Saviour tool now a foreign body.

ABSTRACT: Foreign bodies are commonly seen in children, here presenting a case of a male adult with an impacted thumb pin in the left lower lobe bronchus. Extraction required fiber-optic bronchoscopy, failure of which led to thoracotomy with bronchotomy.

Late lead fungal endocarditis of automatic implantable cardioverter defibrillator.

Lead related infective endocarditis of impantable cardioverter defibrillator occuring after few months of implantation is a rare entity. We present a case presenting after 2.5 years of implantation, which presented with a very short febrile illness and inappropriate shocks from device due to sinus tachycardia. Though patient underwent a successful surgical excision of lead with vegetation but succumbed to ventricular arrhythmic storm.

Anomalous left circumflex in tetralogy of Fallot--a case report.

A case of anomalous left circumflex coronary artery coursing the right atrioventricular groove in a patient with the Tetralogy of Fallot is described, a pattern which, to the best of our knowledge, has not been reported earlier.

Absent conal septum in tetralogy of Fallot. An angiographic study.

Absent conal septum in tetralogy of Fallot (TF) is usually noted intraoperatively when the ventricular septal defect (VSD) is found abutting the pulmonary valve, its superior rim being nearly inaccessible transatrially, and the posterior rim being separated from the tricuspid valve (TV) by a muscular ridge. The authors retrospectively analyzed angiograms of 208 consecutive patients with TF seen at their center from July 1989 to December 1995 for absence of the conal septum and the presence of an interval between the TV and the margin of the VSD in 30 degrees right anterior oblique view. In 13 (6%) patients, angiograms were inadequate or of poor quality for assessment and were excluded. Twenty-two of the remaining 195 (11%) patients had a large muscular interval between the tricuspid annulus and the margin of the VSD, which was associated with an absent conal septum in 14 (7.2%) and a diminutive septum in 8 (4%) patients. Nine of the 14 patients with an absent conal septum at angiography underwent surgery, and this finding was confirmed in all. The authors conclude that absent conal septum is not uncommon in TF and constitutes an important variation in its anatomy that can be identified preoperatively at angiography for optimal surgical management.

Cold agglutinin disease detected during open heart surgery.

Cold agglutinins are commonly found in sera of healthy persons. They rarely become clinically apparent due to their activity at lower temperature. In these patients, cardio-vascular operations requiring hypothermia can result in complications like hemolysis, renal failure, myocardial damage and cause unexpected morbidity and even mortality (Agarwal et al., Ann Thorac Surg 60:1143-1150, 1995). Ideally, all patients should be routinely screened pre-operatively for antibodies and management plans made accordingly but the low incidence of the disease, cost of screening tests and the lack of direct relationship between the titers, thermal threshold and risk of complications makes the screening an uncommon practice.

Combined use of isoflurane and sodium nitroprusside during active rewarming on cardiopulmonary bypass: a prospective, comparative study.

AIMS: To evaluate and compare the effect of isoflurane, sodium nitroprusside (SNP) and combined use of isoflurane and SNP on body rewarming and haemodynamic stability during active rewarming on cardiopulmonary bypass (CPB). SUBJECTS AND METHODS: In a prospective, randomised study 75 adult patients scheduled for coronary artery bypass grafting (CABG) under CPB were studied in three groups of 25 patients each. During active rewarming, patients of group I received SNP infusion in CPB, group-II received isoflurane through vaporiser in gas circuit of the CPB machine and group III received a combination of isoflurane inhalation (0.2-0.5%) + SNP in low doses (<1mg/kg/min). RESULTS: Mean requirements of SNP to achieve maximum pump flow during rewarming were 1.48 -/+ 0.65 mg/kg/min (range 0.3-3.5 mg/kg/min) in group I and 0.75 -/+ 0.25 mg/kg/min (range 0.2-0.85 mg/kg/min) in group III. Mean isoflurane concentration required to achieve maximum pump flow during rewarming was 0.95 -/+ 0.35% (range 0.2-1.5%) in group II and 0.35 -/+ 0.1 (range 0-0.4%) in group III. The requirements of SNP and isoflurane in group III were significantly less than group I and II (p<0.001). The haemodynamic stability was better in SNP + isoflurane group with significantly lesser requirement of inotropes. Four-scaled assessment for rewarming evaluation failed to show significant statistical difference amongst the groups. CONCLUSIONS: All three drug regimens were equally effective in terms of uniform rewarming of the body on CPB. However, combined use of SNP and isoflurane in low doses provides haemodynamic stability during CPB and is superior to either drug alone.

Retained esophageal foreign bodies in children.

Foreign-body (FB) ingestion is common in children. Retained FBs in the esophagus can produce serious complications. We report five children with retained esophageal FBs: one presented with massive hematemesis due to an esophago-carotid fistula and the others had FB impaction above esophageal strictures. The hazards of impaction of small FBs above the strictures and delayed referral are highlighted.

Actinomycosis caecum. A case report.

A case of caecal actinomycosis presenting as a lump in the right iliac fossa is discussed. A right hemicolectomy was performed with complete cure. Clinical awareness of this condition is necessary for proper management and to differentiate it from tumour.

Cattle horn injuries.

The successful management of a patient with potentially lethal intrathoracic trauma resulting from bull horn injury and involving the intrapericardial and extrapericardial portions of the right inferior pulmonary vein is described. To the best of our knowledge this particular injury has not previously been reported. Irrespective of the external appearance of the wound, hospitalization and close observation are essential. Exploration if required should be under optimal operative conditions. Popularization of disbudding and dehorning will prove an effective preventive measure.