A prospective, non-randomized study to determine the role of intraperitoneal drain placement in perforation peritonitis.

BACKGROUND: Surgical site infection continues to be a major problem after laparotomy for perforation peritonitis, as it increases morbidity and hospital stay and decreases the quality of life. Intra-abdominal drain placement is a routine practice in perforation peri-tonitis. The aim of our study is to compare the incidence of surgical site infection in two groups of patients who were operated for perforation peritonitis: The first group received the intraperitoneal drain, while no drain was placed in the second group. METHODS: The present single-center, prospective, non-randomized study was conducted in the Department of General Surgery at the Postgraduate Institute of Medical Education and Research, India. A total of 122 patients underwent exploratory laparotomy for gastroduodenal and small bowel perforation peritonitis, of which 100 participants were included in this study, based on specified cri-teria for inclusion and exclusion. A total of 50 participants each were included in the drain group and the no drain group, respectively. A drain was placed in every alternate patient with perforation peritonitis who received primary closure or resection anastomosis. Patients with diabetes, renal failure, and hemodynamic instability and those who presented more than 72 h since symptom onset were excluded from the study. Peritoneal fluids were cultured. The primary endpoint was to identify the incidence of surgical site infections (SSIs) in the two groups. We also compared the time taken for the return of bowel movements, duration for which a nasogastric tube was inserted, whether any intervention was performed under local or general anesthesia within 30 days of surgery, the duration of hospital stay, and the ease of diagnosing repair leak in the post-operative period in both the groups. RESULTS: Demographics of participants in both the groups were matched. No significant difference was observed between the drain and no-drain groups with respect to the incidence of surgical site infection (p=0.779). The duration of surgery and length of hospital stay were significantly lower in the no drain group. A significant difference was observed between the two groups concerning the peritoneal culture growth, and increased bacterial growth was seen in the drain group. No significant difference in morbidity was noted between the two groups, which was classified according to the Clavien-Dindo classification. CONCLUSION: Routine use of intra-abdominal drains was not found to be effective in preventing SSIs, but a selection bias cannot be ruled out. Patients with no drains had a significantly shorter duration of hospital stay.

Evaluation of cytokine response to extracorporeal membrane oxygenation.

RATIONALE: Increased cytokine response is common in patients receiving extracorporeal life support and is often a poor prognostic indicator. There is interest in using adjunctive cytokine adsorption technologies to reduce inflammatory burden, However, it is debated whether extracorporeal membrane oxygenation (ECMO) itself provides therapeutic benefit beyond gas exchange. Thus, we sought to characterize the inflammatory profile of ECMO in the first 72-96 h of and quantify its effect on cytokine levels in a case series of patients undergoing ECMO. METHODS: Eight patients initiating ECMO were studied. Of these, we measured cytokines pre- and post-oxygenator over 96 h. Comparisons of cytokine levels were made across the oxygenator and over time. RESULTS: The average age of patients was 64.3 years with 62% being male. Centrally cannulated patients had higher IL-6 levels (820.43 vs. 6907.53 pg/ml, p < 0.03), whereas peripherally cannulated patients had higher IL-12p70 levels (7.73 vs. 2.59 pg/ml, p < 0.05). Cytokine levels on day one included IL-12p70 (4.17 ± 2.56), IL-6 (4971.23 ± 8569.88), TNF (undetected), IL-8 (346.68 ± 670.18), IL-1B (undetected), and IL-10 (72.27 ± 87.9). Cytokine levels increased over 96 h; however, no significant differences were appreciated despite blood product transfusion. On day 3, IL-12p70 levels were significantly lower post-oxygenator (p < 0.05). CONCLUSION: The inflammatory profile of ECMO does not change significantly over the early course of illness when accounting for transfusion. However, the decrease in IL-12p70 specifically at day 3 of ECMO may indicate adsorption of specific inflammatory markers by the oxygenator although the clinical significance of this is still unknown. Further investigation of the oxygenator on cytokine response is warranted.

