ABSTRACT
Peripheral arterial disease, being a manifestation of systemic atherosclerosis, carries a high risk of adverse cardiovascular events. Secondary medical prevention therapies of same magnitude as that for coronary artery disease are recommended for peripheral arterial disease patients also. Available evidence indicates that this condition commonly remains underdiagnosed and undertreated. There is lack of any report about management of these patients in India. The objectives of the present study were to characterize the atherosclerotic risk factor profile and pattern of drug prescription for patients of peripheral arterial disease at a tertiary care teaching hospital and to compare this management with standard guidelines. Data were collected from prescriptions of patients attending cardiothoracic and vascular surgery outpatient department with diagnosis of atherosclerotic peripheral arterial disease from July 2012 to Jun 2013. One hundred twenty prescriptions were analysed. The mean age (±SD) of patients was 53±7.18 years and 23.3% were females. History of smoking, either past or present, was present in 91.6% patients. History of ischemic heart disease was present in 25%, while 26.7% patients were diabetic. Mean number of cardiovascular risk factors was 2.6. The percentage of eligible patients who were receiving a particular drug was 100% for aspirin and statins, 48.3% for angiotensin converting enzyme inhibitors, 46.7% for beta blockers and 66.7% for cilostazol. The vascular surgeons of this centre are using antiplatelet agents and statins adequately for peripheral arterial disease. The prescription of angiotensin converting enzyme inhibitors, beta blockers and cilostazol is low. Exercise therapy and smoking cessation need more attention.
ABSTRACT
Simultaneous occurrence of traumatic abdominal wall hernia (TAWH) and traumatic diaphragmatic hernia (TDH) is uncommon. Our report documents the rare delayed presentation of simultaneous occurrence of TAWH and TDH in a patient who sustained a bicycle handlebar injury as a consequence of the bicycle he was riding colliding with a motorbike in a road-traffic accident. Excellent outcome could be achieved in this patient with surgical repair without requiring the use of a mesh.
Subject(s)
Abdominal Injuries/complications , Bicycling/injuries , Diaphragm/injuries , Hernia, Abdominal/etiology , Hernia, Diaphragmatic/etiology , Accidents, Traffic , Hernia, Abdominal/diagnosis , Hernia, Diaphragmatic/diagnosis , Humans , Male , Middle AgedABSTRACT
We report a case of a 22-year-old male with Down syndrome and Morgagni hernia, who presented to us with complaints of cough, regurgitation and vomiting. He was successfully treated surgically and the defect was repaired with prolene mesh.
Subject(s)
Down Syndrome/complications , Hernia, Diaphragmatic/complications , Rare Diseases , Diagnosis, Differential , Follow-Up Studies , Hernia, Diaphragmatic/diagnosis , Hernia, Diaphragmatic/surgery , Humans , Laparotomy/methods , Male , Radiography, Thoracic , Surgical Mesh , Tomography, X-Ray Computed , Young AdultABSTRACT
A case of chondrosarcoma rib which turned out to be a case of metastatic adenocarcinoma on histopathological examination is being presented.
Subject(s)
Adenocarcinoma/diagnosis , Adenocarcinoma/secondary , Colonic Neoplasms/diagnosis , Ribs/pathology , Thoracic Neoplasms/diagnosis , Thoracic Neoplasms/secondary , Chondrosarcoma/diagnosis , Colonic Neoplasms/pathology , Diagnosis, Differential , Fatal Outcome , Humans , Male , Middle AgedABSTRACT
Aspiration of a foreign body in young children is rare but can still cause considerable morbidity and mortality. The case of a 5 1/2-month-old infant with aspiration of a piece of apple is presented, together with a review of the literature.
