Pseudoaneurysm of profunda femoris artery following dynamic hip screw fixation for intertrochanteric femoral fracture

Dynamic hip screw fixation is a commonly performed procedure for internal fixation of intertrochanteric femoral fractures.Arterial injury following the operative fixation is a rare but serious event.We...     

Assessing the efficacy of video versus direct laryngoscopy through retrospective comparison of 436 emergency intubation cases

Video laryngoscopy has become a common practice for tracheal intubations. However, information on its efficacy in emergency intubations is minimal. The external video monitor may act as a means for assistance by present staff, heighten teaching ability, and improve intubation outcomes. We conducted a retrospective review consisting of 436 patients requiring emergency intubation outside the operating room to evaluate the application of a C-MAC video laryngoscope for emergency intubation(s). Nine cases were removed, 315 underwent direct laryngoscopy, 73 underwent video laryngoscopy, and 39 underwent both methods. The C-MAC laryngoscope provided a significantly better visualization of the glottis (p = 0.02). The C-MAC also provided successful intubation on the first attempt in 82 % of the 39 direct laryngoscopy cases subsequently intubated with the C-MAC. The presence of the attending anesthesiologist (while the resident intubates) had no effect on complication rates; the number of attempts required and the grade view obtained were nonsignificant (p = 0.91 and p = 0.34, respectively). Overall, use of the C-MAC video laryngoscope provided a better view of the airway structures during an emergency intubation. The success of the C-MAC laryngoscope in intubation after failed direct laryngoscopy suggests the importance of the video laryngoscope as the primary intubation approach during an emergency intubation.     

Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy

Background

Prolonged operative duration is associated with increased postoperative morbidity and mortality. Although laparoscopic colectomy (LC) is associated with longer operative duration compared with open colectomy (OC), research shows paradoxically decreased morbidity following LC versus OC. The direct impact of operative duration on postoperative pulmonary complications (PPC) following LC versus OC has not been analyzed.

Methods

We queried the ACS/NSQIP 2009-2010 Public Use File for patients who underwent elective LC and OC. The associations between operative duration and a PPC (pneumonia, intubation >48 h, and unplanned intubation) were evaluated. Multivariable regression models were created to determine the independent effect of operative time on the development of PPC controlling for LC versus OC.

Results

A total of 25,419 colectomies (13,741 laparoscopic and 11,678 open) were reviewed; 765 (3 %) patients experienced at least one PPC. Regression modeling demonstrated that for both LC and OC each 60-min increase in operative time up to 480 min was associated with 13 % increased odds of PPC [odds ratio (OR) 1.13; 95 % confidence interval (CI) 1.07–1.19]. Beyond 480 min, each additional 60-min interval was associated with 33 % increased risk of PPC (OR 1.33; 95 % CI 1.12–1.58). Overall, PPCs occurred half as often following LC [270 (2 %) laparoscopic vs. 497 (4.3 %) open; OR 0.45; 95 % CI 0.39–0.53].

Conclusions

Operative duration is independently associated with increased risk of PPC in patients undergoing LC and OC. However, a laparoscopic approach carries half the absolute risk of PPC and, when safe, should be preferentially utilized despite a potential for prolonged operative duration.     

Crouzon syndrome--A case report

Crouzon syndrome is a genetic disorder also known as branchial arch syndrome. Specifically, this syndrome affects the first branchial (or pharyngeal) arch, the precursor of the maxilla and mandible. Since the branchial arches are important developmental features in a growing embryo, disturbances in their development create lasting and widespread effects. Previously referred to as craniofacial dysostosis, the disorder is characterized by a number of clinical features; to date, it has no known single, initiating defect to account for all its characteristics. This article presents a case report of a 10-year-old boy with classical skeletal and soft tissue features of Crouzon syndrome.     

Synthesis of primaquine glyco‐conjugates as potential tissue schizontocidal antimalarial agents

Primaquine ( PQ ) is the only drug used to prevent relapse of malaria due to P. vivax and P. ovale, by eradicating the dormant liver form of the parasite (hypnozoites). The side‐effects associated with PQ limits is uses in treatment of malaria. To overcome the premature oxidative deamination and to increase the life span of drug in the biological system, the novel glyco‐conjugates of PQ were synthesized by coupling of primaquine with hexoses in phosphate buffer. The saccharide part of the hybrid molecules thought to direct the drug to the liver, where hypnozoites resides. All the synthesized compounds were fully characterized and evaluated for their radical curative activities. The three compounds viz glucoside ( 15a ), galactoside ( 15b ) and mannoside ( 15c ) with high activity were tested for their activity in rhesus monkeys where the most active compound 15b showed twofold activity (100% radical curative activity at 1.92 mmol/kg) than the standard drug PQ diphosphate (3.861 mmol/kg). It is proposed that results from these studies may be advantageous to develop a new potent tissue schizonticide antimalarial compound.     

Phenotype of dent disease in a cohort of Indian children

Objective

To describe the clinical and genotypic features of Dent disease in children diagnosed at our center over a period of 10 years.

Design

Case series.

Setting

Pediatric Nephrology Clinic at a referral center in Northern India.

Methods

The medical records of patients with Dent disease diagnosed and followed up at this hospital from June 2005 to April 2015 were reviewed. The diagnosis of Dent disease was based on presence of all three of the following: (i) low molecular weight proteinuria, (ii) hypercalciuria and (iii) one of the following: nephrolithiasis, hematuria, hypophosphatemia or renal insufficiency, with or without mutation in CLCN5 or OCRL1 genes.

Results

The phenotype in 18 patients diagnosed with Dent disease during this period was characterized by early age at onset (median 1.8 y), and polyuria, polydipsia, salt craving, hypophosphatemic rickets and night blindness. Rickets was associated with severe deformities, fractures or loss of ambulation in six patients. Nephrocalcinosis was present in three patients, while none had nephrolithiasis. Generalized aminoaciduria was seen in 13 patients, two had glucosuria alone, and one had features of Fanconi syndrome. Over a median follow up of 2.7 years, one patient developed renal failure. Genetic testing (n=15) revealed 5 missense mutations and 3 nonsense mutations in CLCN5 in 13 patients. Five of these variations (p.Met504Lys, p.Trp58Cys, p.Leu729X, p.Glu527Gln and p.Gly57Arg) have not been reported outside the Indian subcontinent.

Conclusion

Our findings suggest a severe phenotype in a cohort of Indian patients with Dent disease.