scholarly journals The Problem of the Colorectal Anastomosis

2021 ◽  
Author(s):  
Sinziana Ionescu
Keyword(s):  
Methylene Blue ◽  
Colorectal Surgery ◽  
Prediction Models ◽  
Colorectal Anastomosis ◽  
Surgical Oncology ◽  
J Pouch ◽  
Safety And Reliability ◽  
Pros And Cons ◽  
Testing Techniques ◽  
Direct Attachment

Colorectal anastomosis is defined as a surgical procedure in which the colon is attached to the remainder of the rectum after most or some part of it was removed during an intervention. A straight colorectal anastomosis implies a direct attachment, while a J-pouch colorectal anastomosis implies a previous creation of a reservoir, or “pouch” out of bowel material. The problem of colorectal anastomosis safety and outcome is among the most important and persistent issues in colorectal surgery, mainly due to the anastomotic leakage, a threatening and dangerous complication, with an incidence of up to 20% or even more in case of surgical oncology. Various prediction models and anastomosis testing techniques have been described in order to prevent or identify early any possible imperfection of the anastomosis, each with pros and cons. The measures generally used to increase the safety and reliability of the colorectal anastomosis are to evaluate the blood supply of the tissues anastomosed with indocyanine green, or to test the mechanical integrity of the anastomosis for leakage by employing air, methylene blue, or tension.

scholarly journals Comprehensive study of software testing: Categories, levels, techniques, and types

2020 ◽  
Author(s):  
Mubarak Albarka Umar
Keyword(s):  
Software Testing ◽  
Software Quality ◽  
Testing Methods ◽  
Development Lifecycle ◽  
Software Development Lifecycle ◽  
Pros And Cons ◽  
Testing Techniques ◽  
Combination Of Methods ◽  
The Right ◽  
Comprehensive Study

<p><i>Software Testing is the process of evaluating a software program to ensure that it performs its intended purpose. Software testing verifies the safety, reliability, and correct working of software. The growing need for quality software makes software testing a crucial stage in Software Development Lifecycle. There are many methods of testing software, however, the choice of method to test a given software remains a major problem in software testing. Although, it is often impossible to find all errors in software, employing the right combination of methods will make software testing efficient and successful. Knowing these software testing methods is the key to making the right selection. This paper presents a comprehensive study of software testing methods. An explanation of Testing Categories was presented first, followed by Testing Levels (and their comparison), then Testing Techniques (and their comparison). For each Testing Levels and Testing Techniques, examples of some testing types and their pros and cons were given with a brief explanation of some of the important testing types. Furthermore, a clear and distinguishable explanation of two confused and contradictory terms (Verification and Validation) and how they relate to Software Quality was provided.</i></p>

Colorectal surgery

2014 ◽  
Author(s):  
James Wood
Keyword(s):  
Colorectal Surgery ◽  
Cell Biology ◽  
Colorectal Neoplasia ◽  
Surgical Oncology ◽  
Knowledge Bases ◽  
Major Surgery ◽  
Clinical Genetics ◽  
Wide Range ◽  
Abdominal Emergencies ◽  
Inflammatory Bowel

Among the abdominal surgical specialities, colorectal surgery is, argu­ably, the most wide ranging. It spans a number of areas of practice each requiring many distinct knowledge bases. A large part of the speciality revolves around colorectal neoplasia which involves understanding of epidemiology, cell biology, and clinical genetics as well as appreciation of the major surgical presentations including some of the commoner abdominal emergencies, principles of surgical oncology, and pathology. Inflammatory bowel disease features a crossover area with medicine but all students of surgery need to understand the role of surgery in the context of advanced medical therapies including newer biological immu­nomodulatory treatments. On the other hand, functional pelvic floor dis­orders and diseases of the anal canal and rectum require understanding of anatomy and the wide range of local therapies available. This chapter will test all these areas from pathology to anatomy, prin­ciples of major surgery, and outpatient treatments.

