Sumit Yadav

Catastrophic presentation of atrial myxoma with total occlusion of abdominal aorta

Cardiac myxoma is a rare disease with protean manifestations. Embolic phenomena are well-known entities. However, total occlusion of the descending aorta by saddle embolism along with multi-organ embolism is very unusual. We report a patient with cardiac myxoma presenting with multi-organ embolism including saddle embolism of the aorta in a previously healthy female.

Cardiac surgery in indigenous Australians - How wide is 'The Gap'?

BACKGROUND Cardiovascular disease remains the leading cause of mortality in the Indigenous Australian population. Limited research exists in regards to cardiac surgery in the Aboriginal and Torres Strait Islander (ATSI) population. We aimed to investigate risk profiles, surgical pathologies, surgical management and short term outcomes in a contemporary group of patients. METHODS Variables were assessed for 557 consecutive patients who underwent surgery at our institution between August 2008 and March 2010. RESULTS 19.2% (107/557) of patients were of Indigenous origin. ATSI patients were significantly younger at time of surgery (mean age 54.1±13.23 vs. 63.1±12.46; p=<0.001) with higher rates of preventable risk factors. Rheumatic heart disease (RHD) was the dominant valvular pathology observed in the Indigenous population. Significantly higher rates of left ventricular impairment and more diffuse coronary artery disease were observed in ATSI patients. A non-significant trend towards higher 30-day mortality was observed in the Indigenous population (5.6% vs. 3.1%; p=0.244). CONCLUSIONS Cardiac surgery is generally required at a younger age in the Indigenous population with patients often presenting with more advanced disease. Despite often more advanced disease, surgical outcomes do not differ significantly from non-Indigenous patients. Continued focus on preventative strategies for coronary artery disease and RHD in the Indigenous population is required.

Late extrusion of pulmonary plombage outside the thoracic cavity

Plombage, a variant of collapse therapy for patients with pulmonary tuberculosis that uses a variety of foreign materials, was undertaken until the 1950s before the invention of effective antimicrobial therapy. Complications related to previous plombage procedures are not uncommon. Management of these complications can be challenging. We report a patient presenting with extrusion of plombage 59 years later and managed successfully with removal of the plomb and pectoral muscle flap transposition.

Postoperative Care and Complications After Thoracic Surgery

Postoperative care of thoracic surgical patients is a very important part of patient recovery and can be very challenging. Pulmonary complications are responsible for significant numbers of deaths and morbidity of patients undergoing thoracotomy. Thoracic surgery impairs postop‐ erative respiratory function resulting in a relatively high risk of developing postoperative pulmonary complications. The incidence (19-59%) is much higher than following upper (16-17%) or lower abdominal surgery (0-5%). The overall incidence of complications following thoracic surgery varies from 15% to 37.5%, primarily due to the type of pulmonary complica‐ tions studied, the clinical criteria used in the definition and the type of surgery included. The clinical and potential economic impact of these complications is marked, with significantly longer hospital and high Dependency unit stay, frequency of ICU admission and number of deaths.

Papillary Fibroelastoma: A Unique Case of Distant Recurrence

Primary cardiac tumors are rare, with an incidence of 0.001%to 0.28% in autopsy series.(1) The third most common primary tumor, although likely under diagnosed, is the cardiac papillary fibroelastoma (CPF).(2) These tumors are benign, do not exhibit local infiltration on histopathologic examination, and carry a low likelihood of recurrence.(3) After excision, recurrence is rare, with a total of4 reported cases of recurrence. Tamin and colleagues2re-ported 3 cases, occurring at 1, 5, and 6 years after initial surgery, that they described as at or near the previous surgical excision site. Kammerer and associates (3) described a case of mitral valve recurrence after 3 years but hypothesized that incomplete resection in attempt to preserve the valve was the likely underlying mechanism. We report a unique case of recurrent CPF after previous resection,occurring at multiple alternate sites throughout the left ventricle (LV).

A Review of Coronary Artery Bypass Grafting in the Indigenous Australian Population

