Tracheoesophageal fistula (TEF) in adults occurs as a result of trauma, malignancy, cuff-induced tracheal necrosis from prolonged mechanical ventilation, traumatic endotracheal intubation, foreign body ingestion, prolonged presence of rigid nasogastric tube, and surgical complication. Anesthetic management for repair of TEF is a challenge. Challenges include difficulties in oxygenation or ventilation resulting from placement of endotracheal tube in or above the fistula; large fistula defect causing loss of tidal volume with subsequent gastric dilatation, atelactasis, and maintenance of one lung ventilation. The most common cause of acquired nonmalignant TEF is postintubation fistula, which develops after prolonged intubation for ventilatory support. Acquired TEF, which occurs after prolonged intubation, usually develops after 12–200 days of mechanical ventilation, with a mean of 42 days. We present a rare case of TEF that developed after 7 days of intubation. It was a difficult case to be diagnosed as patient had a history of polytrauma, followed by emergency intubation and both these conditions can contribute to tracheobronchial injury.

Background: To analyze the role of Computed Tomography in the evaluation of proptosis. Methods: It is a retrospective review of 30 patients with the history of proptosis who were referred to the department of radiology and imaging for computed tomography of orbit. Computed tomography of orbits was evaluated to assess the nature and extension of the lesion. Final diagnosis was made based on the histopathology, operative findings and clinical outcome. Statistical analysis was carried out with the help of SPSS - 17 to find the accuracy of Computed Tomography. Results: Thirty patients ranging from three to 73 years were included in the study. Mean age was 35.4±19.6 years. Male:Female ratio was 2:1. Most common cause of proptosis was inflammation (47%) followed by tumor. Among the inflammatory causes pseudotumor was the most common type. Other causes of proptosis include tumor (37%), Vascular (10%), Infection (3%) and Trauma (3%). Accuracy of Computed Tomography in the diagnosis of etiology of proptosis was 86.6%. Conclusion: Computed tomography is the simple, cost effective technique in the evaluation of proptosis with the accuracy of 86.6%. Inflammation was the most common cause of proptosis. Nepal Journal of Medical Sciences | Volume 02 | Number 01 | Jan-Jun 2013 | Page 34-37 DOI: http://dx.doi.org/10.3126/njms.v2i1.7649

Introduction: Upper Gastro-intestinal endoscopy is considered the best screening tool for varices in cirrhotic patients. It is still an expensive, invasive tool, has poor compliance and not routinely available in every hospitals in Nepal. This study was undertaken to establish the role of portal vein diameter and spleen size by ultrasonography in predicting gastroesophageal varices.

BackgroundGanglioneuroblastoma is a tumor of peripheral neuroblastic tissue which occurs predominantly in the pediatric age group; it is a rare occurrence in the newborn period with only one case reported at birth to date.Case presentationWe report the case of a newborn male baby of Brahmin ethnicity from Nepal who presented with respiratory distress and blueberry muffin skin lesions after birth. A computed tomography scan showed a mass lesion in the posterior mediastinum, which was diagnosed as ganglioneuroblastoma on fine-needle aspiration cytology. He also had metastases to multiple sites including heart, lungs, skin and brain.ConclusionsGanglioneuroblastoma is a rare tumor in newborns. Any newborn presenting with respiratory distress associated with blueberry muffin skin lesions should be evaluated for neuroblastic tumor.