scholarly journals Experimental Study of Mechanical Integrity Testing in Stapled Large Bowel: Methylene Blue Leak Test Is Not Inferior to Air Leak Test

2020 ◽  
pp. 1-9
Author(s):  
Marius Kryzauskas ◽  
Austeja Elzbieta Degutyte ◽  
Vilius Abeciunas ◽  
Beatrice Lukenaite ◽  
Eugenijus Jasiunas ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Colorectal Anastomosis ◽  
Linear Stapler ◽  
Bursting Pressure ◽  
Air Leak ◽  
Leak Test ◽  
Pressure Monitor ◽  
Mechanical Integrity ◽  
Air Leak Test ◽  
Significant Difference

<b><i>Background/Objectives:</i></b> Anastomotic leakage remains the most devastating postoperative complication in colorectal surgery. The mechanical integrity of the newly formed colorectal anastomosis can be evaluated by visual inspection intraoperatively; both air leak and liquid leak tests are also used to evaluate the integrity of stapled colorectal anastomoses. It is not clear whether double-stapled anastomoses are more prone to leaks than single-stapled anastomoses. The aim of our study was to compare the methylene blue and the air leak test in the experimental setting of single-stapled and double-stapled porcine bowels. <b><i>Methods:</i></b> Twenty-four distal colons were excised from slaughtered pigs without delay. The proximal bowel end was closed with a linear stapler using blue cartridges. The bowels were randomly divided into single-stapled or double-stapled groups. Air leak and methylene blue leak tests were performed. A digital pressure monitor with a gradual pressure increase function was used to both gradually increase pressure within the bowel and to determine the pressure at which the stapler line disintegrated. <b><i>Results:</i></b> Air leakage occurred at a mean pressure of 51.62 (±16.60) mm Hg and methylene blue leakage occurred at 46.54 (±16.78) mm Hg (<i>p</i> = 0.31). The air and methylene blue leaks occurred at comparable pressures in single-stapled bowels and in double-stapled bowels (47.21 [±14.02] mm Hg vs. 50.96 [±19.15] mm Hg, <i>p</i> = 0.6). <b><i>Conclusions:</i></b> The methylene blue solution leak test is not inferior to the air leak test. There is no significant difference in bursting pressure between single-stapled and double-stapled anastomoses.

Three Non-Destructive Methods for the Modulus of Elasticity of the Trachea

2004 ◽  
Author(s):  
V. Hermawan ◽  
A. M. Al-Jumaily ◽  
M. Fatemi
Keyword(s):  
Modulus Of Elasticity ◽  
Radial Strain ◽  
Propagation Path ◽  
Non Destructive Testing ◽  
Thin Cylindrical Shell ◽  
Destructive Testing ◽  
Pros And Cons ◽  
Testing Techniques ◽  
Non Destructive ◽  
Practical Recommendations

Three non-destructive testing techniques are developed and investigated to determine the Young’s modulus of elasticity of the trachea and the results are compared with the standard uniaxial state of stress method. These techniques are based on: (1) simulating the trachea as a pressurized vessel and deducing a special relationship between the pressure and the radial strain; (2) using two hydrophones and determining the variation in acoustic transmittance caused by the presence of the trachea in a propagation path within a water-bath; (3) considering the trachea as a thin cylindrical shell and determining the resonance radial vibration response. Discussion is presented to identify the “pros” and “cons” of each technique and final practical recommendations are made.

scholarly journals CAN FLUORESCENT ANGIOGRAPHY REDUCE THE LEAK RATE OF COLONIC ANASTOMOSES? (a meta-analysis)

2019 ◽  
Vol 18 (4) ◽  
pp. 139-150
Author(s):  
M. V. Alekseev ◽  
Yu. A. Shelygin ◽  
E. G. Rybakov
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Fluorescence Imaging ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Randomized Study ◽  
Colorectal Anastomosis ◽  
Original Data ◽  
Fluorescence Angiography ◽  
Rectal Cancer Surgery

