Successful transcatheter embolization of splenic artery pseudoaneurysm in acute necrotising pancreatitis.

Splenic artery pseudoaneurysm is a rare condition commonly arises as a sequelae of pancreatitis. Pseudoaneurysm is clinically silent until it ruptures. Thus, untreated pseudoaneurysm carries a high mortality rate up to 90%. We present a case of necrotising pancreatitis complicated with unruptured splenic artery pseudoaneurysm, which was found incidentally from computed tomography (CT) of abdomen. Patient was presented with symptomatic anemia and bleeding from the abdominal drain. We proceeded with embolization of pseudoaneurysm by using Histoacryl glue, resulting in successful complete resolution of pseudoaneurysm with good patient outcome. Transcatheter embolization is considered the current treatment of choice for pseudoaneurysm as it provides an alternative to conventional surgery due to its high successful rate. In this case report, we want to shed light on an alternative treatment approach of the splenic artery pseudoaneurysm.

THE OUTCOMES OF TRABECULECTOMY WITH ADJUNCTIVE SUBCONJUNCTIVAL MITOMYCIN C AMONG PATIENTS REQUIRING GLAUCOMA SURGERY AT A TERTIARY CARE HOSPITAL IN RAJASTHAN, INDIA

Introduction: Glaucoma is a chronic multifactorial degenerative optic neuropathy and is the second leading cause of irreversible blindness worldwide. Material And Methods: 50 eyes of 50 patients of diagnosed glaucoma not controlled by maximal medical therapy underwent trabeculectomy adjuncted with subconjunctival Mitomycin C. Preoperative data included age, gender, IOP(intraocular pressure) and number of preoperative medications. Postoperatively IOP, number of glaucoma medications and postoperative complications if any were recorded on follow up at seven days, one month and three months. Results: Baseline characteristics were matched. Preoperative IOP was 33.23±8.41 mm of hg which drastically dropped to 14.67±5.78 mm of hg 3 months postoperatively. The need for postoperative antiglaucoma medications also dropped from 3.92±1.14 medications used preoperatively to 1.14±1.26 postoperatively. Success rate was 50% out of which 46% had complete success while 44% had qualied success. Postoperative complications seen were hypotony(14%), Flat AC(12%), Hyphema (6%), Flat Ac with raised IOP(2%), and Cystoid macular edema (2%). Discussion: In conclusion, this study shows that trabeculectomy with adjunctive MMC provides good patient outcome in the form of treatment success in 90% and reduced postoperative antiglaucoma medications in patients and is a good alternative to trabeculectomy alone.

Analysis of Effectiveness of Treatment of Meibomian Gland Dysfunction in Patients with Computer Vision Syndrome

Aims: To evaluate association, stage and treatment efficacy of treating Meibomian Gland Dysfunction(MGD) in Computer Vision Syndrome(CVS) patients. Setting: Department of ophthalmology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India. Design: Prospective observational study. Materials and methods: Prospective study on 232 CVS patients were evaluated for MGD and randomly divided into groupA and B. GroupA were treated with tear supplements. GroupB were treated with azithromycin ointment and tear supplements. Efficacy was analysed at end of 3months. Statistical analysis: Data was analysed using descriptive statistics. Results: Among 232 CVS patients, MGD was found in 90(38.8%) patients . Among them, 38had stage1, 36had stage2 , 14had stage3 and 2patients had stage4 MGD. By the end of three months, in groupA, 34of 48 patients with stage1 and 2MGD were cured. In groupB, 36 of 42patients with all stages of MGD were cured. 100% of the CVS patients with stage1 , 66.7% of stage2 and 50% of the stage3 MGD improved completely with tear supplements alone whereas 25% of stage3MGD patients improved to stage1 and 25% of stage3 MGD did not improve at the end of three months. But, 100% of the CVS patients with stage1, 77.8% of stage2, 100% of stage3 improved completely and 1patient with stage4 MGD improved to stage1 by the end when treated with tear supplements and azithromycin ointment. Conclusion: 39% of CVS patients have MGD. So while treating CVS patient, its important to evaluate and treat MGD too. Tear supplements alone can be considered as a treatment option for CVS patients with stage1 and 2MGD whereas stage3 and 4MGD needs azithromycin ointment in addition to tear supplements for a good patient outcome.

Delayed onset bleed after percutaneous kidney biopsy: is it the same as early bleed?

