Use of a hand-assisted laparoscopic surgical technique for closure of an extensive mesojejunal rent in a horse

CASE DESCRIPTION A 7-year-old 573-kg (1,261 -lb) Swiss Warmblood gelding was evaluated because of signs of acute abdominal pain. CLINICAL FINDINGS Physical examination revealed a markedly distended abdomen with subjectively reduced borborygmi in all abdominal quadrants. A large, gas-distended viscus was present at the pelvic brim preventing complete palpation of the abdomen per rectum. Ultrasonographic evaluation could not be safely performed in the initial evaluation because of severe signs of abdominal pain. TREATMENT AND OUTCOME Ventral midline celiotomy was performed, and right dorsal displacement of the ascending colon was corrected. Progressive signs of abdominal pain after surgery prompted repeat ventral midline celiotomy, and small intestinal incarceration in a large, radial mesojejunal rent was detected. The incarceration was reduced, but the defect was not fully accessible for repair via the celiotomy. Repair of the mesenteric defect was not attempted, and conservative management was planned after surgery; however, signs of colic returned. A standard laparoscopic approach was attempted from both flanks in the standing patient, but the small intestine could not be adequately mobilized for full evaluation of the rent. Hand-assisted laparoscopic surgery (HALS) allowed identification and reduction of jejunal incarceration and repair of the mesenteric rent. Although minor ventral midline incisional complications were encountered, the horse recovered fully. CLINICAL RELEVANCE HALS techniques should be considered for repair of mesenteric rents in horses. In the horse of this report, HALS facilitated identification, evaluation, and repair of a large radial mesenteric rent that was not accessible from a ventral median celiotomy.

IMAGING DIAGNOSIS-MUSCULAR HYPERTROPHY OF THE SMALL INTESTINE AND PSEUDODIVERTICULA IN A HORSE.

A 14-year-old Thoroughbred gelding was presented for chronic colic and weight loss. Transcutaneous and transrectal abdominal ultrasonography revealed distended, thickened small intestine with primary thickening of the muscularis and a focally more thickened loop with an echoic structure crossing the wall from the mucosa to the serosa. Visualization of diffuse thickening of the muscularis (muscular hypertrophy of the small intestine) and a focal lesion (pseudodiverticulum) helped clinicians make informed decisions. This case illustrates the importance of transabdominal and transrectal ultrasonography in horses with chronic colic and the relevance of considering the abnormalities in layering pattern of the intestinal wall.

Ceco-cecal intussusception in a Simmental heifer

This report describes the clinical, laboratory and ultrasonographic findings in a Simmental heifer with a ceco-cecal intussusception. The general condition of the heifer was moderately reduced and it showed mild colic signs. Physical examination revealed a firm longish mass visible and palpable in the right flank. Findings upon rectal examination, fecal output und defecation were normal. Ultrasound examination of the mass revealed features typical for an intussusception. Based on the slow development of symptoms, normal fecal output and ultrasonography findings, a ceco-cecal intussusception was diagnosed. Right flank laparatomy was performed under general anaesthesia, and an end-to-side anastomosis between the jejunum and the spiral colon was made after resection of the intussuscepted intestines. Recovery was uneventful.

Risk factors for developing complications while awaiting a cholecystectomy

Background. Laparoscopic Cholecystectomy is the gold standard for patients who are diagnosed with biliary colic (NIH, 1993). It has been demonstrated that individuals who wait a longer time between diagnosis and treatment are at increased risk of having complications (Rutledge et al., 2000; Contini et al., 2004; Eldar et al., 1999). County hospitals, such as Ben Taub General Hospital (BTGH), have a particularly high population of uninsured patients and consequently long surgical wait periods due to limited resources. This study evaluates patients the risk factors involved in their progression to complications from gallstones in a county hospital environment. ^ Methods. A case-control study using medical records was performed on all patients who underwent a cholecystectomy for gallstone disease at BTGH during the year of 2005 (n=414). The risk factors included in the study are obesity, gender, age, race, diabetes, and amount of time from diagnosis to surgery. Multivariate analysis and logistical regression were used to assess factors that potentially lead to the development of complications. ^ Results. There were a total of 414 patients at BTGH who underwent a cholecystectomy for gallstone disease during 2005. The majority of patients were female, 84.3% (n=349) and Hispanic, 79.7% (n=330). The median wait time from diagnosis to surgery was 1.43 weeks (range: 0-184.71). The majority of patients presented with complications 72.5% (n=112). The two factors that impacted development of complications in our study population were Hispanic race (OR=1.81; CI 1.02, 3.23; p=0.04) and time from diagnosis to surgery (OR=0.98; CI 0.97, 0.99; p<0.01). Obesity, gender, age, and diabetes were not predictive of development of complications. ^ Conclusions. An individual's socioeconomic status potentially influences all aspects of their health and subsequent health care. The patient population of BTGH is largely uninsured and therefore less likely to seek care at an early stage in their disease process. In order to decrease the rate of complications, there needs to be a system that increases patient access to primary care clinics. Until the problem of access to care is solved, those who are uninsured will likely suffer more severe complications and society will bear the cost. ^

