Effectiveness and predictors of conversion in mini-laparotomy cholecystectomy in developing country: a cohort retrospective study.

BACKGROUND: Mini laparotomy cholecystectomy (MLC) is an alternative surgical procedure in conditions where laparoscopic cholecystectomy (LC) is not feasible. MLC is a simpler and easier technique compared to LC. MLC involves smaller skin incision, low morbidity rate, and early return to oral diet. MLC has the potential to be the preferred surgical technique in developing countries due to its low cost and availability. METHOD: A cohort retrospective study was performed on 44 patients who underwent mini laparotomy cholecystectomy due to ineligibility for LC. Patients were documented for successful mini laparotomy or conversion to laparotomy cholecystectomy. There are pre-operative aspects recorded and analyzed to formulate predictor factors for conversion surgery, as well as intra-operative and post-operative aspects. Patients also filled evaluation questionnaire based on Likert Scale about their satisfaction towards result of MLC. RESULT: MLC is performed in 31 (70.5%) patients while 13 (29.5%) patients underwent conversion to open cholecystectomy. There were no complications nor mortalities observed during and after the surgery. Greater BMI, higher leucocyte count, higher bilirubin level, increasing severity of adhesion, and chronic cholecystitis were found to be statistically significant (p < 0.05) in the conversion surgery group. MLC also resulted in shorter post-operative hospitalization compared to conversion surgery. Patients showed great satisfaction towards the cosmetic aspect and recovery period after MLC procedure. CONCLUSION: MLC is an effective surgery procedure for cholelithiasis and can be safely performed in patients with complication such as cholecystitis and gallbladder adhesion although these conditions increase the risk of conversion surgery.

Rectovaginal fistula surgery with horizontal mattress and running suture after unsuccessful first repair: a report of two cases.

Rectovaginal fistula (RVF) repair after failed primary repair is uncommon. Patients with RVF experience physiological and sexual dysfunction with a significantly high risk of intravaginal infection and sepsis. There are many surgical procedures available for RVF repair. We performed an improvised transvaginal repair technique. Methods: We report two cases of recurring RVF after failed primary repair. Patient 1 developed RVF because of a failed vaginoplasty due to cosmetic reasons, while patient 2 developed RVF because of a fourth-degree perineal rupture repair post-delivery. We used a combination of horizontal mattress and running suture with the addition of diverting colostomy. Both surgeries went successfully and there were no complications. Outcomes: RVF repair using a combination of horizontal mattress and running suture went successfully and there were no complications. Both patients were able to be discharged after a short stay. Long-term evaluation was done by physical and supporting examinations for 2-3 months. Both patients showed excellent wound healing and physiological function. Conclusions: The combination of a transvaginal horizontal mattress and running suture in the posterior to anterior fashion with diverting colostomy is a safe and effective procedure for recurring RVF repair.

Combination of Cattell-Braasch and Kocher maneuver in laparotomy for diverticular resection in the third part of the duodenum: a case report.

A duodenal diverticulum is an outpouching of all or partial layers of the duodenal wall. Duodenal diverticulum complications such as bleeding, diverticulitis, pancreatitis, choledochal occlusion, and perforation can develop. Localization of the diverticulum in the third part of the duodenum is rare. Surgical intervention with a combination of Cattell-Braasch and Kocher maneuvers in laparotomy is currently emerging as a viable option. Case presentation: The authors report a case of a 68-year-old male with chief complaints of black stool and recurring epigastric pain. Barium follow-through showed diverticulum at the third part of the duodenum. Surgery with a combination of Cattell-Braasch and Kocher's maneuvers using a linear stapler was successful, and there were no intraoperative or postoperative complications. Postoperative barium follow-through showed no diverticulum residue. The patient had no more complaints of black stools nor epigastric pain. Clinical discussion: Symptomatic duodenal diverticulum is a rare case with a very small chance of complications. Due to its lack of specific symptoms, imaging examinations play a better role in diagnosis. Surgical intervention is also rarely performed due to the small chance of complications. Diverticulectomy with the use of Cattell-Braasch and the extended Kocher maneuver results in better duodenum exposure, and the usage of a linear stapler also made the surgery safer and quicker to perform. Conclusion: The authors propose that a diverticulectomy of the third part of the duodenum performed with a combination of the Cattell-Braasch and Kocher maneuvers with the use of a linear stapler as a safe procedure.

