Telescoping jejunum: a case of adult intussusception.

Intussusception is the invagination of a proximal part of intestine into the adjacent distal part. Reported frequently in children, it forms a rare presentation in adults and can be difficult to diagnose pre operatively. Imaging modalities are increasingly being used for preoperative diagnosis with almost all cases in adults being secondary to an intestinal lesion. Intraoperative management of such lesions in adults was mostly reported to be done by en bloc resection without attempts at reduction, especially where a preoperative diagnosis of a benign lesion was not in hand. We present a case of a female patient with a background of active metastatic lung cancer presenting with symptoms and signs of high intestinal obstruction, found to have a jejunal intussusception on CT scan and managed conservatively initially, followed by definitive surgical management. Literature review of similar presentations, diagnostic and treatment modalities are discussed thereafter.

National health service in India: be aware of what it means.

India welcomes international partners and businesses. Indians and Indian health care need to understand the nature and role of foreign collaborators so that appropriate use of expertise and resources can happen. India will initially need to find a balance and eventually need to 'grow its own' to achieve success in healthcare.

Unexpected prolonged neuromuscular block after mivacurium: a case report.

OBJECTIVE: To present a case of unexpected prolonged apnoea following the administration of mivacurium, a short-acting muscle relaxant and to identify the factors for early diagnosis and management. CLINICAL PRESENTATION AND INTERVENTION: A 19-year-old physically fit lady without personal or family history suggestive of anaesthetic problems had an excision of fibro-adenoma from the breast. She did not recover as quickly as was expected from the anaesthetic, which included the administration of mivacurium. She had prolonged neuromuscular blockade. She was kept ventilated and sedated. Five hours after the last dose of mivacurium, she showed signs of spontaneous respiration and at 6 h she was extubated and fully recovered. It was shown later that the patient had a pseudocholinesterase deficiency. CONCLUSION: Pseudocholinesterase deficiency is an uncommon occurrence but should be highly suspected in cases of prolonged paralysis following the administration of a short-acting muscle relaxant. The use of a nerve stimulator is recommended whenever muscle relaxants are used. Muscle relaxants should be used only when facilities for prolonged ventilation are available.