White out hemithorax secondary to salivary gland type of lung cancer with metastasis in liver and bone: a case report.

BACKGROUND: Salivary gland-type lung carcinomas are uncommon neoplasms of the lung, representing less than 1% of all lung tumors. The two most common among them are adenoid cystic carcinoma and mucoepidermoid carcinoma. Although they usually have an indolent behavior, adenoid cystic carcinomas can be more aggressive, with 5-year survival as low as 55%. Very few cases are reported in literature. We report a similar rare case of salivary gland type lung carcinoma that presented for the first time with unilateral opacification of left hemithorax. CASE PRESENTATION: A 38-year-old man of North Indian origin, who was a a nonsmoker, presented with complaints of shortness of breath and cough for 1 year, which has increased in the last 2 months and was associated with significant weight loss. A frontal radiograph of the chest and computed tomography of the chest were performed, which showed a mass in the left upper lobe of the lung with its epicenter in the left main bronchus. A bronchoscopic guided biopsy was performed, and histopathology confirmed the diagnosis of lung carcinoma of salivary gland type (adenoid cystic carcinoma). There was invasion of major vessels, hence the patient was offered and started on palliative management instead of surgical treatment. In spite of palliative management of two cycles of chemotherapy and radiotherapy, the patient succumbed to the disease within 2 months from the time of diagnosis. CONCLUSION: Lung carcinoma of the salivary gland type (especially adenoid cystic carcinoma) usually presents at a later stage. The resectability of the tumor depends on the involvement of the surrounding major vessels. Interestingly, these cancers have no association with smoking. The prognosis depends on the extent of the disease at the time of diagnosis. Hence, imaging plays a major role in deciding the further plan of management.

Slipped capital femoral epiphysis as primary presentation in an adolescent with primary hyperparathyroidism due to ectopic mediastinal parathyroid adenoma.

Key Clinical Message: Ectopic mediastinal parathyroid adenoma causes primary hyperparathyroidism presenting as hypercalcemia. When children with hypercalcemia present with slipped capital femoral epiphysis, a detailed evaluation for hypercalcemia must be done before surgery. Abstract: The association between slipped capital femoral epiphysis (SCFE) and hyperparathyroidism has been reported and is rare. Each is known to affect different age groups. We report a case of a 13-year-old boy with SCFE and primary HPT leading to hypercalcemia and skeletal deformities.

Use of the McGRATH™ MAC videolaryngoscope to evaluate the ability of anesthetists to give effective cricoid pressure: An interventional study.

Background and Aims: The application of cricoid pressure (CP) for rapid sequence induction is questioned on two grounds: its effectiveness in clinical settings and its impact on the laryngeal view. The main reason cited for its ineffectiveness is the lack of knowledge and training in its correct application. This study assessed, the performance of anesthetists in applying effective CP in a clinical setting. Material and Methods: Eighty-five ASA I/II adult patients posted for elective surgery requiring oral endotracheal intubation with nasogastric tube (NGT) placement participated in the study. Eighty-five anesthetists divided into five groups based on their level of experience were randomly chosen to apply CP after induction of anesthesia. An experienced anesthetist performed videolaryngoscopy and attempted NGT insertion. The primary outcome was effectiveness of CP defined as the inability to pass the NGT into the esophageal opening. We also noted that the glottic view with and without CP and the effectiveness of CP across different levels of experience of anesthetists. Results: Of the 85 anesthetists, 61 (71.8%) applied effective CP. The effectiveness improved with experience (first-year residents-11/17 [64.7%], second-year residents-11/17 [64.7%], third-year residents-10/17 [58.8%], senior residents-13/17 [76.5%], and consultants-16/17 [94.1%]) (P = 0.157). Post hoc analysis showed higher effectiveness among anesthetists with >3 years of experience (85.3%) compared with <3 years of experience (62.7%) (P = 0.024). CP did not always impede the laryngeal view, rather it has no effect or actually improves the glottic view in many instances (81%). Conclusion: CP is effective in occluding the esophageal lumen without hampering glottic view in the majority of the cases, and its effectiveness improves with experience.

Patient satisfaction with anaesthesia services in a tertiary care cancer centre. (SAY study).

Background and Aims: Patient satisfaction is an important measure of quality of health care. Its assessment leads to a balanced evaluation of the structure, process and outcome of service at an institution. The aim of our study was to assess patient satisfaction with perioperative anaesthesia services provided in our institution and identify factors leading to dissatisfaction which could be preventable or addressed to improve patient care and experience. Material and Methods: A convenient sample size of 200 patients was accrued after written informed consent. A questionnaire to suit local needs of institute was developed, validated and a language appropriate questionnaire was administered by a trained research nurse 24-48 hours post anaesthesia to accrued patients. Data was summarised in percentages and satisfaction scores were compared across demographic variables using Chi square test. Results: A total of 96% (192/200) patients were satisfied with the overall interaction with the anaesthetists in the perioperative period; with 99% (198/200) patients being satisfied with acute pain services provided, postoperatively. As regards to recovery room, 96.5% (193/200) patients were satisfied with the services provided. Satisfaction scores of the pre-anaesthetic clinic (PAC), pain team and anaesthesia services compared across demographic variables - age, gender and education qualifications were found to be statistically non-significant. Conclusion: High rate of patients were satisfied with perioperative anaesthesia care services at our institute. Good and effective preoperative communication with the patient, effective management of postoperative pain and complications significantly contributed towards overall high patient satisfaction.