Defecto del tubo neural: encefalocele occipital. Reporte de caso / Neural Tube Defect: Occipital Encephalocele. A case Report

Resumen El encefalocele es una malformación congénita del sistema nervioso central rara. Se estima que la prevalencia es de aproximadamente 1 de cada 5,000-40,000 recién nacidos vivos. Puede involucrar diferentes sitios anatómicos como la región occipital, frontal, temporal y parietal. La cuarta y quinta semana del desarrollo embriológico son imprescindibles para el desarrollo de la cabeza y el cuello. Cuando existe un fallo en la separación del ectodermo superficial del neuroectodermo, aparecen defectos del tubo neural, en donde se pueden originar los encefaloceles. Genéticamente se puede explicar por la teoría disembriológica, la cual involucra a ciertos genes mutados que interfieren en mecanismos celulares importantes en el desarrollo neural temprano. Actualmente, gracias a las herramientas de cribado prenatal como la ecografía, es posible identificarlos desde la vida intrauterina. Es sumamente importante realizar un diagnóstico temprano para protocolizar y brindar un tratamiento individualizado, en donde se involucrará a un equipo multidisciplinario. A pesar que algunos casos suelen ser compatibles con la vida, el pronóstico dependerá del sitio anatómico involucrado, así como el manejo quirúrgico oportuno. Entre las secuelas más importantes se encuentra el déficit intelectual.

Abstract Encephalocele is a rare congenital malformation of the central nervous system. The prevalence is estimated to be about 1 in 5,000-40,000 live births. It can affect various anatomical locations such as the occipital, frontal, temporal, and parietal regions. The fourth and fifth weeks of embryonic development are critical for the development of the head and neck. When there is a failure in the separation of the superficial ectoderm from the neuroectoderm, neural tube defects occur, from which encephaloceles may arise. Genetically it can be explained by the dysembryological theory, which involves certain mutated genes that interfere with important cellular mechanisms in early neuronal development. Currently, thanks to prenatal screening tools such as ultrasound, it is possible to identify them from intrauterine life. It is extremely important to make an early diagnosis to establish protocols and provide individualized treatment, involving a multidisciplinary team will be involved. Even though some cases are usually compatible with life, the expected prognosis of the anatomical site involved as well as timely surgical management. One of the most important sequelae is intellectual deficit.

Intraoperative Innovation Leading to a Modified Endotracheal Tube: A Case Report of Endobronchial Intubation of Total Laryngectomy Stoma

The post?total laryngectomy airway poses perioperative challenges to anesthesia management. While endobronchial intubation is a cited complication, a low?lying stoma may increase this risk. Furthermore, the stoma’s proximity to a median sternotomy increases surgical and airway management complexity. This report highlights a case of endobronchial intubation in a patient with a low?lying stoma who presented for coronary artery bypass graft. With a stoma at the upper border of the sternum, intraoperative innovation was required to prevent endobronchial intubation while remaining out of the surgical field. This innovation may be useful in urgent surgical situations.

Tracheostomy Tube, An Unusual Foreign Body In Left Main Bronchus: A Case Report

Introduction: Tracheostomy is a very commonly performed surgical procedure in patients of prolonged ventilation and in carcinoma larynx patients presenting with stridor. Tube fracture at the neck and its displacement into the bronchus can be fatal. A 65-year-old presented with respiratory distress with alleged history of aspiration of broken tracheostomy tube whileCase Report: cleaning. Patient had poor follow up after tracheostomy and last tube change was done 6 months back. The foreign body was localized in the left main bronchus embedded in the bronchial mucosa and was removed via a rigid bronchoscope under a short general anesthesia without intubation. There was no signi?cant injury of the bronchial mucosa. Proper tracheostomy tube care and tube change at regular intervals is to beConclusion: followed strictly to avoid complications like dislodgement in bronchus and airway compromise.

