bluuebunny/crossref_metadata_2025_split huggingface dataset:
On Demographic Change and Competitive Equilibrium in American Politics
Authors: Zingher Joshua N. 
Published: July 2017

In their seminal analysis of American elections, Stokes and Iversen (1962) demonstrated that each party’s share of the vote never strays very far from a competitive equilibrium. However, it is difficult to envision how this equilibrium will maintain amid changing demographics. The Republican leaning white proportion of the electorate is shrinking while the Democratic leaning Latino and Asian proportion is rapidly growing. These demographic changes threaten to tip the partisan balance in favor of the Democrats. Can the competitive equilibrium hold amid changing demographics? I answer this question in three steps. First, I analyze presidential election returns since the end of the Civil War. I confirm the presence of a competitive equilibrium. I then use a set of simulations to establish that demographic changes will tip the partisan balance in favor of the Democrats. I then assess how much the Republican Party will have to increase its level of support among whites and/or other groups to remain competitive. I find that relatively modest changes in white and/or Latino and Asian voting behavior will be sufficient to give the Republican Party an even chance of winning well into the future.
Laparoscopic versus open appendectomy during pregnancy
Authors: Alkatary Mohammed M. , Bahgat Nagwan A. 
Published: July 2017

Background: Various causes can be claimed for abdominal pain during pregnancy. Acute appendicitis is the most common cause of abdominal pain during pregnancy. Diagnosis of acute appendicitis during pregnancy is a quiet challenging due to anatomical and physiological changes that occur during pregnancy.Methods: On the period from January 2010 to January 2012we reviewed the number of pregnant patients presented to our facility by abdominal pain and diagnosed as acute appendicitis. Total number was 23 patients. 2 patients were excluded as their magnetic resonance imaging showed normal appendix and were discharged. 6 patients presented on the 1st trimester, 7 patients presented on the 2nd trimester and 8 patients on the 3rd trimester. Laparoscopic appendectomy performed in 9 patients while 12 patients had open appendectomy.Results: The operative time on the laparoscopic group ranged from 50-80 minutes while on the open appendectomy ranged from 40-60 minutes. The length of stay after laparoscopic procedure was 1.5-3 days in comparison to 3-5 days following open appendectomy. Postoperative wound infection detected in 2 patients after open appendectomy (16%) compared with 1 patient (11%) following laparoscopic appendectomy. The postoperative pathology was classified as normal appendix, suppurated appendix and complicated appendix. Table 2 showed the postoperative pathological examination. Preterm labor detected in one patient only had open appendectomy. Fetal outcome was evaluated by Apgar scoring together with fetal length and weight after delivery with no significant abnormality.Conclusions: Laparoscopic appendectomy is safe for both the mother and the fetus during pregnancy irrespective of gestational age, and the procedure is associated with a low risk of post-operative complications.
A review of appendectomy cases at a single teaching hospital, Baghdad, Iraq
Authors: Abdullah Mohanad Hamed , Saood Mahmood J. , Tawfiq Naser R. 
Published: July 2017

Background: Appendectomy is one of the most commonly performed operations. Accurate preoperative diagnosis has long been a great challenge, even to experienced surgeons. To determine the pattern of presentation and rate of atypical pathological presentation of appendicitis.Methods: This is a cross-sectional study in which patients who underwent appendectomy for presumed acute appendicitis from June 2012 to June 2016 were recruited. Incidental appendectomy was excluded. Patient demographics, pathological findings, and surgical outcomes were collected.Results: It was found that the median age of the patients with acute appendicitis was 29 (male 27.3, female 30.7; range (4-67) years. The median length of hospital stay was 2 (range, 1-22) days. There were 184 (75%) patients with clinically and pathologically confirmed acute appendicitis. Out of the 243 patients, 47 appendices were normal, making the overall negative appendectomy rate (NAR) 19.3%; 14.0% in males and 24.6% in females (P<0.001).Conclusions: Appendectomy continues to be a very common surgical procedure. We suggest a more liberal utilisation of preoperative imaging in females of reproductive age, and patients at the extreme age.
A profile study of 50 cases of liver abcess treated by percutaneous catheter drainage
Authors: Patel Prakash Babubhai , Shah Jignesh , Baria Suyadeep 
Published: July 2017

