[REGIONAL LASER THERAPY IN TREATMENT OF PATIENTS WITH STRANGULATED VENTRAL HERNIA].

An analysis of treatment was made of 265 patients with strangulated hernia of the anterior abdominal wall. The patients were divided into main group (n = 138) and control group n = 127). Nonstrain and conventional methods of hernioplasty and low-intensive laser radiation (LILR) were used for the patients of the first group. LILR wasn't applied in the control group. The studied groups were statistically comparable on the basis of main disease, sex and age. Computed thermography was used in addition to standard methods of diagnostics in order to dentify the wound complications in postoperative period. The application of low-intensive laser radiation for patients of main group allowed reducing the rate of development of local infectious complications in the area of plasty as compared with control group from 15.7 and 53.4% to 8.9 and 32.8% (p < 0.05); terms of drainage of postoperative wound decreasing from 8.1 ± 1.0 to 4.2 ± 1.0 days and hospital stay shortening from 11.6 ± 1.0 to 6.2 ± 1.0 days (p < 0.05). The intensity of pain syndrome and rate of complications declined from 38.1 to 17% in control group. There wasn't any recurrence in the main group. Prosthetic methods of plasty and application of LILR significantly improve the immediate and long-term results in case of strangulated hernia of anterior abdominal wall. This rate would approach the results of treatment in planned surgery. Computed thermography allowed well-timed revealing of wound complications and forecasting the course of postoperative period.

Analysis of ocular cyclotorsion in lying position after peribulbar block and topical anesthesia / Análise da ciclotorção ocular em posição supina após bloqueio peribulbar e anestesia tópica

Purpose: Evaluate the magnitude of cyclotorsion during cataract surgery in patients with indication for intraocular toric lenses comparing the results after peribulbar and after topical anesthesia. Methods: This prospective study comprised 112 eyes that underwent cataract surgery with implantation of toric intraocular lens by topical anesthesia or peribulbar block. We estimated how many degrees of cyclotorsion occurred after topical anesthesia and peribulbar block with the patient in supine position. A tag was performed in the position of 180 degrees of the right eye and zero degrees of the left eye, with the patient seated. Afterwards, it was requested a change to the supine position and then a new dial in 180 and zero degrees respectively from right and left eye were made. Results: The current study demonstrated that patients submitted to cataract surgery with implantation of toriclens under local anesthesia showed approximately 6.89 degrees of incyclotorsion (82 eyes) and 6.93 degrees of excyclotorsion (38 eyes) and a mean of cyclotorsion of 6.91 degrees. Patients undergoing peribulbar block showed 5.68 degrees of incyclotorsion (73 eyes) and 4.81 degrees of excyclotorsion (47 eyes) and a mean of cyclotorsion of 4.92 degrees. Conclusion: Through the study we can see that the movement of incyclotorsion in patients undergoing peribulbar anesthesia was lower when compared to topical anesthesia. This is relevant since the greater the incyclotorsion, the lower the predictability of the surgery and the lower the chance of obtaining excellent results in the final refractometric. .

Objetivo: Avaliar a magnitude da ciclotorção durante a cirurgia de catarata em pacientes com indicação de lentes intraoculares tóricas comparando os resultados após o bloqueio peribulbar e após a anestesia tópica. Métodos: Esse estudo prospectivo compreende 112 olhos que foram submetidos à cirurgia de catarata com implante de lente intraocular tórica por meio de anestesia tópica ou bloqueio peribulbar. Foram estimados quantos graus de ciclotorção ocorreu após a anestesia tópica e após o bloqueio peribulbar, com o paciente em posição supina.Foi realizada uma marcação na posição de 180 graus do olho direito e zero grau do olho esquerdo, com o paciente sentado, em seguida,houve uma mudançade posição para decúbito dorsal, sendo realizadas novas marcações em 180 e zero graus dos olhos direito e esquerdo, respectivamente. Resultados: O presente estudo demonstrou que pacientes submetidos à facoemulsificação com implante de lente tórica com anestesia tópica apresentaram aproximadamente 6.89 graus de inciclotorção (82 olhos) e 6,93 graus de exciclotorção (38 olhos) com uma média de ciclotorção de 6.91 graus. Já os pacientes submetidos à anestesia peribulbar apresentaram 5.68 graus de inciclotorção(73 olhos) e 4,81 graus de exciclotorção (47 olhos) com uma média de ciclotorção de 4,92. Conclusão: Através do estudo podemos observar que o movimento de inciclotorção em pacientes submetidos à anestesia peribulbar foi menor quando comparado ao da anestesia tópica. Isso se torna relevante uma vez que, quanto maior for a inciclotorção, menor a previsibilidade da cirurgia e menor a chance de obtenção de excelência nos resultados refratométricos finais. .

