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Experience of First 250 Cases of Tube Thoracostomy Under Thoracic Surgery Unit of BSMMU, Dhaka, Bangladesh
Heemel Saha,
Md. Sharfuddin Ahmed,
A. K. M. Mosharraf Hossain,
Md. Atiqur Rahman
Issue:
Volume 7, Issue 6, November 2021
Pages:
59-63
Received:
12 October 2021
Accepted:
8 November 2021
Published:
17 November 2021
Abstract: Background: The most commonly performed surgical procedure in thoracic surgery is Tube thoracostomy. General surgeons, intensivists, emergency physicians, and respiratory physicians may at one time or the other be required to perform tube thoracostomy as a lifesaving procedure. Objective: To observe experience of tube thoracostomy under thoracic surgery unit of BSMMU, Dhaka, Bangladesh. Methodology: This was a prospective, descriptive study conducted at thoracic surgery unit of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Study duration was from 02.12.2018 to 01.10.2021, total 2 years and 10 months. All patients of all age group such as from 2 years of age to 93 years of age those who underwent Tube thoracostomy under thoracic surgery unit were included in the study. All the data were collected for age, sex, occupation, indications of tube thoracostomy, post procedural complications & hospital stay. Results: 250 patients of different pathologies related to chest underwent tube thoracostomy during this period. Mean age was 47.53 years SD± 2.15; minimum age was 2 years and maximum age was 93 years. Among them 173 (69.2%) were male and 77 (30.8%) were female. Male to female ratio was 2.24: 1. Pleural effusion was the most common indication of tube thoracostomy which was in 141 (56.4%) patients followed by pneumothorax 21 (11.6%) patients. Regarding the etiology for tube thoracostomy, it was found that Shows in (Figure 2) Routine 219 cases 87.6% and Emergency 31 cases 12.4% (Due to chest trauma following road traffic accident, during CV catheterization, during lung biopsy), which includes 141 (56.4%) patients of pleural effusion, 29 (11.6%) patients of hydro pneumothorax, and 27 (10.8%) patients of empyema thoracic. Postoperative complications were recognized in 8 patients in shows (Figure 6). It includes Surgical site infection in 5 (2.0%) patients and accidental withdrawal of chest tube by patient himself 3 (1.2%) had dislodged. In 56.0% cases chest drain tube was removed within 7 days (Table 3). Chest drain tube was always given in “Safety triangle”. All cases were done by local anesthesia (2% lignocaine injection). Mean hospital stay was 15.5 days with the range of 2 to 45 days. Conclusion: Chest tube insertion is the first line treatment for variety of life-threatening chest diseases. This is a safe & effective procedure with 3.2% post procedural complications which is comparable to international literature.
Abstract: Background: The most commonly performed surgical procedure in thoracic surgery is Tube thoracostomy. General surgeons, intensivists, emergency physicians, and respiratory physicians may at one time or the other be required to perform tube thoracostomy as a lifesaving procedure. Objective: To observe experience of tube thoracostomy under thoracic su...
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The Mechanics of Apical Rotation in Patients with Myocardial Infarction and Reduced Left Ventricular Function
Mohamed Roshdy,
Ramy Omar
Issue:
Volume 7, Issue 6, November 2021
Pages:
64-69
Received:
31 December 2020
Accepted:
1 April 2021
Published:
23 November 2021
Abstract: Background: Traditionally the use of Left ventricular ejection fraction (LVEF) for assessment of left ventricular (LV) systolic. Function is the most widely used method. However, this method is inaccurate after acute MI, this attributed to the development of wall-motion abnormalities after acute MI; Inaddition, the biplane Simpson method calculation is inaccurate, because it relys on geometric assumptions. Recently, the use of two-dimensional speckle-tracking imaging has facilitated noninvasive measurement of LV torsion. Objective: The aim of this study was to use speckle-tracking echocardiography to assess apical rotation in patients with anterior and inferior myocardial infarction (MI). Patients and methods: The present study enrolled 54 patients with anterior or inferior MI, in addition to 20 healthy volunteers (matched for age and sex) as the control group. Using commercially available two-dimensional strain software, apical, basal rotation, and LV torsion were calculated. Basal and apical LV short-axis images were acquired for further off-line analysis. Results: Apical rotation was significantly reduced in the patient group compared with the control group (P<0.001). Consequently, torsion degree (P<0.001), torsion rate, and untwisting rate (P=0.007) were significantly reduced. There was a significant correlation between ejection fraction and apex rotation (r=0.466, P=0.044), torsion degree (r=0.499, P=0.03), and untwisting rate (r=−0.543, P<0.001). Correlation with basal rotation was nonsignificant, and thus measurement of apical rotation alone (rather than calculation of LV torsion) might provide a simple and accurate alternative for assessment of LV contractility. Conclusion: Apical rotation and torsion were decreased in ST-elevation MI, and this was statistically significant in patients with LV dysfunction.