Factors predicting complications following cranioplasty.

This study aimed to identify factors that predict complications following cranioplasty, by conducting a retrospective cohort study at a large tertiary care center. Electronic databases were searched to identify all patients who underwent cranioplasty at our institution. Baseline demographics, perioperative variables, and outcomes were extracted. Logistic regression analyses were conducted to identify factors associated with cranioplasty complications. Of the 92 included patients, 15 (16.3%) experienced one or more complications, with 11 (73.3%) experiencing complication within 30 days of cranioplasty. Patients aged ≤60 had decreased odds of all-cause complication (OR 0.058; 95% CI 0.008-0.434) and cranioplasty graft removal (OR 0.035; 95% CI 0.004-0.321) on multivariate analysis. Titanium mesh cranioplasties were associated with increased odds of all-cause complication (OR 19.776; 95% CI 1.021-382.901), and cranioplasty removal (OR 29.780; 95% CI 1.330-666.878). A longer craniectomy-cranioplasty interval was associated with increased odds of cranioplasty removal (OR 1.005; 95% CI 1.000-1.010). An initial craniectomy indication of cerebral infarction was associated with decreased odds of all-cause complication (OR 0.042; 95% CI 0.002-0.876) and cranioplasty removal (OR 0.032; 95% CI 0.001-0.766). Elderly patients may require more aggressive follow-up and antibiotic prophylaxis in the postoperative period following cranioplasty. Additionally, avoiding the use of titanium mesh cranioplasties and prolonged craniectomy-cranioplasty intervals may further reduce complications.

Wireless Wearable Ultrasound Sensor to Characterize Respiratory Behavior.

A wireless wearable sensor on a paper substrate was used to continuously monitor respiratory behavior that can extract and deliver clinically relevant respiratory parameters to a smartphone. Intended to be placed horizontally at the midpoint of the costal margin and the xiphoid process as determined through anatomical analysis and experimental test, the wearable sensor is compact at only 40 × 35 × 6 mm3 in size and 6.5 g weight including a 2.7 g lithium battery. The wearable sensor, consisting of an ultrasound emitter, an ultrasound receiver, wireless transmission system, and associated data acquisition, measures the linear change in circumference at the attachment location by recording and analyzing the changes in ultrasound pressure as the distance between the emitter and the receiver changes. Changes in ultrasound pressure corresponding to linear strain are converted to temporal lung volume data and are wirelessly transmitted to an associated custom-designed smartphone app. Processing the received data, the mobile app is able to display the temporal volume trace and the flow rate vs. volume loop graphs, which are standard plots used to analyze respiration. From the plots, the app is able to extract and display clinically relevant respiration parameters, including forced expiratory volume delivered in the first second of expiration (FEV1) and forced vital capacity (FVC). The sensor was evaluated with eight volunteers, showing a mean difference of the FEV1/FVC ratio as bounded by 0.00-4.25% when compared to the industry-standard spirometer results. By enabling continuous tracking of respiratory behavioral parameters, the wireless wearable sensor helps monitor the progression of chronic respiratory illnesses, including providing warnings to asthma patients and caregivers to pursue necessary medical assistance.

Harmonic medicine: the influence of music over mind and medical practice.

The Yale Medical Orchestra displayed exceptional talent and inspiration as it performed a timeless composition to celebrate Yale School of Medicine's bicentennial anniversary during a December 2010 concert. Under the leadership of musical directors Robert Smith and Adrian Slywotzky, the richly emotional meditations of Mendelssohn, Dvorak, Schubert, and Yale's own Thomas C. Duffy filled the minds and hearts of an audience as diverse as the orchestra. I intend to retrace the steps of that melodic journey in this essay, fully aware of the limits imposed on me to recreate the aural art form through the medium of text. While these symbols can be pale representations of the beauty and complexity of the music, I hope they will be the building blocks for the emotional experience of the audience. I describe the works' inception and their salient musical features and then review what we know about the effects of melody, meter, and timbre on our brains. My intentions are to provide evidence to encourage the further use of music as a tool in medical practice, provide interest in the works explored by the Yale orchestra, support the orchestra itself, and investigate a personal passion.

