ABSTRACT
Primary tumours of the trachea are rare. Adenoid cystic carcinoma [ACC] constitutes less than 1% of these tumours. They occasionally masquerade as asthma. We are presenting a case of a young female, who had been treated for 3 years as asthma. She presented in emergency with severe respiratory difficulty, stridor and decreasing saturation of 85% on room air. Two weeks back, she had a CT scan in a local hospital, but they did not notify the tracheal mass. Her clinical picture and CT scan helped us diagnose the case. She was treated in emergency with primary resection of tracheal mass and anastomosis. The tumor was diagnosed as ACC. Postoperative recovery was uneventful. Continuity of the trachea was restored and adjuvant radiotherapy was given
ABSTRACT
Objective: To share experience about enteral nutrition via feeding jejunostomy in patients undergoing esophagectomies or for palliative purposes and compare our findings with similar studies. The objective of this study is to show the safety/viability of the procedure in patients undergoing esophagectomies and as a palliative procedure in inoperable CA esophagus
Study Design: Observational study
Place and Duration of Study: CMH Lahore and CMH Rawalpindi, from 2010 to 2016
Material and Methods: Feeding jejunostomy is a surgical technique for placement of a feeding tube into small intestine mainly for administration of nutrition. Our method was based upon Witzel jejunostomy technique with emphasis on early postoperative commencement of enteral nutrition and achievement of target caloric and protein requirement subsequently. A total of 439 patients who underwent feeding jejunostomy were included. These include patients suffering from any benign or malignant pathology for which esophagectomy was done and those patients who are suffering from inoperable carcinoma and underwent feeding jejunostomy for palliative purposes
Results: Result and price analysis shows that feeding jejunostomy is financially viable as per day nutrition cost for feeding via total parenteral nutrition [TPN] is Rs 8500 +/- 500 [including required daily labs] and for enteral its around 560 +/- 40 Rs/day. None of our patient was put on TPN and none suffered from malnutrition. Percentage of complications rendered were on par with the results from similar studies and meta-analysis
Conclusion: We conclude that feeding jejunostomy is financially viable with minimal complications, that justifies its use and its superiority over TPN
ABSTRACT
Objective: To evaluate clinical judgment in ruling out pneumothorax during the removal of the chest tube by auscultating the chest before removal and after the extubation of the chest tube in comparison to x ray radiological results
Study Design: Descriptive cross sectional study
Place and Duration of Study: Combined Military Hospital [CMH] Lahore Pakistan, from August 2015 to March 2016
Material and Methods: A sample size of 100 was calculated. Patients were selected via non probability purposive sampling. Children under 14 years were not included. The patients with mal-positioned chest tube, surgical site infection, air leak and the patients with more than one chest tube on one side were excluded. A proforma was made and filled by one person. Chest tubes were removed by two trained senior registrars according to a protocol devised. It was ensured that there was no air leak present before removal clinically and radiologically. Another chest x-ray was done within 24 hours of extubation to detect any pathology that might have occurred during the process. Any complication in the patient clinically was observed till the x-ray film became available. Two sets of readings were obtained. Set A included auscultation findings and set B included x ray results
Results: Out of 100 patients, 60 [60%] were males and 40 [40%] females. The ages of the patients ranged between 17-77 years. Mean age of the patient was 43.27 +/- 17.05 years. In set A out of 100 [100%] no pneumothorax developed clinically. In set B out of 100 patients 99 [99%] showed no pneumothorax on chest x ray, only 1 [1%] showed pneumothorax which was not significant [less than 15% on X ray]. However, the patient remained asymptomatic clinically and there was no need of reinsertion of the chest tube
Conclusion: Auscultatory findings in diagnosing a significant pneumothorax are justified. Hence, if the chest tube is removed according to the protocol, clinically by auscultation we can be sure that no significant pneumothorax developed during extubation, thus there is no need of x-ray after wards