (56%). Most of the children in both the groups are either at birth or <1 month. Only few patients in group B with lipo-meningocele presented beyond the age of 5 years (7%). 12% in group A had hydrocephalus, whereas 15.4% had in group B. The patients underwent similar technique at all sites of MMC. Grossly it appears that there is less wound dehiscence, less CSF leak, less hygroma formation in group B cases. Duration of surgery is similar in both the groups, most of them requiring 60 to 120 minutes. The duration of drainage was more than 7 days in group A (34%) as compared to group B (20%).Conclusions: Lumbodorsal/thoraco dorsal fascial flap adequately supports the vertebral defect and skin flaps. They seem to be superior in addressing the vertebral defect component.
Imaging and cytopathological correlation of space occupying lesions in liver: a prospective observational study
Authors: Patel Sachinkumar , Nichkaode P. B. , Bansod Prasad Y. , Akhtar Murtaza
Published: April 2017

Background: Liver is a common site for Space occupying lesions. It is difficult to distinguish these entities with imaging criteria alone. Development in liver surgery and liver pathology have led to many new types of primary hepatic space-occupying lesions (PHSOLS) being surgically resected and pathologically diagnosed, which has greatly increased the surgicopathological spectrum of PHSOLS.Methods: A 2-year tertiary care teaching hospital based longitudinal study with 77 participants was done. Selection criteria was defined and a prestructured proforma was made to assess and note the findings.Results: The mean age of occurrence of space occupying lesions of liver was 45.49±13.45 years with a range of 24 to 70 years. Space occupying lesions of liver was commonly observed in 4th Decade of life. 64.93% pathology of Space Occupying Lesions of Liver occur in males. 76.62% patients of space occupying lesions of liver present with pain in right upper quadrant.Conclusions: Majority of space occupying lesions were surgically managed with a short-term follow-up of 1 month in which no complications were noted.
Incidence of human epidermal growth factor receptor-2 expression and its correlation with clinicopathological characteristics in gastric cancer at tertiary care centre at IGMC Shimla, Himachal Pradesh, India
Authors: Thakur Vishal , Mahajan Puneet , Sharma Neelam , Sharma Ved Kumar , Patial Tushar , Singh Biplav , Raina Nidhi
Published: April 2017

Background: Trastuzumab has been approved for the treatment of patients with HER-2 positive metastatic/locally advanced adenocarcinoma of the stomach by FDA.1 Most of gastric cancer patients present at an advanced stage in our country, all patients of gastric adenocarcinoma should be subjected to HER-2 testing at initial diagnosis. Immunohistochemistry should be the initial testing methodology and Fluorescence in-situ hybridization should be used to retest immunohistochemistry 2+ samples.Methods: We conducted this study with the aim to establish the expression profile of HER-2 and its correlation to clinicopathological characteristics in resectable cases of gastric adenocarcinoma, in patients presenting with gastric adenocarcinoma at IGMC Shimla. The study was conducted over a year from 1st July 2014 to 30th June 2015. Sample size included 40 diagnosed cases of resectable gastric adenocarcinoma. All patients with operable and resectable disease were subjected to surgery and the specimen were sent for detailed histopathological examination and immunohistochemistry . χ 2 statistical analysis was performed to assess the HER-2 positivity rate . All statistics were performed using 2-sided analysis, with a significance level of p< 0.05.Results: In our study , 7 cases (17.5%) were scored as strongly positive for HER-2 membrane staining (3+), 4 cases (10%) were moderately positive (2+) and 29 cases (72.5%) were HER-2 negative (0/1+) on IHC. The positivity rates in diffuse type (22.2%) and poorly-differentiated (25%) gastric cancer were higher than those in intestinal type (9.9%) and well-differentiated (14.3%) gastric cancer respectively.Conclusions: There is a strong association of human epidermal growth factor receptor-2 positivity with Gastric Malignancy in our country especially in poorly differentiated cancers. Targeted biological therapy with Trastuzumab hence becomes an attractive addition to the multimodality therapy usually required in the treatment of locally advanced /metastatic gastric cancers.
Role of tamsulosin in the management of lower ureteric stone at tertiary care hospital in Western Rajasthan, India
Authors: Chandawat Parikshit Singh , Kumar Ashok , Kumar Mahendra , Kumar Lalit , Kishore Sunder , Rao Mohd. Rafik
Published: April 2017

