Donate organs not malignancies: postoperative small cell lung carcinoma in a marginal living kidney donor

A widening gap between supply and demand for transplantable kidneys has led to increasing use of marginal living donors from an elderly population in kidney transplantation programs. Although the graft survivals of these marginal organs are comparable with those of standard donors, the attendant risk of transmission of malignancy from older donors is high, given that aging is a risk factor for malignancy. Herein we have highlighted a case of small cell carcinoma developing in a marginal elderly donor at 10 months after kidney donation. The recipient remains free of malignancy at 36 months after transplantation. The exhaustiveness of tests for screening of elderly living donors for malignancy as well as the surveillance of recipients at high risk of developing donor-derived malignancy remain uncertain.     

The pulmonary physician in critical care * 6: The pathogenesis of ALI/ARDS

An understanding of the pathogenesis of ARDS is essential for choosing management strategies and developing new treatments. The key mediators involved in the inflammatory and fibroproliferative responses are reviewed and the mechanisms which regulate these responses are highlighted.     

The impact of coping on emotional adjustment to spinal cord injury (SCI): review of the literature and application of a stress appraisal and coping formulation.

OBJECTIVES: This article reviews literature examining the psychological adjustment to Spinal Cord Injury (SCI) and illustrates the applicability of a Stress Appraisal and Coping model (SAC) for rehabilitation of this population. METHOD: Articles concerning psychological adjustment to SCI from the previous three decades have been reviewed and critiqued. When possible the articles have been discussed in a SAC framework. RESULTS: The literature indicates that psychological adjustment to SCI is largely predictable from psychological variables including coping, appraisal and psychosocial resources. Recent literature has suggested psychological intervention can promote positive psychological adjustment following SCI for those individuals at risk of developing clinical levels of depression. CONCLUSION: The SAC model provides a comprehensive formulation to incorporate the heterogeneity of populations with SCI. Suggestions for future research include developing assessment and treatment regimes specifically tailored to the strengths and weaknesses of an individual as highlighted in the model.     

Prostate fossa packing: a simple, quick and effective method of achieving hemostasis in suprapubic prostatectomy

INTRODUCTION: Suprapubic prostatectomy remains a very common surgical treatment for bladder outlet obstruction from an enlarged prostate in the developing world. It is a technically simple procedure which can be learned by nonurologists who perform the bulk of these procedures in the developing world. Intraoperative and postoperative bleeding, however, can be a problem. We describe our experience with prostatic fossa packing at the time of the procedure, as a very simple, quick and effective technique for maximal hemostasis. MATERIAL AND METHODS: We have used this technique for several years at our institution and the results have been excellent. However, the major advantages of this technique became highlighted when the primary author visited Eritrea on a medical mission trip and used it in 42 consecutive cases. We looked at the hemorrhagic complications, both intraoperatively and postoperatively, infections and other complications related to the technique. RESULTS: The 42 patients were typical of the patients that are seen in the developing world for suprapubic prostatectomy. The age range was 49-102 years. 75% had indwelling urethral catheters secondary to urinary retention. The duration of the catheters was from 2 weeks to 10 months. All the patients who had the indwelling catheters had bacteriuria. 56% had associated bladder calculi and 25% had associated inguinal hernias. The average surgical time was 45 min. The average intraoperative blood loss was estimated at 160 ml. There were no blood transfusions. There were no infections and there were no complications related to the packing. CONCLUSION: Packing of the prostatic fossa at the time of enucleation of the adenoma is a very simple, quick and effective way to achieve hemostasis in suprapubic prostatectomy. It is also very easy to learn. With this technique we have achieved zero rate of transfusion and no infections. The surgical time is also reduced. We have had no morbidities associated with this technique and highly recommend it.     

A rare tumour in a rare location: Desmoplastic fibroma in a toe

We report a case of desmoplastic fibroma occurring in the 2nd toe. This lesion most frequently occurs in the long bones or the mandible. This is only the second reported case of desmoplastic fibroma in a toe in the English language. The importance and process of establishing a differential diagnosis in such lesions is highlighted. The similarity between the clinical and histological findings of this tumour and other tumours, both benign and malignant, makes familiarity with the character of desmoplastic fibroma essential for proper treatment.     

