Aneurysm Needle as an Effective Tool in Laparoscopic Port Closure.

The importance of port closure after laparoscopic surgeries is emphasized by the extensive number of techniques being described for the same. Even so, the search for a simple, time-saving, and effective technique still continues. One commonly overlooked factor is the obliquity of laparoscopic ports, which makes direct visualization of the rectus fascia through the skin incision difficult. Also, our patients, mostly of Indian ethnicity, tend to have relatively thick subcutaneous fat that again acts as a constraint during port closure. We have described a simple and effective method of laparoscopic port closure using Moynihan's aneurysm needle and a skin hook. This technique is particularly advantageous in the above-mentioned scenarios. We have been successfully using this technique in our institution for the past 6 years, and we have not encountered any case of port-site hernia. Our technique does not require expensive instruments or the need for visualization via a camera.

Chronic diarrhea as the presenting complaint of systemic lupus erythematosus in a man.

Systemic lupus can involve any part of the gastrointestinal (GI) tract. Diarrhea generally results from complications arising from infection, drugs or pancreatitis. We herein report the case of a 40-year-old hypertensive man with a psychotic disorder in whom the evaluation of chronic diarrhea revealed a diagnosis of systemic lupus erythematosus (SLE), diffuse proliferative glomerulonephritis and protein-losing enteropathy that required treatment with both steroids and mycophenolate mofetil. Over the following year, the patient developed atrial fibrillation, miliary tuberculosis and generalized clonic tonic seizures. He is currently under regular follow-up care and receives antiepileptics, antihypertensives, diltiazem, amiodarone and warfarin.

Biotinidase deficiency--clinching the diagnosis rapidly can make all the difference!

A 2-month-old male infant, born of second degree consanguineous parentage, presented with seizures not responding to phenytoin and phenobarbitone. His perinatal period had been uneventful and there was no family history of seizures. On examination, he had failure to thrive, perioral and perianal rash, alopecia with hypopigmented hair, seborrhoeic dermatitis, bilateral blepharitis, respiratory distress and stridor. Neurological examination revealed hypertonia of all the four limbs, exaggerated deep tendon reflexes and papilloedema. Biotinidase deficiency was suspected within 24 h of admission and empiric oral biotin 10 mg twice daily was started. The symptoms, especially seizures, dramatically improved within 48 h. Serum biotinidase levels revealed a profound deficiency (0.10 nmol/min/ml serum) and the parents were advised regarding the need for regular biotin supplementation. The child is presently 10 months old, thriving well, developmentally normal and is seizure free with total resolution of skin and hair lesions.