Traumatic subcutaneous emphysema following blood donation: A case report.

BACKGROUND: Subcutaneous emphysema is a condition where air becomes trapped under the skin, typically resulting from surgery or skin trauma. It is mostly localized and its occurrence in blood donors is exceedingly rare. Phlebotomy poses minimal risk of subcutaneous emphysema, but procedural errors may lead to such complications. STUDY DESIGN AND METHOD: This is a case report of 29-year-old repeat blood donor who experienced subcutaneous emphysema following blood donation. The donor was vigorously squeezing sponge ball during donation resulting in displacement of the needle which required readjustment. Post-donation, the donor reported a crackling sensation and mild swelling near phlebotomy site. Non-contrast computed tomography (NCCT) scans confirmed subcutaneous emphysema, attributing its development to air trapping in subcutaneous plane due to ball valve mechanism. RESULTS: Computed tomography (CT) imaging revealed subcutaneous emphysematous changes in the right cubital region and no evidence of hematoma. The swelling spontaneously subsided in 10-12 days without any intervention. The case underscores the importance of differentiating subcutaneous emphysema from common complications like hematoma. DISCUSSION: Subcutaneous emphysema in blood donors is exceptionally rare but should be managed with clear communication. Donors should be reassured that the condition, although rare, is benign and self-resolving. Healthcare providers should be equipped to handle such rare complications, offering appropriate care and documenting incidents for future prevention.

Photoluminescence study in Ho3+/Tm3+/Yb3+/Li+:Gd2(MoO4)3 nanophosphors for near white light emitting diode and security ink applications.

Ho3+/Yb3+/Tm3+/Li+:Gd2(MoO4)3 nanophosphors successfully synthesised via solid state reaction method have been structurally and optically characterised. Under 980 nm diode laser excitation the nanophosphors emit intense blue, green, red and NIR emissions peaking at ∼476 nm, ∼543 nm, ∼646 nm and ∼798 nm corresponding to the 1G4 â†’ 3H6 (Tm3+), 5F4, 5S2 â†’ 5I8 (Ho3+), 5F 5  â†’ 5I8 (Ho3+) and 3H4 â†’ 3H6 (Tm3+) transitions respectively. The upconversion emission intensity enhancement in the Ho3+-Yb3+-Tm3+-Li+:Gd2(MoO4)3 nanophosphors for the green band is found to be ∼367, ∼50 and ∼9 times compared to the singly Ho3+ doped, Ho3+-Yb3+ co-doped and Ho3+-Yb3+-Tm3+ tri-doped Gd2(MoO4)3 nanophosphors. The enhancement observed has been explained on the basis of energy transfer process and local field modifications around the rare earth ions. The energy transfer efficiency ∼5% is determined in the tridoped nanophosphors. The interaction involved between rare earth ions for energy transfer process is found to be dipole-dipole type. On changing the Tm3+ ions concentration the colour emitted from the tridoped nanophosphors is tuned from near white to blue region. In the tridoped nanophosphors, on varying the pump power the colour tunability has been observed.

Failed Back Surgery Syndrome: Evaluation with Magnetic Resonance Imaging.

INTRODUCTION: Failed Back Surgery Syndrome (FBSS) is a generalized term used to describe varied spinal symptoms of patients who have had unsuccessful results after spinal surgery. The treatment of FBSS is challenging and varies from conservative management to reoperation. Imaging plays a crucial role in identifying the cause and helps to guide the appropriate therapy. Contrast enhanced Magnetic Resonance Imaging (MRI) with its superior resolution is the imaging modality of choice. AIM: To evaluate the spectrum of imaging findings on postoperative MRI in FBSS. MATERIALS AND METHODS: A total of 30 postoperative symptomatic patients of FBSS were included in this cross-sectional study. Of these, 26 had undergone surgery for degenerative disc disease and four had spinal fixation surgery for spondylolisthesis or trauma. Patients were subjected to detailed clinical examination. All patients underwent MRI which was done on 1.5 Tesla scanner with standard sequences in all planes. Contrast was administered in all cases. Non Contrast Computed Tomography (NCCT) scan was done in patients with metallic implants to better delineate the placement of the implant. Patients with contraindication to MRI scanning were excluded from the study. RESULTS: Of the total 30 cases (23 males and seven females) of FBSS that were evaluated with contrast enhanced MRI of the spine, 16 patients had recurrent/residual disc herniation, six had epidural scar tissue, three patients had recurrent disc herniation and scar tissue, two had evidence of post surgery arachnoiditis, two patients had postoperative discitis and one patient had implant mal alignment. Eight patients underwent reoperation for recurrent disc herniation and one patient for implant malalignment after imaging. CONCLUSION: MRI is the modality of choice for evaluating the postoperative spine. It helps to identify the cause and guide the appropriate treatment.

