Study of the Comparison of Endoscopic Closure and Laparoscopic Repair of Defect of Gastric Wall

Objective: To make analysis on the curative effect on the technique of endoscopic closure and laparoscopic closure, and explore the effect and safety of acute perforation of the endoscopic closure technique. Methods: Analysis on the 40 therapeutic cases of laparoscopic repair and endoscopic closure treatments, respectively, to submucosal tumours (SMT) of the stomach removed through ESE/EFR. According to the double-sample t-test, the differences of operation time and medical expenses between the two closure methods were compared and analyzed. And used the chi-square test to compare the difference in terms of operational difficulty and effects. Results: Postoperative pathology of 76 therapeutic cases operated through ESE and EFR was diagnosed as mesenchymal tumor and 4 cases as leiomyoma, among which 34 cases were in fundus ventriculi, 30 in corpus ventriculi and 16 in antrum. Endoscopic closure is significantly lower than laparoscopic closure in operation time span (endoscopic closure VS laparoscopic repair 74.70±23.55min vs 178.35±38.98min, p < 0.001) , medical expenses (endoscopic closure VS laparoscopic repair 28463.55±8228.96rmb vs 61848.75±8812.12rmb, p < 0.001) and inpatient days (endoscopic closure VS laparoscopic repair 10.50±3.49days vs. 16.95±4.58days, P < 0.01), while there is no significant difference in terms of technical difficulty and effects (P > 0.05). Conclusion: With the training and technical progress of endoscopic closure, it is safe, effective and quick in recovery to have non-laparoscopic assisted surgery on gastric wall closure.

Study of the Comparison of Endoscopic Closure and Laparoscopic Repair of Defect of Gastric Wall

Objective: To make analysis on the curative effect on the technique of endoscopic closure and laparoscopic closure, and explore the effect and safety of acute perforation of the endoscopic closure technique. Methods: Analysis on the 40 therapeutic cases of laparoscopic repair and endoscopic closure treatments, respectively, to submucosal tumours (SMT) of the stomach removed through ESE/EFR. According to the double-sample t-test, the differences of operation time and medical expenses between the two closure methods were compared and analyzed. And used the chi-square test to compare the difference in terms of operational difficulty and effects. Results: Postoperative pathology of 76 therapeutic cases operated through ESE and EFR was diagnosed as mesenchymal tumor and 4 cases as leiomyoma, among which 34 cases were in fundus ventriculi, 30 in corpus ventriculi and 16 in antrum. Endoscopic closure is significantly lower than laparoscopic closure in operation time span (endoscopic closure VS laparoscopic repair 74.70±23.55min vs 178.35±38.98min, p < 0.001) , medical expenses (endoscopic closure VS laparoscopic repair 28463.55±8228.96rmb vs 61848.75±8812.12rmb, p < 0.001) and inpatient days (endoscopic closure VS laparoscopic repair 10.50±3.49days vs. 16.95±4.58days, P < 0.01), while there is no significant difference in terms of technical difficulty and effects (P > 0.05). Conclusion: With the training and technical progress of endoscopic closure, it is safe, effective and quick in recovery to have non-laparoscopic assisted surgery on gastric wall closure.

Xanthogranulomatous pyelonephritis in a 7-year-old girl

The paper presents a case history of xanthogranulomatous pyelonephritis that developed in a 7-year-old girl in combination with urolithiasis background. Our available sources for the last 50 years contain only 283 descriptions of pediatric xanthogranulomatous pyelonephritis (XGP) cases. We were able to find in domestic publications descriptions of two clinical observations of histologically proven XGP in children of 15 and 17 years. Clinical manifestations of the disease, radiological imaging data, and laboratory findings during the initial three months of the condition fit the disease pattern of a diffuse acute pyelonephritis. A remarkable peculiarity of the presented case was in the two-month interval during which the girl with a severe destructive renal process remained under medical supervision as an outpatient, suffered no pain, and had normal urinalysis results. Nephrectomy was performed from lumbotomy access considering clinical manifestations, data from laboratory and radiological isotope studies. The postoperative period was complicated by the development on the 2nd day of acute perforation of a duodenal ulcer. The intensity of perinephric process was unique and never encountered in our earlier practice. The described changes made kidney exposure extremely difficult. Therefore, nephrectomy should be carried out exclusively in the national highly specialized pediatric urological centers.

