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The Gordian Knot of Glutaraldehyde-Treated Autologous Pericardium in Open Cardiac Surgery
Issue:
Volume 7, Issue 2, March 2021
Pages:
13-15
Received:
11 April 2021
Accepted:
18 May 2021
Published:
26 May 2021
Abstract: Glutaraldehyde is classified as a biocide-pesticide under the hazard class for toxic substance and control laws for the human health and environmental worldwide. The regulatory bodies restrict the intended use to disinfectant or laboratory application in hospital. The parenteral pathway in human is not considered and then not allowed, for the high-risk profile, so the constraints are an integral part of the Classification Labeling and Packaging for exposure of occupational health. Contextually, there are no preclinical-safety data as Risk Related Reference (DMEL probability of occurrence and severity of adverse effect (s)/event (s) in a given population under defined exposure conditions), or Chemical Safety Reports that justify any authorization for patient consumer uses. In the context of cardiac surgery, the biomechanical stability in treating the autologous pericardium with glutaraldehyde in solution, results as a hand-built biotech for a patient valve device. Theoretically, the surgeon is a manufacturer that uses a toxic chemical compound for the own product that does not comply to the law and regulations. Contrary to pharmaceutical definition for marketing authorized drugs, the off-label not allowed use of toxic chemical derived manufacture, expose the physicians to legal vulnerability of which it is inclusive the malpractice for the-patient’s informed consent.
Abstract: Glutaraldehyde is classified as a biocide-pesticide under the hazard class for toxic substance and control laws for the human health and environmental worldwide. The regulatory bodies restrict the intended use to disinfectant or laboratory application in hospital. The parenteral pathway in human is not considered and then not allowed, for the high-...
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Giant Bleeding Pseudo-aneurysm of left Sub-clavian Artery Complicating Neurologic Impairment: Management Challenges (Case Report)
Nwafor Ikechukwu Andrew,
Emeruem Nwadinma Uloma,
Onyia Ugochukwu Obinna Chibuife,
Eze John Chukwuemeka,
Okorie Chukwuemeka Ogueri
Issue:
Volume 7, Issue 2, March 2021
Pages:
16-19
Received:
12 April 2021
Accepted:
23 April 2021
Published:
26 May 2021
Abstract: Subclavian artery pseudoaneurysms are rare and occur mostly as a consequence of an inadvertent arterial puncture during central venous catheterization, endovascular therapeutic procedures or after penetrating or blunt trauma. They usually have a late clinical presentation, with pain, swelling or other compressive symptoms. We present a 40-year old man farmer who presented to our service with prior 14 days and 12 days history of left chest upper chest swelling and inability to use the left upper limb respectively, all on account of injury. He went on a night alcohol binge, got drunk and while getting to his sitting room slipped and fell on a nearby glass center table. He had a deep cut on the left upper anterior chest wall. There was immediate profuse spurting bleeding with estimated blood loss of 800 ml. After delay in definitive treatment due to financial constraint the aneurysm increased in size, ruptured and rebled profusely leading to syncope. He was managed by Doppler ultrasound, median sternotomy and subclavian artery exploration to achieve proximal and distal vascular control. Sac was entered into via an infraclavicular transverse incision, heamatoma manually evacuated, bleeding site isolated and secured. He received 5 units of blood. Postoperative course was uneventful as he was managed with analgesics, antibiotics, haematinics and physiotherapy. Power in the upper limb has improved to 3 around the shoulder, 2 around the elbow and 1 around the wrist.
Abstract: Subclavian artery pseudoaneurysms are rare and occur mostly as a consequence of an inadvertent arterial puncture during central venous catheterization, endovascular therapeutic procedures or after penetrating or blunt trauma. They usually have a late clinical presentation, with pain, swelling or other compressive symptoms. We present a 40-year old ...
