A Rapid and Reliable End-To-End Anastomosis Technique for Emergency Vascular Surgery--A Case Report.

A 28 year old male presented to us with 8 hours old open fracture of distal shaft of left femur which was already stabilized with external fixator but had no palpable distal pulse both clinically and on doppler examination. He underwent a primary repair following limited segmental resection. Commonly end-to-end anastomosis techniques following transection of arteries include interrupted and continuous suturing with or without 'parachuting' of the vessel or graft. Here we offer a rapid and reliable technique with following advantages: i) operating system always towards the surgeon, ii) posterior row of suture placed as both ends are well visualized, iii) less chance of catching posterior wall, iv) flushing performed easily before completing anterior row suture. Upto 2nd post operative day anticoagulant used in the form of inj. Heparin 2500 IU subcutaneously 8 hourly and patient was discharged from hospital on 3rd post operative day with presence of good distal pulses both on clinical and Doppler examination. Fourteen days later, on follow up Duplex study showed normal arterial flow without any stenosis or occlusion.

A rare form of Cushing's syndrome in a 10 year old child.

Adrenocortical carcinoma as a cause of Cushing's syndrome in a child is a rare occurrence. Functioning adrenal carcinomas are detected usually when they are small while non-functioning tumors are incidentally detected when they grow to a large size. Here we report a case of Cushing's syndrome due to large functioning adrenal carcinoma(>12 cm in size) in a 10 year old female child who presented with clinical features of Cushing's syndrome along with virilisation.A combination of biochemical laboratory reports along with radiological investigations followed by histopathology helped us to arrive at a proper diagnosis. The tumor was ressected and the patient showed clinical signs of improvement. However, the surgical margin showed invasion by the tumor making a likely possibility of recurrence in the near future.