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ABSTRACTS OF PAPERS PRESENTED AT THE 71ST RESEARCH MEETING OF THE MEDICAL RESEARCH CENTRE OF BOMBAY HOSPITAL ON MONDAY, 20TH OCTOBER 1999, 2.30 PM IN THE SP JAIN CAFETERIA (CONVENOR DR. HL DHAR)

1. MITRAL VALVE REPLACEMENT IN CHILDREN BELOW 15 YEARS OF AGE

OS Chokhani, Somaya A, Nemesha, Partha Bindra


Mitral valve disease still forms a large number of cases in our country. Poor economical conditions of the patients unawareness regarding complications of rheumatic fever in childhood are common cause of the mitral valve disease. Awareness of good diagnostic procedures, availabilities of satisfactory cardiac prosthesis and good results of surgery have promoted many patients to come for the surgery. In this paper, we have tried to emphasise on (a) early surgery (b) Post operative managements of patient (c) Long term follow up with results.

The results are encouraging and should motivate the need for early surgery in childhood.


2. USE OF STREPTOKINASE IN TREATMENT OF STUCK PROSTHETIC VALVES

OS Chokhani, Somaya A, Nemesha, Partha Bindra

One of the complications of prosthetic valve surgery is “Stuck Valve”. The causes of stuck valve may be many but to elaborate few (a) development of pannus around the annulua (b) Clot formation around the valve due to inadequate anticoagulation (c) Improper size of the valve (d) technical problems. First two are usually late complications and needs to be attended.

In the past-stuck valve meant second surgery but now we have successfully avoided the resurgery in at least 25 cases by the use of streptokinase. The diagnosis treatment and the results are discussed in this paper. It is a small series of cases but now many centres are trying this type of treatment with success.

This will definitely bring down the number of resurgery. At present this treatment is found to be successful only in few. This treatment is found to be successful only in few selected cases.


3.ANTICOAGULATION PROGRAMME DURING PREGNANCY - PATIENT WITH VALVE REPLACEMENT

OS Chokhani, Somaya A, Nemesha, Partha Bindra

It is believed that anticoagulants should be stopped during 1st and last trimester of pregnancy and should be changed to heparinization as anticoagulants are harmful to the foetus.

In our small series of 150 patients anticoagulation programme was continued throughout the pregnancy and no untoward incidence was reported or witnessed now there is lot of literature on this direction. He also recommend that anticoagulation programme should not be disturbed or changed during pregnancy unless there is any other medical cause.


4. RETROPERITONEAL LAPAROSCOPIC NEPHRECTOMY; COMPARISON WITH OPEN SURGERY

HR Madusudhana, DD Gaur, Vivek Mehta

The advances in the field of endoscopic and minimal invasive surgery are on forefront of today’s surgical scenario. Open surgery with standard flank approach is the commonly used technique all over the world even today. Although well tolerated it is associated with lot of postoperative pain and discomfort, moreover hospital stay and return to activity were frequently prolonged. With the backing up of our past experiences in the field of retroperitoneoscopic surgery, we decided to compare results of retroperitoneal laparoscopic nephrectomy (RLN) with that of open surgery (ON) in termsof safety, feasibility and final outcome.

12 patient’s (13 units) underwent RLN at our Institute over last one year duration. The indications being nonfunctioning kidney due to PUJ obstruction in 2, reflux nephropathy in 3, renal tuberculosis in 2, end stage nephrolithiasis in 2, chronic pyelonephritis in 1 and TCC of renal pelvis in 1.2 persons underwent donor nephrectomy during the same period. The surgical and clinical parameters are compared with results of 45 simple nephrectomy performed by our department colleague during the same period.

Out of 12 patient operated 1 has to be converted to ON as there were lots of adhesions. The meanoperative time was 140 mins, average blood loss is 80 ml, analgesic requirement is 3.2 days, hospital stay was 3.5 days with convalescence period of 8 days for RLN group compared to 100 mins, 220 ml, 7 days, 8 days and 22 days respectively for ON. The warm ischaemic time in donor nephrectomy was 4.5 mins compared to 3.5 for ON. 23% of RLN gp and 15% of ON gp had minor complication but none of them suffered any form of major complication. Neither of the recipient required renal replacement therapy in post transplantation state.

RLN has advantages over ON with good cosmesis, less blood loss, less need for analgesic, short hospital stay and early return to work. On the otherhand it has certain disadvantages being time consuming, expensive, needs expertise with additional complications of laparoscopy, moreover it is contraindicated in renal resurgery. RLN is ideal minimally invasive procedure in removing benign, small, nonfunctional, symptomatic kidney. It is not suitable to remove larger renal mass because of paucity of the space. Its role in donor nephrectomy and tumour nephrectomy needs to be evaluated further.


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