Background: Currently coronary perforations are rare but can potentially have catastrophic complications. Aim: The aim of this study is to evaluate the incidence, predictors, clinical outcomes, prognosis and management of coronary perforations at a tertiary centre. Materials and methods:The clinical, angiographic, procedural and in-hospital outcomes of patients with or without coronary perforations were compared. Results and discussion: 25 patients (0.9%) had coronary perforations among a total of 2650 consecutive patients who underwent coronary interventions between Oct 1, 2014 and Sept 30, 2015 at our institution. The study group comprising of 25 patients were compared with the control group comprising of 2625 patients who did not develop perforation. Systemic hypertension and dyslipidemia were commoner in study group Coronary perforation was commonest in females <50 years. The clinical profile revealed a strong association with PCI in the background of NSTEMI. Coronary perforation occurred mostly in distal small calibre vessels. In the CTO subgroup blunt end compared to tapering end and long segment CTO compared to short segment had strong positive predictive value for perforation.2 patients had tamponade physiology.10 cases were managed with prolonged balloon inflation. Gelfoam was used in 4 (16%) cases, Coil embolization in 1 (4%) while covered stent was used in 5 (20%) cases. There were two deaths (8%) both occurring in Grade III perforation. At 6 months follow up, 1 died due to non cardiac causes and 5 underwent PCI to non target vessels Conclusion: Coronary perforation is a rare event with an overall incidence of 0.9%.Females<50 years, history of hypertension, dyslipidemia, clinical background of NSTEMI, CTO interventions, interventions in distal small sized vessels, use of stiff guide wires with higher tip load and a higher Balloon to artery ratio were all predictors for coronary perforation. Coronary perforation is mostly managed conservatively with high success rates. Selected cases require heparin reversal, use of covered stents, gelfoams and coils. The 6 month outcome is good. Introduction: Over the last several years, the superior safety profile associated with the radial, rather than the classical femoral approach, in patients subjected to invasive coronary procedures has been proven. Nonetheless, in approximately 10% of cardiac catheterizations performed with a radial access, it is necessary to complete the procedure through another vascular approach. In such cases, the best alternative is currently unknown. Methods: Out of the 21573 procedures undergone in our lab between 2010-2015, we reviewed the 16438 (76.2%) patients that underwent radial access. In 459 (2.8%) of these cases, the radial vascular approach failed. The alternative access used was either the brachial -45 patients (9.8%)-or the femoral artery -414 30-days complications patients (90.2%)-. The main objective pursued was to compare the complications between both accesses in a span of 30 days. Results: Regarding the clinical characte...
<p class="abstract"><strong>Background:</strong> Tracheostomy is one of the most frequently performed surgeries in the emergency department, Intensive care units and at bedside in the present scenario. The aim of our study is to outline the frequent indications, to analyse various complications and to evaluate the outcomes of tracheostomy in our setting in our Institution.</p><p class="abstract"><strong>Methods:</strong> This retrospective study was conducted in the Department of ENT and Head & Neck Surgery, SMGS Hospital, Jammu from January 2018 to January 2020. The cases were recorded from ENT Department and also intensive medical care, intensive neonatal and pediatric care, intensive respiratory care, surgical intensive care units of our institution. We included all the emergency, elective and prophylactic tracheostomies in this group. </p><p class="abstract"><strong>Results:</strong> Out of 100 patients included in our study, male: female ratio was 2.7:1. 61 (61%) patients were in the age group of 41 to 60 years. The mean age was 43 years. In our study 58 (58%) tracheostomies were done on emergency. 38 (38%) were done electively whereas rest 4 (4%) were done prophylactically. 37 (37%) tracheostomies were done for upper airway obstruction, followed by artificial ventilation done in 36 (36%) patients. The most indication was carcinoma seen in 17 (17%) patient followed by head injury seen in 16 (16%) patients. The most common complication was surgical emphysema seen in 8(8%) tracheostomies followed by haemorrhage in 6 (6%) tracheostomies.</p><p class="abstract"><strong>Conclusions:</strong> Tracheostomy still remains a life saving procedure in the surgical management of airway if performed timely despite its few complications.</p>
