Ruptured ectopic pregnancy presenting as an irreducible inguinal hernia

An inguinal hernia that suddenly becomes irreducible may be secondary to a variety of other underlying conditions which can occasionally mislead the attending surgeon. Benign, inflammatory or neoplastic processes, as well as surgical emergencies such as intraperitoneal or retroperitoneal haemorrhage, have all been previously reported to mimic an inguinal hernia that suddenly becomes irreducible with or without clinical features of strangulation. We add an additional interesting presentation to this list in the form of a ruptured ectopic pregnancy, which is the first such case reported in the literature. A swelling in the groin may be much more complicated than it seems on superficial consideration and good clinical acumen is constantly required in managing such cases if a satisfactory outcome without any morbidity is to be expected

Diagnostic value of plain abdominal radiographs in patients with acute abdominal pain

Objective: A prospective study was performed over a 3-month period in a tertiary referral centre to evaluate the appropriateness and contribution of plain abdominal radiographs (PAR) in the diagnosis and management of adult patients presenting with acute abdominal pain. Methods: Forward stepwise logistic regression was used to examine the correlation between PAR findings and the final diagnosis. The Chi-squared test was used to determine any changes in patient management including requirement for surgical intervention based on PAR findings (p < 0.05). Results: Of 168 patients (246 PAR), 59 (35%) had positive findings on PAR. PAR were most sensitive in cases of intestinal obstruction (odds ratio, OR = 33.548, r = 0.561). The sensitivity was further increased if three of the following predictive signs were present: exaggerated bowel sounds (OR = 13.350, r = 0.154), abdominal distension (OR = 2.993, r = 0.234) and age over 50 years (OR = 2.301, r = 0.027). PAR were non-diagnostic in 82% of patients with acute abdominal pain (p < 0.001). Conclusion: PAR do not play a major role in influencing the management of patients with acute abdominal pain without coexisting bowel obstruction

Primary torsion of the greater omentum

Primary or idiopathic greater omental torsion remains a rare cause of acute surgical abdomen in adults and children. The aetiology is as yet unknown and the treatment of choice, once diagnosis is established, is resection of the torted omentum. We report our experience with three such cases encountered over the last five years, two of which were diagnosed and subsequently managed laparoscopically. The performance of diagnostic laparoscopy for acute abdominal pain of an undetermined origin may lead to an increased detection of this condition and subsequent therapeutic intervention

Spontaneous pneumoperitoneum associated with colonic pseudo-obstruction

Pneumoperitoneum is almost always pathognomonic of a perforated abdominal viscus requiring urgent surgical intervention. Spontaneous or non-surgical pneumoperitoneum is a rare clinical condition arising secondary to abdominal, thoracic, gynaecologic or idiopathic causes. In addition to good clinical judgement, an important component in the management process is to rule out other causes of pneumoperitoneum by performing appropriate investigations. We describe a 60-year-old man who presented with clinical features of pseudo-obstruction, following an injury to his back which was compounded by hypokalaemia. Roentgenography revealed massive pneumoperitoneum and colonic distension. As there were no overt clinical features of peritonitis, the patient was managed conservatively with parenteral nutrition and close observation. A water-soluble contrast enema and computed tomography of the abdomen were of no help in identifying the cause of his pneumoperitoneum but were helpful in eliminating the presence of hollow viscus perforation or an obvious inflammatory focus. The aetiology of pneumoperitoneum in our patient was most likely due to dissection of air through the distended colonic wall, secondary to large bowel pseudo-obstruction. The diagnosis of spontaneous or non-surgical pneumoperitoneum is one of exclusion and we stress the importance of relying on clinical parameters when managing such patients conservatively

Mucinous adenocarcinoma arising from chronic perianal fistula

Perianal mucinous adenocarcinoma is a rare tumour which may be associated with long-standing chronic perianal sepsis. Early diagnosis is challenging and is based on a high index of clinical suspicion and specific histological features. Definitive treatment is surgical, in the form of an abdomino-perineal resection. We hereby describe a case of a perianal mucinous adenocarcinoma arising from long-standing recurrent perianal fistula and complement this with a brief review of the literature pertaining in particular to the management of this condition

Obesity and Risk of Colorectal Adenomatous Polyps: a Case-Control Study in Hospital Kuala Lumpur

