The authors describe the use of a 4D-CT angiogram to predict impending rupture in intact aneurysms, as a real-time, less invasive imaging technique. Histopathological verification and immunostaining of the bleb site performed on the study population reveals the significant predictive value of this tool. The point of maximum amplitude of pulsation of the aneurysm wall in unison with the RR interval of the electrocardiogram determines the potential rupture point. This helps in prioritizing the intervention for unruptured aneurysm cases, provides an effective screening of the high-risk population, and aids preoperative planning of clip application.

Background:Hypobaric spinal anesthesia is advantageous for unilateral lower extremity fractures as it obviates pain of lying on fractured limb for performing subarachnoid block.Aims:This study compares block characteristics and complications of three different baricities of constant dose intrathecal hypobaric levobupivacaine to determine an optimum baricity.Settings and Design:One-twenty American Society of Anesthesiologists Physical Status 1 and 2 patients aged 18–65 years undergoing unilateral lower limb surgeries were divided into three equal groups for this prospective cohort study.Materials and Methods:To 2 mL intrathecal 0.5% isobaric levobupivacaine (10 mg), 0.4 mL, 0.6 mL, and 0.8 mL of distilled water were added in Groups A, B, and C, respectively. Baricities of Groups A, B, and C are 0.999294, 0.998945, and 0.998806, respectively. Development of sensory and motor block was assessed by the pinprick method and Bromage scale, respectively. The total duration of analgesia and complications were noted.Statistical Analysis Used:Mean, standard error, one-way ANOVA, and Bonferroni were used to analyze quantitative variables; proportions and Chi-square tests for qualitative variables.Results:Demographic parameters, motor block of operated limb, and complications were comparable. Group C had the fastest onset of sensory block (10.10 min) and maximum duration of analgesia (478.97 min; P < 0.001); but high sensory levels in 48.7%. Group B had T10 sensory level in 92.5%; onset comparable to Group C (P = 0.248), and reasonable duration of analgesia (332.50 min). Group A had inadequate sensory levels, slow onset, and early regression.Conclusions:Group B (baricity - 0.998945) has better block characteristics among three groups compared.

Background: Interstitial lung disease (ILD) refers to a large group of diseases that causes scarring of lung tissue. Diagnosis of exact etiology of ILD is usually by clinico-radiologic-pathologic correlation. HRCT of Lung plays a crucial role in diagnosis of etiology of ILD & determining prognosis. Objective: To describe the HRCT findings in clinically suspected cases of ILD and to compare the role of HRCT with Chest X ray in diagnosis of ILD. Subjects and Methods: A descriptive study was conducted among 50 consecutive, consenting patients with clinical suspicion of interstitial lung disease. History and clinical details of all study participants were noted and first examined with chest radiography and then exposed to HRCT. The data thus collected was properly coded and entered in Microsoft Excel and analysis was done using the software SPSS version 16.0. Results: Mean age of the study population was 48.84 years (SD=14.46).60% of the study participants were males. Specific diagnoses could be made in 25.7% of abnormal case with radiograph and clinical correlation and in 57% with HRCT and clinical correlation. Most common pattern identified was reticular (60%) and most common anatomical area of involvement identified was lower lobe (54.28%). Most common etiology among the cases was idiopathic pulmonary fibrosis (20%) followed by sarcoidosis (11.4%). Conclusion: Idiopathic pulmonary fibrosis, sarcoidosis and Hypersensitivity pneumonitis along with non specific type were the most frequent types of ILD identified in the study. The current study demonstrates a better diagnostic efficacy for HRCT when compared to chest X ray in the evaluation of interstitial lung disease.

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BACKGROUNDThe goal of enteric anastomosis is to prevent leakage, to promote healing, to preserve bowel length, and to prevent stricture formation. An effective anastomosis requires adequate mobilization, perfusion, apposition, and inversion of the mucosal edges into the bowel lumen. METHODSAfter taking the institutional ethical committee approval for the study, the study was conducted at SVRRGG Hospital (a tertiary care centre of about 950 bed size), Tirupati. All patients were above 18 years and were admitted for undergoing gastrointestinal anastomoses electively. Patients who underwent gastrointestinal anastomoses as an emergency procedure in SVRRGG Hospital, Dept. of General Surgery, Tirupati from October 2017 to September 2018 were included in this study. RESULTSOut of the 60 cases in this study, 49 cases were done electively, and 11 cases were done on an emergency basis. The overall leak rate was 11.7%. The p-value is more than the significance level 0.05; the difference in leak rate between elective and emergency cases is not significant. CONCLUSIONSThis study is an attempt to evaluate various factors involved in bowel anastomotic leaks, various presentations of anastomotic leaks, and morbidity and mortality associated with them. With the observations and analysis, we concluded that various preoperative factors like haemoglobin %, nutritional status, serum albumin levels, intraoperative factors like degree of contamination, type of anastomosis and pathology involved have significant impact on outcome of bowel anastomosis.