Subject(s)
Bronchi , Foreign Bodies/etiology , Inhalation , Airway Obstruction/etiology , Cough/etiology , Dyspnea/etiology , Humans , Infant , MaleABSTRACT
Vaginal melanoma is a rare cancer usually diagnosed as a locally advanced disease. Aggressive surgical management of the primary tumor and local-regional recurrences, combined with the use of adjuvant radiation and chemotherapy, improves disease-free interval and, perhaps, survival times. Techniques of regional chemotherapy allow the delivery of high doses of chemotherapy to the tumor bed, while minimizing systemic toxicities. These treatments can be used to decrease tumor size, render bulky tumors resectable, and decrease the need for radical procedures. Additionally, they may help eradicate clinically inapparent local-regional disease and have a favorable effect on survival times.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Chemotherapy, Cancer, Regional Perfusion , Melanoma/drug therapy , Vaginal Neoplasms/drug therapy , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Female , HumansSubject(s)
Ear Diseases/physiopathology , Islam , Nose Diseases/physiopathology , Religion and Medicine , Ear Diseases/surgery , Ear, Middle/physiopathology , Ear, Middle/surgery , Female , Humans , Male , Nasal Polyps/physiopathology , Nasal Polyps/surgery , Nose Diseases/surgery , Rhinitis, Vasomotor/physiopathology , Rhinitis, Vasomotor/surgeryABSTRACT
Forty-seven patients with oesophageal carcinoma were managed in 6 years' time. Average duration of illness was 5.5 months. History of chronic smoking and/or tobacco chewing was present in 80.85% of patients. Carcinoma included squamous cell variety (80.85%) and adenocarcinoma (19.15%). Thirty-one patients were in stage III while 16 patients were in stage II. Surgery included oesophagogastrectomy/oesophagogastrostomy (16 patients), feeding gastrostomy (11 patients), Mousseau-Barbin tube insertion (10 patients), only 10 patients were subjected to palliative radiotherapy. All patients after palliative treatment died within one year whereas 3-year and 5-year survivals after oesophagogastrectomy/oesophagogastrostomy were 68.75% and 31.25% respectively. Local lymph node metastasis adversely affected the 5-year survival rate.
Subject(s)
Adenocarcinoma , Carcinoma, Squamous Cell , Esophageal Neoplasms , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Adenocarcinoma/therapy , Adult , Aged , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Combined Modality Therapy , Esophageal Neoplasms/mortality , Esophageal Neoplasms/pathology , Esophageal Neoplasms/therapy , Female , Humans , India/epidemiology , Male , Middle Aged , Palliative Care , Plants, Toxic , Risk Factors , Smoking/adverse effects , Survival Rate , Tobacco, Smokeless/adverse effectsABSTRACT
During last six years, 2250 patients were treated in Cardiothoracic Unit for thoracic complications of pulmonary tuberculosis. During isoniazid/streptomycin/ethambutol treatment, 2 patients out of 710 (0.28%) developed hepatitis. During isoniazid/rifampicin/ethambutol therapy, 18 patients out of 1540 (1.17%) suffered from jaundice; all these patients were above 30 years of age, and many had gross anemia (Hb less than 9 gm%), hypoalbuminemia (less than 3 gm%) and radiologically far-advanced disease in comparison to those who did not develop jaundice (p less than 0.05). Jaundice subsided completely after discontinuation of isoniazid and/or rifampicin which were re-instituted successfully after recovery without recurrence of hepatitis. It is suggested that the development of hepatitis does not warrant total withdrawal of these two highly effective bactericidal drugs but they should be tried again cautiously after recovery from jaundice.