Background: Many minimally invasive interventional techniques as well as expectant treatments exist for the management of lower ureteric calculi.Methods: 100 patients [group A (50 patients) patients given capsule tamsulosin 0.4mg, 1 daily up to 4 weeks while group B (50 patients) patients given regularly practiced treatment without Tamsulosin] with distal ureteric stone included in the study. Study duration was 6 months and study performed at S.P. Medical College. Bikaner, Rajasthan, India.Results: Group A showed a statistically significant advantage in terms of the stone expulsion rate. 41 patients (82%) in group A and 30 patients (60%) in group B expelled stones. Overall patients in group A had mean expulsion time of 7.86 days, whereas in group B mean expulsion time was 18.64 days. In group A stone expulsion rate was higher as compared to group B. In group A only 12 (24%) patients experienced pain relapses whereas in group B 32 (64%) patients reported pain relapses. The diclofenac dosage required in group A was observed to be 1.62 tablets whereas in group B it was 2.6 tablets.Conclusions: It is concluded that tamsulosin should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage.
Is the laparoscopic approach superior to open approach for treatment of acute appendicitis? A hospital based experience
Authors: Pinate Anil Reddy , Shoeb Mohammad Fazelul Rahman , C. R. Shiva Kumar
Published: April 2017

Background: Laparoscopic appendicetomy remains controversial in Indian perspective. The objective was to compare the clinical outcome of open with laparoscopic appendicectomy.Methods: Prospectively collected data from 150 consecutive patients with acute appendicitis was studied. Patients undergoing surgery for acute appendicitis were alternately assigned into one of the two groups (Group-A patients underwent open appendicectomy and in Group B laparoscopic appendicectomy). The two groups were compared with respect to operative time, length of hospital stay, postoperative pain & wound complications.Results: The mean operative time in the open group was 84.40 minutes; for laparoscopic group, 95.20 minutes (p-0.001). Duration of paralytic ileus, tolerance to oral feeds, resumption of daily routine activity and ambulation of patients were started earlier in laparoscopic group than open group. Group A (OA) patients had pain at the mean of 2.66 days as compared group B (LA), in which patients had pain at the mean of 1.66 days.  Study also showed that the hospital stay for laparoscopic group was almost half of that for open group. Laparoscopic appendicectomy was safe as compared to open surgery in context to post-operative complications.Conclusions: Provided surgical experience and equipment are available, Laparoscopic appendicectomy is as safe and efficient than open appendicectomy.
Laparoscopic repair of primary unilateral inguinal hernia is it to pamper the ego of the surgeon
Authors: Kalyanasundar Suresh , Bandi Pradeep Kumar
Published: April 2017

Background: The study compared the procedure of open Lichtenstein tensionless repair of primary unilateral incomplete uncomplicated inguinal hernia with laparoscopic preperitoneal repair by TEP in a rural secondary level hospital for plantation workers. The aim of the study was to compare both the procedures and if laparoscopic repair had any specific advantage over the conventional open repair with specific relation to time of return to work, recurrence and cost effectiveness of the procedures.Methods: This was a prospective study involving 200 cases which were detected and operated between 2006 and 2014 at our hospital and subsequently followed up till 2016 which is 2 years. The patients selected were plantation workers.Results: In all 200 cases got enrolled in the study 100 underwent open tensionless Lichtenstein repair and 100 of them underwent Laparoscopic repair-TEP.Conclusions: Primary unilateral uncomplicated incomplete inguinal hernia repaired by laparoscopic method has no distinct advantage with reference to return to work recurrence of hernia and the cost involved is more as compared to open Lichtenstein repair.
A rare case of pseudocyst in remnant pancreas after classical pancreaticoduodenectomy- treated by endoscopic drainage
Authors: Perumal Senthilkumar , Sathyanesan Jeswanth , Palaniappan Ravichandran
Published: April 2017

Pancreatic pseudocysts comprise more than 80 % of the cystic lesions of the pancreas. Here we report a 45-year-old female patient who developed a symptomatic pseudocyst in the remnant pancreas following classical pancreaticoduodenectomy for periampullary carcinoma. The pancreatic anastomosis was pancreaticogastrostomy- Dunking technique. She underwent endoscopic cystogastrostomy. Recurrence should always be ruled out before diagnosing pseudocyst in remnant pancreas following pancreaticoduodenectomy for malignant tumors.
Successful surgical management of post-traumatic cirsoid aneurysm
Authors: Sajikumar N. R. , Mathai Jolhf Koshy , Harold Dimmy
Published: April 2017

