Frequency of immediate pneumothorax after subclavian venous cannulation

Objective: to determine the frequency of immediate pneumothorax after subclavian venous cannulation

Material and Methods: this clinical trial was carried out in Mayo Hospital in all four medical ward [East, West, North, and South] and Nephrology ward of Mayo Hospital, Lahore during the period from15th March 2013 to 15th September 2013. It was descriptive case series study. A total of 450 cases fulfilling inclusion and exclusion criteria attending in patient department were selected. After antiseptic preparation of field, local anesthesia was administered. The subclavian vein was punctured at the junction between the middle and inner thirds of the clavicle. Negative pressure was maintained in the syringe to facilitate blood return when the subclavian vein was entered. A J guide-wire was advanced through the cannula to a length of 20 [15-16] cm. A small skin incision was placed at this site for ease of catheter passage. After dilatation, a catheter was inserted and advanced to predetermined point over the guide-wire. The lumen of catheter was sutured to avoid intra cardiac tip displacement and to prevent kinking and accidental withdrawal. Pneumothorax was checked by Chest X-ray taken within four hours of procedure

Results: in our study, 41.56%[n=187] patients were between 30-50 years while 58.44%[n=263] were between 51-70 years, Mean+SD was calculated as 51.92 +/-11.23 years, 57.56%[n=259] male and 42.44%[n=191] were females, frequency of immediate pneumothorax after subclavian venous cannulation was 6.44%[n=29] while 93.56%[n=421] had no findings of the such complications

Conclusion: we concluded that the frequency of immediate pneumothorax among patients with subclavian venous cannulation is in agreement with other studies and not very high. But it is recommended that every patient who undergo with subclavian venous cannulation should be sorted out for pneumothorax. However, it is also required that every setup should have its surveillance in order to know the frequency of this complication

Standardization of micropropagation techniques for Aloe vera: a pharmaceutically important plant

Aloe vera [Syn Aloe barbadensis Mill.], a medicinal plant, has a great potential in cosmetic and drug industry due to presence of more than 200 bioactive compounds. Natural propagation of Aloe vera, by means of suckers, is very slow and insufficient to meet the increasing demand of pharmaceutical and cosmetic industries. Shoot tip was used as an explant for in vitro regeneration of Aloe vera. Explants were disinfested with the use of 0.1% mercuric chloride and 0.5% sodium hypochlorite, and washed thoroughly with autoclaved distilled water. Solid MS medium was used with addition of different concentrations of 6-benzyl aminopurine and Alpha -naphthalene acitic acid. After 7 weeks of inoculation, greatest number of shoots [11.18] and highest shoot length [12.15cm] were found in MS medium supplemented with 0.5 mg 1[-1] 6-benzylaminopurine [BAP] along with same concentration of Alpha -naphthalene acitic acid [NAA]. Best rooting [84.67%] was found in medium supplemented with 1.5 mg 1[-1] of indole butyric acid [IBA]. The rooted explants were then gradually acclimatized and shifted to green house

Guide wire dilatation of anastomotic strictures secondary to surgical repair of esophageal atresia

To evaluate the efficacy of esophageal guide wire dilatation of stricture after surgical treatment of esophageal atresia. This prospective and descriptive study was carried out at Department of Pediatric Surgery, The children's hospital, Pakistan Institute of Medical Sciences [PIMS], Islamabad from January 2008 to December 2011. It included 23 patients, 15 males and 8 females, aged one month to 3 years with esophageal stricture secondary to esophageal atresia who underwent guide wire esophageal dilatation with savary Gilliard Dilators. All procedures were performed under general anesthesia. Associated gastroesophageal reflux [GER]. was noted in 13 patients. Dilatation relieved the stricture in all patients over a follow-up period varying from 3 months to 3 years. Only two patients developed esophageal perforation, which was treated conservatively. Guide wire dilatation is a safe and effective method of treatment in the management of strictures secondary to surgical repair of esophageal atresia

Fournier's gangrene developing secondary to infected hydrocele: a unique clinical scenario

