Comparative study of outcomes following laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese patients: A case control study

AIM To compare the impact of laparoscopic Roux-en-Y gastric bypass(LRYGB) and laparoscopic sleeve gastrectomy(LSG) on weight loss and obesity related comorbidities over two year follow-up via case control study design.METHODS Forty patients undergoing LRYGB, who completed their two year follow-up were matched with 40 patients undergoing LSG for age, gender, body mass index and presence of type 2 diabetes mellitus(T2DM). Data of these patients was retrospectively reviewed to compare the outcome in terms of weight loss and improvement in comorbidities, i.e., T2 DM, hypertension(HTN), obstructive sleep apnea syndrome(OSAS), hypothyroidism and gastroesophageal reflux disease(GERD).RESULTS Percentage excess weight loss(EWL%) was similar in LRYGB and LSG groups at one year follow-up(70.5% vs 66.5%, P = 0.36) while it was significantly greater for LRYGB group after two years as compared to LSG group(76.5% vs 67.9%, P = 0.04). The complication rate after LRYGB and LSG was similar(10% vs 7.5%,P = 0.99). The median duration of T2 DM and mean number of oral hypoglycemic agents were higher in LRYGB group than LSG group(7 years vs 5 years and 2.2 vs 1.8 respectively, P < 0.05). Both LRYGB and LSG had significant but similar improvement in T2 DM, HTN, OSAS and hypothyroidism. However, GERD resolved in all patients undergoing LRYGB while it resolved in only 50% cases with LSG. Eight point three percent patients developed new-onset GERD after LSG.CONCLUSION LRYGB has better outcomes in terms of weight loss two years after surgery as compared to LSG. The impact of LRYGB and LSG on T2 DM, HTN, OSAS and hypothyroidism is similar. However, LRYGB has significant resolution of GERD as compared to LSG.

A Prospective Study of Factors Influencing Wound Dehiscence after Midline Laparotomy

Aim: To evaluate the factors influencing fascial wound dehiscence after midline laparotomy in the patients of perforation peritonitis with an emphasis on measurement of “intra-abdominal” pressure (IAP) and fascial transforming growth factor-beta (TGF-beta). Methods: Hundred eligible adult patients with the diagnosis of perforation peritonitis who underwent emergency exploratory laparotomy were prospectively recruited. Forty five patients who developed midline abdominal wound dehiscence were compared with 55 patients without dehiscence. Results: The variables that were significantly associated with wound dehiscence include anemia, hypo proteinemia, duration of surgery, prolonged postoperative ileus, wound infection and postoperative pulmonary infection. Age, gender, jaundice, cause of peritonitis, wound contamination and types of surgery were non significant variables. The mean IAP value in the patients with dehiscence was significantly higher than “non-dehiscence” group (p = 0.000). The patients with wound dehiscence strongly expressed TGF-beta on the day of burst. Conclusion: The patients of peritonitis undergoing prolonged surgery in the presence of risk factors like anemia, hypo proteinemia, postoperative ileus, wound infection and postoperative pulmonary infection have high risk of abdominal wound dehiscence.

Catamnestic Observation of Premature Newborns with Nervous System Injury in the Kyrgyz Republic

Background: Recently, among child disability disorders nervous system diseases are prevailing 19.5%, while mental disorders are 14.3% and congenital malformations 21%. In most cases, children’s neurological disability is associated with pathology during the perinatal period, while 24% of patients have a cerebral impairment. Premature newborns perished 30 to 35 times more often than in-time newborns, and perinatal mortality in case of premature pregnancies is 30 to 40 times higher than in term delivery. Aim: This article is studying catamnestic observation of premature newborns with nervous system injury and with perinatal pathology in Kyrgyzstan for the period 2020-2021. Preterm newborns’ anthropometric characteristics and main diagnoses associated with diseases in the gestational period were shown. Methods: A comprehensive clinical and laboratory examination including premature newborns health dynamic monitoring with gestational age from 28 to 36 weeks, who were treated in the neonatal pathology department of the Regional Maternity Hospital in Osh for the period from 2020-2021 were carried out. Literature review analysis from PubMed database, MEDLINE, EMBASE, Science Direct, Google Scholar, and clinical trials performed. Results: after clinical examination, it was revealed that pregnancy and childbirth in all mothers of the studied group passed with complications. In mothers of the studying group, the most common pathologies during pregnancy were chronic fetal hypoxia 49 (58.4%), acute respiratory infections 28 (33.4%), the threat of termination of pregnancy 20 (23.9%), preeclampsia 16 (19.11%), sexually transmitted infections 9 (10.8%), pyelonephritis 14 (16.7%), polyhydramnios 9 (10.8%), 71 children (84.6%) were born with asphyxiation and 25 children extracted by cesarean section with varying degrees of severity. Conclusions: Depending on the severity of the perinatal lesion of the nervous system and pathological factor effects, it is very important to start early habilitation measures with preterm newborns who are at risk of developmental delay deviations, and to exit disabling disorders.

Palliative Senning Procedure: Management of dTGA with VSD and PVOD in an Adolescent

Patients with D-TGA with atrial level mixing of systemic and pulmonary blood, the morphological left ventricle supports the low pressure pulmonary circulation and regresses in mass and volume as time passes. The LV once regressed is unable to support the high pressure systemic circulation after ASO. These patients are candidates for early ASO, preferably within 3 weeks of life. As age progresses, the scope of these surgical procedures skews and an atrial switch remains the only option to improve quality of life. In Atrial switch, the pulmonary and systemic circulation is returned into an “in series” circulation and cyanosis is obliterated.

