Learning from mistakes: femoral vein cannulation-an unusual complication or a blessing in disguise!!!

Femoral vein cannulation is often used in resuscitation and in critical care units. We report an uncommon complication of femoral vein counterpuncture-peritoneal puncture and the consequences which led us to diagnose a missed traumatic diaphragmatic rupture.

"Huge axillary mass - neurofibroma brachial plexus".

Axillary swelling arising from soft tissue is not uncommon. Lipoma, Lymphadenopathy due to Kochs or Lymphoma are commonest swellings seen but firm to hard non tender mass arising from maninges of Brachial plexus is not so common. Usually these masses are benign but one may come across malignant tumour. Twenty-three year male presented with mass in anterior chest wall & arm pit having no other specific complaints, was diagnosed as Spindle cell tumour on FNAC & excision biopsy turned out to be Neurofibroma of Brachial plexus.

Pigmented villonodular synovitis great toe.

A young boy of 14 years. presented with swelling over dorsal aspect of right great toe, which was slightly tender, non fluctuant. It was excised under subarachnoid block. The mass was golden brown in colour encircling the extensor tendon (Extensor Hallucis Longus Tendon). Histopathology reported to be Pigmented Villonodular Synovitis.

Perioperative status and complications in opium addicts in Western rajasthan.

Opium addiction is rampant in Western Rajasthan and probably has the highest number of opium addicts in the world. The study envisages upon the presentation, diagnosis and various postoperative complications in surgically ill opium addicts vis-à-vis non addicts. The study is purported to benefit clinicians dealing with opium addict patients. The prospective cohort study was conducted at Mahatma Gandhi Hospital, Jodhpur between December 2004 and February 2006 and included cohorts of 71 opium addict and 50 non-addict patients admitted in various surgical wards. The study focused on presentation and the post-surgical complications encountered in these patients vis-à-vis others. The results thus obtained were evaluated statistically (mean±SD, SEM, two tailed t test, chi-square test), p value of <0.05 was considered as significant. A thorough comparative analysis revealed that opium addict patients had a significantly higher incidence of postoperative respiratory, cardiovascular, systemic and local complications. The requirement of analgesics and duration of hospital stay were also significantly higher as compared to control group. The work concludes that opium addicts suffer a much higher degree of postoperative morbidity as compared to non-addicts.

Rare cause of intestinal obstruction - Vaginal enterocele.

In surgical emergency admissions, acute abdomen with intestinal obstruction is very common problem. Many causes of intestinal obstruction are there but most common once are postoperative bands and adhesions, hernias, tumors and congenital bands. Here we report very rare and unusual cause of acute abdomen with intestinal obstruction in a non hysterectomized 78-year-old female having pelvic herniation i.e. anterior and posterior vaginal enterocele, in which loop of intestine got entrapped, strangulated and became gangrenous. Exploratory laparotomy was performed and resection anastomosis of small bowel was done with obliteration of pouch of Douglas (Rectouterine space) and utero-vesicle space.

Topical phenytoin in the treatment of split-thickness skin autograft donor sites: a comparative study with polyurethane membrane drape and conventional dressing.

The effectiveness of topical phenytoin as a wound healing agent was compared with that of OpSite (Smith & Nephew) and a conventional topical antibiotic dressing (Soframycin, Roussel) in a controlled study of 60 patients with partial-thickness skin autograft donor sites on the lower extremities. Mean time to complete healing (complete epithelialization) was 6.2 +/- 1.6 days in the phenytoin-treated group (30 patients), compared to 8.6 +/- 2.2 days with OpSite (15 patients), and 12.6 +/- 3.4 days in the 15 Soframycin-treated patients. The differences between the treatment groups were significant at P < 0.001. Mean pain scores were also lower in the phenytoin-treated group, 0.40 +/- 0.55 vs. 0.66 +/- 0.60 with OpSite (P < 0.05) and 1.4 +/- 0.50 with the conventional dressing (P < 0.001). Both phenytoin and OpSite were superior to the Soframycin dressing with respect to bacterial contamination and wound infection as measured by Gram stains of wound smears, swab and aspirate (OpSite) cultures, and clinical assessments (P < 0.001) carried out on the fifth day of treatment. No local or systemic adverse effects of the three agents used were noted. Phenytoin appears to be an effective, low-cost and safe method for the treatment of partial-thickness skin graft donor sites, comparing very favourably with, and in some aspects superior to, occlusive dressings. Further clinical use and evaluation of topical phenytoin are merited.