Esophagectomy for Cancer of the Esophagus- GMC Jammu Experience

We retrospectively reviewed a data of 202 patients, who underwent esophagectomy for cancer of the esophagusover 12 years at GMC, Jammu. Out of 262 patients, 202 patients underwent esophagectomy, mean age was53 years, ranging between 31-75 years. 160 patients had squamous cell carcinoma and 31 patients hadadenocarcinoma. 148 patients underwent transhiatal esophagectomy (Orringer’s procedure), whereas 18patients underwent McKeown’s three incision procedure and 10 patients underwent transthoracic esophagectomy(Ivor lewis) procedure. It was observed that mid third tumors accounted for 40%, lower third tumorsaccounted for 55 % and GE junction tumors 5% of the cases. Squamous cell carcinoma was the mostcommon histology (79.5 %). The overall morbidity (significant complications leading to prolonged hospitalization)was 38 %. Perioperative mortality was 13(6.43%). We hereby conclude that esophagectomy is a majorsurgical operation and gives palliation of dysphagia to patient and our experience with it has been with acceptablemorbidity and with favorable short-term results.

Prediction of morbidity and mortality in middle and old aged surgical patients-comparison of standard scoring system and addition of echocardiography with hemodynamic indices.

Background: A prospective study was carried out in our hospital to predict morbidity and mortality in middle and old aged surgical patients by adding echocardiography to standard scoring system with hemodynamic studies. Methods: A total of 50 patients of either sex ranging from 40-70 years of ASA grade 1 & 2 scheduled for various types of noncardiac surgeries were enrolled for the study in our hospital. Patients were divided in two groups according to echocardiographic examinations. The patients with normal echocardiographic values were kept in control group and the patients with abnormal values were kept under study group. The patients in study group were further divided in three groups according to LVEF. Group1-LEVF≥60%, Group2-LVEF≥50-59%, Gr3≥40-49% Tab lorazepam was given to all the patients’ orally prior night of surgery. All the patients were induced with same type inducing agents according to body weight. All the patients were maintained on IPPV by anaesthesia machine with supplemental fentanyl, N2O, O2 and muscle relaxant. SPO2, electrocardiograph (ECG), Non-invasive/invasive blood pressure (BP), Spirometry, Capnography and temperature were monitored. At the end of the research project data’s were compiled systematically and were subjected to statistical analysis using odd’s ratio(OR),95% confidence interval (CI), z value and p value, two statistical software programme were used. Results: Significant difference in the results seen between the three study groups (Gr1, Gr2, Gr3) for perioperative ischemic changes, CHF and arrhythmias. Conclusions: In conclusion preoperative TTE before non-cardiac surgery can predict the risk of perioperative cardiac complications in known or suspected cases of cardiac disease patients.

Research into the standard process of fresh freeze - dried plasma for providing medical treatments with dutch dryer LY3-TTE/DM8

Background: Freeze - Dried Plasma (FDP) has many advantages, which could be stored for a long \ufffd?term and transported across remote areas for providing medical treatments and emergency aid. Objectives: To study the standard process of freeze - dried fresh plasma. Subjects and methods: 10 samples of fresh plasma from volunteer donors were selected according to certain categories. Plasma samples were frozen at \ufffd?75oC in 12 hours, freeze - dried at - 45oC and at the atmospheric pressure of 0.04mbar with Dutch dryer Ly - TTE/DM8. The adequate freeze - drying time for every 100ml of plasma was 60 hours. The protein level, factor VIII, electrolysis, the pH of plasma before and after the drying process were evaluated. Results: Results of tracking protein level in comparison between before and after freeze - dry showed the components and levels of freeze-dried protein changed little, with no statistical significance (P>0.05). The clotting factor before and after freeze-dried retains standard activity. After the freeze-dried process, factor VIII achieved 0.80 Ul/ml, prothombin achieved >80%. However, prothrombin decreased clearly (P<0.05). Electrolytes and pH changed had no statistical significance (P> 0.05). Conclusions: The procedures are applicable for processing and manufacturing drying plasma for long-term-storage and medical treatment. \r\n', u'\r\n', u'\r\n', u'

Anti-inflammatory and antiallergic effects of polysaccharide nucleic acid fraction of bacillus calmette guerin / 中国药理学通报

