Aged, 80 and over ; Aortic Aneurysm ; complications ; Humans ; Male ; Syndrome ; Tomography, X-Ray Computed ; Vocal Cord Paralysis ; diagnostic imaging ; etiology ; physiopathology

BACKGROUND:Peritonitis secondary to small bowel perforation is a common surgical emergency seen across the globe.METHODS:A young male patient presented with ileal perforation that was repaired primarily. He recovered uneventfully after the operation.RESULTS:Histopathology of the margins of the perforation revealed tuberculosis. A search for evidence of a primary focus of tuberculosis was unsuccessful. The patient was started on anti-tubercular therapy and he was followed up with good results.CONCLUSION:This present case underscores the importance of biopsy specimens taken from the margins of patients with ileal perforation to avoid the misdiagnosis of such condition.

BACKGROUND: Valsalva maneuver reduces pain by activating sinoaortic baroreceptor reflex arc. We planned this study to evaluate the role of valsalva in attenuating spinal needle-puncture pain. METHODS: Ninety American Society of Anesthesiologists (ASA) grade I and II enrolled patients undergoing elective surgery were randomized into 3 groups of 30 each. Group I (Control): didn't blow; group II (Distraction): patients blew into rubber tube; Group III (Valsalva): blew into sphygmomanometer tube and raise mercury column up to 30 mmHg for at least 20 seconds. During above procedures, spinal puncture was performed with 25-gauge spinal needle. RESULTS: Eighty-two patient data were analyzed. Incidence of spinal puncture pain was reduced to 10% (3 of 27) in Valsalva group as compared to 100% (28 of 28 in control group and 27 of 27 in Distraction group) observed in other two groups (P < 0.05). Severity of lumbar puncture pain as assessed by visual analog scale (0-10; where 0 is no pain and 10 is the worst imaginable pain) presented as Median (Interquartile range) were significantly reduced in the Valsalva group (0.0 [0.0] as compared to other 2 groups 2.0 [0.0] in the Distraction group and 3.0 [0.8] in Control group) (P < 0.05). Regarding time taken by CSF to fill spinal needle hub, there was no difference among the three groups (P > 0.05). None patient of all groups had post dural puncture headache (P > 0.05). CONCLUSIONS: Valsalva can be performed routinely in ASA I and II patients undergoing spinal anesthesia as it is safe, painless and non-pharmacological method of pain attenuation.
Anesthesia, Spinal* ; Baroreflex ; Humans ; Incidence ; Needles ; Post-Dural Puncture Headache ; Punctures* ; Rubber ; Skin* ; Sphygmomanometers ; Spinal Puncture ; Valsalva Maneuver* ; Visual Analog Scale

BACKGROUND: Venipuncture pain is an uncomfortable suffering to the patient. It creates anxiety, fear and dissatisfaction. The ketoprofen transdermal patch is a proven treatment for musculoskeletal and arthritic pain. We planned this study to evaluate the efficacy of the ketoprofen patch to reduce venipuncture pain. METHODS: Two hundred adult patients, aged 18–60 years, of either sex, ASA grade I or II, were enrolled. Presuming that therapy would decrease venipuncture pain by 30%, a power calculation with α = 0.05 and β = 0.80 required enrollment of at least 24 patients into each group. However, 100 patients in each group were recruited. Group I (Control) received a placebo patch; Group II (Ketoprofen) received a 20 mg ketoprofen patch. A selected vein on the dorsum of the patient's non-dominant hand was cannulated with 18 g intravenous cannula 1 h after the application of the respective patch. Assessment of pain was done by a 10 cm visual analogue scale (VAS) of 0–10, where 0 depicts “no pain” and 10 is “the worst imaginable pain”. The venipuncture site was assessed for the presence of skin erythema, swelling and rashes at 12 h, 24 h and at the time of decannulation. RESULTS: Incidence of pain was 100% (94/94) in the control group as compared to 93% (85/91) in the ketoprofen group. The severity of the venipuncture pain was 6 (2) and 2 (2) for control and ketoprofen groups respectively (P < 0.05). CONCLUSIONS: Application of a ketoprofen patch at the proposed site of venipuncture one hour before the attempt is effective and safe for attenuating venipuncture pain.
Adult ; Anxiety ; Catheterization ; Catheters ; Erythema ; Exanthema ; Hand ; Humans ; Incidence ; Ketoprofen ; Phlebotomy ; Skin ; Transdermal Patch ; Veins ; Visual Analog Scale

Timed barium esophagogram (TBE) is a simple and objective method for assessing the esophageal emptying. The technique of TBE is similar to usual barium swallow with some modifications, which include taking multiple sequential films at pre-decided time interval after a single swallow of a fixed volume of a specific density barium solution. While many authors have used height and width of the barium column to assess the esophageal emptying, others have used the area of the barium column. TBE is being used in patients with suspected or confirmed achalasia and to follow-up those who have been treated with pneumatic dilation or myotomy. This review discusses technique of performing TBE, interpretation and its utility in clinical practice.
Barium ; Esophageal Achalasia ; Esophageal Motility Disorders ; Esophageal Sphincter, Lower ; Esophagus ; Follow-Up Studies ; Humans

