The combined modality treatment of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has gained worldwide acceptance for management of selected patients with peritoneal metastases from various cancers. Cytoreductive surgery is performed with the goal of removing all macroscopic disease and is coupled with perioperative chemotherapy (POC) in the form of HIPEC with or without EPIC (early postoperative intraperitoneal chemotherapy) to deal with the microscopic residual disease. These treatments entail the use of cytotoxic drugs in the operation theatre or in the intensive care unit where they are not commonly used and put the healthcare workers participating in the treatment at risk of exposure. CRS is performed with high voltage electrocautery generating a large amount of surgical smoke which is inhaled by the involved personnel and has potential health hazards. This article outlines the safety measures to be taken while performing CRS and POC.
SUMMARY Fifty patients with occlusive cerebrovascular disease (ischemic thrombotic cerebrovascular disease -ITCBVD) were studied for clinical features, angiographic findings, serum lipids, platelet functions and fibrinolytic activity. Angiograms were abnormal in 24 of 36 cases. Two-thirds of these had an abnormality of the internal carotid artery in the neck; one-third had occlusion of the middle and/or anterior cerebral arteries. A statistically significant rise of serum triglycerides, pre-beta lipoproteins, platelet adhesiveness and aggregation, and a decrease in fibrinolytic activity were noticed in these patients as compared to age and sex matched controls. The correlation coefficient did not show any intercorrelation between the platelet adhesiveness and raised lipid fractions. These factors could be responsible for the atheroma resulting in large vessel occlusion.
Introduction: The role of cardioplegia cannot be underrated in cardiac surgery. St Thomas solution is the most widely used cardioplegic, but needs repeated dosing. Del Nido solution provides long duration of asystole with adequate protection; but has been used mainly in paediatric patients. This study was aimed to compare Del Nido cardioplegia with St Thomas cardioplegia in adult cardiac surgeries, requiring double valve replacement and compare the outcomes. Methodology: This retrospective, observational, descriptive study was conducted over a time period spanning from January 2016 to December 2019. A total of 209 patients were included and were separated in two groups DC group (n = 114) and BC group (n = 95) on the basis of cardioplegic solution used. Del Nido solution was administered as single dose. Parameters noted were CPB time, cross clamp time, wean off bypass time, DC shocks given, inotropic support required, ventilation duration, duration of ICU and hospital stay. Results: There was significantly shorter aortic cross clamp time (72.6 ± 10.2 vs. 98.2 ± 9.2), CPB time (92.1 ± 12.3 vs.129.5 ± 11) and wean off bypass time (19.4 ± 5.9 vs. 31.3 ± 7.6) and less requirement of DC shocks (21.2% vs. 65.9%) in DC group. Inotropic requirement in immediate post-operative period was significantly less in DC group both on day of surgery (5.35 ± 1.44 vs. 7.52 ± 3.8) and 24 hours later (3.4 ± 2.12 vs. 2.18 ± 0.72). There was no significant difference in duration of ventilation, ICU and hospital stay. Conclusion: Del Nido can be used safely in long duration adult cardiac surgeries and in a single dose with better intra operative and immediate post-operative outcomes as compared to St Thomas solution.
Introduction: Chronic mesenteric ischemia is a pathophysiologic condition arising due to demand–supply mismatch of blood supply to bowel postprandially, resulting in chronic abdominal pain, food fear, and weight loss. The most common cause is atherosclerosis. Timely intervention in the form of mesenteric revascularization is the key to successful outcome. There are limited contemporary data on in-hospital outcomes of mesenteric revascularization via open versus endovascular therapy in a resource-challenged setting. Materials and Methods: This retrospective-prospective observational study included eight patients of chronic mesenteric ischemia who underwent open revascularization and were followed for a mean duration of 15 months. All patients were evaluated as per the institutional protocol, and retrograde mesenteric bypass with reverse saphenous vein graft was done in all cases. Outcomes were evaluated in terms of resolution of symptoms and confirmation of graft patency with duplex scan after 1 month and every 6 months thereafter. Results: Out of 8 patients, six patients were males. Predisposing factors for atheromatous diseases were present in all. All patients presented with postprandial abdominal pain and weight loss. Majority of patients (n = 5) had involvement of all three mesenteric vessels (superior mesenteric artery, inferior mesenteric artery, and celiac axis). One patient was re-explored for bleeding in immediate postoperative period. One patient was admitted for small bowel obstruction in 1st month of follow-up after surgery and was managed conservatively. Two patients were lost to follow-up and six patients are symptom free and doing well on a close follow-up of 15 months. Conclusion: Open mesenteric revascularization, by reverse saphenous vein graft as conduit for bypass, performed by experienced surgeon gives promising results in terms of symptom-free duration and graft patency and can be preferred over endoscopic revascularization as a viable option in resource-challenged settings in developing nations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.