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Duong Trieu Trieu, Quoc Van Le, Hien Van Nguyen Department of Colon and Rectal Surgery, The 108 Military Central Hospital, Hanoi, VietnamCorrespondence: Quoc Van LeDepartment of Colon and Rectal Surgery, The 108 Military Central Hospital, No. 1 Tran Hung Dao Street, Bach Dang Ward, Hai Ba Trung District, Hanoi 100000, VietnamTel +84979966103Email levanquoch108@gmail.comAbstract: An internal hernia is the protrusion of visceral contents through a congenital or acquired defect in the peritoneum or mesentery within the abdominal cavity. In approximately 0.6– 5.8% of patients with small intestinal obstruction, the cause is internal hernia, with paraduodenal hernias accounting for approximately 40% of cases. Here, we present the case of a 51-year-old man diagnosed with obstruction of the small intestine caused by a hernia on the left side of the duodenum. The treatment involved returning the bowel loops to the normal position and closing the hernia pocket using Prolene 2.0 sutures. The duration of the surgery was 30 min. Five days later, the patient's condition was stable and he was discharged from the hospital; at the 32-month postoperative follow-up, he remained in stable condition with no recurrence. An abdominal computed tomography scan is valuable for early diagnosis of paraduodenal hernia in the absence of complications, and the cause can be identified and the bowel returned to the normal position by endoscopic surgery, with closure of the hernia pocket if the intestine does not stick to the pocket.Keywords: open surgery, paraduodenal hernia, internal hernia, intestinal obstruction

BackgroundIn 2005, the Ministry of Health in association with the Faculty of Medicine of Niamey decided to launch surgery at the district hospital (DH) level as part of the health strategy for the country. Surgical procedures were provided by general practitioners who received 12 months of training in basic surgery.MethodsWhereas the initiative was launched nationwide, we chose randomly to study the region of Dosso during a 1-year time period of January 2007 to December 2007 in the three district hospitals as well as the regional hospital of Dosso.ResultsDuring the course of 1 year, 544 patients received operations in the three DHs, of which 37.9% (n = 206) were emergent and 62.1% (n = 338) were elective. The most common emergent interventions were cesarean sections (70%) and uterine ruptures (7.8%). For elective surgeries, hernia repairs comprised 80.8% of the cases. The mortality rate of emergent surgeries was 7.3 and 0% in the cases of elective surgeries. Of note, there was a large reduction in transfers to the regional hospital: 52% compared to 2006 and 82% compared to 2005. In 66.1% of the transfers, the cases consisted of fractures, and in 10.4% of abdominal trauma and critical thoracic emergencies. Further study of this initiative has highlighted other challenges, including that of human resources, equipment maintenance, provision of consumables, and the need for continued training.ConclusionsResults from this governmental initiative to provide surgery in rural district hospitals by general practitioners are promising and encouraging. In the rural district of Dosso, there have been no deaths from elective surgery, and the number of surgical transfers to the regional hospital has drastically diminished.

Considering the growing organ demand worldwide, it is crucial to optimize organ retrieval and training of surgeons to reduce the risk of injury during the procedure and increase the quality of organs to be transplanted. In the Netherlands, a national complete trajectory from training of surgeons in procurement surgery to the quality assessment of the procured organs was implemented in 2010. This mandatory trajectory comprises training and certification modules: E-learning, training on the job, and a practical session. Thanks to the ACCORD (Achieving Comprehensive Coordination in Organ Donation) Joint Action coordinated by Spain and co-funded under the European Commission Health Programme, 3 twinning activities (led by France) were set to exchange best practices between countries. The Dutch trajectory is being adapted and implemented in Hungary as one of these twinning activities. The E-leaming platform was modified, tested by a panel of Hungarian and UK surgeons, and was awarded in July 2013 by the European Accreditation Council for Continuing Medical Education of the European Union of Medical Specialists. As a pilot phase for future national training, 6 Hungarian surgeons from Semmelweis University are being trained; E-learning platform was fulfilled, and practical sessions, training-on-the-job activities, and evaluations of technical skills are ongoing. The first national practical session was recently organized in Budapest, and the new series of nationwide selected candidates completed the E-learning platform before the practical. There is great potential for sharing best practices and for direct transfer of expertise at the European level, and especially to export this standardized training in organ retrieval to other European countries and even broader. The final goal was to not only provide a national training to all countries lacking such a program but also to improve the quality and safety criteria of organs to be transplanted.

