Comparing the physical performance of liquid barrier films.

BACKGROUND: Barrier films have been used for many years to protect skin from the damaging effects of excessive moisture and mechanical injury. The performance characteristics important for these protective effects are mainly product durability and its ability to reduce the force of adhesive removal. Additionally, the moisture vapor transmission rate through the film needs to be high enough that maceration is prevented. The current study was undertaken to investigate various physical performance characteristics of six commercially available barrier films. MATERIALS AND METHODS: Several bench tests were used to simulate performance features of the barriers on skin including barrier durability, breathability (moisture vapor permeability), and the effect on adhesive dressing force of removal. RESULTS: Results indicated that barrier films did not perform equivalently. However, Cavilon™ No Sting Barrier Film (NSB) was shown to have significantly greater durability in the barrier integrity test than all other barriers tested and was tied for highest breathability and highest reduction in peel force from steel. No other tested barrier film performed as consistently across the different tests. CONCLUSION: These results may provide mechanistic understanding of how barriers such as NSB may clinically assist with the prevention of adhesive- and moisture-related skin damage.

Total knee arthroplasty with NexGen legacy posterior stabilized.

Total knee arthroplasty (TKA) has been primarily devised for pain free range of movement near physiological demands and even take part in sports and leisure interests along with day to day activities. Therefore we conducted an assessment on the performance of our patients after 5 years of followup. Total of 94 patients ranging from an age group of 38 to 75 years with pathologies of osteoarthritis, rheumatoid arthritis and post traumatic arthritis were subjected to implantation in our institution and included in this restrospective study. All patients were implanted with NexGen Legacy Posterior Stabilisied (LPS) system. The results have been drawn on the basis of the clinical performance and radiographic analysis with a follow up of upto 5 years. Knee society score increase from Preoperatively 60 to postoperatively 85, Knee functional score increase from preoperatively 55 to postoperatively 100. No cases of patella clunk syndrome or patella dislocation were observed in our patients. The final clinical results of operative treatment with Nexgen LPS system after 5 years of follow-up of patients corresponding to daily approved International scoring system. All of this indicates the advantages of this system comparing to its other daily analogues.

Cerebral small vessel disease genomics and its implications across the lifespan.

White matter hyperintensities (WMH) are the most common brain-imaging feature of cerebral small vessel disease (SVD), hypertension being the main known risk factor. Here, we identify 27 genome-wide loci for WMH-volume in a cohort of 50,970 older individuals, accounting for modification/confounding by hypertension. Aggregated WMH risk variants were associated with altered white matter integrity (p = 2.5×10-7) in brain images from 1,738 young healthy adults, providing insight into the lifetime impact of SVD genetic risk. Mendelian randomization suggested causal association of increasing WMH-volume with stroke, Alzheimer-type dementia, and of increasing blood pressure (BP) with larger WMH-volume, notably also in persons without clinical hypertension. Transcriptome-wide colocalization analyses showed association of WMH-volume with expression of 39 genes, of which four encode known drug targets. Finally, we provide insight into BP-independent biological pathways underlying SVD and suggest potential for genetic stratification of high-risk individuals and for genetically-informed prioritization of drug targets for prevention trials.

Tobacco chewing and female oral cavity cancer risk in Karunagappally cohort, India.

This study examined oral cancer in a cohort of 78 140 women aged 30-84 years in Karunagappally, Kerala, India, on whom baseline information was collected on lifestyle, including tobacco chewing, and sociodemographic factors during the period 1990-1997. By the end of 2005, 92 oral cancer cases were identified by the Karunagappally Cancer Registry. Poisson regression analysis of grouped data, taking into account age and income, showed that oral cancer incidence was strongly related to daily frequency of tobacco chewing (P<0.001) and was increased 9.2-fold among women chewing tobacco 10 times or more a day. The risk increased with the duration of tobacco chewing during the first 20 years of tobacco chewing. Age at starting tobacco chewing was not significantly related to oral cancer risk. This is the first cohort study of oral cancer in relation to tobacco chewing among women.

Laparoscopic closure of small bowel perforation: Technique of small bowel anchoring to the abdominal wall.