Cirsoid aneurysms are rare arteriovenous malformations (AVM) of the scalp and extremities. They are commonly congenital but post-traumatic cirsoid aneurysms have also been reported. Clinical features include- gradually increasing swelling, pulsatile mass, bruit, headache and tinnitus. Post-traumatic aneurysms of the scalp are uncommon. We report a case with successful surgical excision of scalp AVM.
Phytobezoar: a rare late complication following laparoscopic sleeve gastrectomy surgery
Authors: Ben-Porat Tair , Elazary Ram , Goldenshluger Ariela , Dagan Shiri Sherf , Grinbaum Ronit , Beglaibter Nahum
Published: April 2017

Case reports of bezoar after bariatric surgery are available to date only following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB), but not following laparoscopic sleeve gastrectomy (LSG). Presented here is the first case reports of phytobezoars occurrence post LSG. Two case reports are presented. The mechanisms involved and the therapeutic implications are discussed. Case 1: A 41-year-old woman with a body mass index (BMI) of 45 kg/m2 underwent LSG surgery. Seven months postoperatively she developed significant vomiting and an upper GI gastrografin swallow study revealed a gastric bezoar, confirmed by an esophagogastroduodenoscopy (EGD). The bezoar was broken up and removed with the endoscope. Case 2: A 34-year-old woman with initial BMI of 42.7 kg/m2 was readmitted 5 years post LSG due to reflux accompanied with epigastric pain, vomiting, dysphagia and constipation. An upper GI gastrografin swallow study revealed esophageal dilatation. EGD showed a gastric phytobezoar 3x4cm size, removed by the endoscope. The lack of reports on bezoar occurrence after LSG may be related to the higher rates of stricture reported for LRYGB procedure comparing to LSG. In addition, LSG is a relatively new bariatric procedure, and the interval between surgery and detection of bezoars may be many years later.  Thus, even being a rare late complication, bezoars should be suspected in LSG patients presenting with obstructive symptoms during the late post-surgery period. We recommend prompt endoscopic intervention to relieve the obstruction before parts of the bezoar migrate to the small bowel, necessitating operative intervention
A rare case of jelly belly (pseudomyxomaperitonnei)
Authors: Mokati Uday Kiran , Barik Kalandi , Rao L. Hari Prasada , Vijaya P. , Avinash P.
Published: April 2017

Pseudo myxomaperitonnei (PMP) is a rare case with progressive dissemination of mucinous tumours and mucinous ascites in the abdomen and pelvis with an estimated incidence of 1 to 2 out of a million. Psedomyxomaperitonnei is a neoplastic disease originating from a primary mucinous tumor of appendix, mucinous cystadenoma of ovary with a distinctive pattern of the peritoneal spread. Computed tomography and histopathology are the most reliable diagnostic modalities. We present a case of pseudomyxomaperitonnei in a 55 year old male presented with pain abdomen and abdominal distension with ascites. Ultrasonography localized collection noted in right iliac fossa and left iliac fossa and ascites present. Computed tomography showed localized collection noted in right iliac fossa and left iliac fossa which is arising from appendix and ascites present. Exploratory laparotomy peritoneal cavity filled with mucinous substance along with ruptured cyst wall in right iliac fossa was found. The mucinous substance drained and the ruptured cyst was resected with appendix at base. In conclusion, pseudomyxomaperitonnei is a rare presentation. Despite the current standard of treatment modalities as extensive surgical resection combined with chemotherapy, PMP frequently recurs with treatment options being limited at recurrence and with severe impact on quality of life.
Does NPWT improve the outcome of osteomyelitis in HCV-HIV coinfected patient?
Authors: Pempinello Ciro , Franco Alfredo , Martucci Fiorella
Published: April 2017

