Digital gangrene induced by inadvertent intra-arterial cocktail injection of anesthetic agents such as pentazocine, promethazine, and atropine: A serious adverse drug experience.

Gangrenous changes in skin due to accidental intra-arterial injection of promethazine and pentazocine have been reported. Accidental intra-arterial injection is most commonly encountered in the antecubital fossa. However, recent reports in the radial and ulnar arteries have also been encountered. We hereby report a serious, preventable adverse drug experience in the form of digital gangrene induced by inadvertent intra-arterial cocktail injection of anesthetic agents such as pentazocine, promethazine, and atropine, which seems to be in the radial artery as the lateral three digits and dorsum of the hand are affected.

Single screw-rod anterior instrumentation for thoracolumbar burst fractures with incomplete neurological deficit.

PURPOSE: To evaluate the outcome of single screwrod anterior instrumentation for thoracolumbar burst fractures with incomplete neurological deficit. METHODS: 16 men and 5 women aged 22 to 55 (mean, 34) years underwent single screw-rod anterior instrumentation for thoracolumbar burst fractures with incomplete neurological deficit. The vertebrae involved were T10 (n=2), T11 (n=2), T12 (n=7), L1 (n=8), and L2 (n=2). No patient had disruption of the posterior ligament complex. Postoperatively, a thoracolumbar sacral orthosis was used until solid fusion. Outcome measures included neurological recovery, degree of kyphosis, complications, and pain and functional status of the patients. RESULTS: The mean follow-up duration was 36 (range, 13-50) months. All patients recovered neurologically by at least one grade. Of the 21 patients, 6 improved from grade B to grade C (n=4) or grade D (n=2), 13 from grade C to grade D, and 2 from grade D to grade E. The mean degree of kyphosis improved from 23º ± 5º to 7º ± 3º. Seven patients had complications including ipsilateral basal atelectasis (n=3), urinary tract infection (n=1), haematuria (n=1), postoperative ileus (n=1), and superficial wound infection (n=1). None had iatrogenic visceral or vascular injury, pseudoarthrosis or hardware-related complications. Only one patient had severe back pain persistently. CONCLUSION: Single screw-rod anterior instrumentation supplemented with an orthosis can be an alternative for double screw-rod anterior instrumentation for thoracolumbar burst fractures in patients with smaller vertebral bodies.

Esophageal diverticulum secondary to impacted foreign body.

We report a two year old child who developed a large esophageal diverticulum over a period of ten months following ingestion of a multispiked leaf of Quercus semicarpipholia. Though the endoscopic removal of foreign body was successful, it did not relieve the symptoms and patient required surgical resection of the diverticulum. Patient is asymptomatic after 4 months of follow up.

Management of extremity vascular trauma: Jammu experience.

Experience in 111 patients treated for extremity vascular trauma between 1995 and 2004 is described. Only 40 (36%) patients presented within 6 hours of sustaining the injury. Penetrating injuries due to stabbing and gunshots were the causes in 65 patients, and blunt trauma in 46. There were associated bone fractures in 73 patients. The brachial artery was the most commonly injured upper limb vessel, whereas the femoral vessels were most often damaged in the lower limb. Surgical procedures consisted of end-to-end anastomosis in 50 patients, an interposition graft in 32, lateral arteriorrhaphy in 14, ligation in 6 and venous patch plasty in 5. Concomitant artery and vein repair was carried out in 12 patients, 6 underwent embolectomy and fasciotomy was performed in 16. Three (2.7%) patients died postoperatively. Good blood flow was obtained after repair in 69 (62%) patients, 29 (26%) had collateral compensation, 5 underwent primary amputation and 5 required secondary amputation. Most vascular injuries due to limb trauma can be managed successfully unless associated with severe damage to bones, nerves or soft tissues.

Pleurocutaneous flap: how useful it is in management of chronic empyema.

BACKGROUND: Definitive surgical treatment of chronic empyema is associated with considerable morbidity and mortality. Methods. Retrospective study of 50 patients with chronic empyema who underwent pleurocutaneous flap procedure during the period 1994 to 2003. RESULTS: Their age ranged from 14 to 70 years; there were 32 males. Thirty-seven (74%) patients were on intercostal tube drainage; nine (18%) presented with bronchopleural fistula; and four (8%) had past-pneumonectomy empyema. Following pleurocutaneous flap procedure, 28 (56%) responded with re-expansion of the lung; 15 (30%) had persistence of pus discharge and air-leak suggestive of bronchopleural fistula. Definitive surgery could be undertaken in nine of the 15 patients. CONCLUSIONS: Pleurocutaneous flap procedure renders the patient ambulatory, facilitates re-expansion of the lung and helps as a tide-over procedure before definitive surgery in patients with chronic empyema.