Moynihan's hump of the right hepatic artery in Calot's triangle: a systematic review and meta-analysis of its incidence and surgical importance.

INTRODUCTION: A rare variation known as "Moynihan's or caterpillar hump" of the right hepatic artery raises the danger of vascular and biliary injuries during hepatobiliary surgery. This research intends to carefully record every case (i.e., patients undergoing laparoscopic cholecystectomy or cadaver dissections) where the right hepatic artery received a caterpillar hump. METHODS: The literature search was conducted with the medical subject headings (MeSH) and EMTREE (subject headings unique to Embase) keywords. The keywords with Boolean operators (OR, AND, and NOT) were used to create search strings in all possible combinations to retrieve bibliographic data. Two authors independently performed a risk of bias assessment and data extraction. The random effects model was used to conduct a meta-analysis. RESULTS: Thirty studies with a total of 8418 subjects reported that Moynihan's hump was present in 3.81% of them, with a predictive interval of 0.88-16.45%. The incidence of the hump was 3.1% in surgical studies (7496 subjects) and 7.22% (95% CI 4.7-10.93%) in cadaveric data (625 cadavers). Only ten studies addressed the relationship between the caterpillar hump and the common bile duct. CONCLUSION: A patient with an unusually "small cystic artery" or "large right hepatic artery" is likely to have a "caterpillar hump". The caterpillar's hump of the right hepatic artery is subject to rare anatomical variations in its course that increase the risk of incorrect vessel ligation or injury during laparoscopic cholecystectomy.

Solitary Osteochondroma of the Scapula in a Young Male: A Case Report.

Introduction: Osteochondroma is a type of cartilaginous tumor. It is the most common benign tumor of axial skeleton usually arising around the knee, proximal humerus, and pelvis. Solitary osteochondroma of the scapula is relatively rare and usually incidental finding accompanied by pain and dysfunction. These lesions can easily be followed radiographically with plain radiograph. Computed tomography (CT) is used to determine the precise location and its relationship with the surrounding soft tissues and enable accurate surgical removal. Case Report: In this report, we present a rare case of a symptomatic scapular osteochondroma in a 18-year-old male who presented with the complaints of swelling over the left scapula. X-ray showed a bony outgrowth along the posteromedial border of the left scapula. CT scan was done to know extent of the growth. MRI was performed to rule out soft-tissue involvement. Despite the young age of the patient, surgical excision was performed. The outcome was good, the patient noticed disappearance of swelling and a normal profile of the scapula was gained. Conclusion: We have described a rare case of scapular osteochondroma associated with different signs, symptoms, and positive radiological findings. This lesion was removed surgically, and a follow-up indicated complete symptom relief with no history of recurrence. By reporting this case, we aim to increase the awareness of unusual manifestations of osteochondroma, particularly in terms of site, age of onset, and atypical presenting signs and symptoms.

The optimum approach for pre-transplant bilateral nephrectomy in small kidneys: dorsal lumbotomy vs laparoscopy.

OBJECTIVE: To evaluate the outcomes of bilateral pretransplant nephrectomy (BPN) for small kidneys, using a bilateral dorsal lumbotomy (BDL) or transperitoneal laparoscopy (TL) approach. PATIENTS AND METHODS: Fifty-eight patients with end-stage renal disease and small kidneys underwent BPN for various indications, most commonly uncontrolled hypertension. There were 38 patients in the BDL group (group 1) and 20 in the TL group (group 2). The variables before and during surgery, and the outcomes afterward, were compared between the groups. RESULTS: The mean age of the patients and male/female ratio were comparable in both groups. The mean size of the kidneys removed were 7.4 and 8.2 cm, respectively, in groups 1 and 2. The mean (range) operative duration was longer in group 2, at 210 (160-240) min, than in group 1, at 112 (90-150) min (P < 0.001). The postoperative analgesic requirement for pain, blood transfusion rate, wound and pulmonary complications were similar between the groups. Bowel function recovered earlier in group 1 than group 2 (19 vs 37 h, P < 0.001). The total cost for the nephrectomy in group 2 was 3.5 times that of group 1. The mean interval between nephrectomy and transplantation was similar in both groups. CONCLUSION: BDL appears to be better than TL for BPN in small kidneys because the surgery is quicker, and there is earlier bowel recovery and lower costs.

