Off pump coronary artery bypass (OPCAB) in critical left mainstem stenosis—Our experience

Background Beating heart surgery has now become the commonest technique of doing Coronary Artery Bypass Graft Surgery (CABG) in our country. It is being used even in such high risk situations like diffuse coronary disease and Critical Left Main stem Stenosis (LMCS) with good results. The aim of this study is to retrospectively review our results in Off-Pump Coronary Artery Bypass Surgery (OPCAB) in patients with critical left main stem stenosis. Methods This study is a retrospective analysis of the data of patients who underwent primary coronary artery bypass surgery. During the period from April 2003 to September 2005 a total of 64 patients underwent OPCAB procedure for critical LMCS. During the same period 10 patients underwent CABG on Cardio Pulmonary Bypass (CPB). The age range was 36–77yrs. The sex distribution was M: F 53∶10. Ten patients were done as emergency. 2 of them were on Intra Aortic Balloon Pump (IABP) support preoperatively. 10 patients were high risk with a Euro score of ≥5. Results Left Internal Mammary Artery (LIMA) was used in 78% of cases. Average grafts per patient was 2.96. The median ventilation time was 5.91 hrs. New IABP insertion in postoperative period was required in 1 patient. One patient was reexplored for bleeding. There was one perioperative myocardial infarction. 57% of patients did not need any blood transfusion. There was no conversion to CPB. There was no operative mortality. Inotropes were used in ten cases. Conclusions OPCAB is a safe method of revascularization in patients with critical LMCS. Preoperative IABP is useful in patients with cardiogenic shock. However, there is a place for CPB in patients needing additional procedures like Mitral Valve repair (MV repair) or Dor's procedure or when the vessels are very diffusely diseased. Those patients who are unstable despite IABP support may be managed by Beating heart On Pump (BHOP) technique.     

Spectra of central nervous system melioidosis

Burkholderia pseudomallei infection of the central nervous system (CNS) is rare with less than 50 cases reported over the last 30 years. The retrospective melioidosis study at University Malaya Medical Centre has documented three cases of CNS melioidosis out of more than 160 cases of melioidosis since 1978. There were two patients with brain abscess and one with spinal epidural abscess. The predisposing factors were: one patient was an aboriginal farmer and the other two were diabetic. Their age ranged from 17 to 45 years. Prominent neurological features were limb weakness, cranial nerve palsy (6th and 7th) and visual disturbance. CT brain scan and MRI spine showed abscess formation, subdural collection, and spinal epidural collection, osteomyelitis of vertebra and occipital bone and also sagital sinus thrombosis. All these patients underwent surgical drainage leading to bacteriological diagnosis as well as appropriate long-term antibiotic therapy. All had good recovery at 6 months after completion of treatment.     

Kinetices of polymerization of 1-octene with the catalyst system VOCl3-AlEt3 (or AlEt2Br)

Kinetic studies of the polymerization of 1-octene with the Ziegler-Natta catalyst systems VOCl₃—AlEt₃ (I) and VOCl₃—AlEt₂Br (II) are reported. The effect of the various parameters such as the Al/V ratio, catalyst and monomer concentrations, reaction time, aging time and temperature on rate of reaction and molecular weight of polymer were studied. Each of these parameters has a profound effect on the polymer yield and the rate of the reaction for both systems. The rate of polymerization increases linearly with increasing temperature, catalyst and monomer concentrations. The reaction is first order with respect to both the monomer and the catalyst concentration in the two catalyst systems studied. From the Arrhenius plot the overall activation energy of polymerization for the two systems was found to be 51,2 and 43,5 kJ/mol, respectively. The mechanism of polymerization is discussed on the basis of the dependence of the polymerization rate on the alkylaluminium concentration.     

Emergence of <Emphasis Type="Italic">Moraxella bovoculi</Emphasis> Associated with Keratoconjunctivitis in an Organized Dairy Farm of India

An investigation was carried out in an organized dairy farm of Tamil Nadu State, India where cattle were reported to have eye infection. Preliminary clinical intervention revealed that the animals had infectious bovine keratoconjunctivitis (IBK). Isolation and identification of pathogen from eye swab revealed the presence of Moraxella spp. On further molecular characterization by Polymerase chain reaction (PCR) suggested that the isolate as Moraxella bovoculi. PCR followed by sequencing was carried and the results showed that the isolate was M. bovoculi and the sequence was submitted in the GenBank with the sequence id. KX121047. Animals were treated with antibiotics as per the results from antibiotic sensitivity test and treatment yielded good results as the animals responded to treatment. This report is the first of its kind from India as there was no previous report regarding M. bovoculi from the country. Further insights into the bacterial genome can aid in identification of the genes or regions involved in pathogenesis of IBK and also to carve out the prevention and control strategies of IBK.     

Right-sided endomyocardial fibrosis with recurrent pulmonary emboli leading to irreversible pulmonary hypertension.

A 26 year old Saudi man with features of both Loeffer's endocarditis and endomyocardial fibrosis presented with mild symptoms and pulmonary emboli. Echocardiographic examination showed obliteration of the right ventricular apex by an attached mass. The results of haemodynamic studies were somewhat abnormal and medical treatment was started. Despite anticoagulation with warfarin the patient's condition deteriorated rapidly over a four month period after a further episode of pulmonary embolism and the development of pulmonary hypertension. Two haemodynamic studies performed four months apart were typical of pulmonary hypertension and later right ventricular failure; they showed none of the characteristics of restriction. Pulmonary embolectomy was attempted but there was no cleavage plane between the organised thrombi and the endothelium of the pulmonary artery. The patient died of severe pulmonary hypertension and right ventricular failure several days after operation. Surgical intervention in the early stages of right-sided endomyocardial fibrosis might have prevented the development of pulmonary embolism and pulmonary hypertension.     

Imaging in whole organ pancreatic transplants and a multimodality review of its complications

This pictorial review will describe the normal anatomy of whole organ pancreatic transplants and the common surgical variants with which the radiologist should be familiar. Complications may be divided into (1) vascular: arterial occlusion and stenosis, venous thrombosis, pseudoaneurysms and arteriovenous fistulae, (2) parenchymal complications such as pancreatitis and the variety of peripancreatic collections, and (3) enteric complications including leak and fistula formation. The radiologist plays a crucial role in the initial assessment of graft anatomy and perfusion, prompt diagnosis, and increasingly, in the management of complications.