Intraperitoneal Haemorrhage Secondary to Rupture of Right Colic Artery Pseudoaneurysm: A Case Report and Literature Review.

This article presents the case of a 58-year-old woman who presented feeling unwell with pain in the right upper abdomen for three days. She had a history of splenic infarcts, was on lifelong warfarin and had recently returned from a trip to Gambia. She was admitted to the hospital under suspicion of sepsis of unknown origin, and a CT scan later revealed haemoperitoneum along with a pseudoaneurysm of the right colic artery. After initially responding to resuscitation, the patient deteriorated haemodynamically, and a decision was made to perform a laparotomy, revealing a ruptured right colic artery pseudoaneurysm. In this article, the authors highlight the challenges of managing a complex unwell patient with a ruptured right colic artery pseudoaneurysm, emphasising the importance of a multi-disciplinary team approach and shared decision-making and reviewing the available literature.

Mirizzi's syndrome: A scoring system for preoperative diagnosis.

BACKGROUND/AIM: Mirizzi's syndrome (MS) is an unusual complication of gallstone disease and occurs in approximately 1% of patients with cholelithiasis. Majority of cases are not identified preoperatively, despite the availability of modern imaging techniques. A preoperative diagnosis can forewarn the operating surgeon and avoid bile duct injuries in cases of complicated cholecystitis. A preoperative scoring system helpful and hence, we aim to devise a scoring system based on clinical, biochemical, and imaging features to predict the diagnosis of MS in cases of complicated cholecystitis. PATIENTS AND METHODS: From January 2000 to July 2013, 1,539 patients with cholelithiasis underwent cholecystectomy. Of these, 96 patients had complicated cholecystitis. Records of these patients were analyzed retrospectively. In these, 32 patients were found to be having MS that formed the study group. A scoring system was devised based on clinical, biochemical, and imaging parameters to predict the diagnosis of MS. Every positive parameter was given 1 point and patients rated on a scale of 0-10. RESULTS: Score of 3 or more was found to have a 90% sensitivity of predicting MS among complicated cholecystitis. Similarly, a score of 6 or more had an 80% sensitivity of predicting Mirizzi's types II, III, and IV indicating fistulization. Jaundice, leucocytosis, associated choledocholithiasis/hepatolithiasis, intrahepatic biliary radical dilatation, meniscus sign and mass at confluence were found to be significant parameters. CONCLUSION: We propose a simple scoring system based on clinical, biochemical, and imaging parameters that can be useful for predicting MS in patients with complicated cholecystitis.

Malrotation of Small Bowel-Diagnostic Computed Tomography (CT) Signs and Intraoperative Findings.

Right paraduodenal hernia usually occurs in setting of nonrotated small bowel, when small bowel herniates through Waldeyer's fossa (a defect in the first part of jejunal mesentery). It lies behind the superior mesenteric artery and inferior to the transverse colon or third portion of duodenum. We studied two cases of right paraduodenal hernia, an incomplete rotation, and nonrotation of small bowel, respectively, and describe CT abdomen signs, which can give a preoperative diagnosis.

Evidence Based Surgery: How Difficult is the Implication in Routine Practice?

Surgery as a discipline has perhaps been slower than other specialties to embrace evidence based principles. Today, surgeons all over Asia are prepared to challenge the dogma of yesterday. Surgical science which rests on a strong foundation of laboratory and clinical research can now be broadened to include the armamentarium of evidence based practice to advance surgical knowledge. The sheer volume of easily accessed information creates a new challenge. This article discusses keeping up with new information and finding the best available answers to specific questions amidst all the other information.

Enterolithiasis complicating eosinophilic enteritis: A case report and review of literature.

We report a case of eosinophilic enteritis involving the proximal small bowel, a relatively rare entity, presenting unusually as enteroliths in a 68-year-old man with complaints of anemia, malena and abdominal pain. The disease if diagnosed in the initial stages responds well to medical treatment but if associated with complications or misdiagnosed, surgical modality is the treatment of choice. In our case, the patient presented with enteroliths and strictures. Resection and anastomosis of the small bowel containing stones was carried out. Histopathology confirmed the diagnosis as eosinophilic enteritis.

An iron(III) ion-selective sensor based on a mu-bis(tridentate) ligand.

