A United Kingdom survey of surgical technique and handling practice of inguinal canal structures during hernia surgery

Background: Recent trials have assessed the impact of elective nerve division on patient outcome after inguinal herniorrhaphy. The aim of this study was to establish UK surgical practice of handling of structures in the inguinal canal during herniorrhaphy. Methods: A cross-sectional survey of all Fellows (n = 1113) of the Association of Surgeons of Great Britain and Ireland (ASGBI) was performed. The main outcomes were to determine method of inguinal hernia repair and routine practice for intra-operative handling of structures in the inguinal canal. Results: A total of 852 (77%) questionnaires were returned, of which 784 (92%) surgeons performed inguinal herniorrhaphy. Approximately two-thirds (63%) of responding surgeons performed less than 50 procedures per annum and 37% conducted more than 50 procedures annually. Mesh was the preferred method used by 90% of surgeons; 6% used non-mesh, and 4% used other (laparoscopic) methods. Routine practice in relation to the inguinal structures varied by volume of hernia surgery; surgeons who conducted more than 50 procedures annually were more likely to visualize and preserve inguinal nerve structures. However, inconsistency in the answers suggested confusion over anatomy. Conclusion: This is the first UK survey to investigate method of hernia repair and usual handling practice of inguinal canal structures. There was wide acceptance of the use of mesh in inguinal hernia repair, with the majority of UK surgeons favoring an open approach. Surgeons performing high volumes of herniorrhaphy were more likely to preserve, rather than transect, inguinal nerve structures. This variation in practice may confound assessment of long-term neuralgia and other post-herniorrhaphy pain syndromes

Multiple Papillomatosis of Breast and Patient's Choice of Treatment

Papillary lesions of breast represent a range of lesions. Intraductal papilloma and its association with nipple discharge are well known. However, multiple papillomatosis has quite distinct characteristics and decision making can be somewhat challenging. We report a case of multiple papillomatosis in association with ductal carcinoma in situ (DCIS). Patient opted for ipsilateral mastectomy and prophylactic mastectomy of contralateral breast. Her decision of having prophylactic mastectomy was vindicated by presence of incidental DCIS in the contralateral breast. To our knowledge, this is the first reported case of multiple papillomatosis with DCIS of breast, along with incidental synchronous papillomatosis of contralateral breast with DCIS. The case illustrates few distinct features of multiple papillomatosis of breast and exemplifies how a patient's choice is so paramount in decision making process. Patients should be fully informed of the treatment options of the condition, and their wishes should be fully taken into account while making the final decision

ESTIMATION OF ALKALOIDS AND PHENOLICS OF FIVE EDIBLE CUCURBITACEOUS PLANTS AND THEIR ANTIBACTERIAL ACTIVITY

Objective: Objective of the present work was qualitative and quantitative estimation of alkaloids and phenolics of five edible cucurbitaceous plants and to evaluate their antibacterial activity against some human pathogenic bacteria.Methods: Total alkaloid present was determined by acid-based titrimetric methods using methyl red as an indicator and observing a faint yellow end point. Total phenolics were estimated by follin-ciocaltue's method using tannic acid as standard. Antibacterial activity was determined by Disc diffusion method using SRL Agar medium. The 70% ethanolic dried powdered was dissolved in 20% DMSO at different concentration to carry out the anti-microbial activity.Results: It was found that all the experimental plants contained almost equal amount of alkaloids but their phenolic contents as tannic acid equivalents were different. Alkaloids content of five Cucurbitaceous plants were found to vary from 1.15 g % to 1.34 g % and phenol content was varied from 4.54 mg/g to 10.13 mg/g. All the selected Cucurbitaceous plants were active against the tested pathogens, except against V. cholerae non.0139 (L4). Only the 70% ethanolic leaf extract of Momordica charantia (Linn.) showed a relative percentage inhibition from 15.02 to 16.63. So, Momordica charantia (Linn.) extract was the most active among five selected plants against the tested pathogens.Conclusion: The activity might be due to the presence of alkaloids and phenols. However, the extent of activity or zone of inhibition was found varied for different extracts might be due to the difference in the constituents present in the plant extracts

Numerical Analysis of Turbulent Fluid Flow and Heat Transfer in a Rectangular Elbow

