Spontaneous Idiopathic Perforation Of Gall Bladder In Neonates

This is a case series of 3 neonates with features of acute abdomen. The first neonate presented on day 6 of life with convulsions and fever. He developed abdominal distension and had bilious vomiting by day 11 of life. After clinical and radiological diagnosis of intestinal obstruction and failure to resolve with conservative management, laparotomy was done which revealed multiple inter bowel loop adhesions and an omental band adherent to distal ileum. On exploration, a localised abscess was seen around the gall bladder , a 0.5cm diameter perforation in the gall bladder. Exploratory laparotomy with cholecystectomy was done. The other two neonates presented with similar features and exploratory laparotomy with cholecystectomy was done. Perforation of the gall bladder is a rare cause of neonatal intestinal obstruction. The management is surgical and cholecystectomy or sewing the perforation should depend on the size of the perforation and the extent of peritonitis

Jejunal Atresia in a Neonate due to Intrauterine Intussusception.

We report a female neonate, who presented with abdominal distension and failure to pass meconium. Antenatal ultrasound at 32 weeks gestation and postnatal ultrasound on day1 suggested intestinal obstruction. During laparatomy, atresia of distal jejunum was found. The lumen of the distal segment contained an intussusceptum. Resection of the blind ends was done and end-to-end anastomosis was performed.

Efficacy of PercuSurge in acute myocardial infarction patients undergoing revascularization with a special emphasis on procedural time.

AIM: To evaluate the efficacy of the PercuSurge Guardwire(R) Plus Temporary Occlusion and Aspiration System, the actual procedural time involved and long-term follow-up in acute MI patients undergoing primary/rescue percutaneous coronary intervention (PCI). METHODS & RESULTS: It was a single centred, prospective study in 67 prospective AMI patients undergoing PCI. They were divided randomly into two groups depending on whether PercuSurge was used (n=30) or not used (control n=37) during PCI. Final TIMI flow, TMP grade and the time involved in or necessary for various steps of the PCI were recorded. PercuSurge showed significantly greater achievement of TIMI III flow and TMP III grade (p<0.01). Its use was associated with less total procedural time (p<0.05). The time required from guidewire crossing to stent placement; from guidewire crossing to TIMI III flow and from predilatation/stent placement to optimal TIMI flow was significantly reduced with its use (p<0.05 for all). Slow/no-reflow was significantly reduced (p<0.001), thus reducing intracoronary vasodilators and GP IIb/IIIa antagonists requirements. A 2 years' follow-up revealed four deaths in control and one death in PercuSurge group. CONCLUSION: PercuSurge reduced the total procedural time with better and faster optimal TIMI flow and TMP grade in primary/rescue PCI and was associated with less long term events.