Management of colonoscopic perforations: A systematic review

Background

Perforation during colonoscopy is a rare but well recognized complication with significant morbidity and mortality. We aim to systematically review the currently available literature concerning care and outcomes of colonic perforation. An algorithm is created to guide the practitioner in management of this challenging clinical scenario.

Novel Technique for Defogging and Cleaning the Laparoscope Lens uring Minimally Invasive Surgery

Background

Condensation on the lens of the laparoscope resulting from differences between room temperature and intra-abdominal temperature is a disturbing problem for laparoscopic surgeons. Anti lens condensation solutions prevent fogging in the intra-abdominal environment, but are troublesome to apply to the scope. We describe a technique that allows the antifogging solution to be applied to the endoscope without removing it from the patient.

Methods

A simple technique is described for cleaning the lens with anti-fogging solution without the need to remove the laparoscope from the abdomen, using a syringe and cheap plastic sheath introduced through a laparoscopic port.

Results

The technique described is a cost-effective and time-efficient way to maintain the correct laparoscope temperature while cleaning and de-fogging the lens as required throughout laparoscopic procedures.

Conclusion

The use of a syringe and cheap plastic sheath can allow application of antifog solution to the laparoscope lens without removing it from the body cavity, overcoming the main issues associated with maintaining lens clarity during laparoscopic surgery.

     

A treatment algorithm for the management of intraoral burns: A narrative review

Oral mucosa follows a distinctly different trajectory of wound healing than skin. Although there are contemporary guidelines regarding treatment of burns to the skin, there is no standard of care specific to intraoral burns. This narrative review proposes an evidence-based treatment algorithm for the management of intraoral burns. Data was collated through a comprehensive review of the literature and only included studies that have reported particular success with favorable short- and long-term prognoses. In order to critically appraise the strength of the treatment recommendations, the GRADE criteria was applied to each arm of the algorithm. The algorithm was initially subdivided into the four primary etiologies of intraoral burns — thermogenic, cryogenic, chemical, electrical. Our findings emphasize the importance of conservative modalities of intra-oral burn treatment.     

Polar orientation of renal grafts within the proximal seal zone affects risk of early type IA endoleaks after chimney endovascular aneurysm repair

Objective

The objective of this study was to describe the polar orientation of renal chimney grafts within the proximal seal zone and to determine whether graft orientation is associated with early type IA endoleak or renal graft compression after chimney endovascular aneurysm repair (ch-EVAR).

The selective pulmonary vasodilatory effect of inhaled DETA/NO, a novel nitric oxide donor, in ARDS-a pilot human trial

OBJECTIVES: To examine the effects of inhaled NONOates in patients with acute respiratory distress syndrome (ARDS). DESIGN: Case-series, phase I clinical trial. SETTING: A multidisciplinary intensive care unit in a tertiary teaching hospital. PATIENTS: Five consecutive patients with ARDS (men; age range, 47-76 years). MEASUREMENTS: DETA/NO (150 micromol) was aerosolized into the lungs of patients on mechanical ventilation via the endotracheal tube over 20 minutes. Hemodynamic parameters were measured and blood samples were taken before, during, and after inhalation. RESULTS: Compared to baseline values, pulmonary vascular resistance decreased until the end of the study period (180 minutes) while intrapulmonary shunting decreased significantly up to 45 min after DETA/NO aerosol administration. Inhaled DETA/NO had no effect on the systemic circulation (systemic blood pressure or cardiac output). CONCLUSIONS: Inhaled DETA/NO is a selective pulmonary vasodilator in patients with ARDS. However, a larger number of patients is required to confirm the findings of this pilot study.