Anshuman Darbari

Esophageal Injuries Due to Aluminum Phosphide Tablet Poisoning in India

Aluminum phosphide is a lethal systemic poison with 80%–90% mortality. Survivors have taken either a very small amount or the tablet had been exposed to air, rendering it less toxic, but often causing severe esophageal injuries. The presentation and treatment of 11 cases of esophageal injury due to aluminum phosphide are described. Ten patients had esophageal stricture, and 1 had tracheoesophageal fistula with stricture. Endoscopic bougie dilatation was sufficient in 7 patients, and surgical intervention was required in 4 who underwent definitive repair via gastric tube or feeding jejunostomy with a 2nd stage repair planned in 2. There was no mortality but significant morbidity. Mortality and morbidity might be prevented by withdrawing this pesticide from the market, making its sale difficult, or modifying the packaging.

Gastropleural fistula: rare entity with unusual etiology.

Gastropleural fistula is a rare condition. We report a case where fistula developed iatrogenically during repeated intercostal drainage tube insertions for empyema.

Hydatid Cyst of the Right Atrium: A Rare Presentation

Hydatid cyst of the heart is an uncommon lesion. Reported is the case of a 24-year-old female patient admitted with a history of chest pain and hemoptysis, and a mass lesion in the right atrium. Investigations and intraoperative intervention revealed the mass to be a hydatid cyst located in the right atrium, along with hydatid cysts of the liver and both lungs. The right atrial mass was successfully removed under cardiopulmonary bypass.

Pulmonary epithelioid hemangioendothelioma: A rare pulmonary tumor in differential diagnosis of bronchogenic carcinoma

37 of heterogeneous consistency, cystic in between and involving major fissure with both lobes of left lung without any pleural and vascular invasion. Left sided extra pericardial pneumonectomy was done. Postoperative course was uneventful and she was discharged after a week in satisfactory condition. Biopsy of specimen diagnosed it as epithelioid hemangioendothelioma of lung. Later, immuno-histochemistry was done for confirmation of the diagnosis, vascular tumor markers CD31 (CD = cluster of differentiationantigen class) and CD34 (CD = cluster of differentiationantigen class) were positive. Patient survived without any morbidity and is doing well so far (postoperative three years). Due to asymptomatic nature, no additional imaging modalities were done.

Unusual sternal mass: Adenocarcinoma with unknown primary site

We are reporting a case of sternal mass-histologically proven high-grade adenocarcinoma. Despite exhaustive investigations, no other primary site was detected. It was difficult to differentiate from metastasis or from primary skin adnexa, but whatever diagnosis is made, wide surgical excision with reconstruction is recommended for improvement of life quality.

Unusual complication of intercostal chest drainage insertion: Retained surgical blade in liver

Intercostal chest tube drainage or tube thoracostomy procedure is widely used by the medical, surgical and critical care specialists. Despite being relatively a minor procedure, devastating complications can occur owing to inadequate knowledge of thoracic anatomy, improper training and lack of experience. Iatrogenic or technical complications are however rare, but can often be life-threatening. Here, we are reporting a case of an accidentally retained surgical blade in the right lobe of liver during chest tube insertion for the management of post-traumatic right pneumothorax. To the best of our knowledge, this is the first ever case report of a retained surgical blade in the liver as a complication of tube thoracostomy procedure, which was later successfully removed using laparoscopy.

Very Important Person Syndrome: A Psychosocial Problem!

Dear Sir, All of us whether physicians or surgeons related to any medical field often get the privilege of treating very important persons (VIP). The VIP patients may be socially, politically, administratively, or even medically affluent persons. Being in the medical profession, one can’t discriminate people on grounds of sex, religion, income, or social group. But the problem arises when the patients or their caretakers start searching for the best available treatment, and in pursuit of the same they sometimes, knowingly or unknowingly, breach the trust of their physicians. Thus, this ‘pick and choose’ approach of the patient towards a physician creates a fracture in relation [1]. The deficit of trust also evolves when the physician treating such VIP persons receives multiple opinions about ailment and suggested line of treatment from those medical experts who are neither involved in the management of the patient at any stage nor have any idea about the ground realities. Doctors in big cities or in a multispecialty hospital generally offer such opinions just because the patient in question is an influential one, which does not seem to be justifiable [2]. In the midst of a variety of medical opinions and prevailing pressure of treating a VIP patient, the physician lands up in an environment that is very vulnerable and may jeopardize the medical management. If not addressed properly, this problem may also invite conflicts, litigations, and violent episodes as patients disagree with recommendations that the primary physician believes are in the patient’s best interest. This problem is mainly being faced in rural and semi-urban regions. Sometimes, this situation may arise due to a lack of interpersonal communication among the patients, attendants, their physicians, and members of the medical community, so it can all lead to strong feeling of disagreement [3]. I’m throwing this thought and raising the topic because this is an issue of significant psychological value for both the patients as well as the doctors and entails detailed deliberation. It’s a matter of debate that most of these types of patients lend in complication due to over enthusiastic treatment or get proper judicious management!