Respiratory failure and chronic ventilator dependence in tetraplegics following cervical injuries located high on the spine (C1-C3) constitute significant challenges in the rehabilitation of patients given the occurrence of repeated hospitalizations and an ever-increasing financial burden. A 30-year-old man presented with posttraumatic tetraplegia following an unstable injury at the C1-C2 level with cord compression; he was managed by posterior stabilization and decompression followed by ventilator dependence and no rehabilitation until 6 months postinjury. We implanted phrenic nerve stimulator electrodes bilaterally for indirect diaphragm pacing by an implantable pulse generator that allowed for weaning from mechanical ventilation and spontaneous ventilator-free breathing at 20 weeks post-implantation and which facilitated post-tetraplegia rehabilitation. At 36 months after implantation, the patient is ventilator-free without any procedure-related complications or respiratory infections. Diaphragm pacing with phrenic nerve stimulation may be a way forward for ventilator-dependent tetraplegics in developing countries to pursue effective rehabilitation and improved quality of life.
Adrenal cyst initially described in 1670s, is being diagnosed more frequently with the advent of widespread use of diagnostic imaging. Most of these cysts are small and remain nonfunctional with requirement of only conservative approach. Functional, malignant or benign lesions more than 5cm in size needs surgical intervention. Giant adrenal cysts (>10cm) do pose a clinical diagnostic dilemma and present with symptoms as was the scenario in the case being described. The management of this case along with a review of literature is being briefly described.
A complex renal mass arousing suspicion of malignancy warrants exploration. Echinococcal etiology without any other organ involvement is a rarity. Experience with such a singular case managed laparoscopically is presented and discussed.
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