Catheter knotting in a neonate

A 36-week preterm neonate with anal atresia and rectoperineal fistula was catheterized with a size 6F Foley’s catheter when she underwent anoplasty on the second day after birth. When the patient recovered from anesthesia, it was decided to remove the catheter. While the catheter was being removed, resistance was felt halfway through the procedure. Abdominal plain films revealed a catheter coiled in the pelvis. With copious lubricant injected into the bladder through the catheter and patient sedated, it was removed by manipulation alone using gentle traction (Figure 1). The infant had no bleeding at the urethral meatus and no obvious abnormality in urination during the 3-month of follow-up.

105 The Mustaq Method: Could This be The Simplest Shoulder Dislocation Reduction Method?

Introduction The Mushtaq Method is a new shoulder reduction technique. It is a simple, reliable, and less traumatic time modulated procedure. Method Patients are placed in the supine position if plausible. Fully adducting the affected arm with the elbow at right angle. The practitioner applies gentle traction above the elbow with the other hand placed deep into the axilla, palpation of the humeral head is followed by lateral pressure resulting in a successful relocation. Internal rotation and a broad arm sling complete the technique. No assistants are needed, and simple analgesia was often enough. Results 95% had a successful reduction within 5 minutes. 75% required analgesia alone, and no periprocedural complications were observed. Conclusions With so many options already, available it is essential to understand what dictates the success and failures of these methods. We have a new, safe, easy to use method requiring minimal force. We hope to increase our cohort size in the future to draw firm conclusions.

Sacral Nerve Stimulation Lead Migration through the Sciatic Foramen, Successfully Repositioned

Introduction: SNS (Sacral Nerve Stimulation) has become an established minimally invasive procedure for urinary and faecal incontinence. Minor complications related to the procedure are common; include pain, infection or migration. We present a case of a tined lead migration through the sciatic foramen. Case Report: A 72-year-old woman with faecal incontinence, who did not respond to dietary of medical treatment, underwent a sacral nerve stimulation test. Under fluoroscopic vision a tined lead was placed in S3 foramen, with an adequate motor and sensory response. In the 7th postoperative day, she reported no improvement and she referred sensory response in the thigh and leg. Radiography showed migration of the electrode through the sciatic foramen. The repositioning of the same electrode was possible with a gentle traction of the lead. Correct placement of the lead was confirmed radiologically, and the patient showed motor and sensory response in the anal area. The patient improved Wexner score from 18/20 to 4/20. Conclusion: Migration of the tined lead should be considered if loss of response in found. Repositioning of the same lead is possible in selected patients, without the need of removal of the device.

Snare salvage technique for deformed WEB device after deployment

The Woven EndoBridge (WEB) device is a new endovascular technology that allows safe and effective treatment of wide-neck bifurcation aneurysms without the need for dual antiplatelet therapy.1–4 The case is presented of a patient in their 50 s with a history of systemic lupus erythematosus and receiving warfarin for recurrent deep venous thrombosis and an unruptured right middle cerebral artery bifurcation aneurysm. The aneurysm was treated with a WEB SL aneurysm embolization device (MicroVention, Tustin, California, USA). After the final deployment, a technical error (inadvertent forward movement of the pusher) led to the deformation of the device along its longitudinal axis, leaving the aneurysm partially untreated. An Amplatz Goose Neck Microsnare was used to capture the proximal detachment marker and used gentle traction to restore the original shape of the device (video 1).5–7 A follow-up angiogram revealed a restoration of the device’s shape with a similar result during the 4- month follow-up angiogram.Video 1

Tracheal pseudomembrane secondary to aspiration pneumonia in a 6-year-old Ragdoll

Case summary A 6-year-old female spayed Ragdoll presented with a 4-day history of acute onset non-productive retching, coughing and anorexia. A complete blood count, serum biochemistry, thoracic radiography and abdominal ultrasound were performed. Initially, aspiration pneumonia was suspected owing to an alveolar lung pattern in the right cranial ventral lung lobes seen on radiographs. The cat did not improve with empirical antibiotic therapy. Bronchoscopy and bronchoalveolar lavage were performed. An intraluminal tracheal mass was identified and removed via endoscopic guidance and gentle traction. Histopathology results were consistent with a fibrinous tracheal pseudomembrane. The cat was concurrently diagnosed with Pseudomonas aeruginosa pneumonia, which was confirmed on bronchoalveolar lavage. Pseudomonas aeruginosa was also cultured within the pseudomembrane. The cat was received antimicrobial therapy for his Pseudomonas pneumonia. In humans, fibrinous tracheal pseudomembranes occur uncommonly as a complication following endotracheal intubation and rarely due to infectious organisms. As there was no prior history of endotracheal intubation, the development of fibrinous tracheal pseudomembrane in this cat was suspected to be secondary to Pseudonomas aeruginosa aspiration pneumonia. Relevance and novel information The present case report is the first to describe a tracheal pseudomembrane in a cat. Bronchoscopy-guided gentle traction and subsequent removal of the tracheal pseudomembrane resulted in a complete resolution of the clinical signs.