Transición de adolescentes con espina bífida hacia sistemas de atención de adultos. Perspectiva de las especialidades integradas / Transition of adolescents with spina bifida to adult systems of care. A perspective of integrated specialties

Los niños con espina bífida (EB) presentan compromiso de múltiples órganos y sistemas lo que genera discapacidad de carácter permanente y que requiere de una atención compleja, específica y sin interrupciones. El objetivo es presentar un plan de abordaje y recomendaciones de las especialidades integradas a Urología para facilitar el acceso de pacientes a centros de adultos y su implementación en jóvenes con EB. Material y Método: Se realizó una búsqueda para revisión sistematizada para cada especialidad. Se examinó la experiencia de cada área y se generaron pautas para la atención en transición y recomendaciones de expertos. Para evaluar la preparación de los adolescentes y padres se utilizó el TRAQ 5.0 versión español argentino. Desarrollo del Equipo: En el año 2005 se formó un equipo interdisciplinario de atención para pacientes con EB, integrando más de 10 especialidades. En el año 2022 se atendieron 270 pacientes y cerca del 5.5% transicionaron a centros de adultos. Neurocirugía: con sospecha de disfunción valvular conecta con Oftalmología y Urología, que al identificar vejiga neurogénica de riesgo recluta a Nefrología. Gastroenterología se focaliza en constipación e incontinencia fecal y junto con Kinesiología y Enfermería trabajan en correctas posturas y ajustes en autoCIL, con soporte de binomio psico-pedagogía. A su vez Kinesiología optimiza indicaciones de Ortopedia y Patología Espinal. Adolescencia facilita las interacciones con Clínicos de centros adultos a manera de feedback. Conclusiones: este algoritmo de "Transición integrada" puede facilitar el acceso del paciente en condiciones crónicas al sistema de salud de adultos y disminuir el tiempo de riesgo sin atención (AU)

Children with spina bifida (SB) often have multisystem involvement, leading to permanent disabilities that require ongoing, specialized care. This study aims to present a structured transition plan and recommendations from various specialties integrated into Urology, to facilitate the transition of SB patients to adult care centers and implement for young people with SB. Methods: A systematic review was conducted for each specialty involved. The experience of each area was analyzed, and guidelines for transitional care were developed, along with expert recommendations. The TRAQ 5.0 Argentine Spanish version was used to assess the preparedness of adolescents and their parents for the transition. Team development: In 2005, an interdisciplinary care team for SB was formed, comprising more than 10 specialties. By 2022, 270 patients were seen, with approximately 5.5% successfully transitioning to adult care centers. Neurosurgery: In cases of suspected shunt dysfunction, Neurosurgery collaborates with Ophthalmology and Urology. Urology, upon identifying a neurogenic bladder at risk, engages Nephrology. Gastroenterology addresses constipation and fecal incontinence and works closely with Physical Therapy and Nursing on posture correction and adjustments in self-catheterization, with psycho-pedagogical support. Physical Therapy also optimizes Orthopedic and Spinal Pathology management. The Adolescent Medicine team facilitates coordination with adult care clinicians, providing feedback during the transition process. Conclusions: This integrated transition approach can streamline access to adult healthcare for patients with chronic conditions, and minimize periods of risk due to lack of healthcare coverage (AU)

Post hysterectomy fallopian tubal prolapse: a diagnostic dilemma

Fallopian tubal prolapse into the vaginal vault is a relatively rare postoperative complication after hysterectomy with adnexal preservation. The exact incidence is not known due to failure to diagnose and under-reporting. We hereby report a case who presented with unexplained vaginal bleeding post-hysterectomy, which was subsequently diagnosed and managed successfully.

Analysis of the Short term Outcomes of Surgical Repair of Myelomeningocele

Background: Myelomeningocele (MMC) is the most frequent form of spina bifida. This congenital malformation is a debilitating condition in neonates that profoundly impacts their quality of life, posing challenges for both the family and the healthcare system. This study's primary goal is to provide an overview of our experience treating myelomeningocele in our community. It will shed light on the specific issues that these patients face immediately postoperatively and spur additional research into the treatment of myelomeningoceles. Methods: A retrospective analysis of 80 patients, who had surgical correction for myelomeningoceles in our department over 30 months was performed. Patients presenting to the hospital with complaints of myelomeningocele aged from 10 days to 2 years of age were included in the study. Patient demographics, preoperative imaging, and postoperative complications were recorded. Patients were monitored for one-month post-MMC repair to detect early postoperative complications. Results: The study of 80 patients revealed that 56.25% of cases were aged 3 to 9 months, with 56.25% of cases being female. Medium-sized MMCs (75%) were common and predominantly affected the lumbosacral region (50%). Hydrocephalus was present in 25(31.25%) cases while Lower limb power was affected in 55% of cases preoperatively. Postoperative complications were low: wound-related complications (16.25%), CSF leaks (7.25%), hydrocephalus (5%), and neurological deficits (2.5%). Outcomes showed 12.5% readmission, 10% re-surgery, one single death, and an average hospital stay of 6.4 days. Conclusion: The study concludes that early and meticulous surgical repair of myelomeningocele can lead to low complication rates and favourable outcomes; highlighting the success of comprehensive care strategies and the need for continuous improvement. It is necessary to conduct more research on preoperative strategies to reduce the risk of immediate postoperative complications and mortality.

