Necrosis and amputation following the bite of the Bibron’s stiletto snake (Atractaspis bibronii) with a concise review of current literature

Atractaspis bibronii are highly specialised snakes found across Southern Africa. Adapted for subterranean hunting of prey, snakes of the genus Atractaspis demonstrate a unique biting mechanism, with an ability to deliver venom via a single fang, protruded over an almost closed mouth in a side-to-side striking pattern. It is not possible to handle these snakes safely. Atractaspididae can be mistaken for medically insignificant snakes and often occur in remote areas that may lead to delayed or reduced presentation to suitable care facilities. We here report a case of an A. bibronii envenomation in remote Southern Africa to the right ring finger from a single fang with significant complication. Medical, and subsequently, surgical management of a progression from discolouration at the bite site, to spreading oedema, blistering, local necrosis and secondary infection required amputation of the digit.

A rare case of desmoid fibromatosis of the transverse colon mimicking a perforated malignancy

ABSTRACT Desmoid tumour of the colon is a very rare and aggressive type of intra-abdominal desmoid fibromatosis. Patients can present with a range of symptoms from a mild chronic abdominal pain to those of an acute abdomen. We present a rare case of abdominal fibromatosis that presented as a rapidly growing mass with free intraperitoneal gas. Intraoperatively however, we found a large tumour arising from the wall of the transverse colon and local necrosis. No bowel perforation was noted. The tumour was removed with a wide resection of transverse colon’s wall instead of colectomy. The histopathology reported benign fibromatosis and excluded malignancy.

Effect of Epigallocatechin-3-Gallate (EGCG) on The Number of Lymphocyte Cells in Inflammation of Pulp with Mechanical Injury

Background: Pulpitis is an inflammatory pulp that can caused by pulp perforation by mechanical injury. Emergency treatment of pulpitis is using Eugenol. High concentrations of Eugenol have a cytotoxic effect that causes local necrosis and inhibits the healing process. Because of negative effects from eugenol, then it’s necessary to consider a new ingredient with minimal side effects, and it’s epigallocatechin-3-gallate (EGCG) in green tea. As a polyphenol, it has good antioxidant effect and plays a role in shortening the duration of inflammation by radical scavenging against Nitric Oxide so that NO levels rapidly decrease which causes migration of neutrophil cells to the area of injury will decrease and the inflammatory process faster so that the healing process become faster. Lymphocyte is plays a role in tissue repair. Purpose: to explain the effect of EGCG hydrogel on the number of lymphocyte cells in pulp inflammation with mechanical injury. Methods: The study used 24 Wistar rats divided into four groups, namely control (C), and 3 groups of treatment (T1, T2, T3). Each group consisted of 6 rats prepared, then EGCG hydrogel 60 ppm was named T1, EGCG hydrogel 90 ppm was named T2, EGCG hydrogel 120 ppm was named P3. On the 3rd day, Wistar rats were decapitated for HPA preparations. Results: This study showed a significant difference in each group (p < 0.05) using One-Way Anova analysis. Conclusion: EGCG hydrogel 90 ppm is effective in increasing the number of lymphocyte cells in inflammation of the pulp with mechanical injury.