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Prospective Analysis of Prevalence of Carotid Artery Disease and Neurological Outcomes After CABG in Patients with Significant Carotid Artery Disease
Issue:
Volume 7, Issue 2, March 2021
Pages:
20-29
Received:
6 May 2021
Accepted:
21 May 2021
Published:
31 May 2021
Abstract: CABG surgery is the utmost frequently performed major cardiovascular operation. Carotid artery stenosis is present-day in 6% to 8% of all patients undergoing CABG and is related with an increased risk of stroke during and after CABG. It is well recognized that the presence of carotid artery stenosis is a significant forecaster of poor consequences in patients undergoing coronary bypass graft surgery (CABG). The incidence of coexisting coronary and carotid artery disease varies between 2% and 14% and approximately 8% of patients undergoing CABG have a significant stenosis in an extra cranial carotid artery. The stated occurrence of carotid artery disease in patients experiencing cardiac surgery has diverse from 2 to 22%, with an average of 8% increasing with age. This prospective observational study was conducted in patients undergoing off-pump coronary artery bypass grafting with carotid artery stenosis from May 2015 to Feb 2017. A total of 2126 patients were observed and classified to three groups based on the grade of carotid artery stenosis in which 221 patients (group A) were Symptomatic or (asymptomatic with ≥ 70% carotid stenosis, unilateral or bilateral), 583 patients (group B) < 70% carotid stenosis, unilateral or bilateral and asymptomatic and 1332 patients (group C) No carotid stenosis. 221 patients were having ≥ 70% Carotid stenosis of which 95% of patients undertook CABG and 4.52% patients undertook CABG with carotid endartrectomy. 583 patients were having < 70% Carotid stenosis of which 99.7% patients undertook CABG. 1322 patients were without Carotid stenosis and all the patients underwent CABG. The nasty age of the patients in group A was 60.93±9.03, in group B 61.30±9.49 and in group C are 61.91±8.95, p=0.18. Postoperative TIA showed statistically noteworthy between the groups p=<0.0001. Means of hospital stay was more in patients with >70% carotid stenosis group (p=0.0004). In our study 6 patients (2.71%) presented with stroke in group A. The frequency in group B and C were 0.69% and 0.08% respectively, and were statistically (p=<0.001). Most of the patients in group A had experienced concomitment endarctectomy of carotid with (4.52%) compared to group B and C (0.17% and 0%). The occurrence of previous history of stroke/TIA was higher in group A compared to other groups (p<0.001) [Previous h/o stroke was seen in 74 (6.3%), 32 (5.4%) and 29 (2.19%) patients in respective groups]. Previous history of stroke has proved a vital role in decisive the outcome of these patients. Higher grade of Carotid stenosis doesn’t affect mortality, ICU stay and the need for dialysis as proved in this study.
Abstract: CABG surgery is the utmost frequently performed major cardiovascular operation. Carotid artery stenosis is present-day in 6% to 8% of all patients undergoing CABG and is related with an increased risk of stroke during and after CABG. It is well recognized that the presence of carotid artery stenosis is a significant forecaster of poor consequences ...
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Rare Triple Presentation of Tuberculous Mycotic Aortic Aneurysm
Kiruthika Shanmugam,
Shivdasani Ravi,
Gopal Murugesan,
Vijit Koshy Cherian,
Karthik Maruthachalam
Issue:
Volume 7, Issue 2, March 2021
Pages:
30-33
Received:
22 January 2021
Accepted:
28 June 2021
Published:
8 July 2021
Abstract: Mycotic Abdominal Aortic Aneurysm (MAAA) is a rare entity that accounts for around 2% of aortic aneurysms. Tuberculous involvement of the aorta is either through hematogenous route or by the way of direct extension of disease from the adjacent structures. It may affect the intima or several layers of the vessel wall resulting in inflammation of the aorta, termed as aortitis, which weakens the aortic wall. The variable immune response to this aortitis can thicken the aorta or can perforate it leading to aneurysm formation. Tuberculosis affects both abdominal and thoracic aorta equally. Neither medical treatment nor surgical repair is curative, when used alone. The various surgical techniques which have been used by the investigators, had refined over period of time and importance of complete clearance of the infective foci is emphasized. Despite advanced imaging techniques, anti-tubercular drugs and adequate surgical options in the present times, the prompt diagnosis and successful repair of tuberculous MAAA are very few in number and there is also possible risk of reactivation of tuberculous process and recurrence. A presentation of a combination of Pott’s spine, psoas abscess and tubercular MAAA is a rare entity with very high mortality. We report the successful surgical and medical treatment of this precarious presentation.
Abstract: Mycotic Abdominal Aortic Aneurysm (MAAA) is a rare entity that accounts for around 2% of aortic aneurysms. Tuberculous involvement of the aorta is either through hematogenous route or by the way of direct extension of disease from the adjacent structures. It may affect the intima or several layers of the vessel wall resulting in inflammation of the...
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