Short Term Audit Of Outcomes Of Children With Neural Tube Defect Repair In A Tertiary Care Center

Introduction: Neural tube defects is typically a disabling condition that results in neurologic, orthopedic, and urologic morbidity. Early diagnosis, surgical intervention and rehabilitation can prevent further neurological damage as well as improve the quality of life as well as ultimate outcome in patients with NTD. Closure of neural tube defects is a common neurosurgical procedure but outcome is highly variable and dependant on multiple factors. The aim of this study was to study outcomes and to identify predictors morbidity of surgically treated NTDs. Short term audit of outcomes of children with neural tube defect repair in a tertiary care center.Aim: Results: A total of 60 babies were included in this study. The median age at admission is 30 days with range from Day 2 -270 of life. Forty-two (70%) of the babies were male and 18 (30%) were female. The median size of swelling at admission was 5cm with range from 2 to 11 cm. Location of swelling were cervical in 4 (6.66%), upper thoracic in 1 (1.66%), dorso-lumbar in 11 (18.33%), lumbar in 22 (36.66%), lumbo-sacral in 19 (31.66%) and sacral in 3 (5%). Weakness in lower limbs was present in 22 (36.66%) patients preoperatively. Neurogenic bladder and bowel along with bilateral CTEV were present in 8 (13.33%) of patients. CSF discharge from swelling was present in 10 (16.66%) patients preoperatively. Preoperative hydrocephalous was present in 15 (25%) patients. Arnold Chiari malformation was present in 18 (30%) patients. Post operatively, wound infection was present in 19 (31.66%), CSF leak was present in 10 (16.66%), new neurological de?cit developed in 11 (18.33%) and new hydrocephalous developed in 9 (15%) patients. Out of total 60 patients, ventriculo-peritoneal shunt was placed in 22(36.66%) for hydrocephalous. The median length of postoperative stay was 10 days with range from 4 to 28 days. Re-admissions were required in 17 (28.33%) patients and 2 (3.33%) patients were expired due to sepsis and aspiration pneumonia. Neural tube defect is a congenitalConclusion: disorder with signi?cant morbidity. Early diagnosis, surgical intervention and rehabilitation can prevent further neurological damage as well as improve the quality of life as well as ultimate outcome in patients with NTD. There is considerable delay in surgical management in the majority of cases, requiring concentrated efforts for early surgical management of neonates with NTD to reduce the morbidity and improve the ultimate outcome.

Management of Bilateral Tension Pneumothorax with Extensive Subcutaneous Emphysema during One-Lung Ventilation

Introduction: Intraoperative complications during thoracic procedures requiring one-lung ventilation (OLV) are rare but life-threatening. Double-lumen endotracheal tubes (DLTs) are commonly used but can lead to complications such as bilateral tension pneumothorax, posing significant challenges for anesthesiologists and thoracic surgeons. This case report highlights a critical incident during a mediastinoscopy under general anesthesia with OLV. Case Presentation: A 43-year-old male with a history of Hodgkin’s lymphoma underwent a mediastinoscopy. Anesthesia induction and intubation with a 37 French Carlen DLT were performed. Shortly after initiating OLV, the patient experienced sudden hypoxemia (SpO2 65%), increased peak airway pressures, bradycardia, and hypotension. Bilateral tension pneumothorax with subcutaneous emphysema was diagnosed, and emergency bilateral chest drain insertion stabilized the patient. Discussion: This case illustrates the severity of DLT-associated complications, particularly tension pneumothorax caused by tube malpositioning and barotrauma. Diagnosing tension pneumothorax is challenging due to similar symptoms with other intraoperative issues. Clinical signs include severe hypoxemia, hypercarbia, hypotension, and increased airway pressures. Rapid diagnosis through chest X-rays and ultrasonography, along with immediate management, such as chest drain insertion, is crucial. Conclusion: The case emphasizes the importance of vigilance and preparedness to manage anesthetic complications during thoracic procedures. Rigorous verification of DLT positioning, continuous monitoring, and prompt interventions are essential to prevent catastrophic events.

