Eventration of diaphragm presenting as recurrent respiratory tract infections – A case report

Eventration of the diaphragm (ED) is a relatively rare condition. Eventration of the diaphragm is an abnormal elevation of the dome of diaphragm in which all or part of the diaphragm is largely composed of fibrous tissue. Clinical manifestations range from asymptomatic to life threatening respiratory distress. Recurrent chest infections are also the presenting complaints in patients. We report a 7 year old boy who presented with recurrent chest infections with left diaphragm eventration treated by plication successfully

Post tubercular gastropulmonary fistula: A rare complication

Gastropulmonary fistulas are themselves a very rare clinical entity and very less has been written about them in literature. Most of the cases listed in literature till now show that most of the gastropleural fistulas have been reported after intrathoracic gastric perforation in hiatal hernia, traumatic diaphragmatic hernia with later gastric perforation, perforated malignant gastric ulcer at fundus, extension of subphrenic abscess with gastric perforation, pulmonary resection and gastric bypass operations and only a single case has been documented till now regarding post intercostal chest tube drainage gastropulmonary fistula in tubercular patient. Here we present a first of its kind case where a middle aged female developed gastropulmonary fistula on the left side after multiple pleural aspirations for tubercular pleural effusion. The patient was operated and left lower lobectomy was done with the resection of involved part of stomach and fistulous tract from the left posterolateral thoracotomy

Evaluation of early postoperative complications after open heart surgery in Hepatitis-B positive patients

Introduction: Postoperative course of cardiac surgery patients in presence of liver dysfunction is associated with a lot of complications like excessive bleeding, coagulopathy, hepatic decompensation, multiple organ failure, infections which account for increased mortality and morbidity among this subset of patients. Method: In this study we evaluate early postoperative outcome of elective cardiac surgery in patients with hepatitis B infection. We studied 21 patients with hepatitis B infection who underwent open heart surgery done at department of cardiothoracic surgery, S.M.S Medical college, Jaipur, Rajasthan, India. All preoperative, operative and postoperative data was collected and analysed. Results: Out of 21 patient 13 were operated for coronary artery bypass grafting of these 7 were done offpump and 6 were done onpump. Out of remaining 8 patients 5 were mitral valve replacement for mitral valve disease and 3 were double valve replacement. Out of 21 patients 9 were re-explored for bleeding. Of the total patients operated 5 patients died, of which 1 succumb to renal failure, 3 died due to excessive bleeding and coagulopathy and 1 died due to delayed recovery following cerebral haemorrhage. 6 patients developed sternal wound infection and 2 out of these required sternal rewiring and debridement. Mean hospital stay was around 18 days with mortality of 23.8% and mobidity of around 28.6%. Conclusion: In the study group we found that there is considerable increase in mortality and morbidity among patients with hepatitis B infection that underwent open heart surgery

Right sided traumatic diaphragmatic hernia repair with intrathoracic herniation of liver, stomach and transverse colon

AbstractTraumatic rupture of the right dome of the diaphragm is an uncommon clinical entity. The diagnosis is difficult due to lack of specificity in clinical signs and chest film findings. Clinical incidence of rupture of the right dome of the diaphragm due to blunt trauma is much less common (10%) compared to the left (90%) and usually associated with more grievous injuries with very high pre hospital mortality thus accounting for rare clinical diagnosis. We report a case of 26year old male who had the blunt trauma chest referred to us after 7days of injury with complaints of shortness of breath and vomiting. On investigations the patient was diagnosed as a case of the ruptured right dome of the diaphragm with intrathoracic herniation of the stomach. The patient also had fracture pelvis. Surgical exploration was done through right 6th intercostal space which revealed intrathoracic herniation of the stomach, liver and transverse colon, which were healthy. Contents reduced into the abdomen and diaphragm was repaired. Post operative chest X-ray suggested complete expansion of the right lung with no residual herniation of abdominal contents. Post operative recovery was uneventful with the patient discharged on 14th post operative day

Midterm outcomes of mechanical versus bioprosthetic valve replacement in middle-aged patients: An Indian scenario

Objective: The goal of this study is to evaluate and compare the midterm outcomes of bioprosthetic heart valve replacement in terms of survival, valve-related events, quality of life, and economic aspects of treatment in population age 45 years and above in females and 48 years in males and their comparison with mechanical valve recipients. Materials and Methods: The patient population under age group of 45–60 years is randomly divided into two groups: One receiving bioprosthetic valves and other receiving mechanical valves. Patients were followed up and data are analyzed. Results: The overall 10-year survival was similar in patients receiving bioprosthetic heart valve and mechanical heart valves. The incidence of major bleeding episodes was very high with mechanical valves (mitral valve replacement [MVR] = 14.3% and aortic valve replacement [AVR] =7.2%) as compared to 0.6% and 0.8% with bioprosthetic MVR and AVR, respectively. About 1.02% of patients with tissue valves have episodes of thromboembolism versus 8.3% patients with mechanical valves. Acute valve thrombosis rates were high in mechanical valve (3.1% vs. 0.0%). Incidences of endocarditis were also more with mechanical valve replacement group (2.3% vs. 0.3%). The quality of life was also better in patients with bioprosthetic valves. Conclusions: Bioprosthetic heart valves seem to be more beneficial in the Indian scenario as compared to mechanical valves because of low incidence of mortality and valve-related events and better quality of life

Dissecting aortic root aneurysm and severe aortic regurgitation following pulmonary tuberculosis

Aneurysms of the aortic root and ascending aorta are often due to degenerative disease of media but tuberculosis is an important but extremely rare cause of aortic root dilatation especially in tropical countries like India where tuberculosis is endemic. Tubercular aneurysmal dilatation of aorta with dissection leading to aortic regurgitation is a rare but important complication of tuberculosis. With worldwide resurgence of tuberculosis due to increasing incidence of drug-resistant tuberculosis and its association with acquired immunodeficiency syndrome, the tubercular aneurysm has become a real clinical entity. Although tubercular aortitis is fairly common, tuberculous mycotic aneurysm of the aorta is rare, with involvement of the aortic root being exceedingly uncommon. Here we describe a case of 18 year old male presenting with severe breathlessness and was found to have dissecting aortic root aneurysm with aortic regurgitation with active pulmonary tuberculosis and spinal deformity in the form of kyphoscoliosis. He underwent a Bentall procedure, and excised aortic root tissue showed epithelioid cell granulomas with panarteritis

Coexistent pulmonary hydatid disease and tuberculosis in an adult male

Hydatid disease with pulmonary tuberculosis coexisting in a patient is an extremely rare occurrence. A patient presenting with nonspecific chest symptoms must be adequately investigated and hydatidosis must be ruled out. This case report presents the unusual coexistence of tuberculosis and hydatid disease in an adult male and its subsequent diagnosis and management

Intralobar pulmonary sequestration in right lower lobe with secondary infection in an adult male

Pulmonary sequestration is a rare congenital bronchopulmonary foregut malformation in which a segment of lung parenchyma is not connected to the tracheobronchial tree. This abnormal segment receives blood supply from the systemic circulation. Varying clinical techniques have been utilized to manage this disease process including surgical intervention, endovascular procedures and operative approaches. The most common presentation of this entity is involvement of the left lower lobe. We present a rare case of intralobar pulmonary sequestration in an adult male involving the right lower lobe with secondary infection