Value of laparoscopy in children with a suspected rotation abnormality on imaging.

BACKGROUND: Although imaging is usually used for the diagnosis of rotation abnormalities, significant false-positive and false-negative rates have been reported. We studied the utility of laparoscopy in the management of children with a suspected rotation abnormality on imaging. METHODS: The charts of all children undergoing laparoscopy for a suspected intestinal rotation abnormality from January 2000 to August 2009 were retrospectively reviewed. RESULTS: There were 51 patients. Preoperative diagnosis based on upper gastrointestinal contrast study with or without contrast enema or ultrasound was malrotation without volvulus in 47%, malrotation with volvulus in 10%, and nonrotation in 6%; the other 37% had equivocal or inconclusive imaging studies. Of the patients who had a "definitive" preoperative diagnosis, 41% had a discrepant finding at laparoscopy. For those with inconclusive imaging studies, 32% were found on laparoscopy to have a narrow mesenteric base, which put them at significant risk of midgut volvulus. CONCLUSION: Imaging studies may be inaccurate in differentiating malrotation from nonrotation or normal rotation. Laparoscopy provides an excellent opportunity to assess the base of the mesentery. Those children without a narrow-based mesentery can undergo laparoscopy alone, and those with malrotation should undergo either laparoscopic or open Ladd procedure.

Acute colonic obstruction from Ladd bands: a unique complication from intestinal malrotation.

In patients with intestinal malrotation, Ladd bands are known to cause obstruction of the duodenum and small bowel. However, acute obstruction of the colon from Ladd bands has not been previously described. We report a case of complete obstruction of the hepatic flexure of the colon secondary to a Ladd band in a previously healthy teenage boy.

[Torsion and infarction of an accessory liver lobe]. / Lob hepatic accesoriu torsionat si infarctat.

Anatomical abnormalities of the liver are extremely rare. We report a case of a 32 year old female who has admitted with acute epigastric pain and vomiting. Physical exam revealed a mobile mass in right middle abdominal quadrant. Ultrasound and contrast--enhanced CT demonstrated a heterogeneous vascular left mass. Small bowel enema shows left jejunal loops displacement. Surgical findings: twisted, congested swelling, attached by a long pedicle to the liver's third segment. Histological examination showed recent hepatic infarction.

Diagnosis and treatment of torsion of the spiral colon in an alpaca.

A 14-year-old 61.7-kg (136-lb) alpaca was examined for colic of 24 hours' duration. An exploratory celiotomy was performed because of lack of response to medical treatment and ultrasonography revealed an abnormally large amount of free fluid in the peritoneal cavity. Exploration of the abdomen revealed a 20-cm diameter mass, consisting of most of the ascending colon. The spiral colon was thick and edemetous, and it was decided to resect the spiral colon. Following a few complications, the alpaca was discharged 17 days after surgery. Colic in camelids is considered a severe problem because clinical signs are subtle and often not recognized until the condition is untreatable. Camelids are reported to be stoic animals, and may have few signs of pain despite severe abdominal disease. Alpacas with signs of abdominal pain should undergo early and complete physical, laboratory, and diagnostic imaging evaluations. Rapid identification of the need for surgery is vital for a successful outcome.