Rupture of the sinus of valsalva into the pulmonary artery

Congenital aneurysms of the sinus of Valsalva are rare lesions that can rupture into any cardiac chamber, due to the central position of the aortic root. Rupture into the pulmonary artery, however, is very rare. We encountered an 18-year-old girl with rupture of the right coronary sinus into the pulmonary artery. During surgical correction, the girl was also found to have a small outlet ventricular septal defect, which was obscured by multiple hypertrophied septal trabeculae in the right ventricular outflow tract.     

High performance liquid chromatography determination of dexamethasone in plasma to evaluate its systemic absorption following intra-space pterygomandibular injection of twin-mix (mixture of 2 % lignocaine with 1:200,000 epinephrine and 4 mg dexamethasone): randomized control trial

Purpose

To determine systemic absorption of dexamethasone by detection of plasma concentration using high performance liquid chromatography following its administration along with local anesthetic agent as a mixture via pterygomandibular space.

Methods

A prospective randomized double-blind clinical study was undertaken to analyze the plasma concentration of dexamethasone after intra-space pterygomandibular injection along with local anesthesia. The study was performed as per split mouth model where the mandibular quadrant allocation was done on a random basis considering each of the 30 patients is included in the two study interventions (SS and CS). For the study site (SS) procedures, dexamethasone was administered as a mixture (2 % lignocaine with 1:200,000 epinephrine and 4 mg dexamethasone) intra-space. In the control site (CS) procedures, a regular standard inferior alveolar nerve block was administered, and dexamethasone was given as intramuscular injection. The plasma dexamethasone determination was done in venous blood 30- and 60-min post injection using high performance liquid chromatography (HPLC). The clinical parameters like pain; swelling; and mouth opening on the first, third, and seventh post-operative day were analyzed and compared.

Results

No significant difference was found in the clinical parameters assessed; comparative evaluation showed less swelling in the SS interventions. The plasma concentration of dexamethasone for the CS interventions was 226?±?47 ng/ml at 30-min and 316?±?81.6 ng/ml at 60-min post injection, and for SS, it was 221?±?81.6 ng/ml at 30-min and 340?±?105 ng/ml at 60-min post injection. On inter-site (CS and SS) comparison, no statistically significant difference was ascertained in dexamethasone plasma concentration at 30-min post injection (P?=?0.77) and at 60-min post injection. (P?=?0.32).

Conclusion

Intra-space (pterygomandibular space) administration of dexamethasone can achieve statistically similar plasma concentration of the drug as when the same dose is administered intramuscularly with demonstration of similar clinical effects.

     

Cytochemical, immunophenotypic and ultrastructural characterization of acute leukemias: a prospective study of fifty cases: haematological malignancy

Cytochemistry and immunophenotyping are established methods in the diagnosis of most leukemias but the role of electron microscopy in diagnosis, apart from understanding the cellular morphology is less studied. We present here 50 cases of acute leukemias that were studied for morphology, conventional cytochemistry, immunophenotyping and transmission electron microscopy (TEM), including ultrastructural cytochemistry using myeloperoxidase (MPO) and platelet peroxidase activity. TEM morphology using ultrastructural cytochemistry helped in definitive typing in one mixed lineage leukemia case, one AML-M5b, one AML-M6b and one microgranular variant of APML. Thus, ultrastructural studies may be useful in accurate diagnosis of biphenotypic leukemia and further classification of acute leukemias. Also, in cases with hypercellular marrow and with associated myelofibrosis, where the marrow aspirate gives low cell count, ultrastructural studies are a valuable aid to arriving at an accurate diagnosis.     

Detection of abnormal proliferation in histologically 'normal' colonic biopsies using FTIR-microspectroscopy

BACKGROUND: Abnormal crypt proliferation and development in the colon has been associated with premalignant stages of colon cancer. Conventionally, molecular markers are used to detect abnormal crypt proliferation. METHODS: In the present work, feasibility studies of FTIR-MSP to distinguish between normal and abnormal crypts from colon biopsies that show normal histopathological features have been undertaken. RESULTS: The results indicate that abnormal crypts show deviations in the pattern of absorbance in the Mid IR region along the crypt height when compared with the normal crypts. The crypts could be empirically classified into three groups such as crypts having a normal absorbance pattern for all biochemical components, crypts with abnormal absorbance pattern for some biochemical components and crypts with completely abnormal absorbance pattern along the height for all or most biochemical components studied by FTIR. The utilization of FTIR-MSP is proposed for diagnosis of abnormal metabolism at the molecular level of histologically completely normal-looking crypts, especially from those biopsies that are taken from sites far away from cancer. CONCLUSIONS: This method could give rise to a reduction in false-negative results during examination of biopsies using the conventional histopathological methods. The present method may be complementary to existing methods for precise demarcation of the zone of colostomy prior to colon cancer surgery.     