AbstractBrucellosis is a frequent zoonosis in some regions of the world and may cause various symptoms. Neurobrucellosis is a rare but serious complication of the infection. Our case report describes the course of neurobrucellosis in a patient who had received a ventriculoperitoneal shunt in his native country 13 years prior to diagnosis of brucellosis. He initially presented to us with symptoms of peritonitis, which misled us to perform abdominal surgery first. After the diagnosis of neurobrucellosis was confirmed and appropriate antibiotics were initiated, the symptoms soon disappeared. Although the ventriculoperitoneal shunt was subsequently removed, the patient did not develop a symptomatic hydrocephalus further on. This case displays the challenges in diagnosing an infection that occurred sporadically in Europe and may be missed by currently applied routine microbiological workup. Considering the political context, with increasing relocation from endemic areas to European countries, it is to be expected that the cases of brucellosis and neurobrucellosis will rise. Brucellosis should be considered and adequate investigations should be performed.

In 2005, the Ministry of Health in association with the Faculty of Medicine of Niamey decided to launch surgery at the district hospital (DH) level as part of the health strategy for the country. Surgical procedures were provided by general practitioners who received 12 months of training in basic surgery. Whereas the initiative was launched nationwide, we chose randomly to study the region of Dosso during a 1-year time period of January 2007 to December 2007 in the three district hospitals as well as the regional hospital of Dosso. During the course of 1 year, 544 patients received operations in the three DHs, of which 37.9% (n = 206) were emergent and 62.1% (n = 338) were elective. The most common emergent interventions were cesarean sections (70%) and uterine ruptures (7.8%). For elective surgeries, hernia repairs comprised 80.8% of the cases. The mortality rate of emergent surgeries was 7.3 and 0% in the cases of elective surgeries. Of note, there was a large reduction in transfers to the regional hospital: 52% compared to 2006 and 82% compared to 2005. In 66.1% of the transfers, the cases consisted of fractures, and in 10.4% of abdominal trauma and critical thoracic emergencies. Further study of this initiative has highlighted other challenges, including that of human resources, equipment maintenance, provision of consumables, and the need for continued training. Results from this governmental initiative to provide surgery in rural district hospitals by general practitioners are promising and encouraging. In the rural district of Dosso, there have been no deaths from elective surgery, and the number of surgical transfers to the regional hospital has drastically diminished. © 2009 The Author(s).

OBJECTIVES: Inflammation is critical in the pathogenesis of abdominal aortic aneurysm (AAA) disease. Combined (18)F-fludeoxyglucose ((18)F-FDG) positron emission tomography with computed tomography (PET-CT) and ultrasmall superparamagnetic particles of iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) are non-invasive methods of assessing tissue inflammation. The aim of this study was to compare these techniques in patients with AAA. MATERIALS AND METHODS: Fifteen patients with asymptomatic AAA with diameter 46 ± 7 mm underwent PET-CT with (18)F-FDG, and T2*-weighted MRI before and 24 hours after administration of USPIO. The PET-CT and MRI data were then co-registered. Standardised uptake values (SUVs) were calculated to measure (18)F-FDG activity, and USPIO uptake was determined using the change in R2*. Comparisons between the techniques were made using a quadrant analysis and a voxel-by-voxel evaluation. RESULTS: When all areas of the aneurysm were evaluated, there was a modest correlation between the SUV on PET-CT and the change in R2* on USPIO-enhanced MRI (n = 70,345 voxels; r = .30; p < .0001). Although regions of increased (18)F-FDG and USPIO uptake co-localised on occasion, this was infrequent (kappa statistic 0.074; 95% CI 0.026-0.122). (18)F-FDG activity was commonly focused in the shoulder region whereas USPIO uptake was more apparent in the main body of the aneurysm. Maximum SUV was lower in patients with mural USPIO uptake. CONCLUSIONS: Both (18)F-FDG PET-CT and USPIO-MRI uptake identify vascular inflammation associated with AAA. Although they demonstrate a modest correlation, there are distinct differences in the pattern and distribution of uptake, suggesting a differential detection of macrophage glycolytic and phagocytic activity respectively. ; This research was supported by grants from the National Institutes of Health Research (NIHR) Efficacy and Mechanism Evaluation Programme (11/20/03), the British Heart Foundation (PG/09/083) and the Evelyn Trust (09/22). Dr. McBride is supported by the Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine. Dr. Joshi is supported by Chief Scientist Office (ETM/160). Dr. van Beek is supported by the Scottish Imaging Network e a Platform of Scientific Excellence. The work of Dr. Rudd is part-supported by the NIHR Cambridge Biomedical Research Centre, the British Heart Foundation and the Wellcome Trust. Dr. Newby is supported by the British Heart Foundation (CH/09/002). The Wellcome Trust Clinical Research Facility and the Clinical Research Imaging Centre are supported by National Health Service Research Scotland through National Health Service Lothian. ; This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.ejvs.2015.12.018