Impact of age and gender on the clinicopathological characteristics of bladder cancer.

PURPOSE: To determine the impact of age and gender on the clinicopathological characteristics of histologically confirmed bladder cancer in India. MATERIALS AND METHODS: From January 2001 to June 2008, records of patients with bladder cancer were evaluated for age and gender at presentation, clinical symptoms, cystoscopic finding, history of smoking, and histopathological characteristics. A total of 561 patients were identified from the computer-based hospital information system and the case files of patients. RESULTS: A total of 97% of the patients presented with painless hematuria. The mean age was 60.2 +/- 4.4 years old (range: 18-90 years old) and the male to female ratio was 8.6:1. Transitional cell carcinoma (TCC) was the most common histological variety, which was present in 97.71% (470 of 481) of the patients. A total of 26% of the patients had muscle invasive disease at the time of presentation. However, 34.5% (166 of 481) of the patients did not show any evidence of detrusor muscle in their biopsy specimen. In patients with nonmuscle-invasive bladder carcinoma, 55% had p Ta while 45% had p T1. Overall, 44.7% (215 of 481) of the patients had low-grade disease. Among patients younger than 60 years old, low-grade (51.0% vs. 38.1%; P = 0.006) and low-stage (77.1% vs. 70.8%; P = 0.119) disease were more prevalent than in patients older than 60 years old. The incidence of smoking was much higher among males compared with females (74% vs. 22%). CONCLUSION: TCC is the predominant cancer, with significant male preponderance among Indian patients. Younger-aged patients have low-grade disease. Hematuria is the most common presentation and greater awareness is needed not to overlook bladder cancer.

Management of vesicovaginal fistula: An experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach.

PURPOSE: We aim to present our experience for the repair of vesicovaginal fistula (VVF) with special reference to surgical approach. MATERIALS AND METHODS: From January 1999 to June 2005, 52 VVF patients with mean age of 32 years underwent operative treatment. Fistulas were divided into two groups, simple and complex, depending on site, size, etiology and associated anomalies. Simple VVFs were approached through the vaginal route and complex VVFs via the transabdominal route. Patients were evaluated at two to three weeks initially, three-monthly twice and later depending on symptoms. RESULTS: Thirty-two (61.5%) had simple fistulas and 20 (38.5%) complex fistulas. The most common etiology was obstetric trauma in 31 (59.6%) patients, while the second most common cause was post hysterectomy VVF. Thirty-two (61.5%) patients were managed by transvaginal route, of which 17 had supratrigonal and 15 trigonal fistulas. Twenty (38.5%) patients with complex fistulas were managed by abdominal route. The mean blood loss, postoperative pain and mean hospital stay were shorter in transvaginal repair. Eleven (21.2%) patients required ancillary procedures for various other associated anomalies at the time of fistula repair. Three patients failed repair giving a success rate of 94.2%. At a mean follow-up of three years 48 women were sexually active, of these 10 (19.2%) complained of mild to moderate dyspareunia. CONCLUSION: Most of the simple fistulas irrespective their locations are easily accessible transvaginally while in complex fistulas we recommend the transabdominal approach. Depending on the clinical context both the approaches achieved comparable success rates.

Design and Hardware Implementation of a New Chaotic Secure Communication Technique.

In this paper, a scheme for chaotic modulation secure communication is proposed based on chaotic synchronization of an improved Lorenz system. For the first time, the intensity limit and stability of the transmitted signal, the characteristics of broadband and the requirements for accuracy of electronic components are presented by Multisim simulation. In addition, some improvements are made on the measurement method and the proposed experimental circuit in order to facilitate the experiments of chaotic synchronization, chaotic non-synchronization, experiment without signal and experiment with signal. To illustrate the effectiveness of the proposed scheme, some numerical simulations are presented. Then, the proposed chaotic secure communication circuit is implemented through analog electronic circuit, which is characterized by its high accuracy and good robustness.