Rare pelvic peritoneal defect causing small bowel obstruction in a young female with virgin abdomen.

This case report discusses a 46-year-old female with no prior surgical history who presented with severe abdominal pain and generalized tenderness. She was found to have a small bowel obstruction secondary to internal hernia caused by a rare congenital pelvic peritoneal defect in the Pouch of Douglas. She required diagnostic laparoscopy and repair of the pelvic peritoneal defect. Congenital peritoneal defect is an extremely rare cause of small bowel obstruction but should remain a possible differential diagnosis in patients with virgin abdomen presenting with acute abdominal pain.

A Sneak Peek Toward Polyaryletherketone (PAEK) Polymer: A Review.

Metals, acrylics, zirconia, and other such materials have been conventionally used in dentistry. The development of polymers has facilitated significant changes in clinical dentistry. High-performance polymer materials are at the forefront of dentistry. Polyaryletherketone (PAEK) is a biocompatible polycyclic, aromatic, thermoplastic polymer having good mechanical and thermal properties. It has two members: polyetheretherketone (PEEK) and polyetherketoneketone (PEKK). The difference in the ratio and structure of ether to ketone group affects the melting point and glass transition temperature. PEEK and PEKK have a high impact with their physical and mechanical characteristics similar to that of the bone and mimic the natural tooth structure. It can be used as a substitute for metals and other materials owing to its non-allergic properties and acceptable aesthetics. Currently, to modify the properties of both materials, additives were used. This semicrystalline structure does not provide any kind of mutagenicity and cytotoxicity. This review provides insight into the properties and applications of polymer in dentistry and the medical field as well. There is room for metal-free restorations in modern dental practice due to the rising demand for aesthetics, a few disadvantages with existing materials, and clinicians changing their paradigms toward metal-free restorations. The objective of this review is to provide a thorough understanding of PEEK and PEKK and their multiple uses in prosthetic, implant frameworks, abutments, crowns, and ortho wires, as well as in restorative dentistry, while demonstrating their potential for clinical applications.

Smart Materials Leading to Restorative Dentistry: An Overview.

Dental material has emerged in the last few decades with enhanced biological properties. The prime characteristics required for dental materials are that they should be compatible with oral cavity fluids such as saliva and gingival crevicular fluids. Their functionality should be enhanced in the presence of such biological factors. Scientific advancements in exploring innovative materials have led to the possibility of achieving beneficial results by using materials that respond more dynamically to the environment in which they are placed. Currently available dental materials are improvised. Restorative materials such as smart composites, smart ceramics, compomers, resin-modified glass ionomer, amorphous calcium phosphate (ACP)-releasing pit and fissure sealants, and other smart burs and orthodontic shape memory alloys have all benefited from the usage of smart materials in dentistry.

Status Quo in Mechanical Plaque Control Then and Now: A Review.

There are various kinds of dental diseases, of which dental caries and disease of periodontal origin are the most common. A very strong connection has been proven between oral inflammation and general health of an individual. Dental Biofilm is the main cause for gingivitis and periodontitis. Dental plaque may also be referred to as microbial plaque that consists of highly organized structures of different microbiotas attached to the hard tooth structure, which may be bound by salivary glycoproteins. Plaque control is a term that refers to removal of already formed or the control of formation of this microbial biofilm. There have been various methods practiced for plaque control; they are broadly classified into mechanical methods and chemical plaque control methods. Mechanical plaque control further includes many other methods such as manual toothbrushes and smart toothbrushes, which includes power-driven toothbrushes, sonic and ultrasonic toothbrushes, solar-powered toothbrushes (ionic toothbrushes), disposable toothbrushes, and laser toothbrushes; this also includes interdental cleaning aids. Continuous advancements with the integration of technology have been made in the field of mechanical plaque control to improve its quality.

Poor Employment Conditions Adversely Affect Mental Health Outcomes Among Surgical Trainees.