Semen Semenovich Girgolav was born on February 2, 1881 in Tiflis, Georgia, Russia. In 1904 he graduated from the Imperial Military Medical Academy with honors. Under the guidance of Prof. M.S. Subbotin, Dr. S. Girgolav prepared and in 1907 successfully defended his doctoral dissertation "Experimental findings on the use of isolated omentum in the abdominal surgery". Later, he headed the chairs of general surgery, hospital surgery of the Military Medical Academy; he also was a scientific director of the Leningrad Research Institute of Traumatology and Orthopedics, head of the surgical department of the medical faculty of the 2nd Leningrad Medical Institute.In the 30s. Prof. Girgolav started a comprehensive work on thermal injuries and continued it until the last days of his life, while basic efforts of the staff of departments and laboratories which he headed were focused on studying local and general effects of low temperatures. From the first to the last days of the Great Patriotic War, he was the Deputy Chief Surgeon of the Red Army, and when Academician Burdenko (Chief Surgeon) fell ill (from October 1941 to May 1942 and in 1945) he acted as Chief Surgeon. During the Great Patriotic War, Prof. Girgolav regularly underlined the priority of the issues of military field surgery management as well as the issues of collecting and sharing the battle experience in surgery.Academician Girgolav's list of works includes more than 140 scientific papers, which can be schematically divided into the following topics: "Military field surgery", "Wounds", "Frostbites", "Issues of Special Surgery", "Traumatology", "Asepsis and antiseptics", "Pain relief", "Neurosurgery", "Endocrinology and oncology", "Manuals and Guidelines". Professor V. G. Weinstein (an outstanding Soviet traumatologistorthopedist who worked under Acad. Girgolav's guidance) suggests the following sections: 38 works are devoted to comprehensive researches on wounds, 17 – to infections, 16 – to military field surgery, 14 – abdominal and thoracic surgery, 13 – ...

"Background: Infection and sepsis represent major complications after abdominal surgery for secondary peritonitis. Finding new tools that can help identify patients at risk for developing postoperative complications is of the utmost importance for clinicians. We tried to evaluate the use of different biomarkers in evaluating the postoperative prognosis of patients with secondary peritonitis. Methods: We searched the available literature on the usefulness of serum biomarkers in evaluating prognosis in patients with secondary peritonitis. Results: Elevated postoperative lactate levels and high procalcitonin (PCT) levels were associated with negative outcomes. C-reactive protein values increase rapidly in response to the surgical insult but have no value in assessing the overall prognosis. Conclusion: Procalcitonin (PCT) is superior to other biomarkers in predicting severe septic complications and overall mortality in patients with secondary peritonitis. "

Reflecting on the recent creation of the surgical technique of 'natural caesarean', this paper investigates how caesarean section, a major abdominal surgery, can be associated with 'natural childbirth' To understand the paradoxical creation of this concept, I look back at the history of obstetrics and at the evolution of the nature/culture dichotomy in European modern thought. The multiple meanings of these two concepts and the epistemological and social premises underpinning the formation of modern obstetrics are examined to unravel the complexity of current medical practices applied to women's bodies as well as women's attitudes. In light of these historical elements, natural caesarean is understood as a notion born from cultural and professional negotiations and fraught with contradictory meanings originating from different medical and cultural discursive traditions.