Demographic Patterns, Risk Factors, and Outcomes of Abdominal Aortic Aneurysms in Young Adults ≤55 Years: An Experience in a Tertiary Care Centre of India.

Introduction Abdominal aortic aneurysms (AAA) are uncommon in young adults ≤55 years of age. There is a lack of literature on clinical characteristics, risk factors, and therapeutic outcomes so we present a case series of 11 patients of AAA aged ≤55 years. Methods We included single-center retrospective case series between 2013 to 2020. We reviewed 44 patients who were operated for AAA in a tertiary care center in India. We identified 13 patients who were ≤55 years; two patients with incomplete records were excluded. A patient information sheet was used to retrieve demographic data, clinical presentation, outcomes, and follow-up. Results Out of 11 patients, 10 were men. Nine patients (81.8%) had symptomatic AAA. The majority (45.4%) exhibited an infrarenal aneurysm and the median size of the aneurysm was 5.8 cm (IQR: 5.5-6.4 cm). Eight patients (72.7%) had a history of smoking. Hypertension was observed in six patients and one patient had associated coronary artery disease. Clamping time was > 45 minutes among three patients; all smokers. Blood loss was > 500 ml in five patients. The median length of hospital stay was 10 days (7-40); more among patients with metabolic equivalents (METS) score < 4, 14.5 (8-19) days. No grade III-IV complications and mortality were noted with a median follow-up of 15 months, with all patients living. Conclusion The aneurysm was symptomatic in the majority of participants. An association of smoking in increasing both the median clamping time and length of hospital stay was seen. No mortality and good disease-free follow-up suggested good outcomes.

Ex-vivo repair for multiple and intraparenchymal renal artery aneurysms.

A 45-year-old woman with known hypothyroidism and no other comorbidities was incidentally found to have multiple right renal artery aneurysms. The largest aneurysm measured 5 x 4.5 cm and arose from an inferior segmental branch while two smaller aneurysms arose from an upper segmental branch of the right renal artery. We performed an ex-vivo repair with reverse saphenous vein graft under cold preservation followed by orthotopic kidney auto-transplantation. Her postoperative course was unremarkable and at 1-year follow-up her right kidney is preserved. In this article, we report successful treatment of complex multiple right renal artery aneurysms and describe the surgical technique used for successful repair.

Uma mulher de 45 anos com hipotireoidismo conhecido e sem outras comorbidades teve achado incidental de múltiplos aneurismas da artéria renal direita. O maior aneurisma media 5 x 4,5 cm e tinha origem no ramo segmentar inferior, juntamente com dois pequenos aneurismas originários do ramo segmentar superior da artéria renal direita. Realizamos o reparo ex vivo com enxerto reverso de veia safena, sob preservação a frio, seguido de autotransplante renal ortotópico. O pós-operatório ocorreu sem intercorrências, e a paciente teve o rim direito preservado no seguimento de 1 ano. Neste artigo, relatamos o tratamento bem-sucedido de múltiplos aneurismas complexos da artéria renal direita e descrevemos a técnica cirúrgica utilizada para o reparo bem-sucedido.

Clinical profile and management of external jugular vein aneurysms.

OBJECTIVE: External jugular vein (EJV) aneurysm is an extremely uncommon clinical condition. We have studied the clinical profile and need for surgery in this present seven case series of primary external jugular vein aneurysms. METHOD: Over the past three years, we have diagnosed and managed aneurysms of external jugular vein in seven patients, who presented with swelling in the posterior triangle of the neck. Venous duplex was obtained in all the patients, followed by computed tomography (CT) in three patients and one patient reported with magnetic resonance (MR) venography from another hospital. Three patients had symptoms ranging from mild intermittent discomfort to moderate pain underwent excision of aneurysm after ligation of both ends of EJV. Four patients had swelling on the lateral side of the neck due to EJV aneurysm, with no other associated symptoms. They were kept on six monthly follow-ups. RESULT: We operated three patients, as they were symptomatic, of which only two had thrombus in the aneurysmal sac. All three symptomatic patients had aneurysm of size >5 cm. Post-surgery and on subsequent follow-ups they were asymptomatic. The four asymptomatic patients kept on conservative management did not develop any thrombosis of aneurysm sac in follow up. CONCLUSION: Surgical excision is indicated for symptomatic patients with EJV aneurysm, preferably for size > 5 cm because of their higher association with thrombosis or symptoms. Asymptomatic patients can be managed non-operatively with regular surveillance by clinical examination and venous duplex or can be treated if patients insist due to cosmetic reasons.

