Value of needle biopsy in intrathoracic masses.

It investigated fifty (50) patients on account of cough followed by hemoptysis, chest pain, breathlessness. A detailed history was taken, clinical examination performed and provisional diagnosis attempted. Routine and special investigations like x-ray chest, coagulogram and pulmonary functions tests were performed. Ultra sound and CT scan were done in some patients. Bronchoscope was done whenever needed. Needle biopsy was carried out which provided hystological diagnosis in 41 cases. In 4 cases normal lung tissue was obtained, in one patient the biopsy material contained carbon particles and in other 4 patients biopsies gave a positive diagnosis. In one patient of anterior mediastinal mass the hystological diagnosis on first needle biopsy was neurofibro; repeat biopsy was done and reported as squamous cell carcinoma. The patients were subjected to open biopsy and the histopathology provided the diagnosis of primary germ cell tumour. No complications were encountered in 47 patients and one patient had needle tract implantation of tumour one month after performing needle biopsy

Missile Cardiovascular Injuries

Background: Missile Cardiovascular injuries have taken epidemic proportion in Kashmir valley since the eruption of militancy in 1990. Present study was undertaken to analyse the mode, pattern, presentation and management of missile cardiovascular injuries. Study Design: Prospective and retrospective. Material & Methods: Retrospective study of patients with missile cardiovascular injury from Jan 1996 to Oct 2008. 386 patients with missile cardiovascular injury were studied. All patients of cardiovascular injury due to causes other than missiles were excluded from the study. Results: All patients of missile cardiac injuries were treated by primary cardiorrhaphy. Right ventricle was the most common chamber affected. Left anterior thoracotomy was most common approach used. Most of the patients of missile vascular group were treated by reverse saphenous vein graft or end to end anostomosis. Most common complication was wound infection (20.83%) followed by graft occlusion (1.94%) in missile vascular group. Amputation rate was 4.66%. Amputation rate was higher in patients with delay of >6 hours and associated fractures. Conclusions: Missile cardiac injuries are becoming common due to use of more sophisticated weapons in domestic violence. Results are best if operated early and outcome depends upon multiple factors including clinical status at arrival, time interval till management, nature of injury and associated injuries. Missile vascular injury needs prompt resuscitation and revascularisation. Preoperative angiography is seldom necessary. Doppler study may sometimes be needed to aid the diagnosis

Study of ventricular septal defect under normothermic.

It studied 25 patients of ventricular septal defect (cardiac disease) analyzed in terms of age and sex. A detailed history was taken and general, physical, local and systematic examination were carried out followed by radiological features which revealed pulmonary vascularity in 7 patients, prominent pulmonary trunk in 10 cases and cardiomegaley in 7 patients. Preoperative location of VSD revealed 17 cases were peri-membranious, 4 were in infundibular septum, 2 patients in trabecular septal area and 1 patient in left muscular septum. All the patients underwent surgery. It has been observed 12 patients regained spontaneous normal rhythm and rest of 11 patients needed electromechanically help to avert to normal sinus rhythm. It also observed that cardiac enzyme showed peak size above normal after 24 hours after surgery in some patients. ECG findings showed that all patients had normal sinus rhythm at the time of discharge. Post operative complications were low output syndrome, infection, hemorrhage etc.16 patients died and rest was in a good condition. It concluded that nonmothermic open heart surgery can be used in any diverse surgical procedure safely and effectively

Study of early post -operative atrial fibrillation after valvular heart surgery.

Objectives: 1) To study the incidence and timing of development of atrial fibrillation after valvular replacement surgery; 2) To know various risk factors for development of this Arrhythmia. Material and Methods: 80 patients of either sex, with rheumatic valvular heart disease undergoing Mitral Valve, Aortic Valve and both Mitral and Aortic Valve replacement with normal preoperative sinus rhythm, operated under cardiopulmonary bypass by standard technique were observed by continuous ECG monitoring (DATA SCOPE SPECTRUM USA) to note the incidence and timing of development of atrial fibrillation. Age, sex, systemic and pulmonary hypertension, preoperative history of intermittent atrial fibrillation, preoperative left atrial and left ventricular systolic and diastolic dimensions, left ventricular ejection fractions and duration of aortic cross clamp were studied as risk factors in patients who developed Atrial fibrillation. Results: 28 patients (35%) developed atrial fibrillation in the post operative period. In majority of cases 13 (46.42%) it occurred between 24- 48 hours post operatively. 7% (14.28%) had more than one episode. It was benign and self-limiting in majority of patients. Age more than 55 years, systemic hypertension, left atrial size more than 50mm, history of pre operative intermittent atrial fibrillation, left ventricular ejection fraction below 35%, duration of aortic cross clamp > 50 minutes were significant risk factors, (P<0.01). Conclusion: Atrial fibrillation develops in significant number of patients post operatively after valvular replacement surgery. In majority of the patients it is benign and self limiting