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Novel method of full-thickness bladder closure with an endoscopic suturing machine: a survival study in a porcine model
Get PDFOBJECTIVE:
To assess the feasibility of a pure endoscopic closure method for vesical perforations using fully absorbable material.
MATERIALS AND METHODS:
A pilot experimental study was performed in eight anaesthetized female pigs. Four 10-mm and four 20-mm endoscopic full thickness cystotomies were created. An endoscopic suturing machine (RD-180®; LSI Solutions, Victor, NY, USA) was deployed through the working channel of a cystoscope and used to close the incisions with absorbable sutures. Immediate assessment of the quality of the closure was obtained by distending the bladder with saline solution stained with methylene blue under laparoscopic control. After 3 weeks of follow-up, a necropsy examination was performed to check for signs of peritonitis and wound dehiscence and to assess the quality of healing.
RESULTS:
The experiment was completed in all eight pigs without complications. The median procedure time was 10 ± 4.3 min. The immediate bladder distention test did not show any methylene blue leakage. The postoperative period was uneventful. The post mortem examination after 3 weeks revealed complete healing of the bladder wall incisions with no signs of infection, wound dehiscence or adhesions in the peritoneal cavity of any of the pigs.
CONCLUSION:
This study describes a successful novel method for endoscopic closure of bladder perforations. The technique was easy, reproducible and safe. Nevertheless, further experimental investigation should be carried out before clinical application of this method
Early precut fistulotomy for biliary access: time to change the paradigm of "the later, the better?
Get PDFBACKGROUND:
The precut timing during the biliary cannulation algorithm is a subject of controversy. Some studies suggest that early institution of precut is a safe and effective strategy even though the extent to which this approach may affect the duration of the ERCP is seldom addressed.
OBJECTIVE:
To assess the success, safety, and procedure duration of an early precut fistulotomy (group A) versus a classic precut strategy after a difficult biliary cannulation (group B).
DESIGN:
Single-center, prospective cohort study.
SETTING:
University-affiliated hospital.
PATIENTS:
A total of 350 patients with a naïve papilla.
INTERVENTIONS:
Standard biliary cannulation followed by needle-knife fistulotomy (NKF).
MAIN OUTCOME MEASUREMENTS:
Biliary cannulation rate, NKF success, adverse events, and ERCP duration.
RESULTS:
The overall cannulation rate was similar, at 96% and 94% for groups A and B, respectively. The adverse event rate was 6.2% and 6.4%, respectively, with pancreatitis as the most frequent adverse event (group A, 3.9%; group B, 5.2%). The mean ERCP duration was, however, significantly shorter in group A, both when biliary cannulation was achieved without precutting (14 minutes vs 25 minutes, P < .001) as well as when biliary cannulation was attempted after NKF (18 minutes vs 31 minutes, P < .0001).
LIMITATIONS:
Single-center study design, referral center.
CONCLUSIONS:
If the endoscopist is experienced in ERCP and precut techniques, an early precut strategy should be the preferred cannulation strategy because this approach is as safe and effective as the late fistulotomy approach and substantially reduces ERCP duration
Fractional exhaled nitric oxide in monitoring and therapeutic management of asthma
Get PDFINTRODUCTION:
Asthma is a chronic respiratory disease characterized by hyper-responsiveness and bronchial inflammation. The bronchial inflammation in these patients can be monitored by measuring the fractional exhaled nitric oxide. This study aims to determine fractional exhaled nitric oxide association with peak expiratory flow and with asthma control inferred by the Global Initiative for Asthma.
MATERIAL AND METHODS:
Observational, analytical and cross-sectional study of children with asthma, 6-12 years-old, followed in the Outpatient Respiratory Pathology of Braga Hospital. Sociodemographic and clinical information were collected through a questionnaire. fractional exhaled nitric oxide and peak expiratory flow were determined by portable analyzer Niox Mino® and flow meter, respectively.
RESULTS:
The sample is constituted by 101 asthmatic children, 63 (62.4%) of males and 38 (37.6%) females. The mean age of participants in the sample is 9.18 (1.99) years. The logistic regression performed with the cutoff value obtained by ROC curve, revealed that fractional exhaled nitric oxide (b(FENO classes) = 0.85; χ(2)Wald (1) = 8.71; OR = 2.33; p = 0.003) has a statistical significant effect on the probability of changing level of asthma control. The odds ratio of going from "controlled" to "partly controlled/uncontrolled" is 2.33 per each level of fractional exhaled nitric oxide.
DISCUSSION:
The probability of an asthmatic children change their level of asthma control, from 'controlled' to 'partly controlled/uncontrolled', taking into account a change in their fractional exhaled nitric oxide level, increases 133%
Omental whirl associated with bilateral inguinal hernia: a case report
Get PDFTorsion of the omentum is a rare cause of abdominal pain. It is clinically similar to common causes of acute surgical abdomen and is often diagnosed during surgery. Inguinal hernia is a common condition but not frequently related with torsion of the omentum.
CASE PRESENTATION:
A 40-year-old Caucasian man came to our emergency department with abdominal pain of the left quadrant and abdominal distension for 2 days. His medical history included an untreated left inguinal hernia in the last year. Computed tomography revealed densification of mesocolon with left omentum "whirl" component and other signs of omental torsion. During an exploratory laparoscopy, a wide twist of his omentum with necrotic alterations that extended to the bilateral inguinal hernial content was observed. Omentectomy and surgical repair of bilateral inguinal hernia were performed.
CONCLUSIONS:
Torsion of the omentum is a rare entity and usually presents a diagnostic challenge. The use of abdominal computed tomography can help diagnosing torsion of the omentum preoperatively and, thus, prevents a surgical approach. Nonetheless, some cases of torsion of the omentum require surgical repair. Accordingly, a laparoscopic approach is minimally invasive and efficient in performing omentectomy