Comparison of surgical recordings using cameras with and without laser pointer for focusing in gastrointestinal surgical field in COVID-19 pandemic: A cross-sectional study.

BACKGROUND: Surgical recording has become very important for digestive surgery skill training in the COVID-19 pandemic. In addition to high quality recordings, the directions of vantage points are also important. To assist our vantage point for our camera, we frequently use a laser pointer to increase accuracy in the shooting range. MATERIALS AND METHODS: We recorded surgery more than 2 h with a fixed top-mounted Panasonic HC-V770 camcorder and otherwise with an action-cam Sony FDR. We installed a laser Pointer TaffLED Tactical Red Dot Laser Gun Picatinny Mount Airsoft Rifle HJ 11. We compared focus field video recordings with and without laser pointer guiding. We divided them into four groups: head mounted with, head mounted without, top mounted with and top mounted without. We recorded a total of five digestive surgery cases of superficial, visceral, and deep visceral procedures for each group after adjusting the laser pointer direction to the center of the cameras' focus. RESULTS: The laser pointer on camcorder Panasonic HC-V770 can assist recording on operation fields to prevent the field of view from being blocked by movement of an object compared to either camera without laser pointer. The head mounted Sony FDR-X3000 action-cam can easily depict surgeon's eye while recording and be controlled by the slightest movement of the surgeon's head by tracking with a red dot. CONCLUSION: From either mounting, the laser pointer aided in focusing the surgical field of view and could increase visibility for surgical recording.

Omental plug using double horizontal mattress suture for gastric perforation on elderly patients with boey score 3: A case series.

INTRODUCTION: Gastric perforation is a life-threatening condition. Patients with gastric perforation with Boey score 3 has very high mortality rate. Immediate source control is required for primary repair and preventing further complications. Furthermore, elderly patients pose a greater risk of morbidity and mortality in cases of gastric perforation, especially during and after emergency surgery. CASE PRESENTATION: We present two cases of elderly patients with gastric perforation with Boey score 3. We performed omental plugging technique with double horizontal mattress suture type. In these cases, we decided not to perform biopsy and margin freshening of the perforation. DISCUSSION: We performed omental plugging technique because we are confident that it could cover the perforation completely without causing gastric outlet obstruction. An emergency source control surgery can be effectively done with this omental plugging procedure. During surgery, margin freshening and biopsy is not performed to perform source control more quickly. This surgical procedure aligned with "quick in-quick out" concept that we adopted for treating patients with gastric perforation. Omental plugging also allows patient to undergo ERAS program for better and faster recovery. The patients were discharged from the hospital without further complications and long-term follow-up showed good results. CONCLUSION: Omental plugging has the least risk of complications than other perforation repair techniques and can be done for small and large perforation. Based on our case series, omental plug with double mattress suture is an effective and safe procedure to be performed in elderly patients with gastric perforation with Boey score 3.

Comparison between camcorder, frontal head and temporal mounted action-cam in digestive surgery: Documentation and educational alternative during COVID-19 pandemic.

OBJECTIVE: COVID-19 pandemic has made impact both in clinical and educational settings. The number of surgeries has decreased; thus, the surgery videos of all cases are important for both documentation and education. This study aimed to compare three kinds of cameras in recording digestive surgery. METHODS: We compared three cameras: Panasonic HV-770 Full HD Camcorder, Sony FDR-X3000 Action-cam, and Ordro EP7 Hands-Free FPV Camera. Each camera was used in several recording for superficial and visceral digestive surgeries and we compared the following: operation field, image focus, surgeon's comfort, practicality, and record settings. RESULTS: Camcorder needs 10-15 min to set up and longer dismounting time, has steady vantage view and focus, good image quality, can be zoomed, but the recording may be obstructed by the surgeon's head. Action camera needs 5-10 min to set up and the dismounting time was equal between Camcorder and Ordro. Action camera depicts surgeon's vision, however, zoom could not be applied while recording. Sony FDR-X3000 used in this study had good image quality, but the use of this camera in a long surgery may generate neck stiffness due to its weight. Ordro EP7 was comfortable in any surgery but it had inferior image quality compared to the others. CONCLUSIONS: Panasonic HC-V770 and Sony FDR X3000 had good image quality, where camcorder excelled in longer surgeries due to its comfort, action-cam excelled for shorter surgeries due to ease of use and settings. Ordro EP7 was the most comfortable among all but has lowest image quality.

