An extremely rare case of long, thin and sharp pin in a young boy which was inhaled initially and defied removal at branchoscopy was eventually recovered in stool after a long and variable course through alimentary tract has been reported.
Background: Self-expanding metal stents (SEMS) have been used in the management of malignant colorectal obstruction for palliation or as a bridging tool to single-stage surgery. We present the clinical results of a series of patients with colonic cancer in whom SEMS were inserted endoscopically under radiological guidance. Methods: Between September 2007 and January 2010, prospectively collected data from 21 patients who underwent SEMS insertion was analysed. This data includes demographics, indication for stenting, stent size, technical success, clinical success, complications, survival and duration of hospitalisation. Results: 14 male and 7 female patients with malignant colonic obstruction underwent SEMS insertion: 19 requiring palliation and 2 bridging to surgery. The rate of technical success was 100% and of initial clinical success was 100%. In 16/19 (84.2%) of the palliation group, clinical success was maintained at mean follow up of 3.4 months (1-6 months), while 3/19 (15.8%) died, two with functioning stents and one with stent occlusion. The two patients with operable tumours were successfully bridged to one-stage elective surgery at 1 month and 4 months following stenting. Post-procedure complications occurred in 5 patients: 1 perforation, 2 pain, 1 migration and 1 stent occlusion. All patients were discharged alive and the median hospital stay was 1 day (range: 1 to 13 days). Conclusion: SEMS provides an effective and safe option in the palliation of malignant colorectal obstruction. In operable patients, it provides a useful option to avoid colostomy, by facilitating safer single-stage surgery. In this prospective study of SEMS insertion, high rates of technical and initial clinical success were achieved. This could be attributed to performing the procedure under combined endoscopic and radiological guidance
Polyuria is not an uncommon perioperative complication, following coronary artery bypass surgery. Diabetes insipidus (DI) results from inadequate secretion of antidiuretic hormone (ADH) from the pituitary gland (Central DI)or the absence of the normal response by the renal tubules to ADH(Nephrogenic DI).Here we present a 55 years old male who underwent Aortic valve replacement. Postoperatively he developed polyuria and was diagnosed with Diabetes insipidus (DI). Its most likely due toalteration within the left atrial non-osmotic receptor during cardioplegia.It can also be a dysfunction of osmotic receptors in the hypothalamus because of transient cerebral ischemia resultingdue to microthrombi during Cardio-Pulmonary Bypass.The patient recovered from symptoms without any administration of vasopressin.
Background: Laparoscopic cholecystectomy (LC) is considered the gold standard for cholecystectomy procedures. In recent years, many investigators have attempted to further improve the established technique of LC with the goal of minimising invasiveness of this procedure by reducing the number and size of the operating ports and instruments.Methods: This was a retrospective study done in a tertiary care hospital comparing the safety and efficacy of mini-laparoscopic cholecystectomy (MLC) with conventional laparoscopic cholecystectomy (CLC) done during the time period of June 2020 to January 2022 based on the variables like total operating time, post-operative pain, conversion rate to open procedure, duration of hospital stay and cosmetic results.Results: Out of 40 cases were collected and analysed, MLC has an advantage over CLC like postop pain on postop day 1 (p=0.016) and on postop day 3 (0.025) and postoperative scar (p<0.001). In aspects like duration of hospital stay (p=0.359) and operating time (p=0.805) MLC is equally comparable to CLC. CLC is proved to be better than MLC in one aspect- conversion to open cholecystectomy (p=0.042).Conclusions: Miniaturised instrumentation is an area of research which is studied for the past 3 decades. Although improved instrument durability and better optics are needed for widespread use of miniport techniques, this MLC approach can be routinely offered to many properly selected patients undergoing elective LC.
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