Small bowel malignant melanoma presenting as a perforated jejunal diverticulum: a case report and literature review.

Although usually harmless and asymptomatic, jejuno-ileal diverticulae are associated with various non-specific gastrointestinal symptoms, and rarely cause surgical emergencies. This case report describes the presentation and management of a patient with an acute abdomen, whose jejunal diverticulum was perforated. Unexpectedly, histopathological assessment demonstrated malignant melanoma lining the diverticulum. Whether this was primary or metastatic is discussed, together with a synopsis of the literature on small bowel diverticulae

Cost-Effectiveness of Haemorrhoidal Artery Ligation versus Rubber Band Ligation for the Treatment of Grade II–III Haemorrhoids: Analysis Using Evidence from the HubBLe Trial

Aim Haemorrhoids are a common condition, with nearly 30,000 procedures carried out in England in 2014/15, and result in a significant quality-of-life burden to patients and a financial burden to the healthcare system. This study examined the cost effectiveness of haemorrhoidal artery ligation (HAL) compared with rubber band ligation (RBL) in the treatment of grade II–III haemorrhoids. Method This analyses used data from the HubBLe study, a multicentre, open-label, parallel group, randomised controlled trial conducted in 17 acute UK hospitals between September 2012 and August 2015. A full economic evaluation, including long-term cost effectiveness, was conducted from the UK National Health Service (NHS) perspective. Main outcomes included healthcare costs, quality-adjusted life-years (QALYs) and recurrence. Costeffectiveness results were presented in terms of incremental cost per QALY gained and cost per recurrence avoided. Extrapolation analysis for 3 years beyond the trial follow-up, two subgroup analyses (by grade of haemorrhoids and recurrence following RBL at baseline), and various sensitivity analyses were undertaken. Results In the primary base-case within-trial analysis, the incremental total mean cost per patient for HAL compared with RBL was £1027 (95% confidence interval [CI] £782– £1272, p\0.001). The incremental QALYs were 0.01 QALYs (95% CI -0.02 to 0.04, p = 0.49). This generated an incremental cost-effectiveness ratio (ICER) of £104,427 per QALY. In the extrapolation analysis, the estimated probabilistic ICER was £21,798 per QALY. Results from all subgroup and sensitivity analyses did not materially change the base-case result. Conclusions Under all assessed scenarios, the HAL procedure was not cost effective compared with RBL for the treatment of grade II-III haemorrhoids at a cost-effectiveness threshold of £20,000 per QALY; therefore

Use of health related quality of life tools in upper gastrointestinal surgery

The objective of this article is to review the literature and discuss the various tools used in upper gastrointestinal surgery for the measurement of health related quality of life (HR-QOL) and highlights various outcome variables that affect the HR-QOL among patients of common upper gastrointestinal disorders. The paper reviews HR-QOL articles published in the last 25 years on different upper gastrointestinal curative or palliative procedures. The paper used an HR-QOL method, which is a questionnaire, which is utilized to assess the changes in the health status of patients after a surgical intervention. These surveys are of increasingly importance, as health care providers are challenged to justify treatment approaches and rationale for any surgical intervention. These HR-QOL tools are very helpful for the evaluation of subjective outcome of common upper gastrointestinal surgical procedures like Gastrointestinal Quality of Life Index (GIQLI) and Quality of life in reflux and dyspepsia (QOLRAD) for Nissen fundoplication, Spitzer\'s QOL index for gastrectomy, Short Form 36 (SF-36) for achalasia and GIQLI for peptic ulcer disease. The paper concludes that use of validated and reliable health instruments in upper gastrointestinal surgery is directed at measuring the impact in a reproducible and valid fashion. Curative or palliative procedures should be offered to the patients of upper gastrointestinal disorders after the assessment by HR-QOL tools. As the impairment of functions that may occur after different operations vary considerably, an operation-specific assessment of HR-QOL for each type of surgical procedure is becoming an essential principle to follow in a successful healthcare system.African Journal of Health Sciences Vol. 15 (1&2) 2008: pp. 14-2