Ex-vivo repair for multiple and intraparenchymal renal artery aneurysms / Reparo Ex Vivo de Aneurismas Intraparenquimatosos Múltiplos da Artéria Renal

Abstract A 45-year-old woman with known hypothyroidism and no other comorbidities was incidentally found to have multiple right renal artery aneurysms. The largest aneurysm measured 5 x 4.5 cm and arose from an inferior segmental branch while two smaller aneurysms arose from an upper segmental branch of the right renal artery. We performed an ex-vivo repair with reverse saphenous vein graft under cold preservation followed by orthotopic kidney auto-transplantation. Her postoperative course was unremarkable and at 1-year follow-up her right kidney is preserved. In this article, we report successful treatment of complex multiple right renal artery aneurysms and describe the surgical technique used for successful repair.

Resumo Uma mulher de 45 anos com hipotireoidismo conhecido e sem outras comorbidades teve achado incidental de múltiplos aneurismas da artéria renal direita. O maior aneurisma media 5 x 4,5 cm e tinha origem no ramo segmentar inferior, juntamente com dois pequenos aneurismas originários do ramo segmentar superior da artéria renal direita. Realizamos o reparo ex vivo com enxerto reverso de veia safena, sob preservação a frio, seguido de autotransplante renal ortotópico. O pós-operatório ocorreu sem intercorrências, e a paciente teve o rim direito preservado no seguimento de 1 ano. Neste artigo, relatamos o tratamento bem-sucedido de múltiplos aneurismas complexos da artéria renal direita e descrevemos a técnica cirúrgica utilizada para o reparo bem-sucedido.

A Clinical and Radiographic Comparison of Platelet-rich Fibrin and Lyophilized Platelet-derived Preparation as Pulpotomy Agent in Primary Molars.

INTRODUCTION: Vital pulpotomy in primary molar teeth is aimed to retain the tooth in function until it is replaced by its successors. AIM: The aim of this study was to evaluate and compare platelet-rich fibrin (PRF) and lyophilized platelet-derived preparation (LPDP) as a pulpotomy agent in primary molars. MATERIALS AND METHODS: Forty primary molars from 20 healthy children aged 5-9 years requiring pulpotomy in the contralateral side of mandible were randomly selected. In both the groups, pulpotomy was carried out by removing coronal pulp and achieving hemostasis, the radicular part of pulp tissue was packed with PRF preparation in Group I and LPDP (Mothercell Research Centre, Trichy, Tamil Nadu, India) in Group II. The teeth were restored with zinc oxide eugenol and glass ionomer cement (GIC), followed by stainless steel crown in the same visit. Clinical and radiographic evaluation was undertaken at 1, 3, and 6 months interval. RESULTS: The overall success rate was 90% in PRF group and 95% in LPDP group at the end of 6 months. The results were statistically nonsignificant between the groups (P > 0.05). CONCLUSION: The overall outcome of the study suggests that PRF and LPDP are acceptable pulpotomy agents and are promising in the era of new vital pulp therapy procedure.

Rupture of Unscarred Uterus With Intestinal Prolapse From Vagina Following Criminal Abortion.