Comparison of methods for assessing in home night time crying in healthy infants

Background. Infant colic is a common condition that is thought to put infants at risk for Shaken Baby Syndrome, a particularly devastating form of child abuse. However, little research has been done on techniques parents can use to deal with infant colic. This pilot study was conducted to assess the equipment that will be used in a randomized control trial that will compare the results for two different techniques that parents can use to reduce crying in infants with colic. ^ Methods. A total of 11 healthy infants, between one and five months of age, were recruited into this pilot study. All infants had a dosimeter, actiwatch and maternal log placed into the home and a subset of infants (N=3) were also recorded by a video camera. The equipment recorded between 6pm and 6am for at least two and up to five nights. The maternal log and video log were compared with one another to determine if the maternal log provides an accurate representation of the infant's night-time activities (i.e. sleep, awake, crying, feeding). The maternal log was then compared to the dosimeter and actiwatch data to determine if the dosimeter/actiwatch accurately reproduce the maternal log. ^ Results. Data from 10 infants were included in the analyses. The maternal log and video log were in full or partial agreement 90% of the time. When comparing events noted by the mother, the maternal log and dosimeter data were in agreement 84% of the time, and the maternal log and actiwatch data were in agreement 87% of the time. In combination, the dosimeter and/or actiwatch data agreed with the maternal log 90% of the time. ^ Conclusions. Our preliminary analyses of these data suggest the dosimeter and actiwatch will be useful tool for defining infant sleep patterns relative to the maternal log. However further analysis will be required to develop threshold values that can be used to objectively define events in the proposed RCT. Such analyses will need to integrate data from multiple dosimeters and deal with the shifting baselines observed for both the dosimeter and actiwatch.^

Percepción de la transición a la maternidad: estudio fenomenológico en la provincia de Barcelona

Objetivos: Describir necesidades y experiencias de madres con hijos menores de un año, identificar los factores que dificultan la transición a la maternidad y orientar en el contenido de un programa de promoción de la salud a desarrollar en sesiones grupales de apoyo a la maternidad. Diseño: Estudio cualitativo con enfoque fenomenológico. Emplazamiento: Ocho centros de Atención Primaria de la provincia de Barcelona, entre julio de 2011 y julio de 2012. Participantes: Un total de 21 madres que participan en dinámicas grupales de apoyo a la maternidad. Método: Selección opinática de las participantes en las entrevistas semiestructuradas. Las transcripciones se analizaron en su estructura (análisis de contenido latente) y contenido (análisis de contenido manifiesto), obteniéndose diferentes categorías. Resultados: Las participantes en el estudio definen el constructo de la maternidad en torno a 3 categorías: los cambios en el estilo de vida, los sentimientos y las percepciones. Identifican como momentos más estresantes: «el nuevo rol», «los cambios en la relación de pareja», «sentimientos encontrados», «experiencias del embarazo y parto», «la idealización», «la falta de apoyo», «llantos», «cólicos», «interpretar las señales del niño», «baño», «descanso», «opiniones contradictorias», «aprendizaje» y «adquisición de nuevas habilidades». Destacan como temas principales para las dinámicas grupales: alimentación, desarrollo, relación afectiva, confianza materna, participación de los padres, papel de la familia, aspectos emocionales, descanso, masaje, baño, prevención de accidentes, cólicos, primeros auxilios, puericultura, recursos y vacunas. Conclusión: Las dinámicas grupales deben contextualizarse de acuerdo a las necesidades percibidas por las madres y permitir la participación de otras figuras familiares.

The common colics of the horse : their causes, symptoms, diagnosis, and treatment /

Mode of access: Internet.

Traité des causes et symptomes de la pierre, et des principaux remedes en usage pour guérir cette maladie ... /

Mode of access: Internet.

Die Kolik des Pferdes und ihre Behandlung, für Tierärzte und Veterinärstudierende sowie für Offiziere und die interessierten Sport- und wirtschaftlichen Kreise ...

Mode of access: Internet.