The numerical analysis of turbulent fluid flow and heat transfer through a rectangular elbow has been done by model with standard wall function. Different inlet uniform velocities of 5m/s, 10m/s, 15 m/s, 20 m/s and 25 m/s corresponding to Reynolds numbers of Re1= 4.09× 104, Re2= 8.17 × 104, Re3= 12.25× 104, Re4= 16.34× 104 and Re5 =20.43 × 104 have been considered for the numerical experimentations. The fluid considered was incompressible, Newtonian non-reacting and the flow was fully turbulent. The heat transfer analysis has been carried out by considering the fluid having at a higher temperature while the wall kept at lower temperature. A detailed study of the turbulent fluid flow shows that presence of recirculation is inevitable at every corner position or at every bend indicating presence of secondary flow incurring energy losses. The velocity distributions at different stations along the downstream path of the elbow have been plotted. The presence of this adverse pressure gradient is confirmed by the reverse velocity or the negative velocity in the vicinity of the vertical wall. In the upper corner there is a vortex extending from the upper wall of the upper limb almost touching the end point of the left wall of the vertical portion of the elbow. The heat transfer also shows the similar tendency as the fluid flow field influences the convective heat transfer process. The detail temperature distributions across any cross section basically explain the dependence of the convective heat transfer on the fluid flow field

Effect of Bottom Wall Heating on the Turbulent Fluid Flow in an Asymmetric Rectangular Diffuser: an Experimental Study

Turbulent fluid flow and heat transfer in an asymmetric diffuser are important in the context of the power plant engineering such as gas turbine, aircraft propulsion systems, hydraulic turbine equipment etc. In the present study, an experimental investigation on the forced convective heat transfer considering turbulent air flow in an asymmetric rectangular diffuser duct has been done. The experimental setup considered for the analysis consists of a diffuser at different bottom wall temperatures and inlet conditions. The air enters into the diffuser at a room temperature and flows steadily under turbulent conditions undergoing thermal boundary layer development within the diffuser. Efforts have been focused to determine the effects of bottom wall heating on the recirculation bubble strength, thermal boundary layer, velocity fields, temperature profiles etc. The distribution of the local average Nusselt number and skin friction factor in the whole flow fields have been critically examined to identify the significance of bottom wall heating effects on the overall heat transfer rates

Aneurysm of antecubital vein: an unusual complication of peripheral intravenous cannulation

<p>Abstract</p> <p>Background</p> <p>Intravenous cannulation is a very common procedure. Venous aneurysm secondary to peripheral intravenous cannulation is extremely rare. Moreover, venous aneurysm can mimic other conditions and may confuse the issue.</p> <p>Case presentation</p> <p>We describe a case of a 45-year-old woman who was referred with the diagnosis of varicose vein of right arm. A history of intravenous cannulation at the same site was noted that raised suspicion. The swelling was compressible and turned out to be a venous aneurysm. The lesion was completely excised. Postoperative recovery was uneventful. Histology findings were in conformity with the preoperative diagnosis.</p> <p>Conclusion</p> <p>Caution should be exercised in diagnosing varicose vein at a site that bears a history of intravenous cannulation. The case also raises an important issue regarding consent. Should patients undergoing peripheral intravenous cannulation be warned of this rare complication?</p

Investigation of mechanism of action of lycopene on cancer cells

Aim: We aimed to identify the antitumoral mechanism of lycopene on human cancer cells of common solid cancers. Methods: The effect of lycopene was assessed by MTT (Methylthiazoltetrazolium) assay at various times and concentrations on human cancer cells of lung (AGS), breast (MCF-7 and MDA-MB-231), colon (WiDR), prostate (PC-3 and LNCaP) and stomach (AGS).  Mechanisms of action were assessed by apoptosis (DNA ladder formulation, DAPI strain, TUNEL assay and western analysis of p53, bcl-2 and bax) and cell cycle study (flow cytometry, BrdU assay and western analysis of cyclinD1, p21 and p27). Results: The results confirmed statistically significant (p&lt;0.05), dose-dependent in vitro inhibitory effect of lycopene on all the cancer cells studied (maximum 54% inhibition on WiDR colon cancer cells). Although a small late apoptosis was noted (10-17% at 96 h), the results were not significant.  Cell cycle arrest in Gl phase was observed (up to 142%, most well seen at 48 h), reciprocated by a decrease in the cell population in S phase.  A decrease of cyclin D1 and an increase of p27 were also noted.  No changes were noted in the expressions of bcl-2 and bax.  Although p523 was slightly decreased, there was no change in the level of its downstream protein p21. Conclusions: Lycopene inhibited growth of common human solid cancer cells in vitro.  Maximum inhibition was noted on WiDR colon cancer cells, mediated through G1 cell cycle arrest and altered expressions of proteins cyclin D1 and p27.  The mechanism was independent of p53 pathway and not mediated by apoptosis.EThOS - Electronic Theses Online ServiceGBUnited Kingdo