A PROSPECTIVE INTERVENTIONAL STUDY ON EXTERIORIZATION OF INTESTINAL ANASTOMOSIS

Colostomy was introduced in surgical practice more than 200 years ago as a simple and safe procedure. Since then, the time honored dictums “exteriorize colon injuries” and a “well prepared bowel is a pre-requisite for any colon repair”, formed the basis for sound colon surgery. In 1945, the practice of routine colostomy was challenged by a military surgeon, James Mason, who introduced the technique of primary suture of unprepared colon and exteriorizing the segment of bowel outside the peritoneal cavity. Initially, this technique did not gain much momentum in civilian practice mainly because of difculties encountered in introducing procedures which would challenge established orthodox surgical practice. Intestinal disruption is a common problem with a wide-ranging aetiology. It requires anastomosis or repair or creation of stoma with or without Total Parenteral Nutrition therapy. Failure of anastomosis leads to signicant morbidity and mortality. Creation of Stoma is associated with signicant morbidity. Stoma closure also carries signicant risk. In this study, we propose an alternative procedure in the form of exteriorisation of intestinal anastomosis (both small and large bowel), followed by delayed internalization after the anastomosis has healed. Aim: To develop a technique which could bypass or minimize the risks associated with intestinal disruption following anastomosis and also alleviate the morbidity associated with creation of stomas. Alternative proposed: Exteriorisation of anastomosis. Materials And Methods: The study has been carried out on 15 patients with clinical presentation of peritonitis in an emergency setting as well as an alternative procedure in an elective setting over a period of 4 years who were seen in general surgery outpatient department (OPD) and general surgery wards of a single teaching institution of Eastern India. The procedural steps include Exteriorisation of anastomosis, keeping the bowel moist using irrigation and internalization after the anastomosis has healed. Results: 12/19 procedures succeeded (63%). One death occurred due to convulsions despite healing of anastomosis. 7/19 procedures failed (37%). There were two deaths due to failure of anastomosis and lung complications respectively. Conclusion: Existing treatment options for gut repairs, particularly if proximal, are not wholly satisfactory. This study throws some light on the fact that the temporary exteriorisation of repaired gut is safe. Dangers of intraperitoneal anastomotic leak are avoided. Complications of stoma may be avoided. The requirement of costly, and potentially harmful Total Parenteral Nutrition therapy is lessened. Best technique is yet to be determined.

Transnasal Percutaneous Endoscopic Gastrostomy (T-PEG): An Alternative Approach to Conventional PEG Placement

Transnasal percutaneous endoscopic gastrostomy (T-PEG) is a novel endoscopic intervention for enteral nutrition. Peroral endoscopic gastrostomy is widely performed feeding procedure. However, it cannot be done in 4 to 7% of cases with head & neck malignancies. T-PEG is a safe and viable alternative procedure in those patients. T-PEG can be performed in patients with head and neck malignancies, malignant oropharyngeal obstruction, and trismus where oral endoscopy is not feasible.

Circulant Singular Spectrum Analysis to Monitor the State of the Economy in Real Time

Real-time monitoring of the economy is based on activity indicators that show regular patterns such as trends, seasonality and business cycles. However, parametric and non-parametric methods for signal extraction produce revisions at the end of the sample, and the arrival of new data makes it difficult to assess the state of the economy. In this paper, we compare two signal extraction procedures: Circulant Singular Spectral Analysis, CiSSA, a non-parametric technique in which we can extract components associated with desired frequencies, and a parametric method based on ARIMA modelling. Through a set of simulations, we show that the magnitude of the revisions produced by CiSSA converges to zero quicker, and it is smaller than that of the alternative procedure.

Effect of COVID-19 pandemic on glaucoma surgical practices in the UK

Background/AimThe aim of the study was to examine the effect of the COVID-19 pandemic on glaucoma surgical practices within the UK.MethodsA cross-sectional online survey was distributed to all consultant glaucoma specialists who are on the UK and Eire Glaucoma Society contact list. Participants were asked specific questions regarding preferences in glaucoma surgical practices and whether these had changed subsequent to the onset of the COVID-19 pandemic.ResultsTrabeculectomy was the procedure of choice for 61 (87%) glaucoma specialists. A total of 51 (73%) respondents reported performing minimally invasive glaucoma surgery (MIGS) procedures before the COVID-19 pandemic. The most commonly performed MIGS procedure was the iStent inject (51%), followed by XEN 45 (36%) and Preserflo (17%). Forty-three (61%) respondents reported modifying their glaucoma surgery practice subsequent to the onset of the COVID-19 pandemic. Of the glaucoma specialists who modified their surgical practices, 21 (43%) specifically reduced the number of trabeculectomies performed. In combination, diode laser (both micropulse and conventional trans-scleral cyclodiode) was the most common alternative procedure. Glaucoma drainage devices, deep sclerectomy and Preserflo were also commonly chosen alternatives.ConclusionAlthough trabeculectomy remains the most commonly performed established glaucoma surgery, it is being performed with reduced frequency during the COVID-19 pandemic due to the number of postoperative visits and procedures required. Alternatives such as conventional and micropulse diode laser, glaucoma drainage devices, deep sclerectomy and Preserflo appear to be the favoured alternative procedures.

Achieving Superplasticity in Fine-Grained Al-Mg-Sc Alloys

Superplasticity denotes the ability of a limited number of materials to achieve exceptionally high tensile elongations of at least 400%. Experiments show that the Al-Mg-Sc alloys provide excellent capabilities for achieving superplastic flow and also they can be formed easily in biaxial superplastic forming operations. It is important, therefore, to examine the superplastic flow mechanism when the alloy is prepared using different procedures. This report examines the superplastic characteristics of these alloys after preparation without subjecting to any severe plastic deformation (SPD), after processing using the two SPD procedures of equal-channel angular pressing (ECAP) and high-pressure torsion (HPT) and after processing using the alternative procedure of friction stir processing (FSP). The results are compared using each technique and they are examined with reference to a theoretical model that was developed specifically for superplastic flow in conventional alloys.