Cardiovascular diseases (CVDs) are the leading cause of mortality in the European Union and accounted for about 36% of all deaths in 2019. Among these diseases, aortic dissection is relatively unknown and difficult to treat, with a survival rate for most severe cases not exceeding 10%. This pathology occurs when an injury leads to a localized tear of the innermost layer of the aorta, called the entry port. It allows blood to flow between the layers of the aortic wall, forcing the layers apart and creating a false lumen. The dissection of these layers may extend over a long portion of the thoracic and abdominal aorta. Endovascular treatment seeks to obliterate the entrances to the false lumen with a stent. The currently available surgical tools for endovascular procedures are selected only from information based on medical imaging techniques. The images are carried out before the intervention and therefore do not consider the deformation of the vascular structure by the implementation of the prosthesis. While many biomechanical studies have been done on the endovascular treatment of aneurysms of the abdominal aorta, there are, however, very few studies on aortic dissections. However,there are few studies as well on the postoperative demonstration of blood flow phenomena in the aortic dissection endovascular treatment. It is crucial to study the hemodynamic of blood in the aorta after an intervention, because the deployment of a stent leads to modifications in the blood flow. For the surgeons, the procedure can only be performed empirically, using MRI-4D images to view the post-operative flow of the patient's blood in the aorta with the stent. The numerical simulation method, instead allows us to simulate the complete endovascular procedure for an adapted recommendation during surgical planning. This thesis aims to present a numerical tool, from the open-source software FOAM-Extend, allowing for Multiphysics numerical simulations, performing the fluid-structure coupling between the hemodynamics and the arterial ...

For many reasons, laparoscopic surgery has been performed worldwide. Due to logistical constraints its first steps occurred in Lubumbashi only in 2008. The aim of this presentation was to report authors' ten-month experience of laparoscopic surgery at Lubumbashi Don Bosco Missionary Hospital (LDBMH): problems encountered and preliminary results. The study was a transsectional descriptive work with a convenient sampling. It only took in account patients with abdominal surgical condition who consented to undergo laparoscopic surgery and when logistical constraints of the procedure were found. Independent variables were patients' demographic parameters, staff, equipments and consumable. Dependent parameters included surgical abdominal diseases, intra-operative circumstances and postoperative short term mortality and morbidity. Between 1(st)April 2009 and 28(th) February 2010, 75 patients underwent laparoscopic surgery at the LDBMH making 1.5% of all abdominal surgical activities performed at this institution. The most performed procedure was appendicectomy for acute appendicitis (64%) followed by exploratory laparoscopy for various abdominal chronic pain (9.3%), adhesiolysis for repeated periods of subacute intestinal obstruction in previously laparotomised patients (9.3%), laparoscopic cholecystectomy for post acute cholecystitis on gall stone (5.3%) and partial colectomy for symptomatic redundant sigmoid colon (2.7%). There were 4% of conversion to laparotomy. Laparoscopic surgery consumed more time than laparotomy, mostly when dealing with appendicitis. However, postoperatively, patients did quite well. There was no death in this series. Nursing care was minimal with early discharge. These results are encouraging to pursue laparoscopic surgery with DRC Government and NGO's supports. ; Peer reviewed

Abstract Background Surgical site infection is a major contributor to increased mortality and health care costs globally which can be reduced by appropriate antibiotic prophylactic use. In Palestine, there is no published data about preoperative antibiotic use. This study aims to find the pattern of antimicrobial prophylaxis use by evaluating time of the first dose, antibiotic selection and duration after surgery in three governmental hospitals in North West Bank/ Palestine during 2011. Methods After approval of Institutional Review Board, a prospective cohort study included a total of 400 abdominal, orthopedic, and gynecological operations which were performed during study period. Trained clinical pharmacists observed selected 301 operations and followed the patient's files for the three intended study parameters. Compliance of prophylactic antibiotic administration was evaluated according to published guidelines of the American Society for Hospital Pharmacist. Data were analyzed using SPSS version 16 applying descriptive methods. Relationship between guideline compliance and selected operation factors such as type of surgery, patient care unit, and hospital shift, in addition to provider's age, gender, experience, and specialization were examined applying chi square test. The statistically significant factors with p < 0.01 were further analyzed using logistic regression model. Results Overall compliance for the studied parameters was very low (2%); only 59.8% received their first dose in appropriate time, 18.5% had appropriate antibiotic selection, and 31.8% of patients received antibiotic in appropriate duration. The OBGYN department had much better compliance regarding timing and duration of antibiotic use ( P < 0.001), however the proper antibiotic selection was best adhered to for the abdominal surgeries (OR = 3.64, P = 0.002). Male providers were statistically significantly much less adherent to the timing of antibiotic dose (OR = 0.28, p < 0.001), but better adherent in antibiotic selection (OR = 0.191, p = 0.028). Anesthetic technicians showed higher compliance than nurses in timing and duration of antibiotic use. Conclusions Lack of guidelines explains the low adherence to appropriate surgical antibiotic prophylaxis in Palestine, with high rate of broad spectrum antibiotic use, long duration and inappropriate time of first dose .We recommend adopting guidelines for prophylaxis and training all health care providers accordingly.

