Biomedical subjects
Publications and source records attributed to M P Mohansingh.
This article deals with the impaction of an angiography catheter in the right coronary ostium and its subsequent retention as a broken foreign body. The case was managed by operative extraction and concomitant CABG. The management of such a case is discussed.
Endomyocardial fibrosis is a fatal disease of obscure aetiology which is notably prevalent in Uganda, Brazil, Kerala State in India, and certain other parts of the world. The main disability in the disease results from fibrotic obliteration of ventricular chambers and insufficiency of the mitral and tricuspid valves. The poor response to medical treatment and the bleak prognosis of the patients led to the introduction of endocardiectomy and replacement of the atrioventricular valves as a palliative procedure by Dubost and colleagues. The present report on the early results in 17 patients from Kerala State would support the continued use of this palliative procedure in endomyocardial fibrosis with severe disability.
The operative mortality in pulmonary surgery was found to be four times higher in patients aged above 70 compared with those below 65. A similar study has been carried out in patients undergoing oesophageal surgery. A corresponding increase in operative mortality with advancing age was not found in this group. Anastomotic leakage remains the most common cause of operative mortality, the incidence of which is no higher in the elderly, though they are more liable to general complications. The overall mortality figures are comparable. The surgical approach to carcinoma of the oesophagus must be radical, and advanced age should not be a reason for withholding surgery.
Two hundred and fifty patients underwent mitral valve replacement for rheumatic valvular disease during a 9-year period from January 1979 to December 1987. A maximum period of follow-up of 10 years and minimum of 1 year was achieved with a mean duration of 4.4 years. The follow-up covered 921 out of a possible 1006 patient-years and was 91.5 per cent complete. Of the patients, 58 (23.2%) were in class II, 145 (58%) were in class III and 47 (18.8%) belonged to class IV. The early mortality for patients in Class II, III and IV was 8.6 per cent, 15.8 per cent and 31.9 per cent respectively and the 3, 5 and 10 years actuarial survival rates for the entire group were 93 per cent, 87 per cent and 70 per cent. The event-free survival rates at the same intervals were 77 per cent, 63 per cent and 57 per cent respectively. Late deaths occurred in 18 (9.5%) of the patients. Twelve of these (66.6%) could be directly ascribed to a valve-related cause.
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