Correction of whistle deformity secondary to cleft lip repair by V-Y plasty: a simple and effective technique

Several techniques are available for the surgical repair of the cleft lip, however, avoiding secondary deformities and achieving consistent results remains a challenge. The whistle deformity is a secondary lip deformity characterised by inadequate fullness of the central upper lip with abnormal exposure of the central incisors when the lips are at rest, giving a whistling appearance. The causes include scarring of the vermilion and failure to restore the mucosal or muscular continuity. Various surgical options are available ranging from simple procedures like V-Y plasty and Z-plasty to complex procedures like complete lip redo, locoregional flaps, fillers and grafts. V-Y plasty is a simple, effective procedure for lip lengthening that can be performed under local anaesthesia as an outpatient procedure. It is less technique sensitive and also allows for some degree of muscle repair. We present a case of whistle deformity satisfactorily corrected with V-Y plasty.

Torsades de pointes in the PACU after outpatient endoscopy: a case report

Background This case demonstrates the severe electrolyte derangements that may present after a common therapy such as a bowel preparation for an outpatient procedure and the rare yet potential detrimental outcomes of those abnormalities. It also highlights the implications of long QT syndrome regarding pharmacology and treatment. Case presentation We present a case of 48 year-old female with severe electrolyte derangements and long QT syndrome (LQTS) leading to Torsades de Pointes (TdP), pulseless ventricular fibrillation, and unsynchronized defibrillation in the post anesthesia care unit (PACU) after uneventful upper and lower endoscopy. This led to an unanticipated intensive care unit admission for aggressive electrolyte repletion, cardiology consultation, and implantable cardioverter defibrillator (ICD) placement. Conclusions This is a rare presentation after an outpatient procedure that would have had a detrimental outcome if not promptly diagnosed and treated appropriately. Therefore, we aim to provide further insight into the diagnosis and treatment of severe hypokalemia and long QT syndrome resulting in Torsades de Pointes and ventricular fibrillation.

Contemporary treatment trends for upper urinary tract stones in a total population analysis in Germany from 2006 to 2019: will shock wave lithotripsy become extinct?

Purpose To describe the change in upper urinary tract stone management in Germany over a 14-year period. Methods Using remote data processing we analyzed the nationwide German billing data from 2006 to 2019. To analyze the clinics’ case numbers and regional trends, we used the reimbursement.INFO tool based on standardized quality reports of all German hospitals. To also cover shock wave lithotripsy (SWL) as an outpatient procedure, we analyzed the research database of the Institute for Applied Health Research with a representative anonymous sample of 4 million insured persons. Results The number of inpatient interventional therapies for upper tract urolithiasis in Germany increased from 70,099 cases in 2006 to 94,815 cases in 2019 (trend p < 0.0001). In-hospital SWL declined from 41,687 cases in 2006 to 10,724 cases in 2019 (decline of 74%; trend p < 0.0001). The percentage of SWL as an outpatient procedure increased between 2013 and 2018 from 36 to 46% of all performed SWL, while total SWL case numbers declined. Contrarily, the number of ureteroscopies increased from 32,203 cases in 2006 to 78,125 cases in 2019 (increase of 143%; trend p < 0.0001). The number of percutaneous nephrolithotomy also increased from 1673 cases in 2006 to 8937 in 2019 (increase of 434%; trend p < 0.0001). Conclusion We observed an increase in interventional therapy for upper tract urolithiasis in Germany with a dramatic shift from SWL to endoscopic/percutaneous treatment. These changes may be attributed to enormous technological advances of the endoscopic armamentarium and to reimbursement issues.

DIAGNOSTIC EFFICACY OF ENDOMETRIAL ASPIRATION CYTOLOGY WITH HISTOPATHOLOGICAL CORRELATION

Background: To assess the diagnostic accuracy of endometrial aspiration technique and to compare the cyto-morphology of aspirated smears with histopathology Methods: Endometrial aspiration was performed using Karman’s cannula in 100 cases who presented with abnormal uterine bleed, infertility and postmenopausal bleed. The endometrial specimens obtained by D&C were processed and evaluated histologically. The endometrial aspirated smears were reviewed for cytomorphological findings and were correlated with histopathological findings for diagnostic accuracy. Results: Aspiration cytology is more specific for diagnosing malignant lesions (100%) while it is more sensitive for the benign conditions (85.06%) as compared to borderline lesions (complex and atypical hyperplasia), cytology also has higher NPV, PPV and Accuracy for malignant conditions as compared to the benign conditions Conclusion: Endometrial aspiration technique with Karman’s cannula is simple, safe, cost effective and well tolerated outpatient procedure. Keywords: Endometrial aspiration cytology, Cyclic endometrium, Dilatation and Curettage, Endometrial malignancy, Karman’s cannula.