External dacryocystorhinostomy conventional surgery versus Pawar implant: A comparative study

Purpose: External dacryocystorhinostomy (DCR) surgeries are cost-effective with excellent success rates. The present study was designed to compare the safety and efficacy of conventional external DCR versus external DCR using Pawar silicone implant in chronic dacryocystitis. Methods: This is a prospective, comparative, interventional case series over a period of 18 months with patients managed by external DCR surgery with and without Pawar implant. Institutional review board approval was obtained before the study. The success of the surgery was objectively measured by sac patency on syringing at the last follow up. Results: A total of 65 patients with chronic dacryocystitis were included in the study. The mean age of patients in the series was 41.43 years (median, 41 years; range, 12 years-60 years). All patients presented with epiphora (100%) and underwent external DCR and were chosen for conventional surgery (n = 33, 51%, group 1) or Pawar silicone implant surgery (n = 32, 49%, group 2) on a random basis. The mean duration of the surgery from the time of skin incision to skin closure for group 1 was 27.7 minutes (median, 26 minutes; range, 21-30 minutes) while in group 2, it was 75.5 minutes (median, 75 minutes; range, 60-88 minutes), which was statistically significant (P < 0.01). The success rate of the procedure done in group 1 was 90% which increased to 97% after the management of failed cases as compared to the success rate in group 2 of 91% and 94%, before and after the management of failed cases, respectively. Conclusion: External DCR using Pawar implant is a safe surgery which is faster than conventional external DCR with almost equal success rates between both the procedures.

Efficacy and Safety of Tubeless Percutaneous Nephrolithotomy versus Standard Percutaneous Nephrolithotomy.

Introduction: We conducted a prospective study of tubeless percutaneous nephrolithotomy (PCNL) in selected patients and compared it with standard PCNL among patients with similar inclusion criteria and evaluated the efficacy and safety of tubeless PCNL over the standard PCNL. Methods: Between December 2009 and December 2011, a total of 298 patients underwent PCNL. 40 patients with stone size <2 cm underwent PCNL. In 20 patients, nephrostomy tube (N) was placed, and in another 20 patients, a exteriorized ureteral stent was placed and did not undergo nephrostomy (NN) (tubeless). These two groups were compared regarding the duration of hospital stay, post-operative pain, analgesic duration, complications, and estimated blood loss - hemoglobin (Hb) drop in g% (before and after PCNL). Results: Out of the 40 patients in the study, there were 13 (32.5%) females and 27 (67.5%) males. 7 patients (17.5%) had stones in calyx, 18 (45%) in pelvis, 3 (7.5%) in pelvi-ureteric junction, and 12 (30%) ureter. The mean age of patients was 41.3 year (7-55 years). The average size of stone was 14.38 ± 4.02 mm. The duration of procedure of all patients was 50.13 ± 15.34 min. The duration of the procedure, visual analog pain score, duration of analgesia use, the length of hospital stay, and drop in Hb and found that in patients who underwent tubeless nephrolithotomy it was 38.5 ± 7.8 min, 2.3 ± 0.5 cm, 2.6 ± 0.5 days, 3.5 ± 0.8 days, and 0.3 ± 0.4 g%, respectively. Whereas it was 61.8 ± 11.7 (P < 0.0001), 3.7 ± 1.1 (P < 0.0001), 4.4 ± 0.9 (P < 0.0001), 0.3 ± 0.4, and 0.5 ± 0.5 (P = 0.13), respectively, in patients undergoing standard nephrolithotomy. One patient developed fever in each group. Conclusion: In properly selected patients, tubeless PCNL with only an externalized ureteral catheter demonstrates significant advantages over standard PCNL regarding post-operative discomfort, morbidity, hospital stay, and period of analgesia requirement. In near future, tubeless PCNL with externalized ureteral catheter can be recommended as a standard of care in the management of selected cases of renal calculi.

Unusual complications of empyema thoracis: diaphragmatic palsy and Horner's syndrome.

We report here a 3 month old child with empyema thoracis, who developed complications of diaphragmatic palsy and Horner's syndrome. These complications of empyema thoracis have not been reported earlier. We discuss the possible mechanisms for these complications.

Brain abscess due to Entamoeba histolytica.

A patient of cerebral amoebiasis due to Entamoeba histolytica with no evidence of disease elsewhere is described. He made a complete recovery after surgical excision of the abscess along with metronidazole therapy.

Severe acute respiratory syndrome (SARS).

Several cases of life threatening respiratory disease with no identifiable cause were reported from Guangdong Province, China; these were soon followed by reports from many other countries. The disease was named as severe acute respiratory syndrome (SARS). A novel coronavirus, isolated from the respiratory secretions of patients, has been implicated in the causation of SARS. The modes of transmission include droplet spread, close contact, and Fomites; shedding of virus from respiratory tract is the primary mode of transmission. SARS clinically presents with high-grade fever, chills and rigors, myalgia, headache, cough with or without sputum production, dyspnea, and dizziness. Chest radiographs reveal unilateral or bilateral, predominantly peripheral, areas of consolidation progressing with in a short time of bilateral patchy consolidation. Preliminary reports suggest a milder illness in young children. The case definition of probable SARS cases, laboratory investigations and precautions for prevention of spread are discussed.