Something left behind: a rare complication of copper-T insertion

This case report presents a unique and intriguing clinical scenario involving an incorrect copper T insertion following a caesarean section. The case presented the importance of training in the right technique for intra-uterine contraceptive device (IUCD) insertions in peripheral health facilities and the potential risks associated with inappropriate procedures. Prompt identification and management of misplaced IUCDs are crucial in minimizing patient discomfort, preventing complications, and optimizing reproductive health outcomes.

A case report on choledochotomy with t-tube in rare case of oriental cholangiohepatitis in 33-year-old male patient

A 33-year-old male patient presented in OPD with c/o abdominal pain in right hypochondrium since 1 month which is mild in nature and intermittent on and off type and yellowish sclera since 1 year which is gradually increases. On CECT abdomen shows CHD dilated (15 mm) and sludge within it, RHD dilated (15 mm) and sludge within it, LHD dilated (11 mm) and calculus within it. patient is operated with choledocotomy with T-tube insertion in CBD, post operatively patient had significant improvement in clinical symptoms and lab findings also suggestive of better outcome.

The “Baseline Widal Titre” Amongst Apparently Healthy Adults Working at a Tertiary Care Medical Institution, a Pilot Study, Uttarakhand, India

Introduction: As typhoid fever is known for its endemicity all over the India, healthy people may contain antibodies against salmonella typhi and paratyphi. These antibodies may react up-to a variable titre either due to past exposure, vaccination or/and cross -reacting antigen. Therefore, antibody titre in widal test varies widely from place to place and is referred as baseline titre of that particular area. Two properly staged tests (2-4 weeks interval) show about a four -fold rise in antibody levels leads to a reliable widal test. Single widal test values are not considered significant for diagnosis but many places still use this as diagnostic marker which further depends upon baseline titre prevalent in that particular area. Aims: This study was undertaken in jhajra, Uttarakhand to determine the baseline titre in this geographical region for calculating significant widal titres. Material and Methods: Blood samples were collected from apparently healthy individuals which included medical students, nursing staff, doctors, and other health care workers (aged 19-45) with proper consent. All the samples after being screened by slide agglutination test were further confirmed by Quantitative tube agglutination test, to find out the baseline titre. The tube agglutination test was carried out by taking 0.5 ml of two-fold serially diluted sera (dilutions from 1:20 to 1:320) in 0.9% normal saline with an equal amount of antigen. Results: Out of total 110 serum samples,36 (32.7%) sera were positive (titre ? 1:20) and 74 (67.3%) were negative(titre<1:20). A total of 36 samples were positive for agglutinins of “O” antigen,32 for agglutinins of “H” antigen,16 for paratyphi A and 10 for paratyphi B. 23 out of 36 (63.8 %) sera were positive for agglutinins of 'O' antigen of Salmonella typhi (TO) at a titre of 1:40 followed by 6 sera positive at 1:20 (16.6%) and 1:80 (16.6%) and 1 serum sample positive at 1:160 (2.77%) 59.3 % (19) sera were positive for 'H' antigen of Salmonella typhi (TH) at a titre of 1:80 and 10 % sera (11) were positive for 'H' antigen at a titre of 1:40 and 2(1.8%) were positive at 1:20.16(44.4%) sera samples were positive for of Salmonella paratyphi A (AH) and Salmonella paratyphi B (BH) respectively, both at a titre of 1:20 and 8.3% sera were positive at 1:40 respectively. Conclusion: The most frequently recorded titre of the reactive sera was 1:40 and 1:80 for anti-O antibodies and anti-H antibodies and 1:20 for AH and BH. Thus, the significant cut-off level for TO and TH was ? 1:80 and ? 1:160 that for AH and BH was ? 1:40.

