Acute aortic syndromes in India: The need for a nationwide program to increase awareness.

Acute aortic dissection is a rare, but potentially life-threatening and time-critical condition that is frequently misdiagnosed. Therefore, its prompt and proper diagnosis is vital to increase a patient's chance of survival and to prevent grievous complications. Raising awareness and educating the general population and healthcare professionals about an aortic dissection is mandatory, for early diagnosis and improving the chances of survival.

Experience with pulmonary endarterectomy: Lessons learned across 17 years.

BACKGROUND: Pulmonary endarterectomy is potential curative therapy for chronic thromboembolic pulmonary hypertension patients. Here, we present our experience with pulmonary endarterectomy spanning 17 years and detail our management strategy. METHODS: This is a single-centre retrospective study conducted on chronic thromboembolic pulmonary hypertension patients who underwent pulmonary endarterectomy at our centre across 17 years. RESULTS: Between 2004 and 2020, 591 patients underwent pulmonary endarterectomy. Amongst them 429 (72.4%) were males with a male to female ratio of 2.6:1, the median age was 38 (range, 14-73) years. The median length of hospital stay was 11 days (IQR, 8-16). Extra corporeal membranous oxygenation was used in 82 (13.9%) patients during/after surgery, out of whom 28 (34.1%) survived. There were 70 (11.8%) in-hospital deaths. Female gender (p < 0.01), pulmonary artery systolic pressure >100 mmHg (p < 0.05) and use of extra corporeal membrane oxygenation (p < 0.001) were significant risk factors for in-hospital mortality. The mortality in the first period (2004-2012) was 15.7% which reduced to 9.1% in the later period (2013-2020). The reduction in mortality rate was 42% (p < 0.05). Following pulmonary endarterectomy, there was a significant reduction in pulmonary artery systolic pressure (86.68 ± 24.38 vs. 39.71 ± 13.13 mmHg; p < 0.001) and improvement in median walk distance as measured by 6-min walk test on follow-up (300 vs. 450 meters; p < 0.001). The median duration of follow-up was 8 months (inter-quartile range: 2-24). CONCLUSIONS: pulmonary endarterectomy has a learning curve, high pulmonary vascular resistance alone is not a contraindication for surgery. Patients following surgery have improved survival and quality of life.

Management of intrapulmonary hemorrhage in patients undergoing pulmonary thrombo-endarterectomy.

Massive pulmonary hemorrhage during pulmonary thromboendarterectomy (PTE) can be managed by a conservative approach with mechanical ventilatory support, positive end-expiratory pressure, lung isolation, reversal of heparin, and correct of coagulopathy. We present three challenging cases that developed intrapulmonary hemorrhage during/after PTE and managed successfully. The first patient had bleeding from the bronchial artery and right internal mammary collaterals, which was managed by coil-embolization. The second patient had a breach in the blood airway barrier in the right upper lobar segment of the lung, and the repair was done using a surgical absorbable hemostat. The third patient developed reperfusion injury, he was instituted on veno-venous extracorporeal membranous oxygenation, a week later, the patient recovered completely. An algorithm was adopted and modified to our requirements; all the 3 challenging intrapulmonary hemorrhage cases were successfully managed. This algorithm can be used for satisfactory outcomes in patients who suffer intrapulmonary hemorrhage during PTE.

Aspiration and Steroid Injection-An Effective Approach for Auricular Seroma.

INTRODUCTION: Auricular seroma is a benign condition of the pinna usually following blunt trauma. This condition which presents with a simple swelling of the pinna is occasionally associated with pain and may result in permanent disfigurement of the pinna owing to delay in diagnosis or mismanagement. Various techniques have been proposed and practiced over the years to treat this uncomplicated condition. However, since this condition is notorious for its recurrence, it has always posed a challenge to the ear, nose, and throat surgeons. Therefore, a simple technique known as aspiration and intralesional steroid injection was proposed in this study for the treatment of auricular seroma. MATERIALS AND METHODS: A total of 30 patients with a clinical diagnosis of auricular seroma were studied over a period of six years at a tertiary care hospital in Mangalore, India. The seroma was aspirated with a 22 gauge needle followed by intralesional injection of Triamcinolone acetate (40 mg/1 ml). The patients were followed up strictly for two weeks, one, three, and six months, as well as one year, and thereafter at yearly intervals as long as possible. No recurrence was observed as the main outcome of treatment for at least one year. RESULTS: None of our patients had recurrence at the end of one year. In total, 15 patients followed up for at least two years. In addition, four patients are continuing follow-ups at the moment (i.e. six years post-treatment). CONCLUSION: Aspiration and intralesional steroid injection is a simple, minimally invasive, cost-effective, and a promising treatment modality which avoids recurrence.