Effectiveness of tutorial videos combined with online classes in surgical knotting course during COVID-19 pandemic: A cohort study.

BACKGROUND: COVID-19 pandemic has changed medical education from offline courses to online formats. Nowadays, offline skill demonstration lessons becomes unfeasible. This study assess the effectiveness of tutorial videos and online classes in delivering knowledge and skill in basic surgical knotting to medical students. METHODS: A group of medical students (n = 95) was divided into two groups: the first group was allowed to watch the tutorial video that we have been made and uploaded into YouTube (https://www.youtube.com/watch?v=WyfOVGhAeVA) while the other group did not watch the video. All participants submitted a demonstration video to show their knotting skill. These videos were graded and made into the first evaluation. Then, all participants attended online classes for the surgical knotting skills via Zoom application. Participants submitted another demonstration video after the online classes. The videos were assessed, and the results were analyzed. RESULTS: The experimental group (n = 50) who watched the tutorial video prior to class scored higher in the first video than the control group (n = 39) with a meanscore of 10.850 versus 7.462, p = 0.000*, In the second video, the assessment showed no significant difference between the two groups with meanscore of 11.220 versus 10.897, p = 0.706. CONCLUSION: The combination of tutorial videos and online classes is the optimal teaching method for surgical knotting skills.

Clinical findings and management of diaphragmatic rupture with hernia caused by safety body harness: A case report.

INTRODUCTION: Acute blunt traumatic diaphragmatic rupture (BTDR) caused by falling from a height is rare. Transabdominal diaphragmatic repair in an acute setting following BTDR requires good clinical decision-making and diagnostic tests. CASE PRESENTATION: A 36-year-old male was involved in a work accident. He fell from a 30-m radio transmitter tower while wearing an attached safety body harness. He arrived in the emergency room with complaints of breathing difficulty, abdominal and pelvic pain. We discovered a diaphragmatic rupture with abdominal organ herniation based on the imaging. We decided to perform an emergency laparotomy. We discovered a 12cm diaphragmatic defect on the anteromedial side of the left during surgery. We carried out the evacuation by suction and controlled the bleeding in the wound at the edge of the diaphragm. On postoperative day 4 (POD), the patient complained of dyspnea, and chest radiology revealed a hemothorax in the left lung. We then installed a water-sealed drainage (WSD) until POD 6. On the following day, his complaint was resolved, the WSD was removed and the patient was discharged uneventfully. DISCUSSION: Abdominal CT scan can be helpful in determining early diagnosis of traumatic diaphragm rupture with abdominal organ herniation, allowing for prompt surgical intervention to minimize morbidity and mortality. Furthermore, reinforced sutures might be useful to prevent recurrence of the symptoms. CONCLUSION: In conclusion, injury due to wearing a safety body harness when falling can be a potential cause of BTDR. Management of BTDR transabdominally is a safe and effective procedure.

Spontaneous cystic biloma after laparoscopic cholecystectomy treated conservatively: A case report.

INTRODUCTION: Biloma forms due to common bile duct (CBD) injury as a laparoscopic cholecystectomy complication. Spontaneous localized biloma forming cysts in the biliary duct is rare. PRESENTATION OF CASE: We report a 47-year-old male with complaint of a painful lump in the upper abdomen two months after laparoscopic cholecystectomy. Magnetic resonance cholangiopancreatography (MRCP) found a large epigastric cyst mass, without any signs of CBD injury. Patient was managed with percutaneous drainage in the outpatient clinic and kept the contents of the drainage bag for evaluation. After two months follow-up the outcome was favorable. DISCUSSION: Biloma forming cysts is a very rare complication post laparoscopic cholecystectomy. Biloma most common occurs as free fluid in the abdominal cavity. Clinical diagnostics, intraoperative historical evaluation and support with MRCP may determine the treatment options. Decision to manage with non-operative procedures by percutaneous drainage and evaluations of the patient in the outpatient clinic had a favorable outcome. CONCLUSION: Post laparoscopic biloma cysts are a very rare case. Management with percutaneous drainage in an outpatient clinic and ambulatory drainage is an effective and safe procedure.

