Annals of Bariatric Surgery
Volume:1 Issue: 4, Autumn 2012

Hydatid cyst، a zoonosis caused by Echinococcus granulosus، is the only recognized parasitic cysts of the spleen and is known to be at least twice as common as the non-parasitic variety.. A 35 year old woman presented with a one year history of dull pain and a dragging sensation in her left hypochondrium. Ultrasonography revealed a hydatid cyst in the lower part of the spleen. Laparoscopic splenectomy along with hydatid cyst was done. Her post-operative phase was uneventful.. Here، we discuss the pathogenesis of the rare entity of splenic hydatid cysts and the various treatment options available.

Context: Correct timing of diagnostic laparoscopy for unexplained infertility management remains as a debate for clinicians. A cost-effective strategy of diagnostic laparoscopy utilization for unexplained infertile patients is much needed. Evidence Acquisition: Detailed evaluation of the articles extracted from a “Pubmed” and “Cochrane database” search using “unexplained infertility and diagnostic laparoscopy” word group between 1993 and 2012 was the preparation style of this review. Diagnostic laparoscopy should be considered when there are abnormal hysterosalpingography results, a past history of pelvic infection, pelvic surgery and/or unexplained secondary infertility during management of an unexplained infertile couple. Currently, omitting diagnostic laparoscopy following a normal hysterosalpingography in couples suspected to have unexplained infertility and proceeding with ovulation induction for several cycles before referring to assisted reproductive techniques are recommended. The additional value of diagnostic laparoscopy after a normal hysterosalpingography was found to be very low prior several attempts of intrauterine insemination. In the absence of pathological findings precluding fertility during an unexplained infertility evaluation, routine diagnostic laparoscopy for infertility evaluation is not necessary because 77% of these patients become pregnant following ovulation induction and/or assisted reproductive techniques treatment. Omitting diagnostic laparoscopy after a normal hysterosalpingography in infertile patients with unexplained infertility and without risk factors for pelvic pathologies related to infertility is reasonable because the majority became pregnant after several cycles of ovulation induction, and/or assisted reproductive techniques treatment while diagnostic laparoscopy is indicated when pelvic endometriosis and/ or tubal pathology is strongly suspected

Operating room (OR) planning involves the creation of a “master surgical schedule” in which surgeons are assigned to specific operating rooms (ORs) on specific days of a week. The master schedule is typically one or two weeks long repeatable for several months. The purpose of this study was to recommend using a mathematical program to generate a rotation in a way that the limited operating room capacity could be distributed based on smoothing expected demand for in-patient beds.Patients and This study concentrated on the service-level scheduling at Sunnybrook Health Sciences Centre in Toronto, Canada, to build such a model. We assumed that the number of blocks (days) for each surgeon was given, and that the expected casemix for each surgeon was chosen by random sampling based on historical data. The goal was to assign surgeons to the blocks so tat bed occupancy in the wards would become as stable as possible during the week. The planning problem was first formulated as a stochastic integer programming. Then, an approach with combination of Monte Carlo simulation and Premium Solver provided an approximate solution. The integer program provided scheduled OR number and day of the week for each surgeon, corresponding to the sample. The final result of model, approximated by the proposed method, was the maximum number of beds for each surgical service throughout the week. These were the required bed capacities to handle demands for surgeries. An Integer Programming was presented to schedule OR and day of surgery for each surgeon with restrictions on the available ORs and required number of blocks. The problem was quickly solved using Premium Solver. The reliability of the results was highly dependent on the data. Another fundamental restriction for implementation of the results was to convince surgeons to accept changes in the schedules. The surgeon preferences might be included in the model constraints for more acceptable results

Post-operative nausea and vomiting (PONV) are the most common unpleasantexperiences following laparoscopic surgeries. In the current research, compared the effect of dexamethasone and ondansetrone combined and separately on preventing nausea and vomiting in the patients undergone elective surgery with general anesthetic using laparoscopic cholecystectomy procedure. Patients and One hundred fifty patients with ASA class I and II aged between 20-65 years voluntarily participated in this double-blind randomized prospective study. The patients were randomly divided into three groups of 50. All the participants faced general anesthetic procedure whereas each group received different treatment regimen as follow: the O-group, 4 mg ondansetrone, the D-group, 8 mg dexamethasone, and the OD –group, combination of 4 mg of ondansetrone plus 8 mg dexamethasone. Every episode of PONV and the need for antiemetic drug were evaluated 6 hours following the operation and then every 6 hours up to 24 hours after the operation. The complete response was defined as the case with no episode of PONV within the 24 hours and the need for anti-vomiting cases was defined as the failure in prophylaxis. The complete response was observed in 62.2, 68.2 and 89.6 percent of O, D, and OD groups, respectively. The frequency of complete response was significantly lower in OD-group (P = 0.011 vs. the D and P = 0.005 vs. the O group). The need for the antiemetic drug in groups O, D, and OD was 28.3, 22.8, and 6.2, respectively. The incidence of vomiting and failure in prophylaxis was observed in D-group during the first six hrs. The highest need for the anti-vomiting drug within the 6 to 24 hours of post operation was observed in group O compared to the group OD (P = 0.012). Combination of dexamethasone and ondansetrone is more effective than the treatment of PONV by each of these drugs separately following the laparoscopic cholecystectomy. The application of dexamethasone alone in preventing premature PONV is less effective than the application of ondansetrone or the combination of these two drugs. In addition, ondansetrone alone is less effective than the combination of these two drugs in preventing PONV.

Large ovarian cysts are rarely seen in children. Developments in minimal access surgery allow novel surgical strategies to be employed in their management.. We report a case where a substantial right ovarian cyst in a 13 year old was removed through a single incision in the superior umbilical fold leaving no discernable scar. The placement of a purse string facilitated safe decompression of the cyst allowing delivery into the wound where the lining was stripped before being returned to the abdomen.. Subsequent single incision laparoscopic surgery (SILS) port placement through the same wound allowed for a full inspection of the pelvis and abdomen. This approach represents an advance on conventional surgery and is a tenable alternative to an exclusive laparoscopic technique.

Myasthenia gravis is a neurological disorder characterized by muscle weakness. The role of thoracoscopic thymectomy in the treatment of this disease is controversial, but has some advantages that include less pain, shorter hospital stays, and better cosmetic results. After the introduction of video-assisted thoracoscopic surgery (VATS) thymectomy, there has been increased interest in the use of this technique for myasthenia gravis. We conducted a retrospective study to assess the safety and efficacy of VATS thymectomy in treatment of myasthenia gravis.Patients and The medical records of 50 patients who underwent VATS thymectomy for the treatment of myasthenia gravis between May 2005 and June 2010 in Afzalipour Hospital, (affiliated to Kerman Medical University of Sciences, Iran) were reviewed. The patients were examined for response to treatment; for patients who were not available for examination, data was obtained through telephone conversations. Forty-three of 50 patients were accessible. Of these, 34 were female and 16 were male, with a mean age of 34.8 years. The treatment responses were remission, 6 (16%); improvement, 30 (70%); and without change, 7 (16%). The total positive response to treatment was 84 percent. VATS thymectomy has been considered as a safe and effective treatment in myasthenia gravis and was associated with low mortality and morbidity. VATS thymectomy is recommended for the treatment of myasthenia gravis.