INTRODUCTION Indigenous Australians experience poorer health outcomes than non-Indigenous Australians. Ischaemic heart disease is a leading contributor to the mortality gap which exists between Indigenous and non-Indigenous Australians. METHODS We reviewed the literature in regards to Indigenous Australians undergoing coronary artery bypass grafting (CABG) for management of ischaemic heart disease. RESULTS Younger patients with higher rates of preventable risk factors constitute the Indigenous Australian CABG population. Indigenous Australian females are over-represented in series to date. High rates of left ventricular dysfunction are seen in the Indigenous CABG cohorts potentially reflecting barriers to medical care or the influence of high rates of diabetes observed in the Indigenous Australian population. The distribution of coronary artery disease appears to differ between Indigenous Australian and non-Indigenous CABG cohorts likely reflecting a difference in the referral patterns of the two population groups with diabetes again likely influencing management decisions. Reduced utilisation of arterial conduits in Indigenous Australian cohorts has been identified in a number of series. This is of particular concern given the younger age structure of the Indigenous Australian cohorts. Indigenous Australian patients suffer excess morbidity and mortality in the longer term after undergoing CABG. Ventricular dysfunction and excess comorbidities in the Indigenous Australian CABG population appear largely responsible for this. CONCLUSION Excess morbidity and mortality endured by Indigenous Australians in the longer term following CABG appears largely contributed to by higher rates of ventricular dysfunction and comorbidities in the Indigenous Australian CABG population. Maximising internal mammary artery use and continued focus on strategies to reduce the impact of diabetes, renal impairment and heart failure in the Indigenous Australian population is essential to reduce the mortality gap experienced by Indigenous Australians secondary to ischaemic heart disease.

An Overview of Indigenous Australian Disadvantage in Terms of Ischaemic Heart Disease

BACKGROUND Indigenous Australians experience poorer health outcomes than non-Indigenous Australians and a significant life expectancy gap exists. Ischaemic heart disease (IHD) represents the leading specific cause of death in Indigenous Australians and is a significant, if not the most significant, contributor to the mortality gap. With this narrative review we aim to describe the burden of IHD within the Indigenous Australian community and explore the factors driving this disparity. METHODS A broad search of the literature was undertaken utilising an electronic search of the PubMed database along with national agency databases-the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). RESULTS A complex interplay between multiple factors contributes to the excess burden of IHD in the Indigenous Australian population: CONCLUSIONS: In terms of IHD, Indigenous Australians experience disadvantage at multiple stages of the disease process. Ongoing efforts are needed to continue to inform clinicians of both this disadvantage and strategies to assist negating it. Further research is needed to develop evidence based practices which may help reduce this disparity in outcomes.

Population dynamics of pink stem borer, Sesamia inferens (Walker) on maize as influenced by weather conditions

A field study on population dynamics of pink stem borer, Sesamia inferens (Walker) on maize was carried out during rabi, 2015-2016 at the research farm of CCS Haryana Agricultural University, Regional Research Station, Karnal. Studies on population dynamics revealed that the maximum number of egg masses was observed during 46th SW (standard week), 2015. The larval population increased after 45th SW and reached the maximum during the 49th SW, 2015 and then declined till 7th SW, 2016. Maximum plant infestation by larvae was recorded 19.5 per cent in inbred HKI 1128 and 21.0 per cent in hybrid HQPM 1 during the 7th SW, 2016. No larval activity of S. inferens, plant infestation and dead hearts were observed during 2nd SW to 4th SW of 2016 (second week to last week of January). It could be due to the fact that insect might have entered the hibernation. Correlation of S. inferens population with various environmental factors revealed that larval population had a significant negative correlation with maxi-mum temperature (Tmax.) and minimum temperature (Tmin.), rainfall (RF) (r= -0.4992, -0.5183 and -0.5698) on HKI 1128 and (r= -0.4872, -0.4717 and -0.5242) on HQPM 1, respectively. Multiple regression analysis of S. inferens population with weather parameters showed that there was 80 per cent (HQPM1) and 82 per cent (HKI 1128) variability in larval population due to various environmental factors. The population dynamics revealed by this study have far reaching significance in pest management strategy as integrated control measures may be focused only during the period wherein population exceeds economic threshold level (ETL).

Bilateral gluteal compartment syndrome after thoracic surgery: an unusual complication: Letters to the Editor

1. Theile DE, Philpot S. Re: Analysis of mortality in colorectal surgery in the Bi-National Colorectal Cancer Audit. ANZ J. Surg. 2016; 86: 951. 2. Teloken PE, Spilsbury K, Platell C, Operations Committee BCCA. Analysis of mortality in colorectal surgery in the Bi-National Colorectal Cancer Audit. ANZ J. Surg. 2016; 86: 454–8. 3. Almoudaris AM, Burns EM, Bottle A et al. Single measures of performance do not reflect overall institutional quality in colorectal cancer surgery. Gut 2013; 62: 423–9.

Thoracic melioidosis: A diagnostic dilemma

The diagnosis of melioidosis can be difficult, and it is frequently described as “the great mimicker”. We report a case of thoracic melioidosis presenting as a mediastinal mass with impending superior vena cava obstruction. With the presumptive diagnosis of mediastinal tumor, the patient underwent surgery for tissue sampling, and a purulent collection was found. The clinical syndromes of melioidosis and the diagnostic dilemma are discussed.