Retained fragmented needle in intravenous drug users: An institutional experience and treatment protocol.

Retained needle fragments can occur in intravenous drug user (IVDU), which can lead to significant morbidity and mortality. The aim of present study is to give an overview of our institutional experience and treatment protocol followed for such patients. IVDU with retained fragment of fractured needle were taken from the patient presenting in Emergency, Medicine and CTVS departments with history of IVDU, from January 2019 to December 2020. Six patients were found with retained broken needles. Detailed history, examination and investigations were done. The needle was removed under local anaesthesia successfully in all patients. IVDU with retained broken needle poses risk for catastrophic complications along with possibility of local complications. A systematic approach in managing such patients is required. These broken needles can be successfully retrieved as day care procedure. Lastly, IVDUs with fractured needles pose threat to the caregivers who should take caution to avoid iatrogenic injury.

Pulmonary Thromboendarterectomy Without Circulatory Arrest

Abstract Introduction: Here we describe our technique and results of beating heart pulmonary thromboendarterectomy (PTE) with cardiopulmonary bypass (CPB) in four patients for treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Retrospective analysis of data from patients who underwent PTE for CTEPH between January 2019 and September 2020. Patients were followed up with clinical assessment, 2D echocardiography, and computed tomography pulmonary angiogram. Results: Four patients were operated for CTEPH using our technique. Moderate tricuspid regurgitation (TR) and severe TR were found in two patients each. Severe right ventricular (RV) dysfunction was found in all cases. Thrombi were classified as Jamieson type II in three cases and type I in one case. Postoperative median direct manometric pulmonary artery (PA) pressures decreased (from 46.5 mmHg to 23.5 mmHg), median CPB time was 126 minutes, and median temperature was 33.35 °C. Mechanical ventilation was for a median of 19.5 hours. There was one re-exploration. Median intensive care unit stay was 7.5 days. There was no mortality. Postoperative 2D echocardiography revealed decrease in median PA systolic pressures (from 85 mmHg to 33 mmHg), improvement in RV function by tricuspid annular plane systolic excursion (median 14 mm vs. 16 mm), and improved postoperative oxygen saturations (88.5% vs. 99%). In follow-up (ranging between 2-15 months), all patients reported improvement in quality of life and were in New York Heart Association class I. Conclusion: With our described simple modifications, advances in perfusion, and blood conservation technologies, one can avoid the need for deep hypothermic circulatory arrest during PTE.

Pulmonary Thromboendarterectomy Without Circulatory Arrest.

INTRODUCTION: Here we describe our technique and results of beating heart pulmonary thromboendarterectomy (PTE) with cardiopulmonary bypass (CPB) in four patients for treatment of chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: Retrospective analysis of data from patients who underwent PTE for CTEPH between January 2019 and September 2020. Patients were followed up with clinical assessment, 2D echocardiography, and computed tomography pulmonary angiogram. RESULTS: Four patients were operated for CTEPH using our technique. Moderate tricuspid regurgitation (TR) and severe TR were found in two patients each. Severe right ventricular (RV) dysfunction was found in all cases. Thrombi were classified as Jamieson type II in three cases and type I in one case. Postoperative median direct manometric pulmonary artery (PA) pressures decreased (from 46.5 mmHg to 23.5 mmHg), median CPB time was 126 minutes, and median temperature was 33.35 °C. Mechanical ventilation was for a median of 19.5 hours. There was one re-exploration. Median intensive care unit stay was 7.5 days. There was no mortality. Postoperative 2D echocardiography revealed decrease in median PA systolic pressures (from 85 mmHg to 33 mmHg), improvement in RV function by tricuspid annular plane systolic excursion (median 14 mm vs. 16 mm), and improved postoperative oxygen saturations (88.5% vs. 99%). In follow-up (ranging between 2-15 months), all patients reported improvement in quality of life and were in New York Heart Association class I. CONCLUSION: With our described simple modifications, advances in perfusion, and blood conservation technologies, one can avoid the need for deep hypothermic circulatory arrest during PTE.

