Delayed diagnosis of intermittent mesenteroaxial volvulus of the stomach by computed tomography: a case report

10.1186/1752-1947-2-343Journal of Medical Case Reports234

Acute Intrathoracic Gastric Volvulus due to Diaphragmatic Hernia: A Rare Emergency Easily Overlooked

Acute intrathoracic gastric volvulus occurs when the stomach undergoes organoaxial torsion in the chest due to either concomitant enlargement of the hiatus or a diaphragmatic hernia. Iatrogenic diaphragmatic hernia can occur after hiatal hernia repair and other surgical procedures, such as nephrectomy, esophagogastrectomy and splenopancreatectomy. We describe a 49-year-old woman who presented to our emergency department with acute moderate epigastric soreness and vomiting. She had undergone extensive gynecologic surgery including splenectomy 1 year before. The chest radiograph obtained in the emergency department demonstrated an elevated gastric air-fluid level in the left lower lung field. An urgent gastroscopy showed twisted structural abnormality of the stomach body. A computed tomography scan demonstrated the distended stomach, located in the left lower hemithorax through a left diaphragmatic defect. Emergent transthoracic repair was performed. Postoperative recovery was uneventful, and the patient did not experience any pain or difficulty with eating

SOSAS Study in Rural India: Using Accredited Social Health Activists as Enumerators

Background: Global estimates show five billion people lack access to safe, quality, and timely surgical care. The wealthiest third of the world’s population receives approximately 73.6% of the world’s total surgical procedures while the poorest third receives only 3.5%. This pilot study aimed to assess the local burden of surgical disease in a rural region of India through the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey and the feasibility of using Accredited Social Health Activists (ASHAs) as enumerators. Material and Methods: Data were collected in June and July 2015 in Nanakpur, Haryana from 50 households with the support of Indian community health workers, known as ASHAs. The head of household provided demographic data; two household members provided personal surgical histories. Current surgical need was defined as a self-reported surgical problem present at the time of the interview, and unmet surgical need as a surgical problem in which the respondent did not access care. Results: One hundred percent of selected households participated, totaling 93 individuals. Twenty-eight people (30.1%; 95% CI 21.0–40.5) indicated they had a current surgical need in the following body regions: 2 face, 1 chest/breast, 1 back, 3 abdomen, 4 groin/genitalia, and 17 extremities. Six individuals had an unmet surgical need (6.5%; 95% CI 2.45%–13.5%). Conclusions: This pilot study in Nanakpur is the first implementation of the SOSAS survey in India and suggests a significant burden of surgical disease. The feasibility of employing ASHAs to administer the survey is demonstrated, providing a potential use of the ASHA program for a future countrywide survey. These data are useful preliminary evidence that emphasize the need to further evaluate interventions for strengthening surgical systems in rural India

Assessing the reliability of the modified Gartland classification system for extension-type supracondylar humerus fractures.

PurposeThe Gartland extension-type supracondylar humerus (SCH) fracture is the most common paediatric elbow fracture. Treatment options range from nonoperative treatment (taping or casting) to operative treatments (closed reduction and percutaneous pinning or open reduction). Classification variability between surgeons is a potential contributing factor to existing controversy over treatment options for type II SCH fractures. This study investigated levels of agreement in extension-type SCH fracture classification using the modified Gartland classification system.MethodsA retrospective review was conducted on 60 patients aged between two and 12 years who had sustained an extension-type SCH fracture and received operative or nonoperative treatment at a tertiary children's hospital. Baseline radiographs were provided, and surgeons were asked to classify the fractures as type I, IIA, IIB or III according to the modified Gartland classification. Respondents were then asked to complete a second round of classifications using reshuffled radiographs. Weighted kappa values were calculated to assess interobserver and intraobserver levels of agreement.ResultsIn all, 21 paediatric orthopaedic surgeons responded to the survey and 15 completed a second round of ratings. Interobserver agreement for classification based on the Gartland criteria between surgeons was substantial with a kappa of 0.679 (95% confidence interval (CI) 0.501 to 0.873). Intraobserver agreement was substantial with a kappa of 0.796, (95% CI 0.628 to 0.864).ConclusionRadiographic classification of extension-type SCH fractures demonstrated substantial agreement both between and within surgeon raters. Therefore, classification variability may not be a major contributing factor to the treatment controversy for type II SCH fractures and treatment variability may be due to differences in surgeon preferences.Level of evidenceIII

