Phrenic Nerve Palsy in Severe Tetanus

Unilateral or bilateral raised hemidiaphragms were observed on chest X-ray in three patients with severe tetanus. Diaphragmatic movement was absent on ultrasonography and fluoroscopy. Nerve conduction study confirmed phrenic nerve palsy. Bilateral involvement caused delayed weaning from the ventilator, whereas unilateral involvement was asymptomatic. There was complete recovery from phrenic nerve palsy in all patients.

THE MIDLATITUDE CONTINENTAL CONVECTIVE CLOUDS EXPERIMENT (MC3E)

The Midlatitude Continental Convective Clouds Experiment (MC3E), a field program jointly led by the U.S. Department of Energy’s Atmospheric Radiation Measurement (ARM) Program and the National Aeronautics and Space Administration’s (NASA) Global Precipitation Measurement (GPM) mission, was conducted in south-central Oklahoma during April–May 2011. MC3E science objectives were motivated by the need to improve our understanding of midlatitude continental convective cloud system life cycles, microphysics, and GPM precipitation retrieval algorithms. To achieve these objectives, a multiscale surface- and aircraft-based in situ and remote sensing observing strategy was employed. A variety of cloud and precipitation events were sampled during MC3E, of which results from three deep convective events are highlighted. Vertical structure, air motions, precipitation drop size distributions, and ice properties were retrieved from multiwavelength radar, profiler, and aircraft observations for a mesoscale convective system (MCS) on 11 May. Aircraft observations for another MCS observed on 20 May were used to test agreement between observed radar reflectivities and those calculated with forward-modeled reflectivity and microwave brightness temperatures using in situ particle size distributions and ice water content. Multiplatform observations of a supercell that occurred on 23 May allowed for an integrated analysis of kinematic and microphysical interactions. A core updraft of 25 m s−1 supported growth of hail and large raindrops. Data collected during the MC3E campaign are being used in a number of current and ongoing research projects and are available through the ARM and NASA data archives.

Morphometry and variations of the human suprascapular notch

AIM

The present study proposes a simple method to study variations in shape and dimensions of suprascapular notch, to classify different types and subtypes of notch and to measure the thickness of superior transverse scapular bar (ossified superior transverse ligament of scapula).

MATERIAL AND METHODS

Seven hundred and twenty-eight dried scapulae were observed, examined and studied in detail. Scapulae with suprascapular notch, with suprascapular foramen having varying degree of ossification in the form of transverse scapular bar were included in the present study. Measurements of suprascapular notch and superior transverse scapular bar were taken with the help of digital vernier calliper and recorded in millimetres. The superior transverse diameter, inferior transverse diameter, depth, maximum thickness of suprascapular notch and thickness at lateral and medial end of transverse scapular bar, mean thickness of superior transverse scapular bar were recorded. The data was analyzed statistically.

OBSERVATIONS AND RESULTS

We observed five types of notch in scapulae, type I: without a discrete notch (ill defined), 25 (3.43%); type II: a "V" shaped notch, 192 (26.37%); type III: "U" shaped notch, 383 (52.60%); type IV: inverted "V" shaped notch, 28 (3.84%); type V with absent suprascapular notch: 6 (0.82%). Type II and type III were again subclassified into subtypes (a, b, c and d) on the basis of depth of notch. Scapulae with superior transverse scapular bar (n=94, 12.91%) were classified according to variation in mean thickness of transverse scapular bar (MTSB).

CONCLUSION

This study will help clinicians to correlate suprascapular nerve entrapment with a specific type of suprascapular notch and notch with ossified transverse scapular ligament.

Role of tracheostomy in the management of foreign body airway obstruction in children

INTRODUCTION

Foreign body aspiration in the airway of children is a life-threatening clinical situation. Endoscopic retrieval alone is successful in the majority of patients. Occasionally, open surgical intervention in the form of tracheostomy, thoracotomy and bronchotomy and/or pulmonary resection is needed. We analysed the specific indications for tracheostomy during the removal of airway foreign bodies in our study.

METHODS

The records of four patients who needed tracheostomy, out of 342 cases of foreign body airway obstruction managed by the senior author, were analysed. These patients underwent an additional tracheostomy for open removal of the foreign body and/or to secure the airway to facilitate the foreign body removal.

RESULTS

Rigid bronchoscopy was successful in retrieving the foreign bodies in 338 (98.8 percent) cases, while four (1.2 percent) cases required additional tracheostomy, either to protect the airway during the procedure or to assist in removing the foreign body. The indications for tracheostomy were subglottic foreign bodies of long duration, sharp subglottic foreign bodies and foreign bodies that were larger than the glottic chink. There was no mortality or long-term complication because of the tracheostomies.

CONCLUSION

Tracheostomy is occasionally indicated in foreign body extraction, when they are subglottic in location and impacted, or are large foreign bodies that get obstructed at the glottic chink during removal.

ICU management of blunt chest trauma: our experience

Blunt chest tramma is a major cause of mortality and morbidity following road side accident. An understanding of the factors affecting the mortality and morbidity will help in formulating better management strategies. The records of 40 consecutive patients presenting with blunt chest trauma (BCT) requiring ICU care from 1994-1996 were reviewed. Flail chest was the most common chest injury seen in 35 patients (87.5%). Isolated flail chest was seen in 22 patients, isolated pulmonary contusion in 2 patients and a combined injury in 13 patients. Ventilatory assistance was required in 34 patients (85%) for an average duration of 16 days (range 2-43 days). All patients with anterior flail required assisted ventilation in contrast to 75% and 88% of patients with unilateral and bilateral flail respectively. Presence of pulmonary contusion with or without flail was also associated with a high incidence of ventilatory support requirement. Chest infection (pneumonia) was the most common complication seen (65%). Adverse outcome occurred in 12 patients (30%). The main contributing factors for increased morbidity and mortality were: associated pulmonary contusion, associated extrathoracic injuries and preexisting medical illness. Statistical significance was observed only with pulmonary contusion.