Background: Liver abscess is a life-threatening disease. Continuous catheter drainage is widely accepted and in combination with antibiotics is considered a safe and effective method of management of liver abscess. The objective of this study was to evaluate predisposing factors and incidence of liver abscess in various age group, sex, social economic study and its comparison with various studies and to evaluate morbidity, mortality and complication rates in patients of liver abscess treated either by percutaneous USG guided catheter drainage.Methods: This is an observational study of 50 patients with pigtail catheter drainage and needle aspiration in liver abscess treated during the period of May 2011 to December 2013 at New Civil Hospital, Surat.Results: In the present study majority of case [11 cases (22.5%)] were observed in the age group of 31-40 years. Male female ratio in our study was 8.2:1. Majority of Liver abscess cases [34 cases (68 %)] belongs to low socio-economic class. The commonest symptoms are pain and fever seen in 64% each. In the present study 100% success rate with no recurrence. None of the patients expired in the present study. Median hospital stay is 5 days with range from 2-25 days.Conclusions: Percutaneous pigtail catheter drainage is more effective in large liver abscess.
Cancer penis evaluation of role of prophylactic inguinal lymph nodes dissection
Authors: Nichkaode Prabhat B. , Agrawal Rajendra , Kulkarni Sayali 
Published: July 2017

Background: Incidence of penile cancer is considerably variable across the globe; this disease is uncommon in the western world. But it is not uncommon to see the disease in Indian subcontinent. Also, it is not uncommon to see Penile growths with palpable unilateral or bilateral lymph nodes. In this retrospective observational study, we would like to present our data of 31 cases of Penile cancer with variable presentations, in terms of palpable groin lymph nodes. FNAC from palpable lymph nodes may not be diagnostic of metastasis. It is said that battle of cancer penis is either won or lost depends on how you deal with groin. It is a clear understanding that in presence of positive groin nodes Lymphadenectomy is the choice of treatment but it is unclear, how to deal with negative groin? In this study we present experience, in terms of deal with the groin lymph nodes aggressively, even when they not palpable for a better outcome after balancing the morbidity of the procedure. Aim was to evaluate the role of early prophylactic inguinal node dissection in patients with squamous cell cancer of Penis.Methods: This retrospective observational study was carried out at tertiary care teaching institute from 2003 till 2012. The clinical, investigational, operative, pathology details and follow-up data were collected from patient records.Results: Study showed data of 47 patients treated during the period from 2003 to 2012 and included 31 patients in this study, 21 patients (67.74%) presented with palpable inguinal nodes at the time of primary presentation. FNAC from these lymph nodes could prove metastasis, only in 16 patients (76.19 %). 5 patients (23.80) on FNAC had no metastasis. Remaining 10 patients were without lymph node enlargement at the time of primary presentation. Patients presented without palpable lymph nodes were offered modified inguinal block dissection. Histology showing 8 nodes positive for metastatic disease. And were FNAC was negative 4 (80 %) out of 5 patients with negative nodes shown positive for metastasis.Conclusions: This retrospective observational study concludes with fact that palpable lymph nodes in the groin, is no doubt an indication for Inguinal node dissection but even when nodes are negative on FNAC or not palpable then prophylactic lymph nodes dissection should be undertaken. Delay in inguinal lymphadenectomy in non-palpable nodes you may lose the battle on cancer penis, as many reports say that, delayed lymphadenectomy has a strong impact on the survival. The only drawback with prophylactic lymph node dissection is the associated morbidity. But with modified procedures this can be very well minimized.
Searching for the safest abdominal closure technique after emergency laparotomy for Hinchey III and IV peritonitis
Authors: Tamini Nicolo , Cereda Marco , Capelli Giulia , Giani Alessandro , Gianotti Luca 
Published: July 2017

