ABSTRACT
Introduction: Penetrating chest injuries may seriously damage the lungs, heart and other thoracic structures. Blunt injuries are most commonly deceleration injuries associated with motor vehicle crashes that result in falls or blows to the chest. Aim of study: To determine the magnitude and management of patients with chest trauma in a rural setup. Materials and methods: A study of 50 cases of chest trauma admitted in, Government Mohan Kumaramangalam Medical College Hospital, from 2013-2017. The data collected included the patient’s demographic profile; mode, type and severity of chest injuries, management scheme and outcome. Results: There were 62(79.5%) males and 38 (20.5%) females, giving a male to female ratio of 3.8:1. The age ranged between 5-67 years with a mean of 32.28 years. Blunt injuries constituted the remaining 30(38.46%) and were all as a result of road traffic accidents (RTA). All patients had chest radiographs from which the commonest lesions; simple rib fractures, hemopneumothorax, hemothorax, and pneumothorax were diagnosed. There were none with major vascular or esophageal injuries. The commonest extra-thoracic associated injuries were limb fractures and abdominal injuries Conclusion: The outcome of thoracic injuries will depend upon the health care provider’s knowledge of the physics of the event and the urgency of the diagnosis, as well as the ability to assess and manage all the variables involved. The proper approach to the patient can positively influence the quality of the assessment, the level of cooperation and the long term outcome of care.
ABSTRACT
Introduction: Constrictive Pericarditis is a chronic inflammatory process that leads to progressive pericardial fibrosis encasing the heart in a thickened and fibrotic pericardium. This leads to impaired diastolic filling of the cardiac chambers, end result of reduced cardiac output. Aim of study: To analyze the perspectives of clinical outcomes and surgical results of pericardiectomy (total or subtotal) done by left anterolateral thoracotomy. Materials and methods: Totally 20 patients were included in the study. The study was conducted in the department of cardiothoracic surgery, Government Mohan Kumaramangalam Medical College Hospital, From 2013-2017. Regardless of the age group, resection of the diseased pericardium was essential for minimizing early morbidity and mortality and improving long-term functional results and quality of life. This study was designed to compare two types of surgical technique of pericardiectomy, total and subtotal pericardiectomy by left anterolateral thoracotomy. Results: There was a lesser degree of pulmonary complications in both the groups' patients requiring antibiotic therapy and two patients required bronchoscopy for retained secretions and two patients had a pleural effusion, which required drainage. Conclusion: The results of pericardiectomy in terms of improvement in NYHA status and mortality are similar in both types of resection. The combination of chemotherapy and surgery yields good results in the treatment of tuberculosis pericarditis.
ABSTRACT
Background: Perioperative myocardial damage is one of the most common causes of morbidity and mortality after heart surgery. The improvement of the technique of myocardial preservation has contributed greatly to significant advances in cardiac surgery. However, serious questions remain regarding the use of warm versus cold cardioplegia, blood versus crystalloid cardioplegia, antegrade versus retrograde delivery and intermittent versus continuous perfusion. Cardioplegic solution is the means by which the ischemic myocardium is protected from cell death. This is achieved by reducing myocardial metabolism through a reduction in cardiac workload and by the use of hypothermia. Chemically, the high potassium concentration present in most cardioplegic solutions decreases the membrane resting potential of cardiac cells. The normal resting potential of ventricular myocytes is about -90 mV. Materials and methods: The study was conducted in the Department of Cardiothoracic Surgery, Government Mohan Kumaramangalam Medical College Hospital from 2016-2017. Thirty patients were selected and divided into two equal groups. Group I, Isothermic blood cardioplegia, patients were cooled to 30˚C, and cardioplegia given at the same temperature as circulating blood in cardiopulmonary bypass and repeated at 20 minutes. The cardioplegic heat exchanger was not utilized in the cardiopulmonary bypass circuit. In group II, conventional cold cardioplegia, patients were cooled to 28-30˚C. Cardioplegia was given at 7-10˚C and was repeated every 30 minutes. To assess myocardial metabolic activity, myocardial oxygen consumption (MVO2), myocardial glucose uptake, myocardial lactate, and acidosis were measured, using arterial and coronary venous blood samples. Results: Mean cardiopulmonary bypass time was significantly shorter receiving isothermic blood cardioplegia (69 v/s 96 minutes). Serum lactate after cardiopulmonary bypass in isothermic blood Pon. A. Rajarajan. Comparison of isothermic and cold cardioplegia in cardiac surgery in Salem District. IAIM, 2019; 6(3): 266-271. Page 267 cardioplegia was lower (1.9 v/s 2.9). There was less metabolic acidosis in the isothermic group (pH 7.37 v/s 7.34). Glucose uptake was higher in the isothermic group. Myocardial contractile function was slightly better in the isothermic group (Ejection Fraction -62 v/s 60 %). Conclusion: The aim of myocardial protection during heart surgery was to preserve myocardial function while providing a bloodless and motionless operating field. In the early stage, myocardial protection was obtained by decreasing myocardial oxygen demand as a consequence of hypothermia. Although intermittent cold cardioplegia perfusion is associated with excellent clinical outcomes in cardiac surgery, this standard technique results in myocardial hypothermia, ischemia and a delay in the recovery of postoperative myocardial metabolism and function. Myocardium utilizes more oxygen and glucose after isothermic cardioplegia, but lactate and acid production were less.