Endoaneurysmorraphy and mitral valve repair in a case of giant cell myocarditis

One of the rare causes of Left Ventricular (LV) aneurysm formation is idiopathic giant cell myocarditis. A young man aged 30 years presented with cardiac failure of sudden onset. He had poor left ventricular function (ejection fraction 20%) with aneurysm of posterolateral wall and severe Mitral Regurgitation (MR). He underwent LV endoaneurysmorrhaphy with mitral valve repair and was discharged from hospital. Post procedure histopathology revealed the diagnosis of Giant Cell Myocarditis (GCM).     

A Prospective Randomized Study to Compare the Effectiveness of Honey Dressing vs. Povidone Iodine Dressing in Chronic Wound Healing

To compare the healing of chronic wounds with honey dressing vs. Povidone iodine dressing in adult subjects with chronic wounds of ≥6 weeks of duration, attending wound care clinic in Surgical Out Patient Department of All India Institute of Medical Sciences, Surgical Out Patient Department of Jai Prakash Narayan Apex Trauma center, New Delhi. Forty five subjects were randomized into two groups i.e., Honey & Povidone iodine dressing group. Dressing was done on alternate day basis for 6 weeks of followup period. Main outcome measure was complete healing at 6 weeks. Wound healing status was assessed at 2 weekly intervals till 6 weeks. Seven out of 22 subjects in honey treated group achieved complete healing as compared to none out of 20 subjects in Povidone iodine treated group. There was a significant decrease in the wound surface area, pain score & increase in comfort score in Honey dressing group in comparison to the Povidone Iodine group at 0.05 level of significance. Honey dressing is highly effective in achieving healing in chronic wounds as compared to Povidone iodine dressing.     

Survival and Recurrence for Patients Undergoing Surgery of Skull Base Intracranial Metastases

Objective Skull base metastases (SBMs) are rare lesions in close proximity to critical neural and vasculature structures. This rarity and complexity have led many to only offer nonsurgical therapies. The surgical outcomes for patients with SBM therefore remain unknown.Design Retrospective, comparison analyses.Setting Johns Hopkins Hospital.Participants All patients who underwent intracranial metastatic tumor surgery.Main Outcome Measure Survival and recurrence.Results Of the 708 patients who underwent intracranial metastatic tumor surgery, 29 (4%) had SBM: 3 (10%) involved the anterior skull base, 7 (24%) the sella, 6 (21%) the orbit, 2 (7%) the sphenoid wing, 3 (10%) the clivus, 4 (14%) the petrous bone, and 4 (14%) the paranasal sinuses. Following surgery, 6 (50%) had improvements in vision and 14 (88%) had improvement and/or maintenance of their cranial nerve symptoms. Three (10%), 0(0%), and 1(3%) developed a new motor, language, and vision deficit, respectively. There were no differences in median survival (10.0 versus 9.2 months, p = 0.48) and local progression-free survival (PFS) (p = 0.52), but there was improved distal PFS (p = 0.04) between patients with and without SBM.Conclusions Patients with SBM are relatively rare. These patients can tolerate surgery with minimal morbidity and mortality, and they have similar prognoses to patients without SBM.     

Radiographic imaging of the wrist

Imaging techniques play an important role in evaluating the complex anatomy of bone and soft tissues of the wrist. The standard wrist radiographs and specialized views still form a very important imaging modality to unravel the wrist pathology in their simplest forms. This article discusses the routine radiography of the wrist followed by ancillary views and dynamic studies for each of the routine view described that helps reveal both static and dynamic pathologies. The literature search was carried out using the search strings or key words, and the databases were searched using the time frame of 1990 to 2011 that included Scopus, MD consult, Web of Knowledge, Pub Med, Ovid Medline and Cochrane Library. The print journals and books available at Manipal University library were hand searched and secondary search was done for the relevant articles included in the references of primary articles. Full articles as well as abstracts were used for the review.     

Towards the Systematic Development of Medical Networking Technology

Currently, there is a disparity in the availability of doctors between urban and rural areas of developing countries. Most experienced doctors and specialists, as well as advanced diagnostic technologies, are available in urban areas. People living in rural areas have less or sometimes even no access to affordable healthcare facilities. Increasing the number of doctors and charitable medical hospitals or deploying advanced medical technologies in these areas might not be economically feasible, especially in developing countries. We need to mobilize science and technology to master this complex, large scale problem in an objective, logical, and professional way. This can only be achieved with a collaborative effort where a team of experts works on both technical and non-technical aspects of this health care divide. In this paper we use a systems engineering framework to discuss hospital networks which might be solution for the problem. We argue that with the advancement in communication and networking technologies, economically middle class people and even some rural poor have access to internet and mobile communication systems. Thus, Hospital Digital Networking Technologies (HDNT), such as telemedicine, can be developed to utilize internet, mobile and satellite communication systems to connect primitive rural healthcare centers to well advanced modern urban setups and thereby provide better consultation and diagnostic care to the needy people. This paper describes requirements and limitations of the HDNTs. It also presents the features of telemedicine, the implementation issues and the application of wireless technologies in the field of medical networking.     

Pediatric femoral shaft fractures treated by flexible intramedullary nailing

Background: Nowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Children between the ages of 5e13 years are treated either by traction plus hip spica and flexible/elastic stable retrograde intramedullary nail, or external fixators in the case of open fractures. The aim of this study is to evaluate the outcome of pediatric femoral shaft fractures treated by stainless steel flexible intramedullary nail in children between 5 and 13 years of age. Methods: There were 32 cases of femoral shaft fractures which were all fixed with stainless steel flexible intramedullary nail under fluoroscopy. Long leg cast was applied at the time of fixation. Partial weight bearing was started 2 weeks after surgery. Patients were evaluated in follow-up study to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, and time to unite the fracture. Results: We were able to follow up 28 out of 32 patients. The patients were 8.14 years of age on average. The mean hospital stay after operation was 4 days and fracture union time was 9.57 weeks. There were 3 cases of varus angulation, 2 cases of anterior angulation, and 4 cases of limb lengthening. Conclusion: Patients aged between 5 and 13 years treated with flexible intramedullary nail for closed femoral shaft fracture have rapid union and recovery, short rehabilitation period, less immobilization and psychological impact, and cost-effective.     

Spontaneous Rupture of a Giant Hepatic Hemangioma-Report of a Case

Hemangioma is the commonest benign hepatic neoplasm. Most cases are asymptomatic. Spontaneous rupture is rare (1–4%). Only 34 cases have been reported in adults. None had history of trauma. We report a case, the first from India of spontaneous rupture of a giant hepatic hemangioma, in a 25 year old male presenting with acute abdomen. He underwent right hepatectomy. Histopathology suggested cavernous hemangioma.