Inferior Vena Cava Agenesis: A Rare Cause of Pelvic Congestion Syndrome.

Complete absence of Inferior Vena Cava (IVC) is a rare anomaly with a reported incidence of 0.0005% to 1%. This is often asymptomatic with incidental detection during cross-sectional imaging. It may also present with deep venous thrombosis, pulmonary thromboembolism or compressive symptoms in form of nerve root compression. Pelvic Congestion Syndrome (PCS) is an increasingly recognized entity with well laid out diagnostic criteria and evolving management protocols. Complete absence of IVC is a rare cause of pelvic congestion syndrome. We present a case of young female presenting with symptoms typical of pelvic venous congestion who was found to have complete absence of IVC as the underlying cause. She also had associated small left kidney with compensatory hypertrophy of the right kidney which is another rare association.

Thoracic Sarcoidosis: Imaging with High Resolution Computed Tomography.

INTRODUCTION: Sarcoidosis is a disease of unknown aetiology that primarily affects the lungs. Clinical and radiological findings with demonstration of non caseating granulomas on pathology is utilised for diagnosing the disease. AIM: To assess and evaluate the features of thoracic sarcoidosis on High Resolution Computed Tomography (HRCT) chest. MATERIALS AND METHODS: A total of 40 (31 males and 9 females) cases of pulmonary sarcoidosis in a period of three years were included in this study. Patients underwent detailed clinical evaluation, imaging, Pulmonary Function Tests (PFT) and pathological confirmation of disease. Chest radiograph was obtained in all patients. HRCT was done on 16 slice Computed Tomography (CT) using 1 mm slice thickness and high spatial frequency algorithm for image re-construction. Images were viewed and evaluated using appropriate lung and mediastinal windows. The lymph nodes were classified as hilar and mediastinal with Maximum Short Axis Diameter (MSAD) more than 10 mm taken as cut-off for enlargement. Pulmonary opacities were classified as nodules (micronodules 1-4 mm and macronodules >5 mm), reticular opacities, fibrotic lesions, ground glass opacities and consolidations. Nodule distribution classified as perilymphatic centrilobular and random. Repeat scanning done on follow up or as clinically indicated. RESULTS: A total of five patients had Stage I disease, 24 patients had Stage II disease, eight patients had Stage III disease and three patients had stage IV disease. Mediastinal lymphdenopathy present in 29 patients. Bilateral hilar adenopathy was the predominant pattern seen in 22 patients. Lung parenchymal lesions excluding end stage disease noted in 32 patients. The characteristic HRCT lung parenchymal involvement of micronodules with a perilymphatic distribution was seen in 26 patients. HRCT features of predominant upper and middle lobe distribution seen in majority of patients. Documented atypical lesions and the characteristic features of end stage lung disease on HRCT noted in a small subset of patients. HRCT was superior to chest radiography for evaluating the features, pattern and distribution of the parenchymal lesions and mediastinal lymph nodes, for assessing the stage and activity of the disease and in aiding detection of subtle parenchymal lesions which are liable to be missed on conventional imaging. CONCLUSION: Thoracic sarcoidosis can have varied presentations. HRCT is superior to conventional CT for the detection and characterisation of the lung parenchymal lesions.

Sphincter saving anorectoplasty (SSARP) for the reconstruction of Anorectal malformations.

BACKGROUND: This report describes a new technique of sphincter saving anorectoplasty (SSARP) for the repair of anorectal malformations (ARM). METHODS: Twenty six males with high ARM were treated with SSARP. Preoperative localization of the center of the muscle complex is facilitated using real time sonography and computed tomography. A soft guide wire is inserted under image control which serves as the route for final pull through of bowel. The operative technique consists of a subcoccygeal approach to dissect the blind rectal pouch. The separation of the rectum from the fistulous communication followed by pull through of the bowel is performed through the same incision. The skin or the levators in the midline posteriorly are not divided. Postoperative anorectal function as assessed by clinical Wingspread scoring was judged as excellent, good, fair and poor. Older patients were examined for sensations of touch, pain, heat and cold in the circumanal skin and the perineum. Electromyography (EMG) was done to assess preoperative and postoperative integrity of external anal sphincter (EAS). RESULTS: The patients were separated in 2 groups. The first group, Group I (n = 10), were newborns in whom SSARP was performed as a primary procedure. The second group, Group II (n = 16), were children who underwent an initial colostomy followed by delayed SSARP. There were no operative complications. The follow up ranged from 4 months to 18 months. Group I patients have symmetric anal contraction to stimulation and strong squeeze on digital rectal examination with an average number of bowel movements per day was 3-5. In group II the rate of excellent and good scores was 81% (13/16). All patients have an appropriate size anus and regular bowel actions. There has been no rectal prolapse, or anal stricture. EAS activity and perineal proprioception were preserved postoperatively. Follow up computed tomogram showed central placement the pull through bowel in between the muscle complex. CONCLUSION: The technique of SSARP allows safe and anatomical reconstruction in a significant proportion of patients with ARM's without the need to divide the levator plate and muscle complex. It preserves all the components contributing to superior faecal continence, and avoids the potential complications associated with the open posterior sagittal approach.

