Single stage removal of right pulmonary and hepatic hydatid cysts.

A case of hydatid disease of lung and liver is described. The patient was investigated because of a circumscribed shadow in the right lung on chest skiagram. Another cystic shadow was picked up in the right lobe of liver on ultrasound examination. Both the cysts in right lung and liver were removed simultaneously through a right thoracophrenotomy. Emphasis is being laid on the utilization of single stage thoracotomy as an operative procedure of choice for hydatid cysts of right lung and liver.

Post-cardiotomy intra-aortic balloon counter pulsation: application and prognostic evaluation.

Cardiac assistance by intra-aortic balloon counter pulsation was studied in 113 cardiac surgical cases comprising 91 male and 22 female patients. This included 82 percent of patients having coronary artery bypass surgery, while 18 percent were operated for valvular lesions. It was observed that the time of institution of cardiac assistance by intra-aortic balloon counter pulsation, following cardiac surgery, was of prime importance to decrease patient mortality. It was lowest (16%) when the balloon was inserted for assistance before termination and highest (50%) when there was delay of more than 15 minutes following termination of cardiopulmonary bypass. Early balloon assistance significantly lowered the pulmonary capillary wedge pressure and usually 1:2 augmentation was more effective, probably because of existing tachycardia in most patients. Advances in catheter technology have reduced the vascular complication at the insertion site. Percutaneous insertion had less local complications (13.3%) than open arteriotomy technique (31.2%). Similarly with sheathless insertion, complications were less (6.6%) in comparison to sheathed insertion (21.7%). Proper placement of balloon avoided position-related complications and there was no compromise of blood flow through left internal mammary artery as noticed in our series.

Thrombolytic therapy for prosthetic valve thrombosis in Third World countries.

In order to clarify the role of thrombolytic therapy for treatment of prosthetic valve thrombosis, all cases admitted in the intensive care unit (ICU), between March 1987 and March 1997 with the diagnosis of prosthetic valve thrombosis and treated with streptokinase, were analysed. In total, 42 patients with clinical and echocardiographic evidence of left side tilting disc prosthetic valve thrombosis were treated. All the patients had only mitral valve prosthesis involvement. Streptokinase was administered as a bolus of 2.5 lac units over 30 minutes followed by 1 lac units/hour for 48-72 hours. Thirty-seven (88%) patients had successful thrombolysis. Overall mortality occurred in 9.5 percent patients due to systemic embolism and bleeding complications. Serial clinical, radiological and echocardiographic studies showed successful thrombolysis in 88 percent patients. This study demonstrates that streptokinase therapy is safe and effective first line treatment for left-sided prosthetic valve thrombosis and surgery should be reserved for those patients who fail to respond to thrombolytic therapy.