Through-and-Through Suture Technique to Stabilize a Sheath in Branched Endovascular Aortic Repair

Purpose: To describe a technique to catheterize antegrade branches of a branched thoracoabdominal endograft from a femoral access with the help of standard sheaths and a vascular suture. Technique: The technique is demonstrated in a patient who underwent successful complex thoracoabdominal branched endovascular aortic repair. After the deployment of an aortic endograft with two antegrade branches for the targeted renovisceral vessels, a standard braided sheath was preloaded with a 3/0 polypropylene suture and introduced inside an additional sheath from the groin to the thoracic aorta. Simultaneous gentle traction on the suture as the preloaded sheath was advanced achieved a very stable 180° curve of the proximal end of the sheath. It was possible to selectively catheterize the antegrade branches and respective target vessels sequentially, as well as deploy the planned bridging stents for each branch. Conclusion: The through-and-through suture technique is a helpful tool in branched endovascular aortic repair. It saves time, radiation, and materials; no snare is needed, and it can be preloaded into a sheath.

Uterine Perforation & Abortion- A Case Report

Sreemoti Ratna Sarker 30 years old lady presented to us with the complaints of amenorrhea for 5 months, lower abdominal pain for 5 days, slight per vaginal bleeding for 2-3 days, a cord like structure is coming down p/v on the day of admission. On general examination she was stable and on p/v examination there was cord prolapse. A gentle traction was given and it was expelled out along with a small piece of placental tissue without any fetal parts and bleeding. Then she was advised for USG of abdomen. USG reported a fetus like structure in the abdominal cavity and the empty uterine cavity . She was managed surgically. Now she is doing well.KYAMC Journal Vol. 5, No.-1, Jul 2014, Page 491-493

Treatment of displaced flexion-type pediatric supracondylar humeral fractures in the prone position

Purpose: This study is to report a new method to reduce and fix the displaced flexion-type pediatric supracondylar fracture in the prone position. Methods: Ten children with displaced flexion-type supracondylar humeral fractures treated between 2007 and 2013 were reviewed. There were three girls and seven boys, with a mean age of 9.5 years. The fracture was reduced by gentle traction of the forearm and gradual extension of the elbow in the prone position. Two or three crossed Kirschner wires (K-wires) were inserted percutaneously to secure the fracture reduction. Radiographic evaluation included the Baumann’s angle and the lateral humerocapitellar angle. Clinical outcomes were assessed using the Flynn’s criteria. Results: Eight children had closed reduction and percutaneous K-wire fixation. The other two children required open reduction through a posterior triceps splitting approach. The mean Baumann’s angle was 70.2° immediately after K-wires fixation and 69.5° after 3 months later. The mean lateral humerocapitellar angle was 38° immediately after K-wires fixation and 35.5° after 3 months later. The clinical outcome was excellent in nine children and poor in one child by the Flynn’s criteria. Conclusion: Reduction of displaced flexion-type pediatric supracondylar humeral fractures by traction and gradual extension in the prone position is an effective and safe method. When reduction is still impossible or nerve incarceration is suspected, open reduction and release of the trapped nerve through a posterior triceps splitting approach are simply accessible.

A Novel Technique of Branchial Fistula Tract Delineation and Excision In Children Allergic To Dyes

IntroductionBranchial arch fistula which results from a second arch anomaly is rarely seen in practice. The patients usually seek medical advice for persistent discharge from an opening in the neck or mucopurulent discharge from the opening of an infected fistulous tract. The treatment of choice for such a fistula is excision. Materials and MethodsA total of seven patients were operated for branchial fistula between 2010 and 2012. Among them, three children could not undergo a fistulogram due to allergy to the dye used and hence they were selected for our modified procedure. Surgical ProcedureA 3-0 or 4-0 polypropylene (Prolene™) thread was inserted into the fistulous tract. Both the ends of the tract were secured with the thread and the sinus tract was dissected out under gentle traction. ResultsThe patients who were allergic to dye could not have preoperative fistulograms and per-operative injection of dye was also avoided. The blue colour of the polypropylene thread inserted in the fistula tract helped in tracing and excision of the sinus tract. No major complications occurred during or after fistulectomy and the post-operative recovery was uneventful. No recurrence was seen in the scheduled follow-ups. ConclusionSurgical excision of branchial fistulas in children with allergy to dyes can be challenging. Insertion of a polypropylene thread into the fistula tract makes its subsequent dissection easy with minimal disruption of adjacent structures.