Surgery for a symptomatic epiphrenic esophageal diverticulum (EED) typically involves a diverticulectomy with myotomy and partial fundoplication. A 54-year-old male patients presented with postprandial retrosternal pain and regurgitation. A contrast-enhanced computed tomography scan revealed an 8 × 6 × 7 cm left-sided EED. We planned the EED excision using the da Vinci Xi robot (Intuitive Surgical) from an abdominal transhiatal approach.The lower esophagus was looped, followed by the mobilization of the diverticulum and division of its neck using a robotic stapler. A 7-cm long esophagogastric myotomy was performed on the right side with a Toupet fundoplication. The total operative time was 240 minutes with a blood loss of 200 mL. An oral contrast study on postoperative day 1 showed no leak, and the patient was discharged the next day on an oral soft diet. The robotic transhiatal approach to treat EED is safe and may successfully overcome the difficulties of exposure and reach encountered in conventional laparoscopic surgery.

Surgery for a symptomatic epiphrenic esophageal diverticulum (EED) typically involves a diverticulectomy with myotomy and partial fundoplication. A 54-year-old male patients presented with postprandial retrosternal pain and regurgitation. A contrast-enhanced computed tomography scan revealed an 8 × 6 × 7 cm left-sided EED. We planned the EED excision using the da Vinci Xi robot (Intuitive Surgical) from an abdominal transhiatal approach.The lower esophagus was looped, followed by the mobilization of the diverticulum and division of its neck using a robotic stapler. A 7-cm long esophagogastric myotomy was performed on the right side with a Toupet fundoplication. The total operative time was 240 minutes with a blood loss of 200 mL. An oral contrast study on postoperative day 1 showed no leak, and the patient was discharged the next day on an oral soft diet. The robotic transhiatal approach to treat EED is safe and may successfully overcome the difficulties of exposure and reach encountered in conventional laparoscopic surgery.

Surgery for a symptomatic epiphrenic esophageal diverticulum (EED) typically involves a diverticulectomy with myotomy and partial fundoplication. A 54-year-old male patients presented with postprandial retrosternal pain and regurgitation. A contrast-enhanced computed tomography scan revealed an 8 × 6 × 7 cm left-sided EED. We planned the EED excision using the da Vinci Xi robot (Intuitive Surgical) from an abdominal transhiatal approach.The lower esophagus was looped, followed by the mobilization of the diverticulum and division of its neck using a robotic stapler. A 7-cm long esophagogastric myotomy was performed on the right side with a Toupet fundoplication. The total operative time was 240 minutes with a blood loss of 200 mL. An oral contrast study on postoperative day 1 showed no leak, and the patient was discharged the next day on an oral soft diet. The robotic transhiatal approach to treat EED is safe and may successfully overcome the difficulties of exposure and reach encountered in conventional laparoscopic surgery.

Background and Objectives: This study aimed to evaluate whether preoperative oral prednisolone improves the intraoperative parameters and postoperative outcomes over a 3-month period in patients of sinonasal polyposis who undergo functional endoscopic sinus surgery. Methods: In a triple-blind, randomized controlled study, 43 patients diagnosed with sinonasal polyposis in the Department of ENT, AIIMS, Jodhpur, were enrolled. After obtaining institutional ethics clearance and registering the clinical trial, randomization was conducted to assign participants into experimental and control groups. Preoperatively, patients were assessed using the clinical severity score (Sino-nasal Outcome Test; SNOT-22), radiological severity score (Lund-Mackay score), and endoscopic severity scores (discharge-inflammation-polyp [DIP] score and Lund-Kennedy score). Intraoperative assessment was done using the Perioperative Sinus Endoscopy (POSE) score, the duration of surgery, intraoperative blood loss, and visual analog scale for visual field during surgery and for the ease of disease removal. Postoperatively, at 3 months all the preoperative parameters were reassessed, and, using independent t-test, comparison was made between the two groups. Results: Twenty-one patients were included in the experimental group (48%), and 22 in the control group (51%). Although the mean duration of surgery in the experimental group was shorter than in the control group, the difference was not statistically significant. Similarly, although the postoperative SNOT-22 score was lower in the experimental group compared to the control group, there was no statistically significant difference in outcomes between the two groups across any of the parameters assessed. Conclusion Although the role of oral steroids has been established in the treatment of sinonasal polyposis, our study did not find any significant difference between the group that received oral steroids prior to surgery and the group that received placebo.

