Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report

Background Various manoeuvres such as McRoberts position, suprapubic pressure, rotational methods, posterior arm extraction and all-four position (HELPERR) have been proposed for relieving shoulder dystocia with variable success. Posterior axillary sling method using a rubber catheter was proposed in 2009 but has not been widely used. We modified this method using ribbon gauzes and a long right-angle forceps and report a successful case. Case presentation A 44 years old parity one Chinese woman with a history of a caesarean delivery and poorly controlled type 2 diabetes mellitus was admitted to the Accident and Emergency Department for advanced stage of labour at term. Upon arrival, intrauterine fetal demise was diagnosed with severe asynclitism causing obstruction at the perineum. Episiotomy resulted in birth of the fetal head. The fetal posterior right shoulder, however, remained very high up in the pelvis and HELPERR methods failed to extract the shoulders. We then tied two long ribbon gauzes together, and guided its knot to the anterior aspect of the posterior axilla. By using a long right-angle forceps (24 cm long) to grasp the knot on the posterior side of the axilla and pulling it through, a sling was formed. Traction was then applied through the sling to simultaneously pull and rotate the posterior shoulder. A stillbirth of 3488 g was finally extracted. Conclusions We modified the sling method by using two ribbon gauzes, tied together and a right-angle forceps with several advantages. Compared to a rubber catheter, ribbon gauze with a knot can be easily held between the fingers for easy guidance past the fetal axilla. It is also thin, non-elastic and stiff enough to ensure a good grip for traction. The long and slim design of the right-angle forceps makes it easy to pass through a narrow space and reach the axilla high up in the pelvis. We emphasize simultaneous traction and rotation, so that the shoulders are delivered through the wider oblique pelvic outlet dimension.

Pioneer shunt implantation surgery in Brazil

One of the first experiences of shunt implantation in the world occurred in 1949, by Nulsen and Spitz, who implanted a rubber catheter with a ball valve system, from the lateral ventricle to the internal jugular vein [1]. In the 1950s, the shunt systems had great development, especially the Spitz-Holter system, first used in 1956, consisting of the first system produced on a large scale. The second patient who benefited from this new system was Holter's son Casey, who had myelomeningocele [2,3]. From these first American reports, the shunt surgery had great worldwide dissemination in the 1960s. One of the first CSF shunts in Brazil and Latin America occurred in 1966, in the city of Uberaba, Minas Gerais, by Prof. Francisco Mauro Guerra Terra, founder of the Chair of Neurosurgery at Triângulo Mineiro Medical School, today part of Federal University of Triângulo Mineiro (UFTM). The procedure was performed at the Children's Hospital of Uberaba, at the time one of University Hospitals, and the patient was a 7-month-old baby named Maria Beatriz. The child suffered from hydrocephalus, as a complication of tuberculous meningitis, and was diagnosed by pneumoventriculography, a procedure described by Dandy, and widely used in the era before tomography [4] (Fig. 1). The child was submitted to a ventriculo-atrial shunt (Figs. 2, 3 and 4), with implantation of a catheter without a valve, an option widely used at the time. Besides Prof. Guerra, the surgical team was composed by the then medical students Jaime Olavo Marquez, later titular of the Neurology Department of UFTM, Antônio Luiz da Costa Sobrinho, later a neurosurgeon, who later settled in Presidente Prudente, São Paulo, Brazil Carlos Antunes de Paula, also later a neurosurgeon, who settled in the city of Santos, São Paulo, Brazil and the anesthesiologist Dr. Newton Camargo Araújo, from Uberaba (Fig. 5). There is a postoperative image of the case, showing the success of the procedure (Fig. 6). The surgery had great repercussion in the national media at the time (Fig. 7).

CORRELATION BETWEEN POSITION OF RED RUBBER CATHETER ON X RAY AND GAP LENGTH IN TYPE C ESOPHAGEAL ATRESIA (EA)

BACKGROUND AND AIM: Gap length is important determinant for feasibility of primary repair in atresia and also for the preparedness and prognosis of delayed or staged operative procedures. A diagnostic plain radiograph with a red rubber catheter in situ might provide reliable information regarding the gap length without involving additional risk and cost. The present study was conducted to assess the gap length between the two esophageal pouches by preoperative plain radiography with in situ red rubber catheter in upper esophageal pouch and to know the correlation between position of red rubber catheter and measured gap length between upper and lower pouch. METHODOLOGY: Out of all patients admitted and diagnosed as gross's type C EA during September 2018 to November 2019 were included in the present study. The data regarding clinical history, general and systemic examination, pre-operative investigations including plain radiograph with in situ red rubber catheter and intraoperative measured gap length were recorded. Statistically correlation assessed between position of red rubber catheter and intraoperatively measured gap length among patients with type c EA. RESULTS: Total 283 patients were included in the present study. Radiologically position of red rubber catheter was found at level of T2, T3 and T4 in 18.7%, 55.5% and 25.8% respectively. A correlation was found between the preoperative radiological assessments of position of red rubber catheter with intra operatively measured gap length in this study and association between these two variable were found statistically signicant (r=-0.66, P=0). CONCLUSION: The preoperatively radiographic position of upper pouch should be assessed carefully to predict the gap width and it helps in preparedness of surgical management of the patients.

