Swallowed dentures in thoracic oesophagus

Oesophagus is the second most (46.8%) common site of impaction of foreign body in the gastro-intestinal tract. Dentures constitute the 3rd most common (2.4%) foreign body in oesophagus of adults, following meat bone (76.1%) and coin (3.6%).In our Institute, impacted dentures in esophageal are referred to our department after a failed endoscopic venture at removal by ENT surgeons. Extraction in such a situation calls for judicial planning and careful timing of the procedure to achieve satisfactory results. The present study was done on 11 cases of thoracic oesophageal dentures which were removed surgically in the Department of CTVS Medical College and Hospital, Kolkata over 2 years of period. Between 1st October 2017 to 30st September 2019, 11 dentures were extracted from thoracic oesophagus via right postero-lateral thoracotomy approach. The defect in the oesophagus after denture removal was primarily closed; with reinforcement using intercostals muscle pedicled flap. A defunctioning cervical oesophagostomy and a feeding jejunostomy (FJ) were done in all cases. Surgical leaks were noted in 5 cases, of which 1 lady had fulminant mediastinitis before she died. Pneumonia was observed in 4 cases, superficial surgical wound infection in 2 cases, blocked FJ tube in 1 case and leakage following closure of cervical oesophagostomy in 3 cases. Thoracic esophageal dentures are serious surgical entities which need early diagnosis and management. Pre-operative optimization is very important for avoiding surgical leakage.

Giant chondrosarcoma of chest wall.

Primary chest wall tumours are very rare. Chondrosarcoma is the most common tumour arising from the chest wall. We describe the occurrence of a slow-growing chondrosarcoma arising from the anterior chest wall in a 35-year-old male patient. The tumour was resected successfully and chest wall was reconstucted with prolene mesh and muscle flap. The patient was discharged uneventfully without any respiratory compromise. There was no recurrence after a three-year follow-up. Wide surgical resection with chest wall reconstruction appears to be the preferred treatment option for this rare tumour of the chest wall.

Cardiorespiratory changes with compact backpack system and distributed mode of load carriage.

In Indian Army, soldiers normally carry 21.4 kg in backpack (BP), haversack, and web distributed in different parts of the body and rifle in hand. This load distribution is unequal, may involve excess energy expenditure, mostly uncomfortable, and restricts the normal movement of the hand carrying rifle. A new BP has been developed which accommodates the rifle on sides leaving the hands free. Physiological evaluation of load carriage [21.4 kg in the existing Load Carriage ensembles (LCe) and in the new BP] and without load was carried out on a group of Indian Army soldiers (n= 8) to understand the efficacy of the new BP vis-á-vis the existing one at 4.5 km/h speed at level ground and at 5% gradient on a treadmill in controlled laboratory environment. Heart rate, oxygen consumption, relative work load and energy expenditure were determined and one-way repeated measure ANOVA was applied to compare the results. All the physiological parameters showed higher responses in distributed mode in comparison to compact mode. However, the differences were not significant. The study may be carried out on a larger sample size to find out the better efficacy of compact mode of load carriage over the distributed mode.

Temporal spatial parameters of gait with barefoot, bathroom slippers and military boots.

Nine temporal spatial parameters of gait were evaluated on 8 normal healthy able-bodied soldiers while walking barefoot, with bathroom slippers and military boots on, respectively. Subjects used their regular bathroom slippers and military boots for the study. A 5 camera based Expert Vision 3-D motion analysis system (M/s Motion Analysis Corporation, USA) was used while the subjects walked 10 meters along a straight and level walkway at a comfortable speed. Cleveland Clinic retro reflective marker sets for lower body were used to record static as well as walk data of both legs. Static and walk data were collected at 60 Hz and 120 Hz respectively. A minimum of 10 walking trials for each subject for each condition were obtained and at least 3 good trials having complete trajectories of all the markers covering entire gait cycle for each condition were selected for analysis as per routine gait analysis procedure. A total of 83, 81 and 74 full strides for barefoot, bathroom slippers and military boot respectively were subjected to statistical analysis. Step length and stride length increased significantly from barefoot to military boot with a significant reduction in cadence. Swing phase and single support time increased significantly from barefoot to bathroom slippers and military boot. Total support time and initial double support time decreased significantly for the same conditions compared to barefoot. The observations in this study indicated that use of footwear (bathroom slippers, military boot) caused significant changes in the gait parameters.