A 21-year-old unmarried and primigravida female indulged in criminal abortion at 18 weeks of gestation with the help of a village midwife. Instrumentation was done, and it led to uterine perforation with prolapse of 200 cm of small bowel through vagina. She was managed with resection of 160 cm of necrotic small bowel, repair of the uterine defect, and end jejunostomy, which was anastomosed with distal ileum three months later. This case highlights the risks of illegal abortion and the primitive societal mindset that forces unmarried women to resort to such means.

A virus precipitation method for concentration & detection of avian influenza viruses from environmental water resources & its possible application in outbreak investigations.

Background & objectives: Avian influenza (AI) viruses have been a major cause of public health concern. Wild migratory birds and contaminated environmental sources such as waterbodies soiled with bird droppings play a significant role in the transmission of AI viruses. The objective of the present study was to develop a sensitive and user-friendly method for the concentration and detection of AI viruses from environmental water sources. Methods: Municipal potable water, surface water from reservoirs and sea were spiked with low pathogenic AI viruses. To concentrate the viruses by precipitation, a combination of potassium aluminium sulphate with milk powder was used. Real-time reverse transcription-polymerase chain reaction was performed for virus detection, and the results were compared with a virus concentration method using erythrocytes. Drinking water specimens from poultry markets were also tested for the presence of AI viruses. Results: A minimum of 101.0 EID50(50% egg infectious dose)/ml spiked H5N1 and 101.7 EID50/ml spiked H9N2 viruses were detected from spiked potable water; 101.0 and 102.0 EID50/ml spiked H5N1 virus was detected from surface water and seawater samples, respectively. The present method was more sensitive than the erythrocyte-binding method as approximately 10-fold higher infectious virus titres were obtained. AI H9N2 viruses were detected and isolated from water from local poultry markets, using this method. Interpretation & conclusions: Viability and recovery of the spiked viruses were not affected by precipitation. The present method may be suitable for the detection of AI viruses from different environmental water sources and can also be applied during outbreak investigations.

Effects of different levels of feed intake during four short periods of gestation and housing systems on sows and litter performance.

The current study investigated the effects of different levels of feed intake during 4 short periods of gestation and of housing systems on sow and litter performance. A total of 255 multiparous sows were allotted to 1-4 dietary treatments using a randomized complete block design blocking by initial body weight (BW), backfat (BF) and parity. Sows were housed either in individual stalls (n=129) or group pens (n=126) with 55 sows in each pen with electronic sow feeder during gestation. All sows were fed one common corn-soybean meal-based diet with the amount of 1.0×maintenance energy level of feed intake (106×BW0.75) throughout gestation except 4 periods of 7 d when dietary treatments were imposed on day 27, 55, 83 and 97 of gestation. During the 4 periods, sows were fed 1 of 4 different levels of feed intake: 0.5, 1.0, 1.5 and 2.0×maintenance energy level (0.5M, 1.0M, 1.5M and 2.0M, respectively). Results showed that both BW gain and BF change during gestation for sows on 1.5M (49.7kg and 3.1mm, respectively) and 2.0M (52.5kg and 3.7mm, respectively) levels of feed intake were significantly (P<0.01) greater than sows on 0.5M (26.1kg and -0.1mm, respectively) and 1.0M (35.6kg and 0.1, respectively) levels of feed intake. In contrast, lactation weight gain for sows on 1.5M (3.3kg) and 2.0M (3.4kg) levels of feed intake during 4 short periods of gestation were significantly (P<0.01) less than sows on 0.5M (18.4kg) and 1.0M (11.4kg) levels of feed intake during 4 short periods of gestation, whereas BF loss during lactation for sows on 1.5M (-3.6mm) level of feed intake during 4 short periods of gestation were significantly (P=0.03) higher than sows on 1.0M (-2.1mm) level of feed intake during 4 short periods of gestation. Additionally, average daily feed intake during lactation for sows on 0.5M (6.6kg/d) level of feed intake during gestation tended (P=0.06) to be greater than sows on 2.0M (5.9kg/d) level of feed intake. There were no differences (P>0.1) among 4 levels of feed intake in terms of numbers of total born and weaning piglets. However, both piglet weight at birth (1.46, 1.52, 1.53 and 1.51kg for piglets from sows on 0.5M, 1.0M, 1.5M and 2.0M levels of feed intake during gestation, respectively) and at weaning (6.37, 6.55, 6.64 and 6.38kg for piglets from sows on 0.5M, 1.0M, 1.5M and 2.0M levels of feed intake during gestation, respectively) were maximized at 1.5M level of feed intake. Sows housed in group pens had greater (P<0.01) net BW gain (24.7 vs. 19.2kg) from day 27 of gestation to weaning compared with sows housed in individual stalls. However, there were no differences (P>0.1) between the 2 housing systems in terms of litter size and piglet weight at birth and at weaning. In conclusion, increasing levels of feed intake during 4 short periods of gestation increased BW and BF gain during gestation and led to less BW gain and more BF loss during lactation. Piglet weight at birth and at weaning was maximized at 1.5M level of feed intake. However, housing systems did not affect reproductive performance. Group pen housing system may be beneficial in terms of increased overall BW gain during gestation and lactation.