Congenital Tracheoesophageal Fistula in Very Low Birth Weight Preterm Neonate with an Oligohydramnios as a Rare Presentation: A Case Report

Tracheoesophageal fistula is a challenging anomaly with a rare prevalence with symptoms mainly respiratory, sometimes digestive. We present a rare case of oesophageal atresia with distal Tracheoesophageal fistula in a female child whose mother presented with severe oligohydramnios on ultrasonography with intrauterine growth retardation before cesarean section. After the birth of preterm and very low birth weight neonate, we initially diagnosed as respiratory distress syndrome with a club foot. However, we diagnosed oesophageal atresia with distal Tracheoesophageal fistula on the 2nd day as nasogastric tube insertion was failed beyond 10cm and confirmed by X-ray with a rubber catheter. Right thoracotomy with ligation of the fistula with end to end anastomosis was performed successfully without complications. Breastfeeding initiated and the child discharged after she started gaining weight. Early post-operation complication (anastomotic stricture) was noticed after 2 weeks; however, corrected with endoscopic balloon dilatation. Currently, the child is healthy weighing 10kgs at 18 months of age.

Kluth type I3 and intra-abdominal variants of esophageal atresia: A case series

Background: Esophageal atresia (EA) encompasses a group of congenital anomalies (one in 2500 live births) comprising an interruption in the continuity of the esophagus combined with or without a persistent communication with the trachea. It is confirmed by passing no. 10 sterile, blunt‑tipped red rubber catheter into the esophagus, which gets failed to pass beyond 10 cm. Case Series: We describe two male neonates in whom the infant feeding tube could be passed to 18-20 cm in the upper esophageal pouch. A babygram with a blunt-tipped soft red rubber catheter in situ confirmed the esophageal atresia (EA) with the long upper pouch in the first case and EA with obstruction at the gastroesophageal junction in the second one. Conclusion: The importance of recognizing rare Kluth variants of EA is stressed. A low threshold for performing a red rubber catheter test is stressed.

Congenital bilateral choanal atresia- Endonasal endoscopic surgery- Report of two cases

Congenital choanal atresia (CCA) is the development failure of the nasal cavity to communicate with nasopharynx. It is an uncommon congenital anomaly of nose with an incidence of approximately 1 in 5000-7000 live births. Choanal atresia is caused by failure of resorption of the nasobuccal membrane during embryonic development. Choanal atresia has a significant association with CHARGE syndrome. Surgical intervention is recommended in the first weeks of life in bilateral cases because this is a life threatening condition. Two cases of congenital bilateral choanla atresia (CCA) was admitted in the department of Otolaryngology & Head-Neck Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU) with the complaints of intermittent attacks of cyanosis, dyspnea, respiratory distress and history of inability to take feeds. On examination both babies had respiratory distress, mucoid discharge from both nasal cavities. A soft rubber catheter was passed into both nares revealed the diagnosis of bilateral CCA which was confirmed by flexible nasoendoscopy. Bilateral CCA was managed with a nasopharyngeal airway. Surgery is the definitive treatment with two main approaches namely transnasal and transpalatal. We discuss successful management of two neonates with bilateral CCA by endonasal endoscopic approach. Bangladesh J Otorhinolaryngol; April 2018; 24(1): 85-89

Novel Passage of Dermis-Fat Graft for Augmentation of Vermilion Deficiency Following Cleft Lip Repair

Despite timely repair of cleft lip, secondary deformities such as vermilion notching or “whistle deformity” often require further surgical treatment. The use of dermis-fat graft for soft tissue augmentation of the upper lip is an established technique. We propose an innovation on this technique, by which the dermis-fat graft can be placed reliably and with minimal dissection by use of a soft red rubber sheath to protect the Keith needle while delivering the graft through the submucosal pocket in the dry vermilion, thereby avoiding the needle inadvertently catching soft tissue inside the pocket. We recommend using an 8F red rubber catheter, cutting the catheter to be just shorter than a 2.5-inch Keith needle. This provides a sheath through which the Keith needle can be passed within the submucosal vermilion tunnel. We believe this to be much more reliable for vermilion augmentation than other techniques, including fat injection, and makes graft inset more predictable, faster, and simpler.

Role of intrauterine balloon tamponade in controlling massive primary post partum haemorrage

Postpartum haemorrhage (PPH) Remains a significant complication of child birth worldwide. The most common cause of PPH is uterine atony. Recently, uterine tamponade using intrauterine condom appearsto be an effective tools in the management of uncontrolled primary PPH. Objectives of our studywas to see the effectiveness of large volume fluid filled condom catheter in the management of primary PPH. Methods: a condom was inserted in the uterus by means of a size 16 rubber catheter and inflated with 250 to 300ml normal saline until the bleeding was controlled. The condom was kept in situ for 24 to 48 hours. Results: Out of 53 cases, PPH was controlled in 52 cases. One patient died as the patient was eclamptic & develped disseminated intravascular coagulation (DIC). No patient required surgical intervention. Conclusion: fluid filled intrauterine condom is an effective method in the management of primary PPH when usual measures & drugs fail to control PPH.TAJ 2016; 29(1): 52-54