BACKGROUND AND OBEJECTIVE: Pulmonary arterial hypertension is a wellrecognized entity in patients with cirrhosis of liver. Various studies have reported a prevalence varying from 2-20%. Present study was intended to find the prevalence of pulmonary hypertension in patients with cirrhosis and to look for the risk factors for pulmonary hypertension. METHODOLOGY: 100 consecutive patients with cirrhosis of liver attending outpatient department and admitted in medicine ward at KIMS, Hubli, were taken for study after considering the inclusion and exclusion criteria. The informed written consent was taken from the patients. Detailed history, examination with relevant investigations including ultrasonography abdomen and endoscopy was done. Patients were screened by echocardiography for presence of PAH. RESULTS: Out of 100 patients with cirrhosis 17% were found to have pulmonary arterial hypertension by echocardiography. There was no statistically significant association between the gender, etiology of cirrhosis, portal hypertension, and severity of liver disease with the risk of development of pulmonary arterial hypertension. INTERPRETATION AND CONCLUSION: Due to small sample size risk factors with smaller effect sizes may not have been detected. The prevalence of pulmonary hypertension was noted to be more common in the patients with portal hypertension (18.6%), female sex (26.67%) and Child pugh class C (20%), but was not statistically significant. The high prevalence of pulmonary hypertension in this study may be due to the use of echocardiography, rather than the right heart catheterization for diagnosis of PAH.
Introduction: Approach to repair of Ostium Secundum atrial defect has undergone modifications in the last decade, with right thoracotomy, being one common approach pursued by.Methods: Right Posterolateral thoracotomy (RPLT) was offered for ASD closure for children, young females below 30 and selected adult male patients with lean body built. Retrospective analysis of these patients with conventional median sternotomy approach over a period of 3 years in this center was included, excluding patients with ostium primum. ASD and associated conditions like PDA, VSD, Mitral valve prolapse, coronary artery disease etc. Common variables including pump time aortic cross clamp time, postoperative ventilation, ICU stay, morbidity were considered for analysis. There were 225 (130 male and 95 females) patients in sternotomy group vs 96 (65 males and 30 females) in RPLT group. The average age in sternotomy group was 36 years (range 2 to 46 years) as compared to 13 years (range 3 to 27 years). Direct closure of ASD was done in 71 patients and pericardial patch closure for 154 patients in sternotomy group, compared with 66 and 20 in the RPLT group.Results: Extra corporeal circulation time was 46 minutes (37 to 90) in sternotomy group, Aortic cross clamp time 22 minutes (18 to 38) in former as compared to 32 minutes (28 to 45) 14 (8 to 36) in the latter. Blood loss in postoperative period was 210 ml (range 40 600 ml in sternotomy group while it was 160 ml range 20 400 ml) in thoracotomy group. Selective ventilation was provided in all patients. Postoperative complications included ( 3 vs. 1). The opening sternal rewiring (31 pain and shoulder movement restriction (12), and secondary suturing (5 patients in RPLT group). The cosmetic appeal of the incision was acceptable for most of the parents of female patients in thoractomy group.Conclusions: Right posteroilateral thoracotomy for ostium scundum ASD closure in a suitable approach as it gives equally good results as median Sternotomy. Patient selection is an important factor.Background: Successful neonatal repair of infradiaphragmatic total anomalous pulmonar T drainage (TAPVD) depends largely on early intervention which in tmn is dependent on early diagnosis, referral and transportation.Methods: Five neonates underwent complete repair of isolated infradiaphragmatic (Obstructed) TAPVD from January 1995 to November 2003. All patients were referred from distant places. Two were males, ages ranged from 6 days to 35 days. Emergency operative correction was performed after instituting resuscitative measmes. The common confluence to LA anastomosis was done, vertical vein ligated and ASD closed in all cases. The mean CPB time was 80 min.
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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