Tracheal bronchus presenting with recurrent haemoptysis in an adult female

  Abnormal bronchus arising directly from the trachea or the main bronchus is a rare developmental anomaly of the tracheobronchial tree. In general, tracheal bronchus has been reported in less than 1% of adult patients undergoing bronchoscopy with a male predominance. Tracheal bronchus is classified as — ‘displaced’ and ‘supernumerary’, the former being the most common type reported. Most patients are asymptomatic; however, cases presenting with cough, haemoptysis or recurrent lung infections are not uncommon. The diagnosis is usually made through computed tomography or bronchoscopy. Awareness of this anomaly may help in timely identification or prevention of perioperative complications during general anaesthesia or resectional thoracic surgery. Herein we report a case of right-sided displaced tracheal bronchus in an adult female presenting with recurrent haemoptysis.

HeW: AHash Function based on Lightweight Block Cipher FeW

A new hash function HeW: A hash function based on light weight block cipher FeW is proposed in this paper. The compression function of HeW is based on block cipher FeW. It is believed that key expansion algorithm of block cipher slows down the performance of the overlying hash function. Thereby, block ciphers become a less favourable choice to design a compression function. As a countermeasure, we cut down the key size of FeW from 80-bit to 64-bit and provide a secure and efficient key expansion algorithm for the modified key size. FeW based compression function plays a vital role to enhance the efficiency of HeW. We test the hash output for randomness using the NIST statistical test suite and test the avalanche effect, bit variance and near collision resistance. We also give the security estimates of HeW against differential cryptanalysis, length extension attack, slide attack and rotational distinguisher.

Actively caseating endobronchial tuberculosis successfully treated with intermittent chemotherapy without corticosteroid: a report of 2 cases

Tuberculous infection of the tracheobronchial tree confirmed by microbiological or histopathological evidence with or without parenchymal involvement is known as endobronchial tuberculosis. Chronic cough is the predominant symptom. Expectorated sputum examination for acid fast bacilli is often negative leading to delay in diagnosis. Therefore, bronchoscopy is crucial for early diagnosis and evaluation of the extent of disease. Bronchostenosis is a significant complication of endobronchial tuberculosis that may be present at the time of diagnosis or develops during the course of treatment. Previously, corticosteroids have been used along with antitubercular therapy to prevent or reduce the extent of bronchostenosis; however, their role is debatable as bronchostenosis often develops despite the use of corticosteroids. Furthermore, the duration of treatment varied from 6–9 months of daily therapy in previous series and little is known about efficacy of intermittent antituberculous therapy. Here we report two cases of actively caseating endobronchial tuberculosis successfully managed with six months of intermittent oral antitubercular therapy without corticosteroids

A case of systemic melioidosis: unravelling the etiology of chronic unexplained fever with multiple presentations

Melioidosis, caused by the environmental saprophyte, Burkholderia pseudomallei, is an important public health problem in Southeast Asia and Northern Australia. It is being increasingly reported from other parts, including India, China, and North and South America expanding the endemic zone of the disease. We report a case of systemic melioidosis in a 58-year-old diabetic, occupationally-unexposed male patient, who presented with chronic fever, sepsis, pneumonia, pleural effusion and subcutaneous abscess, was undiagnosed for long, misidentified as Pseudomonas aeruginosa infection elsewhere, but was saved due to correct identification of the etiologic agent and timely institution of appropriate therapy at our institute. A strong clinical and microbiological suspicion for melioidosis should be considered in the differential diagnosis of acute pyrexia of unknown origin, acute respiratory distress syndrome and acute onset of sepsis, especially in the tropics.Melioidosis, caused by the environmental saprophyte, Burkholderia pseudomallei, is an important public health problem in Southeast Asia and Northern Australia. It is being increasingly reported from other parts, including India, China, and North and South America expanding the endemic zone of the disease. We report a case of systemic melioidosis in a 58-year-old diabetic, occupationally-unexposed male patient, who presented with chronic fever, sepsis, pneumonia, pleural effusion and subcutaneous abscess, was undiagnosed for long, misidentified as Pseudomonas aeruginosa infection elsewhere, but was saved due to correct identification of the etiologic agent and timely institution of appropriate therapy at our institute. A strong clinical and microbiological suspicion for melioidosis should be considered in the differential diagnosis of acute pyrexia of unknown origin, acute respiratory distress syndrome and acute onset of sepsis, especially in the tropics

