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Aims and objective The primary objective of this investigation was to study the effects of cardiopulmonary bypass (CPB) perfusion temperature on renal function parameters [serum creatinine, creatinine clearance, urine albumin, urine protein, and urine albumin/creatinine ratio (ACR)]. The secondary objective was to detect renal complications of CPB. Materials and methods This is a prospective longitudinal study of 30 adult patients (17 men, 13 women; mean age, 53.37 ± 16.02 years) who underwent valvular heart surgery [with or without coronary artery bypass grafting (CABG)]. Serum creatinine, creatinine clearance, urine protein, urine albumin, and urine ACR were collected during CPB (at 28 °C, 32 °C, and 37 °C) and postoperatively (at 12 hours, 24 hours, and 48 hours). Data were analyzed using one-way repeated-measures analysis of variance (ANOVA). A significant ANOVA was followed by a Bonferroni–Holm post hoc test. Results Although serum creatinine (p < 0.001) and creatinine clearance (p = 0.0016) underwent a significant ANOVA change (p < 0.001 and p = 0.0016, respectively) after CPB, there was no statistically significant change compared with their baseline values. Urine ACR showed a significant change at 28 °C (p < 0.01), 32 °C (p < 0.01), and 37 °C (p < 0.05) as compared with baseline values. No significant change in urine albumin was observed during CPB or up to 24 hours. A significant change occurred after 48 hours of CPB (p < 0.05). A significant increase in urine protein was noted after CPB at 12 hours (p < 0.01), 24 hours (p < 0.01), and 48 hours (p < 0.01). Overall, 12 (40%) patients had acute kidney injury (AKI). Ten (33.33%) patients had stage I AKI, one patient progressed to AKI stage II, and another to AKI stage III. Of the 10 patients who had stage I AKI, eight had complete recovery within 48 hours. Conclusions CPB with moderate hypothermia for valvular heart surgeries can be performed safely in patients with adequate renal functional reserve. The glomerular permeability across the Bowman’s capsule increases after CPB as evidenced by significant proteinuria at 12 hours and increased albuminuria at 48 hours after surgery. There is an increased risk of transient stage I AKI after CPB, from which patients recover within 48 hours.

BACKGROUND: A medical student needs to understand the integral theory of continence, clinically elicit urethral hypermobility and understand the surgical principles of repair. A skill development model was designed for the final year curriculum of medical students to explain the basic knowledge of integral theory of continence along with surgical repair of urinary incontinence. AIM: The primary objective of the study was to assess the efficacy of simulation-based teaching (SBT) using a home-developed model as compared to video-based teaching (VBT). The secondary objective was to elicit the feedback of students who underwent SBT. METHODS: One hundred fifty-nine medical students participated in the study. Simulation-based teaching (SBT) (n = 81) was compared with video-based teaching (VBT) (n = 78). Pretest and posttest results were used to assess learning. Feedback was obtained to improve the existing teaching method. RESULTS: In the VBT group, the posttest values of lowest score, 25th percentile, 75th percentile, and maximum scores were 9, 10, 12, and 15, respectively. In the SBT group, the posttest values of lowest score, 25th percentile, 75th percentile and maximum scores were 11, 12, 14, and 15, respectively. The students were able to comprehend the anatomical landmarks and integral theory of urinary continence better in SBT group. The surgical technique demonstration and hands-on training done on the pelvic model improved their comprehension. CONCLUSION: A home-developed model is an effective and economic tool in training medical students. This prototype model of education can be employed as a teaching tool in other surgical disciplines as well.