INTRODUCTION: More and more complicated laparoscopic abdominal surgeries are now being performed across the world. Laparoscopic suturing of the bowel perforations is being performed by experienced surgeons. We have developed our own technique of small bowel anchoring to the abdominal wall before suturing the perforation. OUR MODIFICATION: A single stitch is taken at the corner of the perforation. The long end of the suture is retrieved by a suture retrieval needle and the small bowel is anchored to the abdominal wall. Rest of the bowel perforation is suture by the intracorporeal knot-tying technique. ADVANTAGES: Anchoring the bowel to the abdominal wall helps in fixation of the bowel to be sutured. This helps specifically for large perforation. Suturing and knot tying is relatively easy by this technique.

The laparoscopic transperitoneal approach for irreducible inguinal hernias: Perioperative outcome in four patients.

BACKGROUND: Incarceration and strangulation are the most feared complications of inguinal hernia. Till date, incarcerated hernias have traditionally been treated by conventional open repair. Reports are now available for the feasibility of laparoscopic repair of incarcerated inguinal hernia. Here, we described our experience with the transperitoneal approach for incarcerated hernias. MATERIALS AND METHODS: Between January 2008 and May 2008, four patients were presented with a history of irreducible hernia, abdominal distention and vomiting. All the patients had right-sided inguinal hernia. Reductions of the hernia contents were not possible in any patient. The patients were treated on emergency basis with laparoscopic transabdominal preperitoneal hernia repair. Retrospective analyses of all the patients were done. RESULTS: Reduction of the bowel was achieved in all but one patient, who required the division of the internal ring on lateral side. Transperitoneal mesh repair was performed. No major complications were encountered. One patient developed seroma formation that was treated conservatively. CONCLUSION: Laparoscopic transperitoneal approach has the advantage of observation of the hernia content for a longer period of time. The division of the internal ring can be done under direct vision. Other intra-abdominal pathology and opposite side hernia can be diagnosed and treated at the same time..

Anthropometric factors and breast cancer risk among urban and rural women in South India: a multicentric case-control study.

Breast cancer (BC) incidence in India is approximately twice as high in urban women than in rural women, among whom we investigated the role of anthropometric factors and body size. The study was conducted at the Regional Cancer Centre, Trivandrum, and in three cancer hospitals in Chennai during 2002-2005. Histologically confirmed cases (n=1866) and age-matched controls (n=1873) were selected. Anthropometric factors were measured in standard ways. Information on body size at different periods of life was obtained using pictograms. Odds ratios (OR) of BC were estimated through logistic regression modelling. Proportion of women with body mass index (BMI)>25.0 kg/m(2), waist size >85 cm and hip size >100 cm was significantly higher among urban than rural women. Risk was increased for waist size >85 cm (pre-menopausal: OR=1.24, 95% CI: 0.96-1.62; post-menopausal: 1.61, 95% CI: 1.22-2.12) and hip size >100 cm (pre-menopausal: OR=1.47, 95% CI: 1.05-2.06; post-menopausal 2.42, 95% CI: 1.72-3.41). Large body size at age 10 (OR=1.75, 95% CI: 1.01-3.03) and increased BMI (OR=1.33, 95% CI: 1.05-1.69 for 25.0-29.9 kg/m(2) and OR=1.56, 95% CI: 1.03-2.35 for 30+ kg/m(2)) were associated with pre-menopausal BC risk. Our data support the hypotheses that increased anthropometric factors are risk factors of BC in India.

Management of rectal cancer: strategies and controversies.

Colorectal cancer is one of the most common cancers in the western world. The goal of this review is to outline some of the important surgical issues surrounding the management of rectal cancer. In patients with early rectal cancer (T1), local excision may be an alternative approach in highly selected patients. For more advanced rectal cancer, radical surgical resection is the treatment of choice. Total mesorectal excision and negative radial margin (>1 mm) decreases the local recurrence rate and improves survival. In appropriate patients, laparoscopic resection allows for improved patient comfort, shorter hospital stays, and earlier returns to preoperative activity level. In patients with locally advanced disease, neoadjuvant chemoradiotherapy followed by radical excision according to the principles of TME has become widely accepted. Surgical resection is the treatment of choice for resectable liver metastasis of colorectal origin. Surgical resection improves disease-free and overall survival rate. For patients with unresectable metastatic disease, multimodality approach may increase the resectability rate and hence survival.

Postoperative hemorrhage after major pancreatobiliary surgery: an update.

