Florid reactive periostitis is a pronounced periosteal reaction, usually affecting the hands and feet, for which there is no obvious cause. It is rare in children and in long bones. We report an unusual case of florid reactive periostitis in a ten-year-old girl that involved both bones of the forearm. The lesion resolved over a period of one year, leaving a residual exostosis. She developed a physeal bar in the distal ulna in the region of the lesion at one-year follow-up. This was thought to be a complication of the biopsy procedure and was treated by resection and proximal ulnar lengthening.

Angioleiomyomas are infrequent benign tumors originating from smooth muscle cells of arterial or venous walls. They are most commonly seen in the lower extremities with a prevalence of only 8.5% in the head and neck. We present the case of a 40-year-old male patient who presented to Christian Medical College, Vellore, India, with recurrent episodes of right-sided epistaxis. A computed tomography scan showed an enlarged right inferior turbinate filling the right nasal cavity. The mass was removed endoscopically and sent to pathology. A diagnosis of angioleiomyoma of the nasal cavity was made. This location that has only been described in a minority of cases in the literature. Our case report signifies the importance of maintaining a broad differential when dealing with patients presenting with nasal mass and the importance of histopathological examination for the diagnosis.

Positive airway pressure therapy is usually a well tolerated mode of treatment used for managing patients with various diseases where either oxygenation or ventilation is compromised. Air regurgitation through the naso lacrimal duct (NLD) is a rare complication of positive airway pressure therapy. There are multiple valves in the nasolacrimal duct to prevent the retrograde airflow from the nasal cavity to the lacrimal sac, under normal physiological conditions. Failure of this multi level valve system will lead to the retrograde air flow from the nasal cavity to reach the lacrimal puncta via the nasolacrimal duct. Valve insufficiency by birth or due to a prior procedure done at this region could be the underlying cause for this complication. In this case report, we discuss about the appearance of air regurgitation in a patient with chronic obstructive pulmonary disease on bi-level positive airway pressure (BiPAP) therapy and we also discuss on the causes for this complication and the various treatment modalities to manage this condition.

Background: About 20% to 67% of COVID 19 infected patients who are admitted to the hospitals and 100% of mechanically ventilated patients suffer from acute respiratory distress syndrome. Extrinsic positive expiratory pressure (PEP) can improve oxygenation by direct and indirect mechanisms, thus reducing the need of medical oxygen. But high-budget and sophisticated machines are required to provide this positive airway pressure, adding on to the treatment cost of the patient and investment expenditure by the health-care facilities. We have designed a simple self-working device called self-working water-based instrument for positive expiratory pressure by resistance (SWIPER) device which can provide a PEP. The objective of this study was to assess the effectiveness of this device in improving oxygenation in patients with acute pulmonary edema, which was quantified using pulse oximetry. Methods: Patients who were admitted to the medical intensive care unit during the study period, with an acute pulmonary edema-a diagnosis which was made clinico-radiologically, were chosen as the subjects for the study. Once the patients were critically stabilized by the already existing treatment protocols, the SWIPER device was applied. Results: The device was introduced on 15 patients who were selected after applying the inclusion-exclusion criteria of the study. The mean age of the study group was 65 years (men-64 years, Women-66 years). Eight of them had cardiogenic pulmonary edema whereas seven of them had nephrogenic pulmonary edema. The median baseline SpO2level was 90% (86%, 94%) and the median plateau SpO2level after using the SWIPER device was 94% (91%, 99%) (*P < 0.001). The mean rise in SpO2on using the device was 6% (1.89) which was clinically significant. Conclusion: SWIPER device is effective in significantly increasing the SpO2 in patients with acute pulmonary edema by providing a PEP. This device is not a replacement for the existing positive airway pressure-providing electrical devices. However, SWIPER devices will definitely come in handy in resource-limited settings in providing better treatment and care till the standard therapeutic measures are obtained. It will also help in significantly reducing the medical oxygen consumption in managing such patients.

Patients: Eleven patients from 16 to 72 years old, with adnexal cysts palpable above the umbilical scar. All patients complained of increased abdominal volume and/or pain, and were referred and operated by the Gynecologic Laparoscopic Group. Intervention: Laparoscopic approach of the giant cysts using a direct insertion of an umbilical trocar into the cyst and aspiration of all its contents, with no or minimal cyst fluid's spillage. Measurements and Main Results: All surgeries started with the direct insertion of an 11-mm umbilical trocar into the cyst and aspiration of its content. The largest diameter of the cysts ranged from 20 to 37,5cm (mean 28,5cm), and they were removed either through the umbilical incision or a colpotomy. The mean surgical time was 85 minutes (60 to 120 minutes) and all procedures were carried out through the laparoscopic approach with no major complications. Conclusion:The laparoscopic approach of giant adnexal cysts is a safe procedure, and should be considered as the first option in patients with low risk of malignancy. Open Communications 17dLaparoscopy(4:32 PM d 4:37 PM)