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Bleeding from the site of a trocar insertion is a relatively frequent complication after laparoscopic surgery, despite precautionary techniques aimed at reducing such events. It may result in a hemoperitoneum, requiring emergency reintervention or large hematomas of the abdominal wall. In the latter case, although conservative treatment is possible, hospital stay is prolonged and large amounts of blood-bank resources are consumed. Early diagnosis and selective embolization of the bleeding vessel may reduce the severity and consequences of this complication. [ABSTRACT FROM AUTHOR]

Background: Endoscopic India ink marking techniques are often used for the intraoperative location of colonic polyps and early stage neoplasms. The aim of this study was to compare how effective this technique is compared with conventional localization methods, as well as its influence on the results of colorectal laparoscopy (LSCRC) for endoscopically advanced tumors. Methods: From January 2003 to January 2005, 47 patients with colorectal carcinomas were included in the study. In one group, lesions were localized preoperatively by endoscopic India ink tattooing (n = 21; tattooed group, TG), while conventional methods were used in the others (n = 26; non-tattooed group, NTG). Patients' perioperative clinical and pathoanatomical data were prospectively collected. Results: Both groups were comparable in age, sex distribution, American Society of Anesthesiologists (ASA) score, body mass index (BMI), technique performed, tumor size and proportion of patients who had previous abdominal surgery. Three patients presented ink spillage without clinical repercussions. Visualization of the correct resection site was higher in the TG (100% vs. 80.8%, P = 0.03). Operative time (147.3 ± 46.2 vs. 187.0 ± 52.7 minutes, P = 0.02) and blood loss (99.3 ± 82.8 vs. 163.6 ± 96.6 cc, P = 0.03) were lower in the TG. There were no differences between groups regarding peristalsis, introduction of oral intake, hospital stay or intra- and postoperative complication rates. No differences were observed amongst pathoanatomical data studied. Conclusions: Preoperative endoscopic tattooing is a safe and effective technique for intraoperative localization of advanced colorectal neoplasms, improving the operative results of LSCRC. [ABSTRACT FROM AUTHOR]

This study examined the effects of a large-scale flipped learning (FL) approach in an undergraduate course of Digestive System Diseases. This prospective non-randomized trial recruited 404 students over three academic years. In 2016, the course was taught entirely in a Traditional Lecture (TL) style, in 2017 half of the course (Medical topics) was replaced by FL while the remaining half (Surgical topics) was taught by TL and in 2018, the whole course was taught entirely by FL. Academic performance, class attendance and student's satisfaction surveys were compared between cohorts. Test scores were higher in the FL module (Medical) than in the TL module (Surgical) in the 2017 cohort but were not different when both components were taught entirely by TL (2016) or by FL (2018). Also, FL increased the probability of reaching superior grades (scores >7.0) and improved class attendance and students' satisfaction. The holistic FL model is more effective for teaching undergraduate clinical gastroenterology compared to traditional teaching methods and has a positive impact on classroom attendances. [ABSTRACT FROM AUTHOR]

Primary cutaneous mucormycosis is a deep fungal infection, mainly seen in diabetics and immunocomprornised subjects. Rapid diagnosis and therapy are necessary to avoid fatal outcome. We describe the complete histopathological and micro-biological studies of primary cutaneous mucormycosis in a 74-year-old man with several risk factors, such as chronic obstructive pulmonary disease, respiratory acidosis. hemolytic anemia. myelodysplastic syndrome and iatogenic diabetes, due to corticosteroid therapy. He developed two cutaneous necrotic scars on his left leg. Muconniycosis was suspected and specimens from surgical débridement were hisiopathologically and microbiological]y studied conlirmmning the clinical diagnosis. Amphoterkin B was given topically and intravenously resulting in complete healing of the ulcer. Risk factors and microbiological studies are compared with those in the current literature. It is necessary in certain cases to suspect mucormycosis infections in diahetics, immunocompromised subjects and even in healthy individuals. Rapid diagnosis and treatment are important, but they should be based on complete histopatholgical and microbiological studies, to establish the genus of the causal agent. [ABSTRACT FROM AUTHOR]