Comparative study of catheter drainage and needle aspiration in management of large liver abscesses

Objective  

To compare the effectiveness of percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) in the management of large (>10 cm diameter) liver abscesses.     

Justifying formation of bladder flap at cesarean section?

Introduction  Creation of the bladder flap, i.e., dissecting the urinary bladder from the lower segment of the uterus is a standard part of cesarean section (CS). However, it is yet to be established whether the formation of bladder flap is advantageous. Review of literature  Pelosi and Ortega in 1994 introduced a new minimally invasive technique of CS, which included the omission of bladder dissection together with other modifications. Omission of the bladder flap provides short-term benefits such as reduction of operating time and incision-delivery interval, wound infection, reduced blood loss and analgesic requirement. In addition, it is associated with good long-term outcomes with regards to adhesion formation. Conclusion  Further large-scale controlled randomized clinical trials are needed to investigate the safety of this technique with respect to in deeply engaged head, preterm, subsequent pregnancies and trial of labor and also to determine the future role of this technique that will contribute to advancement and popularity of this technique amongst obstetricians.     

Sham feed or sham? A meta-analysis of randomized clinical trials assessing the effect of gum chewing on gut function after elective colorectal surgery

Purpose  Enhanced recovery programs aim to expedite gut function after elective colorectal surgery. Early oral feeding simulates gut function but is not always feasible. Gum chewing, a form of sham feed, is an alternative. We assessed current evidence for gum chewing and gut function. Study design  All randomized controlled trials (RCTs) between 1990 and 2008 comparing gum chewing with controls/placebo were analyzed irrespective of language, blinding, or publication bias. The Jadad scale was used to assess study quality. Endpoints were time to flatus/feces, postoperative complications, and hospital stay. Random and fixed models were employed to aggregate study endpoints and assess heterogeneity. Results  Six RCTs containing 256 patients were included. Significant heterogeneity was identified and random effects model was employed. Heterogeneity may be explained through variations in delivery of surgical care. Significant reductions in the time to flatus and time to feces were identified but no significant difference in hospital or in-hospital postoperative complications were found. Conclusions  Gum chewing significantly reduced time to flatus and feces; however, hospital stay and postoperative complications were not reduced. Significant study heterogeneity means that these results should be interpreted with caution. Presentation to European Society of Coloproctology Annual Scientific Meeting Malta September 2007 Presentation to West of Scotland Surgical Association Annual Scientific Meeting October 2007     

Nasal septum perforation and bevacizumab

The use of targeted/biologic therapies is now commonplace in the treatment of malignant and non-malignant diseases. The novel mode of action of these drugs has resulted in unpredictable and in some cases unexpected side effects. Given the widespread use of bevacizumab and its distinct mode of action, it is important that oncologists report any unexpected adverse events that may be associated with the drug. Herein, we report three cases of spontaneous nasal septum perforation secondary to bevacizumab. We hypothesize an etiology for this rare event and reasons why it is reasonable to rechallenge the patient.     

Size and Composition of T-Cell Receptor δ (TCRD) Junctional Sequences Are Not Predictive of the Sensitivity of Clonospecific Oligonucleotides Designed for Detection of Minimal Residual Disease in Acute Lymphoblastic Leukemia

We characterized 168 junctional regions of T-cell receptor delta (TCRD) rearrangements from 116 children with acute lymphoblastic leukemia (ALL) (101 with precursor B-cell ALL, 15 with T-cell ALL). Application of 101 allele-specific oligonucleotide (ASO) probes representing 85 Vdelta2Ddelta3, 10 Ddelta2Ddelta3, 3 Vdelta1Jdelta1, 1 Vdelta3Jdelta1, and 2 Ddelta2Jdelta1 junctions for the detection of minimal residual disease (MRD) revealed detection levels of 10(-4) to 10(-6) leukemia cells in the vast majority of cases (93 of 101). Of interest was that neither the N, D, P (nontemplated, diversity, palindromic) content and length of the junctional regions nor the number of nucleotides deleted from the flanking V, D, or J (variable, diversity, joining) elements correlated with the sensitivity of ASO probes. These data indicated that in ALL TCRD rearrangements can serve as suitable tools for the detection of MRD irrespective of the specific composition of the junctional region.