Low tension breast hydatid cyst-A case report

Features of low tension in breast hydatid cyst and symptoms secondary to cyst dying and disintegration are unique and not yet reported in the literature. An young woman of 30 years complained about pain and vague swelling in the right breast during follow-up with albendazole therapy following second laparotomy for post-surgical residual cavity of hydatid cyst in the left lobe of the liver. Breast ultrasound was diagnostic. Segmental breast excision revealed a large dead hydatid cyst. Postoperative course was uneventful. Breast hydatid cyst may become symptomatic and hypotensive after start of albendazole therapy

Prolonged mechanical ventilation causing tracheoesophageal fistula

Tracheo esophageal fistula [TEF] is a congenital or acquired communication between the trachea and esophagus. These fistulae can often lead to fatal complications. Prolonged intubation with high compliance endotracheal tube cuffs used to prevent gas leak and also pulmonary aspiration may cause tracheal damageand lead to tracheoesophageal fistulae

We report a case of a young man developing a TEF after being intubated for multiple injuries with the intent to highlight this rare cause of severe complication and even death

randomized trial of epidural volume extension by sequential combined spinal epidural anesthesia using three different techniques

Sequential combined spinal epidural anesthesia [SCSEA] is gaining popularity in ASA grade III / IV, elderly, low cardiac output state and high risk patients. In view of contradicting results related to sensorimotor characteristics, we undertook this study with the null hypothesis that epidural volume extension [EVE] with local anesthetic or normal saline results in augmentation of initial intrathecal block. Prospective, randomized, double blind study. J N Medical College, Aligarh Muslim University, Aligarh, India. Seventy-five ASA I/II patients divided into three groups and operated upon from September 2007 to January 2009. Group I received 1.5 ml bupivacaine [0.5%] + 25 microg fentanyl in subarachnoid space and epidural catheter was inserted without any top ups. In group II and III with the same technique top ups were given after 10 minutes of the intrathecal block in the form of either 10 ml NS or 10 ml of 0.125% bupivacaine. Augmentation of initial intrathecal block. Significant increase in height of block was seen after EVE by different techniques of epidural top up [T4.64 +/- 0.86 and T3.92 +/- 0.99 in group II and III respectively, p-value < 0.05] as compared to group I [T7.12 +/- 0.83]. The average increase was 3.12 +/- 0.97 and 3.48 +/- 1.35 segments in group II and III respectively as compared to 0.48 +/- 0.51 segments in group I.. Height of low-dose intrathecal block can be enhanced by SCSE using EVE effect even with normal saline

Isolated corrosive pyloric stenosis without oesophageal involvement: An experience of 21 years

Corrosive ingestion is common in Asia and it is a frequent cause of morbidity secondary to intense fibrotic reaction and stricture formation of the oesophagus. Isolated corrosive pyloric stenosis without oesophageal involvement is an uncommon phenomenon. All consecutive patients, with corrosive ingestion in the last two decades, were reviewed and analysed. Eleven out of 201 patients with corrosive ingestion had isolated gastric outlet obstruction. Patients' age ranged from 11 to 29 years with a male: female ratio of 1.75:1. All patients developed pyloric stenosis following ingestion of solution of acids. Barium study revealed complete/ near-complete gastric outlet obstruction in all patients. On laparotomy, there was gastric dilatation in 10 patients, who underwent posterior gastrojejunostomy, whereas the stomach was contracted in one patient, and hence anterior gastrojejunostomy was performed. Seven patients were completely relieved of their symptoms; persistent postprandial epigastric fullness and/or dyspepsia was observed in four patients whose gastrojejunostomy stoma was found adequate on barium study, suggestive of gastric motility disorder. We did not encounter gastrojejunostomy-related complication of stomal ulcer/stenosis in our patients. Isolated corrosive pyloric stenosis is not as rare as is commonly thought. Gastrojejunostomy is effective, although a fair percentage of patients appear to develop gastric motility disorder secondary to corrosive injury

