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Table of contents
- Investigating Breast Cancer Cell Behavior Using Tissue Engineering Scaffolds
- Possession Paralysis Revisited
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Investigating Breast Cancer Cell Behavior Using Tissue Engineering Scaffolds
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Saturday, October 18, Birthday! Previous New Record Cover: Blown. The mobilized fundus of the stomach is pulled through the retroesophageal space to the right side of esophagus and sutured anteriorly. The overall effect of these maneuvers increases the resistance at the lower esophagus and prevent excessive reflux across the esophageal-gastric junction.
This set of maneuvers is best explained by the soft straw experiment please see figure. A soft straw dipped into a glass of water will collapse on itself when sucked. This is because the hydrostatic pressure of the fluid compresses the straw from all directions. In this situation, the only way to make the straw functional is to pull back the straw so that only a short length of it is below the water. Now, the hydrostatic pressure, which acts upon the short length of the straw below the surface of the water, is inadequate to collapse it and the atmospheric pressure on the surface of the water pushes up the water in the straw.
Applying this principle in gastroesophageal disease, the starting point where there is gastroesophageal reflux is the end point of the experiment mentioned above. The completed fundoplication procedure represents the starting point of the straw experiment where the hydrostatic pressure collapses the straw. In effect, by lengthening the intra-abdominal esophagus, the surgeon permits the intra-abdominal pressure similar to hydrostatic pressure to compress the lower esophagus and increase its intraluminal pressure, thereby preventing reflux. Additionally, the fundoplication decreases the radius and increases the resistance, which further acts as an anti-reflux barrier.
It goes without saying that ignoring these vital factors is one of the main reasons for a failed anti-reflux surgery. For decompressing the stomach, a wide nasogastric tube connected to a short and wide tubing e. Good postoperative care is as important as the preoperative preparation and the operative technique, for a successful outcome of an operation. A non-functioning drain compromises many a time the result of a complex surgery.
Normally, a universal connector is used to connect the tubing to the vacuum receptacle, which fits tubing of all sizes. This has a narrow nipple with a small r , which decreases the flow, clotting of blood and failure of the drain. Use of a wide connector will prevent this [ 2 ]. The downside of excessive negative pressure suction is continued effluent from the drainage tube. In , Chintamani et al. A good guide to the timing of decreasing the vacuum would be when the RBC settles on the tube with clear serum above. This indicates that the bleeding has stopped, and it is the serum that is draining [ 3 ].
An option that is increasingly being practiced across the world is to convert the vacuum drainage into regular tube drainage by connecting the tube to a drainage bag instead of the vacuum chamber.
Possession Paralysis Revisited
This prevents unnecessary tissue exudation at the site of the surgery and hastens drain removal and thereby the hospital stay. For example:. In cold-induced vasospastic disease Raynauds disease , cold agglutinins are formed when the temperature drops. Combined with cold-induced spasm, which decreases the radius of the blood vessels and hence decreases the flow Q to the fourth power, this precipitates ischemia to the extremities.
While closing an artery, especially a superficial femoral or a smaller artery, ideally, a transverse arteriotomy is performed, which is closed with continuous or interrupted fine polypropelene suture with no further compromise in flow. While correcting arterial narrowing at two or more sites, it is important first to address the proximal larger diameter lesion.
As the flow changes with the radius to its fourth power, a small increase in radius in a large vessel results in a greater improvement in the blood flow in the smaller distal vessel. This result is a greater flow than that achieved by increasing the fractional diameter of the small distal vessel [ 2 ]. As the flow rate radius is raised to the fourth power, this principle should be borne in mind while repairing any hollow tubular organ like the intestine, bile duct, vas deference, fallopian tube, and ureters in addition to the blood vessels [ 2 ]. In patients with right colonic cancers, obstruction is a late phenomenon.
This is due to the nature of the tumor, exophytic rather than constricting, and also because of the content of the ileum, and the right colon is liquid compared to the left half of the colon. Low viscosity of the contents does not build up the resistance in the lumen, delaying diagnosis until a large mass is formed. Patients who are hypovolemic secondary to hemorrhage rapid fluid replacement is the key to resuscitation.