Clinical spectrum of myasthenia gravis: An institute experience over 8 years from North East India.

Background: Myasthenia gravis (MG) is a neuromuscular junction disorder usually associated with a thymic lesion. Aims and Objective: To study the clinical, serological, and thymic pathology in patient of MG from this corner of the country. Material and Method: A retrospective study involving all myasthenia patients presenting to neurology and cardio-thoracic department from the year 2013 to 2020. The clinical findings, Osserman grade of severity, antibodies profile, computed scanning thorax findings and histopathology of the thymic lesion were noted and collected as data. Results: Thirty patients of MG were included with mean age of onset being 39.10 ± 15.77 years which included 22 females and eight males. Four patients had only ocular findings while 26 patients had generalized myasthenia with three patients of respiratory failure. Ach receptor antibodies were positive in 27 patients and negative in two patients. Anti-MUSK was positive in one out of five patients. Abnormal findings in CT thorax seen in 20 patients which included enlarged thymic gland in 11 patients, thymic hyperplasia in two patients, thymoma in four patients, and anterior mediastinal mass in three patients. Thymectomy was done in eighteen patients with thymoma as the most common histopathological findings seen in eight patients, follicular hyperplasia in five patients; other was thymic hyperplasia, thymic cyst, normal thymus gland, and features of sarcoidosis in one patient. Conclusion: MG is a treatable autoimmune disorder with a variety of clinical, radiological, and histopathological findings.

Eustachian valve myxoma: a rare cause of Budd-Chiari syndrome.

Budd-Chiari syndrome caused by right atrial myxomas are extremely rare. We report the case of a patient who presented with chronic liver disease who upon consequent investigation was found to have a mass occupying the right atrium and ventricle consistent with cardiac tumour. Intraoperatively, a giant mass was removed from the right atrium with the tumour stalk originating from the Eustachian valve. Histologic findings were consistent with myxoma.

Short-term outcome of polytetrafluoroethylene membrane valve versus transannular pericardial patch reconstruction of right ventricular outflow tract in tetralogy of fallot: a randomized controlled trial

Abstract Introduction: Reconstruction of right ventricular outflow tract during primary repair of tetralogy of Fallot often requires the placement of a transannular patch which results in pulmonary regurgitation (PR). We compared the short-term outcomes of bicuspid polytetrafluoroethylene membrane valve versus transannular pericardial patch reconstruction of the right ventricular outflow tract. Methods: Thirty consecutive patients undergoing primary repair of tetralogy of Fallot were randomly allocated to two groups - polytetrafluoroethylene valve (PTFEV) group (n=15) and transannular pericardial patch (TAP) group (n=15). The two groups had similar preoperative demographic characteristics. We compared the short-term clinical and echocardiographic outcomes between these groups. The transthoracic echocardiographic follow-up was performed at one week, one month and six months after surgery. Results: The PTFEV group had significantly lower central venous pressure in the immediate postoperative period compared to the TAP group (7.60±2.06 vs. 10.13±1.73, P=0.002). Extubation time was significantly shorter in the PTFEV group compared to the TAP group (12.93±7.55 hrs vs. 22.23±15.11 hrs, P=0.04). PR in the PTFEV group was absent in five patients at 24 hours post-surgery. At the study endpoint, PR was absent in six, trivial in one and mild in eight patients in the PTFEV group compared to TAP group, where all 15 patients had severe PR. Conclusion: The bicuspid polytetrafluoroethylene membrane valves significantly decrease the central venous pressure in the immediate postoperative period, facilitate early extubation and, thus, prevent ventilator-related comorbidities. They achieve a high degree of pulmonary competence and do not increase the right ventricular outflow tract gradient in short-term follow-up.

Short-term outcome of Polytetrafluoroethylene Membrane Valve versus Transannular Pericardial patch Reconstruction of Right Ventricular Outflow Tract in Tetralogy of Fallot: a Randomized Controlled Trial.