Effect of replacing conventional soybean meal with low-oligosaccharide soybean meal on growth performance and carcass characteristics of wean-to-finish pigs1.

A trial was conducted to determine the effect of replacing conventional soybean meal (CSBM) with low-oligosaccharide soybean meal (LOSBM) on growth performance and carcass characteristics of wean-to-finish pigs. A total of 432 crossbred pigs (19 d and 6.6 ± 1.2 kg BW) were blocked by sex and BW and assigned to 1 of 6 dietary treatments: 1) CSBM in all phases and fishmeal and spray-dried plasma protein (FM/SDPP) in phases 1 to 3, 2) CSBM in all phases but with no FM/SDPP, 3) LOSBM and FM/SDPP in phases 1 to 3 and CSBM in phases 4 to 6, 4) LOSBM in phases 1 to 3 and CSBM in phases 4 to 6, 5) LOSBM in phases 1 to 6 and FM/SDPP in phases 1 to 3, and 6) LOSBM in phases 1 to 6. The results showed that pig growth performance (ADG, ADFI, and G:F) during the overall period (phases 1 to 6) and carcass traits (HCW, dressing percentage, fat depth, loin depth, and lean percentage) were not affected ( > 0.05) by dietary treatments. Moreover, replacing CSBM with LOSBM in phases 1 to 3 did not affect early phase growth performance in the absence of FM/SDPP but reduced ( ≤ 0.05) ADFI and increased ( < 0.05) G:F during the nursery period (phases 1 and 2) in the presence of FM/SDPP. In phase 2, LOSBM increased ( < 0.05) blood urea nitrogen in comparison with CSBM. In conclusion, reduction of oligosaccharide by replacing CSBM with LOSBM in the early, late, or entire phase of the wean-to-finish period did not improve growth performance and carcass characteristics of pigs.

Effect of replacing conventional soybean meal with low oligosaccharide soybean meal fed to weanling piglets.

