Occult papillary carcinoma of thyroid presenting as cervical lymphadenopathy in a young male: case report

Papillary carcinoma of thyroid accounts for 80% of all thyroid malignancies. They tend to have a female preponderance and present in the 4th to 5th decade of life, as a slow growing midline mass. Cervical metastases are common, blood borne being rare. We present a case of a 29 years old who presented with cervical lymphadenopathy that was secondary to an occult papillary carcinoma of thyroid. Patient underwent total thyroidectomy with bilateral neck node dissection for the same.

Adult idiopathic hypertrophic pyloric stenosis: an infrequent cause of gastric outlet obstruction

Hypertrophic pyloric stenosis is a congenital disease, presenting within two weeks of birth. However adult idiopathic hypertrophic pyloric stenosis (AIHPS) presents in middle age, predominantly in males and usually without any antecedent cause. Secondary variant may be due to intra gastric causes or extra gastric post-operative adhesions. Patient presents with symptoms of gastric outlet obstruction. Diagnosis depends on clinical, radiological and endoscopic findings. Treatment is subtotal gastrectomy. Pyloroplasty and endoscopic dilatation may be tried in debilitated patients. We present a case of AIHPS presenting as gastric outlet obstruction in a 16 year old female, that was surgically managed with an antrectomy.

Comparison of caudal dexmedetomidine and fentanyl combined with bupivacaine in pediatric patients undergoing urogenital surgery

Introduction: Caudal epidural block is one of the most popular, reliable, and safe techniques in pediatric patients that can provide analgesia for a variety of supra- and infra-umblical surgical procedures. This study aimed to compare the efficacy of dexmedetomidine-bupivacaine, fentanyl-bupivacaine mixture and bupivacaine alone on duration of postoperative analgesia, sedation, emergence agitation, duration of sensory and motor block, hemodynamic stability and side effects

Methodology: After approval from ethical committee 90 pediatric patients of age 2-7 y were enrolled. The children were randomly allocated to three equal groups of 30 each using a computer generated randomization list. Caudal block was given after induction of general anesthesia for urogenital surgery. General anesthesia was maintained with sevoflurane at a concentration adjusted to maintain BIS between 40-60. Hemodynamic parameters, Pediatric Anaesthesia Emergence Delirium [PAED] score, Richmond agitation sedation scale [RASS], and Children's Hospital of Eastern Ontario Pain Scale [CHEOPS] were recorded immediate postoperatively and then regularly every hour for the next 12 hours

Results: PAED score was less in group BD than group B and BF from baseline. RASS Score was less in Group BD than Group BF from base line to 12 h except at 240 min and Group BF is less than Group B from base line to 12 h. Group BD was less than B from base line to 12 h. CHEOP score was less in Group BD than Group BF and Group B from base line to 12 h

Conclusion: Dexmedetomidine [1 micro g/kg] added to bupivacaine in caudal block increases the duration of postoperative analgesia, provides arousable sedation, and decreases emergence delirium with stable hemodynamics and minimal side effects in pediatric patients

comparative study of intraperitoneal ropivacaine and bupivacaine for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled trial

Introduction: Laparoscopic cholecystectomy is now the gold standard for treatment of symptomatic gallstones. After this surgery patients suffer visceral and shoulder pain secondary to peritoneal insufflation. Use of intraperitoneal and port site instillation of local anaesthetics has been used to reduce postoperative pain and decreases the need for intravenous opioids. Studies regarding comparison of intraperitoneal use of ropivacaine and bupivacaine to reduce postoperative pain are few. This study compared the efficacy of ropivacaine and bupivacaine in reducing postoperative pain after laparoscopic cholecystectomy

Methodology: After ethical committee's clearance and informed consent 100 patients with symptomatic cholelithiasis, aged 20-70 years, of either gender, ASA status I to III and within +/- 20% of ideal body weight, scheduled for laparoscopic cholecystectomy were included. Patients were randomized into two groups with 50 patients in each group. Group-B: Patients received 0.5% bupivacaine in a dose of 2 mg/kg diluted in normal saline to make a solution of 50 ml. Group-R: Patients received 0.75% ropivacaine in a dose of 2 mg/kg diluted in normal saline to make a solution of 50 ml. Drug was instilled intra-peritoneal through in situ placed infra-umbilical trocar before extubation. NIBP, HR, SpO[2], VAS, verbal rating scale [VRS] and rescue analgesia were recorded immediately postoperatively and then regularly every hour for the next 12 hours

Results: HR, SBP and DBP were comparatively lower in Group-R than in Group-B. The VAS score was significantly lower in Group-R from postoperative 5[th] hr to 12[th] hr. Rescue analgesia was given when VAS was > 40. VRS score was significantly lower in Group-R from postoperative 7[th] hr, showing longer duration of analgesia in this group. The rescue analgesia requirement was also less in Group-R

Conclusion: We conclude that the instillation of bupivacaine and ropivacaine intraperitonelly is an effective method of postoperative pain relief in laparoscopic cholecystectomy. It provides good analgesia in immediate postoperative period with ropivacaine providing longer duration of analgesia

Elbow dislocation with ipsilateral diaphyseal forearm bone fracture: A rare injury report with literature review / 中华创伤杂志(英文版)

Dislocation of the elbow along with shaft fractures of both bones of the ipsilateral forearm is a rare injury though elbow dislocation or fracture of the forearm bones may occur separately. Such injuries need a concentric reduction of the dislocation and an anatomical fixation of forearm bones for optimal functional outcomes. We report a case of elbow dislocation with fracture of the lateral condyle of the humerus along with fractures of shafts of the radius and ulna in a 44-year-old female. Closed reduction of the elbow and operative stabilization of all fractures were done with good clinical, radiological and functional outcomes in 2 years follow-up period. A significant degree of force is needed to produce a combined dislocation of a joint and fracture of bones around that joint and these complex injuries may be missed if the clinician is not aware of the possibility of such injuries. The fact that the previously reported cases had a posterolateral dislocation while our case had a posteromedial dislocation and a fracture of the lateral humeral condyle as well makes it unique in its presentation and worth reporting. We have also included an up to date literature review on this topic.

Bilateral central acetabular fracture dislocation in a young patient due to seizure activity: a case report and review of the literature / 中华创伤杂志(英文版)

Various musculoskeletal injuries are well known complications of epilepsy either because of direct trauma or because of unbalanced forceful muscle contraction. We report a case of non-traumatic bilateral central acetabular fracture dislocation due to seizure activity induced by neurocysticercosis of the brain, which was managed conservatively and obtained reasonable good outcome. This case highlights the importance of proper evaluation in young non-osteoporotic patients who have experienced an epileptic attack without any previous history. It is also imperative to mention that these patients should be thoroughly examined neurologically to find out the exact etiology and should be treated accordingly to prevent future seizure activity.

Iatrogenic brachial artery injury during anterolateral plating of humeral shaft fracture / 中华创伤杂志(英文版)

There are several well defined indications for surgical management of humeral shaft fractures. Operative procedures on the humerus are associated with their own complications. Iatrogenic brachial artery injury as a complication of humeral shaft plating has not been reported previously. We report a case of a 48 years old female, who received operation at a district hospital and was referred to us when the surgeon could not palpate the pulse. CT angiogram showed that there was segmental non-opacification of the brachial artery. There was distal reformation and the thrombosis was decided to be managed conservatively. We believe that the arterial injury was a result of improper surgical technique and the segmental block might be due to improper use of plate holding forceps. This case report makes us aware of a rare complication of operative management of humeral shaft fractures and that basic principles of surgery must be always followed to prevent such injuries.