Venous aneurysms are uncommon clinical entities. Venous aneurysms involving the head and neck region are distinctly uncommon, and a saccular aneurysm of the external jugular vein with thrombus is extremely rare. We present a case of saccular aneurysm of the external jugular vein with partial thrombosis in a 30-year-old woman, which was diagnosed on duplex ultrasound and contrast-enhanced computed tomography, and treated by surgical excision.
Introduction: Patients undergoing coronary artery bypass graft surgery constitute a large population of patients with anatomically similar incisions created under similar circumstances. Aim: Our study aimed at analysing and comparing rates of surgical site infections (SSIs) at the sternotomy sites based on the material used for skin closure of the sternal wound with special emphasis on presence of risk factors such as diabetes (glycated haemoglobin (HbA 1c) > 9) and obesity (body mass index (BMI) > 30 kg/m 2) in the 2 respective groups. Material and methods: This is a retrospective observational study. A total of 864 patients were included in the study. The patients were grouped into 2 groups depending on the sternal wound closure strategy used. One group consisted of patients in whom polyamide sutures were used for skin closure, while the other group comprised patients in whom skin staples were used for skin closure. Incidence of sternal wound SSIs in both groups was noted. Co-morbid conditions such as diabetes mellitus (with HbA1c > 9) and obesity (BMI > 30 kg/m 2) were noted and analysed as contributory factors for SSIs. Results: Group A comprised 432 patients out of whom 42 (9.72%) had sternal wound SSIs. Group B comprised the other 432 patients of whom only 20 (4.62%) developed sternal wound SSIs. Co-morbid conditions were analysed in each group. Group A showed SSI in 22/64 (34.3%) diabetic patients, 6/28 (21.8%) obese patients and 16/22 (72.72%) with diabetes and obesity. Group B showed SSIs in 6/56 (10.715) diabetics, 4/26 (6.01%) obese and 4/24 (16.67%) with diabetes and obesity. Conclusions: By pairing staples and sutures, we observed a significantly lower incidence of total wound complications with suture than with staple closure.
Purpose Although multiarterial grafting or bilateral mammary artery use is being increasingly emphasized for contemporary coronary artery bypass grafting (CABG) practice, saphenous vein graft (SVG) still accounts for 80% of all CABG conduits (Park et al., 2020) [ 1 ]. In India, both the individual and sequential saphenous grafting techniques are used arbitrarily, and there has not been a study that compares the mid-term patency of these two. This is specially relevant in view of smaller coronaries in Indians than the Caucasian counterparts. This study aims to compare the patency for on pump CABG’s. Methods In the present study, 323 patients underwent either sequential (group A, N = 151 grafts, each graft having two anastomoses each) or individual (group B, N = 344 grafts) saphenous vein CABG, between February 2014 and June 2017. The SVG anastomoses were created on obtuse marginal (OM1/OM2) and posterior descending artery (PDA). The graft patency of the vein grafts as well as the left internal mammary artery were assessed by serial coronary angiograms. Results Results were evaluated at 6 months, 1, 2 and 3 years post operatively. Group A showed a higher graft patency at 3 years at 80.8%, and group B, 67.1% (P = 0.002). Also, anastomoses on sequential conduits had overall better patency rates at three years (77.2% vs 67.2%, P = 0.005). The groups showed similar results at one year post operatively. Conclusions Sequential bypass grafts were associated with superior mid-term patency compared with individual grafts. These findings suggest the more favourable results of sequential bypass grafting to be attributed to the enhanced flow haemodynamics.
Introduction: Surgical site infection (SSI) is an important morbidity postoperatively after midline sternotomy in patients undergoing cardiac surgery. Collected blood and serous fluids can get infected, which is one of the many factors responsible for surgical site infection, especially in obese patients. Aim: To observe the association of SSI with and without prophylactic use of subcutaneous wound drainage in obese patients undergoing cardiac surgery via midline sternotomy. Material and methods: A retrospective observational study of 152 obese patients who underwent cardiac surgery via midline sternotomy was conducted. Data were analysed after retrieving records between two groups of patients -those who received a prophylactic subcutaneous wound drain (group A) and those who did not (group B) after surgery in terms of superficial and deep surgical site infection including mediastinitis, need for second surgery, VAC dressing, hospital stay and need for readmission. Results: Retrieved data showed that 27 obese patients of the 128 (21%) developed SSI after cardiac surgery via midline sternotomy. Deep sternal wound infection (DSWI) was significantly higher in patients from group B than group A. Multivariate analysis did not show a statistically significant decrease due to suction drains. Superficial infection, though higher, was not statistically significantly different between the two groups. The hospital stay was found to be longer and statistically significant in group B patients than group A. Conclusions: There was a decrease in the incidence of DSWI in obese patients receiving prophylactic subcutaneous wound drainage after cardiac surgery via midline sternotomy but the difference was not statistically significant.
Introduction Constrictive pericarditis (CP) usually presents as a result of chronic fibrous pericardial thickening and calcification of the pericardium which causes reduced cardiac output. Despite the lack of prospective studies comparing the different therapeutic strategies, surgical pericardiectomy is a valuable treatment under most circumstances. Aim We analyzed our records to highlight the predictors of morbidity and mortality of pericardiectomy and also short-term surgical outcome of the same procedure in a single center. Material and methods We carried out a comprehensive retrospective analysis of the records of patients who underwent surgery for CP at our institute between 2013 and 2018. 30 patients underwent isolated pericardiectomy. All patients underwent median sternotomy and total pericardiectomy without the use of cardiopulmonary bypass. Pre-operative, intra-operative and post-operative characteristics were noted. Results Fifteen patients had a history of pulmonary tuberculosis. The majority of the patients presented with NYHA grade III or IV. 60% of the patients were male. The preoperative mean central venous pressure was 24 ±9 mm Hg and decreased to 9 ±5 mm Hg after surgery. The 30-day mortality was 6.66% (2/30). Morbidity was mainly due to low-cardiac output syndrome ( n = 4). A total of 26 patients had significant improvement in their NYHA status. Conclusions Although pericardiectomy for CP remains associated with some operative mortality, the short-term outcome is favorable, and surgical treatment is able to improve the functional class in the majority of survivors.
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