Diagnostic accuracy of ultrasound in common acute abdominal conditions

Background: Ultrasound evaluation is cheap, easily available, even at rural level, and can predict need for surgical intervention in majority of conditions. It involves no exposure to radiation, can diagnose easily, can be repeated any number of times for follow up. Disadvantages are that it is user dependent and distended bowel containing air prevents satisfactory evaluation of abdomen. The objective was to study diagnostic accuracy of ultrasound in common acute abdominal conditions.Methods: All patients presenting to the emergency Department of General Surgery, Narayana general hospital, Nellore with abdominal pain of acute onset and who were diagnosed to be suffering from acute appendicitis, acute perforation peritonitis, acute intestinal obstruction, acute pancreatitis, acute calculous cholecystitis were included in the present study.Results: Diagnostic accuracy of USG for acute appendicitis was little bit low with sensitivity of 71.8% and specificity of 59.1% for operative findings and similar for CT findings. For acute perforation peritonitis it was still very low with sensitivity of 42.9% and specificity of 66.7% for operative findings and similar for CT findings. It was very good for acute intestinal obstruction with sensitivity of 90.9% and specificity of 83.3%, but here it was low compared to CT findings. It was also pretty good for diagnosing acute calculus cholecystitis in comparison with operative as well as CT findings.Conclusions: USG can be used as a diagnostic tool for diagnosis of acute intestinal obstruction and acute calculus cholecystitis but doubtful role in the diagnosis of acute appendicitis and acute perforation peritonitis and acute pancreatitis.

Application of blood plasma enriched with platelet derived growth factors in experimental perforation of the tympanic membrane

Acute traumatic perforation of the tympanic membrane occupies a significant place in the structure of the pathology of the middle ear, since «persistent» perforation of the tympanic membrane is the main cause of chronic inflammation in the middle ear, leading to hearing loss and reducing the quality of life of patients. «Persistent» perforation of the tympanic membrane, according to various authors, is formed in 84-392 cases per 10,000 population, so restoring the integrity of the damaged tympanic membrane is one of the main tasks of reconstructive otosurgery. Most authors are of the opinion that it is advisable to close the traumatic eardrum defect early. To date, many ways to close it have been developed. In modern otorhinolaryngology there is extensive experience in using various methods of myringoplasty using various materials for traumatic perforation of the tympanic membrane. However, such a wide variety of plastic techniques and the variety of materials used for this indicates an unresolved problem of closing the perforation of the tympanic membrane. To date, many works have been published that confirm the effectiveness of the use of blood plasma enriched with platelet growth factors in plastic surgery, cosmetology, traumatology, and dentistry. The result of exposure to blood plasma enriched with growth factors is the expression of proteins that regulate chemotaxis, adhesion, cell proliferation, angiogenesis, cell differentiation and the synthesis of extracellular matrix components. Blood plasma enriched with growth factors is autologous (biocompatible), safe from the point of view of the transfer of infectious pathogens. Thus, it can be assumed that the use of plasma enriched with growth factors during surgery during closure of acute perforation of the tympanic membrane will lead to accelerated tissue regeneration and, consequently, a reduction in the length of the postoperative period, and improved treatment outcomes. The use of this method is possible even in a day hospital.

Lethal haemorrhage due to erosion of external iliac artery in a patient with ureterovaginal fistula following endometriosis surgery

We present a case report of a patient with laparoscopic surgery of a deep infiltrating endometriosis with a complicative course. In addition to a postoperatively diagnosed ureteral fistula with local inflammation, acute perforation and ultimately lethal bleeding from the adjacent external iliac artery occurred more than 3 weeks after surgery. To the best of our knowledge, a case with the same constellation has not yet been published. A literature review on the rare and comparable complication of a ureteroarterial fistula is discussed in connection with the case.

