Posterior dislocation of the hip.
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Hip Dislocation↗
Biomedical subjects
T K Kaul
Publications and source records attributed to T K Kaul.
Primary malignant pericardial mesothelioma: a case report and review.
Primary malignant pericardial mesothelioma is a rare tumor of unknown etiology. The prognosis is extremely poor due to generally late presentation, inability to completely eradicate it surgically and its poor response to radiotherapy or chemotherapy. An unusual case of pericardial mesothelioma which presented as constrictive pericarditis is described. A comprehensive review of the 140 cases reported in the literature so far is presented to assist the readers in the management and prognosis of this rare, pathological tumor.
Antineoplastic Combined Chemotherapy Protocols↗
Mitral valve replacement in patients with severe mitral regurgitation and impaired left ventricular function.
We have studied short- and mid-term effects of preservation and excision of the mitral subvalvar support during mitral valve replacement in 40 patients, who had developed moderate to severe degree of left ventricular function impairment, secondary to pure severe mitral regurgitation. These patients had valve replacement, because valve anatomy was unsuitable for reconstructive procedures. Mitral subvalvar support was excised and valve replaced with a Björk-Shiley prosthesis, in 10 patients with moderately impaired left ventricular ejection fraction (mean 32% +/- 1.2%) and in 18 patients with severely impaired left ventricular function (left ventricular ejection fraction: 22% +/- 0.8%). In 12 patients with severely impaired left ventricular function (left ventricular ejection fraction: 20% +/- 1%) posterior subvalvar apparatus was preserved and valve replaced with a bioprosthesis. Prognosis of patients with moderately impaired left ventricular function was not influenced by the loss of chordopapillary support. Actuarial survival at 8 and 10 years was 46% +/- 7.8% for patients with severely impaired left ventricular function with chordopapillary support excised and 70% +/- 10% for patients with severely impaired left ventricular function with chordopapillary support preserved (p less than 0.01). Preservation of mitral subvalvar support is important in patients with severely impaired left ventricular function (left ventricular ejection fraction less than 25%).
Aged↗
Postoperative tetanus following cryosurgery for haemorrhoids.
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Adult↗
Functional tricuspid regurgitation following replacement of the mitral valve.
In this series, the effect of replacement of the mitral valve was examined in 86/900 (9.6%) patients who had developed moderate functional tricuspid regurgitation, secondary to rheumatic mitral valvar disease. These patients were subdivided according to the severity of pulmonary hypertension and impairment of right ventricular function. Forty-six patients presented with severe pulmonary hypertension and 40 patients had moderate pulmonary hypertension (mean main pulmonary arterial pressure: 78 +/- 14 mmHg vs 41 +/- 6 mmHg; P less than 0.05). The latter had more advanced disease, greater impairment of right ventricular function and dilatation of the right heart chambers. Functional tricuspid regurgitation regressed in 38/42 survivors with severe pulmonary hypertension and persisted or progressed significantly in 22/34 survivors with impaired right ventricular function despite successful replacement of the mitral valve. The latter underwent replacement of the tricuspid valve (n = 16) or tricuspid annuloplasty (n = 6), at a mean interval of 44 +/- 4.4 months after replacement of the mitral valve, which resulted in 8/22 (23.5%) early deaths. Functional tricuspid regurgitation is more likely to persist in patients with advanced right ventricular failure. Tricuspid valvar competence should be restored in these patients at initial replacement of the mitral valve.
Adult↗
Tricuspid valve replacement: factors influencing early and late mortality.
Seventy four patients underwent tricuspid valve replacement (TVR), between 1968 and 1983. 93% were female, mean age was 44 +/- 4 years. Tricuspid valve was replaced with a mechanical prosthesis in 52 and a bioprosthesis in 22 patients. Fifty seven patients underwent primary TVR and 17 underwent a secondary TVR following a mean interval of 41 +/- 2 months (SEM) following a previous mitral or tricuspid valve operation. Preoperatively 86% patients were in NYHA class III-IV and congestive cardiac failure (CHF). Early mortality for primary TVR was 36.8% and 35.2% for secondary TVR. Early mortality has been significantly reduced since the introduction of cardioplegic protection for the associated valve lesions. Early mortality was significantly influenced by the reduced preoperative values of FVC and FEV1 in patients with long standing mitral valve disease and by raised preoperative levels of plasma bilirubin and alkaline phosphate in patients with CHF. Risk of thrombotic occlusion and late deaths remained high during the first year after TVR with a mechanical prosthesis.
Adult↗
Endocrine secreting malignant mediastinal teratoma.
