Pyloromyotomy for infantile hypertrophic pyloric stenosis using a modification of the Tan and Bianchi circumumbilical approach

Background/purpose Different approaches have been advocated for pyloromyotomy.  Since the introduction of umbilical pyloromyotomy, a number of studies have shown that it is as safe as the traditional right upper quadrant approach with superior  cosmetic results. The aim of this study was to assess the feasibility and the safety  of pyloromyotomy for infantile hyprtrophic pyloric stenosis using a modification of the Tan–Bianchi approach.Patients and methods Over a period of 2 years, 20 infants with infantile  hypertrophic pyloric stenosis have been clinically evaluated. The umbilical approach was modified so that a transverse muscle cutting incision rather than a longitudinal midline linea alba incision was performed.Results The total number of cases included in this study was 20 [16 male (80%)  and four female (20%) patients]. Their ages ranged from 23 to 60 days (average  42.6 ±13.54 days), and their weights ranged from 2700 to 4000 g (mean 3605± 437.4 g). Pyloromyotomy was performed safely with negligible blood loss. Four cases of serosal tear occurred, with an incidence of 20%. None of our cases showed significant complications. The mean operating time was 52.5 ± 5.073 min. The postoperative hospital stay ranged from 24 to 72 h. The postoperative course was uneventful in all patients, and, on follow-up, the circumumbilical incision left an almost undetectable scar.Conclusion Pyloromyotomy for infantile hypertrophic pyloric stenosis using the modified Tan and Bianchi technique is feasible and safe, having an accepted operative time, early initiation of postoperative feeding, and short hospital stay. This modification combines the advantage of circumumbilical incision with its better cosmetic results and right transverse upper abdominal approach with its easy and feasible access to the pyloric mass.Keywords: operative intervention, pyloric stenosis, Tan–Bianchi approac

Response of primiparous and multiparous buffaloes to yeast culture supplementation during early and mid-lactation

Strains of live Saccharomyces cerevisiae yeast have exhibited probiotic effects in ruminants. This study investigated the effects of the dietary yeast supplement, S. cerevisiae (Yea-Sacc1026), on primiparous (PP) and multiparous (MP) Egyptian buffaloes in early to mid-lactation. Lactating buffaloes were fed either a basal total mixed ration (TMR, control; 4 PP and 8 MP) or the basal TMR plus 10 g Yea-Sacc1026 per buffalo cow per day (yeast; 4 PP and 8 MP). The feeds were given from 15 days prepartum to 180 days postpartum. Feed intake, body weight, and milk yields (MY) were recorded, and milk and blood samples were collected for analyses. Feces were collected from days 45 to 47 during early lactation and from days 90 to 92 during mid-lactation to determine apparent digestibility of dry matter (DM), organic matter (OM), crude protein (CP) and crude fiber (CF). Energy corrected milk yield (ECM), feed conversion, and energy and nitrogen conversion efficiency were calculated. Yeast treated MP buffaloes consumed more DM (P ≤ 0.041) and CP than the untreated control group. Apparent digestibility of DM and OM were significantly greater at mid-lactation for treated versus control group (P = 0.001). Crude fiber digestibility was greater in MP than in PP buffaloes (P = 0.049), and yeast supplemented MP cows had a greater CF digestibility than control MP buffaloes at mid-lactation (P = 0.010). Total blood lipids decreased after yeast supplementation (P = 0.029). Milk yields, ECM, fat and protein yields increased for yeast treated MP buffaloes (P ≤ 0.039). The study concluded that the response to yeast supplementation in buffalo cows is parity dependent. Multiparous buffaloes respond to yeast supplementation with an increased DM intake and CF digestibility without significant weight gains, allowing a greater ECM yield with less fat mobilization. Supplementing buffaloes with yeast culture may increase milk production in early lactation and results in a more persistent milk production during mid-lactation. Feed conversion and energy and nitrogen conversion efficiency may be increased with the use of yeast supplementation in Egyptian buffaloes

Optimization of EDM process parameters for Al-SiC reinforced metal matrix composite

Volume 8 Issue 2 (February 201

Laser performance of perylenebis (dicarboximide) dyes with long secondary alkyl chains

The laser performance and related photophysical properties of two very soluble perylene dyes with long chain secondary alkyl groups were investigated in cyclohexane solution. With a dye laser as pump source a tuning range of 555–580 nm was obtained at an optimum concentration of 3×10–4 M. The quantum efficiencies (=0.29 and 0.21) were better than 1/2 that of rhodamine 6G. No photodegradation was observed over an excitation period of several hours

