Subsequent Leak Research Articles

Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?

BackgroundAnastomotic leak following colorectal resection is associated with morbidity, mortality, and poor bowel function. Minimal data exists on the relationship between anastomotic technique, intraoperative leak test, and subsequent clinical leak, particularly on the utility of performing end-to-end versus non-end-to-end anastomoses to avoid postoperative leaks. This study’s aim was to analyze potential associations between anastomotic construction, intraoperative anastomotic assessments, and clinical leak. MethodsWe conducted a retrospective cohort study of patients at a tertiary care center with colorectal cancer, who underwent left-sided colorectal resections with colorectal or coloanal anastomoses, comparing anastomotic technique. Outcomes were rates of intraoperative air leak, incomplete anastomotic donuts, and postoperative clinical leak. Univariate and multivariate analyses were performed to evaluate potential association between anastomotic technique and intraoperative anastomotic assessments and subsequent leak. Results/OutcomesAmong 844 patients, 27 (3.2%) had intraoperative leak, 6 (0.7%) had incomplete donuts, and 27 (3.2%) experienced clinical leak. 500 (59.2%) patients had end-to-end anastomoses and 344 (40.7%) had non-end-to-end. There were no significant differences in demographics or comorbidities between groups (p>0.05) or rate of incomplete donuts (p=0.07). End-to-end anastomosis was associated with significantly more intraoperative air leaks than non-end-to-end on univariate (4.9% vs 1.2%, p=0.005) and multivariate analysis (OR 3.6; 95% CI 1.01-12.5, p= 0.049). There was no difference in postoperative clinical leak between groups on univariate (3.0% vs 3.5%, p=0.69) or multivariate analysis (OR: 0.97; 95% CI: 0.40-2.34; p=0.94). ConclusionEnd-to-end anastomosis is associated with higher rates of intraoperative air leak than non-end-to-end anastomosis, even after adjusting for potential confounders.

Improved Non-Negative Matrix Factorization-Based Noise Reduction of Leakage Acoustic Signals.

The detection of gas leaks using acoustic signals is often compromised by environmental noise, which significantly impacts the accuracy of subsequent leak identification. Current noise reduction algorithms based on non-negative matrix factorization (NMF) typically utilize the Euclidean distance as their objective function, which can exacerbate noise anomalies. Moreover, these algorithms predominantly rely on simple techniques like Wiener filtering to estimate the amplitude spectrum of pure signals. This approach, however, falls short in accurately estimating the amplitude spectrum of non-stationary signals. Consequently, this paper proposes an improved non-negative matrix factorization (INMF) noise reduction algorithm that enhances the traditional NMF by refining both the objective function and the amplitude spectrum estimation process for reconstructed signals. The improved algorithm replaces the conventional Euclidean distance with the Kullback-Leibler (KL) divergence and incorporates noise and sparse constraint terms into the objective function to mitigate the adverse effects of signal amplification. Unlike traditional methods such as Wiener filtering, the proposed algorithm employs an adaptive Minimum Mean-Square Error-Log Spectral Amplitude (MMSE-LSA) method to estimate the amplitude spectrum of non-stationary signals adaptively across varying signal-to-noise ratios. Comparative experiments demonstrate that the INMF algorithm significantly outperforms existing methods in denoising leakage acoustic signals.

Effects of Anterior Fundoplication on Postoperative Dysphagia and Reflux After Laparoscopic Esophagocardiomyotomy for Pediatric Achalasia.

Introduction: Achalasia among children often fails endoscopic management (e.g., dilation, botulinum toxin). Laparoscopic esophagocardiomyotomy (L-ECM) is a standard intervention to relieve obstruction but can induce gastroesophageal reflux (GER). Concurrent anterior fundoplication (A-fundo) has been evaluated in randomized trials among adults, demonstrating mixed results on controlling postoperative GER without exacerbating dysphagia. Furthermore, evidence for the best approach among children remains sparse. We hypothesized that, among children undergoing L-ECM without mucosal violation, routine A-fundo would not improve postoperative GER control while exacerbating dysphagia. Materials and Methods: Observational data of 47 consecutive achalasia patients ≤18 years who received L-ECM (2002-2023) at a single academic institution were collected. Patient records were culled for demographics, achalasia characteristics, and outcomes. Two L-ECM groups were identified: with or without A-fundo. Patients were screened for postoperative dysphagia (additional procedures) and GER (new antireflux medications). Univariate independence testing was conducted to identify statistically significant variables. Results: Among 47 patients undergoing L-ECM, 28 (59.6%) received concurrent A-fundo. Compared with patients undergoing L-ECM alone, patients with L-ECM/A-fundo had significantly longer hospital stays (P < .01) without statistically different rates of postoperative dysphagia (P = .81) or GER (P = .51). Five children (10.6%) experienced mucosal injury with L-ECM: 4 recognized intraoperatively received A-Fundo without subsequent leak; 1 mucosal injury was missed and did not receive A-Fundo, which subsequently leaked. Conclusion: In this largest observation of pediatric achalasia patients, A-fundo appeared clinically insignificant when determining contributors to control GER or exacerbate postoperative dysphagia. A-fundo should not be routinely adopted in children having L-ECM for achalasia without further multicenter analysis but appears beneficial in cases having inadvertent mucosal violation.

Leak Monitoring in Split Duct Air Conditioner Based on Internet of Things

Water accumulation in air conditioning (AC) drain pans can lead to corrosion and subsequent leaks, impacting AC system performance. This study focuses on implementing a monitoring system to track water levels and promptly discharge water to prevent corrosion. Using a research and development approach, the study evaluated the water level sensor's performance in measuring water levels and the pump's effectiveness in discharging water at specific levels, ensuring overall system reliability. The system utilized the NodeMCU ESP8266 microcontroller, a water level sensor, an LCD I2C 16x2 display, and Blynk as a smartphone-based monitoring platform. The findings demonstrated the effective functionality of the device in evacuating accumulated water from the AC evaporator. This was achieved through the activation of a water pump when the water level reached a threshold of 2 cm, thereby preventing potential leakage in the air conditioner's storage gutter.

Optimal sensor placement for leak location in water distribution networks: A feature selection method combined with graph signal processing

Nowadays, real-time monitoring of smart water networks is essentially performed by Supervisory Control and Data Acquisition (SCADA) systems and through the use of sensors strategically positioned in the water distribution network (WDN). The purpose of sensor placement is to reasonably collect signals and thus improve the efficiency of subsequent leak diagnosis, while also limiting their deployment and operational costs. Most current sensor placement methods rely on well-calibrated hydraulic models for node selection and subsequent leak location evaluation. In this study, an efficient Optimal Sensor Placement (OSP) method for WDN is proposed, which avoids the reliance on the hydraulic model in the node selection step. It can be generalized as an optimization process, and the algorithm to solve the problem is a heuristic algorithm. We consider the user nodes in the WDN as features and propose a feature selection algorithm combined with graph signal processing. By this method, the importance of different nodes in the WDN is analyzed and the redundancy between different nodes is considered in the iterative selection process. A graph signal reconstruction method is applied to recover pressure data of all nodes using the data monitored by the selected nodes, and the relationship between the number of sensors and the reconstruction error is analyzed. The proposed method is tested on two benchmark networks of different sizes and types. A comparative analysis with other methods shows that the proposed OSP method can be easily extended to other WDNs. In addition, the proposed method achieves better monitoring results while selecting nodes quickly.

Bacterial outer membrane vesicle based versatile nanosystem boosts the efferocytosis blockade triggered tumor-specific immunity

Efferocytosis inhibition is emerging as an attractive strategy for antitumor immune therapy because of the subsequent leak of abundant immunogenic contents. However, the practical efficacy is seriously impeded by the immunosuppressive tumor microenvironments. Here, we construct a versatile nanosystem that can not only inhibit the efferocytosis but also boost the following antitumor immunity. MerTK inhibitor UNC2025 is loaded into the bacterial outer membrane vesicles (OMVs), which are then modified with maleimide (mU@OMVs). The prepared mU@OMVs effectively inhibits the efferocytosis by promoting the uptake while preventing the MerTK phosphorylation of tumor associated macrophages, and then captures the released antigens through forming universal thioether bonds. The obtained in situ vaccine effectively transfers to lymph nodes by virtue of the intrinsic features of OMVs, and then provokes intense immune responses that can efficiently prevent the growth, metastasis and recurrence of tumors in mice, providing a generalizable strategy for cancer immunotherapy.

Highly Sensitive Molecularly Imprinted Polymer-Based Electrochemical Sensors Enhanced by Gold Nanoparticles for Norfloxacin Detection in Aquaculture Water.

The overuse of antibiotics in aquaculture and pharmaceuticals and their subsequent leaking into the environment have been demonstrated to be a potential route for creating antibiotic resistance in bacteria. In order to assess the impact of this problem and take regulatory measures, it is necessary to develop tools that allow for the detection of antibiotics in environmental samples in a routine, low-cost manner. In this study, we integrated gold nanoparticles (AuNPs) into a molecularly imprinted polymer (MIP) membrane to fabricate a new sensor for the detection of norfloxacin in pharmaceuticals and aquaculture samples. The receptor layers were characterized by scanning electron microscopy, electrochemical impedance spectroscopy, and Raman spectroscopy. The results of these studies demonstrate that the addition of AuNPs to the polymer network enhanced the sensor sensitivity by at least a factor of two. The MIP-AuNPs sensor has a low detection limit (0.15 ng/mL, S/N = 3) with a wide linear range and very high sensitivity. The selectivity of the fabricated sensor was measured in the sample containing other antibiotics (like chloramphenicol, ciprofloxacin, and levofloxacin). Rapid and precise norfloxacin detection in pharmaceutical compounds and fishpond water samples indicates that the fabricated sensor has the potential to be used for routine screening of aquacultures and pharmaceutical processes.

Anastomotic perfusion assessment with indocyanine green in robot-assisted low-anterior resection, a multicenter study of interobserver variation

BackgroundSecuring sufficient blood perfusion to the anastomotic area after low-anterior resection is a crucial factor in preventing anastomotic leakage (AL). Intra-operative indocyanine green fluorescent imaging (ICG-FI) has been suggested as a tool to assess perfusion. However, knowledge of inter-observer variation among surgeons in the interpretation of ICG-FI is sparse. Our primary objective was to evaluate inter-observer variation among surgeons in the interpretation of bowel blood-perfusion assessed visually by ICG-FI. Our secondary objective was to compare the results both from the visual assessment of ICG and from computer-based quantitative analyses of ICG-FI between patients with and without the development of AL.MethodA multicenter study, including patients undergoing robot-assisted low anterior resection with stapled anastomosis. ICG-FI was evaluated visually by the surgeon intra-operatively. Postoperatively, recorded videos were anonymized and exchanged between centers for inter-observer evaluation. Time to visibility (TTV), time to maximum visibility (TMV), and time to wash-out (TWO) were visually assessed. In addition, the ICG-FI video-recordings were analyzed using validated pixel analysis software to quantify blood perfusion.ResultsFifty-five patients were included, and five developed clinical AL. Bland–Altman plots (BA plots) demonstrated wide inter-observer variation for visually assessed fluorescence on all parameters (TTV, TMV, and TWO). Comparing leak-group with no-leak group, we found no significant differences for TTV: Hazard Ratio; HR = 0.82 (CI 0.32; 2.08), TMV: HR = 0.62 (CI 0.24; 1.59), or TWO: HR = 1.11 (CI 0.40; 3.11). In the quantitative pixel analysis, a lower slope of the fluorescence time-curve was found in patients with a subsequent leak: median 0.08 (0.07;0.10) compared with non-leak patients: median 0.13 (0.10;0.17) (p = 0.04).ConclusionThe surgeon’s visual assessment of the ICG-FI demonstrated wide inter-observer variation, there were no differences between patients with and without AL. However, quantitative pixel analysis showed a significant difference between groups.Trial RegistrationClinicalTrials.gov Identifier: NCT04766060.

Esophagojejunostomy or Fistulojejunostomy Are Safe Salvage Operations for Bariatric Surgery Leaks

Background: Sleeve gastrectomy is the most commonly performed bariatric surgery, and staple line leaks occur in 1% or less of patients. Gastric bypass is still a common weight loss surgery with a leak rate of 2%. Definitive surgical management of the leak is mainly accomplished with esophagojejunostomy or fistulojejunostomy. Proceeding with surgical management of these leaks is poorly understood given the rare need and high risk. We reviewed our outcomes of definitive surgical management for leaks following weight loss surgery. Methods: An institutional review board approved database identified patients undergoing definitive surgical management for bariatric surgery leaks with either an esophagojejunostomy or fistulojejunostomy. Initial data that led to the leak, intraoperative factors, and postoperative outcomes were collected. Primary endpoint was leak after definitive surgical procedure. Results: A database of 87 patients was queried to find 22 patients undergoing surgery. Twelve patients underwent esophagojejunostomy and 10 patients underwent fistulojejunostomy. There was a mean of 90 days to leak recognition. There was a mean of 228 days from first endoscopic procedure to definitive surgery in the 18 patients undergoing initial endoscopic management. The mean time from the sentinel surgery to definitive surgery was 296 days. There were 6 patients (27%) that had subsequent leaks after definitive surgery. All subsequent leaks healed with endoscopic therapy. No deaths occurred. Conclusion: Bariatric surgery leaks are difficult to manage. When endoscopic management fails, esophagojejunostomy, and fistulojejunostomy are safe and feasible salvage options. Additional leaks following these salvage operations can occur in up to 27% of patients.

The 2016 Presidential Election, the Public Charge Rule, and Food and Nutrition Assistance Among Immigrant Households.

Objectives. To investigate whether the 2016 US presidential election and the subsequent leak of a proposed change to the public charge rule reduced immigrant families' participation in food and nutrition assistance programs. Methods. We used nationally representative data on n = 57 808 households in the United States from the 2015-2018 Current Population Survey-Food Security Supplement. We implemented difference-in-difference-in-difference analyses to investigate whether the election and proposed rule change produced decreases in immigrant families' participation in food and nutrition assistance programs and whether such decreases varied according to state policy generosity toward immigrants. Results. Findings indicate significant and large decreases in Supplemental Nutrition Assistance Program, School Breakfast Program, and National School Lunch Program participation among immigrants in moderately generous states but no changes to receipt of food assistance from nongovernmental sources or to household food insecurity. Conclusions. Both anti-immigrant rhetoric and the perceived threat of policy enactment can be enough to produce chilling effects that have potentially serious implications for the health of immigrant households and thus the health of the nation. (Am J Public Health. 2022;112(12):1738-1746. https://doi.org/10.2105/AJPH.2022.307011).

Potential Prognostic Indicators for Patients With Retinal Vein Occlusion.

The second most prevalent cause of retinal vascular disease is retinal vein occlusion (RVO). RVO raises intravascular pressure in the capillary and veins, triggering vessel barrier collapse and subsequent leaking of blood or plasma components into the tissue (edema). Macular edema (ME) is a major complication of RVO that results in significant visual impairment. Laser therapy, intravitreal steroid injections, and vascular endothelial growth factor (VEGF) inhibitors are the major therapeutic techniques. Different therapies reduce ME of RVO and improve visual activity. However, some people have no impact on the resolution of ME, while others have a poor visual prognosis despite full ME cure. There are many investigators who studied the relationship between indicators of various instruments with visual activity. However, a summary of those findings is currently lacking. Therefore, we will focus on the predictive factors of different studies associated with positive visual activity outcomes, which would be very useful and important to help address both treatment expectations and methods for patients with RVO.

Comparing root exudate collection techniques: An improved hybrid method

1. Plant-microbe interactions are critical for ecosystem functioning and drive rhizosphere processes. Root exudates are an important soil carbon (C) input, as well as a mechanism for communication between plants and rhizosphere microbes, but are notoriously difficult to extract and characterise. Common methods produce either substantial noise from the soil or do not mimic natural systems. Optimising methods for root exudate collection in soil is crucial for advancing our understanding of root-microbe interactions under changing environmental conditions.2. Hybrid root exudate collection methods, where plants are grown in soil and transferred to hydroponics for exudate collection after root washing, might offer an ecologically relevant alternative to existing approaches. However, this method causes potential root damage as well as osmosis and subsequent leaking of cell contents. Here, we assessed different ‘root recovery’ periods after root washing and before hybrid root exudate collection, by comparing root exudate quantity and quality with both damaged root extracts and with leachates collected from the intact root-soil system. This was done across three common grassland species representing three functional groups.3. We found that root exudate profiles of the shortest recovery period (0 days) were similar to damaged root extracts and were very high in C. With an increasing period of root recovery, profiles were more similar to leachates collected from the intact root-soil system, and C concentrations decreased. While both hybrid and leachate collection methods separated species by their root exudate profiles, the hybrid method was less variable in terms of the amount of C measured and provided a more diverse and abundant metabolome with better identification of metabolites.4. Our results show that a recovery period after root washing of at least 3 days is critical to prevent root damage bias in hybrid collection methods, and that our hybrid method yields exudates that discriminate between species. Our data also suggest that exudates collected with this hybrid method are ecologically valid, which is vital for gaining a mechanistic understanding of their role in ecosystem functioning.

ID: 3526427 ENDO-SPONGE IN MANAGEMENT OF ANASTOMOTIC COLORECTAL LEAKS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Following colorectal surgery, anastomotic dehiscence and subsequent leak formation has an incidence of 2 to 7%. Anastomotic leaks (AL) have been associated with an increase in mortality ranging from 1.6% to 12%. Endo-SPONGE has been successfully applied in the management of ALs after colorectal surgery. This is the first systematic review and meta-analysis to evaluate the efficacy and safety of Endo-SPONGE system in the management of colorectal leaks.

Case Studies in Graphitic Corrosion of Cast Iron Pipe

Throughout many parts of the world, cast iron pipe has been and continues to be used for utility piping (water and sewage) and gaseous media piping. Gray cast iron is known to have a limited life in service but is often left in place beyond its reasonable service life. Therefore, end of life is then left to be defined as a rupture or a crack and a subsequent leak, often at an unpleasant time with unpleasant results. The controlling mechanism involved is time dependent and known as graphitic corrosion. This paper provides a review of the phenomenon of graphitic corrosion in the form of key characteristics. Several references are cited that further explore the mechanism involved and corrosion prevention/mitigation. Two case studies are presented that explore graphitic corrosion in gray cast iron pipe from a failure analysis point-of-view. Both case studies feature conditions that further aid in the interpretation of graphitic corrosion and an appreciation for when and how this phenomenon occurs.

Climate change mitigation effects: How do potential CO2 leaks from a sub-seabed storage site in the Norwegian Sea affect Astarte sp. bivalves?

Carbon capture and storage (CCS) is one of the most promising mitigation strategies for reducing the emissions of carbon dioxide (CO2) to the atmosphere and may substantially help to decelerate global warming. There is an increasing demand for CCS sites. Nevertheless, there is a lack of knowledge of the environmental risk associated with potential leakage of CO2 from the storage sites; and even more, what happens when the seepage stops. Can the environment return to the initial equilibrium? Potential effects on native macrofauna were studied under a scenario of a 50-day CO2 leakage, and the subsequent leak closure. To accomplish the objective, Trondheim Fjord sediments and clams were exposed to an acidified environment (pH 6.9) at 29 atm for 7 weeks followed by a 14-day recovery at normal seawater conditions (pH 8.0, 29 atm). Growth and survival of clams exposed to pressure (29 atm) and reduced pH (6.9) did not significantly differ from control clams kept at 1 atm in natural seawater. Furthermore, bioaccumulation of elements in the soft tissue of clams did not register significant variations for most of the analysed elements (Cd, Cr, Pb, and Ti), while other elements (As, Cu, Fe, Ni) had decreasing concentrations in tissues under acidified conditions in contrast to Na and Mg, which registered an uptake (Ku) of 111 and 9.92 μg g−1dw d−1, respectively. This Ku may be altered due to the stress induced by acidification; and the element concentration being released from sediments was not highly affected at that pH. Therefore, a 1 unit drop in pH at the seafloor for several weeks does not appear to pose a risk for the clams.

Critical Role of Cytosolic DNA and Its Sensing Adaptor STING in Aortic Degeneration, Dissection, and Rupture.