Subject(s)
Antitubercular Agents/adverse effects , Chemical and Drug Induced Liver Injury/epidemiology , Tuberculosis, Pulmonary/drug therapy , Adult , Drug Therapy, Combination , Ethambutol/administration & dosage , Female , Humans , Isoniazid/administration & dosage , Male , Retrospective Studies , Rifampin/administration & dosage , Streptomycin/administration & dosage , Tuberculosis, Pulmonary/complicationsABSTRACT
Thirty normotensive patients (ASA class I) and 30 treated hypertensives without any cardiac problem (ASA class II) were subjected to elective cholecystectomy under general anaesthesia. Patients' age ranged from 25-50 yr, and male:female ratio was 1:11. There were significant increases in heart rate and mean arterial pressure in both the groups (P less than 0.05) during surgical manipulations for removal of the diseased gall bladders. The alterations in the treated hypertensive patients were not only much more than in the normotensives, but also were associated with tachyarrhythmias in 33.33 per cent of hypertensive patients. All changes returned to the pre-induction level at the end of the surgery. Mediation through fifth thoracic spinal segment, a common source of sympathetic supply to heart and gallbladder, explained the observed cholecystocardiac link. Anaesthetists therefore need to be vigilant during cholecystectomies.
Subject(s)
Gallbladder Diseases/surgery , Gallbladder/physiopathology , Heart/physiopathology , Hypertension/complications , Adult , Female , Gallbladder Diseases/complications , Gallbladder Diseases/physiopathology , Humans , Male , Middle Aged , Reference ValuesABSTRACT
Respiratory distress caused by a giant mediastinal teratoma is hitherto unreported. This communication presents the case history of an 8-year-old boy who presented with this serious problem, along with perforation of the chest wall.
Subject(s)
Dermoid Cyst/complications , Dyspnea/etiology , Mediastinal Neoplasms/complications , Child , Humans , Male , Rupture, Spontaneous , Thoracic Diseases/etiologyABSTRACT
A total of 100 cases of flail chest were studied to find out the efficiency of the anti-lung contusion regimen containing a diuretic, a steroid and an enzyme preparation for some 10 days, along with pad and strapping. There were 80 males and 20 females. Majority (71%) of patients were between 16 and 45 years. Road side accident was the commonest cause, present in 65% cases followed by bull horn injuries (25%), fall from a height (8%) and gun shot injuries to chest (2%). Associated intrathoracic and extrathoracic injuries were recorded in 45% and 30% cases respectively and they were treated according to their merits. There were 11 deaths with an overall success rate of 89%.
Subject(s)
Flail Chest/therapy , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Flail Chest/etiology , Humans , Infant , Male , Methods , Middle AgedSubject(s)
Echinococcosis, Pulmonary/complications , Pneumothorax/etiology , Child , Humans , Rupture, SpontaneousABSTRACT
Successful removal of unusual intrapleural foreign bodies (surgical blades) by means of a bronchofibrescope (BFS) passed through the thoracostomy tube tract is reported. The potential role for the use of the fibreoptic bronchoscope for this purpose is emphasized.
Subject(s)
Bronchoscopes , Foreign Bodies/therapy , Pleura , Adult , Fiber Optic Technology/instrumentation , Humans , Male , Surgical InstrumentsABSTRACT
Twenty-five cases of bilateral simultaneous pneumothorax were studied. In children it was mostly postpneumonic, whereas in adults it was tuberculous or traumatic. Prompt intercostal drainage on both the sides supported by antibiotics and/or anti-tubercular drugs, and respiratory physiotherapy was curative on most occasions. The association of bronchopleural fistula or septicaemia worsens the prognosis.
Subject(s)
Pneumothorax/pathology , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Pneumothorax/etiology , Respiratory Tract Infections/complications , Thoracic Injuries/complications , Tuberculosis, Pulmonary/complicationsABSTRACT
Tooth in right bronchus in a 60-year-old man who presented with recurrent episodes of chest infection, dyspnoea and haemoptysis is a rare clinical entity. The patient was cured after successful bronchoscopic removal of the tooth.
Subject(s)
Bronchi , Foreign Bodies/etiology , Tooth Extraction/adverse effects , Bronchoscopy , Humans , Male , Middle Aged , MolarABSTRACT
A 3.5-year-old girl sustained compression injury leading to isolated bilateral diaphragmatic rupture with extensive herniation of abdominal viscera into the pleuropericardial cavities. Reduction of the hernia and repair of the defects were readily accomplished through a thoraco-abdominal approach with excellent outcome.