Feasibility and outcome of proximal catheter lleostomy - a pilot study

Loop ileostomy has high complication rates and causes much patient inconvenience. This study was carried out to evaluate the feasibility and outcome of a proximal catheter ileostomy in place of loop ileostomy in patients treated by intestinal repair and/or resection-anastomosis. Prospective study. Setting: J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, India. From November 2006 to November 2009, in all patients treated surgically by primary repair and/or resection-anastomosis of small and/or large bowel, we constructed a catheter ileostomy when a defunctioning proximal protective loop ileostomy was considered advisable. Catheter ileostomy was constructed in the fashion of catheter jejunostomy, with postoperative saline irrigation. Catheter ileostomy was performed in 20 patients in the 3-year period. The mean age of the subjects was 28.6 years and the male: female ratio was 1.86:1. Four patients died of septicemia and multiple organ failure unrelated to catheter ileostomy in the immediate postoperative period. Catheter ileostomy started functioning within 48 hours of the operation, and twice-daily irrigation was found sufficient in 81.25% of the surviving patients. Only one patient developed peritubal leak with mild skin excoriation that cleared within 5 days. Another patient with Koch's abdomen underwent conversion to loop colostomy on re-exploration for postoperative adhesive obstruction. There was no instance of intestinal leak. Ileostomy wounds closed spontaneously within 7-14 days of catheter removal, and none required formal closure. Hospital stay ranged from 12-35 days [mean: 23 days]. Catheter ileostomy is effective in protecting intestinal anastomosis/ repair; there is minimal morbidity and no catheter-related leak/mortality, and we recommend the procedure

Role of proximal catheter ileostomy in typhoid enteric perforation

Addition of loop ileostomy with surgical repair of typhoid enteric perforation has recently reduced mortality rates but ileostomy itself is associated with high complication rates of 25-40%. This study was done to assess the effectiveness of proximal catheter ileostomy in these patients. Prospective study. J N Medical College Hospital, Aligarh Muslim University, Aligarh, India. Patients with typhoid enteric perforation who were treated surgically from November 2006 to November 2009. Proximal catheter ileostomy constructed along with primary surgical repair of typhoid enteric perforations when proximal defunctioning of bowel was considered advisable. Feasibility as well as outcome in terms of morbidity and mortality. Catheter ileostomy was performed in eight patients with typhoid enteric perforations treated by surgical repair. Patients' age ranged from 17 to 45 years [average 25.75 years] with a male to female ratio of 1:1. In the immediate postoperative period, two patients died of septicemia unrelated to catheter ileostomy. Catheter ileostomy started functioning within 48 hours of the operation and twice-daily irrigation was found sufficient. One patient developed mild peritubal leak that cleared within two days. Laparotomy wounds got infected in two patients. Ileostomy wounds closed spontaneously in all patients within 7-14 days after catheter removal. Mean hospital stay was 13.4 days. Follow-up was from 6- 36 months [average 24 months]. Catheler ileostomy is effective and safe in protecting primary repair of typhoid enteric perforations with minimal morbidity

Specific evoked motor response for supraclavicular brachial block

To assess and evaluate the accuracy of individual types of evoked motor responses [EMRs] for prediction of successful surgical anesthesia following peripheral nerve stimulator [PNS] assisted supraclavicular block. A prospective study was carried out over a period of one and half years from August 2004 to January 2006, at J. N. Medical College, Aligarh Muslim University, Aligarh, India, in 60 patients who underwent various elective operative procedures on the upper limb. Any of the EMR, such as forearm flexion or extension, carpal flexion, or extension, prono-supination, or finger flexion, at a definite current of 0.25 mA for 2 ms was taken as an end point for prediction of successful block, and a local anesthetic solution [0.375% Bupivacaine, 30 ml] was administered at that level. Complete surgical anesthesia was observed in those cases where EMR included: flexion of only second and third fingers [n=15/15] or flexion of all 4 fingers with thumb opposition [n=14/14] or uncommon flexion of all 4 fingers without movement of any other joint of the upper limb [n=2/2], suggesting a sensitivity of 100%. However, thumb opposition to the tip of the flexed little finger revealed a success rate of only 83% [n=5/6], and other EMRs were followed by high rates of inadequate surgical anesthesia or total failure. Specific EMR of flexion of second and third fingers, or all the 4 fingers are reliable predictors of complete surgical anesthesia following PNS assisted single injection supraclavicular nerve block with no incidence of pneumothorax and nerve damage

Audiometric changes following spinal anesthesia

A prospective study on audiometric changes following spinal anaesthesia with different gauge spinal needles was carried out in 125 patients; the patients were randomly divided into five groups according to gauge of needles used i.e., 20, 22, 23, 24 and 25 with twenty five -patients in each group. Twelve percent and 8% decrease in audiometric values were recorded on first postoperative day at 250-500 Hz frequencies with 20 and 22 gauge needles respectively and these changes were highly significant [P < 0.001]; these audiometric alterations returned to within normal limits by the 5th postoperative day. Eight percent decrease in audiometric values were observed on first postoperative day at 250-500 Hz frequencies with 23 gauge needle which was also statistically significant [P<0.05]; these changes returned to near normal limits by the 5th postoperative day. There was no significant decrease in the audiometric values following spinal anaesthesia with 24 and 25 gauge needles