In recent years, mortality associated with pancreaticoduodenectomy has come down to less than 5% but morbidity still remains high. Pancreatic fistula is one of the most common complications following pancreaticoduodenectomy. Postpancreatectomy hemorrhage is a rare but disastrous complication and associated with poor outcome. Early bleeding is usually due to some surgical mishap, but the management is simpler. Delayed hemorrhage has more complex pathophysiology and requires a multimodality approach for its management. In this paper, we review the recent articles related to postoperative hemorrhage after major pancreatobiliary surgery. Here we discuss the incidence, cause, investigations and management of early and late postoperative hemorrhage.

Laparoscopic microwave ablation of liver tumors: our experience.

BACKGROUND/AIMS: Microwave ablation is the most recent development in the field of tumor ablation and is a well established and safe local ablative method available for liver tumors (both primary and secondary tumors). The technique allows for flexible approaches to treatment, including percutaneous, laparoscopic, and open surgical access. Laparoscopic technique has the advantages of accurate tumor staging, better tolerability and low cost. It can be performed in tumors which are close to the vital organs. The aim of this study was to evaluate the feasibility and safety of laparoscopic microwave ablation of liver tumors. METHODOLOGY: During January 2001 to December 2005, 57 patients with liver tumors were treated with laparoscopic microwave ablation in the department of Surgical Oncology. There were 34 male and 23 female patients. Out of 57 patients, 11 patients had hepatocellular carcinoma and 46 patients had secondaries in the liver. The most common source of secondaries was colorectal cancers. Laparoscopic microwave ablation of tumors was performed in these patients. RESULTS: During the study period, 57 patients with no evidence of extrahepatic disease underwent laparoscopic microwave ablation of unresectable hepatic tumors. No major intraoperative complications occurred. Postoperatively all the patients did well. Four patients developed liver abscess at the ablation area. Two patients required percutaneous aspiration of the liver abscess. No other major complications occurred. Follow-up CT scan shows complete necrosis of the tumors. Patients were followed-up at regular intervals. CONCLUSIONS: Laparoscopic microwave ablation is a feasible and safe alternative to open microwave ablation of the liver tumors. It carries all the advantage of minimal invasive surgery. In experienced hands, microwave ablation using laparoscopic technique can be done safely and effectively.

Pancreatic neuroendocrine tumors: our approach.

BACKGROUND/AIMS: Pancreatic neuroendocrine tumors constitute a small percentage of pancreatic tumors. Surgical resection is the best treatment for these types of tumors. Aggressive surgical resection including multivisceral resection provides long-term survival. Even palliative resection of the tumor is justifiable. Here we share our experience with the management of pancreatic neuroendocrine tumors. METHODOLOGY: Between January 1993 and April 2007 we operated on 54 patients with pancreatic neuroendocrine tumor. We have analyzed our data retrospectively. Patients were analyzed in terms of demographic characteristics, operative procedure, postoperative outcome and survival. RESULTS: Out of 54 patients, 31 patients had nonfunctional tumor and 23 patients had functional tumors. Neuroendocrine carcinoma was found in 19 patients. Pancreaticoduodenectomy was performed in 21 patients. Simultaneous liver resection was performed in 4 patients and multiorgan resection for locally advanced pancreatic tumor was performed in 3 patients. CONCLUSIONS: Surgical resection is the best option for the treatment of pancreatic neuroendocrine tumors. Aggressive resection provides survival benefit and a better quality of life. If the entire gross tumor can be resected, multiorgan resection or simultaneous liver resection is justifiable.

A new technique for intracorporeal knot tying in laparoscopic surgery.

INTRODUCTION: Laparoscopic intracorporeal knot tying in minimally invasive surgery is an advanced skill. Mastering this skill is a difficult process with a long learning curve. Intracorporeal suturing is essential to advanced laparoscopy and is a rate-limiting step in many procedures. Many different instruments and methods have been described for laparoscopic suturing and knot tying. We have developed a new technique for laparoscopic knot tying. TECHNIQUE: The long end of the suture is held with a left-hand instrument, and the instrument is rotated for 360 degrees in a clockwise direction to make a forward-direction loop. The end of the loop is grasped with the right-hand instrument, and the other end of the suture is grasped with the left-hand instrument. The suture end, held by the left hand, is pulled though the loop and tied, thus making a half-knot of a square knot. The second half-knot is made by using the right-hand instrument with the same technique. DISCUSSION: Laparoscopic suturing and knotting is difficult to perform, especially when the angle between the working instruments is narrow and working space is limited. In all these situations, knot tying using this technique makes knotting more simple and easy to perform, especially for those who have limited experience in intracorporeal suturing and knot tying. No special instrument is required to perform knot tying with this technique.