HOW TO DEFINE THE LEVEL OF INTESTINAL RESECTION IN COMPLICATED FORMS OF INTESTINAL OBSTRUCTION IN CHILDREN

Introduction. The bowel (intestinal) obstruction is a very common case in pediatric surgical practice. Intestinal transit disorders in children are caused by organic or functional problems of congenital origin or by acquired pathology. The incidence of intestinal obstruction is steadily increasing. This is due to an increasing number of cases with congenital gastrointestinal tract malformations as well as to an increasing number and volume of surgical intestinal interventions. Materials and methods. 76 patients, aged 0 months - 14 years, with various forms of intestinal obstruction were taken into the study. All patients were divided into 2 groups. The control group had 30 patients who were treated in medical facilities of the first level; the studied group included 46 patients who were operated in our clinic. In patients from the studied group, the viability of intestine and the level of resection were defined using the original technique “ Detection of the area of local necrosis and the level of intestine resection in children with intestinal obstruction “ , patent No 2 690744, Russian Federation, developed on the basis of another patent No 2 594 978 of Russian Federation “A technique for modeling local intestinal wall necrosis in the experiment.” The technique is as follows: While performing electrical stimulation of the intestinal wall with neurostimulator HNS 12, one can see a characteristic funnel-shaped depression indicating intestinal necrosis. The level of resection is determined by moving the electrode from the central part of the studied zone to distal and proximal directions until the circular contraction of the intestine appears. Results. This technique prevented relaparotomies, reduced transfer to enteral feeding by 33%, reduced the incidence of prolonged intestinal paresis by 62.5%, reduced patients’ stay in ICU by 41% and postoperative hospital stay by 24% as well as accelerated rehabilitation process by 27.3%. Conclusion. The technique developed for detecting the area of local necrosis and the level of intestinal resection promotes a most careful resection of the affected area of the intestine till healthy tissues, as well as prevents complications requiring surgical correction.

Inferring diet, feeding behaviour and causes of mortality from prey-induced injuries in a New Zealand fur seal

New Zealand fur seals Arctocephalus forsteri are the most abundant of the 4 otariid (eared seal) species distributed across Australasia. Analyses of stomach contents, scats and regurgitates suggest a diet dominated by bony fish and squid, with cartilaginous species (e.g. sharks and rays) either absent or underrepresented because of a lack of preservable hard parts. Here we report on a subadult specimen from south-eastern Australia, which was found ashore emaciated and with numerous puncture wounds across its lips, cheeks, throat and the inside of its oral cavity. Fish spines embedded in the carcass revealed that these injuries were inflicted by chimaeras and myliobatiform rays (stingrays and relatives), which matches reports on the diet of A. forsteri from New Zealand, but not South Australia. Shaking and tearing of prey at the surface may help to avoid ingestion of the venomous spines, perhaps contributing to their absence from scats and regurgitates. Nevertheless, the number and severity of the facial stab wounds, some of which led to local necrosis, likely affected the animal’s ability to feed, and may account for its death. Despite their detrimental effects, fish spine-related injuries are difficult to spot, and may be a common, albeit cryptic, type of trauma. We therefore recommend that stranded seals be systematically examined for this potentially life-threatening pathology.

Effect of Intrahepatic Arterial Delivery of Sorafenib on Normal Liver Tissue of Rabbit: An Experimental Study

Objective: To assess the safety, feasibility and eluting efficiency of intrahepatic arterial delivery of sorafenib on normal liver tissue of rabbit. Methods: 24 New Zealand rabbits were randomly divided into three groups: group Ⅰ (Lipiodol-sorafenid), group Ⅱ (Lipiodol) and group Ⅲ (Sorafenib). Group Ⅰ and Ⅱ were treated by transcatheter selective hepatic arterial embolization with emulsions of lipiodol and sorafenib or with only lipiodol, while group Ⅲ was given hepatic arterial infusion with sorafenib. Sorafenib concentration in plasma was determined by HPLC (high performance liquid chromatography) in 0 min, 20 min, 1h, 2h, 4h, 8h, 16h, 32h and 48h respectively. The breathing rate, heart rate, rectal temperature and body weight were measured, as well the blood routine test and the function of liver, kidney, and heart. Two animals of each group were respectively killed in the 3rd day, 1st, 3rd and 6th week after treatment. Histopathologic study was done to liver, heart, kinney, lung, brain, gall bladder and intestine. Result: ① The peak sorafenib concentration (Cmax)and AUC(Area under curve) in plasma in groupⅠwas 2.46±0.101μg/ml and 945.72 ± 52.3 μg/mL.min respectively, while in group Ⅲ which was 3.78±0.180 ug/ml and 546.98±21.1μg/mL.min. Compared with groupⅢ, the Cmax and AUC of groupⅠhad a significant statistics difference (p<0.05). ② The breathing rate, heart rate, rectal temperature and AST/ALT,WBC,NEU% of group Ⅰand groupⅢhas a significant statistics difference(p<0.05) in the 3rd day. ③CK ,CK-MB, DB, Cr，BUN,RBC,PLT in plasma did not change in all group.④Local necrosis was seen in group Ⅰand group Ⅱin the 3rd day and 1st week, but they did not seem to be different. Group Ⅲ showed no necrosis. Granulation tissue with bile duty, portal vein and microfossils hyperplasia were seen in local necrosis area in the 3rd week. No pathological changes were found in brain, heart, kidney, intestine and gallbladder. Conclusion: TAE with emulsions of lipiodol and sorafenib is feasible, safe and has some slow-release effect.

