Stuck coronary angioplasty balloon: A surgical emergency

A 69-year-old patient underwent percutaneous coronary angioplasty and stenting of a calcified tight mid-circumflex coronary artery lesion between the origins of first two obtuse marginal arteries. The balloon got stuck inside the stent in a partially deflated condition and could not be retrieved. Under cardiopulmonary bypass, with cardioplegic arrest, the stent-balloon-catheter were extracted through coronary arteriotomy following endarterectomy of the calcified lesion. The patient had reversed saphenous vein grafts to the two obtuse marginal arteries.     

Low bodyweight Type 2 diabetes in India: Clinical characteristics and pathophysiology

Low body weight Type 2 DM/Type 2 DM-lean is a distinct clinical entity that is neither related clinically or pathophysiologically to LADA nor former fruste of Type 1DM, having absence of markers for autoimmune destruction of β-cells and good insulin and C-peptide reserve for a prolonged period of life. They constitute an independent variant of Type 2 DM with inherent peculiarities of insulin kinetics in the liver along with altered profile and behaviour of key enzymes related to carbohydrate metabolism which are marked by excess extraction of insulin in hepatic bed, hyperactive cytochrome system and non-supressible glucokinase activity. These peculiarities are reflected in the peripheral circulation as states of low circulating levels of insulin, hyperglycemia, dyslipidemia without low high density lipoprotein cholesterol (HDLc), raised triglycerides (Tg), low levels of plasma homocysteine and BMI below 19 make these diabetics less prone to develop macrovascular disease. Peripheral neuropathy and the consequences of poor glycemic control such as increased succeptibility to infections and endothelial dysfunction manifesting as proteinuria dominate the clinical picture. In view of more of infective complications and coexistent severe hyperglycemia (glucose toxicity) many of these diabetics may not respond to OHA adequately at the initiation of therapy. However, due presence of insulin resistance and good β-cell reserve for insulin, despite of lean habitus, most of them respond well to OHA for long periods of life, as may be comparable with any other phenotype of Type 2 diabetes. The insulin resistance observed in Type 2 DM-lean is not consequent to anthropometric parameters like central obesity and WHR as these diabetics are lean with poor fat depot and thus it could be an integral part of the pathogenic mechanism of Type 2 DM per se.     

Myocardial protection during cardiac operations. Decreased morbidity and lower cost with blood cardioplegia and coronary sinus perfusion.

The efficacy of myocardial protection with a single aortic crossclamp and blood cardioplegia was evaluated in 819 consecutive patients stratified for preoperative condition by means of a new clinical risk scoring system. A protocol using either antegrade or antegrade/retrograde blood cardioplegia was compared with antegrade crystalloid cardioplegia in 2582 similar, consecutive, and concurrent patients. In the blood cardioplegia cohort, 97 (11.8%) patients had 129 complications compared with 407 (15.8%) patients and 675 complications in the crystalloid cardioplegia group (p = 0.006). In high-risk patients, combined antegrade/retrograde cardioplegia significantly reduced myocardial infarction, stroke, and respiratory and wound complications. Despite the significantly longer aortic crossclamp time required for blood cardioplegia, patients undergoing crystalloid cardioplegia were 1.7 (95% confidence interval 1.3, 2.1) times more likely to have a morbid event. Time in the intensive care unit, length of hospitalization, and length-of-stay outlier status were significantly decreased in the blood cardioplegia compared with the crystalloid cardioplegia group. The net savings in hospital cost amounted to $2196 per case. When compared separately with crystalloid cardioplegia, combined antegrade/retrograde blood cardioplegia accounted for most of the morbidity reduction by significantly reducing perioperative myocardial infarction, wound complications, and length of stay in patients having reoperations. Antegrade/retrograde blood cardioplegia did not influence 1-year survival or event-free survival, even when risk was considered.     

Xeroderma pigmentosum: resurfacing versus dermabrasion.

Three patients of Xeroderma Pigmentosum (XP) have been managed for recurrent tumours. Improvement in pigment pattern was observed at both the donor as well as the recipient sites. An attempt has been made to prevent further occurrence of tumours over the exposed parts of the body by resurfacing and also by dermabrasion. A comparative study of the two procedures is being carried out and the preliminary results are discussed. Deep dermabrasion appears to be preferable as a prophylactic procedure.     

Decreased photoreceptor count in human eyes with secondary angle-closure glaucoma.

Glaucoma has been known to be associated with a loss of retinal ganglion cells and their axons throughout the fundus and a decreased count of photoreceptors and retinal pigment epithelial (RPE) cells in the parapapillary region. This study investigated whether glaucomatous changes of the deep retinal layer occur outside the parapapillary region. The nuclei of the retinal photoreceptors and RPE cells were counted in histologic slides of 23 eyes with painful secondary angle-closure glaucoma resulting from perforating corneal injuries. Fourteen eyes with malignant choroidal melanoma not involving the ciliary body or trabecular meshwork served as the control group. No surgical procedure, including laser treatment, had been performed posterior to the ora serrata. There were no hints of retinal vessel occlusion and localized traumatic retinopathy, historically, ophthalmoscopically, or histologically. Photoreceptor count was significantly lower (P less than 0.05) in the glaucoma eyes than in the control group. Count of RPE cells did not differ between the two groups. This may indicate that glaucoma can be associated with a loss of photoreceptors. This could be important for psychophysical testing and may point to a more widespread involvement of ocular tissues in glaucoma than believed.     

Esthesioneuroblastoma—report of two cases

Olfactory neuroblastoma is an uncommon malignant tumour originating in the olfactory epithelium in the roof of the nose. It usually produces nasal obstruction and is often mistaken for a nasal polyp. It causes death by distant metastasis or by intracranial spread through the cribriform plate and has a low cure rate. Two patients of olfactory neuroblastoma have been treated by us. We have reviewed the literature and attempted to draw meaningful conclusions regarding the management.     

Keratoplasty and cataract extraction.

Fifty eyes were evaluated following penetrating keratoplasty and cataract extraction. Twenty five of them had intracapsular lens extraction while the remaining 25 had intercapsular method of extracapsular lens extraction. Both operative and post operative complications were more in group I. Visual outcome and graft clarity were also better in eyes of group II. Combined keratoplasty and intercapsular method of extracapsular lens extraction was recommended in eyes having both corneal and lenticular pathology.