Two port laparoscopic ventral hernia mesh repair: An innovative technical advancement

AbstractVentral hernia is a common surgical problem. The traditional open surgical repair has the disadvantage of excessive morbidity, long hospital stay and high recurrence rates. Laparoscopic ventral hernia repair (LVHR) is gaining acceptance but there is no standardized technique for the repair of these hernias. We have introduced an innovative technique of 2-port laparoscopic mesh repair for ventral and incisional hernias.Between January 2002 and September 2008, 168 patients underwent the 2-port repair of ventral hernias at our institution, with Bard polypropylene mesh in 162 cases and Gore-tex expanded polytetrafloroethylene mesh in 6 patients. The average size of the defects was 10.2 cm (6.6–24.8 cm). Mean operating time was 61.4 min (48–102 min). The mean post-operative hospital stay was 1.2 days. Prolonged ileus over one day occurred in 22 patients while 6 patients had urinary retention in the post-operative period. There were 6 recurrences (3.94%) in the mean follow up period of 42 months (6–62 months). Seroma formation occurred in 5.3% cases but all of them subsided within 6 weeks without any active intervention.In conclusion we recommend that the 2-port LVHR is a technically sound procedure which is less invasive and with comparable complication rates to the 3 or 4 port hernia repair

Tension band wiring in a rare case of isolated acromion fracture: a case report

Fracture of the acromion process is an uncommon injury. The most common mechanism of injury is direct trauma to the acromion. Isolated acromion fractures are rare as usually they are associated with concomitant skeletal and soft tissue injuries of the shoulder. We present a case of a 45-year-old male with a type 3 fracture of acromion process with reduction of subacromial space. Patient was managed surgically and fracture was fixed using tension band wiring. Patient was followed up using UCLA, DASH and VAS scores and showed good radiological and functional outcomes. Minimally displaced fractures should be regularly followed up for displacement and sub-acromial space compromise. Although acromion fractures are usually treated conservatively, albeit a higher non-union rate, they should be treated surgically in the event of displacement or sub-acromial space reduction, in order to achieve good functional recovery.

Type 4 congenital proximal radio-ulnar synostosis mimicking as malunited radial neck and deformed radial head with insidious onset extension block: a case report and results after excision

Proximal radio ulnar synostosis is a rare entity presenting with restriction of supination and pronation. Among the various types, type 4 variety is even more-rare and its presentation, can pose a diagnostic challenge specially, if with history of trauma. Radiologically, it is usually overlooked as a malunited radial neck and therefore needs thorough evaluation. We presented a case of a 15-year-old male who complains of new onset extension block following trauma, with chronically restricted supination and pronation. History suggested the restriction in supination and pronation since birth, and the extension block occurring de novo. Radiographs and CT scan of the elbow revealed proximal radio-ulnar synostosis and anteriorly dislocated, mushroom-shaped radial head, misleading and mimicking like an old, neglected and malunited radial neck fracture with a deformed radial head.  The family insisted to not address the restriction of supination pronation but, asked for solution to more disabling extension block. Thus, patient was managed with open procedure, involving radial head-neck excision and removal of malformed radial head. At 1-year follow-up, the child has a well-reduced and stable elbow joint with a functional range of flexion and extension movements with restricted supination and pronation. Type 4 congenital radio ulnar synostosis not only leads to conventionally known restriction of supination pronation but also give rise to extension block de novo as presented in this case. Excision of the deformed head and neck can treat the restriction in extension, however the synostosis will require various other augmented procedures

Transcriptomic data meta-analysis reveals common and injury model specific gene expression changes in the regenerating zebrafish heart.

Zebrafish have the capacity to fully regenerate the heart after an injury, which lies in sharp contrast to the irreversible loss of cardiomyocytes after a myocardial infarction in humans. Transcriptomics analysis has contributed to dissect underlying signaling pathways and gene regulatory networks in the zebrafish heart regeneration process. This process has been studied in response to different types of injuries namely: ventricular resection, ventricular cryoinjury, and genetic ablation of cardiomyocytes. However, there exists no database to compare injury specific and core cardiac regeneration responses. Here, we present a meta-analysis of transcriptomic data of regenerating zebrafish hearts in response to these three injury models at 7 days post injury (7dpi). We reanalyzed 36 samples and analyzed the differentially expressed genes (DEG) followed by downstream Gene Ontology Biological Processes (GO:BP) analysis. We found that the three injury models share a common core of DEG encompassing genes involved in cell proliferation, the Wnt signaling pathway and genes that are enriched in fibroblasts. We also found injury-specific gene signatures for resection and genetic ablation, and to a lower extent the cryoinjury model. Finally, we present our data in a user-friendly web interface that displays gene expression signatures across different injury types and highlights the importance to consider injury-specific gene regulatory networks when interpreting the results related to cardiac regeneration in the zebrafish. The analysis is freely available at: https://mybinder.org/v2/gh/MercaderLabAnatomy/PUB_Botos_et_al_2022_shinyapp_binder/HEAD?urlpath=shiny/bus-dashboard/

