Effect of Cardiopulmonary Bypass on Blood and Coagulation Profile in Patients Undergoing Cardiac Surgery.

This study was carried out in the department of cardiac surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2014 to April 2016. This study aims to evaluate the inadvertent effect of cardiopulmonary bypass on complete blood count and coagulation profile. This study was also compared the hemostatic parameters between patients undergoing elective cardiac surgery with CPB and without CPB. A total of 55 patients were included in this study. Among them 20 patients (Group A) were selected for elective cardiac surgery without cardiopulmonary bypass (CPB), 20 patients (Group B) with cardiopulmonary bypass time less than 90 minutes and 15 patients (Group C) were included with cardiopulmonary bypass time either 90 minutes or more. The mean age were 51.5±4.7 years ranging from 40-57 years in Group A, 33.2±10.2 years ranging from 18-50 years in Group B and 34.2±11.4 years ranging from 18-57 years in Group C. The difference of age was statistically significant (p<0.05) among three groups. The difference of post-operative mean hemoglobin and RBC value, WBC and Platelet count on arrival at the intensive care unit, at 48 hours and at 7 days after surgery were statistically significant (p<0.05) in the three groups. However, on arrival at Intensive Care Unit, after 48 hours and at 7 days after surgery, the change of coagulation profile like mean fibrinogen level, bleeding time, clotting time and prothrombin time were statistically significant (p<0.05) among the groups. Patient with long cardiopulmonary bypass time had shown blood and coagulation profile abnormality and it can be minimized if we can curtail the bypass time.

Atypical Location of an Atrial Myxoma: A Case Report.

Here, we report a case of a right atrial myxoma attached to the lateral wall, which is seen in only 10% cases, impinging upon the tricuspid valve. A 57 year old male normotensive, non-diabetic, nonsmoker patient was presented to us on 5th of August 2018 with the complaints of cough, dyspnea and orthopnea for the last two years. This type of presentation is very rare. After excision of myxoma, there was a significant improvement in the signs and symptoms of the patient. In this report, we emphasize the rarity of myxoma in the Right Atrium, and its difficulty in diagnosis because of its uncommon location and atypical presentation, surgical management has shown to quickly alleviate the majority of symptom and expectant sequeale.

Ruptured Aneurysm of Sinus of Valsalva: A Case Report.

We have presented a case of ruptured aneurysm of sinus of valsalva, in a female of 24 years old, with the symptoms and signs of right heart failure. Diagnosis made by echocardiography. For further evaluation, cardiac catheterization was done. After improvement of her general condition, she was undergone operation. Per-operative findings were bicuspid aortic valve having no calcification. A fistulous tract having windsock appearance found in between fused RCC & NCC extending into the RV cavity, which was opened inferior to the tricuspid valve. Fistulous tract was excised and the opening in the root of the aorta was closed with PTFE patch by 5/0 polypropylene and RV side was closed by direct suture. Patient was symptomless after operation. Patient discharged on eighth postoperative day in stable condition.

Left Atrial Myxoma in a Late Case of Lung Carcinoma.

Concomitant occurrence of lung carcinoma and an atrial myxoma is rare. We are reporting such a case, a 55 year old male, farmer, smoker for 30 years was under evaluation for his recent episode of stroke with hemiparesis during which an echocardiography showed presence of a left atrial myxoma and chest x-ray showed a lesion in the midzone of right lung. Fine needle aspiration cytology (FNAC) from enlarged right supraclavicular lymphnode revealed metastatic adenocarcinoma. Patient was referred to a tertiary cancer care hospital thereafter.

A Case of Massive Pleural Effusion: Pleurodesis by Bleomycin.

