Laparoscopic splenectomy is a gold standard for management of planned benign splenic pathologies. Spontaneous rupture of the spleen (SRS) leading to acute abdomen occurs in only 1% of all splenic ruptures. Laparoscopic splenectomy in traumatic and atraumatic rupture due to intra-splenic pathology is reported. We present the first reported case of laparoscopic splenectomy in a 23-year-old male who presented with hemoperitoneum due to idiopathic or SRS. The procedure was safely accomplished with slight modified technique and minimum usage of advanced gadgets.
Management of massive liver trauma (grades IV-VI) is associated with high morbidity and mortality. It can pose serious challenges to treating physician and requires multimodality interventions. For a successful outcome, timing of intervention is crucial. We report a case of grade V hepatic injury treated successfully with angioembolization, laparoscopic lavage, and endoscopic stenting during a time period from admission to discharge on the 24th day. Angioembolization was performed at admission after resuscitation as CT scan showed active extravasation in the arterial phase. Laparoscopic lavage and drainage was performed on the fifth day as abdominal inflammatory response failed to respond to medical management. There was biliary component of abdominal fluid noticed during laparoscopy, which manifested by postoperative localized biliary fistula; hence endoscopic stenting of the bile duct was performed on the seventh day. The patient recovered well with timely minimal invasive approach and was fine at 1 year follow-up.
Patients with breast cancer and positive sentinel node biopsy usually require axillary dissection. Different instruments are used for axillary dissection like regular scalpel,monopolar cautery, bipolar cautery etc. All these instruments are having its advantages and disadvantages. Our dept did a pilot study to know the efficacy of ultrasonic shears over cautery for axillary dissection. Parameters considered were cumulative drain amount, number of days with the drain and number of lymphnodes harvested. Ultrasonic shear machine delivers precisely directed mechanical energy with an ultrasonic vibrating blade.A single device dissects, cuts, grasps, spot coagulates. This machine was used for doing axillary dissection in one group and regular cautery in the other group. Study period was from April 2011 to June 2011 at Dept of Surgical Oncology, St Johns Hospital, Bangalore. Nine people in the ultrasonic shear group and 11 people in the cautery group were included in the pilot study. No significant difference were noticed in the cumulative drain amount, number of days with the drain, and number of lymphnodes harvested in both the groups. Axillary dissection using ultrasonic shears do not show any significant difference in the cumulative drain amount, number of days with the drain, and number of lymphnodes harvested. These are the findings of the pilot study, further prospective randomized studies are required for substantiating the findings.
In last three decades, lot of research work has been done by statisticians and academicians (others) in the field of Combinatorial testing (CT) and its use in software testing. However, its tremendous potential in terms of test optimization and fault detection is yet to be exploited to its fullest. This paper showcases some of the real-world examples from iGATE Corporation, where CT has been used successfully to achieve breakthrough results in software testing. The paper, through three case studies taken from different domains describes the challenges faced by testing teams in terms of test scenario complexities, schedule and budget constraints; and how CT helped resolve those challenges successfully. Our experience shows 60 to 70 percent benefits in terms of optimization of test efforts while enhancing test case coverage. In the end, the paper highlights some learnings from our experiences in implementing CT approach which may be of help to fellow practitioners.
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