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Abstract:Introduction: About 70% of discrete thyroid swelling is clinically "isolated" and 30% are dominant. In

The development of an incisional hernia is a common complication of midline laparotomy. Improper fascial closure techniques have a significant role in its development. It can also lead to poor wound healing and increase the risk of developing surgical site infections (SSI). Upon conducting a thorough literature review, various studies have been conducted on closing abdominal wounds. However, there is a dearth of studies portraying the role of suture length in the prevention of incisional hernia and SSI. The effect of using a greater suture-to-wound length ratio on postoperative outcomes was not clearly analyzed or described. The objective of this study is to assess the effectiveness of using a suture length to wound length ratio ≥4:1 versus a ratio <4:1 in preventing postoperative complications such as incisional hernia and SSI.This study is a systematic review of randomized controlled trials on abdominal wound closure using a suture length to wound length ratio of ≥4:1 and <4:1. published in PubMed, Google Scholar, and Cochrane library. The inclusion and exclusion criteria were defined. The relevant studies identified from 1991 to 2017, were included in the analysis. The primary endpoint was the incidence of incisional hernia, and the secondary outcome was the incidence of SSI.This meta-analysis considered five randomized controlled trials that compared the effects of using different suture length to wound length ratios during abdominal closure on incisional hernia and SSI. Participants ranged in size from 100 to 363. The trial follow-up period ranged from a minimum of 10 months to five years. The outcomes studied in the two groups were incisional hernia and SSI. The relative risk of the occurrence of incisional hernia if the suture length to wound length ratio was ≥4:1 was 0.42 with a p-value of <0.001 which was considered significant. This implied that using a suture length of more than four times that of the wound i.e., 4:1, significantly decreases the risk of developing an incisional hernia by more than half. The relative risk of developing a SSI was 0.98 with a p-value of 0.966. Thus, this method of abdominal closure uing a longer suture length to wound length ratio does not contribute to an increased incidence or significant change in the risk of developing SSI.

A single intraperitoneal injection of cadmium acetate induced histopathological changes in liver viz., dilatation of central vein, Kupffer cells hyperplasia, feathery degeneration of hepatocytes and foci of necrosis. These findings suggest that cadmium might have produced deleterious effect on this organ.Cadmium has been described to be associated in various pathological conditions viz., hepatic and renal dysfunction, growth inhibition, anemia and changes in plasma protein level and proteinuria)1-4) In cadmium intoxication, regardless of the administrative route, the largest quantity has been observed to accumulate in the liver and kidney, which results in interlobular hepatic and interstitial renal fibrosis.2,4-6) All these disorders of liver had been reported after chronic exposure. But very little work has been performed on the acute phase of the metal.7) Recently, hepatic lesions have been described in squirrels after 24 hours of cadmium injection.8) In the present study hepatic lesions have been recorded during first week of cadmium acetate treatment in common Indian ground squirrel (Funambulus pennanti, Wroughton). The body weight of control and treated squirrels both revealed increase due to cadmium intoxication, although differently. The cadmium treated animals increased in body weight slowly than controls ( Fig. 1). After one day of cadmium injection, the central vein dilatation and some cloudy swelling of hepatocytes were well pronounced.Whereas, after three days of treatment cloudy swelling and feathery degeneration of hepatocytes and a few foci of necrosis were significant. Five days after intoxication all these changes were more pronounced and several foci of necrosis in the vicinity of dilated central vein were clearly observed (Fig. 2). After seven days all these alterations were exaggerated and portal triaditis also set in. However, the architecture of liver remained normal throughout. The cloudy swelling of hepatocytes was observed as early as first day after administration of intraperitoneal cadmium and was more marked after passage of exposure time. This degeneration appeared to have represented some sort of water and protein disturbance in hepatocytes.Kawai and Kimura also reported gradual development of generalized cloudy swelling of the proximal convolution of tubules during first week after a single injection of cadmium chloride in rabbits.13) Cadmium has been found to combine with a protein of low molecular weight, may be metallothionein14,15) and this lesion may be taken up a consequence of cadmium binding to protein of hepatocytes. The hepatocytes revealed feathery degeneration after different intervals. The distribution of cadmium in different parts of liver has been described both after acute16,17) and chronic exposures.18) These studies suggested that cadmium is either equally distributed in the different parts of liver lobules or concentrated in the periphery of the lobules. Feathery degeneration of hepatocytes in the present study seems to be in agreement with the former. This lesi...

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