Background: The optimal strategy for abdominal wall closure has been an ongoing issue of debate and convincing evidence is still lacking. The INLINE systematic review and meta-analysis published on annals of surgery 2010 suggested that a running suture with a slowly absorbable suture material was the gold standard technique for abdominal wall closure after elective surgery, while there’s no general agreement in the emergency setting.Methods: Retrospective study regarding patients who underwent emergency surgery for a generalized peritonitis due to colonic perforation from 2002 to 2014 at San Gerardo hospital (Monza, Italy). Particularly study analyzed differences between continuous suture (Maxon loop, Covidien ©) and interrupted suture (Safil, B. Braun ©) for fascial closure and between metallic clips and second intention healing for incision management. After completion of data retrieval, 110 patients were included in the statistical analysis.Results: Incisional hernia rate was 15/101 (14.9%) and surgical site infection rate was 29/110 (26.4%). No significant statistical differences were found between incidence of incisional hernia and surgical site infection in the two groups, although there was a higher prevalence of incisional hernia in the running suture group (25% vs 11,7%). There was no difference between skin-stapler’s and second-intention’s wound closure groups in terms of surgical site infection and incisional hernia development.Conclusions: We consider reasonable to use an interrupted long time absorbable suture for fascial closure after emergency midline laparotomy for Hinchey III and IV peritonitis, at least in high-risk patients. Considering skin closure, suggestion is to perform a primary skin closure.
Comparison between laparoscopic and open abdominal rectopexy for full-thickness rectal prolapse: controlled clinical trial
Authors: Abdelraheem Omar , Singh Magdy Khalil 
Published: July 2017

Background: Abdominal rectopexy is an appropriate treatment option for full-thickness rectal prolapse (FTRP). Our aim is to evaluate the effectiveness and surgical outcome of laparoscopic posterior mesh rectopexy in treatment of FTRP by comparing this procedure with the traditional open approach.Methods: Thirty consecutive cases with FTRP were included and subjected to abdominal posterior mesh rectopexy from September 2013 to February 2016 at Sohag University Hospital. Thirteen patients were managed laparoscopically and 17 patients underwent open posterior mesh repair. Demographic data and surgical outcome were compared in both groups.Results: Laparoscopic group showed an earlier tolerance to oral feeding (1.26±0.42 versus 2.16±1.36 days, p=0.03), and earlier hospital discharge and return to work (5.63±2.91 versus 8.24±4.64 days, p=0.016, 18.28±2.61 versus 28.64±3.82 days, p=0.032, respectively). The mean consumed postoperative analgesics per day was less among laparoscopic group (1.63±16.2 versus 2.68±34.21 ampoule/day, p=0.012). Incidence of wound infection, wound dehiscence, prolonged ileus and postoperative chest infection were more in open group. There were significant postoperative improvement of continence status, rectal bleeding and abdominal pain in each group. Incidence of postoperative constipation was slightly increased in both groups, but without significant difference. Recurrence occurred in one case only in open group. There were no mortalities in both groups.Conclusions: Laparoscopic posterior mesh rectopexy for FTRP can be done safely even in elderly patients. It offers less postoperative pain, low incidence of postoperative morbidities, early hospital discharge and return to work, in addition to cosmetically better outcome. Laparoscopic rectopexy has the same functional outcome as open technique.
A study of the role of diagnostic laparoscopy in 25 cases of acute abdomen
Authors: Ram Kamlesh , Chandana Sanjog 
Published: July 2017

Background: Acute abdomen is associated with patient discomfort and diagnostic challenges. Diagnostic laparoscopy is a tool which can help in providing diagnosis and treatment. This study is aimed to use laparoscopy as diagnostic and therapeutic procedure. It can avoid unnecessary open procedure, provide early discharge, and decrease patient discomfort.Methods: A case study of 25 cases of acute abdomen was done. All cases were initially evaluated with ultrasonography abdomen and abdominal X-ray and diagnostic laparoscopy was done. Therapeutic procedures were done according to pathology encountered. All patients were followed up 1 year from dischargeResults: A total 25 cases were used; appendicectomy was done in 12 patients, adhesiolysis in 3 patients, peptic perforation repair done in 3 patients. Drainage of fluid done in 1 patient. Omental biopsy was taken in 1 patient. Marsupialisation of left ovary done in 1 patient. 8% cases required open surgery. Open right hemicolectomy and resection anastomosis, open enteric perforation repair was done in 1 patient each. 52% cases were discharged within 2 days. 10% patient required stay for 6 days.Conclusions: Diagnostic laparoscopy can be used in acute abdomen. It avoids unnecessary laparotomy and helps in diagnosis in which radiological findings are equivocal. Post-operative recovery is fast in compare to open procedure.
Dor fundoplication for achalasia of the esophagus: is it time to simplify the established technique? evaluation of clinical outcome
Authors: Triantafyllou Tania , Natoudi Maria , Stathopoulos Ioannis Ntanasis , V. Xiromeritou , A. Mantides , G. Zografos , D. Theodorou 
Published: July 2017

