Fluoroscopic‐guided balloon dilatation and stenting in tracheal stenosis with metallic self‐expandable stents and long‐term follow‐up results

The purpose of this study was to assess the safety and long‐term efficacy of self‐expandable stents in the treatment of benign tracheal stenosis. Nine patients (seven men) with tracheal stenosis (including one with fistula) of varied cause were treated by fluoroscopically guided balloon dilatation and stenting with self‐expandable metallic stents. The procedure was carried out under topical spray in eight patients and under general anaesthesia in one patient. The patients were followed up for a period ranging between 13 and 60 months. In eight of the nine patients, satisfactory positioning of the stent was achieved at the first instance, with immediate relief of dyspnoea. One patient with innominate artery aneurysm died 16 days after the procedure because of renal failure. At 1 month of follow up, six out of eight (75%) of our live patients were without any respiratory embarrassment. This dyspnoea‐free result reached almost 90% by the end of 1 year especially so in the fibrous strictures. Four out of the eight live patients (50%) had cough for 2 months and two (25%) had mild blood‐tinged sputum treated by inhalation and mucolytic agents. Secondary intervention was required in one patient at 1 month because of recurrent symptoms. The patient with tracheo‐oesophageal fistula required surgical intervention because of fracture of the stent. Fluoroscopically guided balloon dilatation and stenting of the tracheal stenosis is an effective non‐surgical therapy resulting in cure of fibrous strictures and palliation in cases of malignancy.     

Lipid Profile In Transplant Patients: A Clinical Study

15 renal transplant recipients were studied for their lipid profile. The patients were on regular post transplant follow up and had non clinical or laboratory evidence of graft dysfunction, intercurrent infection or post transplant diabetes mellitus for at least 3 months prior to the study. The mean duration of transplant was 15 ± 9.5 months (range 3-32 months). Majority (86%) were on triple immunosuppression therapy and received a mean prednisolone dose of 10.5 mg. An equal number of healthy subjects were randomly selected and studied for their lipid profile and served as control for the study group. There was no significant change in the HDL-cholesterol level as compared with controls. However, these patients showed a significantly higher LDL-cholesterol and total cholesterol levels. Further, a significant inverse correlation was observed between triglycerides and total cholesterol levels and transplant duration.Key Words: Lipid profile, Renal transplant     

Prevention of post operative phrenic nerve palsy in patients undergoing cardiac surgery

Introduction Close proximity of phrenic nerves to pericardium and internal mammary arteries (IMA) makes them liable to injury during cardiac surgery which occurs due to its transection, compromised vascularity or hypothermia. Methods Between July, 1999 to August, 2000 fifty fresh cadavers were examined and the intrathoracic course of phrenic nerves was studied. This information was utilised while performing 200 open heart operations. Intermittent cooled saline (4°C) was used instead of ice slush for topical cooling and pericardiophrenic branch of IMA was preserved while harvesting it. Results Variations were observed in the anatomical relationship between the phrenic nerves and proximal internal mammary arteries. Incidence of unilateral phrenic nerve injury among patients who had open heart surgery was 1.5% and was 4% among patients in whom internal mammary artery was harvested. Conclusion A thorough knowledge of anatomical variations in the course of phrenic nerves, preservation of pericardiophrenic branch of IMA while harvesting it for CABG and use of cooled saline instead of ice slush for topical cooling helps in avoiding phrenic nerve injury during cardiac surgery. (Ind J Thome Cardiovasc Surg, 2001; 17: 225-229)