Anesthetic Treatment in Operations of Small Pelvic Organs Pathology

The article presents data on the surgical treatment of 405 patients with pelvic organ surgical and gynecological diseases. When using regional anesthesia during operations in the lower abdominal cavity of patients with pelvic pathology, a smoother operation course and early postoperative period were observed compared with general anesthesia use. In this work, 405 patients with surgical and gynecological diseases of pelvic organs, operated in the surgical and gynecological departments were analyzed. When using regional anesthesia, it was observed that intraoperative blood loss in patients and consumption of narcotic analgesics in the postoperative period decreases.

Development of Blood Donation Activities in Kyrgyzstan and General Implications for Blood Donation

Objectives: This article is aiming to give an essential informative principle about the development of blood donation activities in Kyrgyzstan. Background: The sequence of blood donation procedure steps before donation, during donation, and after donation was shown and discussed. Methods/Materials: Rhesus factor determination in donors was achieved by “COLICO” method which is based on the use of monoclonal antibodies solution. Results: According to the blood donation activity of donors in Osh, Kyrgyzstan for the 2018 year, it was found that gratuitous donors who donated blood in 6 months were 269, in 9 months were 366, and in 1 year were 499 people. Relative donors who donated blood in 6 months were 3480, in 9 months were 5100, and in 1 year were 6701 people. Active donors donated blood in 6 months were 12, in 9 months were 14 and in 1 year were 17 people. Conclusion: No agglutination was observed in any of the plates for the first blood group;agglutination was observed with anti-A monoclonal antibody solution for the second blood group;agglutination was observed with anti-B monoclonal antibody solution for the third blood group;agglutination was observed with both of anti-A and anti-B monoclonal antibody solutions for the fourth blood group.

Multi-modality parathyroid imaging:A shifting paradigm

The goal of parathyroid imaging in hyperparathyroidism is not diagnosis,rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach.Hence,the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration.The common causes include solitary parathyroid adenoma,multiple parathyroid adenomas,parathyroid hyperplasia and parathyroid carcinoma.It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging.The various imaging modalities available include high resolution ultrasound of the neck,nuclear imaging studies,four-dimensional computed tomography(4D CT)and magnetic resonance imaging.Contrast enhanced ultrasound is a novel technique which has been recently added to the armam-entarium to differentiate between parathyroid adenomas and its mimics.Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.

Overview of perspectives on cancer,newer therapies,and future directions

Theword“cancer”is associated with terrifying situations,and there is often an aggressive intent to cure.Uncertainty about survival and fear of disfigurement cause major turmoil in the minds of patients and relatives.Teamwork with multimodal care is the key to achieving satisfactory outcomes.Advanced imaging modalities have aided in early detection and derivation of optimal treatment plans.Although radical excision of tumors with neoadjuvant or concurrent chemotherapy/radiotherapy has long been the best management option,we have moved froma radical to a conservative approach.In advanced disease,the plan should be to provide supportive care and improve quality of life.Compassion and counseling play important roles.Nutritional support for correcting cancer cachexia is equally important during tumor excision.Newer therapies such as targeted therapy,stem cell therapy,and chemodynamic therapy are all focused on ensuring safe and efficient outcomes;however,the war against cancer continues to oscillate between hope and despair.

International expert consensus on laparoscopic pancreaticoduodenectomy

Importance:While laparoscopic pancreaticoduodenectomy(LPD)is being adopted with increasing enthusiasm worldwide,it is still challenging for both technical and anatomical reasons.Currently,there is no consensus on the technical standards for LPD.Objective:The aim of this consensus statement is to guide the continued safe progression and adoption of LPD.Evidence Review:An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreaticoduodenectomy.Statements were produced upon reviewing the literature and assessed by the members of the expert panel.The literature search and its critical appraisal were limited to articles published in English during the period from 1994 to 2019.The Web of Science,Medline,and Cochrane Library and Clinical Trials databases were searched,The search strategy included,but was not limited to,the terms'laparoscopic','pancreaticoduodenectomy,'pancreatoduodenectomy','Whipple's operation',and'minimally invasive surgery'.Reference lists from the included articles were manually checked for any additional studies,which were included when appropriate.Delphi method was used to establish expert consensus and the AGREE II-GRS Instrument was applied to assess the methodological quality and externally validate the final statements.The statements were further discussed during a one-day face-to-face meeting at the 1st Summit on Minimally Invasive Pancreatico-Biliary Surgery in Wuhan,China.Findings:Twenty-eight international experts from 8 countries constructed the expert panel.Sixteen statements were produced by the members of the expert panel.At least 80%of responders agreed with the majority(80%)of statements.Other than three randomized controlled trials published to date,most evidences were based on level 3 or 4 studies according to the AGREE II-GRS Instrument.Conclusions and Relevance:The Wuhan international expert consensus meeting on LPD has produced a set of clinical practice statements for the safe development and progression of LPD.LPD is currently in its development and exploration stages,as defined by the international IDEAL framework for surgical innovation.More robust randomized controlled trial and registry study are essential to proceed with the assessment of LPD.

Innocuous cardiac gunshot that proved fatal： A bitter lesson learned

有保留的 intra 心囊的外国身体的血液动力学地正常的病人的管理仍然是一件事推测。可得到的文学支持如此的无害的外国身体的非起作用的管理。我们从火器损害与一个保留的 intra 心囊的小团报导我们一个血液动力学地正常的病人的经验。他开始收到了成功的非起作用的管理，但是开发了致命的 hemopericardium 在损害以后的 21 天。在这份报纸，我们考虑到可得到的文学在如此的损害的管理讨论了陷井并且总结了临床的经验。