Follow-up of 50 children after posterior urethral valve management in Al-Azhar University Hospitals

Objective: This study was performed to assess the various clinical presentations, complications, and surgical management, as well as follow-up, of patients with posterior urethral valve (PUV).Patients and methods: This is a prospective descriptive analysis of the data of 50 patients with PUVs of different age reviewed. Serum creatinine levels, clinical examination, abdominopelvic ultrasound, and magnetic resonance urography were performed, and the diagnosis was confirmedby voiding cystourethrography. The patients were divided into two categories: primary intervention and surgical intervention.Results: A total of 50 boys with a mean age at diagnosis of 100 ±15 days were included in this work. The most common presentation in patients managed by valve ablation was difficult micturition (60%), whereas in patients managed by initial vesicostomy the most common presentation was febrile urinary tract infection (67%). Vesicoureteral reflux presented in 61.2% and hydronephrosis in 82.6%, whereas complications occurred in three (6%) children. Mortality occurred in five (10%) patients. Postoperative improvement of hydronephrosis grade in both categories is not appreciably different.Conclusion: Urinary drainage using small catheters or nasogastric tube in the early days of infancy followed by valve ablation is the best treatment modality in PUV.Keywords: children, outcome, posterior urethral valve, urinary drainage valve ablation, vesicostom

Modified Vertical Rectus Abdominis Musculocutaneous Flap for Limb Salvage Procedures in Proximal Lower Limb Musculoskeletal Sarcomas

Introduction and aim. Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. The authors present modified vertical rectus abdominis musculocutaneous (VRAM) flap techniques to reconstruct extensive defects after debridment of these complicated wounds. Material and Methods. Over a period of 4 years (2002–2005), 5 men and 2 women were managed. Median age was 21 years (range 15–49). The patients were managed for complicated lower trunk, groin, and upper thigh wounds after resection of three pelvic chondrosarcomas as well as two pelvic and two proximal femur osteosarcomas. The modifications included a VRAM flap with lateral and tongue-like extension design of the skin paddle (5 cases) or a delayed extended VRAM flap (2 cases). Results. All flaps showed complete survival and healing with no ischemic events providing stable coverage. All patients were ambulant with good limb functions in terms of walking and gait after adequate rehabilitation, 2 needed support with crutches. Conclusion. The modified VRAM flaps offer reliable reconstructive tools for coverage of complex groin and thigh defects by providing larger well-vascularized soft tissue with acceptable donor site

Biocompatibility and application of carbon fibres in heart valve tissue engineering

The success of tissue engineered heart valves relies on a balance between polymer degradation, appropriate cell repopulation and ECM deposition, in order for the valves to continue their vital function. However, the process of remodelling is highly dynamic and species dependent. Carbon fibres have been well used in the construction industry for their high tensile strength and flexibility, and therefore might be relevant to support tissue engineered hearts valve during this transition in the mechanically demanding environment of the circulation. The aim of this study was to assess the suitability of carbon fibres to be incorporated into tissue engineered heart valves, with respect to optimising their cellular interaction and mechanical flexibility during valve opening and closure. The morphology and surface oxidation of the carbon fibres was characterised by scanning electron microscopy (SEM). Their ability to interact with human adipose derived stem cells (hADSCs) was assessed with respect to cell attachment and phenotypic changes. hADSCs attached and maintained their expression of stem cell markers with negligible differentiation to other lineages. Incorporation of carbon fibres into a stand-alone tissue engineered aortic root, comprised of jet-sprayed poly-caprolactone aligned fibres had no negative effects on the opening and closure characteristics of the valve when simulated in a pulsatile bioreactor. In conclusion, carbon fibres were found to be conducive to hADSC attachment and maintaining their phenotype. Carbon fibres were sufficiently flexible for full motion of valvular opening and closure. This study provides a proof of concept for the incorporation of carbon fibres into tissue engineered heart valves to continue their vital function during scaffold degradation

Evidence of phonon-assisted tunnelling in electrical conduction through DNA molecules

We propose a phonon-assisted tunnelling model for explanation of conductivity dependence on temperature and temperature-dependent I-V characteristics in deoxyribonucleic acid (DNA) molecules. The capability of this model for explanation of conductivity peculiarities in DNA is illustrated by comparison of the temperature dependent I-V data extracted from some articles with tunnelling rate dependences on temperature and field strength computed according to the phonon-assisted tunnelling theory. PACS Codes: 87.15.-v, 71.38.-k, 73.40.GkComment: 6 pages, 3 figure

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding