ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.

Subcoracoid acromioclavicular joint dislocation (Rockwood type VI) sustained in motorcycle crash: A case report

We present the case of a young male who sustained a rare acromioclavicular joint (ACJ) injury during a road traffic accident. A left-sided ACJ injury was identified on plain radiographs fourteen days following a motorcycling accident during which significant distracting injuries were sustained. Owing to persistent shoulder pain during awake tertiary surveillance, repeat shoulder plain radiographs were obtained, along with re-examination of the patient's index computed tomography (CT) shoulder imaging, indicating a grade VI left-sided acromioclavicular subluxation. The patient underwent operative management of the above injury at three weeks, with initial examination under anesthetic revealing a stiff shoulder joint significantly limited external rotation requiring extensive release of fibrosis. The left ACJ was reduced under anesthesia, being temporarily secured with Kirschner wire insertion. A Synthes locking distal tibial "L" plate was contoured and applied across the AC joint, and secured with locking screws. Intensive post-operative physiotherapy resulted in an significantly improved post-operative range of motion in the patient's left shoulder. Acromioclavicular joint injuries, commonly shortened to ACJ injuries, are most regularly traumatic in etiology, ranging in severity from mild sprain to complete joint disruption. ACJ injuries are classified according to the position of the clavicle with respect to the acromion and coracoid. The above case highlights the requirement for comprehensive tertiary surveillance of trauma patients both pre and postextubation, in order to identify such injuries that may require prompt surgical management in order to restore range of motion and function in affected joints.

Effect of Temperature on Attachment, Development, and Interactions of Pasteuria penetrans on Meloidogyne incognita

The effect of temperature (10, 20, 25, 30, and 35 C) on attachment and development of Pasteuria penetrans on Meloidogyne arenaria race 1 was elevated in growth chambers. The greatest attachment rate of endospores of P. penetrans occurred on second-stage juveniles at 30 C. The bacterium developed more quickly within its host at 30 and 35 C than at 25 C or below. The development of the bacterium within the nematode female was divided into nine recognizable life stages, which ranged from early vegetative thalli to mature sporangia. Mature sporangium was the predominant life stage observed after 35, 40, 81, and 116 days at 35, 30, 25, and 20 C, respectively. The body width and length of M. arenaria females infected with P. penetrans were smaller initially than the same dimensions in uninfected females, but became considerably larger over time at 25, 30, and 35 C. This isolate of P. penetrans also parasitized and completed its life cycle in males of M. arenaria.

[Malaria introduced into Switzerland from 1974-1976]

In recent years there has been an increase in imported tropical diseases in Switzerland. Travellers to the tropics are often inadequately or not at all informed about the dangers and possible prophylaxis of infection. This is true for malaria, of which 207 cases covering the years 1974 to 1976 are studied. Most involved were people between 21 and 30 years old. The main infections (71%) come from African countries. Plasmodium falciparum was found somewhat more frequently than P. vivax. Only a seventh of those infected took chemoprophylaxis regularly. Very many took irregular prophylaxis, while scarcely a third ever took an antimalarial drug. All the severe cases were in this group. A review is conducted of aspects of malaria in Switzerland, a country where the disease is not endemic. However, as it can be brought in at any time from tropical areas, it must be considered in the diagnosis of various clinical pictures. As the characteristic course of the fever is rare and onset of the disease often follows later than a month after the return from the infection area, malaria is only recognized late. The diagnosis is nevertheless relatively easy if the possibility of malaria is borne in mind.