Management of gallstone-induced severe acute cholecystitis and pancreatitis in the second trimester of pregnancy during covid-19 pandemic: A case report.

INTRODUCTION: Gallstone-induced severe acute cholecystitis with acute pancreatitis during pregnancy can be life-threatening both for the mother and fetus. Surgical approach is recommended in this complicated disease to prevent morbidity and mortality. During COVID-19 pandemic, additional precautions are needed when dealing with abdominal complaints. PRESENTATION OF CASE: We present a 37-year-old female patient, pregnant at 22 weeks gestational age, who complained of fever, diffuse abdominal pain, and shortness of breath. Laboratory examination results revealed anemia, leukocytosis and an increase in amylase level. SARS-CoV-2 antibody is non-reactive. Imaging strongly suggested cholelithiasis and cholecystitis. The patient was given antibiotics for three days but there was no significant improvement. Open cholecystectomy with subcostal (Kocher) incision was performed. Patient was released from the hospital without post-operative complications. DISCUSSION: Treatment of gallstone induced severe acute cholecystitis with acute pancreatitis during pregnancy is challenging with the surgical complications. In the second and third trimester of pregnancy, it is more difficult to perform laparoscopic cholecystectomy because of the size of uterus. Laparoscopic procedure is also not recommended in early Covid-19 pandemic period. Therefore, open cholecystectomy with Kocher incision becomes the surgery of choice to avoid preterm birth. CONCLUSIONS: Based on our case, open cholecystectomy with Kocher incision is a safe and effective procedure for pregnant patients with cholelithiasis, cholecystitis, and pancreatitis.

Gallbladder adhesion degree as predictor of conversion surgery, common bile duct injury and resurgery in laparoscopic cholecystectomy: A cross-sectional study.

BACKGROUND: The gold-standard treatment for cholecystectomy, laparoscopic cholecystectomy, has remarkably variable outcomes and conversion rates. We investigated the gallbladder adhesion degree as a predictor of conversion surgery, common bile duct injury, and resurgery. METHODS: We reviewed 157 medical records and video recordings of laparoscopic cholecystectomy on patients with cholelithiasis with or without cholecystitis at three hospitals in Yogyakarta, Indonesia from January 2016 to December 2018. The degree of gallbladder adhesion is classified into 4 categories: no adhesion, <50% adhesion, 50%-buried GB, and completely buried GB. RESULTS: One hundred fifty seven patients were involved in this study, of whom 58 were males and 99 females with average age 49.2. Eighty-one patients out of 157 patients (51.6%) had gallbladder adhesion comprising of 61/157 (38.9%) with <50% adhesion and 20/157 (12.7%) 50%-buried GB. There is one incidence each of conversion surgery, CBD injury, and resurgery. The degree of GB adhesion has low degree of correlation with conversion surgery, CBD injury, and resurgery wirh r value of 0.156, 0.041, and 0.156 respectively. There is significant correlation between the degree of GB adhesion and conversion surgery and resurgery with p value of 0.032, and 0.032 respectively. There is no significant correlation between degree of GB adhesion and CBD injury with p value of 0.453. CONCLUSION: The degree of GB adhesion has low degree of correlation with conversion, CBD injury and resurgery. This study also showed that patients with high degree of gallbladder adhesion are still eligible for laparoscopic procedure performed by an experienced surgeon.

Modified Duhamel with lateral anal sphincterotomy and coloanal stump for adult Hirschsprung's disease: A case series.

INTRODUCTION: Hirschsprung's disease (HSCR) or megacolon congenital is the most common congenital intestinal motility disorder and characterized by the absence of ganglion cells (aganglionosis) in the myenteric plexus and submucosa of the distal intestine. PRESENTATION OF CASE: This study reports three cases of adult HSCR, with all young female patients who underwent colostomy for obstructive ileus. The chosen definitive therapies were Duhamel pull-through procedure combined with a temporary coloanal stump. DISCUSSION: The three patients underwent Duhamel pull-through procedure with temporary anal stump in conjunction with stoma reversal. The temporary anal stumps were removed within 1-2 weeks after pull-through procedure. All patients were discharged from the hospital and underwent routine follow-up. All patients had fecal incontinence in early follow-up which resolved shortly afterwards. Long term follow-up showed normal intestinal functions and good cosmetic results. CONCLUSIONS: The combination of Duhamel pull-through procedure with temporary coloanal stump in definitive therapy of adults with HSCR is a safe and effective technique.