Colorectal adenomas are precursor lesions of colorectal cancer. Several studies have proposed that obesity is a risk factor for colorectal adenoma. This case-control study examined the relationship between body mass index (BMI), waist circumference, waistto-hip ratio (WHR), body fat percentage and colorectal adenomatous polyps (CRA) in patients who have had a colonoscopy at the Hospital Kuala Lumpur (HKL). Fifty-nine patients (42 males and 17 females) positively identified as having CRA and 59 polypfree subjects were recruited as controls (33 males and 26 females). A pre-tested questionnaire was used to collect socio-economic information, while anthropometric measurements were determined directly by established methods. The mean BMI of female case subjects was significantly higher than control females (25.63 + 4.87 kg/m2 vs. 23.86 + 3.70 kg/m2, p<0.05) but the difference in BMI was not significant in men. The mean WHR of male subjects was significantly higher in the case group (0.92 + 0.07 vs. 0.90 + 0.06, p<0.05). After adjusting for confounders, waist circumference was the only indicator that was found to significantly increase the risk for CRA in women (OR = 6.349, 95% CI = 1.063 � 37.919). Higher BMI, WHR and body fat percentage showed a non-significant risk in female subjects. In men, none of the obesity indicators were found to be significant risk factors for CRA. These findings suggest that abdominal obesity may be a contributing factor to CRA risk particularly in women. A prospective study is needed to confirm the role of obesity in the development of CRA in Malaysians. A1, Kandiah M2, H3, & JA

PENGARUH KUAT ARUS LAS SMAW TERHADAP STRUKTUR MIKRO, KEKUATAN TARIK DAN KEKUATAN IMPACT SAMBUNGAN V BAJA TAHAN KARAT AISI 304

Abstrak Pada pengelasan banyak terdapat beberapa macam penyetelan kuat arus atau variasi arus yang dipakai untuk penyalaan busur listrik yang bertujuan untuk melelehkan elektroda dan bahan dasar. Besar dan kecilnya kuat arus menentukan kekuatan sambungan las tersebut. Tujuan penelitian ini adalah (1). Untuk mengetahui kekuatan Tarik pada bahan baja tahan karat AISI 304 hasil pengelasan dengan variasi arus 65 A, 80 A dan 100 A dengan mengunakan Las SMAW (Shielded Metal Arc Welding). (2). Untuk mengetahui kekuatan Impact pada bahan baja tahan karat AISI 304 hasil pengelasan dengan variasi arus 65 A, 80 A dan 100 A dengan mengunakan Las SMAW (Shielded Metal Arc Welding). (3). Untuk mengetahui struktur mikro pada bahan baja tahan karat AISI 304 hasil pengelasan dengan variasi arus 65 A, 80 A, 100 A dengan menggunakan las SMAW (Shielded Metal Arc Welding). Penelitian ini menggunakan metode eksperimen dan metode literatur, objek dalam penelitian ini menggunakan baja tahan karat AISI 304, dengan mengandung sedikitnya 16% krom dan 6% nikel. Hasil penelitian menunjukkan bahwa kuat arus las SMAW 65 A, 80 A dan 100 A mempunyai pengaruh yang signifikan terhadap nilai kekuatan tarik dan kekuatan impact. Hasil pengelasan SMAW memiliki perbedaan kekuatan antara kekuatan tarik dan kekuatan impact, dimana untuk hasil uji tarik yang paling optimal adalah arus 65 A dengan nilai rata-rata kekuatan tarik maksimumnya 565,35 N/mm² dan kekuatan tarik yang paling rendah 80 A dengan nilai rata-rata kekuatan Tarik maksimumnya 486,39 N/mm². Sedangkan untuk pengujian impact hasil yang paling optimal adalah arus 100 A dengan harga impact 0,102 J/mm² dan hasil paling rendah adalah arus 65 A dengan harga impact 0,058 J/mm². Dari hasil foto struktur mikro arus 80 A memiliki ferit acicular dan ferit batar butir yang paling lembut, seharusnya disini arus 80 A memiliki kekuatan yang tinggi tetapi dengan munculnya lubang las di daerah batas las sehingga arus 80 A memiliki kekuatan sambungan yang kecil. Kata kunci: Variasi kuat arus , Struktur Mikro , uji Tarik dan uji Impact. Abstract There are many welding On some sort of Setup current or current variation used for electric arc lighting aimed at melting the electrode and the base material. Large and small current determine the strength of the connection the welding. The purpose of this research is (1). To know the power of pull on the material stainless steel AISI 304 with welding current variation results 65 A, 80 A and 100 A using Welding SMAW (Shielded Metal Arc Welding). (2) to find out the strength of Impact on material stainless steel AISI 304 with welding current variation results 65 A, 80 A and 100 A using Welding SMAW (Shielded Metal Arc Welding). (3). To know microstructure on material stainless steel AISI 304 with welding current variation results 65 A, 80 A, 100 A using welding SMAW (Shielded Metal Arc Welding). This research uses experimental methods and methods of the objects in the literature, this research uses stainless steel AISI 304, with contains at least 16% chromium and 6% nickel. The results showed that current welding SMAW 65 A, 80 A and 100 A significant influence of tensile strength and impact strength. SMAW weld has the distinction of powers between tensile strength and impact strength, where the results for the most optimal pull-test is the current 65 A with the average value of the maximum tensile strength N/mm ² 565.35 and lowest tensile strength 80 A with an average value of 486.39 the maximum tensile strength N/mm ². As for testing the impact of the most optimal results is the current 100 A with the price impact 0.102 J/mm ² and the lowest is the current 65 A with the price impact 0.058 J/mm ². From the results of the photo current micro-80 A structure have acicular ferrite and ferrite grains are the most gentle batar, should the current 80 here with high powers but with the emergence of a hole in the area of las las limits so that current 80 A power connection that small. Keywords: strong currents, variations of the Microstructure, Tensile test and test Impact

