BACKGROUND:The purpose of this study was to evaluate the quality of information available on the internet to patients undergoing laparoscopic cholecystectomy.MATERIALS AND METHODS:The sources of information were obtained the keyword ‘laparoscopic cholecystectomy’, from internet searches using Google, Bing, Yahoo!, Ask and AOL search engines with default settings. The first 50 web links were evaluated for their accessibility, usability and reliability using the LIDA tool (validation instrument for healthcare websites by Minervation). The readability of the websites was assessed by using the Flesch Reading Ease Score (FRES) and the Gunning Fog Index (GFI).RESULTS:Of the 250 links, 90 were new links. Others were repetitions, restricted access sites or inactive links. The websites had an average accessibility score of 52/63 (83.2%; range 40-62), a usability score of 39/54 (73.1%; range 23-49) and a reliability score of 14/27 (51.6%; range 5-24). Average FRES was 41.07 (4.3-86.4) and average GFI was 11.2 (0.6-86.4).DISCUSSION AND CONCLUSION:Today, most people use the internet as a convenient source of information. With regard to health issues, the information available on the internet varies greatly in accessibility, usability and reliability. Websites appearing at the top of the search results page may not be the most appropriate sites for the target audience. Generally, the websites scored low on reliability with low scores on content production and conflict-of-interest declaration. Therefore, previously evaluated references on the World Wide Web should be given to patients and caregivers to prevent them from being exposed to commercially motivated or inaccurate information.

BackgroundUnprovoked superficial thrombophlebitis and subsequent venous thromboembolism are well-described albeit rare presenting features of advanced visceral malignancy that often manifest too late for curative intervention to be beneficial.Case PresentationWe present the first reported case of early gastric carcinoma presenting with these paraneoplastic phenomena in an otherwise healthy farmer. The early presentation allowed for a curative partial gastrectomy, which itself was complicated by the presence of a deep vein thrombosis extending into the inferior vena cava. Fortunately, stabilization of the clot allowed for surgery to proceed without the need for a caval filter. The patient was referred for adjuvant chemotherapy and has since made an excellent recovery.ConclusionsThis case provides new evidence for the presentation of superficial thrombophlebitis in early gastric carcinoma and the potential for curative surgery in such instances. A high index of suspicion and a prompt diagnostic workup are essential for timely planning and execution of surgery in these early albeit rare presentations.

No abstract

A 49-year-old man was diagnosed as HIV infected, with a CD4 count of 60 cells/µl. He was started on an antiretroviral treatment regimen comprising zidovudine, lamivudine and efavirenz. Following treatment, his CD4 count improved and the viral load was undetectable. He was subsequently found to have a moderately differentiated adenocarcinoma of the lower oesophagus.

A pre-tested interviewer-administered questionnaire was used to assess the adoption of laparoscopic approach by Sri Lankan surgeons who perform surgery for CRC. Data was collected prospectively from consecutive patients who underwent open and laparoscopic colorectal cancer surgery at the University Surgical Unit of the National Hospital of Sri Lanka from April 2016 to May 2019. The histopathology records were analysed to determine the longitudinal and circumferential resection margins (CRM) and the number of lymph nodes (LN) harvested. The resection margins were classified as positive or negative. The total number of LN examined was evaluated. Chi square was used to compare CRM and T test was used to compare the LN harvest. Of the 59 surgeons interviewed, only 11 (18.6%) performed laparoscopic colorectal cancer surgery although 51 (86.4%) performed cholecystectomy laparoscopically. A total of 137 patients were studied. 81 procedures were laparoscopic and 56 procedures were open. All patients had clear longitudinal resection margins. 51 patients(91%) in the open group and 78 patients in the laparoscopic group(96%) had clear CRM(p>0.05). A total of 2188 LNs (mean 15.9) were resected in all procedures. 689 lymph nodes were removed during open procedures(mean 12.3, SD 0.4) and 1499(mean 18.5, SD 0.6) were removed during laparoscopy(p<0.05).