Covid-19 mimicking symptoms in emergency gastrointestinal surgery cases during pandemic: A case series.

BACKGROUND: The COVID-19 pandemic has changed patient management in all sectors. All patients need to be examined for COVID-19, including in digestive surgery emergency cases. In this paper, we report four digestive surgery emergency cases with clinical and radiological findings similar to COVID-19. CASE PRESENTATION: We report four digestive surgery emergency cases admitted with fever and cough symptoms. Case 1 is a 75-year-old male with gastric perforation and pneumonia, case 2 is a 32-year-old female with intestinal and pulmonal tuberculosis, case 3 is a 30-year-old female with acute pancreatitis with pleuritis and pleural effusion, and the last case is a 56-year-old female with rectosigmoid cancer with pulmonal metastases. All the patients underwent emergency laparotomy, were hospitalized for therapy, and discharged from the hospital. After 1-month follow-up after surgery, 1 patient had no complaints, 2 patients had surgical site infection, and 1 patient died because of ARDS due to lung metastases. DISCUSSION: For all four cases, the surgeries were done with strict COVID-19 protocol which included patient screening, examination, laboratory assessment, rapid test screening, and RT-PCR testing. There were no intrahospital mortalities and all the patients were discharged from the hospital. Three patients were followed-up and recovered well with 2 patients having surgical site infection which recovered within a week. However, 1 patient did not show up for the scheduled follow-up and was reported dead 2 weeks after surgery because of ARDS due to lung metastases. CONCLUSIONS: Emergency surgery, especially digestive surgery cases, can be done in the COVID-19 pandemic era with strict prior screening and examination, and safety protocol.

Anal encirclement using polypropylene mesh for high grade complete full-thickness rectal prolapse: A case report.

INTRODUCTION: Rectal prolapse is defined as protrusion of the rectal wall outside the anus caused by pelvic floor abnormalities. Operative repair is the only definitive treatment. Until now, there is no ideal surgical technique that can be used for all patients. PRESENTATION OF CASE: Here we report two cases of full-thickness rectal prolapse in elderly patients with high-risk comorbidities. A seventy and seventy-eight-year-old female patients presented with complaints of anal lumps. Their past medical history was significant for arrhythmia, hypertensive heart disease, and pneumonia. The patients then underwent surgical repair with mesh cerclage. The patients were hospitalized for three days after surgery. On days 3, 7, 14, and 6 months after surgery the patients did not complain of any recurrence nor complications. DISCUSSION: We did a modified anal encirclement surgical repair technique in managing these elderly patients with full-thickness rectal prolapse and high-risk comorbidities using mesh to prevent recurrence. CONCLUSIONS: Anal encirclement technique using mesh can be considered as an alternative procedure for the treatment of full-thickness rectal prolapse in elderly patients with high-risk comorbidities because this procedure is simple, safe, causes fewer postoperative complications, and also can prevent recurrence.

Head and tail pancreatic duct stones mimicking duplex staghorn renal calculi: A rare case.

INTRODUCTION: Pancreatolithiasis is an uncommon disease and the diagnosis of pancreatic duct stones is challenging. The radiological findings of pancreatic duct stones may mimic other diseases, such as renal stones. CASE PRESENTATION: A 42-year-old male came with chief complaint of recurrent bilateral flank pain accompanied by fever which worsen 7 days before admission. The patient was diagnosed as gastritis and received analgesics in several hospitals. Ultrasonography and IVP examinations showed stones in both kidneys. CT-scan was not performed due to limitation in the hospital. Patient was diagnosed bilateral staghorn nephrolithiasis. The patient underwent bilateral bivalve nephrotomy for staghorn renal stone performed by urologist, but intraoperatively, no stones were found. The patient was then consulted intraoperatively to the digestive surgeon and get immediate median laparotomy. Intraoperatively, stones were palpated in the head and tail of the pancreas. The stones were evacuated. The symptoms were relieved, neither recurrence, nor pain, nor postoperative leakage was found. Patient was discharged uneventfully 4 days after the procedure and had no complaints in further follow-ups. DISCUSSION: The symptoms of pancreatolithiasis may overlap with nephrolithiasis and gastritis. The presented case was unique because from the history taking, clinical symptoms, USG, and IVP findings supported the diagnosis of nephrolithiasis, but intraoperative findings reveal pancreatic duct stones. CONCLUSION: For patient diagnosed with renal calculi based on sonography and IVP findings, differential diagnosis of pancreatic stone should be considered especially if no underlying cause is detected. In such circumstances relying on IVP and sonographic findings alone can be misleading.

