ABSTRACT
Background & Objectives: Aorto-bi-femoral bypass is one of the most important surgical strategies in vascular surgical practice. The procedure is employed in surgical revascularization for both stenotic and aneurysmal diseases involving the aorto-iliac segment. The present study was carried out to analyze our recent experiences with this procedure for aorto-iliac occlusive diseases (AIOD) at the National Institute of Cardiovascular Diseases (NICVD). Materials and Methods: Over a period of 3 years (April 2008 to March 2011), a total of 47 patients underwent aorto-bi-femoral or aorto-bisiliac bypass grafting for AIOD using a Y-graft prosthesis. The mean age of the patients was 46.4 years (range 25-75 years). Thirty eight of the patients were male and the remaining 9 were female. A retroperitoneal approach was used in 27 patients. In the remaining 20 patients, the operation was done using a transperitoneal approach. A Gelatin-coated Dacron Y-graft prosthesis was used in 43 (5 of which were silver-coated prosthesis) patients while PTFE (Polytetrafluoroethylene) prosthesis was used in the remaining 4 patients. The operation was carried out under epidural anesthesia with sedation in most cases. Results: The operation was well-tolerated in all patients. There was no intraoperative mortality in this series. Two patients died in the immediate post-operative period- one due to myocardial infarction and the other due to acute renal shut-down leading to renal failure accounting for a mortality rate of 4.3%. Wound infection and lymphorrhoea at the groin incision site were the two main immediate post-operative complications. There was no incidence of graft infection in this series. Twelve patients were available for post-operative follow-up up to 2 years. Out of them, 5 patients returned with occluded grafts 8-23 months after the operation. Three of these patients underwent graft excision with re-do Y-graft bypass. The remaining two were treated with extra-anatomic bypass (Axillobifemoral). Conclusions: Aorto-bi-femoral bypass is an effective surgical strategy for occlusive diseases involving the abdominal aorta and the iliac arteries. The procedure is well-tolerated with a low incidence of early post-procedural complications and graft failure. However, poor adherence of the patients to follow-up remains a significant obstacle for evaluating the long-term outcome of this procedure.
ABSTRACT
Background: In recent years, high thoracic anaesthesia (HTEA) combined with general anaesthesia has been extensively studied in patients undergoing coronary artery bypass graft surgery with or without cardiopulmonary bypass. Off-pump coronary artery bypass grafting was implemented to reduce trauma of surgical coronary revascularization by avoiding extracorporeal circulation. TEA in combination with GA further reduces intraoperative stress resulting in more rapid extubation and significantly better pain relief in patients undergoing off-pump coronary artery bypass grafting (OPCAB). In addition, common postoperative complications are also decreased. Methodology: 40 male patients aged between 40-65 years with CAD undergoing OPCAB surgery at NICVD from April 2006 to October 2008 were randomly divided in two groups. Group A received epidural analgesic drugs through an indwelling catheter introduced before induction of anesthesia while group B patients received standard general anesthesia (GA) alone. Group A patients received continuous epidural analgesia delivered through the indwelling catheter with a mixture of Lignocaine (2%) 20 ml + Bupivacaine (0.5%) 20 ml + Fentanyl 50 gm 1 ml + normal saline q.v. 50 ml at the rate of 1-2 ml/hour by a syringe pump for up to 72 hours. Group B patients received conventional intermittent narcotics (Morphine)/NSAIDS (Ketorolac/Diclofen) for up to 72 hours. Results: Haemodynamic parameters of all patients in both the groups were within acceptable range throughout operations. Incidence of cardiac dysrhythmias was less in patients of group A. Group A patients showed faster recovery and better analgesia compared to Group B patients. There was also decreased incidence of nausea, vomiting, arrhythmia, O2 desaturation, confusional states, renal failure and requirement of iontropic support in ICU in Group A patients. TEA for postoperative analgesia was safe and well accepted by the patients. There was no complication related to epidural anesthesia in any patient. Conclusion: TEA in general anesthesia provides faster recovery and effective analgesia. Nonetheless, the actual and potential risks of TEA during cardiac surgery should not be underestimated.
