Innovative Journal of Medical and Health Sciences

Background: We aimed to identify the clinical utility of a simple echocardiography approach for estimating the pulmonary capillary wedge pressure (PCWP) on the basis of pulse wave doppler in pre and post hemodialysis patient.

Method: A prospective observational study was done in 50 patient’s attending their Hemodialysis session at Chettinad Hospital with the age limit <70 years. From the total subjects 30 were males and 20 were females. In this present study we analyzed the pre and post dialysis volume changes using Estimated PCWP and correlate it with other volume markers. To determine that estimated PCWP might be one of the diagnostic accuracy to detect volume load in the patient undergoing Hemodialysis.

Result: In this study, it was found that patients who had very low Estimated PCWPs (PCWP-less than 4mmHg) after a dialysis session started to experience wooziness, cramping, etc. The patient's hemodynamic state in the post-dialysis period is significantly impacted by intra-dialytic weight gain. The changes in Pulmonary Capillary wedge pressure in Post Dialysis session is well correlated with the other volumetric markers like Systemic blood pressure, LA Diameter, Creatinine and BUN levels.

Conclusion: Echocardiography plays an important role in day-to-day clinical diagnosis. In this study, patients with chronic kidney disease underwent haemodialysis. In Post dialysis period the intra dialytic weight gain play a major impact on the patient hemodynamic status. To overcome this various volume markers were used. At this point, the estimated pulmonary capillary wedge pressure can be used as one of the most specific volume load markers in patients undergoing Hemodialysis and it is well correlated with other volume markers too.

Emphysematous cholecystitis (EC) is a life-threatening surgical emergency characterized by gangrene of the gallbladder due to an infection with gas-forming organisms. It is a severe and rare variant of acute cholecystitis commonly seen in elderly males, immune-compromised hosts, patients with arteriosclerosis, history of embolic events. Delayed presentation or diagnosis is associated with high morbidity and mortality.

Percutaneous trans-hepatic drainage of the gallbladder (GB) is the initial treatment of choice for severe acute cholecystitis in a patient with multiple comorbid conditions and unstable hemodynamic status. An interval laparoscopic cholecystectomy is usually recommended after 6 weeks. However, this drainage procedure may not serve the purpose in patients with emphysematous cholecystitis because of the frequent association of focal gangrenous patches in the gall bladder in these patients.

Laparoscopic surgery is a feasible option with an excellent postoperative outcome. However, it is often very challenging due to the distortion of the anatomy secondary to severe inflammatory changes and demands a skilled laparoscopic surgeon. We report the case of a 75 years female known as Alzheimer’s, hypertensive and congestive cardiac failure patient with a delayed presentation and decreased responsiveness, diagnosed as emphysematous cholecystitis by a contrast CT scan, who underwent successful laparoscopic management after initial periods of resuscitation. The culture of the pus from the gallbladder grew Escherichia coli. A literature search was performed to highlight the management options of these patients.