Discovery of highly potent and selective influenza virus neuraminidase inhibitors targeting 150-cavity

Encouraged by our earlier discovery of N1-selective inhibitors, the 150-cavity of influenza virus neuraminidases (NAs) could be further exploited to yield more potent oseltamivir derivatives. Herein, we report the design, synthesis and biological evaluation of a series of novel oseltamivir derivatives via the structural modifications at C5\u2013NH2 of oseltamivir targeting 150-cavity. Among them, compound 5c bearing 4-(3-methoxybenzyloxy)benzyl group exhibited the most potent activity, which was lower or modestly improved activities than oseltamivir carboxylate (OSC) against N1 (H1N1), N1 (H5N1) and N1 (H5N1\u2013H274Y). Specifically, there was 30-fold loss of activity against the wild-type strain H1N1. However, 5c displayed 4.85-fold more potent activity than OSC against H5N1\u2013H274Y NA. Also, 5c demonstrated low cytotoxicity in vitro and no acute toxicity in mice. Molecular docking studies provided insights into the high potency of 5c against N1 and N1\u2013H274Y mutant NAs. Besides, the in silico prediction of physicochemical properties and CYP enzymatic inhibitory ability of representative compounds were conducted to evaluate their drug-like properties

Diagnostics and Accelerated Life Endurance Testing of Polymeric Materials for HVDC Application

The brochure starts with examining the fundamental processes of electrical ageing of polymeric insulation under dc stress. Then, an overview of diagnostic properties is given to probe the effect of these ageing processes and to determine insulation quality. HVDC testing techniques are described focusing on the tests used for HVDC cable systems from the design phase, via prequalification and type testing to routine testing and diagnostic measurements in service. In the last chapter of the brochure, a number of possible future (on-line) testing methods are presented

Diagnostics and accelerated life endurance testing of polymeric materials for hvdc application - Cigr\ue9 - WG D1.23

There is a renewed and growing interest in high voltage direct current (HVDC) transmission and particularly in the use of polymeric materials as insulation in HVDC equipment. However, many polymers show a non-linear behaviour when they are stressed with DC voltages, a phenomenon which is further amplified by the temperature dependence of the resistivity. Space charges may accumulate that can increase the local electric field and may cause premature failure of the insulation. Thus, space charge formation and dynamics play an important role in the ageing of polymers under HVDC. Partial discharges may occur at dc stress as well and they will be influenced by the space charge formation. Evidently, testing and diagnostics of polymeric materials considered for use in HVDC applications need to take into account the above mentioned phenomena. There are however few standards or technical brochures currently available that tackle this topic. Therefore, the main aim of this document is to describe the techniques used for quality control of materials and combinations of materials for HVDC applications in the factory and on-site, from models of insulation systems to full-size equipment and suggest new techniques where they are deemed to be important. The approach taken by the WG is first to examine the fundamental processes of electrical ageing of polymeric insulation under dc stress. Then, an overview of diagnostic properties is given to probe the effect of these ageing processes and to determine insulation quality. In Chapter 3, the document focuses on space charge and, more in particular, on the relation between chemical composition and stability and the presence of space charge. The interaction between space charge and polymer ageing is discussed in detail. Chapter 4 deals with HVDC testing, focusing on the tests used for HVDC cable systems from the design phase, via prequalification and type testing to routine testing and diagnostic measurements in service. Although many measurement techniques are now available, diagnostic tests that can be used online are virtually non-existent. In Chapter 5, stressing the need for further development in this area, a number of possible future testing methods is presented. Finally, some conclusions are drawn in Chapter 6. In Annexes 1 and 2, currently used practices are described for the measurement of space charge on full-size cables, respectively the test conditions used in Japan for the qualification of polymeric materials for HVDC applications