Stings of the missing string: missing Copper T thread

Background: Missing CuT thread is a worrisome complaint for a woman. The string may be curled in or the Cu T might have expelled or migrated.Methods: It was a retrospective study. Authors collected the data between January 2017 to December 2017. Data was collected from OPD, OT register and Indoor patient record file. The objective was to ascertain the symptomatology, type of insertion, investigations and mode of retrieval of CuT.Results: There were 63 cases of missing CuT thread, out of which, 42 were postpartum. 33 patients were asymptomatic. Irregular vaginal bleeding (19 patients) was commonest complaint, followed by abdominal pain (10 patients). Pregnancy was detected in one patient. Transvaginal ultrasonography (TVS) detected intrauterine location of CuT in 60 cases. X-ray abdomen erect was needed in 3 cases, which detected intra-abdominal migration of CuT in two cases. CuT was expelled in third case. In 31 patients, CuT was removed by artery forceps in OPD. In 17 cases, hysteroscopic Copper T removal was needed. Two cases with migrated CuT underwent laparoscopy for retrieval of CuT. One patient had to be converted to laparotomy to rule out bowel injury.Conclusions: Missing CuT thread is commonest with postpartum IUCD. TVS should be first investigation in missing CuT thread. X-ray abdomen is needed only if CuT is not visualized on TVS. Hysteroscopy can be used in patients where CuT retrieval with artery forceps fails. Laparoscopy and laparotomy may be required in migrated CuT cases.

Near Complete Laryngopharyngeal Obstruction due to Vegetable Foreign Body in an Infant

Introduction Impaction of foreign bodies and obstruction in the upper aero-digestive tract is a medical emergency. Case Report A 5-month-old male infant presented with impacted large vegetable foreign body lying in the hypopharynx of an infant causing almost complete laryngeal obstruction. Cardiopulmonary resuscitation was initiated and back blows were given between the blades of the scapula to assist in its removal. Only available curved artery forceps was gently passed beyond the foreign body; blades of the forceps were opened to engage it and foreign body was swept and rolled out. Patient was revived after intensive resuscitation. Conclusion Suspect foreign body in the upper aero-digestive tract in any child presenting with severe respiratory distress or apneic spells or choking. Foreign body may be removed with only available curved artery forceps by gently passing beyond it, followed by opening and engaging blades of the forceps to sweep and roll it out of the upper aero-digestive tract.

Surgical instruments, materials, and the acquisition of surgical skills

Introduction 92Scalpel handles 94Needle holders 94Scissors—suture and dissecting 96Tissue dissecting forceps 98Tissue holding forceps 98Artery forceps 100Hand-held retractors 101Self-retaining retractors 103Bowel clamps 107Vascular instruments 109Suckers 111Endoscopic equipment 112Laparoscopic equipment 116Suture materials ...