Spontaneous common bile duct perforation: a rare case report

Spontaneous common bile duct (CBD) perforation is a rare and life threatening clinical condition. The course of management and choice of surgical intervention depends on clinical presentation; site, size, nature of defect. It is usually reported in infants and adults due to congenital anomalies and following invasive procedure respectively but spontaneous CBD perforation in older age groups is rare without underlying cause presenting as acute abdomen. In this case report, an 82-year-old female presented to the emergency room with an acute abdomen diagnosed as spontaneous CBD perforation and its prompt management and its successful outcome.

Examining folic acid intake: a cross-sectional study of pregnancy-related practices

Background: Folic acid supplementation during the periconceptional period is critical in preventing neural tube defects (NTDs) in the developing fetus. In Pakistan, a profound lack of awareness is seen regarding preventable pregnancy-related illnesses and the consequential high maternal and fetal mortality and morbidity rates. However, data from the surveys in the region of Sindh lacks inquiries regarding the baseline characteristics of the surveyed participants. Therefore, this study endeavoured to address this gap. Methods: Between October 2022 and April 2023, a cross-sectional study was conducted at two major tertiary care hospitals in Hyderabad and Jamshoro, Pakistan. A total of 374 participants, chosen by non-probability consecutive sampling, comprised the sample size. The association of demographic variables and knowledge, attitude, and practice of consumption of folic acid during pregnancy was determined using the ?2 test. A p value of less than 0.5 was considered statistically significant. Results: The mean age of the participants was 26.4�7 years. A total of 199 (53.20%) participants were literate, compared to 175 (46.79%) participants who were illiterate. Literate women fared better than illiterate women in all the metrics with a p-value of <0.001 and a Pearson correlation coefficient (r) of >0.7. Moreover, folic acid was consumed by only 38% of pregnant women during the periconceptional period. Conclusions: A substantial lack of knowledge regarding folic acid was found in the surveyed sample, significantly more marked in the illiterate faction. Additionally, the practice was rather unsatisfactory. However, the attitude remained encouraging.

Folic Acid Protection in Congenital Neural Tube Defects: A Narrative Review

Introduction: Neural tube defects, a congenital malformation of multifactorial source, affect more than 200,000 to 300,000 births a year, and are twice as common in developing countries. Food fortification with folic acid has been shown to be effective reducing this congenital malformation. The aim of this study was to look for evidence on the efficacy, interval and best dose of folic acid to be administered in the prophylaxis of neural tube defects. Methods: Narrative literature review, using the PubMed database, available at: https://pubmed.ncbi.nlm.nih.gov/, using the keywords "Folic Acid and Pregnancy and Neural Tube", and applying the filters "Systematic review" and "last five years". Two researchers independently selected articles on the effects of folic acid in preventing neural tube birth defects. After reading the titles and abstracts, 11 of the 21 articles selected were read in full and all were included in the review. Another nine articles obtained from the PUBMED database, using the same keywords and published in the year 2023, were included to discuss the synthesis of the data. Synthesis of the Data: Neural tube defects were associated with family history, previous stillbirth, unplanned pregnancy, stress during the periconceptional period, lack of prenatal care, use of alcohol, tobacco and exposure to medicines, pesticides, maternal age over 35, chronic maternal illness and low schooling. No evidence of side effects was found as to the supplementation with folic acid. Daily supplementation with 400-800?g, starting 1.5 months before conception and lasting 4 months, prevented the occurrence of neural tube defects and dietary supplementation with folic acid reduced the occurrence of the disease. Conclusion: Current evidence indicates that folic acid supplementation for pregnant women, starting at 1.5 months before conception and lasting for 4 months, protects against congenital neural tube defects.

Fetal ultrasonography of Chiari II malformation

Chiari II malformation is a complex hindbrain malformation, embryologically presenting as a neural tube closure defect comprising of downward herniation of cerebellum, pons, medulla and fourth ventricle into the spinal canal. We present a case of Chiari II malformation depicting essential sonographic observations at 20 weeks of gestation. Such fetuses have high morbidity and mortality and early diagnosis of such a disease is essential in terms of planning including pregnancy termination or neurosurgical procedures for follow-up pregnancy. Ultrasonography is an indispensable modality for the evaluation of fetal anatomy, growth, and such congenital anomalies.