We report the first case of Fournier's gangrene [FG] developing secondary to an infected hydrocele worldwide. We present a case report with a brief overview of the literature relating to FG and its aetiology, diagnosis and management. A 70 year-old male was referred by his General Practitioner with a 2 week history of worsening symptoms of scrotal discomfort and swelling. Following clinical examination, an initial diagnosis of an infected right-sided hydrocele was made and treatment, consisting of antibiotics, was initiated. Despite showing good clinical improvement, several days later, necrotic areas were observed over the right hemiscrotum with spreading cellulitis. A diagnosis of FG was made. The patient was started on triple-therapy antibiotics and taken to the operating room for urgent surgical debridement. Necrotic skin and subcutaneous tissue extending over the perineum and lower anterior abdomen was debrided down to healthy tissue. A further debridement took place 2 days later. The patient continued to improve and was eventually discharged under the care of Plastic Surgeons for reconstruction of the soft tissue defect. FG is a type of necrotising fasciitis predominantly affecting the male perineal, perianal, genital and anterior abdominal wall regions. It has a significant mortality rate, and the key to survival is early detection and treatment consisting of antibiotics and surgical debridement of the affected area. To the best of our knowledge, this is the first reported case of FG developing secondary to an existing hydrocele without any prior urological intervention. The case highlights the important clinical diagnostic and therapeutic interventions required to prevent complications associated with this, potentially fatal, condition

Duplication cyst in a new born

Intestinal duplication is a rare congenital anomaly. Duplications found in proximity of small intestine are the most common enteric duplications encountered and majority of these occurs in the ileum. They may be either cystic or tubular and most of them are located in the mesentery of intestine. We are here presenting a case of a neonate who got delivered by lower segment caesarean section [LSCS] with a huge abdominal mass. At surgery there was huge small gut duplication at ileum

Intralesional bleomycin injection- A primary therapy for peripheral lymphangiomas

To evaluate the efficacy of intralesional Bleomycin Injection [IBI] as a primary therapy for peripheral lymphangiomas in children. A prospective study was conducted at NICH Karachi from January 2003 to December 2005. Patients with peripheral lymphangiomas were included in the study. Exclusion criteria included previously treated lymphangiomas, infected lesions, intra-thoracic and intra-abdominal lesions. Thirty three patients were included in the study. All were treated with Intralesional Bleomycin Injection [IBI]. After aspiration of fluid from the lesion, 0.5 mg/kg of Bleomycin diluted in saline was administered at different sites into the lesion. Depending upon the size of lesion and age of patient, procedure was performed in operating theatre under local or general anesthesia. Reduction in size was seen in 90% cases [n=29], out of them 30% [n=10] showed near complete disappearance and 63% [n=21] showed good response. Two patients [6%] showed poor response and they underwent surgery. Few patients had minor complications like fever, pain, redness and increase in the size after injection. All these complications were managed conservatively with symptomatic treatment and no patient required hospitalization. IBI is an effective therapy for lymphangiomas, with results comparable to surgical excision. It has the added advantage of avoiding inadvertent injury to vital structures, scarring and other complications of surgery. We recommend it as a primary therapy for all peripheral lymphangiomas

Palliative surgery for advance osteosarcoma of shoulder region

We are presenting here eight cases of advanced osteosarcoma of shoulder region involving scapula and upper humerus in children upto the age of thirteen years. All patients had complete loss of movement. Five patients underwent fore quarter amputation. Extensive amputation although a major mutilating procedure, provides patients a dramatic relief for the period that he survives

experience with four cases of split notochord syndrome and review of literature

To evaluate the rarity of split notochord syndrome, to access frequency of various associated anomalies and to find out compatibility of this condition with survival. All those cases who presented with vertebral abnormalities and those who presented with spina bifida associated with gastrointestinal and urological abbarasion were further investigated for possible association of split notochord syndrome. The study was conducted at the Department of Paediatric surgery the Children Hospital Pakistan Institute of Medical Sciences from 1987-2001. All those children and aborted fetuses who had gross spinal cord defect, accessory limb, or teratoma like lesion associated with mylomeningocele or those who had gross duplication of pelvic genitourinary organs were further assessed by detailed examination of the local lesions and further radiological, contrast and histopathological studies. We could identify four such cases, each had completely different anatomical presentation. One was an aborted fetus of 24 weeks gestation. Another child died soon after the delivery. One had pelvic skeletal and organs duplication with enteric fistulae, double exstrophy of bladder, double penis, and split lumbosacral spine, and the fourth case had complete duplication of external genitourinary organs in the form of fully formed double vulvae and split spinal column in the region of sacrum and coccyx. Split notochord syndrome is perhaps rare abnormality, but often it may not be identified especially if it is not specifically looked for. Fifty percent of our cases were either aborted or still-born, therefore to assess the actual incidence of split notochord syndrome it is suggested that study should be conducted by antenatal ultrasounds and all fetuses who show spinal column defects and aborted should be examined with detailed dissection and histopathology analysis of the tissues