Background: Surgery is the most efficient treatment to achalasia of the esophagus with a success rate estimated 90%. Laparoscopic myotomy is combined with a fundoplication. One of the most common types of wrap is the anterior partial fundoplication, also known as Dor fundoplication. The 10% of surgical failure has been attributed to incomplete myotomy and/or tight fundoplication. The present study describes a modified anterior partial fundoplication that may have the potential to improve the clinical outcome of surgical treatment for achalasia.Methods: In this prospective study, we describe a modification of the standardized technique of Dor fundoplication applied to twenty-nine achalasia patients with intention to decrease the rates of failure. Short-term clinical result was evaluated with preoperative and six- months postoperative Eckardt scores (ES).Results: The mean number of months from initial symptoms to the time of diagnosis was 35.5 months (range 3-156 months). According to the Chicago Classification (CC v3.0), 11 patients (37.9%) were classified as achalasia type I, 17 (58.6%) as type II and 1 (3.4%) as type III. The mean ES was diminished from 7.8 to 0.6 postoperatively.Conclusions: The modification proposed in the present study omits the fixation of the right side of the myotomy to the right crus. This alteration may have the potential to anatomically and functionally affect postoperative rates of dysphagia and antireflux result among patients surgically treated for achalasia.
The role of microvascular tissue transfer in severe limb trauma
Authors: Kakkar Vikas , Kansal Sandeep , Sachdeva Kamal , Bajwa Balcharan Singh 
Published: July 2017

Background: Lower extremity reconstruction is an essential part of plastic surgery and focuses on the treatment of wounds. The restoration of an intact covering is the primary surgical requisite following trauma of the lower extremity because deep healing can be no better than the surface covering. Present study will review the field of lower extremity reconstruction focusing on the micro-vascular tissue transfer for severe limb traumatic injuries.Methods: Patients were fully evaluated and defect was assessed depending on the defect requirement free micro- vascular flap was planned. 20 micro vascular flaps in 18 males and 2 females were used for the wound / defect of lower limbs following trauma.Results: There were 18 men and 2 women with a mean age of 43.6 years (range, 18-62 years) in the present study. The overall survival of the flaps was 95% (19/20).Conclusions: The free flap is an effective method of lower-extremity reconstruction. Good outcomes can be achieved with complete debridement and the selection of appropriate recipient vessels and flaps according to the recipient site.
Observational study of small bowel perforation in a tertiary care hospital
Authors: Nahar Shashank , Ranjan Alok 
Published: July 2017