Malignant mediastinal teratoma containing yolk sac elements are rare tumours and invariably have a poor prognosis. An elevated alpha fetoprotein level is a useful indicator of the malignant nature and the invasiveness of the tumour. A case with such a tumour who also presented with precocious puberty is described. This patient was treated with radiotherapy and chemotherapy prior to radical surgical excision, and has now survived for over 64 months without evidence of metastases.
Child↗
Combined mitral and aortic valve replacement with Bjørk-Shiley prostheses: long term survival and valve-related complications.
Between 1974 and 1985, combined aortic and mitral valve replacement (DVR) was performed in 209 patients using Bjørk-Shiley tilting-disc prostheses. Early and late mortality were 9.5% and 10.5% respectively for the entire series. Factors significantly influencing early mortality were: Emergency DVR, preoperative NYHA Class IV, double valve, critical stenosis, and small aortic replacement prostheses. The effect of the latter was augmented by the suboptimal orientation of the implanted prostheses. The overall survival was 74 +/- 4.4% at 12 years; but was only 40 +/- 6.1% at 8 years in patients who were in NYHA class IV preoperatively. Intermittent disc occlusion (DO) and thrombotic disc occlusion (TO), presented as early, anticoagulant related haemorrhage (AH) and prosthetic valve endocarditis (ENDO) as sporadic, and thromboembolism (TE) and paravalvular leak (PVL) as continuous risk factors. Freedom from all known valve-related complications was 77 +/- 4.5% at 12 years (DO, TO, AH, ENDO, TE, PVL: 98%, 97%, 96%, 96%, 88% and 89% respectively). Lethal DO and TO occurred in mitral prostheses. Freedom from reoperation was 95% at 5 and 12 years. Patient-related valve failure rate in this series is comparable with the other series which used mechanical prostheses and is lower than those which used bioprostheses.
Adult↗
Vasoactive pressure hormones during and after cardiopulmonary bypass.
The differences in the pattern of the vasoactive hormone release in response to the stress of surgery and cardiopulmonary bypass (CPB) (pulsatile n = 15 and non pulsatile n = 23) were studied in the adult patients with mitral valve disease (MVD), aortic valve disease (AVD), and the coronary artery disease (CAD). A differential stimulation of the osmoreceptors, baroceptors, renin-angiotensin and the sympathetico-adrenal systems in these patients, resulted in the variations in the pattern of hormone release. Patients with MVD showed a greater stimulation of osmoreceptors, baroceptors and release of Arginine vasopressin (AVP). Renin-angiotensin system was more easily triggered in patients with AVD or CAD; and sympathetico-adrenal system in patients with CAD. The renin-angiotensin-aldosterone axis was better preserved in patients with CAD (r = 0.49, p less than 0.001) than in the patients with MVD (r = 0.38, p less than 0.02). Plasma renin release showed a significant correlation with noradrenaline release in the patients with MVD (r = 0.47, p less than 0.01); but this relationship was lost in the patients with the CAD, due to an excessive noradrenaline release. Pulsatile bypass reduced but did not abolish this response. Under unfavourable conditions, the stress response may persist in the early post-operative period.
Aortic Valve↗
Late results of aortic valve replacement with Bjork Shiley prostheses: a comparison of standard aortic valve prosthesis with reversed mitral valve prosthesis implanted in aortic position.
Between 1976 and 1983, 435 patients underwent aortic valve replacement (AVR) with Bjork Shiley prostheses. Standard aortic Bjork Shiley prostheses (ABP) were used in 150 patients (Group I) and a reversed mitral Bjork Shiley prostheses in 285 (MBP in 250 and MBC in 35) patients (Group II). There was no significant difference in the number of the patients with valve calcification or the size of aortic root in the 2 groups. There was no significant difference in the early mortality in these two groups. The total follow up period in Group I was 912 years and 2130 years in Group II. The incidence of major aseptic prosthetic dehiscence and valve occlusion with tissue ingrowth were higher in Group I than in Group II. Reversed Bjork Shiley mitral valve prosthesis was successfully used in aortic position with reduced incidence of valve related complications.
Aortic Valve↗
Plasma albumin and calcium levels following cardiopulmonary bypass.
A significant fall in the levels of plasma albumin and a corresponding fall i in the levels of extracellular calcium occurred following cardiopulmonary bypass with the crystalloid prime. Postoperative hypoalbuminaemia was well tolerated, except in the patients with poor left ventricular function. Postoperative hypocalcaemia may increase digoxin sensitivity and may augment the negative inotropic effect of verapamil.
Calcium↗
Late results of total correction of tetralogy of Fallot in adults.
