Introduction: The endoscopically harvested vein from thigh usually falls short by half to one length in patients requiring multiple conduits. Increased risk of complications precludes routine endoscopic vein harvest from the leg and an extra incision for open technique is often required thereby nullifying the sole purpose of the former. We employed the endoscope to harvest this extra length of vein from the upper half of the leg with little or no extra risk. Methods: From January 2006 to September 2006 we endoscopically harvested the vein in thigh as well as the leg using the same entry point incision over the medial epicondyle in 40 cases. The only exclusion criterion for the study was a superficial location and subcutaneous visibility of the vein in the leg. We made 3 incisions in each patient of average size 2. 5 cm. Results: Five patients required conversion to the open technique. The average harvest time was 59 minutes. Average length of the conduit was 48 cms. Complications included 1 minor wound infection, 1 case of superficial wound dehiscence, 1 haematoma requiring aspiration and minor erythema at the incision site in 2 patients. Most common complication observed was ecchymosis in 6 patients (5 thigh; 3 leg). None of the patient developed lymphoedema and none required re-hospitalization for vein harvest related wound complications. Conclusion: "Extended endoscopic vein harvest" and avoidance of the open incision was possible in most patients with no additional risk and that the procedure could be routinely employed in patients requiring multiple conduits. (Ind J Thorac Cardiovasc Surg, 2007; 23: 125-127)

Hernias are amongst the oldest afflictions of mankind. The tension-free mesh repairs revolutionized and radically changed the whole concept of anatomical tissue repairs. The introduction of mesh, though beneficial, posed a new set of postoperative problems with the mesh infection being the most morbid one. Laparoscopic surgery has been able to reduce the incidence of mesh infection as opposed to the open hernia repairs. The infection occurs mostly early but rarely does it present several years after the surgery. Herein we report our case of delayed mesh infection developing 6 years postoperatively. This is our first such case in a series of more than 1000 laparoscopic hernia repairs over a period of 6 years (2010-2016). The patient needed an open exploration which revealed a large preperitoneal cavity containing 770 ml of pus with a mesh floating in it. The mesh was removed and the thorough toileting of the wound was done.

Aims Baseline elevated B-type Natriuretic Peptide (BNP) has been found in high altitude pulmonary edema susceptible population. Exaggerated pulmonary vascular response to hypoxia may be related to endothelial dysfunction in hypoxia susceptible. We hypothesize that baseline BNP levels can predict hypoxia susceptibility in healthy individuals. Main methods The pulmonary vascular response to hypoxia was compared in 35 male healthy individuals divided into two groups based on BNP levels (Group 1 ≤ 15 and Group 2 > 15 pg/ml). Acute normobaric hypoxia was administered to both the groups, to confirm hypoxia susceptibility in Group 2. Key findings Unlike Group 1, Group 2 had elevated post hypoxia BNP levels (26 vs 33.5 pg/ml, p = 0.002) while pulmonary artery pressure was comparable. A negative correlation with tissue oxygen consumption (delta pO 2 ) and compartmental fluid shift was seen in Group 1 only. Endothelial dysfunction in Group 2 resulted in reduced vascular compliance leading to elevation of mean blood pressure on acute hypoxia exposure. BNP showed a positive correlation with endothelial dysfunction in Group 2 and has been linked to pre-diabetic disorder (HbA1c 6 ± 0.44%) and may additionally represent a lower cross-sectional area of vascular bed related to vascular remodeling mediated by chronic hypoxia. Significance Hypoxia susceptibility in healthy individuals may be related to endothelial dysfunction that limits vascular compliance during hypoxic stress. BNP level showed positive correlation with HbA1c ( r = 0.49, p = 0.04) and negative correlation with delta pO 2 ( r = −0.52, p = 0.04) can predict reduced microvascular compliance due to endothelial dysfunction contributing to hypoxia susceptibility in healthy individuals. BNP levels≤15 pg/ml at sea level is indicative of hypoxia resistance.

Salmonella enterica serovar Weltevreden is not a commonly isolated serotype in India. We report isolation of Salmonella Weltevreden, from an unusual site-an ulcer on the gluteal region of a patient who had undergone coronary artery bypass surgery. To our knowledge, Salmonellae have never been reported to cause isolated ulcerative lesions on the skin. This is the first report of an isolated ulcerative lesion on the skin caused by Salmonella Weltevreden. Our findings indicate that there may be modes of pathogenesis of Salmonella infections that we are yet unaware of. Further work and extensive reporting of all Salmonella infections are necessary to elucidate these mechanisms.

Laparoscopic cholecystectomy has traditionally been performed under general anaesthesia, regional anaesthetic techniques like spinal and epidural anaesthesia has emerged as a more suitable alternative for the minimally invasive laparoscopic cholecystectomy. We conducted a clinical study comparing levobupivacaine with clonidine and a combination of levobupivacaine with dexmedetomidine in thoracic epidural anaesthesia for laparoscopic cholecystectomy as sole anaesthetic. MATERIAL AND METHODSAfter taking approval from Institutional Ethical Committee, 100 adult patients of ASA grade I and II were divided into two groups; Group 1 where levobupivacaine 0.5% (2mg/kg) with 1.5µg/kg clonidine was given and in Group 2 levobupivacaine 0.5% (2mg/kg) with 0.5μg/kg of dexmedetomidine. Thoracic epidural was given at the T10-T11 interspace to obtain a sensory block of T4-L2 dermatome, which was judged every minute by pinprick method till complete sensory block was established. Hemodynamic parameters like heart rate, non-invasive blood pressure, electrocardiogram, oxygen saturation were monitored and readings were recorded initially then at every 5 mins after administration of drug intraoperatively. RESULTDuration of block was longer in group 2 patients, onset of block was comparable in both the groups. Also fall in blood pressure and heart rate was greater in group 2 patients. Less incidence of shoulder pain was found in group 2 patients. Oxygen saturation (Spo2) was comparable in both the groups and no respiratory distress was seen. More post-operative analgesia was required in group 1. Also no complications were seen postoperatively in both the groups. CONCLUSIONLevobupivacaine with dexmedetomidine provides better anaesthesia than levobupivacaine with clonidine in thoracic epidural for laparoscopic cholecystectomy.