Characteristics of pseudoaneurysms in Northern India; risk analysis, clinical profile, surgical management and outcome

Objective: To determine the risk factors, clinical characteristics, surgical management and outcome of pseudoaneurysm secondary to iatrogenic or traumatic vascular injury

Methods: This was a cross-sectional study being performed in department of cardiovascular and thoracic surgery skims soura during a 4-year period. We included all the patients referring to our center with primary diagnosis of pseudoaneurysm. The pseudoaneurysm was diagnosed with angiography and color Doppler sonography. The clinical and demographic characteristics were recorded and the risk factors were identified accordingly. Patients with small swelling [less than 5-cm] and without any complication were managed conservatively. They were followed for progression and development of complications in relation to swelling. Others underwent surgical repair and excision. The outcome of the patients was also recorded

Results: Overall we included 20 patients with pseudoaneurysm. The mean age of the patients was 42.1 +/- 0.6 years. Among them there were 11 [55%] men and 9 [45%] women. Nine [45%] patients with end stage renal disease developed pseudoaneurysm after inadvertent femoral artery puncture for hemodialysis; two patients after interventional cardiology procedure; one after femoral embolectomy; one developed after fire arm splinter injury and one formed femoral artery related pseudoaneurysm after drainage of right inguinal abscess. The most common site of pseudoaneurysm was femoral artery followed by brachial artery. Overall surgical intervention was performed in 17 [85%] patients and 3 [15%] were managed conservatively

Conclusion: End stage renal disease is a major risk factor for pseudoaneurysm formation. Coagulopathy, either therapeutic or pathological is also an important risk factor. Patients with these risk factors need cannulation of venous structures for hemodialysis under ultrasound guide to prevent inadvertent arterial injury. Patients with end stage renal disease who sustain inadvertent arterial puncture during cannulation for hemodialysis should receive compression dressings for 5 to 7 days

Outcome of trans-axillary approach for surgical decompression of thoracic outlet: a retrospective study in a tertiary care hospital

The aim of this study was to evaluate the trans-axillary surgical approach in patients with thoracic outlet syndrome. This retrospective study is comprised of data acquired from January 1998 until Oct 2008. Case histories of all the patients were reviewed from the Medical Records Department of Sher-i-Kashmir Institute. Relevant information and follow-up of the patients was carried out by examining the relevant clinical notes available by telephone interviews and personal contact whenever possible. All data was compiled and analyzed statistically. There were a total of 139 patients. The female: male ratio was about 6:1. Pain was the most common presenting symptom followed by weakness and parasthesia. Nerve conduction velocity was abnormal in 111 patients. Twenty-eight patients had abnormal Doppler study of subclavian vessels. Preoperative symptoms persisted in 13 patients. Overall, 126 patients showed improvement in symptoms and no recurrence or persistence of symptoms on follow-up examination. Trans-axillary approach provides a good exposure and cosmesis in patients with thoracic outlet syndrome. It should be considered as the gold standard in the management of thoracic outlet syndrome

pattern, presentation and management of pardah pin inhalation: report from a single center in northern india

Objective: To describe the clinical characteristics, presentation and management of Pardah pin inhalation in female teenagers of single center in northern India

Methods: This was a prospective cross-sectional study being performed in department of cardiovascular and thoracic surgery of Sher-i-Kashmir institute of medical sciences located in northern India from January 2009 to December 2012. We included 36 female patients with Pardah pin inhalation who were admitted to our center during the study period. All patients underwent rigid bronchoscopy under local or general anesthesia. We recorded the baseline characteristics including the demographic information, the site of the pin and clinical findings as well as the management strategies and the outcome of these patients

Results: All patients were female using scarf to wrap their head and neck as religious obligation. Mean age of the patients was 14.3 +/-3.6 years. The most common symptom was chocking followed by cough being reported in all [100%] and 31 [86.1%] patients respectively. Bronchoscopy was successful in removing the pin in 31 [86.1%] patients. Pins were located in right main bronchus in 20 [55.5%] patients, and in left main bronchus in 10 [27.7%] patients. There was no mortality in our series. Pin was removed in 31 [86.1%] patients with the help of bronchoscope, but 5 [13.9%] patients needed bronchotomy for removal of the pin. Average hospital stay was 12.43 +/-1.6 hours. 1

Conclusion: Rigid bronchoscopy is an ideal approach in management of Pardah pin inhalation. However somff patients may need bronchotomy to remove the Pardah pin

Outcome of the surgical treatment of bullous lung disease: a prospective study

This study aimed at evaluating the outcome of surgery for bullous lung disease by comparing the preoperative and postoperative subjective dyspnea score, pulmonary function and clinical features. This prospective study was conducted from May 2009 to October 2011, on 54 patients operated for bullous lung disease. Follow-up at 3-6 months consisted of taking a comprehensive history, physical examination, radiological work-up, and evaluation of changes in subjective dyspnea score, arterial blood gas analysis [ABG], and pulmonary function test [PFT]. After comparison with preoperative values, the student's paired t-test was used to calculate the statistical significance. With approximately 21.6 cases per year, the most common underlying lung pathology was primary bullous lung disease, followed by COPD. The most common presenting complaint was spontaneous pneumothorax in tall young adults in their fourth decade of life with a history of smoking. Bullectomy, with or without decortication, was done for all cases. Improvement in mean PaO2 [arterial partial pressure of oxygen], SaO2 [arterial oxygen saturation] and PaCO2 [arterial partial pressure of carbon dioxide] was seen in most cases but was statistically insignificant. Improvement in mean FEV1 [forced expiratory volume in 1st second], FVC [forced vital capacity] and FEV1 / FVC was statistically significant, with FEV1 being the most reliable indicator of postoperative progress. Improvement in subjective dyspnea score was statistically significant and showed an inverse correlation with FEV1. Those with diffuse pulmonary parenchymal involvement had poorer baseline values and less significant postoperative improvement. Complications occurred more commonly in those with diffuse disease. Mortality was seen exclusively in those with diffuse disease. We conclude that surgery is required for bullous lung disease more frequently in our community since we have a high number of young patients with primary bullous lung disease and localized parenchymal involvement and these patients have a good surgical outcome. Potentially fatal complications like pneumothorax and recurrent infections can therefore be prevented in them. Those with underlying diffuse disease and severely decreased FEV1 [especially below 1 L] also benefit from surgery but require careful patient selection

Vascular injuries caused by tear gas shells: surgical challenge and outcome

Tear gas shells are used to disperse the mob during any type of street protests. Vascular injuries due to tear gas shells have not been reported. The present study was undertaken to analyse the pattern, presentation, management and outcome of vascular injury due to tear gas shells. Eighteen patients with vascular injury caused by tear gas shells from 1[st] Jan. 2008 to 31[st] Dec 2009 were studied. Patients with vascular injuries caused by causes other than tear gas shells were excluded from the study. All patients were treated with reverse saphenous vein graft as segmental loss was less than 2.5 cm. wound infection was the most common complication, followed by graft occlusion. Amputation rate was 16.66%. Associated nerve injury occurred in 44.44% of the patients. Tear gas shell injuries should not be taken lightly. They can cause injuries as serious as vascular injuries. Vascular injuries cased by tear gas shells require prompt revascularization to improve limb salvage. Despite proper revascularization, patients have significant morbidity and need proper rehabilitation in the follow ups