Incidencia de infección de vías urinarias con catéter de nefrostomía percutánea posterior a la implementación de un programa estandarizado de cuidados / Incidence of urinary tract infections in patients with permanent percutaneous nephrostomy after implementation of a standardized care program

Resumen Antecedentes: Los catéteres de nefrostomía percutánea (CNP) que se utilizan en algunos hospitales oncológicos condicionan un incremento en las infecciones del tracto urinario (ITU). Objetivo: Determinar el impacto de un programa estandarizado de atención en la incidencia de ITU que requiere hospitalización (ITU-RH). Material y métodos: Estudio retrospectivo que incluyó pacientes con un primer CNP. Se comparó la incidencia, riesgo relativo (RR), costos y evolución de los pacientes con ITU-RH durante el período previo a la intervención (P0) versus posterior a ella (P1). Resultados: Se instalaron 113 CNP durante P0 y 74 durante P1. Durante P0, 61 pacientes (53.9 %) presentaron 64 episodios de ITU-RH, en 22 557 días de uso de CNP. Durante P1, cuatro pacientes (5.4%) cursaron con ITU-RH en el transcurso de 6548 días de uso del CNP (razón de tasa de incidencia de 0.21, IC 95 % = 0.05-0.57). El RR fue de 0.09 (IC 95 % = 0.03-0.25). El costo mensual por día-cama fue de 3823 USD en P0 y de 1076 USD en P1; el de los antibióticos, de 790 USD en P0 y 123.5 USD en P1. Conclusiones: Este estudio resalta la importancia de un programa estandarizado del cuidado de los dispositivos permanentes, el cual disminuye el uso de antibióticos, la hospitalización y el costo de la atención.

Abstract Background: Percutaneous nephrostomy tubes (PNT), which are used in some cancer hospitals, are associated with an increase in the incidence of urinary tract infections (UTI). Objective: To determine the impact of a standardized care program on the incidence of UTI requiring hospitalization (UTI-RH). Material and methods: Retrospective study that included patients with a first PNT inserted. The incidence, relative risk (RR), costs and outcomes of patients with UTI-RH were compared during the period before (P0) vs. after the intervention (P1). Results: 113 PNCs were inserted during P0, and 74 at P1. During P0, 61 patients (53.9%) experienced 64 UTI-RH events in 22,557 PNT days. At P1, four patients (5.4%) had a UTI-RH in 6,548 PNT days (IRR: 0.21, 95% CI: 0.05-0.57). The RR was 0.09 (95% CI: 0.03-0.25). Monthly cost per day/bed was USD 3,823 at P0 and USD 1,076 at P1, and for antibiotics, it was USD 790 at P0 and USD 123.5 at P1. Conclusions: This study highlights the importance of a standardized care program for permanent percutaneous devices, since this reduces antibiotic use, hospitalization, and the cost of care.

Nasogastric Tube Insertion in Anaesthetised and Intubated Adult Patients: A Comparison Between the Digital Assistance Technique and Conventional Blind Technique

Background and Aims: Nasogastric tube (NGT) insertion can be challenging in an anaesthetised patient, with the conventional method bearing a failure rate of about 50%; hence, several different techniques including a novel digital assistance technique has been tried over years. Objectives: To compare the success rates, procedure time and incidence of adverse events for NGT insertion, among the conventional and digital assistance technique in anaesthetised, intubated adult patients. Materials and methods: 80 patients, aged 18 years and above, of either sex, posted for elective surgeries, requiring nasogastric tube intraoperatively, were randomly, divided into two equal groups. After doing endotracheal intubation, NGT were inserted in patients of Group A by conventional method, and that of Group B by digital assistance technique. The procedure time was calculated from insertion of the tip of the NGT into nostril till the confirmation of its position. Number of attempts and total procedure time were recorded upto 5 times, in both the groups. Results: In the first attempt, successful NGT placement and procedure times in Group A was in 19 patients (47.5%) and 68 ± 16.4 seconds respectively while that in Group B was in 32 patients (80%) and 69 ± 13.7 seconds respectively (p value 0.026). Adverse events occurred in 35% in Group A and 15% in Group B (p value 0.069). Conclusion: The digital assistance technique appears to be a better alternative to the conventional blind technique in adult patients with better success rate, less procedure time and lesser adverse events.

