Antrochoanal polyp — Validating its origin and management by endonasal endoscopic sinus surgery (eess)

Aim and Objectives: 20 fresh cases of Antrochoanal Polyps were subjected to EESS for studying the site of origin and to validate its efficacy. Study Design: This was a prospective study in which the cases were subjected to surgery and were followed; up for evaluation of results. Methods: The surgery performed was an endoscopic endonasal sinus surgery preceded and followed by transcanne sinuscopy. Results/Findigs: The age at the time of presentation ranged from 7-35 years. Male to female ratio was 1:1:5. Occurrence Antrochoanal Polyp was 1.5 times more common on the left side. The mean duration of symptoms was 3 years. The main presenting symptom was unilateral nasal obstruction in 100% of cases. Allergic symtomps.were noticed in 10%. Vasmotor symptom were present in 15% of the patients. Antroscopy revealed the antral part.to be cytic in 100% of the cases. The site of origin of the polyp could be ascertained in only 12 out of 20 cases; in 7 of them it acrose from the infrolateral wall of maxillary sinus, in 2 from the infromedial wall und in 2 it appeared to arise from the supromedial wall while in 1 from margin of the ostium. Post-surgery intra-natral remnants were found in 3 out of 20 cases i.e. in 15% of them. In two cases it was removed through maxillary ostia but in one case removed through transcanine route. Conclusions: Endoscopic Sinus Surgery is the best modality of treating Antrochoanal Polyps. We report a success rate of 95% in our series.     

Pediatric Scrub typhus in Indian Himalayas

To retrospectively confirm the suspected rickettsial disease (Scrub typhus) using a gold standard diagnostic test i.e. microimmunofluorescence in pediatric patients with acute febrile illness of unknown etiology. Two serological tests, Weil-Felix and Microimmunofluorescence were used to confirm infection. All five children had fever, vomiting and generalized lymphadenopathy, but none had eschar or rash. One was cured with doxycycline, remaining four patients treated with azithromycin and one died despite treatment. Scrub typhus is a cause of fever of unknown origin in Himalayan region of India and azithromycin is an effective alternative to doxycycline in treating this disease.     

Impact of annual immunisation programme with oral polio vaccine on the prevalence of paralytic poliomyelitis

Lameness survey was conducted in a rural community development block of Haryana in 1985. Enumerators contacted school teachers, anganwadi workers and several key informants in the community to identify lame children in 1–11 years agegroup. Physician verified 219 lame cases to be due to poliomyelitis. Prevalence of poliomyelitis lameness was 7.3/ 1000 children born in 1974–76, 7.7/1000 children born in 1977–1980 and 2.3/1000 children born in 1981–1984 (expected to increase to 3.1/1000 when all children born in 1981–84 cross 5th year of life). Immmunisation coverage with 3 doses of oral polio vaccine (OPV) was less than 10% during 1974–80 when immunisation was a clinic based activity. Coverages increased from 50 to 80% during 1981–85 when OPV was given in annual immunisation campaign. The results indicate that prevalence of paralytic poliomyelitis dropped at least by 60% after giving OPV in annual immunisation campaigns.     

Long-term hypoxia alters endocrine and physiologic responses to umbilical cord occlusion in the ovine fetus

OBJECTIVE: This study was designed to determine the effect of umbilical cord occlusion (UCO) on fetal endocrine responses in the long-term hypoxemic (LTH) ovine fetus. METHODS: Pregnant ewes were maintained at high altitude (3820 m) from day 30 of gestation. Normoxic control and LTH fetuses were catheterized, and an inflatable occluder was placed on the umbilical cord at day 132 of gestation. In the LTH group, maternal oxygen tension was maintained at approximately 60 mmHg by nitrogen infusion through a maternal tracheal catheter. On day 137, two 5-minute UCOs were performed. On day 139, the study was repeated with a 10-minute UCO. RESULTS: Basal adrenocorticotropic hormone (ACTH) levels and peak responses to the first 5-minute UCO were not different between control and LTH fetuses (17.6 +/- 4.0 to 418.8 +/- 41.3 in controls, 25.7 +/- 4.0 to 530.0 +/- 93.0 pg/mL in LTH fetuses). A similar pattern was observed during the second UCO. Basal cortisol levels were similar in both groups. In response to UCO, a significant increase in cortisol was observed in both groups, but peak concentrations in the LTH group were significantly higher than those in the control group (23.9 +/- 4.8 versus 14.8 +/- 2.9 ng/mL, respectively, P <.05). The second occlusion also increased cortisol concentrations, but no differences were observed between groups. After the 10-minute UCO, the ACTH and cortisol responses were similar to the first 5-minute occlusion, with higher cortisol levels in the LTH fetuses. CONCLUSION: Despite similar ACTH responses to UCO, the cortisol response was greater in the LTH fetuses than in normoxic controls. LTH appears to result in enhanced adrenal sensitivity to a secondary stressor or altered cortisol metabolism.     

Radiofrequency ablation of incessant orthodromic tachycardia in a young child with a univentricular heart

The incidence of supraventricular tachycardia is high in infants and children with congenital heart disease. We report a case of incessant orthodromic tachycardia in a child with a univentricular heart, which was successfully treated with radiofrequency ablation.     

The Cost of Complications Following Major Resection of Malignant Neoplasia

Background

Rising healthcare costs have led to increased focus on the need to achieve a higher “value of care.” As value-maximization efforts expand to include more complex surgical patients, evidence to support meaningful implementation of complication-based initiatives is lacking. The objective of this study was to compare incremental costs of complications following major gastrointestinal (GI) resections for organ-specific malignant neoplasia using nationally representative data.

Methods

National (Nationwide) Inpatient Sample data, 2001–2014, were queried for adult (≥?18 years) patients undergoing major resections for malignant neoplasia. Based on system-based complications considered relevant to the long-term treatment of GI disease, stratified differences in risk-adjusted incremental hospital costs and complication probabilities were compared. Differences in surgical outcomes and costs over time were also assessed.

Results

A total of 293,967 patients were included, weighted to represent 1,408,117 patients nationwide. One fourth (26.1%; 95% CI, 25.7–26.4%) experienced ≥?1 pre-discharge complication (range, 45.3% esophagectomy to 24.0% rectal resection). Resultant annual risk-adjusted incremental hospital costs totaled $540 million nationwide (19.5% of the overall cost of care and an average of $20,900 per patient). Costs varied substantially with both cancer/resection type and complication group, ranging from $76.7 million for colectomies with infectious complications to $0.2 million for rectal resections with urinary complications. For each resection type, infectious ($154.7 million), GI ($85.5 million), and pulmonary ($77.9 million) complications were among the most significant drivers of increased hospital cost.

Conclusions

Quantifying and comparing the impact of complications on an indication-specific level in more complex patients offers an important step toward allowing providers/payers to meaningfully prioritize the design of novel and adaptation of existing value-maximization approaches.