Cutaneous mucormycosis with necrotising fasciitis in a young immunocompetent individual

Primary cutaneous mucormycosis is uncommon and is extremely rare in immunocompetent young individuals. Here we report a case of necrotising fasciitis due to mucormycosis in an immunocompetent young individual following minor trauma. Mucormycosis must be suspected in any wound that is worsening despite appropriate treatment even in immunocompetent individuals.     

Repeat Pulmonary Valve Replacement: Similar Intermediate-Term Outcomes With Surgical and Transcatheter Procedures

Objectives

This study compares 30-day, 1-year, and 3-year echocardiographic findings and clinical outcomes of transcatheter pulmonary valve-in-valve replacement (TPVR) and repeat surgical pulmonary valve replacement (SPVR).

Impact of alphacypermethrin treated bed nets on malaria in villages of Malkangiri district, Orissa, India

The impact of use of bed-nets treated with alphacypermethrin, at 20 mg (ai)/m2, in comparison to untreated nets or no nets on malaria vectors and malaria incidence was studied in tribal villages of Malkangiri district, Orissa state, India, which are highly endemic for falciparum malaria. Treated or untreated nets were supplied to the villagers in June 1999 and the nets were re-treated in September 1999, just before the rise in vector abundance and malaria incidence. The seasonal pattern of indoor resting Anopheles fluviatilis females was similar in all the three groups of villages before the start of intervention and the indoor resting catches were not significantly different between treatment-groups (two-way ANOVA, F = 1.53; d.f. = (2, 78); P = 0.2). During intervention, the indoor resting catches differed significantly among treatment groups (two-way ANOVA, F = 38.9; d.f.= (2, 66); P < 0.005). There was a 99% reduction in the indoor resting catches of An. fluviatilis in villages with treated nets and 61% reduction in villages with untreated nets compared with no-net villages. Comparison between villages with and without treated nets showed that there was 97% reduction in indoor resting catches in villages with treated nets. Pair-wise comparison showed that the reductions between villages with and without nets as well as between villages with treated and untreated nets were significant (Dunnett's C-test, P < 0.05). The indoor resting catches of Anopheles culicifacies did not differ significantly among the three groups of villages either before (F = 0.99; d.f. = (2, 121); P = 0.4) or during intervention (F = 0.21; d.f. = (2, 66); P = 0.8). Bioassay with 3 min exposure to treated bed nets showed 100% mortality of An. culicifacies for 2 months and with An. fluviatilis for 4.5 months after which tests were not carried out. In villages with treated nets, the Annual Parasite Incidence (API) significantly declined (P < 0.05) by about 65.7% and prevalence of infection among children (< 15 years) declined by 57.1%, whereas in villages with untreated nets, there was only 34% reduction in API and 13% in the prevalence of infection. In villages with treated nets, there was 48% reduction in API and 64% in prevalence of infection compared with villages with untreated nets. The impact of use of treated bed nets on other arthropod pests lasted for at least 1.5 months. After 1.5 months, observations on arthropod pests were not continued. The use rate of treated nets varied from 49.8 to 93.7% in three seasons and about 68.3% of treated bed nets and 60% of untreated nets were in good condition 1 year after distribution. Out of 489 users of treated net, five people complained of a burning sensation on the face (skin irritation) for 5 days following the distribution of treated nets. There were no other complaints of any discomfort in using the treated nets. The use of alphacypermethrin treated bed nets at 20 mg (ai)/m2 can be one of the options for reducing the vector abundance and incidence of malaria in this area.     

Food poisoning associated methemoglobinemia: Time to wake up

Dear editor,With interest we read the recent article on methemoglobinemia by Chan et al.[1]Through this letter,we would like to add few additional comments regarding methemoglobinemia and its relevance in medicine practice with regards to food poisoning.While Chan et al[1]successfully managed their patient of methemoglobinemia and could pinpoint choy sum as the responsible agent,we wonder if there were any more cases of choy sum related to methemoglobinemia detected at the same time in the community?