An experiment was conducted to investigate the effect of replacing conventional soybean meal (CSBM) with low-oligosaccharide soybean meal (LOSBM) on growth performance, blood urea nitrogen (BUN), intestinal morphology, viscosity of the intestinal contents, and visceral organ weight of weanling pigs. Thirty-two 19-d old individually housed pigs (6.2 ± 0.4 kg BW) were blocked by BW, and randomly assigned from within blocks to 1 of 4 dietary treatments: (1) CSBM with inclusion of fish meal and spray dried plasma protein (CSBM+), (2) CSBM without inclusion of fish meal and spray dried plasma protein (CSBM-), (3) LOSBM with inclusion of fish meal and spray dried plasma protein (LOSBM+), and (4) LOSBM without inclusion of fish meal and spray dried plasma protein (LOSBM-) according to a 2 × 2 factorial arrangement. Pigs were fed the experimental diets ad libitum for 14 d. Average daily gain and ADFI were not affected ( > 0.05) by the dietary treatments. However, inclusion of fish meal and spray dried plasma protein improved ( = 0.04) the gain to feed ratio. Replacing CSBM with LOSBM reduced ( = 0.01) viscosity of the intestinal contents. Dietary treatments had no effect ( > 0.05) on the small intestinal length and weights of organs including the pancreas, liver, heart, kidney, and spleen. No differences ( > 0.05) were observed between dietary treatments in villus height, crypt depth, and the ratio of villus height to crypt depth in the ileum, and crypt depth and the ratio of villus height to crypt depth in the jejunum; however, jejunal villus height was reduced ( = 0.02) when replacing CSBM with LOSBM. Concentration of BUN was higher ( = 0.01) for pigs fed the LOSBM diets compared with pigs fed the diets containing CSBM. In conclusion, LOSBM reduced the intestinal digesta viscosity but had no effects on growth performance and intestinal morphology when fed to piglets during the first 2 wk after weaning.

Effect of dietary supplementation of oregano essential oils to sows on colostrum and milk composition, growth pattern and immune status of suckling pigs.

This study evaluated the effects of supplementing sow diets with oregano essential oils (OEO) during gestation and lactation on sow colostrum and milk composition and on the growth pattern and immune status of suckling pigs. A total of 70 second-parity sows were randomly assigned to 1 of 2 gestation dietary treatments within 24 h after service: control (CON) or CON + 250 mg/kg of OEO (OREG). In lactation, sows were again assigned to either the CON or OREG dietary treatment. Thus, the lactation treatments were CON-CON, CON-OREG, OREG-CON, and OREG-OREG. Colostrum and blood samples were collected from 6 sows per lactation dietary treatment. Thymus lymphocyte (T lymphocyte) subpopulations (γδ, cluster of differentiation 8, and 32 cluster of differentiation 4) were enumerated in blood and mammary secretions along with IGF-1, IgG, and IgA concentrations. Piglet growth rate were determined from 18, 17, 17, and 18 litters from the CON-CON, CON-OREG, OREG-CON, and OREG-OREG lactation dietary treatments, respectively. Growth rates were determined in 630 piglets, and piglets were individually identified and weighed on 1, 5, 9, 12, 16, and 19 d of age. Oregano essential oil supplementation during gestation or lactation had no effect (P > 0.05) on GE, CP, GE:CP, GE:fat, and IGF-1 in sow milk. Reductions of the fat percentage in milk on d 7 (P < 0.05) and d 14 (P = 0.07) were found in sows supplemented with OEO during lactation compared with those in the CON treatment. Milk from sows supplemented with OEO during lactation had the greatest number of T lymphocytes compared with those in the lactation CON treatment on d 14 of lactation (P < 0.01). The number of T lymphocytes in milk was greater for sows in the CON-OREG treatment compared with those other treatments on d 14 of lactation (P < 0.05). Energy intake was greater on d 1 to 5 in piglets from sows fed OEO during gestation than those from sows in the CON treatment (P < 0.05). A trend (P = 0.10) for greater milk intake was observed in piglets from sows supplemented with OEO during gestation compared with those from sows in the CON treatment. Similarly, a tendency for an increase in ADG on d 1 to 5 was found in piglets from sows supplemented with OEO during gestation compared with those from sows in the CON treatment (P = 0.10). Insulin-like growth factor-1 at birth and on d 7 and 14 of lactation did not differ among piglets from sows assigned to the different dietary treatments. Oregano essential oil supplementation of sow diets did not affect (P > 0.05) immunoglobulin concentrations in piglets after suckling. Supplementing sow diets with OEO during gestation or lactation did not affect (P > 0.05) the T lymphocytes, percentage of T-lymphocyte subpopulations, and natural killer cell activity of piglets during lactation. Supplementing sow diets with 250 mg/kg of OEO during gestation and lactation did not affect the growth potential of and immune responses in suckling piglets.