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ABSTRACT: Median arcuate ligament (MAL) syndrome or celiac artery (CA) compression syndrome previously treated mainly by vascular surgeons using the open approach is now being increasingly performed by general surgeons with training in advanced laparoscopy. Although this approach has all the advantages of minimal access surgery, the procedure is fraught with serious complications like injury to major vascular structures during dissection. Vascular injury by far is the major cause of conversion to open procedure. Herein, we report a laparoscopic repair of iatrogenic CA injury by intra-corporeal suturing during MAL release. We also elaborate the causes, the preventive measures that can be applied to avoid such catastrophic occurrences in future. To the best of our knowledge, this is the first report of a laparoscopic repair of CA bleed during MAL release.

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We herein report a rare case of duodeno-duodenal intussusception (IS) presenting with obstruction caused by tubulovillous adenoma in an adult with malrotation that was managed by a novel laparoendoscopic hybrid technique. This was done by passing transjejunal nasogastric tube (NG) through one of the ports and manoeuvring it towards the IS. Two hundred and fifty millilitre of saline was flushed by aseptosyringe with pressure connected to the NG. This hydrostatic reduction technique resulted in distension of the jejunal and duodenal loop achieving reduction of IS. Intraoperative endoscopy was performed to exactly localise the mass lesion. The duodenum was kocherised and was delivered through a 4-cm transverse incision. Anterior duodenotomy was performed; the mass was excised; and duodenotomy was closed transversely. An extensive literature search did not show any case report of duodenoduodenal IS being managed by this technique. The combination of novel retrograde decompression and intraoperative endoscopy helped us to manage this rare case by this novel technique.

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Lumbar hernias are uncommon and about 300 cases have been reported till date. They commonly occur due to trauma, surgery and infection. They are increasingly being reported after motor vehicle collision injuries. However, spontaneous lumbar hernias are rare and are reported infrequently. It is treated with different surgical approaches and methods. We report a case of primary spontaneous lumbar hernia which was repaired by transperitonial laparoscopic approach using Vypro (polypropylene/polyglactin) mesh and covered with a peritoneal flap.

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BACKGROUND: Fatigue is one of the most common, ongoing symptoms reported by patients undergoing radiotherapy and has profound effects on the quality of life. AIMS: This study attempts to identify the magnitude of fatigue and its implication on the quality of life during radiotherapy. METHODS AND MATERIALS: A prospective study was conducted from March 2004 to September 2005, on 90 patients with histologically proven cancer, receiving radiotherapy. Pretreatment and weekly assessment of fatigue and QOL was done during radiation treatment using Brief Fatigue Inventory Scale and EORTC QLQ C30 respectively and repeated one month after completion of radiotherapy. All the scores were measured in the 0 to 100 scale. STATISTICAL METHODS USED: Trimean, SPSS 11.0 and Sysstat 8.0 were used for statistical analysis. RESULTS: Fatigue was present in 87.8% of patients initially and increased gradually over the course of radiotherapy and peaked in the last week. However at follow up it was nearing the pretreatment level. There was significant reduction in the functional scores ( P < 0.001) of QOL (physical, role and emotional function), which returned to pretreatment level at follow up. In the seventh week impairment of cognitive function (P=0.059) was noted. Significant reduction of social function (P < 0.001) at second week and global health status (P < 0.001) at fifth week was noted while financial difficulty was seen from second week onwards. CONCLUSION: Fatigue is transiently increased by radiotherapy before reaching pretreatment level after few weeks of completion of radiotherapy. QOL is also affected by fatigue which follows the same pattern.

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AIMS: To find out the efficacy of epidural analgesia in providing continuous pain relief for patients undergoing brachytherapy for cervical cancer. SETTINGS: Teaching Hospital. DESIGN: Retrospective Study. MATERIALS AND METHODS: A total of 152 patients of cervical cancer received epidural analgesia during 18 to 21 hours of pelvic brachytherapy. Epidural top up was given using 60-100 microg of buprenorphine every 08-10 hrs. Additional top up or systemic analgesics were given for breakthrough pain. RESULTS: Majority of patients 119 out of 152 received epidural top up twice during their stay in the brachytherapy ward. Only 20 out of 152 needed additional analgesics. CONCLUSIONS: Epidural analgesia is safe and provides satisfactory pain relief during brachytherapy and makes patient's stay more comfortable.

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This study examined the effect of an integrated yoga programme on chemotherapy-related nausea and emesis in early operable breast cancer outpatients. Sixty-two subjects were randomly allocated to receive yoga (n = 28) or supportive therapy intervention (n = 34) during the course of their chemotherapy. Both groups had similar socio-demographic and medical characteristics. Intervention consisted of both supervised and home practice of yoga sessions lasting for 60 min daily, while the control group received supportive therapy and coping preparation during their hospital visits over a complete course of chemotherapy. The primary outcome measure was the Morrow Assessment of Nausea and Emesis (MANE) assessed after the fourth cycle of chemotherapy. Secondary outcomes included measures for anxiety, depression, quality of life, distressful symptoms and treatment-related toxicity assessed before and during the course of chemotherapy. Following yoga, there was a significant decrease in post-chemotherapy-induced nausea frequency (P = 0.01) and nausea intensity (P = 0.01), and intensity of anticipatory nausea (P = 0.01) and anticipatory vomiting (P = 0.05) as compared with the control group. There was a significant positive correlation between MANE scores and anxiety, depression and distressful symptoms. In conclusion, the results suggest a possible use for stress reduction interventions such as yoga in complementing conventional antiemetics to manage chemotherapy-related nausea and emesis.

