Practical Tips for Surgical Management of Bilateral Choanal Atresia.

Choanal atresia refers to congenital blockage of posterior choana of nose by the presence of a bony or membranous soft tissue. It causes respiratory distress in newborn which requires emergency surgical intervention. Various surgical methods are available for correction of choanal atresia and endoscopic approach is the commonly used one. However there is risk of re-stenosis after surgery. This article focuses on surgical refinements to improve the surgical outcome. It is a retrospective study done on eight newborns with bilateral congenital choanalatresia. Data included gestational age, any ante-natal issues, breathing activity at birth, diagnostic tests for choanal atresia and Head to Foot examination findings. Initial diagnostic work up included CT scan of paranasal sinus and Echocardiography to rule out associated cardiac anomalies. All the newborns were treated initially in NICU with ventilator support and then taken up for endoscopic correction of atresia. After surgery, newborns were successfully weaned off from ventilator. Among the 8 newborns, there were 5 males and 3 females and their gestational age was full term. (except in one). Initial presentation included respiratory distress on day 1 of life with difficulty in inserting feeding tube through the nose. Imaging showed bilateral atresia in 7 newborns and unilateral atresia in one newborn. 5 of them underwent atresia surgery using endoscopic approach. One newborn required revision surgery. Remaining newborns remained symptom free during the follow up period. Currently endoscopic approach remains a safer method for correction of choanal atresia with very minimal chance of re-stenosis. Surgical refinements like adequate widening of neo-choana and usage of mucosal flaps to cover the raw area has been found to improve the surgical outcome.

Safety of Percutaneous vs Open Tracheostomy on Intubated Patients in ICU Setting: Which One is Better?

To study the safety of percutaneous vs open tracheostomy approaches on patients requiring long term ventilation in ICU setting. It is a prospective study done over a period of 2 years on 105 patients requiring long term ventilation in ICU set up in a tertiary care hospital. Patients were subjected to either open approach or percutaneous tracheostomy bedside in ICU itself. Then patients were followed during their hospital stay to look for any tracheostomy related complications. Data regarding age, gender, indications of long term ventilation and complications were compiled and analysis was done. It was found that most of the patients were of male gender (88.6%) in the age group of 50-59 years of age. The most common cause for tracheostomy was head injury secondary to road traffic accident, seen in 79 out of 105 cases. On comparing complications rate, there was no statistically significant difference in both the groups. However rate of peristomal infection is more with open approach group (P < 0.05). Percutaneous tracheostomy can be performed safely in ICU as a bedside procedure. There is significant reduction in peristomal infection with percutaneous tracheostomy and there is no significant difference in other complications between the two groups. Thus percutaneous tracheostomy is as safe as an open approach tracheostomy in properly selected cases.

4-Bromo-2-(dieth-oxy-meth-yl)phenyl benzoate.

In the title compound, C18H19BrO4, the aromatic rings enclose a dihedral angle of 81.9 (7)°. There are no short directional contacts in the crystal structure.

Comparison of a PACS workstation with laser hard copies for detecting scaphoid fractures in the emergency department.

Picture archiving and communication systems (PACS) for imaging studies is rapidly being adopted in hospitals throughout the UK. However, very little comparison has been made between PACS and laser hard copies for assessing the diagnostic accuracy of detecting fractures by emergency physicians. A prospective paired comparison study was undertaken looking at correct reporting of scaphoid X-rays on PACS and conventional film by emergency department medical staff. A total of 34 imaging studies were reported by 38 physicians using both PACS workstations and laser-printed films. The percentage of emergency physicians correctly reporting imaging studies was similar when comparing PACS images to laser film copies (80.7% versus 81.0%). The sensitivity and specificity of PACS for diagnosing scaphoid fractures was 79.5% and 81.6%, versus 78.1% and 83.8% for conventional films. There is no significant difference in accuracy of diagnosis between PACS and laser film copies when scaphoid X-rays are reported by emergency physicians.

Imaging of childhood torticollis due to atlanto-axial rotatory fixation.

Atlanto-axial rotatory fixation is a rare cause of childhood torticollis. It may occur spontaneously or may be associated with trauma, upper respiratory tract infection or congenital abnormality of the cervical spine. Presentation is usually with persistent torticollis and "cock robin" deformity of the neck. In this paper the radiological experience in three patients is presented. Investigations included plain radiographs, plain anteroposterior tomography, CT and MRI. Displacement of the lateral mass of the atlas and the eccentric position of the odontoid peg can be seen in the plain films. CT scan can exclude fractures and confirm atlanto-axial rotation. The superimposition of CT images is demonstrated as a way of diagnosing subluxation. MRI offers better soft tissue differentiation and allows assessment of the integrity of the transverse ligament. This has an important bearing on the prognosis and may influence surgical treatment. It is important to recognise the plain film features of this uncommon condition and confirm the diagnosis with CT or MRI. The treatment options are discussed with particular reference to long term outcome.

Sciatica in degenerative spondylolisthesis of the lumbar spine.

Intraspinal synovial cysts are an uncommon but well recognised cause of backache and sciatica, and should be considered in patients, in particular with degenerative spondylolisthesis, who are symptomatic. MRI is the initial investigation of choice. If there is any doubt as to the diagnosis, CT with or without facet joint arthrography is helpful.

Monolayer system of cultivating bovine polymorphonuclear leukocytes (PMNL): effect of long-term cultivation on the viability and phagocytic function of the cells.

A monolayer system of cultivating bovine PMNL is described. Poly-L-Lysine (PLL) significantly (P less than 0.01) enhanced the attachment of bovine PMNL to glass. Long-term cultivation up to seven days, in a mixture of calf serum and RPMI 1640, had no effect on the viability of the cells, but cultivation for 3 days or more significantly reduced the ability of the PMNL to phagocytose bacteria.