Stevens Johnsons Syndrome following Intravenous Vancomycin use: A Case Report.

Stevens –Johnsons Syndrome (SJS) is a rare autoimmune condition usually affecting the skin and mucus membranes. Stevens-Johnson syndrome is a minor form of toxic epidermal necrosis, with less than 10% body surface area (BSA) detachment. Various factors are notoriously known to cause this serious condition like medications, infectious and immunecompromised states, etc. We report the case of a 3 year girl with right sided pyothorax developing SJS during the course of her treatment and our subsequent management.

Post-traumatic synchronous twin inter-muscular abdominal and diaphragmatic hernias: A rare presentation.

Simultaneous occurrence of traumatic abdominal wall hernia (TAWH) and traumatic diaphragmatic hernia (TDH) is uncommon. Our report documents the rare delayed presentation of simultaneous occurrence of TAWH and TDH in a patient who sustained a bicycle handlebar injury as a consequence of the bicycle he was riding colliding with a motorbike in a road-traffic accident. Excellent outcome could be achieved in this patient with surgical repair without requiring the use of a mesh.

Morgagni hernia with down syndrome: A rare association.

We report a case of a 22-year-old male with Down syndrome and Morgagni hernia, who presented to us with complaints of cough, regurgitation and vomiting. He was successfully treated surgically and the defect was repaired with prolene mesh.

Metastatic adenocarcinoma rib presenting as chondrosarcoma.

A case of chondrosarcoma rib which turned out to be a case of metastatic adenocarcinoma on histopathological examination is being presented.

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%.

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.

Bilateral simultaneous pneumothorax--a study of 25 cases.

Twenty-five cases of bilateral simultaneous pneumothorax were studied. In children it was mostly postpneumonic, whereas in adults it was tuberculous or traumatic. Prompt intercostal drainage on both the sides supported by antibiotics and/or anti-tubercular drugs, and respiratory physiotherapy was curative on most occasions. The association of bronchopleural fistula or septicaemia worsens the prognosis.

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.

Penetrating chest trauma: a review of 150 cases.

Penetrating injuries of the chest with emphasis on the policy of selective management in 150 cases, 145 males and 5 females, with age ranging from 5-60 years were reviewed. Chest pain and breathlessness were the commonest presenting features. Haemorrhagic shock and haemoptysis were noted in 30% and 20% cases respectively. Fire arms injury was the leading cause of chest trauma, being present in 80 (53.33%) cases. Except for 6 (3 cases had superficial stab wounds and 3 died on way to operation theatre), all patients (144) needed surgical intervention (tube thoracostomy drainage in 110 and major operation in 34 patients). There were 7 deaths in this study; massive haemorrhage was the cause of death in 4 and septic shock in 3 cases. An overall success rate of 95.34% was observed in this series.