Psuedoaneurysm of the right hepatic artery: a rare cause of obscure GI bleeding

A 63 years old female with 1 month history of hematemesis and malena, severe weakness and lethargy, for which she had upper GI endoscopies multiple times, but the source of bleeding could not be identified. Base line investigations revealed Hb of 6.0g/dl. CT scan abdomen showed cholelithiasis with air inside the gallbladder. The selective celiac axis / Hepatic artery angiogram revealed a right hepatic artery aneurysm [pseudoaneurysm]. After resuscitation with blood transfusion and fluids, the patient under went surgical exploration, revealing an aberrant right hepatic artery aneurysm bleeding inside the gall bladder with a cholecystodeudenal fistula [Mirrizi type III] into the 1st part of the deudenum form where the blood was leaking into the gastrointestinal tract and causing severe hematemesis and malena. A cholecystectomy, dissection of sleeve of liver bed, ligation of the aneurysmal bleeding vessel, repair of the cholecystodendenal fistula and placement of the T-Tube done. Post operative the patient remained stable and was discharged on 7th post operative day. Biopsy revealed acute on chronic cholecystitis and cholelithiasis. Biopsy of the aneurysmal wall revealed inflamed granulation tissue

measurement of turbidity by changing distance of sample column from light source

Turbidity of the known standards have been measured by changing the- distance of sample column from light source with the help of cell risers in the cell compartment. The cell risers of 10, 20, 30, 40, 50, 60, 70, and 80 mm were used to reduce the light path-length between the bottom of the sample cell and the detector window when measuring the turbidity of the known standard 1 to 5 Nephelometric Turbidity Units [NTEJ]. The data indicate that at above 50 mm cell riser the results were matched with the actual one

Peri-anesthetic management of tracheo-esophageal fistula.

During a 3-year period 11 neonates underwent general anesthesia for primary repair of tracheo-esophageal fistula (TEF). The age ranged from 1-10 days. Out of these patients, 8 (72.7%) had atresia of the esophagus with a blind upper pouch and lower segment communicating with a trachea. A total of 7 patients (63.6%) had aspiration pneumonitis pre-operatively. Intubation was difficult in 3 (27.3%). There was no intraoperative mortality. However, the incidence of post-operative mortality was 27.3% (3 cases). The cause of death in all these cases was severe non-resolving pneumonia.