AIM: to evaluate of efficacy of fluorescence angiography (FA) in reducing the anastomotic leakage (AL) rate after colorectal surgery in meta-analysis.SEARCH STRATEGY: PubMed were searched up to May 2019 for studies comparing fluorescence imaging with standard approach. The primary outcome measure was colorectal anastomotic leakage (AL) rate. The Newcastle-Ottawa scale was used for quality assessment. A meta-analysis with random-effects model was performed to calculate odds ratios (ORs) from the original data.RESULTS: Two thousand four hundred and sixty-six patients from 7 non-randomized studies and 1 randomized study were included. Fluorescence imaging significantly reduced the AL rate in patients after colorectal surgery (OR 0.58; 95%CI 0.39-0.85; p=0.006) and after rectal cancer surgery (OR 0.28; 95%CI, 0.14-0.55; p=0.0002). A limitation of this meta-analysis is the inclusion of only one randomized study.CONCLUSION: Fluorescence angiography with indocyanine green is a method of preventing of leakage of colorectal anastomosis. The results of randomized clinical trials are needed to confirm the effectiveness of this technique.

scholarly journals Indocyanine Green-Enhanced Colorectal Surgery—between Being Superfluous and Being a Game-Changer

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 742
Author(s):  
Catalin Alius ◽  
Corneliu Tudor ◽  
Cristinel Dumitru Badiu ◽  
Ana Maria Dascalu ◽  
Catalin Gabriel Smarandache ◽  
...  
Keyword(s):  
Lymph Node ◽  
Colorectal Surgery ◽  
Indocyanine Green ◽  
Statistical Power ◽  
Near Infrared ◽  
Colorectal Anastomosis ◽  
Future Research ◽  
Anatomical Landmarks ◽  
Nir Fluorescence ◽  
Game Changer

Nowadays, surgical innovations incorporate new technological conquests and must be validated by evidence-based medicine. The use of augmented reality-assisted indocyanine green (ICG) fluorescence has generated a myriad of intraoperative applications such as demonstration of key anatomical landmarks, sentinel lymph nodes, and real-time assessment of local blood flow. This paper presents a systematic review of the clinical evidence regarding the applications of ICG near-infrared (NIR) fluorescence in colorectal surgery. After we removed duplicate publications and screened for eligibility, a total of 36 articles were evaluated: 23 on perfusion assessment, 10 on lymph node mapping, and 3 on intraoperative identification of ureters. Lack of homogenous studies, low statistical power, and confounding evidence were found to be common amongst publications supporting the use of ICG in colorectal surgery, raising concerns over this seductive technique′s cost efficiency and redundancy. The compiled data showed that ICG NIR fluorescence may be a game-changer in particular situations, as proven for low colorectal anastomosis or lateral pelvic lymph node dissection, but it remains controversial for routine use and sentinel lymph node assessment. Further randomized studies are needed to confirm these conclusions. Future research directions include tumor-targeted fluorescence imaging and digital software for quantitative evaluation of fluorescence.

Framework for developing labour-hour prediction models from project design features: case study in structural steel fabrication

2019 ◽  
Vol 46 (10) ◽  
pp. 871-880
Author(s):  
Arash Mohsenijam ◽  
Ming Lu
Keyword(s):  
Structural Steel ◽  
Prediction Models ◽  
Future Research ◽  
Project Design ◽  
Design Features ◽  
Information Models ◽  
Building Information ◽  
Data Driven Approach ◽  
Pros And Cons ◽  
Steel Fabrication

Assigning labour-hours to a certain scope of work during design and estimating is still more of an art than a science. This research proposes a data-driven approach that uses multiple linear regression (MLR) and available historical data from building information models (BIM) to associate project labour-hours and project design features. The framework relies on an enhanced version of stepwise regression technique to select the most relevant predictive factors and generate a predictive model without compromising the achievable accuracy of regression. The framework also encompasses analytical methods for justifying MLR application, validating the resulting model, and establishing range estimates for point-value predictions. In collaboration with an industry partner, the framework application is exemplified by analyzing labour-hours and design features for structural steel fabrication, leading to the creation of a valid MLR model in the simplest form. Finally, pros and cons for the proposed framework and opportunities for future research are discussed.

