Gall bladder retrieval from umbilical port is associated with lower port site pain than GB retrieval from epigastric port in patients undergoing elective laparoscopic cholecystectomy. We recommend umbilical port for gall bladder retrieval.
Objective. To determine the fecal incontinence and recurrence rate in patients with complex fistula in ano managed with cable tie seton at a tertiary care teaching hospital. Methods. This is a prospective case series of patients with complex anal fistula i.e. recurrent fistula or encircling >30% of external anal sphincter, managed with cable tie seton from March 2003 to March 2009. Patients were seen in the clinic after 72 hours of seton insertion under anesthesia and then every other week. Each time the cable-tie was tightened if found loose without anesthesia and incontinence was inquired according to wexner's score. Results. Seventy nine patients were treated during the study period with the age (mean ± standard deviation) of 41 ± 10.6 years and. The seton was tightened with a median of six times (3–15 times range). Complete healing was achieved in 11.2 ± 5.7 weeks. All the patients were followed for a minimum period of one year and none of the patients had any incontinence. Recurrence was found in 4 (5%) patients. Conclusion. The cable tie seton is safe, cost effective and low morbidity option for the treatment of complex fistulae-in-ano. It can, therefore, be recommended as the standard of treatment for complex fistulae-in-ano requiring the placement of a seton.
Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.
The gallbladder specimens of patients who underwent cholecystectomy for symptomatic gallstones between 2003 and 2005 were evaluated for the presence of Intestinal Metaplasia. (IM) and its risk factors. IM was positive in 39% of 293 patients tested, and in the comparative analysis of 114 metaplasia positive versus 179 negative patients, a high risk was found in patients who were 60 years or older [adjusted odds ratio (aOR) = 3.0, 95% confidence interval (CI): 1.5, 6.2]. Other factors with aOR greater than 1 were moderate to excessive use of chilies (1.8) and ethnic origin of North India (1.7). Screening method has yet to be devised for early detection of gallbladder cancer by identifying metaplastic lesions early in life. We believe that large geographic variation and lifestyle environmental factors associated with the development of gallbladder metaplasia and cancer mortality are concealed in our study that needs to be further explored.
Glucocorticoids are known to have both stimulatory as well as inhibitory effects on cells growth related activities. A number o f studies have shown that dexamethasone (DEX) and cortisol decrease the collagen synthesis in cultured fibroblasts (1,2,3). On the other hand an increase in collagen tind total protein synthesj s has also been observed when human fibroblasts and bovine aortic muscle cells were exposed to DEX ( 4 , 5 ) .These discrepancies in finding could possibly have resulted due to the differences in culture conditions used. Some recent report suggest that certain metabolic processes including collagen synthesis and degradation observe a different pattern when cells are cultured under conditions which resemble tissue like environment (6,7). For this reason many inves tigators have used fibroblasts embedded in collagen lattice to observe the effects of hormones and other regulatory bi omolecules ( 8 , 9 ) .Determination of collagen turnover rate is being used as a criterion to observe the growth related activities of different cells and to investigate the affect of hormones, growth factors and cytokines on cells in culture particularly when the studies are directed to elucidate the mechanisms involved in disease processes related to abnormalities of connective tissues.Keeping these aspects in view, we considered it appropriate to investigate the effect of DEX on collagen biosynthesis when cells are maintained in collagen matrix.Human skin fibroblasts were isolated from fore-skins obtained at circumcision Cells were initially grown in 75 c m ' * tissue cultured flasks in Dulbecco's modified Eagle's medium (GMEM) supplemented with 10% foetal calf serum, 4 mM L-glutamine and 50 pg of gentamycin sulfate perml. Studies on collagen synthesis were carried out using the cells between passage 4 to 6 . For this purpose cells were seeded either in monolayer form or in collagen matrix in 30 mm diameter tissue culture dishes as described by Gillery et al. ( 1 9 8 9 ) .To investigate the effect of DEX on collagen biosynthesis each dish except control received appropriate concentration of the hormone dissolved in ethanol, while equal volume of ethanol was added to control dishes.In addition each dish was supplemented with 2 pCi "C-proline/ml, 0 . 2 m M unlabelled proline, 50 ug/ml 13-aminopropionitrile and 50 ug/ml ascorbic acid.After 48 hours incubation period medium from each dish was removed and Rrocessed to determine the incorporation of Our results (Fig.1) demonstrates that dexamethasone decreases the biosynthesis of C-proline in collagen matrix [ a ] . collagen in two different culture conditions used in this study, however, this effect of DEX appears to be more pronounced (between -_ Matrlx El Monolayer CONTROL 250 500 1000 Qg.& DEx AMET H ASONE nM EFFECT OF DEXAMBTHASONE IN COLLAGEN BIOSYNTHISIS Fibroblastswere cultured in twodifferent conditions are described in the text. Eac value represents the mean of quadruplicate determinations of r4C-proline incorporation into collanen. 55 t o 70% o f c o n t r o l )...
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