Evolution of Minimally Invasive Surgery for Donor Nephrectomy and Outcomes

Modifications to the laparoscopic donor nephrectomy technique may increase this option to donors who may have been considered unsuitable heretofore

Public perception of "scarless" surgery : a critical analysis of the literature

Evidence relating to the perception and view of patients and physicians on natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) was scrutinized. A comprehensive literature search was performed through PubMed. A total of 18 studies were included in the analysis. Patients demonstrated interest in scarless surgery, with a preference for LESS over NOTES. Safety and efficacy remain the key factors in the decision-making process of patients. With more information about the safety and reproducibility of LESS and NOTES, and with improved educational efforts, patients and physicians alike may feel more comfortable in widespread application of scarless surgery.(undefined

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

STUDIES ON THE FOREGUT OF ORTHAGA EX VINA CEA HAMPSON (LEPIDOPTERA: PYRALIDAE) DURING PREPUPAL DEVELOPMENT

Morphological studies on the foregut of Orthaga exvinacea at its prepupal stage could be divided into pharynx, oesophagus and crop. Histologically the wall of the foregut is composed of peritoneum, muscle layers, basement membrane, epithelium and intima. The epithelium is composed of cuboidal and squamous cells

Occult splenic rupture in a case of chronic calcific pancreatitis with a brief review of literature

Introduction: Splenic rupture in chronic pancreatitis is a life threatening rare complication. The anatomical proximity of the pancreas with the spleen and the pathophysiological process in acute and chronic pancreatitis form the basis of this dreaded complication. Presentation of case: We cite the case of a young male previously undiagnosed with chronic pancreatitis presenting with atraumatic splenic rupture. Definitive diagnosis was made by contrast enhanced computed tomography of the abdomen, intra operative findings, and histopathological examination of the splenectomy specimen. Discussion: The splenorenal ligament forms the main anatomic proximity between the pancreas and the spleen. A few pathophysiological mechanisms though suggested are incompletely understood. splenic vein thrombosis, intrasplenic pseudocysts, splenic rupture, infarction, necrosis, splenic hematoma, and severe bleeding from eroded splenic vessels are the complications noted of which splenic rupture is the second most common following splenic vein thrombosis forming 36% of the complications noted. Chronic pancreatitis as an etiology of occult splenic rupture is rare and forms 8.27% of cases; commonest causes being neoplastic and infectious. The diagnosis is based on clinical and radiological findings and the management is predominantly surgical. Conclusion: High clinical suspicion on the part of the treating physician and the emergency team is essential to the management of atraumatic splenic rupture. The increasing understanding of the pathophysiology and presentation of splenic complications in pancreatitis may alert the index physician to these fatal complications

Targeted tumescent liposuction for fistula superficialization

Obesity poses problem with the cannulation of arteriovenous fistula and difficulty in establishing functional autogenous access for hemodialysis. We describe a case where we used targeted tumescent liposuction to remove subcutaneous fat over the fistula

Are populations of postpartum women differentially served by community health worker programs: an observational cohort study from Zanzibar, Tanzania

Abstract Background Although community health worker (CHW) programs focus on improving access to healthcare, some individuals may not receive the intended quality or quantity of an intervention. The objective of this research was to examine if certain populations of pregnant women differentially experience the implementation of a community health worker-led maternal health intervention in Zanzibar. Methods We included pregnant women enrolled in the Safer Deliveries (Uzazi Salama) program, which operated in 10 of 11 districts in Zanzibar, Tanzania between January 1, 2017, and June 19, 2019 (N = 33,914). The outcomes of interest were receipt of the entire postpartum intervention (three CHW visits) and time to first postpartum CHW visit (days). Visits by CHWs were done at the women’s home, however, a telehealth option existed for women who were unable to be reached in-person. We conducted statistical tests to investigate the bivariate associations between our outcomes and each demographic and health characteristic. We used multivariate logistic regression to estimate the relationships between covariates and the outcomes and multivariate linear regression to estimate the association between covariates and the average time until first postpartum visit. Results Higher parity (OR = 0.85; P = 0.014; 95%CI: 0.75–0.97), unknown or unreported HIV status (OR = 0.64; p < 0.001; 95%CI: 0.53–0.78), and receipt of phone consultations (OR = 0.77; p < 0.001; 95%CI: 0.69–0.87) were associated with a lower odds of receiving all postpartum visits. Similarly, women with an unknown or unreported HIV status (estimated mean difference of 1.81 days; p < 0.001; 95%CI: 1.03–2.59) and those who received a phone consultation (estimated mean difference of 0.83 days; p < 0.001; 95%CI: 0.43–1.23), on average, experienced delays to first visit. In addition, current delivery at a referral hospital was associated with lower odds of receiving a postpartum visit and longer time to first visit compared to delivery at home, cottage hospital, PHCU + , or district hospital. Women from all other districts received their first visit earlier than women from Kaskazini B. There were no differences in the odds of receiving the entire postpartum intervention by sociodemographic variables, including age, education, and poverty assessment indicators. Conclusion The results indicate no differences in intervention contact across wealth and education levels, suggesting that the program is effectively reaching women regardless of SES. However, women with other characteristics (e.g., higher parity, unknown or unreported HIV status) had lower odds of receiving the complete intervention. Overall, this work generates knowledge on existing disparities in intervention coverage and enables future programs to develop approaches to achieve equity in health care utilization and outcomes