Background: This study attempts to review our experience. with the diagnosis, management and long term follow up of major tracheobronchial injury Methods: The medical records of 17 patients who underwent surgery for major airway injury between [1986][1987][1988][1989][1990][1991][1992][1993][1994][1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005]
Background: Lower hemisternotomy is a popular minimally invasive approach to correct cardiac lesions. Since June 2000, we started the programme of minimally invasive approach for a variety of cardiac lesions. For the same we have indigenously designed a set of instruments.Methods: Total of 86 patients were operated through this approach. The cardiac lesions corrected include atrial septal defect (ASD) in 60 patients (70%), ventricular septal defect (VSD) in 12 (14%) and mitral valve replacement (MVR) in 14 (16%). The results of ASD closure in 40 patients done through this approach were compared with the control group of patients who underwent ASD closure through full-length sternotomy.Results: In patients in whom ASD closure was done, the mean CPB and aortic cross clamp time in lower hemisternotomy group were significantly longer, 35±14.2 min and 23.3±10.8 min respectively compared to 23±3.9 min and 14±3.5 min in full sternotomy group (p<0.001). Mean ventilation time, blood loss, ICU and hospital stay were significantly low (p<0.001) In patients who were operated through this approach compared with those who were operated through full-length sternotomy.Conslusion: Lower Hemisternotomy is a safe approach in both the pediatric and adult patients and the indigenously designed instrumentation is simple and reusable which helps in improving the operative exposure and ease of surgery.
Introduction:Left Atrial tumors are known to present in congestive heart failure by their propensity to block flow in the left heart. Myxomas are commoner of these tumors; however other tumors have to be considered. Left atrial myxomas warrant an emergency surgery, however a thorough workup is emphasized even in an emergency.Case Report: A 35 year lady presented to the emergency department with acute congestive heart failure. CXR showed cardiomegaly and florid pulmonary edema. An echocardiogram revealed a 43x33mmleft atrial myxoma (Charuzi class III) and pulmonary hypertension. Since she was too sick, for emergency surgery, medical stabilization was done. A repeat CXR showed clearing of pulmonary edema but also a persistent suspicious opacity in the left upper lung zone. Computed tomography of thorax revealed a mass extending from the arch of aorta into the left atrium and ventricle. Computed tomography guided needle biopsy of the mass showed presence of a primary synovial sarcoma.Conclusions: LA myxomas presenting with congestive heart failure often require emergency surgery. However through evaluation prior to surgery cannot be substituted. Presence of florid pulmonary edema on chest x-ray can mask other lung lesions especially metastasis. In such instances further investigations are necessary to make the correct diagnosis.Background: Presentation of neurologic complications following cardiopulmonary bypass (CPB) are myriad, ranging from acute stroke to subtle neurocognitive changes. We report a case following coronary artery bypass surgery under cardiopulmonary bypass when Phenytoin toxicity in early postoperative period mimicked a neurological stroke leading to delay in its diagnosis and discuss the implications of the behaviour of a vital drug like Phenytoin due to CPB.
Background: SVC syndrome results from malignant causes in 90 % cases. Sclerosing mediastinitis alone or as a component of familial multifocal fibro sclerosis can cause SVC obstruction warranting surgical management Case Report: A 51 year old lady presented to us with neck and face swelling for 3 months and headache, giddiness and inability to lie flat for 2 weeks. She had undergone right hemithyoidectomy and was on eltroxin. Clinical examination also revealed engorged veins over the neck and chest wall and a firm, mobile nodule in the left lobe of thyroid. Contrast enhanced CT Neck & Chest and MRI Chest showed mediastinitis and also significant lymph nodes in the right paratracheal region with one of them compressing the SVC and partially obstructing it. Completion thyroidectomy was carried out. Bypass grafting was done between left innominate, right internal jugular veins and proximally on the right atrium using PTFE grafts. Biopsy of the mass lesion in the mediastinum and the paratracheal node showed sclerosing mediastinitis and non specific inflammation respectively. Hurthle cell adenoma was identified in the thyroidectomy specimen. Patient did well post operatively and is on regular follow up.Conclusions: Sclerosing mediastinitis along with Hurthle cell adenoma and retroperitoneal fibrosis represents a rare idiopathic group of disorders under Multifocal fibrosclerosis which requires surgical management for specific indications as in this case we encountered. The outcome is good in cases with no associated malignancy.
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