BACKGROUND: Poor mental health in junior clinicians is prevalent and may lead to poor productivity and significant medical errors. We aimed to provide contemporary data on the mental health of surgical trainees and identify risk factors relating to poorer mental health outcomes. METHODS: A detailed questionnaire was developed comprising questions based on the 36-item short-form health survey (SF-36) and Physical Activity Questionnaire. Each of the questionnaires has proven validity and reliability in the clinical context. Ethics approval was obtained from the Royal Australasian College of Surgeons. The questionnaire was aimed at surgical registrars. We used Physical Activity Questionnaire, SF-36 scores and linear regression to evaluate the effect of putative predictors on mental health. RESULT: A total of 83 responses were collected during the study period, of which 49 (59%) were from men and 34 (41%) were from women. The mean Mental Component Summary (MCS) score for both sexes was significantly lower than the population mean at ages 25-34 (p < 0.001). Poor satisfaction with one's work culture and a feeling of a lack of support at work were extremely strong predictors of a lower MCS score (p < 0.001). Hours of overtime worked, particularly unpaid overtime, were also strong predictors of a poorer score. CONCLUSIONS: Australian surgical trainees reported lower MCS scores from the SF-36 questionnaire compared to the general population. Increasing working hours, unpaid overtime, poor job security, and job satisfaction were associated with poorer scores among trainees. Interventions providing improved working conditions need to be considered by professional training bodies and employers.

Fifteen-year groin hernia trends in Australia: the era of minimally invasive surgeons.

BACKGROUND: Groin hernia repairs (GHRs) are among the commonest general surgical procedures in the Western population. The introduction of minimally invasive surgery has prompted the development of laparoscopic totally extraperitoneal and trans-abdominal preperitoneal hernia repairs. We aimed to determine the hernia treatment trends in Australia over the last 15 years. METHODS: Using Medicare Benefit Schedule data, we categorized the number of laparoscopic and open hernia repairs between 2000 and 2015 in Australia. Population data were collected from the Australian Bureau of Statistics. Hernia repair rates were standardized by age, gender and location. RESULTS: During the study period, a total of 324 618 GHRs were performed on adult patients in Australia, 43% by a laparoscopic method. While there was a slight yearly increase in overall total GHRs performed, laparoscopic surgeries increased by 3.1 per 100 000 population every year (95% CI: 2.9-3.3) while open surgeries declined yearly by 2.6 per 100 000 population (95% CI: 2.4-2.8). From the available data, there appears to be a crossover point in 2011/2012 where the laparoscopic hernia repair became more frequent. Considerable state and gender-based trends exist. CONCLUSIONS: The use of laparoscopic GHRs has increased considerably over the last 15 years. Despite the increased use, significant state-based and gender discrepancies were observed. Our data offer insight to the public sector and the respective healthcare-related expenditures pertaining to laparoscopic hernia repair.

A case of concomitant perforated acute cholecystitis and pancreatitis.

Introduction. Concomitant cholecystitis and gallstone pancreatitis is an infrequent clinical encounter, reported sparsely in the literature. Concurrent acute cholecystitis and pancreatitis complicated by gall bladder perforation has not been reported before. Presentation of Case. We report a 39-year-old female presenting with concomitant cholecystitis and acute pancreatitis, complicated by gallbladder perforation. Discussion. There is much controversy surrounding the timing of cholecystectomy following gallstone pancreatitis, with the recent literature suggesting that "early" operation is safe. In the current case, gallbladder perforation altered the "routine" management of gallstone pancreatitis and posed as a management dilemma. Conclusion. Clinical judgement dictated timing of operative management and ultimately cholecystectomy was performed safely.

A 12-year experience of the Trendelenburg perineal approach for abdominoperineal resection.

BACKGROUND: The abdominoperineal resection (APR) is the current accepted surgical technique for low rectal cancers. Negative circumferential surgical margins are an important prognostic indicator and are best obtained by producing a cylindrical specimen. The 'ideal' approach to produce such specimen is debated between a standard lithotomy position and turning the patient in the prone position in the later stages of the procedure. We aimed to assess results of perineal morbidity and oncological outcomes following the lithotomy approach at a single institution. METHODS: Data were collected retrospectively at a single institution. All patients undergoing the APR for low rectal cancers were included in the current study. Patients underwent this procedure in the standard lithotomy position and a mucocutaneous flap was not routinely used for closure of the perineal wound. The primary outcome measures in this study were local and systemic tumour recurrence and overall patient survival. RESULTS: Fifty-three patients undergoing APR were included in the current study. Majority of patients (87%) received neoadjuvant therapy. Perineal morbidity was observed in 11% of patients loco-regional recurrence occurred in 4% at 5 years. One-, 3- and 5-year survival was 87, 75 and 66%, respectively. Patients with T3/4 disease and positive circumferential surgical margins had significantly poorer survival outcomes. CONCLUSION: APR can be performed in the lithotomy position with acceptable perineal morbidity and oncological safety. Negative circumferential margins can be achieved reliably by producing a cylindrical specimen with this position.