The global paediatric surgery network: early measures of interest in the website.

PURPOSE: The Global Paediatric Surgery Network (GPSN) website was launched in May 2010, with the following goals: to serve as a clearing house for pediatric surgery volunteer work performed worldwide, to provide online resources for surgeons working in areas of limited medical resources, and to provide practical and educational information for surgeons who wish to volunteer. The purpose of this study was to assess use of the website over the first year since its launch (May 6, 2010-May 5, 2011). METHODS: The GPSN website was examined for number of pages, number of listings in Past Work, Present Work, and Help Needed categories, as well as number of volunteers available. The online tool Google Analytics was used to assess parameters that measure use of the website, such as number of visits, number of page views, number of visitors, time on the website, and geographic origin of visitors. RESULTS: The GPSN website consists of 30 pages. There are 9 listings in Past Work, 23 listings in Present Work, and 13 listings in Help Needed categories. 118 people have registered as willing to volunteer, and 96 have indicated that they are able to work in times of a natural disaster. There were 8437 visits to the website, with 28 916 page views by 5170 visitors from 145 countries, with an average number of page views of 3.43 and an average time on the website of 4:05 min. The most visited pages were the homepage, the meetings page, and the pediatric surgery organizations page. 4 websites of pediatric surgery organizations have links to the GPSN website. CONCLUSIONS: Based on early website use, we conclude that there is an interest in the GPSN. We speculate that participation in the GPSN will continue to grow, but that there is a continued need to promote the website in the global pediatric surgery community.

Assessment of the biosorption characteristics of lychee (Litchi chinensis) peel waste for the removal of Acid Blue 25 dye from water.

The aim of this study was to examine the adsorption potential of lychee (Litchi chinensis) peel waste for the removal of Acid Blue 25 dye from aqueous solutions. The adsorption was studied as a function of contact time, initial dye concentration and temperature by batch method. Equilibrium sorption isotherms showed that the lychee peel adsorbent possessed a high affinity and sorption capacity for Acid Blue 25, with a monolayer sorption capacity of ca. 200 mg g(-1). The equilibrium adsorption data were well described by the Langmuir model. Kinetic studies revealed that the present system of dye adsorption on lychee peel adsorbent could be described more favourably by the pseudo-second-order kinetic model. The thermodynamic parameters, namely free energy (deltaG degrees), enthalpy (deltaH degrees) and entropy (deltaS degrees) changes, were determined for the process. The results of the present study suggest that lychee peel waste can be used beneficially as an adsorbent in treating industrial effluents containing dyes.

Biosorption optimization of nickel removal from water using Punica granatum peel waste.

The present study was undertaken to evaluate the feasibility of Punica granatum (pomegranate) peel waste for the removal of nickel from water. Batch experiments were performed to study the biosorption of nickel on prepared pomegranate peel adsorbent. The sorption process was well explained with pseudo-second-order kinetic model. The maximum sorption capacity of pomegranate peel adsorbent for nickel removal was ca. 52 mg g(-1). The sorption has been found to be endothermic and data conform to the Langmuir model. The Gibbs free energy was determined to be negative, indicating the spontaneous nature of the sorption process. The results of the present study suggest that pomegranate peel waste can be used beneficially for nickel removal from aqueous solution.

Adsorptive removal of 2,4-dichlorophenol from water utilizing Punica granatum peel waste and stabilization with cement.

The present study investigates the adsorption potential of Punica granatum (pomegranate) peel as an adsorbent for the removal of 2,4-dichlorophenol (2,4-DCP) from aqueous solutions. The adsorption was studied as a function of contact time, initial concentration and temperature by batch method. The adsorption capacity of pomegranate peel adsorbent for 2,4-DCP was found to be 65.7 mg g(-1). The equilibrium adsorption data was well described by the Langmuir model. Kinetic studies suggest that the present system of phenol adsorption on pomegranate peel adsorbent could be described more favorably by pseudo-first-order kinetic model. Column studies were also undertaken in order to test the practical utility of prepared adsorbent and found promising. After the adsorption studies, the phenol-laden adsorbent was stabilized in cement for its ultimate disposal. The results of the present study clearly reveal that prepared adsorbent can be used beneficially in treating industrial effluents containing phenols and safely disposed of by stabilizing into cement.