Increased rate of cholecystectomies performed with doubtful or no indications after laparoscopy introduction: a single center experience

Background During recent years laparoscopic cholecystectomy has dramatically increased, sometimes resulting in overtreatment. Aim of this work was to retrospectively analyze all laparoscopic cholecystectomies performed in a single center in order to find the percentage of patients whose surgical treatment may be explained with this general trend, and to speculate about the possible causes. Methods 831 patients who underwent a laparoscopic cholecystectomy from 1999 to 2008 were retrospectively analyzed. Results At discharge, 43.08% of patients were operated on because of at least one previous episode of biliary colic before the one at admission; 14.08% of patients presented with acute lithiasic cholecystitis; 14.68% were operated on because of an increase in bilirubin level; 1.56% were operated on because of a previous episode of jaundice with normal bilirubin at admission; 0.72% had gallbladder adenomas, 0.72% had cholangitis, 0.36% had biliodigestive fistula and one patient (0.12%) had acalculous cholecystitis. By excluding all these patients, 21.18% were operated on without indications. Conclusions The broadening of indications for laparoscopic cholecystectomy is undisputed and can be considered a consequence of new technologies that have been introduced, increased demand from patients, and the need for practice by inexperienced surgeons. If not prevented, this trend could continue indefinitely.

Three-trocar laparoscopic cholecistectomy in patient with situs viscerum inversus totalis. Case report and review of the literature

Situs viscerum inversus totalis is a rare defect with a genetic predisposition, which can present difficulties in the management of abdominal pathology, especially in laparoscopic surgery (mirror-image anatomy). We report the case of a 52-year-old female with situs viscerum inversus totalis, known from pediatric age, with a medical history of colic pain in the epigastrium radiating to the right abdominal quadrant. Laparoscopic cholecistectomy was safely performed with a three trocar technique. To the best of our knowledge this is the first time that laparoscopic cholecistectomy by three trocars was performed in a patient with situs viscerum inversus. We also review the relevant literature concerning this issue.

Squamous cell carcinoma of the renal pelvis with stones and inferior vena cava infiltration. Case report

We report a rare case of a 50 year old man with renal squamous cell carcinoma (SCC) who first came to our attention with renal colic and fever not responding to antibiotic or analgesic treatment. He had a long history of kidney stones, but had not undergone any imaging in the last 5 years. Physical examination revealed tenderness and a palpable mass in the right flank and lumbar region. A whole body CT scan was performed, revealing an 11 cm mass in the right kidney infiltrating the inferior vena cava. There were areas of calcification within the mass and multiple stones within the renal pelvis. The tumor was considered unsuitable for resection according to radiological and clinical criteria. The mass was biopsied percutaneously under CT guidance and histological examination revealed squamous cell carcinoma of the renal pelvis. The patient was treated with neoadjuvant chemotherapy and embolization of the renal artery. He died one month after diagnosis. To our knowledge this is the second reported case in the world of renal SCC infiltrating the inferior vena cava and with kidney stones.

Trastornos gastrointestinales funcionales en menores de dos años: prevalencia y factores asociados en una IPS Bogotá 2015 - 2016

Antecedentes: Los trastornos gastrointestinales funcionales de la infancia (TGFI) son manifestaciones gastrointestinales crónicas en cualquier parte del tubo digestivo sin daño estructural o bioquímico los cuales se pueden clasificar según los criterios de ROMA III. Se desconoce su prevalencia en niños latinoamericanos menores de 4 años. Objetivos: Estimar la prevalencia de los TGFI y cada una de sus entidades en menores de 2 años y explorar sus factores asociados. Metodología: Estudio corte trasversal con muestra aleatoria (n=323) tomada de la población de una institución de salud en la ciudad de Bogotá, realizando mediante encuesta diligenciada por los padres. El análisis se realizó por medio del software SPSS© utilizando estadística descriptiva y análisis bivariado, como medida de asociación se calculó las Razones de Disparidad (RD) con IC95%. Resultados: Se encontró una prevalencia de TGFI de 22.1%, diarrea funcional 14.6%, disquecia 12%, regurgitación 9.2%, estreñimiento 3.3%, vómito cíclico 2%, cólico infantil 1.6% y rumiación 0%. La administración de tetero durante la estancia hospitalaria neonatal se asocia con vómito cíclico RD= 6 IC 95% (1.076 – 33.447) p=0.021. La administración de formula infantil durante los primeros 6 meses de vida se asocia con diarrea funcional RD= 0.348 IC 95% (0.149 – 0.813) p=0.012 Conclusiónes: Los TGFI son una causa frecuente de molestias en los menores de 2 años de edad. Sugerimos realizar la validación del cuestionario “questionnaire on infant/toddler gastrointestinal symptoms rome version III” con el fin de mejorar la validez y precisión de los hallazgos en estudios futuros.