Primary cutaneous 'ulcerative' tuberculosis of the scrotum: a rare occurrence.

Tuberculosis (TB) is a global disease and if not adequately treated can lead to morbidity and mortality. Though genitourinary TB is common and only next to pulmonary TB, cutaneous 'ulcerative' tuberculosis of the scrotum is not reported so far in the literature. We present a 32-year-old man with a non-healing scrotal ulcer and underwent excision. Histopathology was consistent with TB. Antitubercular therapy was given and at the end of a year's follow-up, there has been no recurrence. TB of the scrotum should be considered in the differential diagnosis of scrotal ulcers. Proper diagnosis and adequate treatment will offer a cure to such patients.

Repair of an aneurysm of the ascending aorta and arch in an infant with Loeys-Dietz syndrome.

Aortic aneurysms in childhood are rare disease entities and are usually seen in patients with genetic connective tissue disorders such as Marfans, Ehler-Danlos, and Loeys-Dietz syndrome (LDS). Patients affected with LDS present early in life and have a rapid disease progression. We report a case of repair of an ascending and aortic arch aneurysm in an infant with Loeys-Dietz syndrome.

Single-stage repair for multiple muscular septal defects: a single-centre experience across 16 years.

OBJECTIVES: Multiple muscular ventricular septal defects (VSDs) are surgically challenging and its management remains controversial. We present a technique of surgical repair for muscular VSDs, which includes surgical exposure and detection of these defects and has excellent clinical outcomes. METHODS: We have analysed consecutive patients who underwent surgical repair of isolated multiple muscular VSDs under cardiopulmonary bypass over a 16-year period (from January 2001 to November 2016) in a single centre from the southern part of India. These defects were accessed through the right atrium in most cases and closed directly; completeness of closure was confirmed by pressurizing the left ventricle with blood cardioplegia. There were no haemodynamically significant residual VSDs following repair. RESULTS: One hundred and two patients with an average time of follow-up of 4.1 years (1 month-12 years) were included. The mean age of our patients at the time of operation was 23.5 months (3 months-22 years) with a mean weight of 7.9 kg (2-55 kg). The mean cardiopulmonary bypass and cross-clamp time was 118.8 ± 39.2 min (mean ± SD) and 76.5 ± 29.4 min (mean ± SD), respectively. There were 10 (9.8%) hospital deaths and 3 late deaths in the entire study group. Permanent pacemaker was implanted in 2 patients. Seventy patients could be followed up after discharge. Postoperative pulmonary artery pressure was normal in 52% of the patients, mild-to-moderate hypertension in 27% and severe in 7% of the patients. The ejection fraction was >60% among the survivors, and there were no reoperations or reinterventions. CONCLUSIONS: This surgical approach to multiple muscular VSDs is safe and effective with minimal risk of complete heart block and diminution of ventricular function.

Basaloid squamous cell carcinoma of the tonsil: report of a case and review of the literature.

The most common type of malignancy affecting the upper aerodigestive tract is squamous cell carcinoma. Basaloid squamous cell carcinoma (BSCC) is a rarely seen, high-grade, bimorphic variant of squamous cell carcinoma, which displays distinct histological features. This entity was first described by Wain et al. in 1986. Since then, approximately 170 cases of head and neck basaloid squamous cell carcinoma have been reported. Tonsils are an uncommon site of occurrence of basaloid cell carcinoma. Only 10 cases of basaloid squamous cell carcinoma arising in the tonsils have been described in current English literature. Histopathologically, these carcinomas are characterised by the presence of a basaloid component in close association with squamous cell carcinoma. In this article, a case of BSCC of the tonsil is reported. The clinical and histopathological features of this tumour are discussed. Relevant literature has been reviewed and differential diagnosis of this tumour is discussed.

Sinonasal T cell lymphoma: a case report.

Sinonasal lymphomas are aggressive locally destructive midfacial necrotizing lesions. Most of them initially diagnosed as lethal midline granulomas, a term which is slowly replaced by sinonasal lymphoma. Here is one such case report of sinonasal T cell lymphoma where there was a difficulty in diagnosis and required an incisional biopsy.

Difficulty in shaving: a rare complication after total laryngectomy.

INTRODUCTION: Many complications and sequelae after laryngectomy have been described in the literature. Here, we are reporting an unusual, till now, unreported complication after laryngectomy. CASE REPORT: A 51-year-old man who underwent total laryngectomy for stage 3 carcinoma of larynx presented with cough on attempting to shave the beard 4 months after the surgery. The management of this patient along with a brief review of the literature is discussed. CONCLUSION: Cross nerve innervation was thought to be the cause for this complication.