Trans-mediastinal herniation of lung is seen occasionally but herniation of bulla across the mediastinum is rare. We report two cases with trans-mediastinal herniation of bullae leading to an unusual line appearing near the mediastinum. We propose the name ‘Semilunar sign’for this radiological sign because of its resemblance to the half-moon shape.

2 cases of portal, splenic and superior mesenteric vein thromboses related to prolonged stay at high altitude are presented. Both presented initiaUy with innocuous appearing vague pain in abdomen with no physical signs. Later hepatosplenomegaly, and pleural effusion (left) was also detected. Diagnosis was based on CT scan and colour Doppler study showing thrombosed veins and porto-systemic coUateral. 1 patient developed a large splenic haernatoma requiring splenectomy. Both were managed with early anticoagulation and have done well in the short follow up. MJAFI 2001; 57: 158-160

An ocular defect can be due to many reasons such as congenital absence of an eye and acquired causes which occurs due to enucleation or exenteration procedure. Ocular defects requires urgent rehabilitation to prevent further changes and to prevent shrinkage. In this article we are going to describe a for fabrication of a prosthesis that should be light weighted (pneumatic) using a lost salt technique basically to reduce the weight of prosthesis for large socket, to overcome the worsening effects of conventional solid prosthesis.

INTRODUCTION: Acute fatty liver of pregnancy (AFLP) is a rare entity with high morbidity and mortality. We aim to review the 5 years data of patients with AFLP, presenting to a tertiary care hospital. METHODS: The Swansea criteria were used to diagnose AFLP. We collected data and analyzed it for demographic profile, clinical presentation, complications, obstetrical outcome and mortality. RESULTS: Twenty eight women attending the obstetrical emergency services were diagnosed with AFLP from 2014 to 2018. The mean age was 25.7+/- 4.1 years. Most women were multigravidas and the median gestational age was 35 weeks (range 31-40 weeks). Of the women who delivered, 19/28 (67%) had male fetuses. The commonest initial presenting symptoms included jaundice and vomiting. The average median Swansea score was 7 (range 6-9). The median duration of illness before admission was 4 days. Most women underwent a torment course of disease. There were fifteen deaths. The commonest causes of death were sepsis, acute kidney injury and multiorgan dysfunction. Other contributory factors of mortality were coagulopathy, liver failure, encephalopathy, acidosis, acute respiratory distress syndrome and pancreatitis. Hypertension was observed in half (14/28) of the patients. All patients required transfusion of blood products and ICU care. Nineteen women had vaginal delivery while seven underwent caesarean section. Hemorrhage was noted in 20 (71%) as postpartum bleeding, vaginal and abdominal hematomas and urinary tract bleed. CONCLUSION: AFLP is a rare obstetrical cause of acute liver failure with high maternal morbidity and mortality. Sepsis, acute kidney injury and hemorrhage are the important contributory causes of death.

Eighty female patients in the age group of 20-40 years, weighing 40 ± 15 Kg, in ASA physical status I and II, awaiting either elective or emergency caesarean delivery were selected for this study. Patients with cardiovascular disorders and those with significant systemic ailments were excluded from the study. They were randomly divided into two equal groups of 40 patients each. Group I was subdivided randomly into two equal sub-groups (1A and 1B) of 20 patients each and was selected for administration of epidural narcotics. Patients in sub-group 1A were given epidural morphine in the dose of 3-5 mg and those in subgroup 1B were given buprenorphine in the dose of 0.1-0.15 mg. Group II consisting of 40 patients, were again subdivided randomly into two equal subgroups (2A and 2B) of 20 patients each and were selected for administration of parenteral (intravenous) narcotics. Patients in subgroup 2A were given morphine in the dose of 5-7.5 mg I.V., and those in subgroup 2B were given 0.15-0.3 mg of buprenorphine intravenously. The degree of pain relief was assessed by applying numerical rating scale (NRS) and resulting complications were observed and recorded. It was found that 60-80% of patients with epidural narcotics, with various dosage schedules, experienced good to excellent analgesia as compared to 30-40% of patients with parenteral use of narcotics.