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Pulmonary parasitic infestations are a worldwide problem associated with significant morbidity and socioeconomic impact. They are known to have varied clinical presentations and radiological appearances. Prevention of parasite transmission and medical treatment of cases form the two pillars of control of these diseases. The role of surgery is limited to the diagnosis and definitive treatment of the minority of pulmonary parasitic afflictions, most notably hydatidosis. Despite surgery being established as the treatment of choice in pulmonary hydatid cysts (PHCs) for over half a century, variations and unresolved controversies persist regarding the best surgical technique. Complications brought on by cyst rupture, multiplicity and multi-organ involvement add complexity to treatment decisions. The development of videoassisted thoracoscopic surgery (VATS) brings the promise of reduced peri-operative morbidity but is yet to be universally accepted as a safe technique. In this review, we endeavor to discuss the common pulmonary infestations focusing on the current trends and controversies surrounding surgery for PHC.

Introduction: Post-operative nasogastric intubation after emergency laparotomy is a commonpractice in many centers, with the intent of hastening the return of bowel function, relievinggastrointestinal discomfort, reducing various post-operative complications and reducing hospitalstay. However, bowel rest and gastric decompression have been re-examined in the light of morerecent data. Many studies and meta-analyses over the last 50 years have challenged the routine useof nasogastric tubes after laparotomy. The objective of this study is to evaluate the need for routinenasogastric decompression after emergency laparotomy.Methods: A prospective, randomized controlled trial was conducted for 12 months (May 1, 2007 toApr 30, 2008) in the Department of Surgery, Tribhuvan University Teaching Hospital, after ethicalapproval. Patients were enrolled as per criteria (Box 1), and subsequently allocated by simplerandomization into two groups: Group 1 and Group 2. Patients undergoing emergency laparotomyfor perforation peritonitis, intestinal obstruction and abdominal trauma were randomized to twogroups – with or without nasogastric tube after surgery. Gastric upset, return of bowel function andpostoperative complications were compared.Results: Total of 115 patients met the inclusion criteria. There was no statistically significantdifference in the occurrence of gastric upset (P: 0.38), wound complications (P: 0.30), respiratorycomplications (P: 0.30) and anastomotic leak (P: 0.64) between two groups. Bowel function returnedin comparable times in both groups (correlation coefficient: 0.14; P: 0.54). Nasogastric tube had tobe reinserted in three patients in the group with nasogastric decompression postoperatively, andfour in the group without (P: 0.43). Thus, routine nasogastric decompression neither prevented thedevelopment of gastrointestinal discomfort nor precluded the need for tube replacement once it wasdiscontinued. For every patient who required post-operative nasogastric decompression, at least 14patients were spared one. Mean hospital stay was significantly more in the decompressed group(7.52 days; correlation coefficient: 0.22; P<0.05).Conclusion: This study has shown that the prophylactic nasogastric decompression followingemergency laparotomy is ineffective in achieving any of the intended goals._______________________________________________________________________________________Keywords: complications; decompression; emergency laparotomy; flatus; nasogastric tube; prophylactic._______________________________________________________________________________________

Inflammatory myofibroblastic tumour (IMT) is an uncommon mesenchymal tumour, which can occur anywhere in the body, rarely in esophagus. Mostly, the diagnosis is postoperative, after the hispathological evaluation of the specimen. There are no definite guidelines regarding the diagnosis and management. Here, we report a 60 year old lady presenting with dysphagia, diagnosed to have a submucosal esophageal tumor with Barium esophagogram and contrast enhanced computed tomography. She was managed successfully with surgical enucleation with the final histopathological diagnosis of IMT. Surgical excision is not only therapeutic but also diagnostic in such cases.

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