Pilot study on an innovative biosensor with a range of medical and surgical applications

Objectives The objective of this article is to briefly outline the utilization of biosensors in medicine and surgery and present diagnostic efficacy of thermal product (TP) based biosensor. Results The working principle of biosensor is based on measuring TP of a material in contact with the sensor. When an electrical square wave pulse of certain amplitude and duration is passed through TP based biosensor, the generated heat from its higher resistance will be dissipated and recorded by the sensor. As the surrounding material composition changes, the dissipated heat split between the sensor substrate and surrounding material changes which can be correlated to the change in TP of the material. For biological tissues, it is known that the thermal properties of tissues are quite different for different layers in the body and hence the heat absorbed will be different. The experiments were conducted on biological and non-biological tissues. For data acquisition software LabView 2014 (64-bit) was used and software used for post-processing was MATLAB R2015a (64-bit). The resulting graphs of TP from various materials (oil, water, saline, acetone) and biological tissue (porcine belly, porcine thigh layers and porcine abdominal viscera) expressed prominent deflections indicating diagnostic efficacy of TP based biosensor

Epidemiology, burden and seasonal variation of fasciolosis determined through faecal examination and excretory/secretory antigens based ELISA

ΔΕΝ ΔΙΑΤΙΘΕΤΑΙ ΠΕΡΙΛΗΨΗThe study was conducted to evaluate predominance and the related risk factors of sheep fasciolosis in Faisalabad district, Punjab, Pakistan. In addition, comparison of the coprological examinationand excretory/secretory antigens (ES Ag)-based ELISA was also performed to determine the variation in the prevalence of fasciolosis. Ofthe1200 faecal and blood samples,128 (10.67%) and 241 (20.08%) samples were found positive for Fasciola infection and anti-Fasciola antibodies respectively.The prevalence of fasciolosis was significantly (P < 0.05) higher in female and adultanimals. Most of the animals showed moderate (55.47%) infection which was significantly higher than mild (28.91%) and severe (15.63%) infections. The highest prevalence of fasciolosis was determined in December (26.00% through faecal examination; 42.00% through ELISA) with a mean EPG of 842.3 while lowest in May (02.00% through faecal examination; 07.00% through ELISA) with a mean EPG of 650. The frequency distribution of fasciolosis was significantly (P < 0.05) highest in the winter (faecal examination 20.67%; ELISA 34.67%) followed in order by the monsoon (faecal examination 09.00%; ELISA 18.67%), spring (faecal examination 08.33%; ELISA 17.33%) and summer (faecal examination 04.67%; ELISA 09.67%). The highest mean EPG of fasciolosis was determined in the spring (894) followed in order by the winter (851.67), summer (654.67) and monsoon (616.33). Although the faecal examination is the gold standard and the “best method” in the diagnosis of sheep fasciolosis; however, the serological tests should not be excluded especially the home-made ES Ag-based ELISA which might be preferred and more affordable risk assessment tool in the field epidemiology

Perceptions of parents on satisfaction with care in the pediatric intensive care unit: the EMPATHIC study

Abstract: PURPOSE: To identify parental perceptions on pediatric intensive care-related satisfaction items within the framework of developing a Dutch pediatric intensive care unit (PICU) satisfaction instrument. METHODS: Prospective cohort study in tertiary PICUs at seven university medical centers in The Netherlands. PARTICIPANTS: Parents of 1,042 children discharged from a PICU. RESULTS: A 78-item questionnaire was sent to 1,042 parents and completed by 559 (54%). Seventeen satisfaction items were rated with mean scores or =1.65, and thus considered of limited value. The empirical structure of the items was in agreement with the theoretically formulated domains: Information, Care a

Hughes Abdominal Repair Trial (HART) – Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial

Background Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs. The ‘Hughes Repair’ combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision. Methods/design This is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome. Discussion A feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions