Aortopulmonary window with patent ductus arteriosus and interrupted aortic arch: A case report

Indian Journal of Thoracic and Cardiovascular Surgery -     

Genes for skeletal muscle myosin heavy chains are clustered and are not located on the same mouse chromosome as a cardiac myosin heavy chain gene.

Myosin heavy chain (MHC) genes are expressed as several distinct isoforms in a tissue- and stage-specific manner; three skeletal muscle MHC isoforms appear sequentially during development. We have isolated cDNA clones, identified by RNA blot hybridization and by nucleotide sequence determination as coding for portions of the embryonic (pMHC2.2), perinatal (pMHC16.2A), and alpha(V1) cardiac (pMHC141 and pMHC101) MHC isoforms. These four probes and the adult skeletal MHC probe (pMHC32) have been used on Southern blots of genomic DNA to detect restriction fragment length polymorphisms defining the alleles for these genes in mouse species Mus musculus and Mus spretus. In this way, we followed the segregation of skeletal and cardiac MHC genes in 42 offspring resulting from an interspecies backcross. We found that the embryonic, perinatal, and adult skeletal MHC genes are clustered on chromosome 11 near the locus nude, the skeletal and cardiac MHC genes do not cosegregate, and the alpha(V1) cardiac MHC gene is located on chromosome 14 close to Np-1. This result is in contrast to that for other contractile protein genes such as the alkali myosin light chain and the actin multigene families, which are dispersed in the genome.     

Valgus intertrochanteric osteotomy for malunion and nonunion of trochanteric fractures

OBJECTIVE: To evaluate the results of valgus intertrochanteric osteotomy for varus nonunion and malunion of trochanteric fractures. SETTING: University hospital. DESIGN: Retrospective clinical study. PATIENTS: Fifteen patients (age range 29-84 years) with varus malunion (11 cases) or varus nonunion (4 cases). Indication for surgery was nonunion or varus malunion with limb shortening greater than 2 cm associated with limp, abductor muscle insufficiency, hip pain, and back pain. INTERVENTION: The patients were treated by a valgus intertrochanteric osteotomy fixed with a 120 degrees double-angled blade plate. RESULTS: Average follow-up was 5.5 years (range 2-10 years). Fourteen patients healed without complications: 12 patients within 4 months; 2 delayed unions within 6 months. One patient required revision surgery for a loss of fixation due to a fall 6 weeks after surgery. This osteotomy also healed. Average lengthening achieved by osteotomy was 2 cm (range 1-5 cm). In all patients, the resulting range of flexion in the hip joint was greater than 90 degrees, Harris hip score before surgery was 73 points (range 61-83), and after surgery 92 points (range 76-98). Osteoarthritis or avascular necrosis of the femoral head did not develop in any of the cases. CONCLUSION: Valgus intertrochanteric osteotomy is an effective procedure that reliably restores hip function in trochanteric malunion or nonunion.     

The Essex-Lopresti forearm fracture (case report)

The radial head fracture associated with dislocation in the distal end of the ulna and tear of interosseous membrane of the forearm with a subsequent proximal migration of the radial shaft is a relatively rare injury. For the first time it was described by Essex-Lopresti in 1951. Our report presents one case together with an analysis of available literature relating to the diagnosis and treatment. A man, 69 years old, hurt his right elbow and forearm in a fall on the outstretched arm. There was a 2 x 1 cm excoriation on the lateral portion of the elbow and a dominating pain and limitation of the range of motion of the right elbow and wrist. The radiograph of the elbow, forearm and wrist showed a dislocated comminuted fracture of the radial head, dorsal subluxation of the ulnar and proximal displacement of radius. The condition was assessed as Essex-Lopresti fracture of the forearm indicated for surgery. The four-fragment fracture of the radial head did not allow reconstruction and therefore the head was resected. Subsequently the distal radio-ulnar joint was revised from dorsal approach with a K-wire inserted transversally. In order to prevent proximal displacement of the radius a K-wire was inserted in the medullary cavity of the radius close to the distal end of the humerus with the elbow in 90 degrees flexion and slight supination. The wounds were sutured and plaster of Paris applied extending across the elbow up to the metacarpal heads. After 6 weeks the plaster fixation and K-wires were removed. Full weight bearing was permitted 4 months after the surgery. Ten months after the surgery the patient was without complaints. Flexion in the elbow ranged between 0-5-130 degrees, pronation-supination was limited by 10 degrees in both extreme positions. The ulnar head became prominent on the dorsal side, dorsiflextion and ulnar duction in the wrist were limited to 10 degrees. The radiograph of the wrist showed and evident proximal displacement of the radius, the dorsally subluxated ulnar head overhung by 7 mm. Our case has confirmed that a mere extirpation of the head with a subsequent stabilization and transfixation of the proximal end of the radius and transfixation of the distal radio-ulnar joint cannot prevent after the extraction of wires a proximal displacement of the radius and development of the "plus variant" resulting in the limitation of both the range of motion of the wrist and the pronation-supination movement of the forearm.     

Complications Related to Dapsone Use for Pneumocystis Jirovecii Pneumonia Prophylaxis in Solid Organ Transplant Recipients

Dapsone, used for prevention of Pneumocystis jirovecii infections, has been reported to cause hemolytic anemia and methemoglobinemia; its tolerability in solid organ transplant recipients is not well described. We investigated dapsone-related adverse events in patients undergoing solid organ transplantation from 1999 to 2004. Transplant providers identified patients for the investigators who then reviewed the patients' hospital and outpatient records. Sixteen solid organ transplant recipients fit case definitions for dapsone-related hemolytic anemia (n = 11) or methemoglobinemia (n = 5). Median time from event to dapsone discontinuation was 15 days; all patients improved after drug discontinuation. G6PD enzyme activity was normal in all patients whose test results were available. Dapsone may be associated with hemolytic anemia or methemoglobinemia, even with normal G6PD levels. These events are often not promptly recognized, and drug discontinuation is delayed. Dapsone-related hemolytic anemia or methemoglobinemia should be considered in solid organ transplant recipients with unexplained anemia or hypoxia.     

In vitro anti-proliferation/cytotoxic activity of epingaione and its derivatives on the human SH-SY5Y neuroblastoma and TE-671 sarcoma cells

Epingaione (4-Methyl-1-(5-methyl-2, 3,4,5-tetrahydro-[2,3']bifuranyl-5-yl)-pentan-2-one) was isolated as one of the major lipophilic secondary metabolites from the leaves and stems of Bontia daphnoides L. The compound gave 79.24% and 50.83% anti-proliferation/cytotoxic activity on the human SH-SY5Y neuroblastoma and TE-671 sarcoma cells in vitro at 50 pg/mL, respectively. Epingaione was transformed into eleven derivatives under laboratory conditions using ethanol, some gave greater anti-proliferation/cytotoxic activity on the cancer cell lines tested. One of the derivatives (compound 2) with enhanced cytotoxic activity was elucidated as 5'-Ethoxy-5-methyl-5-(4-methyl-2-oxo-pentyl)-2,3,4,5-tetrahydro-5'H-[2,3']bifuranyl-2'-one. Both epingaione and compound 2 caused an accumulation of arrested or dead SH-SY5Y neuroblastoma in the m-phase of the cell cycle as revealed by the m-phase specific marker KE 67.     

Comparison of Phaconit Rollable IOL with Acrylic Foldable IOL

Background

Phaconit or ultra micro incision phacoemulsification cataract surgery involves phacoemulsification through a 0.9 millimetre sleeveless phaco tip and irrigating chopper followed by implantation of a rollable intraocular lens. The procedure leads to negligible astigmatism and faster visual recovery as compared to phacoemulsification with a foldable intraocular lens.

Methods

This prospective study analysed 80 cases of sub millimetre phaconit surgery with implantation of rollable intraocular lenses(IOL) in 40 cases and acrylic foldable IOL in the remaining 40 cases. Evaluation of efficacy and adaptability of procedure, equipment settings, operative constraints, postoperative complications, keratometric and topographic evaluation of induced astigmatism with visual outcome and patient''s rehabilitation were studied.

Results

The intraoperative complications were surge/ chamber collapse in 16 (20%), iris chaffing in one and corneal burns in two cases. All cases had an induced astigmatism of less than or equal to ± 0.25 D in four to six weeks after rollable IOL and ± 0.5 D to ± 0.75 D after acrylic IOL implantation. All patients had best-corrected visual acuity of 6/6 by third post operative day.

Conclusion

Phaconit with rollable IOL is a perfect blend of surgical skill, application of technology and ultra thin IOL.Key Words: Phaconit, Ultra micro phaco, Submillimetre incision, Rollable IOL implantation     

Report from the Caribbean renal registry, 2006

AIM: To develop a renal registry that will monitor renal epidemiology in the Caribbean and help determine the burden of disease. METHODS: Questionnaires were sent out to different Caribbean countries for distribution to the dialysis units. Data were obtained for patients with End Stage Renal Disease (ESRD) who were on long term renal replacement therapy in 2006. The demographic data, type of renal replacement therapy, laboratory data and causes of ESRD were obtained from the questionnaire. Data were analyzed using SPSS 11.0 RESULTS: Data were reported from six English-speaking Caribbean countries: Bahamas (n = 211), Barbados (n = 185), British Virgin Islands (n = 27), Cayman Islands (n = 41), Jamaica (n = 366) and Trinidad and Tobago (n = 436). Haemodialysis was reported in all the countries; transplantation was not reported from the Cayman Islands. Only Bahamas, Jamaica and Trinidad and Tobago reported peritoneal dialysis. In Jamaica, male to female ratio was 1.5:1. The three commonest causes of end stage renal failure were hypertension (65.5%), diabetes mellitus (27.6%) and primary chronic glomerulonephritis (12.5%). The age range was 11-94 years (mean 47.7 years). Barbados had a male to female ratio of 1.8:1, age range of 19-81 years (mean age: 52.3 years). Hypertension (55.7%) and diabetes mellitus (27.0%) were the commonest causes. Trinidad and Tobago had a male to female ratio 1.3:1. The age range was 8-84 years (mean age 52.5 years). The four commonest causes of ESRD were diabetes nAellitus (28.9%), hypertension (25.3%) and autosomal dominant polycystic kidney disease (3.9%) and chronic glomerulonephritis (3.9%). The British Virgin Islands, Tortola, had a male to female ratio 1.7:1.0. Age range was 26-86 years (mean, 57 years). Hypertension (67.9%) and diabetes mellitus (46.4%) were also the commonest causes. The Bahamas had a male to female ratio of 1:1.1 unlike the other countries. Hypertension (25.6%), diabetes mellitus (28.0%) and chronic glomerulonephritis (13.3%) were the commonest causes of ESRD. The Cayman Islands reported a male to female ratio of 1.2:1, with a mean age of 54.3 years. Hypertension (n = 27), diabetes mellitus (n = 12) and autosomal dominant polycystic kidney disease (n = 3) were the commonest causes of ESRD. Barbados and Jamaica had more than 50 per cent of its renal replacement therapy patients with serum albumin above the minimum of the normal range of 35-40 g/L. In regards to the calcium phosphate product, two-thirds of the patients in all countries reporting data had values below the recommendation of 4.4 mmol2/L2. The percentage of patients achieving haemoglobin concentration above 10.0 g/dL was: 16.9%for Jamaica, 75.6%for The Cayman Islands, 35.9%for Barbados and 68.6%for Tobago. Erythropoietin usage was not reported. The URR was only available for Jamaica and the Bahamas and 80.6% and 60.9% respectively had URR above the accepted value of 65%. For all reporting countries the range of patients coded for hypertension but who also had diabetes mellitus was 2.2% to 17.1%. Only Bahamas reported on vascular access with 51.7% ofpatients having native arteriovenousfistulae. CONCLUSION: Hypertension, diabetes mellitus and chronic glomerulonephritis were the commonest causes of ESRD across most of the English-speaking Caribbean countries. Peritoneal dialysis was only offered in some of the islands and kidney transplantation was rarely reported. More males than females were on long term renal replacement therapy in most of the islands.