Background: Tooth hypersensitivity presents a significant clinical challenge in managing molar-incisal hypomineralization (MIH), potentially compromising the effectiveness of restorative treatments. Cryotherapy has emerged as a promising approach to reduce pain and inflammation. This study aimed to evaluate and compare the effects of cryotherapy as an adjuvant to nerve blocks in reducing operative pain and sensitivity in patients. Methods: A split-mouth randomized controlled trial was conducted in 28 patients with MIH of the right and left lower molars. ie, 56 teeth. Group (1) control group (n = 28) was administered an Inferior Alveolar Nerve block and group (2) was administered cryotherapy spray after the Inferior Alveolar Nerve block. The Visual Analog Scale (VAS) and Legs, Activity, Cry, Consolability (FLACC) scales were used to compare intraoperative pain. The Mann-Whitney U test was used to test the significance across the study groups, and the chi-square test was used to compare success rates between the two groups; a value of less than 0.05 was considered significant. Results: For VAS scale, the mean value in Group A is 8.89 ± 0.79, whereas in Group B, the values are 4.71 ± 1.46. For the FLACC scale, Group A scores were 7.14 ± 1.04, and Group B scores were 4.48 ± 1.37.When intergroup values were compared, the FLACC and VAS scores were statistically significant at P < 0.001. Conclusion Within the limitations of this study, applying cryotherapy to tooth surfaces following an Inferior Alveolar Nerve block effectively reduces pain and sensitivity in teeth affected by MIH.

Background: There is a shortage of data on brain tumor patients admitted in to intensive care unit (ICU) from developing countries. We aimed to assess the clinical course and 30-day mortality with factors affecting the mortality of brain tumor patients who were admitted to medical ICU. Methods: This study was a single-centre retrospective observational cohort study and was conducted in a medical ICU of a tertiary care center in India. We included 42 patients admitted in to the medical oncology ICU over 3 years. Data regarding demographics, baseline characteristics, clinical and laboratory data, need for organ support, and 30-day mortality were collected. Factors associated with increased mortality in these patients were determined. Results: Overall 30-day mortality was 30.95%. The most common indication for ICU admission was altered sensorium (57.1%) followed by sepsis (23.8%). Age [odds ratio, OR: 0.843 (95% confidence interval, CI: 0.721–0.986)], and need for invasive mechanical ventilator (IMV) support [OR: 484.62 (95% CI: 2.707–8676.02)] or vasopressor support [OR: 523.83 (95% CI: 2.12– 3,023.13)] were directly associated with 30-day mortality. Severity indices such as Sequential Organ Failure Assessment (SOFA) score, SAPS II (Simplified Acute Physiology Score II), and Acute physiology and chronic health evaluation II (APACHE II), APACHE III and APACHE IV scores were higher in non-survivors than survivors. Conclusion Advancing age and need for IMV or vasopressor support may be associated with worse prognosis in brain tumor patients admitted in to ICU. A scoring system could be used along with clinical judgement to triage brain tumor patients for ICU admission.

Background: Tooth hypersensitivity presents a significant clinical challenge in managing molar-incisal hypomineralization (MIH), potentially compromising the effectiveness of restorative treatments. Cryotherapy has emerged as a promising approach to reduce pain and inflammation. This study aimed to evaluate and compare the effects of cryotherapy as an adjuvant to nerve blocks in reducing operative pain and sensitivity in patients. Methods: A split-mouth randomized controlled trial was conducted in 28 patients with MIH of the right and left lower molars. ie, 56 teeth. Group (1) control group (n = 28) was administered an Inferior Alveolar Nerve block and group (2) was administered cryotherapy spray after the Inferior Alveolar Nerve block. The Visual Analog Scale (VAS) and Legs, Activity, Cry, Consolability (FLACC) scales were used to compare intraoperative pain. The Mann-Whitney U test was used to test the significance across the study groups, and the chi-square test was used to compare success rates between the two groups; a value of less than 0.05 was considered significant. Results: For VAS scale, the mean value in Group A is 8.89 ± 0.79, whereas in Group B, the values are 4.71 ± 1.46. For the FLACC scale, Group A scores were 7.14 ± 1.04, and Group B scores were 4.48 ± 1.37.When intergroup values were compared, the FLACC and VAS scores were statistically significant at P < 0.001. Conclusion Within the limitations of this study, applying cryotherapy to tooth surfaces following an Inferior Alveolar Nerve block effectively reduces pain and sensitivity in teeth affected by MIH.