ABSTRACT
Mediastinal teratomas are rare, often asymptomatic, but clinically significant neoplasms that can manifest with a spectrum of symptoms, frequently attributed to the compression of surrounding critical anatomical structures. Here, we present the case of a 19-year-old male with respiratory distress and chest pain attributed to a large anterior mediastinal mass, ultimately diagnosed as a benign mature teratoma of the thymus. Radiological imaging revealed a large, partially cystic mass compressing the pulmonary arteries, aortic arch, and left main bronchus. Surgical excision was deemed necessary due to symptomatic presentation. Anaesthesia management during mediastinal mass excision posed significant challenges, with prompt sternotomy due to ventilation difficulties after induction. Immediate decompression of the mass improved ventilation and saturation. Despite postoperative complications, including pulmonary leaks necessitating tracheostomy, the patient achieved significant recovery. Anaesthesia strategy was to prioritise avoiding muscle relaxants and maintaining spontaneous ventilation to mitigate airway collapse and hemodynamic instability during induction. Collaboration between anaesthesia, surgical, and intensive care teams is vital for comprehensive preoperative assessment, intraoperative readiness, and postoperative care. This case underscores the importance of interdisciplinary collaboration and meticulous planning to optimise outcomes in patients undergoing surgery for mediastinal teratomas.
ABSTRACT
Background: Data are sparse on smokeless tobacco (SLT) use in Bhavnagar. We assessed the prevalence and awareness of and expenditure on SLT use in Bhavnagar. Methods: We conducted a community-based, cross- sectional study in an urban slum of Bhavnagar on a sample of 260 SLT users for a period of three months in 2017. Results: The prevalence of SLT use in Bhavnagar was 27.3% (95% CI 25%-30%). Mawa, a preparation of tobacco flakes mixed with areca nut and lime, was the most commonly chewed form of tobacco; commonly kept in the buccal mucosa. The mean age ofstarting SLT use was 25 years; the mean number of years since chewing was 15 years; the mean time tobacco was kept in the mouth per consumption was 5 minutes and the mean number of packets of tobacco consumed per day was five. The mean expenditure on SLT use per month was ?536. All SLT users were aware that tobacco consumption led to oral cancer. Peer influence was the most common (75%) reason for starting SLT use, and addiction was the most common (74%) reason for its continued use. Among SLT users, 47% had made at least one attempt to quit; of them, 98% had tried self-control for quitting but did not succeed. The most common (72%) reason given by those not able to quit (n=119) was addiction to SLT use. Among the 260 study participants, 72% had read the warnings on packets of tobacco; 59% wished to chew tobacco even after reading the warnings and 62% opined on banning the sale and consumption of tobacco. Ninety-two per cent of SLT users were not comfortable with the idea that imitating them, their children too would start chewing tobacco. Conclusions: Every third person in the urban slum of Bhavnagar was a SLT user. Even though SLT users knew about the harmful effects of tobacco, only a handful were able to quit due to addiction to it. This burden on health services, in addition to the expenditure on purchase of tobacco, requires a comprehensive tobacco cessation programme at the community level.