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

efficacy of rigid bronchoscopy for foreign body aspiration

The aim of the current study was to determine the pattern, presentation and management of foreign body aspiration in our population. This prospective study comprised 55 patients with foreign body aspiration admitted to our department from January 2009 to December 2011. All patients underwent rigid bronchoscopy under local or general anesthesia. The patients' demographic information along with clinical characteristics and their outcome were recorded and reported. The mean age of the children was 13.3 +/- 3.6 years. There were 32 [58.2%] females and 23 [41.8%] males. The frequent symptom was an attack of chocking followed by cough. The predominant sign was wheezing. Rigid bronchoscopy was successful in removing foreign body from 52[94.5%] patients. Three [5.5%] patients who had undergone thoracotomy with bronchotomy needed exploration, after failure of bronchoscopy to remove the foreign body. There was no mortality in our series. Average hospital stay was 12 hours. It could be concluded that rigid bronchoscopy is modality of choice in management of foreign body aspiration especially in pediatric population

Lung contusion: a clinico-pathological entity with unpredictable clinical course

Lung contusion is an entity involving injury to the alveolar capillaries, without any tear or cut in the lung tissue. This results in accumulation of blood and other fluids within the lung tissue. The excess fluid interferes with gas exchange leading to hypoxia. The pathophysiology of lung contusion includes ventilation/perfusion mismatching, increased intrapulmonary shunting, increased lung water, segmental lung damage, and a loss of compliance. Clinically, patient's presents with hypoxiemia, hypercarbia and increase in laboured breathing. Patients are treated with supplemental oxygen and mechanical ventilation whenever indicated. Treatment is primarily supportive. Computed tomography [CT] is very sensitive for diagnosing pulmonary contusion. Pulmonary contusion occurs in 25-35% of all blunt chest traumas

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