Mitral valve repair in a developing country

Out of 454 patients who underwent mitral valve surgery, 210 (46.2%) had isolated mitral valve disease and the rest had mixed valvular disease. Repair was considered for 393 (86.6%) patients but was feasible in only 269 (59.3%) valves. Commissurotomy was performed in 177 (65.8%), leaflet plasty in 25(9.3%), chordal repair in 93(34.6%), papillotony 116(43.1%) and annuloplasty in 210 (78.0%) patients. The hospital mortality for the repair group was 1.49 per cent. There were 2(0.75%) late dealts. Twenty-seven (10.05%) patients underwent reoperation over 20 months, out of which four could be repaired again. Amongst the survivors, 95.5 per cent are in functional class I and II. The techniques of repairs undertaken have been described and its importance in the setting of a developing country has been highlighted.     

Traumatic fracture of the clivus and vermian contusion in a child

The case of a fracture of the clivus in a 10-year-old boy following a road traffic accident is reported. He also suffered a contusion of the cerebellar vermis and the management dilemma in this case is highlighted. Fracture of the clivus in a child is extremely rare; this is the second reported case and the first reported with survival.     

Developing a surveillance system for HIV/AIDS in Pakistan

Apart from other interventions, surveillance remains a major focus of the national response to HIV/AIDS. However, with a shift in the epidemic pattern, the existing surveillance strategies are barely insufficient and long-term structural changes are desirable. This article provides a conceptual framework for developing a scientific system for HIV surveillance in Pakistan. Second generation surveillance system including repeated cross-sectional surveys in high risk population groups are suggested to collect behavioral and serological data at regular intervals on an annual basis to monitor the epidemic trend as well as the associated behaviors. In addition, multiple data resources have been highlighted, which could be coordinated to describe the epidemic pattern in the country. This information should form the basis for national prevention planning and ought to be used for making sensible choices through which prevention efforts are most likely to reduce new infections.     

The Isadora syndrome: a case report of cervical, oesophageal and tracheal transection in a go-karting accident

We report a case of cervical spine, tracheal and oesophageal trauma from a go-karting injury caused by the patient's scarf catching in the vehicle's wheel. We discuss the significance of the pre-hospital and operative management of this potentially life-threatening injury by a multi-specialty surgical team. The importance of health and safety issues in recreational sports is highlighted in view of the increasing incidence of cervical spine trauma over past two decades.     

Haemorrhagic adrenal pseudocyst: a case report

A case of a non-functioning adrenal pseudocyst is reported herein. The key role of sonography and abdominal CT in the diagnosis of this rare retroperitoneal cystic lesion is highlighted. A possible etiological relationship with the trauma of parturition is proposed in our patient.     

Adult tonsillectomy--are long waiting lists putting patients at risk?

There is a paucity of data on morbidity associated with long waiting lists for adult tonsillectomy. The aim of this study was to assess the morbidity associated with long waiting lists for adult tonsillectomy in a developing world setting. Of 350 patients on the waiting list at Groote Schuur Hospital for 18 months or more, only 55 were contactable. This low yield (15.7%) from the telephonic survey highlighted the difficulty of managing long waiting lists efficiently in a developing world setting. As only 1/55 patients on the waiting list had a complication (quinsy), it appears to be safe to delay tonsillectomy in adult patients. Only half of patients ultimately required tonsillectomy because of a natural reduction in the number of episodes of tonsillitis with time. In order to avoid unnecessary tonsillectomy we need to find better prognosticators to identify the subgroup of adult patients likely to have continued recurrent tonsillitis.     

How to negotiate with your hospital

SUMMARY:: The orthopaedic trauma market place and career track have changed considerably over the last 10 years. There is an increasing demand from community hospitals for orthopaedic trauma. Understanding how to assess the practice opportunity and engage prospective employers is key to developing a successful and sustainable program and career. The article reviews the market place changes and how to approach negotiations. Lessons from other aspects of life and business are highlighted.     

