IntroductionOn-table extubation (OTE) Viz., extubation of the patient in the operating room immediately (usually within 15 minutes) after surgery, is not uncommonly Abstract Background: 'On-table extubation' (OTE) is a simple, cost-effective method promising wider applicability. Most congenital cardiac corrective surgeries involve post operative ventilatory support that lead to ventilator associated complications and cost overuns in elective Congenital Cardiac Surgery (CCS). The objective of the study is to assess the feasibility and safety of OTE in patients undergoing for CCS. Patients and Methods: A retrospective study of 58 consecutive patient's case sheets who underwent elective CCS at KJ Hospital Chennai, India under the Needy little hearts of KJ Research Foundation from August 2005 to June 2009 was made. Outcomes measured included OTE rate, incidence of re-intubation morbidity and mortality. Results: 58 patients underwent elective CCS during the study period -43 Atrial Septal Defect (ASD), and, 11 Ventricular Septal Defect (VSD), 3 Combined Atrial and Ventricular Septal, (ASD&VSD) and 1 Ventricular Septal Defect with Double-Chamber Right Ventricle (VSD & DCRV). Median age was 12 yrs and medianweight was 12 kg. Patients underwent cardiopulmonary bypass; median bypass time was 40 minutes and median cross-clamp time 18.57 minutes. OTE was achieved in all 58 patients. Primary outcome was that no patient required re-intubation and ventilation. Secondary outcomes were 5 patients developed complications. One patient developed lower respiratory infection complicating pulmonary oedema. Five had superficial wound infection and one, had migraine. None of these complications could be attributed to OTE. There was no mortality.Conclusion: OTE is feasible in selected patients undergoing CCS in with excellent outcomes and acceptable morbidity. It should be considered as an option in appropriate treatment protocols. (Ind J Thorac Cardiovasc Surg 2010; 26: 5-10)

Complete transection of duodenum and partial transection of transverse colon following blunt injury abdomen and its clinical picture is often obscure and is extremely rare. High index of suspicion on the basis of mechanism of injury is important in early diagnosis. Early intervention in duodenal injuries have improved outcome and if it is more than 24 hours the mortality increased from 11 to 40%. The retroperitoneal location of the duodenum, its proximity to important abdominal structures and organs, its marginal blood supply, the biliary, pancreatic secretion drainage and diagnostic delay of its injuries cause therapeutic difficulties. All these factors create intraoperative dilemmas in the surgical management of duodenal injuries. The management of duodenal traumas remains controversial. We have discussed here a case of complete transection of duodenum and partial transection of transverse colon injury in blunt injury abdomen with the handle bar in a two wheeler accident. KEYWORDSDuodenal Injury, Blunt Injury Abdomen, Tension Free Primary Anastomosis.HOW TO CITE THIS ARTICLE: Subbiah P, Papu GS, Rajendran R, et al. Management of complete transection of duodenum and partial transection of transverse colon in blunt injury abdomen in a rural setup.

A case of giant cell tumour replacing the entire sternum for which total Sternectomy with B/L sternoclavicular joint excision was carried out. This procedure has been done for the first time in the literature. The clinical data are summarized and the surgical technique has been described. After Sternectomy the area of resection was reconstructed with stainless steel plates and screws, prolene mesh and poly methyl methacrylate which assured stability of the chest wall. We discussed the method of reconstruction, technical details and outcome of the procedure in terms of complications and the return of the preoperative level of function. KEYWORDSSternectomy, Giant Cell Tumour of Sternum, Sternal Tumours. HOW TO CITE THIS ARTICLE:Soundararajan JCB, Subbiah P, Rajendran R, et al. Total sternectomy with bilateral sternoclavicular joint excision for giant cell tumour sternum.

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Ganglioneuroblastoma is a neuroblastic tumour arising from primitive sympathetic ganglion cells. Neuroblastic tumours have a broad-spectrum of clinical behaviour from spontaneous regression to benign ganglioneuromas to metastatic dissemination. We present a case report of 2-year of girl who had a provisional diagnosis of an ovarian mass. Exploratory Laparotomy in a peripheral center revealed a retroperitoneal mass crossing the midline extending into the pelvis. She was unresectable and histopathology showed Ganglioneuroblastoma Stage III. She was managed with chemotherapy and repeat surgery for residual disease. Surgery remains the choice of treatment for neuroblastic tumours.