INTRODUCTION: Reconstruction of right ventricular outflow tract during primary repair of tetralogy of Fallot often requires the placement of a transannular patch which results in pulmonary regurgitation (PR). We compared the short-term outcomes of bicuspid polytetrafluoroethylene membrane valve versus transannular pericardial patch reconstruction of the right ventricular outflow tract. METHODS: Thirty consecutive patients undergoing primary repair of tetralogy of Fallot were randomly allocated to two groups - polytetrafluoroethylene valve (PTFEV) group (n=15) and transannular pericardial patch (TAP) group (n=15). The two groups had similar preoperative demographic characteristics. We compared the short-term clinical and echocardiographic outcomes between these groups. The transthoracic echocardiographic follow-up was performed at one week, one month and six months after surgery. RESULTS: The PTFEV group had significantly lower central venous pressure in the immediate postoperative period compared to the TAP group (7.60±2.06 vs. 10.13±1.73, P=0.002). Extubation time was significantly shorter in the PTFEV group compared to the TAP group (12.93±7.55 hrs vs. 22.23±15.11 hrs, P=0.04). PR in the PTFEV group was absent in five patients at 24 hours post-surgery. At the study endpoint, PR was absent in six, trivial in one and mild in eight patients in the PTFEV group compared to TAP group, where all 15 patients had severe PR. CONCLUSION: The bicuspid polytetrafluoroethylene membrane valves significantly decrease the central venous pressure in the immediate postoperative period, facilitate early extubation and, thus, prevent ventilator-related comorbidities. They achieve a high degree of pulmonary competence and do not increase the right ventricular outflow tract gradient in short-term follow-up.

Pulmonary hydatid cyst: Review of literature.

Echinococcosis is a rare infectious disease in human being that occurs by the larval stages of taeniid cestodes of the genus Echinococcus. Human cystic echinococcosis is the most common presentation. The liver is the most common site of echinococcal cyst, followed by the lungs. The symptoms of lung infestation lead to sudden onset of chest pain, cough, fever, and hemoptysis after a cyst rupture. The diagnosis is confirmed by radiology supplemented with serology. Chest X-ray and computer tomography of chest is the principal investigation for pulmonary hydatid cyst (PHC). The treatment of PHCs is either pharmacotherapy and/or surgery. Surgical intervention is the most preferred treatment of choice; pharmacotherapy is useful in selected patients. Pharmacotherapy includes oral administration of benzimidazoles group of drugs like mebendazole or albendazole.

Chronic constrictive pericarditis complicated with huge right atrial thrombus in a child with abdominal tuberculosis: a rare life-threatening condition.

Chronic constrictive pericarditis (CCP) is the most common pericardial pathology. CCP complicating with intracardiac thrombus is a rare entity, the detection of thrombus preoperatively is life-saving in avoiding the risk of pulmonary thromboembolism during anterior pericardiectomy. Transesophageal echocardiography has been shown to have better sensitivity in detecting atrial thrombus than transthoracic echocardiography. Surgical removal of right atrial thrombus under cardiopulmonary bypass should be considered.

A large aneurysmal bone cyst of the rib.

An aneurysmal bone cyst is a very rare benign tumor of the ribs. It mainly involves the long bones and vertebrae, and requires histopathological examination for definitive diagnosis. We present a case of large aneurysmal bone cyst of the left 6th rib in young adult male. The diagnosis of aneurysmal bone cyst should be kept in mind in young patients presenting with an expansile lytic lesion of the rib, because it has an excellent outcome after complete surgical resection.

Type II aortopulmonary window with tetralogy of Fallot: successful repair.

Aortopulmonary window associated with tetralogy of Fallot is a rare cardiac anomaly. An 8-month-old boy presented with failure to thrive and recurrent chest infections. Echocardiography and imaging studies revealed a type II aortopulmonary window with tetralogy of Fallot. Corrective surgery in the form of patch closure of the aortopulmonary window and intracardiac repair of tetralogy of Fallot was carried out successfully.