Assessing dust exposure in an integrated iron and steel manufacturing plant in South India.

A study to monitor and estimate respirable particulate matter (RPM), toxic trace metal concentrations in the work environment was carried out in different sections of an integrated steel manufacturing industry. The average RPM concentration observed varied according to the section blast furnace was 2.41 mg/m;{3}; energy optimization furnace, 1.87 mg/m;{3}; sintering plant, 0.98 mg/m;{3}; continuous casting machine, 1.93 mg/m;{3}. The average trace metal concentration estimated from the RPM samples like iron, manganese, lead and chromium did not exceed ACGIH prescribed levels.

CD19-positive antibody-secreting cells provide immune memory.

Long-lived antibody-secreting cells (ASCs) are critical for the maintenance of humoral immunity through the continued production of antibodies specific for previously encountered pathogen or vaccine antigens. Recent reports describing humoral immune memory have suggested the importance of long-lived CD19- bone marrow (BM) ASCs, which secrete antibodies recognizing previously encountered vaccine antigens. However, these reports do not agree upon the unique contribution of the CD19+ BM ASC subset toward humoral immunity. Here, we found both CD19+ and negative ASCs from human BM were similar in functional capacity to react to a number of vaccine antigens via ELISpot assays. The CD19+ cells were the predominant ASC population found in lymphoid tissues, and unlike the CD19- ASCs, which were found only in spleen and BM, the CD19+ ASCs were found in tonsil and blood. CD19+ ASCs from the BM, spleen, and tonsil were capable of recognizing polio vaccine antigens, indicating the CD19+ ASC cells play a novel role in long-lasting immune defense. Comparative gene expression analysis indicated CD19+ and negative BM ASCs differed significantly by only 14 distinct messenger RNAs and exhibited similar gene expression for cell cycle, autophagy, and apoptosis control necessary for long life. In addition, we show identical CDR-H3 sequences found on both BM ASC subsets, indicating a shared developmental path. Together, these results provide novel insight for the distribution, function, genetic regulation, and development of long-lived ASCs and may not only impact improved cell therapies but also enhance strategies for vaccine development.

Trajectory of an oil spill off Goa, eastern Arabian Sea: field observations and simulations.

An oil spill occurred off Goa, west coast of India, on 23 March 2005 due to collision of two vessels. In general, fair weather with weak winds prevails along the west coast of India during March. In that case, the spill would have moved slowly and reached the coast. However, in 2005 when this event occurred, relatively stronger winds prevailed, and these winds forced the spill to move away from the coast. The spill trajectory was dominated by winds rather than currents. The MIKE21 Spill Analysis model was used to simulate the spill trajectory. The observed spill trajectory and the slick area were in agreement with the model simulations. The present study illustrates the importance of having pre-validated trajectories of spill scenarios for selecting eco-sensitive regions for preparedness and planning suitable response strategies whenever spill episodes occur.

An update and our experience with metastatic liver disease.

Metastatic liver disease remains a challenging and life-threatening clinical situation with an obscure and dismal prognosis and outcome. The liver is the most common site of metastatic spread of colorectal cancer and nearly half of the patients with colorectal cancer ultimately develop liver metastasis during the course of their diseases. Death from colorectal cancer is often a result of liver metastases. Over half of these patients die from their metastatic liver diseases. At the time of diagnosis, hepatic metastases are present in 15-25% of patients, and another 25-50% will develop metachronous liver metastases within 3 years following resection of the primary tumor. Over the last decade, there have been tremendous advances in the treatment of metastatic liver disease. Hepatic resection still remains the gold standard for the treatment of metastatic lesions which are amenable to surgery. Unfortunately, up to 40 percent of patients are identified as having additional disease at the time of exploration, and 20 percent are found to be unresectable. Regional therapies such as radiofrequency ablation, microwave ablation and cryotherapy may be offered to patients with isolated unresectable metastases. Other options like hepatic artery chemotherapy and chemoembolization, portal vein embolization and immunotherapy also play a vital role in management of metastatic liver disease when used in combination with other therapies. This article reviews the history of metastatic liver disease, epidemiology, diagnosis and various treatment modalities available for liver metastases along with our experience in management of advance metastatic liver disease.

