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991.
Gaurav Tyagi Utsav Gupta Ankit Verma Dhananjay Saxena Atul Mittal Amit Goyal Jeevan Kankaria R.K. Jenaw 《International journal of surgery case reports》2014,5(10):717-719
INTRODUCTION
Ileal pouch anal anastomosis (IPAA) after total proctocolectomy is a frequently performed surgery for medically refractory ulcerative colitis (UC). Volvulus of the ileal pouch as a complication of IPAA is extremely rare. We present a case of volvulus of S-type ileal pouch.PRESENTATION OF CASE
A 28 year old male, with history of total proctocolectomy with IPAA for severe UC in 2009 presented with signs of bowel obstruction. Emergency laparotomy was done and a volvulus of the S-type ileal pouch was derotated and pouchpexy done.DISCUSSION
The IPAA has a wide spectrum of complications, with obstruction of proximal small bowel occurring frequently. Volvulus of the ileal pouch is extremely rare with only 3 reported cases. Early diagnosis and intervention is important to salvage the pouch. Computed tomography (CT) may aid the diagnosis in stable patients.CONCLUSION
The diagnosis of ileal pouch volvulus although rare, should be kept in mind when dealing with patients complaining of recurrent obstruction following IPAA. 相似文献992.
Pushpendra Sarwa Ranbir Singh Dahiya Nityasha Samir Anand Chandrabhan Sekhar Gogna Deepanshu Gupta Bhavinder Arora 《International journal of surgery case reports》2014,5(9):617-619
INTRODUCTION
Accidental and unnoticed ingestion of foreign bodies are not very uncommon. Most of such foreign bodies pass through gastrointestinal tract uneventfully and only on rare instances cause obstruction and/or perforation.PRESENTATION OF CASE
We are reporting a case in which a 45 yr old male presented to accident and emergency department of our institute with complaints of pain abdomen, greenish vomiting, abdominal distension, fever and non passage of flatus and stool following alcoholic binge 15 days back. On presentation tachycardia, hypotension, generalised abdominal tenderness and guarding were present. After initial resuscitation and investigation diagnosis of perforation peritonitis was made and emergency exploratory lapratomy was done and a single perforation with plastic foreign body protruding through it was found in jejunum 5 cm distal to duodeno-jejunal junction.DISCUSSION
The majority of ingested FBs that reach the stomach pass uneventfully through the gastrointestinal tract. The majority of cases occur in children. Only 1% of patient of patients requires surgical intervention depending upon nature, size and shape of the foreign body.CONCLUSION
Present case report intends to draw the attention towards possibility of intestinal obstruction and perforation by a single plastic foreign body. High index of suspicion is needed as this foreign body is not even radio-opaque and cannot be picked up in X-ray investigations. Also with increasing use of such plastic materials there are increased chances of such incidents. 相似文献993.
994.
Win Brown Nel Druce Julia Bunting Scott Radloff Desmond Koroma Srishti Gupta Brian Siems Monica Kerrigan Dan Kress Gary L. Darmstadt 《Studies in family planning》2014,45(1):73-84
This report describes the purpose for developing a quantitative goal for the London Summit on Family Planning held in July 2012, the methodology behind its formulation, and the lessons learned in the process. The London Summit has evolved into the global initiative known as FP2020, and the goal has become “120 by 20,” or reaching 120 million additional users of modern contraceptive methods by 2020 in the world's poorest countries. The success of FP2020 will first be evaluated on the basis of quantitative verification to determine that the “120 by 20” goal was reached. More important, however, is the extent to which the goal today serves as a global rallying cry to mobilize resources and leadership around current family planning programs, with a focus on voluntary family planning and quality of care, and with an emphasis on meeting girls' and women's unmet needs and their right to practice contraception. We hope this article provides greater transparency and understanding of the FP2020 goal, and that the global goal spurs annual monitoring of progress toward national goals in the world's poorest countries. 相似文献
995.
