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The direct tactile assessment of surface textures during palpation is an essential component of open surgery that is impeded in minimally invasive and robot-assisted surgery. When indirectly palpating with a surgical instrument, the structural vibrations from this interaction contain tactile information that can be extracted and analysed. This study investigates the influence of the parameters contact angle α and velocity v→ on the vibro-acoustic signals from this indirect palpation. A 7-DOF robotic arm, a standard surgical instrument, and a vibration measurement system were used to palpate three different materials with varying α and v→. The signals were processed based on continuous wavelet transformation. They showed material-specific signatures in the time–frequency domain that retained their general characteristic for varying α and v→. Energy-related and statistical features were extracted, and supervised classification was performed, where the testing data comprised only signals acquired with different palpation parameters than for training data. The classifiers support vector machine and k-nearest neighbours provided 99.67% and 96.00% accuracy for the differentiation of the materials. The results indicate the robustness of the features against variations in the palpation parameters. This is a prerequisite for an application in minimally invasive surgery but needs to be confirmed in realistic experiments with biological tissues.

Introduction: Varicose veins of the lower extremities are one of the most common peripheral vascular diseases. A variety of treatments methods have emerged as an alternative to traditional surgery but are limited by their need for equipment and expertise which increases the cost of treatment making it unviable especially in rural India. Thus traditional surgery still forms the mainstay of treatment. Aims: To evaluate and compare the outcomes in patients undergoing Trendelenberg's procedure with stripping and without stripping of varicose veins. Materials and methods: The study comprised of 50 patients who were admitted with varicose veins. They were allocated into two groups of 25 each where they either underwent Trendelenberg's procedure with stripping or without stripping of varicose veins. The patients were followed up for six months to assess the efficacy of the procedure as per the parameters of the study. Results were analyzed using SPSS software. Percentages and proportions were used for qualitative data; mean and standard deviation were used for quantitative data. Chisquare test and student t test were applied where appropriate. Results: In the group undergoing stripping, 28% (7 of 25) patients developed hematoma, post operative pain scores on day 0,3,7 and 10 were 3.8±0.9, 2.6±0.7, 1.1±0.6 and 0.2±0.4 respectively. Mean post operative ambulation was achieved on 3.88 days and recurrence at 6 months was seen in 12% (3 of 25) patients. In the group undergoing ligation alone, 4% (1 of 25) patients developed hematoma, post operative pain scores on day 0,3,7 and 10 were 3.0±0.8, 1.6±0.8, 0.8±0.5 and 0.1±0.3 respectively. Mean post op ambulation was achieved on 2.16 days and recurrence at 6 months was seen in 20% (5 of 25) patients. Conclusions: With lesser rates of hematoma formation, better post operative pain scores and quicker ambulation in patients undergong ligation of veins alone, we conclude that Trendelenberg's procedure without stripping is a better procedure than Trendelenberg's procedure with stripping of veins in the treatment of varicose veins. [ABSTRACT FROM AUTHOR]

ABSTRACT: Isoniazid and rifampicin are used for management of tuberculosis. Acute poisoning due to isoniazid overdose is associated with repetitive generalized tonic-clonic seizures and severe metabolic acidosis. In toxic doses, rifampicin is known to produce hepatic, renal, hematological disorders, and convulsions. Sometimes, it may produce red man syndrome. We report a case of fatal poisoning with isoniazid and rifampicin. The case was characterized by late presentation, lactic acidosis, and renal failure. [ABSTRACT FROM AUTHOR]

Autosomal recessive distal renal tubular acidosis (dRTA) is associated with mutation in the ATP6B1 gene encoding the B1 subunit of H + -ATPase, one of the key membrane transporters for net acid excretion of α-intercalated cells of medullary collecting ducts. Sensori-neural deafness frequently accompanies this type of dRTA. We herewith describe a patient who had distinct features of dRTA with bilateral sensori-neural hearing loss and ATP6B1 mutation. This is a rare entity.

Chloroform, a halogenated hydrocarbon, causes central nervous system (CNS) depression, cardiac arrhythmias, hepatotoxicity, and renal failure. We describe a successful outcome in a case of chloroform ingestion with renal and hepatotoxicity with N-acetylcysteine (NAC) administration and hemodialysis support.

Incidence of acute kidney injury (AKI) in patients with pyogenic liver abscess is rare. In our study we found AKI in 32.6% of patients with liver abscess. Majority of the patients were in their fifties and sixties. As per acute kidney injury network trial criteria, renal failure was in stage 1 in 26.6%, stage 2 in 40%, and stage 3 in 33.3% of the patients. Dialysis support was needed in 26%. All patients except one recovered from AKI.