<p class="abstract"><strong>Background:</strong> Septoplasty is one the most commonly performed surgery in ENT. The aim of this study was to evaluate change in voice after septoplasty using voice handicap index (VHI).</p><p class="abstract"><strong>Methods:</strong> The current study was conducted at Department of ENT, SMGS Hospital, Government Medical College, Jammu, from October 2017 to November 2018. The study population was the patients who had come to the department with deviated nasal septum admitted for septoplasty. Voice assessment was done by Subjective Voice evaluation using VHI. It was done at three times i.e. preoperatively, postoperatively at 1 week and then postoperatively at 1 month. </p><p class="abstract"><strong>Results:</strong> Out of 50 cases operated, 84% patients of present study were in the age group of 18-30 years. The mean age was 25 years. The eldest patient in our study was 55 years old. 40 patients were males and 10 were females with male: female ratio of 4:1. Mean VHI score at preoperative, postoperative 1 week and postoperative 1 month were 23.2, 22 and 21.5 respectively. No statistical difference was obtained while comparing the mean VHI score at different time intervals. The scores between 0-30 are in the mild category i.e. minimal amount of handicap.</p><p><strong>Conclusions:</strong> According to our experience a widened nasal cavity has no effect on voice quality and procedures about nasal obstruction like septoplasty can be performed safely. However, professional voice users, in particular, should be informed about the possible minor postoperative changes, before the septoplasty procedure. </p>
Background: Orbital cysticercosis is an infectious cause of preventable blindness not uncommon in India. It is a parasitic infestation caused by Cysticercus cellulosae, which is the larval form of Taenia solium. The aim of our study was to evaluate the role of the ultrasonography and CT scan in detecting ocular and adnexal cysticercosis. Materials and methods: This hospital based retrospective study was conducted in the department of Ophthalmology and Radio-diagnosis of GMC Hospital Jammu from July 2017 to January 2020. A total of 12 patients with suspected diagnosis of ocular and adnexal cysticercosis were studied with the help of ophthalmic examination, serology profile, ultrasonography and CT imaging. Results: Our study included 12 patients with male to female ratio 2:1. Majority of the patients had unilateral presentation with only two having bilateral eye involvement. The most common site of lodgement of orbital cysts was seen in the subconjunctival space in 4 patients (33%), followed by 2(16%) in eyelid, 2(16%) in extraocular muscles, 2(16%) in posterior segment, 1(8%) in optic nerve and 1(8%) retro-orbital space. Indirect ophthalmoscopy in one case showed a free floating cyst in the vitreous cavity while in two other patients a translucent cyst with an intracystic whitish spot suggestive of scolex was demonstrated. Conclusion: On the basis of present study, it can be concluded that the diagnosis of orbital cysticercosis is usually accomplished by high degree of clinical suspicion, ophthalamoscopic demonstration of the larval worm and the characteristic features on imaging studies. CT scan can be helpful in assessing extraocular cysticercosis, neurocysticercosis and ancillary findings, if any.
Background: Glaucoma is a serious vision-threatening condition appropriately called as the silent killer of sight. The effect of postoperative fibrosis on success of filtration surgeries requires modulation of the wound healing process. Aim: The aim of the study was to compare trabeculectomy augmented with collagen matrix implant with mitomycin C in primary glaucoma. Materials and Methods: This prospective, longitudinal, hospital-based, analytical, and interventional study was conducted on 36 eyes of 36 patients. Group 1 included 18 patients who underwent trabeculectomy combined with subconjunctival collagen matrix implant and Group 2 included 18 patients who underwent trabeculectomy augmented with intraoperative mitomycin C (0.04 mg/ml) for 2 min. Each patient underwent detailed ocular examination and comparison was drawn by recording intraocular pressure (IOP), bleb characteristics, and postoperative complications. Results: The cumulative success rates at the end of our study were similar in two groups, 94.44% in Group 1 and 88.89% in Group 2 ( P = 1.000). The mean reduction in IOP at 24 weeks in Group 1 was 18.67 ± 7.59 mmHg and in Group 2 was 21.32 ± 5.84 mmHg. The reduction in IOP was similar between the two groups ( P = 0.290). The mean fall in IOP was 56.46% in Group 1 and 64.70% in Group 2 at 24 weeks. Mean bleb score in Group 1 was 10.33 ± 1.23 and in Group 2 was 8.89 ± 1.41, and the difference was statistically significant ( P = 0.002). Shallow anterior chamber, overfiltration, and hypotony were statistically higher in Group 2 than in Group 1 ( P = 0.041, 0.041, and 0.046, respectively). Conclusion: Collagen matrix implant as an adjuvant to trabeculectomy is noble, safe, and effective option as compared to mitomycin C.
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