Sporadic aortic aneurysm and dissection (AAD), caused by progressive aortic smooth muscle cell (SMC) loss and extracellular matrix degradation, is a highly lethal condition. Identifying mechanisms that drive aortic degeneration is a crucial step in developing an effective pharmacologic treatment to prevent disease progression. Recent evidence has indicated that cytosolic DNA and abnormal activation of the cytosolic DNA sensing adaptor STING (stimulator of interferon genes) play a critical role in vascular inflammation and destruction. Here, we examined the involvement of this mechanism in aortic degeneration and sporadic AAD formation. The presence of cytosolic DNA in aortic cells and activation of the STING pathway were examined in aortic tissues from patients with sporadic ascending thoracic AAD. The role of STING in AAD development was evaluated in Sting-deficient (Stinggt/gt) mice in a sporadic AAD model induced by challenging mice with a combination of a high-fat diet and angiotensin II. We also examined the direct effects of STING on SMC death and macrophage activation in vitro. In human sporadic AAD tissues, we observed the presence of cytosolic DNA in SMCs and macrophages and significant activation of the STING pathway. In the sporadic AAD model, Stinggt/gt mice showed significant reductions in challenge-induced aortic enlargement, dissection, and rupture in both the thoracic and abdominal aortic regions. Single-cell transcriptome analysis revealed that aortic challenge in wild-type mice induced the DNA damage response, the inflammatory response, dedifferentiation and cell death in SMCs, and matrix metalloproteinase expression in macrophages. These changes were attenuated in challenged Stinggt/gt mice. Mechanistically, nuclear and mitochondrial DNA damage in SMCs and the subsequent leak of DNA to the cytosol activated STING signaling, which induced cell death through apoptosis and necroptosis. In addition, DNA from damaged SMCs was engulfed by macrophages in which it activated STING and its target interferon regulatory factor 3, which directly induced matrix metalloproteinase-9 expression. We also found that pharmacologically inhibiting STING activation partially prevented AAD development. Our findings indicate that the presence of cytosolic DNA and subsequent activation of cytosolic DNA sensing adaptor STING signaling represent a key mechanism in aortic degeneration and that targeting STING may prevent sporadic AAD development.

SPONTANEOUS EPIDURAL BLEED: A DIRE COMPLICATION OF SICKLE CELL CRISIS

SESSION TITLE: Case Report Semifinalists 1 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Sickle cell disease (SCD) is caused by a single amino acid substitution on the beta globin chain resulting in the propensity of the hemoglobin molecule to polymerize in deoxygenated state. Neurologic manifestation secondary to SCD is common and affects almost 35% of patients. About 54% of these patients suffer from ischemic strokes and 34% from intracranial bleeding. Isolated non-traumatic spontaneous epidural hematoma (EDH) is an exceedingly rare complication of SCD. Other reported etiologies of spontaneous SDH are infectious, coagulation abnormalities associated with end stage renal disease and hemodialysis, dural metastasis and Langerhans cell histiocytosis. CASE PRESENTATION: A 20-year-old African American female with SCD presented with severe generalized pain. She was hypertensive, tachycardic, tachypneic with an oxygen saturation 98% on room air. Physical examination revealed poor bilateral air entry on lung auscultation due to splinting and a normal neurological examination. Blood work showed leukocytosis of 12,800 with 53% neutrophil and 1% band, hemoglobin 7.5 gm/dL, platelet 181,000/dL, reticulocyte count 13%, LDH 1144 IU/L. Liver function tests were normal except a total bilirubin level of 16.2 mg/dL. The patient was started on IV hydration, analgesia was achieved by IV narcotics. About 24 hours after hospital admission, the patient suddenly became unresponsive. An emergent CT scan of the head revealed a large right sided fronto-parietal epidural hematoma with midline shift, subfalcine and uncal herniation. No noticeable bone infarction overlying the hematoma. The patient underwent emergent hematoma evacuation but died 24 hours post-surgery. DISCUSSION: Spontaneous non-traumatic EDH is a rare manifestation of SCD. Only 30 cases have been reported in the literature. The pathophysiology is not completely understood. Three explanations have been proposed over the years. 1) Vaso-occlusion of the haematopoietically active calvarial diploic bone resulting in bone infarction and subsequent leaking of blood in the periosteal and subsequently epidural or in the subgaleal space 2) Acute rapid expansion of hematopoiesis with resultant microfracture of already thinned inner cortex and extravasation of blood and hematopoietic tissue 3) Sludging of sickle cells in the diploic veins hampering venous drainage and oozing of blood due to vascular injury and elevated back pressure.Presence of coagulopathy or platelet dysfunction is also likely responsible for hematoma expansion and worse clinical outcome. Overlying bony infarction is associated with better prognosis. CONCLUSIONS: The understanding regarding this rare disease entity is rapidly evolving in the era of advanced technology and improved awareness among health care providers. We believe this report will shed more light on the clinical as well as the pathophysiologic aspect of the disease process. Reference #1: Hettige S, Sofela A, Bassi S, Chandler C. A review of spontaneous intracranial extradural hematoma in sickle-cell disease. Acta Neurochirurgica. 2015;157(11):2025-9. Reference #2: Ohene-Frempong K, Weiner SJ, Sleeper LA, Miller ST, Embury S, Moohr JW, et al. Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood. 1998;91(1):288-94. Reference #3: Banerjee C, Yowtak J, Fridlyand D, Alleyne C, Jr. Acute spontaneous intracranial epidural haematoma and disseminated intravascular coagulation in a paediatric sickle cell patient. BMJ case reports. 2018;2018. DISCLOSURES: No relevant relationships by Hau Chieng, source=Web Response No relevant relationships by Boris Medarov, source=Web Response No relevant relationships by Biplab Kumar Saha, source=Web Response No relevant relationships by Aditi Saha, source=Web Response

