IJTCVS 2004; 20:39

IJTCVS, Jan Mar, 2004

s e w n to a Dacron tube graft to fabricate a valved conduit in 45 patients. Composite grafts were u s e d in r e m a i n i n g 5 patients. R e s u l t s : A v e r a g e hospital stay w a s 13 days. There were 5 re explorations, 4 for bleeding a n d 1 for pericardial effusion. There were 7 e a r l y m o r t a l i t i e s (5 o f w h i c h w e r e e m e r g e n e c i e s ) , 4 d u e to uncontrolled bleed, 2 to myocardial p u m p failure a n d 1 d u e to stroke. 40 patients are in functional class (FCI), one h a d a stroke a n d another h a d CHF. All fabircated valved conduits were functioning well a n d s h o w e d similar results as the composite graft. Conclusions: Elective aortic root replacement can be p e r f o r m e d w i t h a low operating risk u s i n g a n on table fabricated valved conduit a n d the long term results are similar to composite grafts. O n table fabricated valved c o n d u i t can be a low cost alternative to composite graft.

Surgical management o f myasthenia gravis Ahlawat V, Devgarha S, Sharma S, Khulbey S, Yadav A, Yadav RG, Yadav RK, Sharma A, Kushwaha KK, Plathur RPl, Stu~vastava CP

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Introduction: M y a s t h e n i a g r a v i s is n e u r o m u s c u l a r d i s o r d e r characterised by a u t o i m m u n e alteration in postsynaptic acetylcholine receptors, fatiguability, decremental response to repetitive stimuli a n d varied response to different therapeutic modalities. This retrospective s t u d y w a s done to analyse clinical features, epidemiological profile a n d operative findings. M e t h o d s : This s t u d y w a s c o n d u c t e d on 29 patients of m y a s t h e n i a gravis w h o were operated in the d e p a r t m e n t of CTVS, SMS Medical College, Jaipur, from 1993 to 2003. There were 16 males a n d 13 females. Most of the patients were in thrid & second decade of life. A g e r a n g e d from 13 years to 56 years. All patients were on O s s e r m a n ' s grade 2B, 3 or 4. Clinical features involved fatiguability of occular m u s c l e s in 75% of cases a n d extremity muscles. All patients were evaluated by the neurologist. All patients u n d e r w e n t m e d i a n s t e r n o t o m y w i t h avoidance of aminoglycosides a n d muscle relaxants. Results: T h y m i c p a t h o l o g y i n c l u d i n g thymitis, t h y m o m a a n d hyperplasia w a s f o u n d in 18 cases, near n o r m a l looking t h y m u s w a s f o u n d in seven cases, while cystic thymic m a s s w a s f o u n d in two cases. A d v a n c e d m a l i g n a n c y invading s u r r o u n d i n g tissue w a s e n c o u n t e r e d in two cases a n d were b e y o n d operability. Total t h y m e c t o m y w a s done in 23 patients a n d radical could be possible in two cases. There were an overall mortality of three cases. Conclusions: U n p r e d i c t a b l e r e s p o n s e to v a r i o u s t r e a t m e n t modalities in patients of m y a s t h e n i a gravis m a k e s t h y m e c t o m y a fair option.

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11401

SMS Medical College & Hospital, Jaipur

Introduction: A r e t r o s p e c t i v e s t u d y w a s d o n e to a n a l y s e e p i d e m i o l o g i c profile, clinical f e a t u r e s , o p e r a t i v e f i n d i n g s a n d histopathological findings in patients p r e s e n t i n g w i t h m e d i a s t i n a l masses. M e t h o d s : This s t u d y w a s c o n d u c t e d on 106 patients w h o were operated in the d e p a r t m e n t of CTVS, SMS Medical College, Jaipur from 1993 to 2003 w i t h clinical diagnosis of mediastinal m a s s w i t h male to female ratio of 1.9:1. A g e range w a s from 6 m o n t h s to 62 years w i t h peak incidence in third a n d fourth decade of life (56%). Clinical features were those of m y a s t h e n i a gravis, dyspnoea, pain chest, c o u g h a n d incidental finding on chest x ray. CT scan w a s d o n e to assess

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Surgical experience o f myasthenia gravis [----] Hirakannwar A, Singh A, Kumar TKS, All M, Patwardhan AM, Khandeparkar ]MS, Agrawal NP, Khandekar]V, Pathare HP

1'4'1

Dr PK Sen D e p a r t m e n t of Cardiovascular & Thoracic Surger T, KEM Hospital, M u m b a i