Rachel Pruchno Maureen Wilson-Genderson Adarsh K. Gupta 《American journal of public health》2014,104(5):924-929
Objectives. We tested hypotheses about the relationship between neighborhood-level food sources and obesity, controlling for individual-level characteristics.Methods. Data (collected November 2006–April 2008) derived from a random-digit-dial sample of 5688 community-dwelling adults aged 50 to 74 years residing in 1644 census tracts in New Jersey. Using multilevel structural equation models, we created latent constructs representing density of fast-food establishments and storefronts (convenience stores, bars and pubs, grocery stores) and an observed indicator for supermarkets at the neighborhood level, simultaneously modeling obesity and demographic characteristics (age, gender, race, education, household income) at the individual level.Results. When we controlled for individual-level age, gender, race, education, and household income, densities of fast-food establishments and storefronts were positively associated with obesity. Supermarkets were not associated with obesity.Conclusions. Because people living in neighborhoods with a higher density of fast food and storefronts are more likely to be obese, these neighborhoods may be optimal sites for interventions.Rates of obesity increased more than 100% between the 1970s and 2008.1 Although rates have leveled off since 2003and 2004,2 today more than a third of the US population is obese, and estimates indicate that by 2030 between 42% and 51% of the population will be obese.3 People aged 45 to 64 years are more likely to be obese than are those in any other age group.4 If obesity trends continue at their current rate, disability rates among persons aged 50 to 69 years are projected to increase by 1% per year through 2020.5 Because of the relationships between obesity, poor health, and high medical expenditures, obesity is a greater threat to public health than either smoking or drinking.6Trends in obesity rates are most likely the result of changing environmental factors, including agriculture, food processing and marketing, transportation, and physical demands of work. Because the characteristics of the neighborhoods in which people live can make it easier for them to consume excessive calories and more difficult to expend those calories,7 it is likely that there is an association between obesity and the neighborhoods in which people live. Yet since most existing studies of the relationship between neighborhoods and obesity among older adults focus on the socioeconomic characteristics of neighborhoods8–14 rather than the neighborhood food environment, we lack understanding of how specific characteristics of the neighborhood food environment influence obesity.The analyses that follow examine the extent to which the local food environment is related to obesity among older adults, controlling for individual characteristics with known associations to obesity, including age, gender, socioeconomic status, and race.Evidence regarding the extent to which the neighborhood food environment is associated with obesity in the adult population is conflicting, with some studies showing a positive association15–19 and others finding that proximity to fast-food restaurants is not associated with body mass index (BMI).20–23 Similarly, although some studies found that proximity to supermarkets decreased the risk of obesity,18,19,21,24 others found that supermarkets were not associated with BMI.22,23Although few studies have examined the effects of neighborhood environment and obesity on older people, Yen et al.25 suggest that obesity among older adults may be even more strongly influenced by neighborhood characteristics than is the case for school-aged children and younger adults. Like studies of adults in general, studies linking characteristics of neighborhood food environments and obesity in older people yield conflicting findings. Hanibuchi et al.26 found that better access to supermarkets, fast-food outlets, and convenience stores was positively associated with obesity among older people in Japan, whereas Morland et al.27 found that the presence of supermarkets was associated with a lower prevalence of obesity and that the presence of convenience stores was associated with a higher prevalence of obesity in a large community-dwelling sample of Americans.Rundle et al.24 suggest that because density measures for food sources such as supermarkets, convenience stores, and fast-food restaurants are correlated with each other, their associations with obesity may be difficult to disentangle. Moreover, because not all studies examine these neighborhood food sources in tandem with one another, findings across studies are difficult to compare. Further adding to the complexity of this issue, most studies do not simultaneously adjust for the inherent nesting of people in neighborhoods and measurement error.We investigated the relationship between obesity and the local food environment among older adults. We tested the following hypotheses depicted in Figure 1: (1) when age, gender, income, education, and race are controlled for, people living in neighborhoods with more fast-food restaurants and storefronts (small grocery stores, convenience stores, and bars) are more likely to be obese than people living in neighborhoods with fewer of these amenities; and (2) when these same individual-level variables are controlled for, people living in neighborhoods with greater availability of supermarkets will have lower rates of obesity than those living in neighborhoods where supermarkets are less prevalent.Open in a separate windowFIGURE 1—Multilevel structural equation models of individual-level obesity with (a) characteristics at the individual (within) level and (b) food sources at the neighborhood (between) level: Ongoing Research on Aging in New Jersey: Bettering Opportunities for Wellness in Life (ORANJ BOWL), 2006–2008.Note. NS = not significant. The 2 arrows pointing to Obesity are indicators for the measurement error associated with the observed variable. 相似文献
996.
997.
Pawan Agarwal Shivkant Gupta Prashant Yadav D. Sharma 《Indian Journal of Plastic Surgery》2014,47(1):95-101
Background:
Awareness of anatomical variations of the median nerve at wrist is important in repair of traumatic injuries and treatments of compression syndrome because in these situations precise dissection of the nerve is mandatory and such variations are not infrequent.Materials and Methods:
In this study, 52 hands of 52 fresh cadavers were dissected and median nerve anatomy along with the presence of persistent median artery (PMA) was noted.Results:
A total of 26 hands (50%) had the deviation from the standard text book anatomy of the median nerve. There was early division of the median nerve into the medial and lateral branches in 11.53% hands. There was early branching of the 2nd common digital nerve in 9.6% hands. The transligamentous motor branch to the thenar muscle was most prevalent (42.3% hands). The single motor branch to the thenar muscles was found in the majority of hands (84.6%). The PMA was present in 11.53% hands and it was associated with variations in the median nerve anatomy in all cases.Conclusions:
This study shows a high percentage of deviation from standard anatomy as well as a high percentage of transligamentous thenar muscle motor branch. The presence of PMA was associated with variations in the median nerve anatomy in all cases. Therefore if PMA is present there are very high chances of associated median nerve anomalies.KEY WORDS: Anatomical variations, cadaveric study, median nerve, persistent median artery, wrist 相似文献998.
Gaurav Gupta Sachin Kumar Sangeeta Gupta K. B. Golhar Swapnil Deshpande 《The Indian journal of surgery》2014,76(4):319-320
Case Report
We report a case of 4-day-old male infant who developed rapid abdominal distension with progression to shock. Abdominal radiography showed free gas under diaphragm for which emergency laparotomy was done revealing a perforation in the greater curvature of the stomach that was sutured after excising surrounding ischemic stomach wall. 相似文献999.
1000.
Various methods have been described in the literature for earlobe reconstruction in one or many stages. Authors describe here a simple, single-stage technique to reconstruct the loss of the earlobe. The technique is clearly illustrated in a step-by-step manner and produces a natural-looking earlobe without an unpleasant secondary deformity with desirable texture and color match. Level of Evidence: Level IV, therapeutic study. 相似文献