ABSTRACT
Preeclampsia is a leading cause of fetal growth retardation, infant morbidity, mortality and maternal death. Several biochemical changes occur during the course of the disease, among them serum total calcium and 24 hr urinary calcium excretion rate have drawn remarkable attention. A case control study was designed to see the association of serum calcium and 24 hours urinary excretion of calcium in patients of pre- eclampsia. The study was done from July 2008 to June 2009 in the Department of Biochemistry, Dhaka Medical College, Dhaka. Total 60 subjects were selected as study population. Among them 30 were diagnosed case of preeclampsia and 30 were age- and sex-matched normal pregnant female healthy control. It was found that the mean measured serum calcium level in case group were 1.96 ±0.17 ( mean±SD ) mmol / l and that of control group were 2.34±0.12 (mean±SD) m mol/ l respectively. The mean 24 hr urinary calcium excretion level were 94.40 ±10.68mg/24 hr (mean±SD) in case group and that of control group were 154.35±66.68 (mean ±SD) mg / 24 hr respectively. The study suggests that low level of serum calcium and urinary excretion of calcium was associated with Pre-eclampsia.
ABSTRACT
Background: The antifibrinolytic drug tranexamic acid (TA) decreases blood loss in Pediatric patients under going cardiac Surgery. However its efficacy has not been extensively studied in children. Method: We examined 750 children under going cardiac surgery form 2004 to 2007 in National Institute of Cardiovascular Diseases (NICVD), 379 children in the Tranexamic Acid group (TA) and 371 included in placebo (P) group. After induction of anesthesia and prior to skin incision, patients received either tranexamic acid (10mg/kg followed by 1mg/kg/hr) and saline placebo. After admission to intensive care unit total blood loss and transfusion requirements during the first12 hours were recorded. Result: Children who were treated with tranexamic acid had 24% less total blood loss (26±7 vs 34±17 ml/kg) compared with children who received placebo (p<0.05). Additionally, the total transfusion requirements, total donor unit exposure and financial cost of blood components were less in the tranexamic acid group. Conclusion: Tranexamic acid can reduce perioperative blood loss in children undergoing cardiac surgery.
ABSTRACT
This prospective study was undertaken to assess the accuracy of clinical and sonographic estimated fetal weight (EFW) in Bangladeshi population. The study protocol consisted of achieving clinical followed by sonographic estimated fetal weight (uEFW) using Shepard formula and then its correlation with actual birth weight (BW). A total of 140 pregnant women participated in this study. The study was conducted in the department of Radiology & Imaging and in the department of Gynae & Obs., Bangladesh Medical College Hospital (BMCH) from January 2005 to December 2005.Maximum number of patients belonged to 26-30 years age group and the mean +/-SD age of the study patients was 26.8+/-4.7 years. Maximum number of women (41.4%) was primigravida and 24.3% women were second gravida. The mean+/-SD gestational age of the patient was 35.9+/-2.8 weeks. We found, clinically EFW was 3432.1+/-410.1 gm (mean+/-SD) and uEFW was 2715.4+/-509.1gm (mean+/-SD) with difference 716.7+/-278.5 gm (mean+/-SD), (P<0.001), which is highly significant. Babies who were delivered within 1st week of clinical and sonographic EFW were selected and their weights were compared with actual BW. The Pearson correlation chi square test and student 't' test were the statistical analysis used. It was found that the P value of clinical versus actual BW was <0.05, this was significant. P value of sonographic versus actual BW was >0.05, this was not significant. Percent error (PE) was found 2+/-7.33% in calculating uEFW from actual BW with minimum error -23.9% and maximum error 11.81%. This study conducted on Bangladeshi fetus using the Shepard formula showed that the actual BW recorded after delivery of the fetus is more close to uEFW than clinically EFW.