Peculiarities of surgical treatment of children with ulcerous necrotic enterocolitis

Ulcerous necrotic enterocolitis is the most severe disease in newborns. In this disorder, lethality reaches 45% in average. It significantly increases when gestational age is reduced reaching 100% and results in peritonitis in children with extremely low body weight (less than 1,000 g). Though surgeons agree upon indications to surgery, approach to the management and surgical treatment of patients with progressive necrotic enterocolitis is still rather contradictory today.Purpose: to improve treatment outcomes in patients with ulcerous necrotic enterocolitits developing the determination method of local necrosis area and level of intestinal resection.Materials and methods: the work was done at the clinics of pediatric surgery of Rostov State Medical University based on the Regional Children’s Clinical Hospital where 58 patients underwent treatment for ulcerous necrotic enterocolitits from 2010 to 2017. In all cases, viability of the entodermal canal was determined using our developed determination method of local necrosis area and level of intestinal resection. Decision on Russian grant dated April 5, 2019 based on application No. 2017143990 dated December 14, 2017.Results: the developed determination method of local necrosis area timely determines necrosis of the intestinal wall at the stage of preperforation until the signs of peritonitis when the intestine is resected with enteroanastamosis. This method also determines the optimal level of intestinal resection within healthy tissues.Conclusions: the method improves the outcomes of surgical treatment and quality of life of patients suffering from this disease and reduces the time of rehabilitation.

Clinical application of the developed device for wound closure after radical mastectomy

Aim. To improve the results of treatment of patients with breast cancer after radical mastectomy through the development and application of a device for wound closure after radical mastectomy, providing favorable conditions for wound healing. Methods. The proposed device for wound closure after radical mastectomy was used in 42 patients after the mandatory informed consent. A patent for the invention was obtained for the developed device. The study group included patients with indications for performing Madden mastectomy (Halsted, Patey) for breast cancer in the range of stages T1-4N0-1M0. The age of the patients was 57.5±10.4 (m±δ) years. In group 1 (n=21), wound closure after radical mastectomy was performed using the developed device, in group 2 (n=21) - without it. Results. In the process of working with the developed device, the following positive features were observed. The magnitude of the buckling in the plane of the jaws follows the contour of the thorax in the region of operation of the patient preventing the appearance of the plots of overpressure by the device to the adjacent tissue and ensuring uniformity of traction paravulnar tissues. The complete absence of tissue tension in the area of the suture is the result of the suturing of surgical wounds only after the complete wound edges attachment by means of the device. The above-mentioned factors lead to the formation of point scars in the joints, the absence of extended forms of postoperative scars. Conclusion. The developed device for wound closure after radical mastectomy performed for breast cancer allows shortening the hospital stay after surgery by 36% (p=0.01) and the deadline for removal of drainage by 31% (p=0.01), reducing the incidence of local necrosis of the flap (p=0.44) compared to traditional suturing of the wounds.