Background: Perforation of the small intestine causing peritonitis is the most common abdominal surgical emergency encountered in study region. Late presentations with sepsis and septic shock makes evaluation and management of these patients a formidable surgical challenge. The aim of this study was to identify the etiologies, clinical presentation, diagnostic dilemmas and modalities of treatment of the small bowel perforation of diverse etiology in this study region. Objective was to study the demography, etiology, pathology, clinical presentation and various surgical procedures in treatment of small bowel perforation in hospital.Methods: This study was a prospective observational study conducted in the department of general surgery Rohilkhand medical college Bareilly, Uttar Pradesh, India from November 2015 to December 2016. 90 patients admitted in the emergency of this hospital who eventually turned out to be those of small bowel perforation were included in this study and an analysis of the demographic data, clinical presentations, radiological findings, site of perforation, surgical procedure performed, surgical complications and duration of hospital stay was done.Results: Duodenal perforation was the commonest cause of small bowel perforation, contributing to 51 (56.66%) patients. Peptic ulcer disease accounted for 49 (96.07%) patients and blunt trauma abdomen for 2 (3.9%) of these patients. Jejunal perforations accounted for 9 (10%) patients and ileal perforations for 30 (33.34%) patients. Typhoid fever was the commonest cause of ileal perforation in 24 (80%) patients Blunt trauma abdomen was the commonest cause in 5 (55.55%) patients of jejunal perforations.Conclusions: Indiscriminate use of NSAIDS/Steroids accounted for most of the peptic ulcer perforation in our region. The other additive factors include alcohol consumption and smoking.
Limb cellulitis in rural setting in India: a case control study
Authors: Grover Ankur , Shahapurkar Vinay V. , Shinde Raju K. 
Published: July 2017

Background: Cellulitis is the bacterial infection of dermis and the subcutaneous layer. Limb cellulitis is the most common and yet least studied form. This study aims at studying clinical profile, management and complications of limb cellulitis in inpatients at an Indian rural hospital.Methods: After taking institutional ethics committee approval, patients admitted to Jawaharlal Nehru medical college and Acharya Vinoba Bhave rural hospital, Wardha, Maharashtra, India with limb cellulitis during April 2007 to September 2009 were included. Their history, clinical examination and photographs were noted. They were treated conservatively or surgically depending on severity and followed up till complete recovery or 30 days after discharge whichever was earlier.Results: 130 patients i.e. 40 (30.77%) females and 90 (69.23%) males were included in this study with farming being commonest occupation. Commonest risk factor was bare foot working while least common was venous insufficiency. Right lower limb was frequently affected. Local swab cultures were sterile in 74 (56.92%) patients while E. coli grew predominantly in positive cultures and all blood cultures were negative. 84 (64.62%) patients were treated conservatively and only 46 (35.38%) required surgical intervention. 125 (96.15%) patients showed complete recovery while 5 (3.85%) patients succumbed to illness due to sepsis and multiorgan dysfunction syndrome.Conclusions: Limb cellulitis is a common disease to outpatient department and needs admission in patients with elevated risk factors. Most cases can be managed conservatively and seldom surgical intervention. Though majority can be cured completely, few with elevated risk succumb to the disease.
Comparative efficacy of different modules on pulmonary functions after lung resection
Authors: S. Ghandi , Ramana Kumar G. V. 
Published: July 2017

Background: Lung resection in patients with lung cancer and inflammatory lung pathology, not only improves the symptoms but also long-term survival. The aim of this study was to compare the effect of conventional chest physiotherapy, continuous positive airway pressure (CPAP) and incentive spirometry (IS) after lung resection on pulmonary function tests and postoperative pulmonary complications.Methods: A prospective, randomized, case control study was conducted in a tertiary care teaching hospital. Thirty patients were included, who underwent lung resection. Detailed clinical history, examination and appropriate investigations were done. Patients were randomized into three groups, and accordingly postoperative incentive spirometry with physiotherapy, CPAP with physiotherapy and physiotherapy alone was given. All the groups were compared pre-and postoperatively for pulmonary functions and complications.Results: Majority males (90%) patients of 40-60 years. Significant difference was present in FEV1/FVC on post-OP day one and day twenty-eight only (p<0.05). FVC in all three groups declined most significantly on first postoperative day and then consistently increased till 28th day. Group II and III patients showed a significant difference in increase in FVC between 8th and 28th postoperative day. In group, I maximum increase in FEV1 occurred till day 8th, whereas in group II and III significant difference was still present on day 28th. There was no significant difference between the three groups with regard to FVC, FEV1 and FEV1/FVC. No significant difference in pH value while pO2 showed a marked decrease on first post-op day in all groups. Incidence of atelectasis was found to be highest in group I (5 out of 11).Conclusions: As incentive spirometry offered no advantage over chest physiotherapy but does involve the added expense of spirometer, a vigorous chest physiotherapy requires no special equipment and can be delivered by less trained personnel, chest physiotherapy is more economic.