Simultaneous Transcatheter Closure of Ventricular Septal Defect and Pulmonary Valvuloplasty

Background

Transcatheter balloon valvuloplasty has been the accepted first line treatment for congenital pulmonic stenosis (PS) in children. Transcatheter closure of perimembranous ventricular septal defect (VSD) with Amplatzer VSD occluder is an alternative to surgical repair.

Case Presentation

A 12 year old boy presented with history of exertional dyspnea and atypical chest pain. Physical findings were suggestive of severe pulmonic stenosis. Transthoracic echocardiography, right and left ventricular angiography showed medium to large sized perimembranous VSD and severe valvar pulmonary stenosis. Transcatheter closure of VSD was done first so as to avoid large left to right shunt across VSD after balloon pulmonary valvuplasty.

Conclusion

We demonstrated the feasibility and success in treating combined ventricular septal defect and severe pulmonary valve stenosis with transcatheter interventional procedure in the same session.     

Comparing the efficacy of prophylactic p6 acupressure, ondansetron, metoclopramide and placebo in the prevention of vomiting and nausea after strabismus surgery

To compare the efficacy of acupressure wrist bands, ondansetron, metoclopramide and placebo in the prevention of vomiting and nausea after strabismus surgery. Two hundred patients, ASA physical status I or II, aged between 10 and 60 years, undergoing strabismus surgery in Farabi Hospital in 2007-2008 years, were included in this randomized, prospective, double-blind and placebo-controlled study. Group I was the Control, group II received metoclopramide 0.2 mg/kg, group III received ondansetron 0.15 mg/kg iv just before induction, in Group IV acupressure wristbands were applied at the P6 points. Acupressure wrist bands were placed inappropriately in Groups I, II and III. The acupressure wrist bands were applied 30 min prior to the induction of anesthesia and removed six hours after surgery. Postoperative nausea and vomiting (PONV) was evaluated within 0-2 hours and 2-24 hours after surgery by a blinded observer. Results were analyzed by X(2) test. A P value of < 0.05 was taken as significant. The incidence of PONV was not significantly different in acupressure, metoclopramide and ondansetron during the 24 hours. Acupressure at P6 causes a significant reduction in the incidence of PONV 24 hours after strabismus surgery as well as metoclopramide 0.2 mg/kg and ondansetron 0.15 mg/kg iv for patients aged 10 or more.     

Synthesis of fuzzy logic for prediction and medical diagnostics by energy characteristics of acupuncture points

A great number of reflexologies use ancient concepts that do not coincide with modern medical terminology of anatomy, physiology, and biophysics, substantially reducing the trust of today's physicians in this direction of their profession. Recently, several mathematical models of internal and biological active points of meridian structures interaction have been proposed. These models allowed specification of diseases for which reflex diagnostics and reflex therapy methods are most effective and also increased the efficacy of these procedures. Good results for the prediction and early diagnosis of diseases from the reaction energy of biologically active points (acupuncture points) are obtained using fuzzy logic decision making.