Gossypiboma: To Err is Human – A Case Report

Gossypiboma (retained surgical sponge) is one of the identities that can be a disaster not only to the carrier of operating surgeon but also for the hospital as far as the financial burden and the reputation is concerned. The patient may have severe morbidity and in worst of the event can have mortality. The aim of this article is to highlight the fact that the incidence is not as rare as has been reported in different literatures and to discuss its various –clinico-radiological features, predisposing factors, measures to avoid it and how to manage when such a calamity has occurred. This article increases the awareness about the problem thus avoiding unnecessary morbidity/mortality to the patient as well as save the surgeon from malpractice law suits, great psychological trauma and negative publicity.

Intraperitoneal Drainage Under Local Anaesthesia In Patients Of Perforation Peritonitis Before Definitive Management: Is It Justified?

Introduction: Perforation peritonitis is one of the most frequently encounter surgical emergency around the world. In spite of advances in diagnosis, antimicrobial therapy, surgery, it remains a fatal affliction with high mortality rate. This high mortality rate makes way for innovation in techniques in addition to the persisting knowledge for a better outcome. Aims: A pilot study was conducted, to evaluate the efficacy of intraperitoneal drainage in patients of perforation peritonitis during the resuscitation period before definitive surgical treatment. Methods: This was a prospective control study, conducted on the patients of perforation peritonitis with gastro-intestinal perforation for a period of 2 years w.e.f. January, 2011 to November 2012. 100 patients were included in this study and were divided into two groups (50 each). Group I- patient with preoperative intraperitoneal drainage under local anaesthesia, group II- patient without preoperative intraperitoneal drainage, before definitive surgery. Results: The overall morbidity and mortality of the patients in group-I were comparable with those in group-II Conclusion: Intraperitoneal drainage under local anaesthesia, in patients of gastrointestinal perforation peritonitis seems to be effective in decreasing morbidity and mortality.

Severe laryngospasm following LMA removal: Questionable role of symptomatic treatment for Upper Respiratory Infection: A case report.

We present a case of life threatening laryngospasm following LMA removal in an asymptomatic infant with past history of watery nasal discharge, relieved of his symptoms by nasal drops. Child was operated for hernia under general anaesthesia with spontaneous ventilation on LMA with an uneventful intra-operative course.

Evaluation of Anti-inflammatory activity of Qurs-e-Mafasil Jadeed.

With an increased incidence of drug toxicity and resistance to allopathic drugs, plant drug formulations could be an interesting alternative. Some plant drugs and phytochemicals are known to be anti-inflammatory properties, and can be of great significance in treatment of inflammatory disorders. These considerations require the scientific evaluation of the most important and commonly used traditional herbal formulations. A study has been done to find anti-inflammatory activity of Qurs-e-Mafasil Jadeed containing Colchicun luteum, Curcuma longa and gum of Acacia Arabica. In this proposed work 2 % aqueous suspension of qurs/tablet powder in gum acacia was used to determine its anti-inflammatory activity by carrageenin induced oedema test and cotton pellet induced granuloma test. Efficacy of this Unani formulation was compared with standard referent drug, Diclofenac sodium. The obtained results using carrageenin oedema test showed decrease in left hind paw volume significantly after 3 hours of carrageenin injection. In cotton pellet induced granuloma test, animals in all the test and standard drug tested groups, shows reduction in granuloma formation significantly. Thus, our results clearly indicate that this test formulation possesses significant anti-inflammatory activity in both acute and sub-acute phase.

Clinicopathological profile of carcinoma of oesophagus at Aligarh.

Forty-seven patients with oesophageal carcinoma were managed in 6 years' time. Average duration of illness was 5.5 months. History of chronic smoking and/or tobacco chewing was present in 80.85% of patients. Carcinoma included squamous cell variety (80.85%) and adenocarcinoma (19.15%). Thirty-one patients were in stage III while 16 patients were in stage II. Surgery included oesophagogastrectomy/oesophagogastrostomy (16 patients), feeding gastrostomy (11 patients), Mousseau-Barbin tube insertion (10 patients), only 10 patients were subjected to palliative radiotherapy. All patients after palliative treatment died within one year whereas 3-year and 5-year survivals after oesophagogastrectomy/oesophagogastrostomy were 68.75% and 31.25% respectively. Local lymph node metastasis adversely affected the 5-year survival rate.

