Govind Chetty

Liver blood flow during cardiac surgery

Objective: Impairment of liver blood flow and, therefore, potentially liver function, has important short-term consequences because of the liver’s key metabolic importance and role in drug metabolism. The objective of this study was to quantify the effect of cardiac surgery on liver blood flow from before the induction of anaesthesia to 24 hours postoperatively. Method: Ten patients with no history of liver impairment, moderate or good left ventricular function, and undergoing routine hypothermic coronary artery bypass graft surgery, were entered into the study. Liver blood flow was determined by the clearance of indocyanine green (ICG), expressed as a percentage disappearance rate (PDR). Results: The mean baseline percentage disappearence rate (PDR) of indocyanine green (ICG) was 19.849-4.47%/min. This increased marginally to 20.429-6.67%/min following the induction of anaesthesia, but after 15 min of cardiopulmonary bypass, the PDR fell to 13.519-3.69%/min; this was significantly lower than all other PDRs measured throughout the study. Prior to extubation, the PDR increased again to 20.019-3.72%-min, and this level was maintained at 12 hours (PDR 20.329-3.53%min) and 24 hours (PDR 20.519-2.27%/min). Conclusion: The induction of anaesthesia and positive pressure ventilation do not affect liver blood flow. Cardiopulmonary bypass at 308C is associated with a significant reduction in liver blood flow, which returns to normal within 4 / 6 hours of surgery and remains normal for up to 24 hours after surgery.

Comparative Analysis of the Bonanno Catheter and Tube Thorocostomy in Effective Aspiration of Pleural Effusion

BACKGROUND AND METHODS In our earlier report, we suggested the Bonanno catheter (a 14-gauge suprapubic catheter) as a less traumatic but equally effective alternative for drainage of a variety of fluid collections, including pleural effusion. This study aims to evaluate the efficacy of the Bonanno catheter compared with closed-tube thoracostomy in draining pleural effusion in 38 patients following routine cardiac surgery between 2003 and 2004. Twenty patients were managed using the Bonanno catheter and 18 were treated with standard tube thoracostomy. Data were collected retrospectively and statistical analysis was performed using the SPSS software. P < .05 was considered significant. RESULTS There were 20 (53%) male and 18 (47%) female patients with a mean age of 63.5 years (range, 31-83 years). Significant differences were observed with regards to the amount of lignocaine administered locally, intra-procedure pain score, post-procedure pain score after 15 minutes, and amount of analgesia used on a regular basis (P < .05 in each case). Statistically, significant differences were also noted during 2 to 3 weeks follow-up between the 2 groups with regards to pain score. In the the tube thoracostomy group, 22.2% developed infection of the procedure site, requiring antibiotic treatment, whereas no infection was reported in the Bonanno group (P < .001). CONCLUSION This study provided evidence that smallbore drains such as the Bonanno catheter are safe and better tolerated than standard chest drains. This is consistent with the British Thoracic Society guidelines that strongly recommend small-bore drains for the drainage of pleural effusions as they are more comfortable than larger-bore tubes.

A rare case of giant coronary artery aneurysm in the context of multiple arterial aneurysms

INTRODUCTION Whilst the incidence of CAA has been reported as up to 5%, giant CAA (>2cm) is rare. PRESENTATION OF CASE We present a rare case of 3cm×4cm giant coronary artery aneurysm (CAA) in the context of aorto-iliac aneurysmal disease, treated by staged open surgical repair. DISCUSSION Abdominal aortic aneurysm (AAA) and CAA share risk factors and aetiological mechanisms, therefore should be considered, particularly when CAA is diagnosed in the first instance. CONCLUSIONS Surgical intervention for diagnosed giant CAA appears to be the treatment of choice in the reported literature, with the order of intervention when AAA co-exists remaining a point for debate.

Diaphragmatic and Intercostal Muscle Tear After an Episode of Violent Sneezing: Spontaneous Diaphragmatic Injury

Spontaneous diaphragmatic injuries are rare, accounting for approximately 1% of all diaphragmatic injuries. We report a case of a 69-year-old male with a concurrent lower respiratory tract infection who sustained diaphragmatic and intercostal muscle injuries after an episode of violent sneezing. To our knowledge, this is the first reported case of spontaneous diaphragmatic injury after sneezing.

The short saphenous vein: A viable alternative conduit for coronary artery bypass grafts harvested using a novel technical approach

A multitude of vascular conduits are available to the Cardiac Surgeon performing Coronary Artery Bypass Graft operations. The Internal Mammary Artery, Radial Artery (RA), and the Long Saphenous Vein (LSV) have proven to be excellent conduits, especially in the current era of statin usage. However, previous stripping or varicosities of the LSV and calcification of the RA, coupled with the need for multiple vessel grafting, requires an alternative candidate. We describe a novel harvesting technique for bilateral simultaneous Short Saphenous Vein harvest and propose this, often forgotten vein, as a viable alternative conduit.

Oesophageal strictures: new indication for intra-aortic balloon pumps?

Oesophageal strictures regardless of aetiology are a difficult and challenging problem facing the oesophageal surgeon. Various methods and techniques have been described and are routinely used in clinical practice with varying rates of efficacy and complications. We describe here a novel graded atraumatic technique for the management of oesophageal strictures using intra-aortic balloon pumps.

Not the typical winter cough

We report on a young adult with a foreign body lodged in the right main bronchus for at least 5 days, with no alleged recollection of aspiration despite the size and shape of the object, which was removed successfully by rigid bronchoscopy.