Stentless prostheses in the aortic position produce a superior hemodynamic profile in comparison to that with stented valves. To determine whether routine use of stentless valves in an elderly population is justified, a 10-year retrospective review was performed of a consecutive series of patients aged > or =75 years undergoing stentless aortic valve replacement (AVR).Demographic, operative and mortality data were obtained retrospectively. Survivors were interviewed by telephone according to a defined protocol. Univariate and multivariate analysis was used to identify independent predictors of 30-day and overall medium-term mortality. Definitions and analyses were in accordance with joint STS/AATS guidelines.A total of 103 patients (57 males, 46 females; mean age 79.8 years; range: 75-91 years) underwent AVR with a either a Toronto stentless porcine valve (size range: 21-29 mm; n = 74) or an aortic homograft (n = 29). Twenty-eight patients (27%) had either urgent/emergency surgery, 12 (11%) underwent redo surgery, and in 54 cases (52%), the preoperative left ventricular function was significantly impaired (ejection fraction <50%). Forty patients (39%) also underwent concomitant coronary artery bypass grafting. The mean cross-clamp and cardiopulmonary bypass times were 105+/-22 min and 144+/-47 min, respectively. The overall 30-day mortality was 11.6% (n = 12). The 30-day mortality for all elective cases was 5.3%, but for isolated elective AVR was only 2.5%. Using a multivariate model, the only independent predictor of 30-day mortality and medium-term overall mortality was increasing age. The mean follow up period was 3.6 years (range: 0.1-9.3 years), and the Kaplan-Meier actuarial five-year survival was 52%. At follow up, 92% of patients were in NYHA functional classes I and II.Stentless AVR in elderly patients is associated with excellent functional and survival outcome in the medium term. Furthermore, in elective cases, age alone should not be a deterrent to the routine use of stentless aortic valves.
Ulcerative colitis is a chronic inflammatory condition in which patients show altered bowel habit such as diarrhoea, constipation, rectal bleeding, tenesmus, passage of mucous and crampy abdominal pain etc. These symptoms may be relapsing and remitting episodes of inflammation limited to the muscles layer of colon. Allopathic medicine definitely made the life comfortable for human beings with various research and advancement in treatment modalities but in certain disease like ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, inflammatory bowel disease and many more diseases it also searches a search engine and probably Ayurveda play this role in several ways. In Ayurveda Raktaja Arsh, Raktatisara, Raktaja Pravahika, Grahani shows symptoms having resemblance with Ulcerative colitis. Ayurveda described various treatment modalities for the management of Ulcerative colitis such as Anuvasan Basti, Piccha Basti, Samshamanyogas, proper nutritional supplements, herbal therapy, Yoga and meditation etc. In present study, A diagnosed case of ulcerative colitis, age 61yrs male from Dhanbad, Jharkhand came to OPD of Kayachikitsa, Government Ayurvedic College and Hospital, Patna. He complained of pain in abdomen, bleeding per rectum, excessive thirst, pain in joints of lower limb bilaterally. He was given Anuvasan Basti and Piccha Basti along with some drugs and his complaints not only relieved delayed remission as well. The goals of the treatment are to improve quality of life, minimize the risk of colon cancer and achieve steroids free remission of the disease ulcerative colitis.
Ankylosing spondylitis (AS) is chronic inflammatory disorders of unknown cause that primarily affects the axial skeleton (Predominantly sacroiliac joints and spine) peripheral joints and of extra articular structures may also be involved in an asymmetrical pattern. The disease usually begins in the second or third decade; the male to female prevalence is approximately 3:1. Patients having AS, more than 95% of them are positive HLA-B27. Use of NSAIDS are the first line of management and they effectively relieve the symptoms. Few Ayurvedic medicines found to be effective in the management of AS. Here, a case study of AS managed by Ayurvedic treatment approaches is presented. A patient 21yrs male came to OPD of Kayachikitsa i.e., Room No. 9 of GACH, Patna. He complaint of pain in B/L ankle left>right, also B/L knee joint pain as well as low back pain for 6 months. He was diagnosed on the basis of its signs and symptoms of AS with HLAB27 positive. He was managed by Ayurvedic medicines like Panchatikta Ghruta Gugglu, Ekangveer ras, Tab. Shallaki, Cap. Stresscom, Jrumax oil, Vaishwanar churna, Laxarid for 7 months and relief in his signs and symptoms.
Annadrava shoola is one of the diseases of the alimentary canal in which there is colic occurs after digestion, during digestion or at any time and Patient feels relief after vomiting. It can be said gastric ulcer on the basis of its signs and symptoms.
Gastric ulcers are most commonly located on the lesser curvature, whereas duodenal ulcers are most common at the duodenal bulb. The ulcer is round to oval with a smooth base. Acute ulcers have regular borders, while chronic ulcers have elevated borders with inflammation. An ulcer extends beyond the muscularis mucosa. Ayurveda encourages lifestyle interventions and natural therapies to regain a balance between the body, mind and the environment. In this paper, a case study on Annadrava shoola has been explained. A female patient of 42 years of age came to the Kayachikitsa OPD (OPD REG.no-6836) Government Ayurvedic College and Hospital, Patna-03 having complain of pain and burning sensation in abdomen for 5 months as well as irregular bowel evacuation (>3episode) in the last 3 months. The nature of pain was gradual on onset and burning type and exaggerated after meal. On the basis of history of the patient and endoscopy report, he was diagnosed as gastric ulcer and pan gastritis. We have done the Shamana Chikitsa for the patient. In Shamana Chikitsa was done with combinations of Sutashekhar Ras, Tab Aciloss and Shatavari Churna for one month. Endoscopy was repeated after one and half months of treatment. Report showed only that the treatment cured the Annadrava shoola (gastric ulcer) of the patient. So, there is hope in Ayurveda for the treatment of Annadrava shoola.
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