Liquid gold: the cost-effectiveness of urine sample collection methods for young precontinent children.

BACKGROUND: Urinary tract infection (UTI) is a common childhood infection. Many febrile children require a urine sample to diagnose or exclude UTI. Collecting urine from young children can be time-consuming, unsuccessful or contaminated. Cost-effectiveness of each collection method in the emergency department is unknown. OBJECTIVE: To determine the cost-effectiveness of urine collection methods for precontinent children. METHODS: A cost-effectiveness analysis was conducted comparing non-invasive (urine bag, clean catch and 5 min voiding stimulation for clean catch) and invasive (catheterisation and suprapubic aspirate (SPA)) collection methods, for children aged 0-24 months in the emergency department. Costs included equipment, staff time and hospital bed occupancy. If initial collection attempts were unsuccessful subsequent collection using catheterisation was assumed. The final outcome was a definitive sample incorporating progressive dipstick, culture and contamination results. Average costs and outcomes were calculated for initial collection attempts and obtaining a definitive sample. One-way and probabilistic sensitivity analyses were performed. RESULTS: For initial collection attempts, catheterisation had the lowest cost per successful collection (GBP£25.98) compared with SPA (£37.80), voiding stimulation (£41.32), clean catch (£52.84) and urine bag (£92.60). For definitive collection, catheterisation had the lowest cost per definitive sample (£49.39) compared with SPA (£51.84), voiding stimulation (£52.25), clean catch (£64.82) and urine bag (£112.28). Time occupying a hospital bed was the most significant determinant of cost. CONCLUSION: Catheterisation is the most cost-effective urine collection method, and voiding stimulation is the most cost-effective non-invasive method. Urine bags are the most expensive method. Although clinical factors influence choice of method, considering cost-effectiveness for this common procedure has potential for significant aggregate savings.

Wireless Wearable Ultrasound Sensor on a Paper Substrate to Characterize Respiratory Behavior.

Respiratory behavior contains crucial parameters to feature lung functionality, including respiratory rate, profile, and volume. The current well-adopted method to characterize respiratory behavior is spirometry using a spirometer, which is bulky, heavy, expensive, requires a trained provider to operate, and is incapable of continuous monitoring of respiratory behavior, which is often critical to assess chronic respiratory diseases. This work presents a wireless wearable sensor on a paper substrate that is capable of continuous monitoring of respiratory behavior and delivering the clinically relevant respiratory information to a smartphone. The wireless wearable sensor was attached on the midway of the xiphoid process and the costal margin, corresponding to the abdomen-apposed rib cage, based on the anatomical and experimental analysis. The sensor, with a footprint of 40 × 35 × 6 mm3 and weighing 6.5 g, including a 2.7 g battery, consists of three subsystems, (i) ultrasound emitter, (ii) ultrasound receiver, and (iii) data acquisition and wireless transmitter. The sensor converts the linear strain at the wearing site to the lung volume change by measuring the change in ultrasound pressure as a function of the distance between the emitter and the receiver. The temporal lung volume change data, directly converted from the ultrasound pressure, is wirelessly transmitted to a smartphone where a custom-designed app computes to show volume-time and flow rate-volume loop graphs, standard respiratory analysis plots. The app analyzes the plots to show the clinically relevant respiratory behavioral parameters, such as forced vital capacity (FVC) and forced expiratory volume delivered in the first second (FEV1). Potential user-induced error on sensor placement and temperature sensitivity were studied to demonstrate the sensor maintains its performance within a reasonable range of those variables. Eight volunteers were recruited to evaluate the sensor, which showed the mean deviation of the FEV1/FVC ratio in the range of 0.00-4.25% when benchmarked by the spirometer. The continuous measurement of respiratory behavioral parameters helps track the progression of the respiratory diseases, including asthma progression to provide alerts to relevant caregivers to seek needed timely treatment.