SummaryA 3.5-year-old child developed a tight oesophageal stricture following ingestion of caustic soda. At the end of the fourth anaesthetic for oesophageal dilatation, laryngospasm and dificulty in mask ventilation was followed by cyanosis, bradycardia, and cardiac arrest. Chest X ray showed a large pneumopericardium, which was immediately aspirated, but unfortunately resuscitation was unsuccessful. It was presumed that during attempted manual ventilation of the lungs in the presence of a closed glottis, air had been accidentally forced into the pericardium through a small tear in the fragile oesophagus. Key wordsComplications; pneumopericardium, death. Gastrointestinal tract; oesophagus. Surgery ; oesophagoscopy.In children, oesophagoscopy is usually performed to dilate a stricture or to remove a foreign body. Perforation of the oesophagus, pneumomediastinum, mediastinitis, pneumothorax and surgical emphysema are some of the complications of this technique. We report the development of tension pneumopericardium in a child following oesophagoscopy under general anaesthesia.Case history A 3.5-year-old boy was brought to the emergency room with a history of ingestion of caustic soda (sodium hydroxide granules) which is extensively used as drain opener in Saudi Arabia. Clinical examination showed evidence of chemical burns in the oral cavity and marked oedema of the soft palate, with ulceration of the posterior pharyngeal wall. The rest of the systemic and biochemical examination was normal. X ray of the chest was also normal. The child was treated conservatively with intravenous fluids, antibiotics and hydrocortisone and was discharged after 4 days in hospital.Four weeks later the child was re-admitted with recurrent vomiting and refusing to eat or drink. On examination, he was markedly dehydrated and malnourished and there was dribbling of saliva which he was unable to swallow. Systemic examination and chest X ray was essentially normal. Barium swallow and examination showed extensive mucosal ulceration, oedema and narrowing of the lumen of the oesophagus. The pylorus was the size of a pin hole and the child underwent a pyloroplasty. During the subsequent visit upper gastro-intestinal endoscopy was performed under general anaesthesia. A tight stricture of 7-8 cm in length was noted, which started at 7cm from the central incisor and finished 2 cm from the oesophagogastric junction. The stricture was dilated gradually up to 1 1 mm (5, 7,9, 11 mm) using the Savory Gillard dilators and re-endoscopy confirmed adequate dilation. The child underwent three dilations under general anaesthesia at 2-3 week intervals without any complications.Twelve weeks after the initial admission the child was again brought to the hospital with increasing dysphagia, even to semi-solid food and fluids. A pre-operative assessment was done by a consultant anaesthetist. The family was informed about the possible complications and consent was obtained. He was a child of average height and body build (body weight 15 kg). He had no cough or na...

Bilateral thalamic haemorrhage is an unusual complication of burr hole drainage surgery. We present the case of a patient with this rare postoperative complication of bilateral thalamic haemorrhage following burr hole drainage of a chronic subdural hematoma.

BACKGROUND Trauma is one of the most common causes of death and lifelong disability in early decades of life, of which majority of cases are neurological trauma. TBI is becoming the most common and devastating problem due to exponential growth in population and increased vehicle use. Head injuries due to road traffic accidents (RTA) are the second most common cause of death, only next to cancer. The present study was observational, prospective study undertaken to evaluate the correlation between CT scan findings and level of consciousness in patients following acute craniocerebral trauma. The aim of this study is to correlate the CT scan findings and level of consciousness and to observe the outcome of the patient with single and multiple lesions. MATERIALS AND METHODS The study was conducted in Department of Neurosurgery, Krishna Medical College and Hospital. All the patients presenting to the hospital with history of head injury and admitted to Department of Neurosurgery were included as study population. Of all patients admitted with head injury and polytrauma, a careful history was collected from the patient and/or attendants to reveal the mechanism of injury and the severity of trauma. The patients were then assessed clinically to evaluate their general condition and the local injury. Glasgow coma scale, Glasgow outcome score and CT findings were evaluated. Statistical analysis-The statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 21 for Windows. RESULTS It was observed that majority of patients were in the age group of 21-40 years (55.65%) followed by 41-60 years (20%). The majority of patients were males (71.43%) and females were 28.57%. Patients had higher RTA incidences (72.40%) followed by fall (22.22%) and assault (5.38%). In the clinical findings, majority of patients presented with vomiting (67.20%) followed by loss of consciousness (38.74%). The other clinical presentation includes ENT bleeding (24.46%) and convulsion (18.34%). The history of alcohol consumed was given by 23.48% of patients. It was observed that majority of patients were having abnormal CT findings (80.74%) and only 19.26% patients had normal CT findings. The most common brain lesion among patients was cerebral contusion (46.74%) followed by subdural haematoma (22.11%), inter-parenchymal haematoma (12.34%), subarachnoid haemorrhage (14.17%), skull fractures (8.06%) and midline shift (30.28%). It was observed that majority of patients had mild injury (73.72%) followed by severe type (16.34%) and moderate injury among 174 (9.94%) patients. According to outcome of brain injury, the majority of patients had good recovery (73.89%). The death was observed among 198 (11.31%) patients. It was observed that epidural haematoma, subdural haematoma, inter-parenchymal haematoma, SAH and IVH showed statistically significant relation with level of consciousness, (p < 0.05). It was observed that pneumocephaly and midline shift showed statistically significant relation with level of consciousness (p ...

BACKGROUND Spontaneous intracerebral haemorrhage produces devastating neurological disability and is by far the most untreatable form of stroke. ICH is mainly managed medically. To date there are no studies to prove that surgery has better outcome in deep scatte red ICH than medical treatment alone. Stereotactic aspiration of haematoma and urokinase treatment is a minimally invasive method, which gives excellent radiological and good clinical outcome. This procedure is simple, less expensive and less invasive than formal craniotomy.

SummaryClinical findings, pharmacological control and the surgical treatment adopted in an unusual case of extranasal rhinosporidiosis without a nasal lesion is being presented.