One-stage correction of recto-vestibular fistula by trans-fistula anorectoplasty (TFARP).

BACKGROUND: The present article details a new technique for the repair of recto-vestibular fistula. MATERIALS AND METHODS: Twenty-five patients with recto-vestibular fistula, between 13 days and 4 years of age underwent surgical correction by trans-fistula ano-recto-plasty (TFARP). The technique, described in detail, involves mobilization of the fistula and the rectum through the fistula and creation of a new anus in the anatomically normal site by preserving both the perineal skin bridge (skin between the neo-anus and the posterior fourchette) and the levator muscle. RESULTS: The mean operating time was 85 min, and the mean hospital stay was 5 days. Moderate anal stenosis developed in 1 patient and was treated successfully by anal dilatations using Hegar dilators. A diverting colostomy was not required in any patient, and none of the patients developed rectal prolapse. Eleven patients who are now 3 years of age or older have voluntary bowel movements with good fecal continence scores. The 14 neonates and infants, who are still too young to be evaluated for continence, have symmetric anal contraction to stimulation and strong squeeze on digital rectal examination. The average number of bowel movements per day was three to five, without the need for any laxative or enema. CONCLUSIONS: Trans-fistula ano-recto-plasty is a simple surgical procedure that does not divide the levator muscle or the perineal body. Preservation of these structures contributes significantly toward improvement of the aesthetic appearance of the perineum and of fecal continence.

Complex urethral disruptions: in pursuit of a successful reconstruction.

OBJECTIVES: We analyzed the methods and outcomes of urethroplasty in men with complex urethral disruptions. METHODS: The medical records of 40 men with complex urethral disruptions were analyzed. Surgical methods were individualized according to stricture location, severity and length of the stricture, bladder neck characteristics and presence of complicating factors. Patients were divided into four groups based on the above characteristics. RESULTS: End-to-end urethroplasty performed in six patients with short bulbar strictures (<3 cm) was successful in all. Elaborated perineal repair was performed in 10 patients with intermediate (3-6 cm) strictures with or without complicating factors. Elaborated perineal repair with urethral substitution was performed in nine patients with long segment stricture (>6 cm). Abdominal transpubic repair was successfully applied to patients with rectourethral fistula or lacerated bladder neck. Success rate of anastomotic urethroplasty was 95% while over all success rate was 85%. CONCLUSION: Guidelines for urethral reconstruction of complex urethral disruptions are predicated on stricture length, location, bladder neck characteristics and associated complicating factors. End-to-end urethroplasty with stricture excision is highly reliable for short strictures for which previous operative repair have failed. Elaborated perineal repair is extremely versatile for intermediate and longer strictures with associated complicating factors. Abdominal transpubic urethroplasty is effective for patients with rectourethral fistula or lacerated bladder neck.

Central neural blocks: a quality assessment of anaesthesia in gynaecological surgeries.

Quality of anaesthetic care can be improved only after identifying the factors contributing to patients' discomforts and dissatisfaction. The purpose of this prospective observational study was to assess the quality of central neural blocks in terms of physiological alterations and undesired events and to find out modifiable factors associated with patients' discomforts and dissatisfaction. Total 204 female patients (ASA I and II) undergoing gynaecological surgeries received either of the subarachnoid block (SAB), combined spinal epidural anaesthesia (CSEA) or lumbar epidural anaesthesia (LEA) depending on the nature of the procedure. Intra-operative and immediate post-operative physiologic alterations and undesired effects, surgeons' rating of the operation condition and patient satisfaction (using 10 cm visual analogue scale) and acceptability of the technique were analyzed. Out of 204 patients, hypotension, bradycardia and nausea occurred in 45.1%, 17.6% and 14.7% respectively. Fifty-six (27.4%) patients experienced discomforts whereas 10.8% had tolerable pain and 4.9% patients required conversion to general anaesthesia. The main causes of discomfort in these patients were inability to move lower limbs in 35.7% and discomfort in the upper limbs in 32.1% of patients. Operating conditions were suboptimal and unacceptable in 3.9% and 4.3% of patients respectively. The mean patient satisfaction VAS score was 8.2 +/- 1.3 and patient acceptability was 90.2%. Significant failure or unacceptability (approximately in 10.0%) along with a high incidence of preventable discomforts demand improvement in preoperative patient education, intra-operative care and liberal uses of sedation to improve the quality to bring the acceptability closer to 100.0%.