Laparoscopic loop ileostomy with a single-port stab incision technique

Loop ileostomy is an effective means of temporary fecal diversion. It is technically easy to create and manage. Moreover, ileostomy closure does not require a formal laparotomy. With the advent of laparoscopy, many of these loop ileostomies are being performed with laparoscopic assistance. Studies have proved the beneficial effects of laparoscopically created loop ileostomy for fecal diversion. Techniques for performing laparoscopic loop ileostomy have been described using two or more 10- to 12-mm ports with Hassan’s technique at the umbilical site for pneumoperitoneum creation. We describe a modified technique, wherein pneumoperitoneum is created using a 10-mm port at the site of the future ileostomy, and a second 5-mm port is placed under vision at the umbilical site. This procedure requires minimal intervention and a reduced pneumoperitoneum time. Since the umbilical port site is 5 mm, it does not require closure, and it also reduces the chances of port-site hernia, formation, patient discomfort and scarring. Because intervention is minimally invasive, operative time is reduced, and there is less of chance postoperative ileus and adhesion formation.     

Nucleotide sequence and genome organization of Dweet mottle virus and its relationship to members of the family Betaflexiviridae

The nucleotide sequence of Dweet mottle virus (DMV) was determined and compared to sequences of members of the families Alphaflexiviridae and Betaflexiviridae. The DMV genome has 8,747 nucleotides (nt) excluding the 3′ poly-(A) tail. DMV genomic RNA contains three putative open reading frames (ORFs) and untranslated regions of 73 nt at the 5′ and 541 nt at 3′ termini. ORF1 potentially encoding a 227.48-kDa polyprotein, which has methyltransferase, oxygenase, endopeptidase, helicase, and RNA-dependent RNA polymerase (RdRP) domains. ORF2 encodes a movement protein of 40.25 kDa, while ORF3 encodes a coat protein of 40.69 kDa. Protein database searches showed 98–99% matches of DMV ORFs with citrus leaf blotch virus (CLBV) sequences. Phylogenetic analysis based on the RdRP core domain revealed that DMV is closely related to CLBV as a member of the genus Citrivirus. DMV did not satisfy the molecular criteria for demarcation of an independent species within the genus Citrivirus, family Betaflexiviridae, and hence, DMV can be considered a CLBV isolate.     

CT arthrography: in vitro evaluation of single and dual energy for optimization of technique

The purpose of this study was to optimize CT arthrography technique and determine if dual energy CT (DECT) can provide any benefit over single energy CT (SECT). Iodinated contrast attenuation at different concentrations was measured using DECT and SECT at different beam energies (140, 120, and 80 kVp). Dose and noise were measured on phantoms at different tube currents. Three bovine femoral condyles with artificially created cartilage defects were scanned with dose-equivalent protocols. Contrast-to-noise ratio (CNR) between cartilage and iodine was measured, and the appearance of cartilage defects was graded by two readers. DECT scans were post-processed for iodine quantification. The beam energy 80 kVp had the highest iodine signal, 50% greater than DECT, 75% greater than 120 kVp, and 100% greater than 140 kVp. Noise was nearly identical for all techniques when dose was matched. The 80 kVp level had the highest CNR, 25% higher than 120 kVp and DECT, and 33% greater than 140 kVp. The 80 kVp technique was also preferred by both readers. DECT iodine quantification was significantly limited by the post-processing application, noise, and beam hardening. In this in-vitro study, the SECT 80 kVp CT arthrography technique was superior to currently performed 120 and 140 kVP SECT techniques and DECT.     

Diagnostic yield of third eye retroscope on adenoma detection during colonoscopy:A systematic review and meta-analysis