Between 1966 and 1986, 30 patients underwent total correction of the tetralogy of Fallot. Preoperative presenting features were: dyspnoea on exertion, clubbing, cyanosis and polycythaemia. Twenty-six patients had one or more palliative procedures prior to definitive repair. Preoperatively, all patients had a significant gradient across the right ventricular outflow tract (mean gradient 70 +/- 46 mmHg). Peak right ventricle to left ventricle systolic pressure ratio (pRV/LV) was 0.9 +/- 0.2. A functioning Blalock Taussig shunt was ligated in 11 patients prior to the institution of cardiopulmonary bypass. All patients had a patch closure of the ventricular septal defect. An additional muscle bundle resection from the right ventricular outflow tract was performed in 15, pulmonary valvotomy in 6 and enlargement of the right ventricular outflow tract in 2 patients. There was a significant fall in pRV/LV ratio postoperatively (P less than 0.05). There were 3 early and 2 late deaths. Mild right ventricular outflow tract obstruction has persisted in all survivors. Four patients have remained on antiarrhythmic drugs. Long term results after definitive repair were satisfactory in this group of adult patients who have survived due to palliative procedures performed during childhood.
Adult↗
Primary meningococcal pericarditis with tamponade.
A case of primary purulent meningococcal pericarditis presenting with chest pain, hypotension and cardiac tamponade followed by oliguric renal failure is reported. Treatment with antibiotics and surgical drainage was successful.
Acute Kidney Injury↗
Re-operation for aortic and mitral prosthetic dysfunctions.
The overall incidence of re-operation and prosthetic valve endocarditis was low in the present series as mechanical prostheses were used predominantly. The prosthetic dysfunctions were less frequent following the primary implantation with Bjork Shiley prostheses, but high operative risk was associated with the clotted Bjork Shiley prostheses. We also had unusual experience of strut fracture and sticking of Bjork Shiley discs in the closed position in both aortic and mitral positions. The early deaths were nil since the use of cardioplegic protection. Intra-operative bleeding due to adhesions can be minimised by using synthetic or heterologous pericardium during the primary operation.
Adult↗
False aneurysm of the ascending aorta with aortico-right atrial fistula.
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Aortic Diseases↗
Myocardial protection during cardioplegia in open-heart surgery: a review.
The use of cardioplegia (pharmacologically induced electromechanical arrest) to achieve the ideal conditions for cardiac surgical operations was introduced over 20 years ago in clinical practice. Since then a number of ingredients have been added in various proportions to different cardioplegic solutions and their evaluation in experimental laboratories and clinical practice has continued. Any additive to a cardioplegic solution should be investigated in experimental laboratories and asanguinous cardioplegic solutions should be carefully formulated to avoid extremes of ionic concentrations, pH and osmolarity. Cold blood cardioplegia has not been found advantageous when compared with conventional asanguinous solutions. A combination of pharmacologically induced arrest with cold asanguinous cardioplegic solution and topical hypothermia protects the myocardium better than topical hypothermia alone or normothermic cardioplegia, and continuous infusion of cardioplegic solutions has proved no better than multidose administration. Multidose administration of cold cardioplegic solutions with moderate hypothermia and surface cooling has been found most satisfactory for prolonged aortic cross clamping (up to two hours). Use of cardioplegia in recent years has undoubtedly improved the prognosis of a number of patients undergoing surgical correction of complex cardiac lesions.
Cardiac Surgical Procedures↗
An analysis of electrocardiographic, radiographic, and vectorcardiographic findings in patients with implanted cardiac pacemakers.
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Cardiac Catheterization↗
Heparin administration during extracorporeal circulation: heparin rebound and postoperative bleeding.
The individual variations in heparin dose response and heparin activity decay have indicated limitations of the protocols based on body surface area and weight of the patients. In the present study the heparin levels and simpler clotting tests were monitored in a consecutive series of 71 patients undergoing standard cardiac operations. The clotting tests used were the Celite activated clotting time (Celite ACT) and the whole blood activated recalcification time (BART). Forty-four patients received a loading dose of heparin, 3 mg. per kilogram, a maintenance dose of heparin, 1.5 mg. per kilogram per hour, and 6 mg. of protamine sulfate per kilogram at the termination of extracorporeal circulation (ECC) (Protocol I). Twenty-seven patients received a similar initial dose, but the maintenance dose of heparin and the dosage of protamine sulfate were administered according to the measured heparin levels (Protocol II). A significant difference was seen in the measured heparin levels (p less than 0.01, Celite ACT (p less than 0.01), and BART (p less than 0.01) in patients on Protocols I and II. Ten of the 24 patients on Protocol I and none on Protocol II showed heparin rebound phenomenon, and blood loss in patients on Protocol I was significantly greater than that in patients on Protocol II. The study clearly demonstrates that our protocol of heparin administration and control with simpler tests ensures safe hypocoagulation during ECC and efficient reversal at the end, with minimal postoperative blood loss.
Adolescent↗