Thoraco-laparoscopic management of diaphragmatic hernia of adults: a case series

Diaphragmatic hernia (DH) usually occurs in childhood; however, in adult it is uncommon. Most common aetiology of DH in adult is trauma while spontaneous DH is a rare entity accounting for <1%. The management is primarily surgical repair in the form of open or laparoscopic approach; the later has been associated with low morbidity, mortality and excellent long term outcomes with low rate of recurrence. In this case series, confirmation of the diagnosis was done by CT scan and by laparoscopy in all the patients; laparoscopic repair was performed in all the patients along with thoracoscopic aid in two cases. We found that minimal access techniques can be safely done in DH; in conditions when the herniated content are difficult to get reduced laparoscopically alone, a simultaneous thoracoscopy has helped in great deal in reducing the content and completing the procedure entirely by minimal access techniques. This gives all the advantages of minimally invasive approach like less postoperative pain, shorter hospital stay, quicker recovery and low recurrence rate; provided tissue repair is done in tension free manner by an experienced laparoscopic surgeon.

Drug utilization study in schizophrenia patients in outpatient department of psychiatry: an observational prospective study

Background: A mental disorder or psychiatry disorder is a behavioural or mental pattern that causes significant distress or impairment of personal functioning. Schizophrenia is one of the most common psychiatric disorders. Aim of the study is to study drug utilization pattern in schizophrenia patients in outpatient department of psychiatry.Methods: A prospective and observational study was conducted in psychiatry outpatient department between May 2018 to October 2018 at Government Medical College and Hospital Aurangabad. Approval from ethics committee was taken. Data collected was of age, sex, final diagnosis, drugs prescribed to patients from case report form. The data obtained was then analyzed in Microsoft excel.Results: Total prescriptions of 129 patients were analyzed. Out of 129 patients 99 (76.74%) were male, while 30 (23.26%) were female. The mean age of the patients admitted in Psychiatry OPD was 36.71±11.76 years. Number of drugs prescribed per patient being 3.40±1.12 (mean±SD). The most common drugs used were olanzapine (66.6%), trihexyphenidyl (51.9%), lorazepam (44.9%), risperidone (39.5%), trifluoperazine (27.9%).Conclusions: Our study shows that atypical antipsychotics were the most common drugs prescribed in patients. Olanzapine was the most common medication used followed by risperidone. Our prospective study is carried out to get a more comprehensive data so that we can improve the drug utilization in our hospital.

Dieulafoy lesion in mid-esophagus with esophageal varices.

Dieulafoy lesion is an uncommon cause of gastrointestinal (GI) bleeding. Most such lesions are reported in the stomach, though a few have been reported in the distal esophagus. We report a 54-year-old man who presented with upper GI bleeding and had esophageal varices but bled from a Dieulafoy lesion 5 cm above the proximal end of the varices.

Mucosal melanomas of the upper aerodigestive tract.

Mucosal melanoma of the upper aerodigestive tract is a rare disease with a relentless inexorable course. This lesion involved the nasal cavity, maxillary sinus and palate in two cases each all of whom underwent a radical excision. The disease did not respond to radiotherapy in two patients with nasopharyngeal involvement. One other patient died of distant metastasis within five weeks of diagnosis. Despite surgery offering variable disease free periods, the prognosis remains guarded.