Prompt Repair of Post Cholecystectomy Bile Duct Transection Recognized Intraoperatively and Referred Early: Experience from a Tertiary Care Teaching Unit

Postcholecystectomy bile duct injuries are a cause of significant morbidity and occasional mortality. Intraoperative recognition and repair of complete biliary transection with hepaticojejunostomy is the recommended treatment; however, it is possible only in few patients as either the injury is not recognized intraoperatively or the center is not geared up to perform an urgent hepaticojejunostomy in these patients with a nondilated duct. Retrospective analysis of data from a tertiary care referral center over a period of 10 years from January 2000 to December 2009 to report the feasibility and outcomes of prompt repair was done (defined as repair within 72 h of index operation) of postcholecystectomy bile duct injury. Ten patients of postcholecystectomy bile duct injury detected intraoperatively and referred early underwent prompt repair. All patients had a complete transection of the bile duct (type of injuries as per Strasberg classification: Type E V: 1, Type E III: 5, Type E II: 3 and Type E I: 1). The mean duration between injury and bile duct repair in the form of Roux-en-Y hepaticojejunostomy (RYHJ) was 22.7 (range 5–42) hours. The mean diameter of the anastomosis was 1.63 (range1–2.1) cm, and the anastomosis was stented in 7 patients. The mean duration of surgery was 4.6 +1.7 h. One patient developed bile leak on the first postoperative day, which settled by day 5. The mean duration of hospital stay was 5.1 (range 4–8) days. With a mean follow-up of 42 (range 24–110) months, all patients had excellent (70 %) or good outcome (30 %). Prompt RYHJ (within first 72 h) for postcholecystectomy biliary transection is an effective treatment and potentially limits the morbidity to the patient.     

Utilizing cystic plate for safe and rapid liver retraction at laparoscopic cholecystectomy: A useful technique

Nowadays, laparoscopic cholecystectomy for gallstone disease is considered not only the gold standard but an essential component of surgical training. In this regard, liver retraction plays an important role during cholecystectomy and also after specimen extraction. We describe a simple technique for liver retraction that achieves rapid, safe and steady exposure of the cystic fossa along with the subhepatic region for tackling any inadvertent bile leaks or bleeding. It is especially useful for diseased livers which are otherwise prone to iatrogenic laceration during haphazard and uncontrolled hepatic manipulation. Nonetheless, it may be easily mastered by surgical trainees, and thus reduce their learning curve.     

Appropriateness,diagnostic value,and outcomes of repeat testing following index echocardiography

Aims

Emergency admission to hospital is associated with an economic burden and mortality. Echocardiography is often the first‐line cardiovascular imaging investigation. Repeat testing is common; however, there are sparse data on the prevalence, appropriateness, or outcome of repeat testing.

Methods

We performed an electronic database search for patients with emergency admissions to our institution in February 2015. An electronic patient record review of inpatient echocardiograms was undertaken. Indications for echocardiography were classified as appropriate, may be appropriate, or rarely appropriate. One‐year follow‐up for repeat testing and mortality was investigated.

Results

A total of 409 of 2306 (17.7%) unplanned/emergency admissions underwent inpatient echocardiography. Abnormalities were identified in 165/409 (40.3%) of these patients; 154 of 409 (37.7%) had a repeat echocardiogram within the next year. Rarely appropriate indications for echocardiography occurred in 51 (33%) of repeat vs 53 (16%) of index echocardiograms, P < .0001. Repeat testing was associated with a change in findings in 17/154 (11%) patients overall. All of whom had an abnormal index echocardiogram and had an appropriate indication. There was no difference in mean survival time between patients who underwent repeat and those who only underwent a single index echocardiogram (310 days vs 327 days), P = .34.

Conclusion

Inpatient echocardiography in emergency hospital admissions identifies clinically important pathology. Repeated testing is common within 1 year of hospital admission. New diagnostic findings occurred in 11% of patients and only in patients with appropriate studies and an abnormal index echocardiogram. Identification of methods to reduce repeat testing and implement appropriateness criteria is warranted.     

Sustainable fragrance cum antimicrobial finishing on cotton: Indigenous essential oil

Fragrance finishing of textile has been enormously increased and used in domestic and industrial application. Fragrance can be synthesis chemically but available in natural and inorganic. The investigation of this research is to study the combined effect of fragrance and antimicrobial finishing on cotton fabric by lavender essential oil with the use of β-Cyclodextrin, Chitosan citrate and β-Cyclodextrin/Grafted Chitosan through pad-dry method. Fourier Transform Infrared spectroscopy (FTIR) was used to study the formation of ester bonds between β-cyclodextrin/grafted chitosan and cotton celluloses. For all the finished fabric samples fragrance release rate performance and antimicrobial properties were measure by standard test methods. The results revealed that β-CD was highly soluble in 0.6 gpl NaOH solution and 80 gpl β-CD and 6% essential lavender oil solutions were found to be a most suitable combination for fragrance and antimicrobial finishing. FTIR studies reveal about the formation of a carboxylic ester between cotton and β-Cyclodextrin/Grafted Chitosan at 1730 cm^?1 ester peak.