Comparative evaluation of postpartum versus post MTP insertion of intrauterine contraceptive device

Background: This study was planned to evaluate acceptability, safety and continuation rate of postpartum intrauterine contraceptive device (PPIUCD) and to compare it with well accepted post MTP IUCD in Indian population.Methods: This was a prospective study conducted in VMMC and Safdarjang Hospital, New Delhi, India. Copper T 380-A was inserted in 100 woman in postpartum period and in 100 woman in post MTP period. Follow up done at 6 weeks, 3 months and 6 months. Safety was assessed in terms of expulsion, IUCD failure/pregnancy rate, perforation, removal of IUCD, visibility of strings and various complain at each visit. Continuation rate along with their level of satisfaction was compared at the end of 6 months. SPSS software, Chi-square test and student T test were used for analyzing the results. P value ≤0.05 considered as significant.Results: Acceptance of post MTP IUCD was more than PPIUCD. There was statistically no significant difference in expulsion rate, removal of IUCD and various complaints. There was no case of perforation in either group. Non visibility of strings was major cause of concern and apprehension in PPIUCD group. Only one case of pregnancy was reported in PPIUCD group while no failure was reported in post MTP group. Continuation rate and level of satisfaction were comparable in both groups.Conclusions: PPIUCD is equally safe and effective as post MTP IUCD.

Neglected fracture shaft femur presenting with pseudoaneurysm: a case report

A pseudoaneurysm is a collection of blood leaking from a damaged arterial wall. Development of the false aneurysm is due to either initial injury of the vessel or is a complication of internal fixation of the femoral fracture. Femoral artery pseudoaneurysms (FAPs) may close spontaneously if the tear is small enough to allow for clotting and sealing. On the other hand, rupture of the aneurysm can trigger thrombosis, distal embolization and compression of adjacent structures. We present a case of left superficial femoral arterial pseudoaneurysm in a 36-year-old male with fracture of left femoral shaft. A 36-year-old male with history of road traffic accident presented to our institute with pain and swelling in left thigh. Patient was investigated and diagnosed with fracture left femoral shaft with a pseudoaneurysm of the left superficial femoral artery (SFA). Stenting was done for SFA followed by open reduction and internal fixation of the femoral shaft fracture. Such cases require multidisciplinary approach and a proper planning with involvement of different medical specialities to achieve optimal results and to minimise any intraoperative and post operative complications

Kinetics of Various Chemical Changes During Storage of Processed Cheese

Three batches of processed cheese (PC) were manufactured by the standard procedure and packed aseptically in polystyrene (Sunpet) pet jars with screw cap of about 200 g capacity and stored at 5, 30 and, 45°C. The PC samples were analysed for proximate composition, selected physico-chemical characteristics and sensory attributes at intervals of 7 days for the product stored at 5°C upto 56 days, 3 days for the product stored at 30°C upto 6 days and 24 days at 45°C till the sample became organoleptically unacceptable. The results revealed that 30°C was conducive for mold growth, due to which the product got spoiled after 8 days of storage and hence the studies were terminated at this temperature. An increasing trend was observed in all the chemical parameters except pH with increase in time of storage at all the temperatures. The reaction rate constants for all the chemical parameters, followed a zero order reaction and were higher at higher temperature of storage as compared to lower temperatures. The least square analysis of variance for the chemical parameters had no significant differences between batches, while there was a significant to highly significant difference between storage period and temperature of storage

Repair of avulsion flap injury of heel by multiple point anchorage using Kirschner wires-a case series

The heel pad is a dense band of fibrous tissue with complex anatomy. Injuries to heel pad are uncommon but very challenging due to its precarious blood supply. In this study we tried fixing acute heel pad avulsion injuries using multiple Kirschner wires and results were evaluated according to the American orthopedic foot and ankle society hind foot score. Results were excellent for 3 -out of 9 patients and good for 6 patients according to the AOFAHS scoring system. Anchorage of acute heel pad avulsion injuries using multiple Kirschner wires is an effective and reliable treatment modality

Large axillary accessory breast hamartoma: a rare entity

Hamartomas are uncommon benign tumours of axilla and breast. They show varied imaging appearances depending upon the proportion of various tissue elements present. The mammographic, ultrasound and elastographic appearances of a case of left axillary hamartoma is described in a 49 years old Indian patient