No abstract available.
Eosinophils* ; Karyotype* ; Myelodysplastic Syndromes*

Primitive neuroectodermal tumours (PNETs) arise from pluripotent neural crest cells and are classified as either central or peripheral. Peripheral PNETs (pPNETs) arise outside the central nervous system and sympathetic chain. These rare neoplasms comprise only 1% of all sarcomas and have highly aggressive biological behaviour and dismal prognosis. Adolescents and young adults are typically affected. Only isolated case reports on pPNETs appearing in both typical and atypical sites can be found in the literature. Timely diagnosis of pPNETs is a challenge to clinicians and radiologists due to the disease's insidious onset and variable locations, coupled with the limited studies that focus on the imaging features of pPNETs. Hence, this article serves to review the imaging features of this rare tumour.
Contrast Media ; Diagnosis, Differential ; Diagnostic Imaging ; Humans ; Neuroectodermal Tumors, Primitive, Peripheral ; diagnosis

Simultaneous isolated bilateral patellar fractures are very rare injuries and most often associated with systemic disorders such as hyperparathyroidism, osteoporosis, stress fracture and kidney failure. Isolated bilateral traumatic fracture of patella following an unusual mode of injury is seldomly reported in the literature. We reported such a case following a road traffic accident without any associated injuries or co-morbid condition. The patella on the right side had transverse open fracture which was fixed with two Kirschner wires following tension band principle, and that on the left side sustained upper pole comminution which was treated by partial patellectomy. The patient achieved good outcome: at 6 months he was able to squat and sit cross legged; at one year he obtained nearly normal muscle strength and full range of motion. We discussed the injury mechanism, management and rehabilitation in such a case and reviewed the available literature regarding such a presentation.
Bone Wires ; Fracture Fixation, Internal ; Fractures, Bone ; Fractures, Comminuted ; Humans ; Knee Injuries ; Patella ; injuries

Objective: The purpose of this study was to evaluate the essential oil composition as well as antibacterial activities of essential oil and leaves extracts of Lantana camara against five bacterial strains. Methods: Essential oil was obtained by hydro-distillation from the leaves and analyzed by GC and GC-MS. The antibacterial activities of essential oil and the leaves extracts were tested by using disk diffusion method against five bacterial strains. Results: Thirty seven compounds were identified representing 98.11% of the total oil, of which trans-caryophyllene (13.95%), bicyclogermacrene (9.77%), α-curcumene (8.57%), sabinene (8.28%), (E)-citral (6.90%), 1,8 cineole (5.06%), α-pinene (4.03%), γ-terpinene (3.83%) and germacrene D (3.13%) were detected as major components. In respect to the antibacterial activities, essential oil showed the high degree of sensitivity against Micrococcus luteus, Escherichia coli, Staphylococcus aureus and Bacillus cereus except Pseudomonas aeruginosa while extracts of leaves obtained through petroleum ether, benzene, methanol and water exhibited good to moderate antimicrobial activity against all tested bacterial strains. Conclusions: The present study suggested that M. luteus showed best zone of inhibition for the essential oil as well as aqueous extract among all the tested bacterial strains. The most active extract can be subjected to isolation of the therapeutic antimicrobials to carry out further pharmacological evaluation.

Methods: A total of 90 American Society of Anesthesiologist grade I–III patients, aged 18–65 years, with a motor power of ≥4/5 grade as per the Medical Research Council Scale in all four limbs who were scheduled for elective spine surgery under transcranial electrical motor evoked potential monitoring were enrolled. The subjects were randomly allocated into the following three groups: group PD who received 0.5 μg/kg/hr dexmedetomidine infusion, group PK who received 0.5 mg/kg/hr ketamine infusion, and group PS who received normal saline infusion, along with standard propofol–fentanyl based TIVA regime. Amplitude and latency of bilateral motor evoked potentials of the tibialis anterior and abductor halluces muscle were recorded at Ti (at train-of-four ratio >90%), T30 (30 minutes post-Ti), T60 (60 minutes post-Ti), and Tf (at the end of spine manipulation). Results: Baseline median amplitudes were comparable among the study groups. In group PK, we noted a gradually enhanced response by 24%–100% from the baseline amplitude. The median amplitudes of all the muscles were higher in group PK than those in groups PS and PD at time points T60 and Tf (p <0.05). Conclusions The present study demonstrated that compared with dexmedetomidine and control treatment, a subanesthetic dose of ketamine caused gradual improvement in amplitudes without affecting the latency.