Efficacy of Distal Pancreatectomy Combined With Modified DuVal Procedure in Patients With a High Risk of Postoperative Pancreatic Fistula

Background The incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains high. The present study aimed to clarify the efficacy of our modified DuVal (mDuVal) pancreatojejunostomy following DP in patients with a high risk of POPF. Methods The medical records of 346 consecutive patients who underwent DP between 2006 and 2016 were retrospectively reviewed. Perioperative features were compared between 24 patients undergoing mDuVal (mDuVal group) and 322 patients undergoing standard DP (standard DP group). Results Preoperative American Society of Anesthesiologists physical status 1 was more frequent in the standard group than in the mDuVal group ( P = .02). The start of a solid diet after operation was significantly earlier in the mDuVal group than in the standard DP group ( P = .01), while there were no significant differences between the groups for clinically relevant POPF, amylase concentration in the drainage fluid on postoperative day 1 and days 3-5, time to drain removal, additional intervention for POPF, overall complications, or postoperative hospital stay. Discussion The mDuVal procedure could be an option for patients with a high risk of POPF to improve the outcomes after DP. Further investigation involving large study populations is necessary to clarify the efficacy of this procedure.

Dissection Technique for Abdominoplasty With Scarpa Fascia Preservation: Comparative Study on Avulsion Technique Versus Diathermocoagulation

Background Many strategies have been developed to lower the high complications rate associated with a full abdominoplasty. The dissection technique may have a role to achieve this goal. Objectives The present study compares two different dissection techniques to perform a full abdominoplasty with Scarpa fascia preservation: avulsion technique and electrodissection. Methods A retrospective observational cohort study was performed in two health institutions from January 2005 to January 2019. A total of 251 patients were involved: 122 patients submitted to abdominoplasty using the avulsion technique (Group A) and 129 with diathermocoagulation (coagulation mode) (Group B). The latter was further divided into group B1(57 patients with device settings according to surgeon’s preferences) and B2(72 patients with a specific regulation aiming at minimal tissue damage). Several variables were analyzed: population characteristics, time of hospital stay, time to drain removal, total and daily drain output, emergency department visits, readmission, reoperation, local and systemic complications. Results There were no statistically significant differences between the general characteristics of both groups, except for previous abdominal surgery. The diathermocoagulation group had a significantly lower length of hospital stay and time to drain removal. Moreover, these advantages were maximized when electrocautery was done with a specific low voltage setting as significant differences were found. The other outcomes were identical. Conclusions Limiting the extension of electrodissection with the avulsion technique didn´t present any advantage. Using diathermocoagulation (coagulation mode) during a full abdominoplasty with Scarpa fascia preservation, especially when it’s aimed at minimal tissue damage, reduces patients’ time with drains.

Robot-assisted inguinal lymphadenectomy: preliminary experience and perioperative outcomes from an Italian referral center

Background: Inguinal lymphadenectomy remains the gold standard for the treatment of inguinal lymph node metastases from penile carcinoma, melanoma, Merkel cell carcinoma, and squamous cell carcinoma (SCC). This procedure is associated with significant complications. In order to reduce morbidity, minimally invasive approaches have been described. We report our preliminary experience with robot-assisted inguinal lymphadenectomies (RAIL). Methods: RAIL was performed according to the Sotelo technique. When indicated, a robot-assisted pelvic lymphadenectomy (RAPLND) was performed. We recorded age, sex, comorbidities, baseline oncologic diagnosis, operative time, hospital stay, lymph node yield, complications, time to drain removal, and oncologic outcomes. Results: From December 2016 to February 2019, 13 patients underwent RAIL. Median age was 65 years (range: 31–85 years). Primary malignancy was melanoma in five patients, Merkel cell carcinoma in four, dermal duct tumor in one, penile cancer in two, and SCC in one. RAIL was monolateral in 12 cases and bilateral in 1 case. A total of 10 monolateral RAPLNDs were performed; median operative time was 279 min (range: 169–320). Median lymph nodes yield was 11 (range: 2–24) for monolateral RAIL and 9 for monolateral RAPLND (range 2–24). Median hospital stay was 4 days (range: 2–5). No procedure was converted to open. Median follow up was 16 months (range: 5–31). Five Clavien-Dindo grade I complications were recorded. Median time to drain removal was 32.5 days (range 7–65). Three recurrences and two cancer-related deaths were recorded. Conclusions: RAIL is feasible and associated with a short hospital stay, with little incidence of perioperative complications.

Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children: a single-institution prospective cohort study

Background: Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy is gaining popularity as a treatment for choledochal cyst in children. The aim of this study is to determine the feasible and safe of the laparoscopic excision with Roux-en-Y hepaticojejunostomy, and evaluate the short-term outcomes after treatment for children with choledochal cyst.Methods: A prospectively of 51 consecutive pediatric patients undergoing laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy performed by one surgeon cysts at Hue Central Hospital from June 2012 to December 2017 was studied.Results: The mean operative time was 214.7±67.95 minutes (range, 100~360 minutes), including the time for intraoperative cholangiography. There were two children requiring blood transfusion. Time to first flatus was 40.35±28.55 hours in average. The mean time to drain removal was 2.89±1.02 days. Mean postoperative hospital stay was 9.31±3.43 days. 6 out of 51 cases having early complications, including 2 cases of pancreatitis and 4 cases of bile leakage. Most of cases (90.5%) were classified as good after 10 days to 3 months of follow-up.Conclusions: Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy was feasible and safe in children. The short-term outcomes were good in most cases.

Metaphorical Violence in Political Discourse

Metaphor is more than a literary device. It is a fundamental cognitive ability that drives the capacity to reason about state and actions in the world. Metaphor—which involves under- standing of abstract concepts in terms of more basic ones—permeates political discourse. Its ubiquity is evident in the frequent use of statements such as “It’s time to drain the swamp”, “Obama sprinted toward victory on Election Day”, and “Trump attacks Jeff Sessions over Russian probe methods”. No one is releasing water, running, or causing physical harm. How is metaphor- ical violence expressed, for instance, expressions with words such as “attack”, “slaughter”, and “hit”, and how does it influence political thought and communication? Here, we describe novel time-resolved observations and explanatory dynamical models of the use of metaphorical violence language in political discourse on U.S. cable television news in the period leading up to the two most recent presidential elections. Our results quantify the details and dynamics of the use of these metaphors, revealing how cable news shows act as reporters, promoters, expectation-setters, and ideological agents in different degrees in response to differing cultural situations. Our work has implications for shaping political discourse and influencing political attitudes.

Indocyanine Green Lymphangiography as an Adjunct for the Optimal Identification and Management of Lymphatic Leaks in the Groin

Background The treatment of lymphatic leaks and lymphoceles in the groin can be challenging with no optimal management determined to date. We postulate that indocyanine green (ICG) lymphangiography improves visualization of the site of a lymphatic leak and can optimize their management. Methods A retrospective review was conducted of all cases in which ICG lymphangiography was used in the management of lymphatic leaks in the groin over an 18-month span. The inciting surgical procedure resulting in the leak was determined. Following thorough debridement, ICG was injected intradermally in the distal extremity and the site of the lymphatic leak was documented (superficial or deep) and oversewn. Outcomes were reported with regard to healing, infection, time to drain removal, and adjunctive procedures. Results Fifteen patients underwent ICG lymphangiography during the surgical treatment of a lymphatic leak in the groin during the study period. In all cases, the site of the lymphatic leak was accurately identified and oversewn. In eight cases, the site of the lymphatic leak was in the subcutaneous tissue superficial to the femoral vessels rather than medial to the femoral vessels in the area of the lymph node basin. A local muscle flap was used in 10 cases simultaneously. All wounds healed primarily without an associated wound or infection. Conclusion ICG lymphangiography facilitated the identification of lymphatic leaks in the groin and optimized their management in these challenging cases, many of which may have been missed if the area around the inguinal lymph node basin was treated exclusively.

Measurement of gravitational acceleration with the leak tank method

<p class="Abstract">An experimental device of the mechanics of tank draining under gravity has been constructed. It mainly consists of a cylindrical tank with a circular orifice at the center bottom of the tank. The inner radius of the tank is 134 mm, while there are seven variations of orifice radius, those are 2.25 mm, 2.50 mm, 3.00 mm, 3.50 mm, 4.00 mm, 5.00 mm, and 6.00 mm. The tank is filled by water which is then allowed to flow out throuh the orifice. This experiment can be used to measure the value of gravitational acceleration () on the experiment location. We call this method as the leak tank method. The measurement of g is carried out by measuring the total time to drain the tank from 300 mm initial height of water surface inside the tank for various orifice radius. It is found in this experiment that = (9.89± 0.03) m/s². This result is good enough because it is almost the same as the conventional standar value of 9.80665 m/s² with discrepancy of around 0.85%. It indicates that the leak tank method which is described in this paper can be used to estimate the gravitational acceleration value with a good result.</p>