Acute lung injury after oesophagectomy is well recognized but the risk factors associated with its development are poorly defined. We analysed retrospectively the effect of a number of pre-, peri- and post-operative risk factors on the development of lung injury in 168 patients after elective oesophagectomy performed at a single centre. The acute respiratory distress syndrome (ARDS) developed in 14.5% of patients and acute lung injury in 23.8%. Mortality in patients developing ARDS was 50% compared with 3.5% in the remainder. Features associated with the development of ARDS included a low pre-operative body mass index, a history of cigarette smoking, the experience of the surgeon, the duration of both the operation and of one-lung ventilation, and the occurrence of a post-operative anastomotic leak. Peri-operative cardiorespiratory instability (measured by peri-operative hypoxaemia, hypotension, fluid and blood requirements and the need for inotropic support) was also associated with ARDS. Acute lung injury after elective oesophagectomy is associated with intraoperative cardiorespiratory instability.

The ratio of vaginal hysterectomy to abdominal hysterectomy in the UK is 1:3. It is well known that patients who have had a vaginal hysterectomy recover better compared with abdominal hysterectomy. However, abdominal hysterectomy is the preferred method in most hospitals because it is deemed easier to do. With ERBE Biclamp diathermy forceps, vaginal hysterectomy could be safely and easily performed by gynaecologists. This study showed a different surgical technique for performing vaginal hysterectomy. It allowed easier and safer operations in patients with large uterus, fibroid uterus, where there was no uterine descent and narrow introitus. Also it allowed the adnexal appendages to be removed easily by the vaginal route. We compared 100 patients who had a vaginal hysterectomy performed using this method, with patients who had a vaginal hysterectomy performed by the conventional method using sutures. We found that we could safely perform vaginal hysterectomy with greater ease. Also, the need for postoperative analgesia was less and the patients were discharged earlier. Consequently, the patients' convalescence period was shorter and better.

The objective of the study was to assess the risk factors associated with obstetric brachial plexus injury. It was a retrospective analysis over a 7-year period, of women whose labours were either complicated by shoulder dystocia or had neonates who sustained brachial plexus injury. The 133 women included were divided into two groups: (1) Non-brachial plexus injury (Non-BPI) group: 106 women with labours complicated by shoulder dystocia. (2) Brachial plexus injury (BPI) group: 27 women whose neonates sustained BPI. Comparison of ante-partum, intra-partum and post-partum factors was done. In the BPI group, there were significantly more nulliparous women, with more use of oxytocin. The neonatal variables were similar in both groups. Mean birth weight was more than 4 kg in both groups. In the presence of similar neonatal variables, brachial plexus injury is more likely to occur in neonates of primiparous women in the presence of shoulder dystocia, if labour is accelerated.

We report a case of brachial plexus birth palsy in an infant with the inability to move the left upper limb since birth. There was neither history of birth trauma nor any complications during delivery. Magnetic resonance imaging (MRI) of brachial plexus showed postganglionic injury with musculoskeletal abnormalities. The child underwent surgical repair of the plexus and is on physical rehabilitation. In this case report, we discuss the utility of a single MRI examination with an elaborate discussion on various MRI signs of brachial plexus injury including secondary musculoskeletal manifestations. The case reiterates the significance of two-in-one approach while imaging these cases with MRI. Apart from reporting the damage to the brachial plexus, the radiologist should actively search for glenohumeral dysplasia. Awareness of classification and assessment of glenohumeral dysplasia should be routinely included as an integral part of imaging report as it adds incremental value to the overall patient management and functional outcome.

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