Aim To study the anti-inflammator y and antiallergic effects of polysaccharide nucleic acid fraction of bacillus cal mette guerin (BCG-PSN). Methods Effect of BCG-PSN on itch thr eshold of guinea pigs caused by phosphoric acid histamine, ear oedema of mice ca used by xylene, carrageenan-induced hind paw oedema in rats, delayed hypersensi tivity reaction induced by 2,4-dinitroflurobenzene in mice, homologous passive cutaneous anaphylaxis in rats and heterologous passive cutaneous anaphylaxis in mice were investigated. BCG-PSN was administered intramuscularly every other d ay for three weeks. Results BCG-PSN(0.1,0.2,0.4 mg?kg -1) had no effect on itch threshold of guinea pigs caused by phosphoric aci d histamine. In mice, BCG-PSN(0.15,0.30,0.60 mg?kg -1) significant ly inhibited ear oedema caused by xylene and heterologous passive cutaneous anap hylaxis in a dose-dependent manner. BCG-PSN at the dose of 0.60 mg?kg -1 also significantly inhibited delayed hypersensitivity reaction induced by 2,4 -dinitroflurobenzene in mice. In rats, BCG-PSN(0.1,0.2,0.4 mg?kg -1 )significantly inhibited carrageenan-induced hind paw oedema and homologous passive cutaneous anaphylaxis. Conclusion BCG-PSN inhibites ac ute inflammation, immediate type allergy and delayed type allergy.

Two Cases of Chiari Network

A network of strands (Chiari Network) in the right atrium with attachments extending from the crista terminalis to eustachian valve and thebesian valve or sometimes to the floor of the right atrium in the region of the opening of the coronary sinus. While this congenital remnant is seldom clinically important, this membranes have been reported as site of thombus formation, and hence potential etiologies of pulmonary emboli as well as a source of entrapment of a right-heart catheter and arrhythmia. We report two cases of right atrial mass-like chiari form network incidentally detected by transthoracic echocardiography (TTE) and confirmed by transesophageal echocardiography (TEE).

Echocardiographic Characteristics of Normally Functioning CarboMedics and St.Jude Medical Mitral Valve

BACKGROUND: CarboMedics and St.Jude Medical bileaflet valves are in widespread use but few noninvasive studies about the two types of valves were performedd. The aim of this study was to assess the characterisics of the normally functioning CarboMedics and St.Jude Medical prosthesis in the mitral position. METHODS: Patients with normally functioning CarboMedics and St.Jude Medical valve in the mitral position were included. They underwent transthoracic and transesophageal echocardiography 7 to 14days after mitral valve replacement. With the use of color flow Doppler transesophageal echocardiography, we measured the length, width, and area of maximal physiologic regurgitation and by using 2-D transesophageal echocardiography, we measured the opening and closing angles of the bileaflet valves and we tried to elucidate whether spontaneous echo contrast is present in the left atrium. RESULTS: 31 pateints underwent mitral valve replacement with CarboMedics and 10 patients with St.Jude Medical. The length of maximal physiologic regurgitation ranged from 11mm to 44mm in carboMedics mitral valve and from 12mm to 36mm in St.Jude Medical mitral valve. The area ranged from 0.19cm2to 3.48cm2in CarboMedcs and from 0.58cm2to 4.49cm2in CarboMedics and The mean opening and closing angles are 83.2(+/-1.1)degrees, 22.3(+/-1.3)degrees in CarboMedics and 86.5(+/-1.2)degrees 26.2(+/-3.2)degrees in St.Jude Medical. Spontaneous echo contrast was positive in 66% of patients, of whom patioents with atrial fibrillation showed nuch higher revalence of SEC than patients with sinus rhythm. CONCLUSION: These finding valve will give us a reference valvue for the evaluation of prosthetic valve function in mitral position.

Clinical Utility of Transesophageal Echocardiography(TEE) in Prosthetic Valve Dysfunction

BACKGROUND: Better imaging resolution and less flow masking with TEE than with TTE makes it easier to evaluate the prosthetic valve dysfunction. However, direct comparison between two methods to evaluate prosthetic valve dysfunction remains elucidated. METHODS: Both TTE and TEE were performed in 19 patients with suspected prosthetic valve dysfunction who were admitted to Seoul National University Hospital for evaluating porsthetic valve dysfunction from July, 1992 to May, 1993 and those findings were compared with those of cardiac catheterization and angiography, and surgery 19 cases were included in this study. RESULTS: 11 patients with congestive heart failure underwent TTE, TEE and angiography and each finding was compared to one another. We could see that there is good correlation between transesophageal echocardiographic and angiographic grading in the severity of regurgitation but poor correlation between transthoracic echocardiographic and angiographic finding in that of regurgitation. We also could differentiate between central and eccentric leakage with TEE and in 2 cases TEE enabled us to detect a vegetation on prosthetic valve not detected with TTE and in 1 case the cause of cardiac hemolysis could be known with TEE : eccentric leakage in prosthetic mitral valve. Left atrial thrombi were detected with TEE in two patients with recent cerebral infaction history. CONCLUSION: We conclude that TEE is a good method that enables us to diagnosize the prosthetic valve dysfunction and detect the structural abnormalities surrounding prosthetic valve such as paravalvular leakage, vegetation, cardiac hemolysis and Left atrial thrombi not detected easily by TTE.