Hepatitis in patients with surgical complications of pulmonary tuberculosis.

During last six years, 2250 patients were treated in Cardiothoracic Unit for thoracic complications of pulmonary tuberculosis. During isoniazid/streptomycin/ethambutol treatment, 2 patients out of 710 (0.28%) developed hepatitis. During isoniazid/rifampicin/ethambutol therapy, 18 patients out of 1540 (1.17%) suffered from jaundice; all these patients were above 30 years of age, and many had gross anemia (Hb less than 9 gm%), hypoalbuminemia (less than 3 gm%) and radiologically far-advanced disease in comparison to those who did not develop jaundice (p less than 0.05). Jaundice subsided completely after discontinuation of isoniazid and/or rifampicin which were re-instituted successfully after recovery without recurrence of hepatitis. It is suggested that the development of hepatitis does not warrant total withdrawal of these two highly effective bactericidal drugs but they should be tried again cautiously after recovery from jaundice.

Cholecysto-cardiac link.

Thirty normotensive patients (ASA class I) and 30 treated hypertensives without any cardiac problem (ASA class II) were subjected to elective cholecystectomy under general anaesthesia. Patients' age ranged from 25-50 yr, and male:female ratio was 1:11. There were significant increases in heart rate and mean arterial pressure in both the groups (P less than 0.05) during surgical manipulations for removal of the diseased gall bladders. The alterations in the treated hypertensive patients were not only much more than in the normotensives, but also were associated with tachyarrhythmias in 33.33 per cent of hypertensive patients. All changes returned to the pre-induction level at the end of the surgery. Mediation through fifth thoracic spinal segment, a common source of sympathetic supply to heart and gallbladder, explained the observed cholecystocardiac link. Anaesthetists therefore need to be vigilant during cholecystectomies.

Conservative management of flail chest.

A total of 100 cases of flail chest were studied to find out the efficiency of the anti-lung contusion regimen containing a diuretic, a steroid and an enzyme preparation for some 10 days, along with pad and strapping. There were 80 males and 20 females. Majority (71%) of patients were between 16 and 45 years. Road side accident was the commonest cause, present in 65% cases followed by bull horn injuries (25%), fall from a height (8%) and gun shot injuries to chest (2%). Associated intrathoracic and extrathoracic injuries were recorded in 45% and 30% cases respectively and they were treated according to their merits. There were 11 deaths with an overall success rate of 89%.

Prospective study of changes in serum calcium after diethyl-ether anaesthesia.

Changes in serum calcium after diethyl-ether anaesthesia given for various routine surgical operations, were studied in 30 patients. Mean (+/- SD) concentration (mg%) of serum calcium before induction of anaesthesia was 10.37 +/- 0.77. Serum calcium decreased by 0.05 per cent after 10 min of induction and by 3.33 per cent at the end of anaesthesia which was highly significant (P less than 0.001). There was a correlation (r = 0.63; P less than 0.01) between decline in serum calcium and duration of ether anaesthesia. Serum calcium returned to near normal levels after 24 h of ether anaesthesia. In view of the fall in serum calcium, it is emphasized that ether should be either avoided in patients with known or suspected hypocalcaemia or be used for as short a time as possible with due precaution and calcium supplementation.

A new role of bronchofibrescope in the removal of unusual intrapleural foreign bodies.

Successful removal of unusual intrapleural foreign bodies (surgical blades) by means of a bronchofibrescope (BFS) passed through the thoracostomy tube tract is reported. The potential role for the use of the fibreoptic bronchoscope for this purpose is emphasized.

Tooth in the bronchus--an unusual foreign body and presentation.

Tooth in right bronchus in a 60-year-old man who presented with recurrent episodes of chest infection, dyspnoea and haemoptysis is a rare clinical entity. The patient was cured after successful bronchoscopic removal of the tooth.

Corrosive pyloric stenosis--a report of two cases.

Two unusual cases of post corrosive pyloric stenosis in adults are reported. Both the cases were diagnosed clinically and confirmed by barium meal examination. Patients were discharged following anterior gastrojejunostomy. Follow-up examination did not reveal any problem. However, both of them are undergoing regular dilatation for the associated oesophageal stricture.