RESUMEN
The middle lobe is usually a part of the right lung as it is tri-lobar in normal anatomy. In patients with Kartagener's syndrome, the middle lobe belongs to the left lung due to situs inversus. They are prone to develop bronchiectasis due to ciliary dyskinesia and bronchial anatomy of the middle lobe. We hereby report an interesting case of left middle lobectomy done in a patient with Kartagener's syndrome with bronchiectasis.
RESUMEN
Isolation of the left subclavian artery is a rare anomaly associated with right aortic arch. We report a case in which this subclavian artery was supplying the pulmonary circulation in a patient with tetralogy of Fallot (TOF) which effectively acted as a natural systemic to pulmonary artery shunt. The patient had good room air saturation and no features of vertebrobasilar insufficiency or left upper limb ischemia. She underwent a total correction of TOF and ligation of the aberrant left subclavian artery.
RESUMEN
Trans-catheter device closure of atrial septal defects (ASD) is considered to be safe with minimal complications. But, there are certain complications that arise after these device closures which might require urgent or late surgical intervention. We have retrospectively analysed our experience. Out of 780 patients who underwent device closure, 11 (1.4%) patients required urgent surgical intervention to retrieve the embolized device. The size of the ASD, expertise of the cardiologist and the type of the device directly impacted the rate of device embolization. Early diagnosis and prompt surgical retrieval is paramount before any life threatening complications arise due to the embolized device. One patient developed infective endocarditis later, which required surgery. Regular long term follow up is needed after these procedures to diagnose the complications earlier so that prompt surgical intervention could be done.
RESUMEN
Pulmonary mucormycosis (PM) is a rare disease. Literature about the surgical management of PM in India is sparse. Recently, there has been a surge in the number of cases of mucormycosis in association with the coronavirus disease 2019 (COVID-19) pandemic, igniting the interest in PM. Hence, we endeavoured to analyse our surgical experience in treating PM prior to the pandemic, in a tertiary care centre, to provide insight into this disease. Data of 10 adult patients with isolated PM, who underwent surgery between the years 2009 and 2020, and maintained in our departmental database, were retrieved and analysed.
RESUMEN
INTRODUCTION AND PURPOSE: Though hydatidosis is a ubiquitous zoonosis endemic to India, there is a dearth of literature regarding the management of thoracic hydatid disease (THD) in India. There are no surgical guidelines available. The aim of this study is to analyse the details of THD operated upon in a tertiary care hospital in India and propose a protocol for its management. METHODS: The case files of all adult patients operated upon for THD in our institution between 2009 and 2019 were retrieved and a retrospective study done. RESULTS: A total of 186 patients, 103 (55.4%) males and 83 (44.6%) females, with a mean age of 34.2 years were studied. The commonest symptom was cough as in 83 (44.6%) patients. Complications were seen in 22 (11.8%) patients. Computerized tomogram (CT) was confirmatory in most patients. Isolated pulmonary disease was seen in 135 (72.6%) patients with 153 (82.3%) uni-lobar involvement. Right lower lobe was most frequently involved as in 56 (30.1%). Extra-pulmonary, intra-thoracic involvement was seen in 6 (3.2%) and synchronous extra-thoracic disease in 45 (24.2%) patients. All patients were initiated on anthelmintics. Postero-lateral thoracotomy was the commonest surgical approach. Twenty (10.7%) patients required lung resections. The mean hospital stay was 5.9 days. Air leak, seen in 10 (5.4%) patients, was the commonest post-operative complication. There was single in-hospital mortality. Age, diabetes mellitus, secondary bacterial infection of the cyst and cyst characteristics were found to significantly affect the surgical outcomes. CONCLUSION: Surgery, the treatment of choice for THD, can be done with negligible morbidity and mortality and should be expedited to prevent complications. Risk factors should be identified pre-operatively for better decision-making. Adequate concurrent medical therapy may prevent recurrences. Prolonged follow-up is mandatory to detect late recurrences.
RESUMEN
INTRODUCTION AND PURPOSE: Empyema thoracis (ET) is defined as the accumulation of pus in the pleural cavity. Early stages of ET are treated medically and the late stages surgically. Decortication, thoracoplasty, window procedure (Eloesser flap procedure) and rib resections are the open surgical procedures executed. There are no strict guidelines available in developing nations to guide surgical decision-making, as to which procedure is to be followed. METHODS: Details of all adult patients treated surgically for ET, between the years 2009 and 2019, and maintained in a live database in our institute, were retrieved and analysed. Medically managed patients were excluded. RESULTS: There were 437 patients in the study. The average age was 38 years. There was right side preponderance with a male:female ratio of 5:1. Tuberculosis was the commonest aetiology identified in 248 (57%) patients and diabetes was the commonest co-morbidity present in 97 (22%) patients. There was a higher incidence of a window procedure (WP) in tubercular patients 145 (59%). Only 26 (14%) of the non-tubercular patients underwent a WP. Post-operative complications were persistent air leak in 12 (6%) patients and premature closure of a window in 7 (4%) patients. There were 4 (0.9%) post-operative mortalities. CONCLUSION: Surgical management of late stages of ET provides good results with minimal morbidity and mortality. In developing nations like India, the high incidence of tuberculosis and late presentations make the surgical management difficult and the strategies different from those in developed nations. No clear guidelines exist for the surgical management of ET in developing nations. There is a need for a consensus on the surgical management of empyema in such countries.
