This study correlates the mode of breech delivery to the immediate neonatal outcome in preterm breeches. We had 9816 deliveries in the period between 1st January 1994 to 31st August 1996. The incidence of breech deliveries was 3.95% and the incidence of preterm breech deliveries was 1.9%. Totally 112 (69%) patients delivered vaginally and 50 (31%) underwent caesarean section. Between 30-36.6 weeks gestation the incidence of birth asphyxia was higher in the vaginal group. In this group the take home baby rate after vaginal delivery was 81% as compared to 86% in caesarean group. Head entrapment, cord prolapse, respiratory distress syndrome and intraventricular haemorrhage were the various complications seen with vaginal breech delivery.

This was a study to compare continuous intravenous infusion of atracurium with continuous intravenous infusion of vecuronium for intraoperative muscle relaxation in 62 ASA I / II patients. Scheduled for laparotomies and pelvic surgeries under general anaesthesia. They were randomly allocated in two groups to receive either vecuronium infusion of 50 microg/kg/hour following a bolus dose of 0.1 microg/kg, or atracurium infusion of 400 microg/kg/hour following a bolus dose of 0.5 microg/kg. The mean infusion dose of atracurium was 478 +/- 44.11 microg/kg/hour and that of vecuronium was 63.2 +/- 74 microg/kg/hour for adequate muscle relaxation. The depth of neuromuscular blockade was monitored by using peripheral nerve stimulator so that only one twitch of train of four was present, resistance to ventilation, surgical relaxation and haemodynamic changes. Vecuronium infusions produced more haemodynamic stability than atracurium infusions. Vecuronium produced lesser change in systolic blood pressure (mean change of 3. 46 +/- 3.33%) from baseline values as compared to atracurium (mean change of 5.81 +/- 3.73%) from baseline values ( p < 0.01) which was statistically significant. The difference in mean pulse rate change from baseline value in the atracurium group (4.78 +/- 2.745%) was less than that in the vecuronium group (5.99 +/- 2.67%), which was not statistically significant. Spontaneous recovery was faster with vecuronium (540.94 +/- 76.46 seconds) as compared to atracurium (596. 33 +/- 72.48 seconds). 84.4% of patients who received vecuronium fell within good to very good category of muscle relaxation as compared to 63.3% in atracurium group. There were no cost benefits when either agents were used in infusion form.

Tuberculosis of the stomach and duodenum is rare in patients with pulmonary tuberculosis. Primary involvement is even rarer. Two cases of primary tuberculosis of the localised to the pyloro-duodenal area are presented. The most common symptoms are non-specific leading to a difficulty in establishing a pre-operative diagnosis. A high degree of suspicion is therefore required for its diagnosis and to differentiate it from more frequent causes of gastric outlet obstruction such as chronic peptic ulcer disease and gastric carcinoma. The treatment of gastric tuberculosis is primarily medical with anti-tuberculous drug therapy. The role of surgery lies in the cases with obstruction following hypertrophic tuberculosis. The surgery done is usually a gastroenterostomy. With the relative rate of extra-pulmonary tuberculosis increasing, tuberculosis of the pyloro-duodenal area should be considered in the differential diagnosis of gastric outlet obstruction.

Spontaneous non-traumatic oesophageal perforation secondary to bursting of a mediastinal tuberculous abscess into the oesophagus is rare. The diagnosis is delayed, as perforation remains localised due to mediastinal lymph nodes. Patient can be effectively managed by paraoesophageal drainage of the mediastinal abscess and oesophageal diversion.

Nasal gliomas are uncommon lesions, with approximately 100 cases reported in the literature. We present a case of intranasal glioma with a pedicle of glial tissue and defect in the cribriform plate of the ethmoid bone. Presence of such a pedicle is almost always present in the encephaloceles and is known to be distinctively uncommon in nasal gliomas.

Recognition of postoperatively retained foreign body referred euphemistically as gossypiboma is essential but is very often considerably delayed. Legal implications as well as confusing configuration patterns cause considerable dilemma in the accurate diagnosis. We present computed tomographic features of gossypiboma in two patients who presented with symptoms of fever and pain in the immediate post-operative period. A prospective radiological diagnosis is essential for further management in these patients.

A case of corpus callosum agenesis associated with a chromosomal structural defect is described.