SMS Medical College & Hospital, Jaipur

Study o f 106 cases o f mediastinal masses Sh~vastava CE Ahlawat V, Devgarha S, SharmaS, Khulbey S, YadavA, YadavRG, YadavRK, SharmaA, KushwahaKK, Plathur RM,

operability. A n t e r o s u p e r i o r m e d i a s t i n u m w a s involved in 76 cases (72%), middle m e d i a s t i n u m in 13 cases a n d posterior m e d i a s t i n u m in 17 cases. M y a s t h e n i a gravis w a s present in 27% of cases. Results: Complete surgical excision w a s possible in 68% of cases. Hostopathologically 41 patients h a d t h y m i c pathology, 31 patients h a d l y m p h o m a , 14 patients h a d g e r m cell t u m o u r s , 12 patients h a d neurofibroma a n d 4 patients h a d ganglioneuroma. Two patients h a d bronchogenic cyst while thymic cyst a n d m e s o t h e l i o m a w a s f o u n d in one patient each. There w a s a n overall mortality of four patients. Conclusion: Anterosuperior mediastinal m a s s e s a n d a m o n g t h e m t h y m o m a s are the c o m m o n e s t b e n i g n lesion. It can be completely excised with low morbidity a n d mortality.

O b j e c t i v e : To a n a l y s e a n i n s t i t u t i o n a l e x p e r i e n c e of s u r g i c a l t r e a t m e n t o f m y a s t h e n i a g r a v i s w i t h r e s p e c t to o u t c o m e a n d recurrence. M e t h o d s : From Januar T 2001 to September 2003, 40 t h y m e c t o m i e s w e r e p e r f o r m e d for m y a s t h e n i a g r a v i s . C l i n i c a l l y p a t i e n t s of m y a s t h e n i a gravis were g r a d e d according to m o d i f i e d O s s e r m a n Classification. 4 (10%) patients were in class 1, 29 (72.5%) were in class IIa, ? (17.7) in class IIb N o patients w a s from class III& IV. 12 patients (30%) h a d t h y m o m a . M e a n d u r a t i o n of s y m p t o m s before operation w a s 15 20 m o n t h s . All thymectomies were performed t h r o u g h m e d i a n s t e r n o t o m y & all fibrofatty tissue from Rt. phrenic to Lt phrenic & from d i a p h r a g m to i n n o m i n a t e vein w a s removed. Results: M e a n d u r a t i o n of follow u p w a s 18 m o n t h s . Operative mortality w a s 0%. 5 patients (12.5%) became free of disease w i t h o u t medication (remission), 28 patients (70%) i m p r o v e d s y m p t o m a t i c a l l y a n d or required less mediaction (improvement), 7 patients (17.5%) h a v e a stable disease w i t h no change in s y m p t o m s if c o m p a r e d to clini al status before operation. No one presented a deterioration of their clinical status with worse s y m p t o m s . No one died because of m y a s t h e n i a gravis. Patients with short d u r a t i o n of s y m p t o m s before operation & y o u n g e r in age & lower class of m y a s t h e n i a gravis s h o w e d higher rate of r e m i s s i o n / i m p r o v e m e n t . Conclusions: T h y m e c t o m y is effective in m a n a g e m e n t of patients w i t h m y a s t h e n i a gravis w i t h low morbidity.

Mediastinal masses - Six years' experience [----] Dey AK, Vasisth R, Chakrabarti A, Guha I, Dey S, Sengupta G, Saha T, Maiti N, Roy BC, Mukherjee S, Pal MS, Chakraborty S

11421

Medical College, Kolkata

Introduction: Mediastinal m a s s e s are often a s y m t o m a t i c a n d are discovered on routine chest X ray. However, s o m e m a y present w i t h specific s y m p t o m s . M a n y of the patients w h o have CT g u i d e d FNAC, t h e r e s u l t s are i n c o n c l u s i v e i n s p i t e o f r e p e a t e d a s p i r a t i o n & examination. At Medical College Kolkata, we h a d experiences of 87 cases of mediastinal masses. Material & M e t h o d s : Time s p a n six years from July 1997 to June 2003. Total n u m b e r of cases 87.80% of w h o m were male. A g e g r o u p ranges from 9 to 70 years. Cases excluded: a n e u r y s m s , cases d i a g n o s e d by F N A C a n d stent to Oncology D e p a r t m e n t Anatomical Location : Ant. M e d i a s t i n u m 43 Cases, Post M e d i a s t i n u m 23 cases, Middle M e d i a s t i n u m 15 cases a n d "Sterum to Vertebrae" 6 cases. 43 cases u n d e r w e n t Midline s t e r n o t o m y followed by Rt. t h o r a c o t o m y 23 cases a n d Lt. t h o r a c o t o m y 21 cases.

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