Despite high satisfaction, majority of gastro-oesophageal reflux disease patients continue to use proton pump inhibitors after antireflux surgery.

BACKGROUND: While antireflux surgery is effective in controlling symptoms of gastro-oesophageal reflux, its role in eliminating the use of antireflux medicines after surgery and as such its long-term cost-effectiveness remains controversial. AIM: To assess the patient satisfaction and the continued medication use following laparoscopic Nissen fundoplication at a tertiary level community hospital. METHODS: Adult patients who underwent laparoscopic Nissen fundoplication at our institution over a period of over 3 years were asked to complete a questionnaire recording their demographic information, date and reason for the surgery, preprocedure and postprocedure symptoms, smoking and alcohol use, and medication use preoperatively and post-operatively. Patients were also asked about their satisfaction with surgery. RESULTS: One hundred patients participated in the study. Overall, 90% patients experienced satisfaction with their surgery. Eighty percentage patients were willing to undergo surgery again, if needed. Over two-thirds (67%) patients had decrease in the severity of their symptoms. None of the patients had worsening of symptoms post-operatively. However, 80% patients were still taking antireflux medications including proton pump inhibitors (53%). CONCLUSIONS: Most patients continue to use antireflux medications including after laparoscopic Nissen fundoplication despite high satisfaction with surgery.

Postinfectious gastroparesis related to autonomic failure: a case report.

BACKGROUND AND AIM: Severe dysautonomia may be secondary to viral infections, resulting in impaired autoimmune, cardiovascular, urinary and digestive dysfunction. Herein, we present a case of a 31-year-old white female patient who had severe gastroparesis related to autonomic failure following an episode of acute gastroenteritis. This seems to be the first report providing thorough assessment of the enteric and autonomic nervous system by analysis of full-thickness small intestinal biopsies, cardiovagal testing and autopsy. HOSPITAL COURSE: This patient affected by a severe gastroparesis was treated with antiemetics, prokinetics, analgesics and gastric electrical stimulation to control symptoms. Nutritional support was made using jejunal feeding tube and, in the final stage of disease, with total parenteral nutrition. Autonomic studies revealed minimal heart rate variability and a disordered Valsalva manoeuvre although the enteric nervous system and the smooth muscle layer showed a normal appearance. Hospital courses were complicated by episodes of bacteraemia and fungemia. Serum antiphospholipid antibodies were noted but despite anticoagulation, she developed a pulmonary embolism and shortly thereafter the patient died. Autopsy revealed acute haemorrhagic Candida pneumonia with left main pulmonary artery thrombus. Sympathetic chain analysis revealed decreased myelinated axons with vacuolar degeneration and patchy inflammation consistent with Guillain-Barre syndrome. The evaluation of the enteric nervous system in the stomach and small bowel revealed no evidence of enteric neuropathy or myopathy. CONCLUSION: A Guillain-Barre-like disease with gastroparesis following acute gastroenteritis is supported by physiological and autonomic studies with histological findings.

Degradation of predigested distillery effluent by isolated bacterial strains.