Powtarzające się krwioplucie u dorosłej kobiety z oskrzelem tchawiczym

Nieprawidłowe oskrzele wychodzące bezpośrednio z tchawicy lub oskrzeli głównych jest rzadką anomalią rozwojową drzewa tchawiczo-oskrzelowego. Oskrzele tchawicze zostało stwierdzone u mniej niż 1% dorosłych pacjentów, którzy mieli wykonywaną bronchoskopię; a większość z nich stanowili mężczyźni. Oskrzele tchawicze może być „przemieszczone” lub „nadliczbowe”, przy czym drugi rodzaj jest spotykany częściej. U większości pacjentów nie występują żadne objawy, chociaż zdarzają się osoby skarżące się na kaszel, krwioplucie lub nawracające infekcje płuc. Nieprawidłowość jest najczęściej rozpoznawana podczas badania tomografii komputerowej lub bronchoskopii. Świadomość istnienia anomalii może pomóc w identyfikacji lub uniknięciu okołooperacyjnych powikłań podczas ogólnego znieczulenia lub zabiegu chirurgicznego klatki piersiowej. W niniejszej pracy przedstawiono przypadek prawostronnego oskrzela tchawiczego u dorosłej kobiety skarżącej się na nawracające krwioplucie.Nieprawidłowe oskrzele wychodzące bezpośrednio z tchawicy lub oskrzeli głównych jest rzadką anomalią rozwojową drzewa tchawiczo-oskrzelowego. Oskrzele tchawicze zostało stwierdzone u mniej niż 1% dorosłych pacjentów, którzy mieli wykonywaną bronchoskopię; a większość z nich stanowili mężczyźni. Oskrzele tchawicze może być „przemieszczone” lub „nadliczbowe”, przy czym drugi rodzaj jest spotykany częściej. U większości pacjentów nie występują żadne objawy, chociaż zdarzają się osoby skarżące się na kaszel, krwioplucie lub nawracające infekcje płuc. Nieprawidłowość jest najczęściej rozpoznawana podczas badania tomografii komputerowej lub bronchoskopii. Świadomość istnienia anomalii może pomóc w identyfikacji lub uniknięciu okołooperacyjnych powikłań podczas ogólnego znieczulenia lub zabiegu chirurgicznego klatki piersiowej. W niniejszej pracy przedstawiono przypadek prawostronnego oskrzela tchawiczego u dorosłej kobiety skarżącej się na nawracające krwioplucie

Management of infected non-unions of long bones using limb reconstruction system (LRS) fixator

Background: Due to increasing number of high-energy traumatic events, the incidence of complex and compound fractures are also in the rise. Such fractures are often exposed to various environmental contaminants, inadequate debridement and sometimes erroneous decision making leading to cases of infected nonunions. Eradication of infection in such cases and achieving union may sometimes pose serious challenge to orthopaedic surgeons. Presence of comminution, bone gap or deformity can seriously complicate the situation. No definite surgical technique has been found to be full proof in dealing with these infected nonunion cases. In this scenario the limb reconstruction system (LRS) fixator is emerging as a useful option for infected nonunions with deformity or gap nonunion.Methods: Twenty seven cases of infected nonunions involving tibia (n=19), femur (n=7) and humerus (n=1) were treated by LRS fixators after debridement of the infected nonunion site. Flap cover procedure was done as per necessity. Bone gaps and limb length discrepancies were dealt with bone transport or limb lengthening by the LRS instrument. Weight-bearing and removal of fixator was decided according to the radiological evidence of healing.Results: All the nonunions and the regeneration sites healed uneventfully, although the union time was varied (range, 21-52 weeks). Commonest complication was pin-tract infection and pain. The mean lower extremity functional score (LEFS) was 60.3 out of 80. Conclusions: LRS fixator is an excellent tool for management of infected nonunions which is easy to apply, comfortable for the patient with minimum complications and predictable as well as reproducible outcomes

Operative outcome of high energy pilon fractures: a retrospective comparison between internal fixation and Ilizarov external fixation

Background: Pilon fractures are serious injuries with many devastating soft-tissue complications associated with them. Deciding a definite treatment plan has always proved a challenge. Comparative studies between the various surgical techniques used for pilon fractures are uncommon and consensus is yet to be reached regarding the best surgical option. Purpose of this study is to retrospectively compare the operative results (complications, functional and radiographic outcomes) of pilon fractures treated either with internal fixation or Ilizarov ring fixators.Methods: Forty-six patients with pilon fractures were retrospectively studied; twenty-one of them had minimal invasive fixation by ankle spanning Ilizarov fixators and 25 patients had internal fixations by either minimal invasive plate osteosynthesis (MIPO) or by open reduction.  The patients were followed-up for a mean of 34 months (range, 24-51 months).Results: The internal fixation group had a higher incidence of soft-tissue complications and deep infections. In comparison the Ilizarov group had only superficial pin-tract infections but no other soft-tissue complications. Although the Ilizarov group had a higher incidence of malreduction and malunion in their series compared to the internal fixation group, there was no significant difference in the AOFAS ankle function score (p-value 0.2922) between the two groups after a follow-up of 2-4 years.Conclusions: The moderately long term functional outcome appears to be similar in both internal fixation and Ilizarov groups. But the Ilizarov technique is less likely to cause any serious peri-operative soft-tissue complications or deep infection. Familiarity of the surgeon with a particular technique should also be considered during surgical decision making.

Common variable immunodeficiency disorder - An uncommon cause for bronchiectasis

Bronchiectasis continues to be a common respiratory problem of varied etiology. Common variable immunodeficiency disorder (CVID) is an uncommon cause for bronchiectasis. However, the prevalence of bronchiectasis remains very high in patients with CVID. This remains largely an underdiagnosed entity as primary immunodeficiency is not suspected in adults as a cause of bronchiectasis and hence, serum immunoglobulin (Ig) levels are not measured routinely. In addition to bronchiectasis, patients with CVID usually present with various extrapulmonary symptoms. I report here a case of young man who presented with bronchiectasis and multisystem complains who was diagnosed as CVID