Background While the majority of bleeding complications after a percutaneous kidney biopsy (PKB) occur early (≤24 h), delayed onset bleeding complications (>24 h) have been rarely reported and can be catastrophic for the patient. Purpose To describe the incidence, risk factors, and outcomes of delayed bleeding complications after PKB. Material and Methods We retrospectively studied native and graft kidney biopsies in patients who developed delayed bleeding complications (>24 h) after the biopsy performed in the Department of Nephrology and Renal Transplantation of a tertiary care medical institution in north India between January 2014 to December 2018. Results Of the 4912 renal biopsies reviewed, 20 patients (16 men, 4 women; 0.40%) had a delayed biopsy bleeding complication. Of these patients, 95% had major bleeding complications requiring blood transfusions and 85% needed intervention like gelfoam/coil embolization. Despite intervention, one patient (5%) had mortality due to complications of bleeding and sepsis. When compared to a control group of patients with early biopsy bleed, patients with the delayed biopsy bleed had similar demographic and clinical profiles except for higher pre-biopsy hemoglobin and lower systolic and diastolic blood pressure. Conclusion A post-PKB delayed onset bleed is not uncommon, and the vast majority of these patients had major bleeding complications requiring blood transfusions and/or intervention like embolization. They had a similar demographic and clinical profile presentation as early bleed patients. Meticulous outpatient monitoring and patient education after discharge may be useful to detect this complication promptly and to intervene early to have good patient outcome.

Anaphylactic Reactions in Radiology Procedures

Reactions to contrast agents are uncommon but range from mild urticaria to life threatening anaphylactic reactions. Majority of these reactions occur due to intravenous administration of iodinated contrast media. Acute reactions to MRI gadolinium-based contrast are much less common but they do occur and thus have to be managed. Usual presentations include urticaria, nausea, vomiting, angioedema, bronchospasm, laryngospasm and systemic hypotension. Majority of these reactions occur within the first twenty minutes after administration of contrast. Therefore, their recognition and prompt treatment are critical for good patient outcome. Attendant to this the radiology department must be adequately prepared to handle these emergencies as and when they do occur. This means an up to date emergency tray must be checked regularly before the start of the procedure, ensure there is epinephrine, antihistamines, beta-2-agonists metered dose inhalers, IV fluids, and ready supply of oxygen. Close collaboration of radiology staff with the hospital emergency response team is critical since severe reactions will need the intervention of this team.

Case Report: Successful Use of Extracorporeal Therapies After ECMO Resuscitation in a Pediatric Kidney Transplant Recipient

The combination of extracorporeal membrane oxygenation (ECMO) and extracorporeal blood purification in children is rarely used due to small total blood volumes, risks of hemodynamic instability and a negative association between volume of blood transfusion and patient outcome. To our knowledge, this is the first description of a multimodal extracorporeal detoxication in the setting of ECMO in a post-kidney-transplant child on immunosuppression. We describe a case of a 30-months old child, who was extracorporeally resuscitated after cardiac arrest during kidney transplantation surgery and additionally treated with a number of extracorporeal blood purification methods (plasma exchange, CytoSorb, and lipopolysaccharide adsorption) in the setting of immunosuppression therapy. This case report shows the successful use of multimodal extracorporeal therapies for a good patient outcome. The lack of response to CytoSorb therapy might suggest an occult infection and not necessarily failure of treatment.

Management of COVID-19-Positive Patient with Bilateral Longitudinal Petrous Fractures: A Case Report

Temporal bone fractures are bilateral in 8 to 29% of cases. High index of suspicion of coronavirus disease 2019 (COVID-19) infection is important while dealing with any patient with special concern to the surgical and traumatized patients to reach a good patient outcome especially during the pandemic of COVID-19. We describe in this report the management of COVID-19-positive patient with bilateral longitudinal petrous fractures and moderate head injury.

Lightning Injury with Multi-System Involvement

Lightning leads to trauma and disability such as burns, hearing loss, blindness, cardiac arrhythmia, cardiac arrest, stroke, kidney injury, and can also lead to death. Such cases are seldom reported, and hence their database is scanty. We present a case of a 40-year-old female with lightning injury with four such manifestations, which is not commonly encountered. We have elaborated on these complications of lightning injury and their timely management, which has led us to good patient outcome.

Cultural research deconstructs the psychosocial construct ‘expressed emotion’

Summary Expressed emotion (EE) is a highly researched psychosocial construct. Cultural research challenges the assumption that high family criticism is a universal determinant of poor outcome, especially for chronic illness. The concept of warmth, an original component of EE, was dropped owing to the complexity of its measurement. Warmth has now been resurrected as an important predictor of good patient outcome. Cultural scrutiny and appropriate adaptation of any psychosocial construct is necessary before its acceptance into the medical lexicon of healthcare.

Complete resection of a massive mesenteric lymphangioma in an adult

Mesenteric lymphangioma is a benign cystic tumour of the lymphatic vessels that occurs rarely in adults. Due to the infrequency of cases and the insidious presentation, these tumours can be diagnosed late and become massive. Resection of mesenteric lymphangioma in its entirety is the recommended management in order to prevent recurrence. This case report describes the finding of a massive mesenteric lymphangioma (dimensions 420×470×100 mm) in a young man, the investigations leading to diagnosis, and the subsequent surgical management. The substantial size of this tumour produced considerable challenges for the surgical team, including involvement of adjacent small bowel and mesenteric vasculature. Preoperative diagnosis and assessment of the anatomy was pivotal in achieving a complete resection and a good patient outcome.