Batch studies were conducted on degradation of anaerobically digested distillery wastewater by three bacterial strains, viz. Xanthomonas fragariae, Bacillus megaterium and Bacillus cereus in free and immobilized form, isolated from the activated sludge of a distillery wastewater treatment plant. The removal of COD and colour with all the three strains increased with time up to 48 hr and only marginal increase in COD and colour removal efficiency was observed beyond this period up to 72 hr. After this period removal efficiency remained fairly constant up to 120 hr. The maximum COD and colour removal efficiency varied from 66 to 81% and 65 to 75%, respectively for both free and immobilized cells of all the three strains. The strain Bacillus cereus showed the maximum efficiency of COD (81%) and colour (75%) removal out of the three strains. An interrelationship between the percent COD and colour removal was carried out by correlation and regression analysis and was justified by high values of coefficient of correlation (r = 0.99) for all the cases. The first order removal rate kinetics was also applied and rate constants were evaluated for COD and colour removal efficiencies.

Isolation, screening and identification of bacterial strains for degradation of predigested distillery wastewater.

Three bacterial isolates from the activated sludge of a distillery wastewater treatment plant identified as Xanthomonas fragariae, Bacillus megaterium and Bacillus cereus were found to remove COD and colour from anaerobically digested distillery wastewater in the range of 55 to 68% and 38 to 58% respectively.

Lactose intolerance: diagnosis and management.

Lactose intolerance affects hundreds of millions of people worldwide. Although the presentation is frequently atypical, it should be part of the differential diagnosis when evaluating nonspecific gastrointestinal symptoms. We review the terminology, types of lactase deficiencies, diagnostic procedures, and management.

Effectiveness of single dilation with Maloney dilator versus endoscopic rupture of Schatzki's ring using biopsy forceps.

Current recommendations for treatment of patients with symptomatic Schatzki's ring are based on anecdotal experience or uncontrolled studies. Maloney dilation is the gold standard. We performed a randomized controlled trial to compare the use of a single 52-Fr Maloney dilation versus four quadrant biopsy of Schatzki's ring for relief of dysphagia. The subjects answered standardized dysphagia-related questions on a scale of 0-5 (0 = no dysphagia; 5 = cannot handle secretions). To account for modifications in diet and eating habits, subjects answered 11 question to arrive at a eating/diet score. Patients with Schatzki's ring were randomized into one of the two protocols. Group 1 underwent endoscopic biopsies of the ring, one biopsy in each quadrant. In group 2, the endoscope was taken out, and a single 52-Fr Maloney dilation was performed. Twenty-six patients participated in the study and were followed for up to 15 months. There was no significant difference in age, sex, race, smoking, alcohol abuse, or medication intake between the two groups. Dysphagia score improved by 91% in both groups at three months and 84% and 85% at 12 months in groups 1 and 2, respectively. The eating/diet habit score improved by 78% in both groups. There was one failure in each group, and one recurrence at six months in the dilation group. Fifty-five percent of dilation group and 100% of biopsy group described the procedure as easy. There was no difference in the amount of sedatives used during the procedure or the acid blockers after the procedure. In patients undergoing endoscopy, the superior cost/safety profile of endoscopic biopsy makes it a preferred choice for treatment of Schatzki's ring over bougienage.

Prevalence of previous appendectomy among patients needing gastrointestinal endoscopy.

BACKGROUND: The appendix may be an immune modulator of the gut, and its absence may lead to an increase in gastrointestinal illnesses. If this is true, we may expect patients needing endoscopy to have a higher prevalence of previous appendectomy. METHODS: We did a case-control study at the University of Oklahoma Hospital for 13 months. Subjects having endoscopic evaluation at the University of Oklahoma Hospital formed the study group. Patients seen at the general medicine clinic of the University of Oklahoma served as controls. We recorded the patient's name, age, sex, race, history of smoking, and history of appendectomy or tonsillectomy. RESULTS: The endoscopy group had 524 patients; 469 patients were in the control group. There were no differences based on race or history of smoking. There was greater prevalence of previous appendectomy in the endoscopy group (33.46% vs. 20.55%). The prevalence of tonsillectomy was 29.28% in the study group vs. 21.61% among the controls. Multiple regression revealed that history of appendectomy and not tonsillectomy was related to the performance of endoscopy. CONCLUSION: History of appendectomy is associated with greater performance of endoscopy.