Topical gentamicin does not provide any additional anastomotic strength when combined with fibrin glue

Background

We evaluated the effect of a combination of fibrin sealant and topical gentamicin on a colonic anastomosis in a rat model.

Methods

Partial anastomosis in the transverse colon was performed in 70 male Sprague–Dawley rats aged 6 to 10 weeks using 5 interrupted sutures. The rats were divided into 4 groups (control, gentamicin, fibrin glue, and combination). On postoperative days 3 and 5, the rats in each group were killed, anastomotic bursting pressures scores and bowel loop adhesions were determined, and histologic examination was performed.

Results

No significant difference was noted in the bursting pressures, adhesions, inflammatory infiltrates, fibroblasts, or neoangiogenesis between the fibrin-glue only and the combination groups for both the day 3 and day 5 subgroups.

Conclusions

The combination of topical gentamicin and fibrin glue had little effect because the combination did not provide additional anastomotic strength or decrease the number of adhesions when compared with fibrin glue alone.     

Minimally invasive training during surgical residency

The field of postgraduate minimally invasive surgery training has undergone substantial growth and change. A survey was sent to all program directors in surgery. Minimally invasive training patterns, facilities, their views, and performance of residents were examined. Ninety-five directors (38%) responded to the questionnaire. Of these, 51 per cent (n = 48) had a program size of three to four residents and 33 per cent (n = 31) had a program size of five to six residents. In 3 per cent of programs (n = 3), residents could not achieve the minimum Accreditation Council for Graduate Medical Education required numbers for advanced laparoscopic cases. Only 47 per cent of programs (n = 45) had dedicated rotations in minimally invasive surgery, ranging from 2 to 11 months. Up to 10 per cent (n = 9) of program directors felt that the current training in minimally invasive surgery was insufficient. Fifty-five per cent (n = 52) felt that laparoscopic adhesiolysis was an advanced laparoscopic procedure, and 33 per cent (n = 31) felt that there should be a separate minimum requirement for each of the commonly performed basic and advanced laparoscopic cases by Accreditation Council for Graduate Medical Education. Fifty-six per cent (n = 53) of programs were performing robotic surgery. Minimally invasive surgery training for surgical residents needs to increase opportunities so that they are able to perform laparoscopic procedures with confidence. There should be specific number requirements in each category of individual basic and advanced laparoscopic procedures.     

Hydatid disease presenting as cutaneous fistula: review of a rare clinical presentation

Hydatid disease has a worldwide distribution as a result of more global travel. Liver and lungs are the most common sites for the primary hydatid cysts in the human body. We managed a 68-year-old man who presented with abdominal distension and umbilical fistula, discharging daughter cysts. Ultrasound imaging of the abdomen showed hepatic hydatid cyst forming a fistula at the umbilicus. The patient underwent a laparotomy with partial cystectomy and excision of the fistula tract. The umbilicus healed after the procedure. The patient did not have any recurrences in 5 years of follow-up. Spontaneous cutaneous fistulization of liver hydatid cyst is a rare presentation. A detailed literature search revealed 15 cases published in all languages. Hydatid disease presenting as an umbilical fistula has not been reported yet. We summarize all these cases including the presentation, findings, management, and outcome. Combined surgical and medical treatment is successful in healing of hepatic hydatid cutaneous fistula.     

Incidental biliary dilation in the era of the opiate epidemic: High prevalence of biliary dilation in opiate users evaluated in the Emergency Department

BACKGROUNDBiliary dilation is frequently related to obstruction; however, non-obstructive factors such as age and previous cholecystectomy have also been reported. In the past two decades there has been a dramatic increase in opiate use/dependence and utilization of cross-sectional abdominal imaging, with increased detection of biliary dilation, particularly in patients who use opiates.AIMTo evaluate associations between opiate use, age, cholecystectomy status, ethnicity, gender, and body mass index utilizing our institution’s integrated informatics platform. METHODSOne thousand six hundred and eighty-five patients (20% sample) presenting to our Emergency Department for all causes over a 5-year period (2011-2016) who had undergone cross-sectional abdominal imaging and had normal total bilirubin were included and analyzed.RESULTSCommon bile duct (CBD) diameter was significantly higher in opiate users compared to non-opiate users (8.67 mm vs 7.24 mm, P < 0.001) and in patients with a history of cholecystectomy compared to those with an intact gallbladder (8.98 vs 6.72, P < 0.001). For patients with an intact gallbladder who did not use opiates (n = 432), increasing age did not predict CBD diameter (r² = 0.159, P = 0.873). Height weakly predicted CBD diameter (r² = 0.561, P = 0.018), but weight, body mass index, ethnicity and gender did not.CONCLUSIONOpiate use and a history of cholecystectomy are associated with CBD dilation in the absence of an obstructive process. Age alone is not associated with increased CBD diameter. These findings suggest that factors such as opiate use and history of cholecystectomy may underlie the previously-reported association of advancing age with increased CBD diameter. Further prospective study is warranted.     

Tonsillar lymphangiomatous polyp — a case report

Tumors which are benign in origin in palatine tonsils are not uncommon. They may create anxiety in patients and pose difficulty in differentiating from malignancy. We report a case of tonsillar polyp of lymphangiomatous origin.     

Evaluation of anti-inflammatory activity of chloroform extract of Bryonia laciniosa in experimental animal models

The anti-inflammatory effect of the leaves of Bryonia laciniosa was evaluated using carrageenan, dextran, histamine, serotonin induced rat paw oedema and cotton pellet induced granuloma (chronic) models in rats. In mice, carrageenan peritonitis test was performed for the extract by oral administration. The chloroform extract of Bryonia laciniosa (CEBL) exhibited significant anti-inflammatory effect at the dose 50, 100 and 200 mg/kg. Maximum inhibition (52.4%) was noted at the dose of 200 mg/kg after 3 h of drug treatment in carrageenan induced paw oedema, whereas the indomethacin (standard drug) produced 62.1% of inhibition. The extract exhibited significant anti-inflammatory activity in dextran induced paw oedema in a dose dependent manner. The extract also exhibited significant inhibition on the hind paw oedema in rats caused by histamine and serotonin respectively. In the chronic model (cotton pellet induced granuloma) the CEBL (200 mg/kg) and standard drug showed decreased formation of granuloma tissue by 50.1 and 57.3% (p<0.001) respectively. The extract also inhibited peritoneal leukocyte migration in mice. Thus, the present study revealed that the chloroform extract of Bryonia laciniosa exhibited significant anti-inflammatory activity in the tested models.