Malignant pleural effusion is a common complication of primary and metastatic pleural malignancies. Pleurodesis for the management of malignant pleural effusion is intended to achieve symphysis between parietal and visceral pleura, and to prevent relapse of pleural effusion. Many chemical agents are tried to induce inflammation and damage of the pleural mesothelial layer to achieve this symphysis. Hemorrhagic pleural effusion, especially in the right hemithorax commonly occurs as presentation of primary and metastatic pleural malignancies. This case reports massive right-sided hemorrhagic pleural effusion as the sole manifestation of primary lung cancer in a 45 year old man. Patient attended our department of thoracic surgery complaining of cough, shortness of breath and right sided chest pain. A chest X-ray and chest computer tomography (CT) radiograph shows right sided massive pleural effusion. Right sided tube thoracotomy done. Pleural fluid study was done. Fluid for cytopathology was positive for malignant cell. Computed tomography guided fine needle aspiration cytology from right lung lesion was also done. Diagnosis was as small cell carcinoma. Pleural effusion resolved after 9(th) post operative day of chest tube insertion. Bleomycin pleurodesis was done. Day after pleurodesis intra thoracic tube was removed and patient was discharged from hospital on 10(th) Post operative day with an advice to attend the oncology department for further treatment. The protocol of tube thoracostomy and chemical pleurodesis was almost always successful in giving symptomatic relief of respiratory distress for a considerable period of time. However, chemical pleurodesis is not possible in all cases of malignant pleural effusion because it has got potential complication including death.

A Rapid and Reliable End-To-End Anastomosis Technique for Emergency Vascular Surgery--A Case Report.

A 28 year old male presented to us with 8 hours old open fracture of distal shaft of left femur which was already stabilized with external fixator but had no palpable distal pulse both clinically and on doppler examination. He underwent a primary repair following limited segmental resection. Commonly end-to-end anastomosis techniques following transection of arteries include interrupted and continuous suturing with or without 'parachuting' of the vessel or graft. Here we offer a rapid and reliable technique with following advantages: i) operating system always towards the surgeon, ii) posterior row of suture placed as both ends are well visualized, iii) less chance of catching posterior wall, iv) flushing performed easily before completing anterior row suture. Upto 2nd post operative day anticoagulant used in the form of inj. Heparin 2500 IU subcutaneously 8 hourly and patient was discharged from hospital on 3rd post operative day with presence of good distal pulses both on clinical and Doppler examination. Fourteen days later, on follow up Duplex study showed normal arterial flow without any stenosis or occlusion.

Surgical Closure of Atrial Septal Defect with High Pulmonary Vascular Resistance--A Case Report.

We have reported a case of successful pericardial patch closure of atrial septal defect with high pulmonary vascular resistance in a 32 years aged male. Diagnosis was confirmed by Doppler Echocardiography, Cardiac catheterization and lung biopsy. Before starting (orally) bosentan pulmonary arterial pressure was 105 mm Hg and pulmonary vascular resistance was 8 wood's unit. Bosentan was started at a dosage of 125 mg per day (62.5 mg twice a day) for 4 months before operation in this case. Just day before operation pulmonary arterial pressure was 87 mm Hg. Bosentan lowered pulmonary arterial pressure and reversed remodeling of pulmonary arteries and allowed surgical correction. During the post operative course, partial pressure of oxygen was significantly decreased and bilateral radiolucent opacity was present in lower zone of both lungs. All these were managed successfully in postoperative period. This case report has demonstrated that surgical correction of an atrial septal defect is feasible but requires long time pre and post operative treatment with pulmonary vasodilators.

Ice test in diagnosis of ocular myasthenia.

This observational, non-control, non equivalent pretest and post test descriptive study was carried out at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2009 to December 2009 to compare the efficacy of ice test and repetitive nerve stimulation (RNS) in diagnosis of ocular myasthenia gravis. Ten patients with fluctuating ptosis (4 male and 6 female) who were suspected of having ocular myasthenia were included in the study. Male and female ratio in the study was 2:3. The mean age of the patients was 28.1 years. Positive response to pyridostigmine was taken as confirmation of ocular myasthenia. A piece of ice (2cm × 1cm) was placed over the upper eyelid for 2 minutes and the vertical eye lid fissure height was noted before and after the application of ice. Repetitive nerve stimulation was performed in the same subjects subsequently. Results of two tests were compared. Eight patients shows good (>2mm) elevation of eyelid with ice and three patients had abnormal RNS. In conclusion, ice test appears as more sensitive clinical test to detect ocular myasthenia than RNS test.