Foreign body granulamatous reaction to endoluminal gas in pneumatosis intestinalis — a case report

Pneumatosis intestinalis is a rare condition occurs in a wide variety of patients, some of whom require urgent surgery, while others can be observed with resolution of symptoms and radiographic findings. Most often the need for surgery is intestinal obstruction. We report a case of pneumatosis intestinalis with an abdominal mass causing obstruction. The histological surprise and the rarity of the obstruction is highlighted in this case report.     

Mediastinoscopy as a therapeutic tool

Mediastinoscopy is a safe and effective diagnostic modality to obtain tissue specimens from the anterior mediastinum in most patient lymph node tissue. The technique can also be applied to remove other material from the mediastinum. We describe a case in which a bullet was retrieved from the mediastinum, lying very close to the innominate artery. Important differences in using the device for this purpose are highlighted.     

Hangman's fracture in a paediatric patient: considerations for anaesthesia

Cervical spine injuries are quite uncommon in children. When occurring, these lesions are of particular concern for the anaesthesiologist. This case refers to an hangman's fracture diagnosed in a four-month-old female infant, which probably occurred at birth. We describe the anaesthetic management adopted in this infant undergoing diagnostic procedures and conservative treatment. The problems related to airway control and the anaesthetic management utilized to diagnose and treat this unusual paediatric pathology are highlighted.     

Skin substitutes: An Indian perspective

There have been numerous alternatives developed to replace skin. These can either be permanent substitutes or temporary substitutes, which need to be replaced later by autologous grafts. These have been tried in recent times as an attempt to reduce the need or in the case of permanent substitutes ,altogether replace autologous skin grafts. However till date no ideal skin substitute has been developed. Various factors have to be considered while choosing one of these substitutes. In a developing country like India awareness and availability of these skin substitutes is not adequate considering the volume of cases that require this modality of treatment. Also there are skin substitutes developed in our country that need to be highlighted. This article is an attempt to review the vast array of skin substitutes that have been developed and consider their utility and feasibility for developing countries.KEY WORDS: India, permanent substitutes, skin substitutes, temporary substitute     

Pasteurella multocida meningo-encephalitis with aphasia in a young adult

We report the first case of Pasteurella multocida meningo-encephalitis with aphasia in a 28 year-old-patient. The investigations confirmed the diagnosis of bacterial meningitis. But the delay in identification of the organism involved iterative changes of antibiotherapy. The evolution was finally favourable with appropriate antibiotic treatment. The epidemiologic investigation highlighted the responsibility of a patient's cat carrying the same bacterial strain. Finally we discuss the epidemiologic, clinical and therapeutic features of this unusual meningitis.     

Aniline-induced methaemoglobinaemia in a glucose-6-phosphate dehydrogenase enzyme deficient patient

A case of methaemoglobinaemia following ingestion of an aniline-containing material is described. The detrimental effect of methylene blue, the classical antidote of methaemoglobinaemia, in a patient with glucose-6-phosphate dehydrogenase deficiency is highlighted.     

Case report: hand-assisted laparoscopic radical heminephrectomy for renal-cell carcinoma in a horseshoe kidney

A 63-year-old woman with an incidentally detected 10-cm enhancing renal mass in the left moiety of a horseshoe kidney was treated with a transperitoneal hand-assisted laparoscopic (HAL) radical heminephrectomy. The operative time was 273 minutes, and estimated blood loss was 250 mL. To our knowledge, this is the initial case of HAL radical heminephrectomy for renal-cell carcinoma in a horseshoe kidney. Appropriate pre-operative imaging and surgical technique for the isthmusectomy are highlighted.     

Fractures of the capitellum: a new method of fixation using a maxillofacial plate

Isolated capitellar fractures are rare, intraarticular fractures requiring an aggressive management regimen. Several treatment options have been described for the Type 1 fracture. A new technique of direct anatomic reduction and fixation of the fracture using a maxillofacial plate is reported. Advantages of this new technique are highlighted, and results with its use in treating patients of all ages are described.