Testing Techniques for Chaotic Vibration of Buckled Aircraft Structures

1996 ◽  
Vol 210 (3) ◽  
pp. 281-290 ◽  
Author(s):  
C F Ng
Keyword(s):  
Chaotic Motion ◽  
Large Amplitude ◽  
Dynamic Behaviour ◽  
Chaotic Dynamic ◽  
Acoustic Excitation ◽  
Base Excitation ◽  
Chaotic Vibration ◽  
Non Linear ◽  
Testing Techniques ◽  
Direct Attachment

A simple model of non-linear and chaotic dynamic behaviour of buckled plates is presented. Special procedures are described for setting up the tests of flat and buckled plates with vibrations of large amplitude. The difficulties of measuring chaotic motion include the problems in designing the clamping fixtures, controlling the excitation and analysing the results. Case studies of tests with shaker direct attachment, base excitation, and acoustic excitation are used to illustrate the procedures and ways to solve the various problems. The important non-linear dynamic characteristics of curved plates are found to be the transition from softening spring effects to hardening spring effects through the intermediate region of chaotic motion. The chaotic motion is a large amplitude dynamic snap-through motion between the two static buckled positions of the plate.

From Endoscopic Detorsion to Sigmoid Colectomy—The Art of Managing Patients with Sigmoid Volvulus: A Survey of the Members of the American Society of Colon and Rectal Surgeons

2018 ◽  
Vol 84 (9) ◽  
pp. 1518-1524 ◽  
Author(s):  
Richard Garfinkle ◽  
Nancy Morin ◽  
Gabriela Ghitulescu ◽  
Carol-Ann Vasilevsky ◽  
Marylise Boutros
Keyword(s):  
Decision Making ◽  
Colorectal Surgery ◽  
Laparoscopic Colectomy ◽  
Colorectal Anastomosis ◽  
Sigmoid Volvulus ◽  
Sigmoid Colectomy ◽  
Dietary Restrictions ◽  
Surgeon Experience ◽  
Colonic Decompression ◽  
American Society

This study queried American Society of Colon and Rectal Surgeons members for management of sigmoid volvulus and aimed to determine whether surgeon experience impacts decision-making. American Society of Colon and Rectal Surgeons members received a 16-item survey in March, 2017. Items included endoscopic detorsion technique and colonic decompression, preoperative dietary considerations, surgical approach, and respondents’ demographics. Respondents were separated into low experience (LE; ≤10 years in practice) and high experience (HE; >10 years in practice). Of 1996 survey recipients, 10 per cent (197) responded; 124 were HE and 73 were LE. Most were fellowship-trained (93.8%) and primarily in colorectal surgery practice (74.6%), however only 27.4 per cent managed >20 sigmoid volvulus cases as attendings. Fifty-two per cent use rectal tubes for continued colonic decompression after successful endoscopic detorsion; 81.2 per cent would perform sigmoid colectomy on the index admission after successful detorsion, but within a variable timeframe (one to seven days postdetorsion) and with variable dietary restrictions in the interval period; 49.7 per cent would perform a laparoscopic colectomy and 68.3 per cent would perform a stapled colorectal anastomosis. LE surgeons reported a higher proportion of gastrointestinal-performed endoscopic detorsions (P = 0.015), were more likely allow regular diet in the interval period (P = 0.031), and were more inclined to use laparoscopy (P = 0.008), versus HE surgeons. There remains controversy among many of the components in the management of sigmoid volvulus after successful endoscopic detorsion.

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