Protein expression of STAT3, pSTAT3, MMP-7 and VEGF in colorectal adenocarcinoma: an immunohistochemical study

Background: The purpose of the present study is to investigate the expression levels of STAT3, pSTAT3, MMP-7 and VEGF in colorectal adenocarcinoma, and also to determine association with the clinico-pathological parameters and co-expression of these genes. Methods: An immunohistochemical method was used to evaluate the expression of MMP-7 and VEGF genes in 93 archival tissues whereas STAT3 and pSTAT3 expression was determined in 75 cases. Results: Overexpression of STAT3 was detected in 26.7% (20/75), pSTAT3 in 13.4% (10/75), MMP-7 in 38.8% (36/93) and VEGF in 59.2% (55/93) of the colorectal carcinomas. STAT3, MMP-7 and VEGF immunopositivity were significantly correlated with poorly-differentiated tumors (P = 0.004; P = 0.03; P =0.002, respectively) but not with other parameters. However, pSTAT3 immunostaining was not significantly associated with the clinico-pathological characteristics. Significant relationship was noted between overexpression of pSTAT3 and STAT3 (P \u3c 0.001), pSTAT3 and VEGF (P = 0.044), pSTAT3 and MMP-7 (P = 0.003), and STAT3 and VEGF (P = 0.037) but marginal association was detected between STAT3 and MMP-7 (P = 0.057), and MMP-7 and VEGF (P = 0.052). Conclusion: Our data suggest that expression of these genes may have an important role in tumor dedifferentiation and may be useful as indicators of biologic aggressiveness. Co-expression of the bio-markers by cancer cells may have important implications in colorectal cancer biology and could be useful biological markers of the malignant phenotype

PVSYST-Based Solar Power Plant Planning

This research uses the PVSyst software which can plan an off-grid SPP system and find out how much electricity is generated in the Auditorium Building Campus 2, Ujung Pandang State Polytechnic. PVSyst is a software package that is used for the learning process, sizing, and data analysis of the PV mini-grid system. PVSyst is divided into grid connected systems, standalone systems, pumping systems. PVSyst is also equipped with a database from a wide and diverse range of meteorological data sources, as well as data on PV mini-grid components. In planning a PVSyst-based solar power plant, it can be used to find out how much electrical energy is generated to meet the electricity needs of the Campus 2 Auditorium Building, Ujung Pandang State Polytechnic. In this study using the PVSyst software according to the proposed load requires an average energy of 482 kWh/day, therefore, the panel module used is the polycrystalline type model CS3W-410P-HE manufacturer Canadian Solar Inc, where each panel unit used has a nominal power of 410 WP requires 422 modules, 2 modules in series and 211 modules in parallel. The battery used is a lead acid type with a 12-CS-11PS model manufactured from Rolls. The batteries used are 195 batteries, of which 3 batteries are installed in series and 64 batteries are installed in parallel. The controllers needed in this design are 50 units with the FLEXmax 80-36V model manufactured from Outback. The technology of this controller is an MPPT converter. In planning Solar Power Plant using PVSyst in the Auditorium Building Campus 2 of Ujung Pandang State Polytechnic, it produces electricity of 227,122 kWh per year