Symmetrical peripheral gangrene: a prospective study of 14 consecutive cases in a tertiary‐care hospital in eastern India

Background Symmetrical peripheral gangrene (SPG) is characterized by sudden onset of peripheral, frequently symmetrical gangrene in the absence of major vascular occlusive disease. SPG is associated with a wide range of underlying medical problems and usually has disseminated intravascular coagulation (DIC) in the background. Although sporadic cases and a few retrospective case series of SPG have been reported, lack of any prospective study on the profile and outcome of these patients prompted us to undertake the present work. Objectives To study the clinical profile, aetiological factors, and outcome of a group of patients of SPG from eastern India. Patients/methods Prospective, observational study of consecutive patients presented at or referred to the Dermatology Department of a tertiary‐care hospital during 2001 to 2008. Results We observed 14 patients (5 males, 9 females; mean age: 43.36 years) of SPG during the study period. All had clinical and laboratory evidence of DIC in association with a shock syndrome. Associated purpura fulminans was noted in 11 patients. In 12 patients, the cause of SPG was infective, Pneumococcus being the commonest organism involved. Two patients developed DIC and SPG postoperatively. Nine patients survived and the remaining five patients died. Three patients had leukopenia and all of them died. Amongst the survivors, four patients had auto‐amputation of some parts of distal limbs; surgical amputation was done in two patients. Conclusions SPG carries a high mortality rate frequently requiring multiple limb amputations in survivors. Leukopenia may be a poor prognostic factor of SPG and DIC may occur universally.     

Role of IL-10 -819(T/C) Promoter Polymorphism in Preeclampsia

—Preeclampsia is a severe complication of pregnancy characterized by an excessive maternal systemic inflammatory response with activation of both the innate and adaptive immune system. Interleukin-10 affects maternal intravascular inflammation, as well as endothelial dysfunction. The aim of the study was to investigate the association between IL-10 T-819 C polymorphism and preeclampsia. A total of 120 pregnant women with preeclampsia and 120 women with normal pregnancy attending the Gynecological Unit of Government Maternity Hospital, Petlaburz, Hyderabad, India, were considered for the present study. A standard amplification refractory mutation system (ARMS) PCR was carried out for genotyping of IL-10 T-819 C promoter polymorphism in all the participants. Genotypic distribution of the control and patient groups was compared with values predicted by the Hardy-Weinberg equilibrium using χ2 test. Odds ratios (OR) and their respective 95 % confidence intervals were used to measure the strength of association between IL-10 gene polymorphism and preeclampsia. The frequencies of IL-10 T-819 C genotypes, CC, CT, and TT, were 47.5, 28.3, and 24.2 % in women with preeclampsia and 20.8, 48.3, and 30.8 % in the controls, respectively. There is a significant difference in the distribution of genotypes and alleles of IL-10 T-819 C between the two groups (test power?=?0.66). The present study suggests that the IL-10 T-819 C gene promoter polymorphism can be a major genetic regulator in the etiology of preeclampsia     

ANEURYSM OF SINUS OF VALSALVA DISSECTING INTO THE INTERVENTRICULAR SEPTUM – ECHOCARDIOGRAPHIC DIAGNOSIS (A Case Report)

Aneurysm of sinus of Valsalva dissecting into interventricular septum is a rare entity. We report one such case who was incidentally diagnosed by echocardiography to have this abnormality during evaluation of a clinically suspected isolated aortic regurgitation.KEY WORDS: Aneurysm – dissecting – sinus of Valsalva, Echocardiography     

Total cavopulmonary anastomosis using atrial septal flap: technique and early results

Introduction The Fontan procedure has undergone many modifications to avoid atrial arrhythmias and thrombus formation. We used patient’s interatrial septum as a flap to direct the inferior venacaval blood to the superior venacava. Methods Seventeen patients, aged 1 to 17 years, underwent modified total cavopulmonary anastomosis. Interatrial septum was used to create the inner half of the atrial tunnel, outer half being formed by right atrial free wall. Post-operatively, all patients underwent echocardiography. Seven patients underwent 24 hour ambulatory Holter monitoring and 6 patients underwent cardiac catheterization and cineangiography. Results There was one early death due to low cardiac output. One patient had transient supraventricular arrhythmia. Two patients had singnificant pleural effusion. Holter Monitoring reveled sinus rhythm in all 7 patients studied. Follow up ranged from 18 to 60 months and patients were evaluated as they came for follow up. Long term follow up is currently being compiled. There was one late death from a non-cardiac cause. The remaining patients were in New York Heart Association (NYHA) Class I or II. All patients were in sinus rhythm. Echocardiography and cineangiography revealed absence of obstruction or leak. Conclusions Total cavopulmonary anastomosis using autogenous atrial septum is a useful modification for classical cavopulmonary anastomosis and provides good early results.     

温血或冷晶体心脏停搏液对体外循环术后房性心律失常发生的影响

目的　了解不同的心肌保护方法是否对体外循环 (ECC)术后房性心律失常有影响。　方法　将 12只成年杂交犬随机分为两组 ,A组 :6只犬 ,用持续温血心脏停搏液灌注 ;B组 :6只犬 ,用冷晶体心脏停搏液灌注和局部低温。两组动物主动脉阻断时间均为 30分钟。记录术前及术后 1～ 5天 2 4小时动态心电图 ,计算标准化房性心律失常 ,标准化室性心律失常和 2 4小时平均心率。　结果　 ECC后两组动物均未出现心房颤动。尽管术后 A组标准化房性心律失常率高于 B组 (P<0 .0 5 ) ,但两组动物术前、术后标准化房性心律失常率无明显变化 ,标准化室性心律失常率亦无明显变化。此外 ,两组动物术后 2 4小时平均心率亦升高 ,且 B组高于 A组 (P<0 .0 5 )。　结论　不同的心肌保护方法对 ECC术后房性心律失常的发生无明显影响。