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Effects of an integrated yoga program in modulating perceived stress levels, anxiety, as well as depression levels and radiation-induced DNA damage were studied in 68 breast cancer patients undergoing radiotherapy. Two psychological questionnaires--Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS)--and DNA damage assay were used in the study. There was a significant decrease in the HADS scores in the yoga intervention group, whereas the control group displayed an increase in these scores. Mean PSS was decreased in the yoga group, whereas the control group did not show any change pre- and postradiotherapy. Radiation-induced DNA damage was significantly elevated in both the yoga and control groups after radiotherapy, but the postradiotherapy DNA damage in the yoga group was slightly less when compared to the control group. An integrated approach of yoga intervention modulates the stress and DNA damage levels in breast cancer patients during radiotherapy.

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Increased human use of fenugreek seeds (Trigonella foenum graecum) entails the generation of toxicity data in experimental animals. In this investigation, toxic effects of debitterized fenugreek (DFG) powder have been assessed following acute and subchronic regimens in mice and rats. In the acute study, DFG powder intragastrically administered to albino mice (CFT-Swiss, Mus musculus) and albino rats (CFT-Wistar, Rattus norvegicus) of both sexes failed to induce any signs of toxicity or mortality up to a maximum practical dosage of 2 and 5 g/kg body weight, respectively. Further, no significant alterations either in relative organ weights or their histology were discernible at terminal autopsy. In the 90-day subchronic study, DFG fed to weanling rats of both sexes at dietary doses of 0, 1, 5 and 10% in a pure diet had no effect either on the daily food intake or growth. Terminal autopsy revealed no alterations in relative organ weights of various vital organs, or their histoarchitecture. Haematological constants in DFG-fed rats were on par with those of controls. Further, biochemical measurements in serum and liver of DFG-fed rats revealed no appreciable changes in various parameters such as enzyme levels of GPT , GOT and ALP, as well as many serum constituents such as proteins, cholesterol, urea and creatinine at any of the dietary levels. From these results, it may be concluded that DFG does not produce any significant acute and cumulative toxicity at the doses administered, as reflected by the various parameters investigated.

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Proximate composition, sarcoplasmic and myofibrillar protein fractions of buffalo meat were similar to those of beef. Buffalo meat was also rich in lysine. Meat from young animals had a lower collagen content than that from old ones. As the temperature of holding the carcasses was increased, the rate of pH fall was faster. Meat from stressed animals showed a higher ultimate pH. Percentage of cooking loss and thermal shrinkage was higher in muscles of old animals than in young ones, which probably reflected the poor condition of the older animals. Meat cooked by pressure cooking showed lower Warner-Bratzler shear values as compared with meat cooked in boiling water.

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A study has been conducted on the microbiology of sheep carcasses processed in a modern abattoir. The data revealed that careful handling at the different stages of processing of sheep reduced the level of microbial contamination of carcasses. Processing steps such as evisceration and washing did not increase the microbial counts on the carcass surface. Sources of microbial contamination in the abattoir were examined. It was observed that skin, floor washings, intestinal contents and gambrels were the major sources of microbial contamination. Seasonality did not have any effect on the microbial contamination of carcasses. The study revealed that total plate counts in 86·6% of the carcasses ranged between 3·0-4·9log/cm(2). The counts of coliforms, staphylococci, enterococci and psychrotrophs were low. Pathogens such as Salmonella were not detected. The microbial counts were well within the generally acceptable levels. These findings demonstrated hygienic handling of carcasses. Shoulder and neck are the critical points for microbiological sampling as these sites showed higher microbial counts. Micrococcus and Staphylococcus predominated among microorganisms associated with carcasses. It was noted that differences occurred in microbial types of carcasses processed in tropical and temperate climates. The data generated in a model facility procided useful information for improving meat handling practices.

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The semimembranosus (SM) and semitendinosus (ST) muscles were removed from 18 four to five year old Bannur breed ewes which were slaughtered and carcasses (six each) suspended by the (a) Achilles tendon at 26 ± 2°C for 1 h before cutting (b) Achilles tendon at 2-3°C for 42 h and (c) Pelvis at 26 ± 2°C for 7 h followed by chilling at 2-3°C for 17 h. The muscles were cooked by boiling in a water bath for 30 min or by heating in a pressure cooker for 20 min and the tenderness measured with a Warner-Bratzler tenderometer. Hardness, cohensiveness, elasticity and chewiness were also measured with a General Foods Texturometer. With conventional hanging at 2-3°C the SM muscle was the toughest and the ST muscle the most tender. By holding carcasses at 26 ± °C for 1 h before cooking there was an increased tenderness. The most tender meat was found from carcasses which were suspended by the pelvis at 26 ± °C before chilling. The increase or decrease in shear values were respectively associated with contraction or stretching of muscles effected by carcass conditioning treatments. In contrast, thermal shrinkage due to cooking had opposite effects so that greater thermal shrinkage resulted in lower shear values. The shear values from the Warner-Bratzler tenderometer did not correlate well with the parameters measured by the General Foods Texturometer.

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Minced meat was examined for microbiological quality and for shelf-life at higher temperatures. Total plate counts, coliforms, Staphylococcus aureus, Enterococci and psychrotrophs were estimated. Types of bacteria associated with meat spoilage were isolated and identified. It was observed that minced meat obtained from local retail shops showed significantly higher microbial counts and shorter shelf-life than that processed under hygienic conditions. The predominant bacteria associated with fresh meat were S. aureus, Micrococcus and Escherichia. The results revealed that microbial spoilage of meat at higher temperatures was mainly due to the growth of mesophilic microorganisms such as Escherichia and S. aureus.