New advantageous tool in single incision laparoscopic cholecystectomy: the needle grasper

Introduction: During single-incision laparoscopic cholecystectomy (SILC), the gallbladder is suspended with stitches, resulting in perforation risk and difficulty in exploration. Aim: We used the needle grasper in SILC to hang and manipulate the gallbladder. Material and methods : Sixty-five patients (43 female, 22 male) who underwent SILC between December 2013 and December 2014 were analyzed retrospectively for patient demographics, duration of operation, laparotomy or conventional laparoscopy necessity, drain use, complications, and hospital stay periods. To place the SILC port (Covidien, Inc.), the needle grasper was inserted at the right upper abdominal quadrant without an incision to hang and manipulate the gall-bladder. Results : The mean age was 47.9 ±13.068 years; the mean body mass index (BMI) was 26.94 ±3.913 kg/m2. ASA scores were 1, 2, and 3. Two patients with high BMI with additional trocar use were excluded. The operations were completed without any additional trocar in 59 patients. The mean operation time was 89 ±22.41 min. Eighteen patients required a drain; all were discharged after drain removal. One patient needed re-hospitalization and percutaneous drainage and was discharged on the 9th day. Fifty-three patients were discharged on the 1st post-operative day. Eleven patients with drains were discharged on the 2nd day, and 1 was discharged on the 7th day. The mean hospital stay period was 1.26 ±0.815 days. Conclusions : The main difficulty of SILC is to manipulate hand tools because the triangulation principle of laparoscopy use is not possible in SILC. Inserting a needle grasper into the abdominal cavity at the right subcostal area to manipulate the gallbladder helps and does not leave a visible scar

Rectus sheath hematoma: three case reports

<p>Abstract</p> <p>Introduction</p> <p>Rectus sheath hematoma is an uncommon cause of acute abdominal pain. It is an accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. It could occur spontaneously or after trauma. They are usually located infraumblically and often misdiagnosed as acute abdomen, inflammatory diseases or tumours of the abdomen.</p> <p>Case presentation</p> <p>We reported three cases of rectus sheath hematoma presenting with a mass in the abdomen and diagnosed by computerized tomography. The patients recovered uneventfully after bed rest, intravenous fluid replacement, blood transfusion and analgesic treatment.</p> <p>Conclusion</p> <p>Rectus sheath hematoma is a rarely seen pathology often misdiagnosed as acute abdomen that may lead to unnecessary laparotomies. Computerized tomography must be chosen for definitive diagnosis since ultrasonography is subject to error due to misinterpretation of the images. Main therapy is conservative management.</p

Characterization of greater middle eastern genetic variation for enhanced disease gene discovery

The Greater Middle East (GME) has been a central hub of human migration and population admixture. The tradition of consanguinity, variably practiced in the Persian Gulf region, North Africa, and Central Asia1-3, has resulted in an elevated burden of recessive disease4. Here we generated a whole-exome GME variome from 1,111 unrelated subjects. We detected substantial diversity and admixture in continental and subregional populations, corresponding to several ancient founder populations with little evidence of bottlenecks. Measured consanguinity rates were an order of magnitude above those in other sampled populations, and the GME population exhibited an increased burden of runs of homozygosity (ROHs) but showed no evidence for reduced burden of deleterious variation due to classically theorized ‘genetic purging’. Applying this database to unsolved recessive conditions in the GME population reduced the number of potential disease-causing variants by four- to sevenfold. These results show variegated genetic architecture in GME populations and support future human genetic discoveries in Mendelian and population genetics

Incidence of postdural puncture headache: Two different fine gauge spinal needles of the same diameter

Objective: The aim of this study was to compare two spinal needles with different bevel designs regarding their technical handling capacities and complication rates. Materials and Methods: After the clinical trials Ethics Committee approval and informed consents from the patients, 220 pregnant female patients undergoing elective cesarean delivery under spinal anesthesia were recruited in the study. Patients were divided into two groups as, Group A (n = 110) and Group Q (n = 110); who received spinal anesthesia via 26 gauge (26-G) atraumatic spinal needle (Atraucan® , B. Braun Melsunger, Germany) and via 26-G Quincke spinal needle (Spinocan® , B. Braun Melsunger, Germany), respectively. Procedure duration, puncture attempts and postdural puncture headache (PDPH) incidence were recorded. The costs of the spinal needles were also noted. Results: There were no significant differences between the two groups in spinal puncture attempts and procedure durations. Similarly, incidence, severity, onset time and duration of headache were not found to be significantly different between the two groups. Ten patients (9.2%) in Group A and 11 (10.3%) in Group Q had developed PDPH. Conclusion: Both spinal needles offer good handling characteristics with comparable incidence of PDPH. Taking into account economical factors 26-G Quincke needle may be preferred to 26-G Atraucan®

Sorption of strontium and barium on clays and soil fractions

Sorption properties of strontium and barium on kaolinte, montmorillonite, chlorite + illite type of mixed clay and soil fractions have been studied by using batch technique at room temperature. 90Sr and 133Ba were used as tracers. Montmorillonite type clay was found to sorb strontium more strongly than the other clays whereas chlorite 4-illite mixed clay was found to be the best sorbent for barium. Variation of distribution ratio, Rd, as a function of cation concentrations exhibited characteristic inverse S-shaped curves. Sorption isoterms were well described by Freundlich and Dubinin-Radushkevich equations in all cases.Hatipoglu Sinan, Eylem Cahit, Göktürk Hale, Erten Hasan N. Sorption of strontium and barium on clays and soil fractions. In: Proceedings of the 9th international Clay Conference, Strasbourg, 1989. Vol II : Surface chemistry. Structure and mixed layering of clays. Strasbourg : Institut de Géologie – Université Louis-Pasteur, 1990. pp. 79-86. (Sciences Géologiques. Mémoire, 86

Sorption of strontium and barium on clays and soil fractions

Sorption properties of strontium and barium on kaolinte, montmorillonite, chlorite + illite type of mixed clay and soil fractions have been studied by using batch technique at room temperature. 90Sr and 133Ba were used as tracers. Montmorillonite type clay was found to sorb strontium more strongly than the other clays whereas chlorite 4-illite mixed clay was found to be the best sorbent for barium. Variation of distribution ratio, Rd, as a function of cation concentrations exhibited characteristic inverse S-shaped curves. Sorption isoterms were well described by Freundlich and Dubinin-Radushkevich equations in all cases.Hatipoglu Sinan, Eylem Cahit, Göktürk Hale, Erten Hasan N. Sorption of strontium and barium on clays and soil fractions. In: Proceedings of the 9th international Clay Conference, Strasbourg, 1989. Vol II : Surface chemistry. Structure and mixed layering of clays. Strasbourg : Institut de Géologie – Université Louis-Pasteur, 1990. pp. 79-86. (Sciences Géologiques. Mémoire, 86