Lifestyle practices, health problems, and quality of life after coronary artery bypass grafting.

INTRODUCTION: Severe coronary artery disease continues to be a major health problem in India, and coronary artery bypass grafting (CABG) is the accepted modality of treatment. Post-operative long-term quality of life depends on the healthy lifestyle practices and appropriate control of risk factors. We tried to bring out the patient awareness and their practices after the surgery and their implications on their quality of life (QOL). MATERIALS AND METHODS: Five hundred patients who completed 6 months after isolated CABG were interrogated for their lifestyle practices, health problems, and quality of life using a structured questionnaire. Those who underwent additional cardiac procedures, redo CABG, and coronary interventions after CABG were excluded. RESULTS: Eighty percent were in good functional class (NYHA I, II). Detailed evaluation showed that only 11.6% adhered to healthy lifestyle practices. Obesity, uncontrolled diabetes mellitus, uncontrolled hypertension, and hypercholesterolemia continued to be problems in 9.6, 20.2, 35, and 48.4%, respectively. Quality of life was assessed to be good in 27.6%, average in 46.4%, and poor in 26%. Psychological evaluation showed that 23% were significantly anxious and 20% had significant depression. Pre-operative diagnosis and left ventricular function at discharge influenced the QOL. Unhealthy lifestyle practices and failure to attain risk factor reduction adversely affected the quality of life. CONCLUSION: This study emphasises the need for aggressive counselling as well as continuing health education to improve patient awareness about adopting healthy lifestyle practices after CABG to improve the quality of life.

Inflammatory myofibroblastic lung tumor with dysphagia in a 4-year-old child.

Inflammatory myofibroblastic tumors of the lung are rare in adults but common among pediatric lung tumors. A 4-year-old girl was evaluated for respiratory symptoms, dysphagia, and weight loss. Radiology revealed a right hilar mass that persisted despite antibiotic treatment. On exploration, a hilar mass involving the pulmonary vasculature, diaphragm and gastroesophageal junction was found. Aggressive surgical excision including a right pneumonectomy was performed. Histopathology confirmed an inflammatory myofibroblastic tumor with no features of malignancy. At the 2-year follow-up, the child was clinically stable with no recurrence. Dysphagia is a very rare presentation of such tumors.

Late presentation of esophageal rupture following blunt thoracic trauma.

Esophageal rupture following blunt thoracic trauma is extremely rare. A 30-year-old man sustained a road traffic accident causing blunt thoracic trauma that resulted in lower esophageal rupture. He presented 24 h after the initial trauma and was managed with primary repair and aggressive lavage with a drainage procedure. Early identification and repair of esophageal rupture is vital for preventing mediastinitis, but an aggressive surgical and postoperative management strategy can prevent mortality even in late presentations.

Post-traumatic (haemorrhagic)liver cyst.

Traumatic cysts of liver are amongst the less frequently known sequelae of liver trauma. The incidence of this entity is very low. We report a case of large posttraumatic liver cyst in a young adult female, who sustained blunt abdominal trauma 2 months back. The cyst was diagnosed by CECT Abdomen and was treated by hepatic resection(left lobe). The aim of presentation of this report is to highlight the fact that blunt trauma abdomen can result in such rare presentations which can lead to hepatic resection.