Incidence of malignancy in gastric/antral perforation

Background: Gastrointestinal perforation is one of the most commonly encountered cases in emergency department. Acute perforation of the stomach and duodenum causes significant morbidity and mortality. These perforations occur more commonly as a complication of peptic ulcer disease but in a few cases gastric cancer also present as gastric/antral perforation. Previously it was reported that approximately 10-16% of all gastric are caused by malignancy/gastric cancer. To study the incidence of malignancy in gastric perforation in present time, a study was carried out at our institute including all cases of gastric/antral perforations that presented to emergency department over a period of two years.Methods: Cases of gastric/antral perforation that presented to our emergency were included in study. Biopsy from the margin of perforation was taken and sent for histopathological examination. Results obtained were further analysed with respect to total no. of cases, age, sex, personal habits and histopathological type.Results: Out of total 60 cases that were included in study, biopsy report of 5 cases came to positive of malignancy.Conclusions: The incidence of malignancy in gastric/antral perforation was found to be 8% in our study which shows a decline in this region as compared to incidence in the world.

Clinical evaluation of patient with perforation peritonitis and their peritoneal fluid analysis for culture and sensitivity

Background: Perforation peritonitis is one of the most common emergency that is encountered by surgical unit in emergency department and timely management of it can prevent morbidity and mortality, its important to reach the diagnosis earliest and intervene immediately. we find that understanding the peritoneal fluid obtained on exploratory laparotomy and knowing its culture and sensitivity and treating with appropriate antibiotic has a significant role in better management and early recovery of such patients.Methods: This study comprises of 100 consecutive cases of acute perforation peritonitis on whom exploratory laparotomy was done. In a study period from 1/4/2016 to 13/7/2017 conducted by department of General surgery Government medical college Haldwani-Nanital. Diagnosis was made on basis of clinical and radiological examination. Peritoneal fluid sample was obtained after opening the peritoneum and sent for peritoneal fluid analysis to microbiology department to get culture and sensitivity.Results: Male to female ratio was 3:1 and the most common age group involved was between 20 to 40 years. The most common site of perforation was found to be duodenum amounting to 55% of cases followed by ileal perforation found in 20% cases, gastric perforation was found in 10 % of case. Most common microorganism among Gram negative organism was Klebsella found in 52% cases followed by E. coil in 36% cases, both were found together in 5% cases in rest of the cases proteus and pseudomonas were found. Sensitivity was found to ceftrioxone,ciprofloxacillin and amikacin in more than 87% of gram negative organism while resistance was seen to amplicillin and clotrimoxazole other antibiotics that showed sensitivity to microorganism were Linizoild and minocycline in 76% cases. Around 8% fluid showed presence of methecillin resistant or sensitive Staphylococcus aureus and both were sensitive to linizoilid and minocycline and resistant to penicillin, erythromycin and cephxatin.Conclusions: Peptic ulcer perforation is found to be most common site of perforation where second part of the duodenum supersedes Gastric perforation ratio been 5:1 jointly they are responsible for 65% of perforations. Second most common cause of perforation was due to enteric fever causing ilial perforation which was seen in 20% of the cases. Most common microorganism found is Klebsella and E. coli found in almost 81% of the case and were found to be sensitive to ceftrioxone, amikacin, linizoild and minocycline in almost all the cases.

Right Ventricular Perforation by a Defibrillator Lead Migrating to the Left Breast

Cardiac perforation after an ICD implantation is a rare complication, with a reported incidence between 0.6-5.2%. Its manifestation might be acute, subacute, or delayed, with an acute perforation occurring within the first 24 hours after implantation, frequently accompanied by severe clinical signs, while subacute and delayed perforations have a more benign progression. Here, we report a case of a 69-year old patient with an acute right ventricular perforation by a defibrillator lead migrating all the way through the pericardium and thoracic wall into the left breast, with an unusually mild and benign clinical course, delaying prompt diagnosis and postponing subsequent surgical treatment. Heart perforation with a defibrillator electrode is a rare but dangerous complication, which may lead to pacing failure, cardiac tamponade, cardiogenic shock, and even death. Even with a benign clinical course, one must think of cardiac wall perforation at any time after device implantation, and a contrast enhanced computer tomography (CTA) must be performed if perforation is suspected. At re-implantation, the lead should be located at a different anatomical position within the RV, preferably at the interventricular septal site, and manipulation of the injury site within the RV avoided.