Primary repair of duodenal injuries: a retrospective cohort study from a major trauma centre in South Africa.

The management of duodenal trauma remains controversial. This retrospective audit of a prospectively maintained database was intended to clarify the operative management of duodenal injury at our institution and to assess the risk factors for leak following primary duodenal repair. This was a retrospective study undertaken at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa. Operative techniques used for duodenal repair were recorded. Our primary outcome was duodenal leak in the postoperative period. Patients from January 2012 to December 2016 were included. All duodenal injuries were graded according to the American Association for the Surgery of Trauma (AAST) grading. Only patients who had a primary repair were included in the final analysis. During the five-year data collection period, a total of 562 patients underwent a trauma laparotomy; of which 94 patients sustained a duodenal injury. A primary pyloric exclusion and gastro-jejunostomy (PEG) was performed in three patients. These three were then excluded from further analysis. Of the 91 primary duodenal repairs, seven (8%) subsequently leaked. These were managed by PEG in three and by secondary repair and para-duodenal drainage in four. The two physiological parameters most associated with subsequent leak were lactate and pH level. There was a significantly higher mortality rate for those who leaked vs those who did not leak. Chi-squared test revealed a significant difference in the leak rate between AAST I (0%), AAST-II (1.6%) and AAST-3 (66.7%) grade injuries (p <0.01). The trend towards primary repair of duodenal injuries appears to be justified. However duodenal leak remains a significant risk in certain high risk patients and strategies to manage injuries in this subset requires further work.

Protection of the in-vacuum-operating straw chambers from vacuum penetration

Abstract In the past years, drift chambers with thin-wall tubes (straws) operating in high vacuum ( ∼ 10−5 mb) has become to be used in experimental studies of rare decays. Any drift tube of the operating chamber may suffer a mechanical or electrical damage and a subsequent leak. The complete failure of the tube is not excluded either. To protect the chambers against the above damage, we have developed and tested a relatively simple protection system based on uniquely designed energy-independent devices. If air-tightness is broken and gas starts leaking from the tube into the vacuum, they automatically cut off the gas flow on both ends of the damaged tube and disconnect it from the gas supply.

Routine Early Fluoroscopy and Clinical Observations Following Laparoscopic Roux-En-Y Gastric Bypass for Obesity Fail to Predict Subsequent Anastomotic Leakage

One of the most feared complications of Roux-en-Y gastric bypass is anastomotic leak; early identification of which is associated with reduced morbidity and mortality. Efforts to identify patients who may suffer from such leaks have focused around routine early fluoroscopy, post-operative blood tests and clinical signs. We aimed to assess the role of these factors in our patient cohort. A retrospective cohort analysis was performed in order to assess the sensitivity, specificity and negative/positive predictive values of routine early fluoroscopy, post-operative blood tests and clinical signs in predicting anastomotic failure. 108 patients were identified for whom 107 files were available. Leaks occurred in 4 patients (3.7%), none of whom were identified on fluoroscopy. Of the clinical signs and blood tests examined, only average heart rate was significantly different in the leak ground (94.5 versus 108.5 beats per minute, p = 0.02). Nevertheless, as with other measurements, a low positive predictive value was noted. Fluoroscopy in our cohort of patients was not useful in identifying subsequent anastomotic leaks. The low positive and high negative predictive value of clinical signs and routine blood tests means that stratifying patients who may benefit from fluoroscopy is also challenging. Therefore, identifying patients who will subsequently leak remains a challenge with a high index of suspicion remaining in the main technique used to identify leaks.