Q) THE vs TTE which is not true? ( Question asked in all AIIMS and INI exams since 2017)
a) Leak rates are more with TTE
b) Pulmonary complication is more with TTE
c) Side to side stapler anastomosis has less leaks than open two layer suturing
d) THE can be done through minimally invasive surgery
Pulmonary complications 57% with TTE 27% with THE ( SKF 409)
Anastomotic leak 16% TTE and 14% THE ( not significant) subclinical leak slightly more in THE
Option D is correct
Cardiac complications, Vocal cord paralysis , wound infection, chyle leak are all more with TTE
Blackmon et al. published a propensity-matched analysis comparing outcomes between side-to-side stapled anastomosis, end-to-end circular stapled anastomosis, and handsewn,
with no significant difference in leak rate noted. ( SKF page 475)
For patients with disease confned to the thyroid, total thyroidectomy is recommended to remove all C cells with elective dissection of the central neck nodes. If there is evidence of nodal metastases, gross
disease should be remove
Q) Newborn with abdominal distension on day 2, not passed meconium. There is absent anal orifice. WHat is the next step? # NEET SS 22
a) Cross table X ray
d) Sigmoid colostomy
Ans a) Cross table X ray
1st step in such cases Rule out congenital abnormalities of spine, sacrum , kidney heart etc
2nd step Cross table x ray If it shows Perineal fistula do ANoplasty, If x ray shows rectal gas below coccyx do PSA RP with or without colostomy, If it shows gas above coccyx with associated defects do colostomy
Butyrate For the fermentable complex carbohydrates available, colonic flora produce short-chain fatty acids (SCFAs).
Butyrate, an SCFA, is the principal source of nutrition for the colonocyte.
Mammalian cells do not produce butyrate, the colonic epithelium and luminal bacteria form an essential and elegant symbiotic relationship.
Antibiotics disrupt this cohabitation—decreased bacteria leads to less butyrate, which, in turn, negatively affects colonocyte function leading to diarrhea.