Osteomyelitis with severe skin and soft tissue damage in a critical patient cannot be treated by an orthopedic specialist. In such patients, a team appOsteomyelitis with severe skin and soft tissue damage in critically ill patients cannot be treated solely by an orthopedic specialist. In such patients, a team approach is required. We report the treatment of osteomyelitis in an HCV and HIV positive patient with several severe comorbidities (liver failure, peripheral vascular disease, and peripheral neuropathy). The patient underwent mechanical debridement, followed by three months of antibiotic therapy. Six months later the infection relapsed and a second debridement was performed. V.A.C.Ulta therapy with instillation of “Dermacyn” solution, a super-oxidized disinfectant, as an antiseptic solution was applied for 20 days and the wound healed. Three years follow-up with inflammatory laboratory tests, clinical and radiographic examinations showed healing of the wound without any relapse of the infection. In this paper, we suggest combining debridement and NPWT with installation for critical patients with severe soft tissue damage that poorly respond to other therapies. Keywords—antibiotic therapy, HCV, HIroach is required. We report the treatment of osteomyelitis in patient HCV/HIV coinfected with several severe comorbidities (liver failure, peripheral vascular disease and peripheral neuropathy). The patient was underwent debridement, followed by a long period of antibiotic therapy. Six months later the infection relapsed, the second debridement was performed, VAC-Ulta therapy with instillation of antiseptic solution was applied for 20 days and the wound healed. Three-years follow-up with inflammatory laboratory tests, clinical and radiographic examinations showed healing of wound without any relapse of infection. In this paper, we suggest different therapeutic strategies for critical patients with severe soft tissue damage that are not good responsive to other therapies, showing that the melding of different approaches can provide a picturesque legacy of outcomes for unusual procedures.
Role of nutritional intervention in negative pressure wound therapy (NPWT). Case report of patient treated by 'open abdomen' method.
Authors: Kuczynska Barbara
Published: April 2017

Introduction

Wound healing process depends on many factors. As it has been proved many times before, nutrition is one of the key factors in wound healing therapy. When there is an insufficient supply of nutrients and malnutrition, wound healing processes slow down and the inflammatory phase is prolonged, which requires high energy expenditure and as a consequence may lead to the loss of lean body mass and the development of sarcopenia and cachexia. This promotes the formation of non-healing chronic wounds.

In this paper, we would like to emphasize the role of nutrition, as an integral part of wound healing processes, which should encompass the current metabolic needs associated with patient’s clinical condition.

This case describes a young male patient with gastrointestinal tract insufficiency and an extensive postoperative wound treated by the open abdomen method. In the course of increased catabolism, water and electrolyte loss and disturbances as well as nutritional insufficiencies, body mass loss and progressive cachexia occurred in this patient and, as a consequence, the wound healing processes was significantly diminished.

Inducing and maintaining the anabolic processes in the organism and control of the enhanced catabolism in response to metabolic stress or injury are essential actions in optimizing the treatment and healing process. These are possible to achieve by the early introduction of balanced and individualized nutritional treatment regimens, provision of the energy and appropriate nutrients, which enables the restoration of lean body mass and stimulation of the healing processes.
Detection of group a rotavirus and histopathological studiesin diarrheic piglets of Kamrup district, Assam
Authors: Pegu Seema Rani , Sarma Dilip Kumar , Rajkhowa Swaraj , Choudhury Manjisa , Das Jyoti Prasad , Sarma Diganta
Published: April 2017

Porcine group A rotavirus (PoRVA) is a major cause of neonatal diarrhea in suckling and recently weaned piglets worldwide. Rota viral diarrhoea is an important cause of morbidity and mortality in the neonates of pigs. The present study was carried out to determine the prevalence of rotavirus infection among piglets of organized and unorganized pig farms in Kamrup district of Assam. During the present study 107 diarrheic faecal samples from different pig farms of Kamrup district of Assam were collected. The collected samples were screened for the presence of rotavirus antigen by Immunochromatographic assay and RT-PCR. Of the 107 diarrheic samples, 20 (18.7%) were found to be positive for rotavirus Group A antigen by monoclonal based immunochromatographic assay. All the diarrheic samples found positive for the viral antigen by immunochromatographic assay were also analyzed by RT-PCR and 14 (13.1%) samples were found to be positive. The histopathological studies in the intestinal tissue samples of 12 piglets died of diarrhoea showed atrophy of villous in the small intestine along with sloughing of mucosae. Scanning Electron Microscopy analysis of intestinal tissues confirmed replication of rotaviruses in the villous enterocytes resulting in villous atrophy.