A Rare Case of Spontaneous Stump Ectopic Pregnancy Atier Adnexectomy

Ectopic pregnancy is an obstetric emergency associated with morbidity. The commonest site for an ectopic pregnancy is the fallopian tube. Occurrence of ectopic in a remnant of tubal stump is a rare form which is not yet classified. Here we present a case of spontaneous stump ectopic pregnancy in a patient who had an adnexectomy. The ruptured remnant end was excised. There is a need to emphasise that the tube should be excised till the cornual end when performing salpingectomy to avoid recanalisation or fistulae formation and stump ectopics.

Risk Factors for Postoperative Sore Throat in Patients with a Double-lumen Endotracheal Tube / 中山大学学报(医学科学版)

ObjectiveTo investigate risk factors for postoperative sore throat in patients with double-lumen endotracheal intubation. MethodsThe data used in this post-hoc analysis were prospectively collected from a randomized， controlled trial. Age from 18 to 65 years old， ASAI-Ⅲ patients undergoing general anesthesia with a double-lumen endotracheal tube were enrolled. The perioperative data collected retrospectively were as follows： gender， age， smoking history， endotracheal tube diameter， duration of endotracheal tube， dose of Sufentanil， use of Flurbiprofen Axetil， cough after extubation， etc..Dynamometer was applied to assess extubation force. According to occurrence of postoperative sore throat， patients were divided into two groups： those who experienced sore throats and those who did not. Comparative analysis and multivariate logistic regression analysis were performed to screen the risk factors. ROC curve was used for predicting the predictive value of risk factors. ResultsAmong the 163 patients ， 74 （45.4%） had postoperative sore throat vs 89 （54.6%） not had. Multivariate logistic regression showed female ［OR95%CI=3.83（1.73， 8.50）， P=0.000 1］ and extubation force ［OR95%CI=1.78（1.45， 2.17）， P＜0.001］ were independent risk factors for postoperative sore throat. AUC value showed the extubation force was 0.773［95%CI（0.701， 0.846）， P＜0.001］. Youden index was 0.447， and the cut-off valve of extubation force was 13N. ConclusionFemale and extubation force were risk factors for sore throat in patients with double lumen endotracheal intubation.

Application of 10-F pig tail drainage tube in single-port thoracoscopic lobectomy / 局解手术学杂志

Objective To explore the effect of 10-F pig tail drainage tube on postoperative incision pain and drainage effect in patients undergoing single-port thoracoscopic lobectomy.Methods A total of 120 patients with lung cancer who underwent single-port thoracoscopic lobectomy admitted to First Affiliated Hospital of Hebei University of Traditional Chinese Medicine were selected and divided into the control group and the observation group,with 60 cases in each group.Patients in the control group were placed a 28-F silicone drainage tube in the posterior mediastinum from the side that deviated from the surgical incision after surgery;and patients in the observation group were placed a 10-F pig tail drainage tube horizontally in the posterior mediastinum at the 7th intercostal space of the posterior axillary line(besides,a 10-F pig tail drainage tube should be placed in the 2nd intercostal space of the midclavicular line if the upper or middle lobes were resected).The pain scores 1,3 and 5 days after operation,healing of surgical incision,extubation time of drainage tube,total drainage volume after opera-tion of patients in the two groups were compared.The incidences of postoperative subcutaneous emphysema,atelectasis and re-intubation of patients in the two groups were recorded.Results There was no statistically significant difference in the total drainage volume,extubation time,incidences of subcutaneous emphysema,atelectasis or re-intubation after operation of patients between the two groups(P>0.05).The postoperative healing of surgical incision of patients in the observation group was better than that in the control group(P<0.05),and the score of postoperative incision pain was significantly lower than that in the control group(P<0.05).Conclusion The application of 10-F pig tail drainage tube after single-port thoracoscopic lobectomy can reduce postoperative incision pain,and ensure the drainage effect of postopera-tive hydrothorax and pneumatosis,without the increase of pulmonary complications.