A mu-bis(tridentate) ligand named 2-phenyl-1,3-bis[3'-aza-4'-(2'-hydroxyphenyl)-prop-4-en-1'-yl]-1,3-imidazolidine (I) has been synthesized and scrutinized to develop iron(III)-selective sensors. The addition of sodium tetraphenyl borate and various plasticizers, viz., chloronaphthalene, dioctylphthalate, o-nitrophenyl octyl ether and dibutylphthalate has been used to substantially improve the performance of the sensors. The membranes of various compositions of the ligand were investigated and it was found that the best performance was obtained for the membrane of composition (I) (10mg):PVC (150mg):chloronaphthalene (200mg):sodium tetraphenyl borate (9mg). The sensor showed a linear potential response to iron(III) over wide concentration range 6.3x10(-6) to 1.0x10(-1)M (detection limit 5.0x10(-6)M) with Nernstian slope (20.0mV/decade of activity) between pH 3.5 and 5.5 with a quick response time of 15s. The potentiometric selectivity coefficient values as determined by match potential method (MPM) indicate excellent selectivity for Fe(3+) ions over interfering cations. The sensor exhibits adequate life of 2 months with good reproducibility. The sensor could be used in direct potentiometry.

Manganese (II) selective PVC based membrane sensor using a Schiff base.

N,N',N'',N'''-1,5,8,12-tetraazadodecane-bis(salicylaldiminato)(H(2)L) has been used as ionophore for preparing Mn(2+) selective sensor. Membranes of different composition with regard to ratio of H(2)L:PVC:NPOE:NaTPB have been prepared and investigated. The best performance was obtained with the membrane of composition 10:150:150:10 (H(2)L:PVC:NPOE:NaTPB) (w/w; mg). This membrane generated linear potential response in the concentration range of 5.0x10(-6) to 1.0x10(-1)M with a Nernstian slope of 30.0mV/decade of activity and fast response time (10s). Hydrogen ion does not effect to the performance of sensor in the pH range 3.0-6.5. The sensor was found to be sufficient selective for Mn(2+) over a number of alkali, alkaline and heavy metal ions and could therefore be used for the determination of manganese in various samples by direct potentiometry.

Aluminum(III) selective potentiometric sensor based on morin in poly(vinyl chloride) matrix.

Al(3+) selective sensor has been fabricated from poly(vinyl chloride) (PVC) matrix membranes containing neutral carrier morin as ionophore. Best performance was exhibited by the membrane having composition as morin:PVC:sodium tetraphenyl borate:tri-n-butylphosphate in the ratio 5:150:5:150 (w/w, mg). This membrane worked well over a wide activity range of 5.0x10(-7) to 1.0x10(-1)M of Al(3+) with a Nernstian slope of 19.7+/-0.1mV/decade of Al(3+) activity and a limit of detection 3.2x10(-7)M. The response time of the sensor is approximately 5s and membrane could be used over a period of 2 months with good reproducibility. The proposed sensor works well over a pH range (3.5-5.0) and demonstrates good discriminating power over a number of mono-, di- and trivalent cations. The sensor can also be used in partially non-aqueous media having up to 20% (v/v) methanol, ethanol or acetone content with no significant change in the value of slope or working activity range. The sensor has also been used in the potentiometric titration of Al(3+) with EDTA and for its determination in zinc plating mud and red mud.

Ni(2+) selective sensors based on meso-tetrakis-{4-[tris-(4-allyl dimethylsilyl-phenyl)-silyl]-phenyl}porphyrin and (sal)(2)trien in poly(vinyl chloride) matrix.

PVC-based membranes of meso-tetrakis-{4-[tris-(4-allyl dimethylsilyl-phenyl)-silyl]-phenyl}porphyrin (I) and (sal)(2)trien (II) as electroactive material with dioctylphthalate (DOP), tri-n-butylphosphate (TBP), chloronapthalene (CN), dibutylphthalate (DBP) and dibutyl(butyl) phosphonate (DBBP) as plasticising solvent mediators have been found to act as Ni(2+) selective sensor. The best performance was obtained with the sensor having a membrane of composition of I: sodium tetraphenyl borate: PVC in the ratio 5:5:150. The sensor exhibits Nernstian response in the activity range 2.5x10(-6) to 1.0x10(-1)M, performs satisfactorily over wide pH range (2-5.5) with a fast response time ( approximately 8s). The sensor was found to work satisfactorily in partially non-aqueous media up to 20% (v/v) content of methanol or ethanol and acetone and could be used over a period of 4 months. Potentiometric selectivity coefficients determined by matched potential method (MPM) indicate excellent selectivity for Ni(2+) ions. The sensors could be used successfully in the estimation of nickel in different brand of chocolates and also as an indicator electrode in potentiometric titration.