Pancreas-preserving total duodenectomy without pancreato-enteric anastomosis.

BACKGROUND/AIMS: Pancreas-preserving total duodenectomy is a challenging surgical technique with organ preservation and has limited indications. We assessed the safety, feasibility and short-term functional outcome of PPTD without the need of pancreato-enteric anastomosis in our surgical technique. METHODOLOGY: During the two-year period from 2005 to 2007, three patients underwent pancreas-preserving total duodenectomy at our center. Two patients had diffuse adenomatous polyposis; another had previous transduodenal excision for polyp with recurrence. In all three patients pancreas-preserving total duodenectomy was performed without the pancreato-jejunal anastomosis and were analyzed prospectively. The surgical procedure and outcome is described. RESULTS: Out of three patients who underwent pancreas-preserving total duodenectomy, one patient had pancreatitis postoperatively and recovered well with conservative line of management. The other two patients had an uneventful postoperative course. All the patients were closely followed up and were symptom free, in a good condition with good functional status. CONCLUSIONS: To the best of our knowledge this is the first series of pancreas-preserving total duodenectomy without pancreato-enteric anastomosis ever reported. Although the indication for pancreas-preserving total duodenectomy is limited, it can be performed safely with good surgical expertise and knowledge of pancreato-duodenal anatomy. It can be beneficial in elderly patients with concomitant heart disease and associated risk factors. Although it is technically demanding requiring high surgical skills, it excludes the need of pancreas resection with maintenance of gastrointestinal function and the procedure can be performed safely and in less time. But the procedure should be contraindicated in the presence of malignancy and the operated patient should be under long-term surveillance.

Gastrointestinal stromal tumor of gastrohepatic omentum in a patient with von Recklinghausen's disease (neurofibromatosis type 1).

It is very rare to find large gastrointestinal stromal tumors arising from the gastrohepatic omentum in a patient with neurofibromatosis type 1. We here document a case of two large gastrointestinal stromal tumors arising from the gastrohepatic omentum in a patient with von Recklinghausen's disease. In the present case, two large tumors in the lesser sac were evident on preoperative computed tomography and magnetic resonance imaging and were surgically removed successfully. Biopsy was suggestive of gastrointestinal stromal tumors.

Environmental and biological monitoring in a lead acid battery manufacturing unit in India.

An environmental and biological monitoring of a lead acid battery manufacturing unit was carried out to measure the respirable particulate matter, lead content in working atmosphere and blood lead levels of workers employed in different sections. The results showed high mean air lead concentration in buffing (1444.45 microg/m(3)), plate cutting (430.14 microg/m(3)) and pasting (277.48 microg/m(3)) sections. The mean blood lead levels of employees in these sections were also higher than the values prescribed by ACGIH.

Survival in patients with recurrent glioma as a measure of treatment efficacy: prognostic factors following nitrosourea chemotherapy.

The assessment of efficacy of treatment in patients with recurrent glioma is notoriously difficult, and survival is the most objective endpoint. Between 1970 and 1992, a cohort of 211 patients with recurrent glioma received nitrosourea-based chemotherapy at the time of disease progression. The median survival from the start of chemotherapy was 7 months, with 30% 1-year and 10% 2-year survival probabilities. One-year survival was 22% in 147 patients with recurrent high-grade astrocytoma, 41% in 37 patients with low-grade astrocytoma and 45% in 24 patients with oligodendroglioma. Age, histological grade and Karnofsky performance status (KPS) at recurrence were independent prognostic factors for survival on multivariate analysis. Based on patients' age, tumour grade and KPS, it was possible to define three distinct prognostic groups with 1-year survival probabilities of 60, 21 and 17% (P < 0.005). Response to chemotherapy was difficult to assess but correlated with prognostic subgroup, with highest response rate (46%) in the most favourable group and lowest (13%) in the poor prognostic group. In patients with recurrent glioma, patient and tumour parameters are the major determinants of outcome which are identical to prognostic factors at the time of primary diagnosis. They can be used to provide prognostic information for the individual patient, and to stratify patients particularly in trials assessing the efficacy of novel treatments.