Unusual bronchial foreign body.

We present an unusual case of bronchial foreign body in an adult who presented with bronchiectasis more than two decades later. The patient was unaware of his accidental aspiration of the foreign body, and the final diagnosis was made intraoperatively.

Lung biopsy in diffuse interstitial lung disease (simple technique).

A simple, safe, easily reproducible and quick method of taking lung biopsy in diffuse interstitial lung disease is described.

Uterine torsion mimicking supine hypotension syndrome after regional anaesthesia.

A 40-year-old gravida 5 para2 +2 was admitted at 38 weeks +5 days of gestation for elective caesarean section in view of unstable lie. After spinal anaesthesia, when the patient was positioned supine for caesarean section, she developed acute onset breathlessness and dizziness. Blood pressure was unrecordable. She remained symptomatic with hypotension and bradycardia despite lateral tilt and intravenous atropine. On entering the peritoneal cavity, a congested uterus with torsion in a clockwise direction to almost 180° with the posterior wall facing anteriorly was noted. Immediate attempt to detort the uterus was successful. The patient immediately became symptomatically better and the uterine congestion resolved. Uterine incision was given in the anterior lower segment delivering a healthy baby. High index of suspicion and detorsion of the uterus avoided the inadvertent incision in the congested posterior uterine wall which could have resulted in massive postpartum haemorrhage.

Successful Surgical Treatment of a Septuagenarian with Anomalous Right Coronary Artery from the Pulmonary Artery with an Eleven Year Follow-Up: Case report and review of literature.

An anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a very rare coronary artery anomaly with only 98 cases reported in literature till date. We report the oldest surgically treated patient and the fourth ever septuagenarian with this anomaly diagnosed ante-mortem with an eleven year follow-up. The literature on this anomaly was reviewed and discussed to highlight the clinical implications.

Persistent Left Superior Vena Cava With Absent Right Superior Vena Cava and Bicuspid Aortic Valve: A Case Report and Review of Literature.

Persistent left superior vena cava with absent right superior vena cava is a rare congenital anomaly with few cases reported to date. To the best of our knowledge, the current case is the first one to be reported from New Zealand. The condition may present difficulties in central venous catheterization, pacemaker electrode insertion and cannulation during cardiopulmonary bypass. We describe a case of persistent left superior vena cava with absent right superior vena cava, who presented with aortic stenosis (bicuspid aortic valve) and rhythm disturbances.

Timely 'off-label' use of recombinant activated factor VII (NovoSeven(®)) can help in avoiding hysterectomy in intractable obstetric bleeding complicated with disseminated intravascular coagulation: A case report and review of the literature.

Massive intra-operative bleeding is not an infrequent occurrence in obstetrics. Worldwide obstetric bleeding remains a major cause of morbidity and mortality. Conventional management of this bleeding consists of resuscitation with fluids, blood, surgical maneuvers, and embolisation of feeding blood vessels. But in most of cases, these measures appear to be ineffective in controlling bleeding. Recently, the 'off-label' use of the recombinant activated factor VII (rFVIIa) concentrate has emerged as promising treatment for such bleeding when conventional measures fail. We came across a similar scenario in which a young lady was admitted with per-vaginal bleeding due to abruptio placentae. In spite of usual surgical and medical interventions, she continued to bleed. rFVIIa was administered as a desperate measure to avoid hysterectomy and the bleeding could be stopped. She recovered successfully without any complication. Thus, the timely use of rFVIIa, hence, can be used to save life and fertility in cases of intractable obstetric bleeding.

Plasma pseudo cholinesterase deficiency leading to seven hour apnoea in a child undergoing adeno-tonsillectomy.

OBJECTIVE: We report a rare, silent, potentially fatal operative complication of seven hour apnoea in a patient undergoing adenotonsillectomy secondary to deficiency of plasma cholinesterase. Awareness of this hereditary disorder is important to otolaryngologist as; it is difficult to diagnose, can be unexpectedly alarming for parents and the surgeon. METHODS: Case report and review of world literature. RESULTS: A four-year male with obstructive sleep apnoea underwent a routine elective adenotonsillectomy; there was no spontaneous recovery of respiration following surgery. He was transferred to the intensive care unit and 7 h later was successfully weaned from the ventilator and extubated. A plasma cholinesterase level of 456 1U/L was discovered much later. CONCLUSION: To our knowledge this is the first case report of pseudo cholinesterase deficiency reported in otolaryngology literature and first in Oman. The patient should receive information about the condition, the associated risks, inheritance and need for testing other family members.

Complication of warfarin therapy presenting as empyema.

A number of risk indices have been formulated in an attempt to predict risk of a major hemorrhage in an individual on warfarin therapy. No single index to date is able to reliably predict this risk in an individual patient. Although most warfarin related hemorrhages are gastrointestinal or intracranial in origin this case represents a particularly rare entity of a major hemorrhage presenting as an encysted empyema. To the best of our knowledge this has never before been described.

Subclavian vein injury and massive hemothorax requiring thoracotomy following insertion of tunneled dialysis catheter--a case report and review of literature.

Tunneled dialysis catheters are widely used for hemodialysis. Large caliber dilator is used for insertion of such catheter which can result in serious vascular injury leading to haemothorax. Here we report such an inadvertent central venous injury requiring thoracotomy following blind dilator advancement along with review of literature and recommendation to prevent such complication.