INTRODUCTION: Peritoneal dialysis catheter (PDC) placement for chronic kidney disease (CKD) amongst overweight and obese patients is difficult owing to deeper operating field. Literature being discordant on survival and complications in this patient subset, we attempted to analyse this research question in Indian population. MATERIALS AND METHODS: We retrospectively analysed PDC inserted by nephrologist using surgical minilaparotomy for survivals and complications amongst 'overweight and obese' cohort ('O') at two tertiary care government hospitals in India, and compared results with normo-weight cohort ('N'), with 12−36 months follow-up. RESULTS: 245 PDCs were inserted by surgical minilaparotomy and 'N' to 'O' ratio was 169:76. 'O' group were more rural residing (P = 0.003) and post-abdominal surgery (P = 0.008) patients. The 1, 2, and 3-year death censored catheter survival rate was 98.6%, 95.8%, and 88.2% respectively in 'O' group, and 97.6%, 94.5% and 91.8% in 'N' group respectively (P = 0.52). Patient survival (P = 0.63), mechanical complications (P = 0.09) and infective complications (P = 0.93) were comparable despite technically challenging surgery in 'O' group. Refractory peritonitis related PDC removal was comparable (P = 0.54). Prior haemodialysis or catheter related blood stream infections or diabetes were non-contributory to results. CONCLUSIONS: Catheter survival and patient survival amongst obese and overweight CAPD patients was non-inferior to normal weight patients. Mechanical, and infective complications were comparable despite technically challenging abdominal terrain in 'O' group. The overall CAPD performance was good amongst obese and overweight.

We report the case of a four years-old female proceeding from rural nor-oriental Colombia, without previous medical history, who was admitted to our institution with an abdominal mass that was noted one month previous to the consult, associated to ictericia, weight loss and hiporexia. A bilateral Wilms tumor was documented on diagnostic images. The patient received preoperative chemotherapy and was treated with bilateral partial nephrectomy. ; En este artículo se reporta el caso de una niña de cuatro años de edad, sin antecedentes perinatales o patológicos de importancia, procedente de área rural, en la región nororiental de Colombia, quien ingresó al Hospital Militar Central de Bogotá, Colombia, remitida por un cuadro de cinco meses de evolución que inició con tinte ictérico, pérdida de peso e hiporexia. Posteriormente, distensión abdominal y masa palpable abdominal de un mes de evolución. Por imágenes diagnósticas se documenta tumor de Wilms bilateral, el cual se trata con quimioterapia preoperatoria y nefrectomía parcial bilateral.

One year after beginning a large-scale research inquiry into how young people construct their identities I became ill and subsequently underwent abdominal surgery which triggered an early menopause. The process which was experienced as creatively bruising called to be written as "Artful Autoethnography" using visual images and poetry to tell a "vulnerable, evocative and therapeutic" story of illness, menopause, and their subject positions in intersecting relations of power. The process which was experienced as disempowering called to be performed as an act of resistance and activism. This performance ethnography is in line with the call for qualitative inquirers to move beyond strict methodological boundaries. In particular, the voice of activism in this performance is in the space between data (human voice and visual art pieces) and theory. To this end, and in resisting stratifying institutional/medical discourse, the performance attempts to create a space for a merger of ethnography and activism in public/private life.