Introduction: Total Anomalous Pulmonary Venous Connection (TAPVC) is an uncommon congenital heart defect. They are classified into cardiac, supracardiac, infracardiac and mixed subtypes. It has a very high mortality without surgical correction. Aim: To assess the results and early outcomes of surgical repair in patients with isolated total anomalous pulmonary venous drainage with biventricular anatomy. Materials and Methods: This was a prospective study on 27 patients with isolated TAPVC, who underwent surgical correction between January 2012 and December 2018 at a tertiary cardiac care centre in Chennai, Tamil Nadu, India. This study involved detailed pre-operative Echocardiography and CT pulmonary angiography. Analysis of surgical repair, post-operative intensive care unit stay and up to 1 year follow-up of patients was done. Parametric variables were expressed as mean±standard deviation. Chi-square test was used to analyse categorical variables and calculate p-value. Results: The mean age of 27 patients was 4.86±10.08 months and mean weight was 4.69±4.13 kg. The subtype of anomalous connection decided the specific technique of surgical correction. The mean cardio-pulmonary bypass time for all TAPVC types was 111.04±39.82 minutes, mean aortic cross clamp time was 61.44±25.95 minutes and mean hospital stay of the patients was 9.11±2.08 days. There was one early post-operative death in supracardiac TAPVC variant (72 hours after surgery). There were three late post-operative deaths in infracardiac TAPVC variant due to post-operative pulmonary venous obstruction. One patient died three months after surgery and the other two died six months after surgery. The cumulative proportion of patients surviving at the end of one year was 0.88 (standard error of 0.07). Conclusion: Good early outcomes after surgical correction for TAPVC can be achieved. The duration of cardio-pulmonary bypass in infracardiac type of TAPVC is significantly higher than supracardiac and cardiac variants. Infracardiac TAPVC and preoperative Pulmonary Venous Obstruction (PVO) are associated with a poorer prognosis. This subset of patients represents the extreme end of TAPVC spectrum where they often require prolonged cardiopulmonary bypass support.

Aortic valve replacement in rheumatic disease is one of the procedures that clearly prolonged the life expectancy of adult patients. Our study objectives are to assess the mortality and morbidity associated with aortic valve replacement, and study the effects of successful, valve replacement on ventricular volume and performance in aortic stenosis and in aortic incompetence. Between January 1997 and December 2001, 148 patients underwent aortic valve replacement at our institution. The records of these patients were evaluated retrospectively. A total of 136 survivors were followed up both actively and passively. There were 9 deaths (6.07%) with an early mortality at 30 days of 4.05% and valve related mortality of 4.05%. Bleeding events and operated valve endocarditis occurred infrequently (0.03% and 0.04% / patient year). 2 patients had nonstructural valve dysfunction (paravalvular leak) (0.02% / patient year). Following successful valve replacement, ventricular volume decreased substantially, while there was no significant increase in ventricular performance in aortic stenosis, and aortic incompetence. Aortic valve replacement can be performed today with a low mortality and morbidity. Although the ventricular volume and cardiac size reduced substantially following valve replacement, the ventricular performance remained unchanged in aortic stenosis, and aortic incompetence because of the impaired ventricular function pre-operatively and because the ejection fraction tends to over estimate contractile function in aortic regurgitation. Low preoperative ejection fraction is therefore an important risk factor for postoperative left ventricular dysfunction.

Mycobacterium fortuitum infection of the sternum following cardiac surgery is a rare occurrence.It is usually diagnosed late and has a considerable mortality. We present a female patient with mycobacterium fortuitum sternal wound infection following mitral valve replacement, who was successfully managed with radical surgical debridement combined with multidrug antibiotics. Multidrug antibiotic therapy is essential because of the emergence of resistant strains.

Cystic lymphangiomas are relatively uncommon benign tumours of the lymphatic system. These lesions frequently are apparent at birth and more than 90% are detected before the end of the second year of life. More commonly cystic lymphangioma presents as a soft tissue mass in the neck and only rarely does it extend into the mediastinum. Isolated mediastinal lymphangiomas are exceedingly rare and have been reported infrequently. Herein we have reported two cases of mediastinal cystic lymphangioma, one in a child and the other in an adult patient, who were treated successfully by complete surgical excision

Pulmonary leiomyosarcomas can be highly vascular tumours which provide a challenge in their management. Computerised Tomography (CT) scan of a 27 year old gentleman demonstrated a vascular 12 × 10 cm tumour in the region of middle lobe. We proceeded with a right pneumonectomy after embolization of the major feeder vessels to the tumour.

Cystic lymphangioma is a developmental malformation of the lymphatic system. As they develop in the body surface, 90% of all lymphangiomas are found by 2 years of age. However, those developing in the mediastinum, which account for less than 1%, are mostly asymptomatic and are usually found accidentally in adulthood. 2 We report here a rare case of isolated mediastinal cystic lymphangioma in a 3-year-old child.