AIM: To determine the diagnostic yield of the "third eye retroscope",on adenoma detection rate during screening colonoscopy.METHODS: The "third eye retroscope" when used with standard colonoscopy provides an additional retrograde view to visualize lesions on the proximal aspects of folds and flexures.We searched MEDLINE(Pub Med and Ovid),SCOPUS(including MEDLINE and EMBASE databases),Cochrane Database of Systemic Reviews,Google Scholar,and CINAHL Plus databases to identify studies that evaluated diagnostic yield of "third eye retroscope" during screening colonoscopy.Der Simonian Laird random effects model was used to generate the overall effect for each outcome.We evaluated statistical heterogeneity among the studies by using the Cochran Q statistic and quantified by I2 statistics.RESULTS: Four distinct studies with a total of 920 patients,mean age 59.83(95%CI: 56.77-62.83) years,were included in the review.The additional adenoma detection rate(AADR) defined as the number of additional adenomas identified due to "third eye retroscope" device in comparison to standard colonoscopy alone was 19.9%(95%CI: 7.3-43.9).AADR for right and left colon were 13.9%(95%CI: 9.4-20) and 10.7(95%CI: 1.9-42),respectively.AADR for polyps ≥ 6 mm and ≥ 10 mm were 24.6%(95%CI: 16.6-34.9) and 24.2%(95%CI: 12.9-40.8),respectively.The additional polyp detection rate defined as the number of additional polyps identified due to "third eye retroscope" device in comparison to standard colonoscopy alone was 19.8%(95%CI: 7.9-41.8).There were no complications reported with use of "third eye retroscope" device.CONCLUSION: The "third eye retroscope" device when used with standard colonoscopy is safe and detects 19.9% additional adenomas,compared to standard colonoscopy alone.     

Osteoradionecrosis of the mandible and mastoiditis after radiotherapy for parotid mucoepidermoid carcinoma

Osteoradionecrosis of the mandible in conjunction with mastoiditis is an extremely rare occurrence following irradiation of salivary gland malignancy in the orofacial region. We report one such case of a patient who presented to us with trismus, jaw pain, and ear discharge. Imaging of the jaws revealed classical features of osteoradionecrosis and mastoiditis. This case is important because presenting features like trismus and dental infection led us to investigative procedures that revealed extensive bone involvement including mastoiditis. Trismus progressively increased over a period of 8 years. In this case, we would like to emphasize the importance of good oral hygiene in the postradiotherapy stage for head and neck cancer.     

MRI appearance of surgically proven abnormal accessory anterior–inferior tibiofibular ligament (Bassett’s ligament)

Objective A thickened accessory anterior–inferior tibiofibular ligament (Bassett’s ligament) of the ankle can be a cause of ankle impingement. Its imaging appearance is not well described. The purpose of this study was to determine if the ligament could be identified on magnetic resonance imaging (MRI), to determine associated abnormalities, and to determine if MRI could be used to differentiate normal from abnormal. Materials and methods Eighteen patients with a preoperative ankle MRI and an abnormal Bassett’s ligament reported at surgery were found retrospectively. A separate cohort of 18 patients was selected as a control population. The presence of Bassett’s ligament and its thickness were noted. The integrity and appearance of the lateral ankle ligaments, talar dome cartilage, and anterolateral gutter were also noted. Results In 34 of the 36 cases (94%), Bassett’s ligament was identified on MRI. The ligament was seen in all three imaging planes and most frequently in the axial plane. The mean thickness of the ligament in the surgically abnormal cases was 2.37 mm, compared with 1.87 mm in the control with a p value = 0.015 (t test). Nine of the 18 abnormal cases (50%) had talar dome cartilage lesions as a result of contact with the ligament at surgery, with only 3 cases of high-grade defects seen on MRI. Fourteen of the 18 abnormal cases (78%) had of synovitis or scarring in the lateral gutter at surgery, with only 5 cases with scarring seen on MRI. The anterior–inferior tibiofibular ligament was abnormal or torn in 8 of the 18 abnormal cases (44%) by MRI and confirmed in only 3 cases at surgery. Discussion Bassett’s ligament can be routinely identified on MRI and was significantly thicker in patients who had it resected at surgery. An abnormal Bassett’s ligament is often present in the setting of a normal anterior–inferior tibiofibular ligament. The cartilage abnormalities and synovitis associated with an abnormal Bassett’s ligament are poorly detected by conventional MRI.     

Growth-inhibitory effects of a mineralized extract from the red marine algae, Lithothamnion calcareum, on Ca-sensitive and Ca-resistant human colon carcinoma cells

Proliferation and differentiation were assessed in a series of human colon carcinoma cell lines in response to a mineral-rich extract derived from the red marine algae, Lithothamnion calcareum. The extract contains 12% Ca²⁺, 1% Mg²⁺, and detectable amounts of 72 trace elements, but essentially no organic material. The red algae extract was as effective as inorganic Ca²⁺ alone in suppressing growth and inducing differentiation of colon carcinoma cells that are responsive to a physiological level of extracellular Ca²⁺ (1.4 mM). However, with cells that are resistant to Ca²⁺ alone, the extract was still able to reduce proliferation and stimulate differentiation.