Abstract: Background: Traditionally the use of Left ventricular ejection fraction (LVEF) for assessment of left ventricular (LV) systolic. Function is the most widely used method. However, this method is inaccurate after acute MI, this attributed to the development of wall-motion abnormalities after acute MI; Inaddition, the biplane Simpson method calculatio...
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Acute Mediastinitis Following Esophageal Perforation with Swallowing of Duck Bone: A Case Report
Issue:
Volume 7, Issue 6, November 2021
Pages:
70-74
Received:
29 October 2021
Accepted:
15 November 2021
Published:
23 November 2021
Abstract: Background: Acute mediastinitis is still associated with a high morbidity and mortality. Mediastinitis secondary to esophageal perforation is a rare but potentially life-threatening condition. Case presentation: This report aims to present an acute mediastinitis case, in a 54-year-old healthy female patient, which originated from an intrathoracic esophageal perforation with swallowing of duck bone that confirmed by computed tomography of the chest. The patient was successfully treated by an emergency left thoracotomy, effective surgical drainage and aggressive debridement of the affected mediastinal compartments, primitive repair of perforated esophagus with intercostal muscle flap, decompressive gastrostomy and jejunostomy for feeding. Post-operatively, the patient was benefited from broad-spectrum antibiotics, intensive care and resuscitation associated with a close follow-up consequence. Results: Mediastinitis was well-controlled. Post interventional computed tomography scan with hydro-soluble contrast ingestion showed no extraluminal leak and good integrity of esophagus. The patient restored normally oral feeding without any complications and was discharged after 24 days of hospitalization without any sequelae. Conclusions: Early diagnosis is critical for expediting the choice of an optimal treatment strategy and plays an important role in improving mortality from acute mediastinitis following perforated esophagus. Besides intensive care and resuscitation, we advocate an emergency thoracic surgery for cases with established mediastinitis following intrathoracic esophageal perforation.
Abstract: Background: Acute mediastinitis is still associated with a high morbidity and mortality. Mediastinitis secondary to esophageal perforation is a rare but potentially life-threatening condition. Case presentation: This report aims to present an acute mediastinitis case, in a 54-year-old healthy female patient, which originated from an intrathoracic e...
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Surgical Resection of Atypical Metastatic Melanoma to the Atriocaval Junction
Vitalis Chukwuebuka Osuji,
Maha Mohammed Alkhuziem,
Daniel John Beckman
Issue:
Volume 7, Issue 6, November 2021
Pages:
75-77
Received:
3 November 2021
Accepted:
19 November 2021
Published:
25 November 2021
Abstract: Background: Metastatic tumors to the heart include lymphomas, sarcoma, leukemia, and melanoma. Of these, metastatic melanoma is the most common, and are usually hematogenous, where metastatic lesions can be present in the left ventricle, right atrium, and/ or the right ventricle. Objective: We present an atypical metastatic melanoma pattern, where cardiac metastasis originated by direct extension from the adjacent gastric mesentery. We also present our trans-cardiac resection approach, which was the safest way to access the cardiac metastasis intra-operatively without disrupting the tumor. Method: This was an incidental intraoperative finding, and no formal study methods were employed. During the operation, the atrium was opened via standard procedures. The point of tumor adherence to the posterior atrial wall was identified and resected. The tumor was found to extend by a pedicle into the mesentery of the gastric pull-up. Result: The outcome of this procedure was favorable. The tumor was completely resected, along with the adjacent heart and mesenteric tissues. The edges of the atrial tissues were cryoablated to eliminate any micro-invasion, and at 2-week follow-up, patient indicated significant improvement in pre-operative symptoms. Conclusion: Our patient’s metastatic melanoma presented as a solitary metastasis to the right atrial caval junction. Trans-cardiac resection of the tumor was affected with deep hypothermic circulatory arrest without complications. We recommend this as the safest way to access the tumor at the atrial caval junction.
Abstract: Background: Metastatic tumors to the heart include lymphomas, sarcoma, leukemia, and melanoma. Of these, metastatic melanoma is the most common, and are usually hematogenous, where metastatic lesions can be present in the left ventricle, right atrium, and/ or the right ventricle. Objective: We present an atypical metastatic melanoma pattern, where ...
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