Glomus vagale presenting as a supraclavicular mass: Magnetic resonance imaging findings

Glomus vagale are rare vascular tumours of the paraganglion cells of the vagus nerve, and they usually occur in the carotid space. Tumours can be familial, multicentric, malignant but rarely hormonally active. A rare case is reported of glomus vagale presenting as a supraclavicular mass.     

Conjoint bicondylar Hoffa fracture in an adult

Conjoint bicondylar Hoffa fracture is an extremely rare injury. Only one case has been reported previously in the pediatric age group. We describe this injury in a 17-year-old male who presented following a fall with direct impact on his semiflexed right knee. Plain radiographs were inadequate to define the exact pattern of injury. Computed tomographic (CT) scans demonstrated the coronal fracture involving both the femoral condyles which were joined by a bridge of intact bone. The patient was treated with open reduction and internal fixation using swashbuckler (modified anterior) approach. Union occurred within 3 months and at final followup (at 18 months) the patient had a good clinical outcome. The possible mechanism of injury is discussed.     

Hydrocelectomy: a proxy for hydrocele prevalence in coastal Kenya

To assess the value of hydrocelectomy as an indicator of the prevalence of lymphatic filariasis, the frequency of hydrocelectomy was investigated in five hospitals in an area of coastal Kenya where filariasis is endemic. Two of the hospitals studied (Kinango and Msambweni) were in Kwale district, two (Kilifi and Malindi) in Kilifi district and one (the Coast Provincial General Hospital) in Mombasa. Surgical operations performed between January 1991 and August 1993 were tallied from the main theatre registers. Additionally, admission files for hydrocelectomy patients were examined prospectively between September 1993 and February 1994, to obtain age profiles. Hydrocelectomies accounted for 27.6%, 16.6%, 13.6%, 4.3% and 2.0% of the major operations (totalling 6339) recorded in Kinango, Msambweni, Kilifi, Malindi and Coast Provincial General Hospital, respectively. The proportion of operations involving hydrolectomy was significantly higher in the two hospitals in Kwale district, in the southern part of the study area, than in the two hospitals in Kilifi district, in the northern part (23.4%, with 95% confidence intervals of 20.9%-25.9%, v. 10.3%, with 95% confidence intervals of 8.7%-11.9%; P < 0.001). The generally high frequencies of hydrocelectomy in the study area are evidence of the heavy social and economic burden imposed by hydrocele-attributable morbidity and its management. The age distribution pattern of the hydrocelectomy patients paralleled that of the individuals with hydrocele in the surrounding area.     

Cardiac MRI in Congenital Heart Disease – Our Experience

A significant recent advance that has occurred world over in the continuously evolving field of Magnetic Resonance Imaging (MRI) practice is the introduction of Cardiac applications. Cardiac MRI has moved to the centre stage of clinical management strategy by non-invasively imaging the structure as well as function of the heart. It has a wide range of specific applications such as delineation of morphological anatomy, quantification of flow and pressure across cardiac valve dysfunction, evaluation of myocardial function, assessment of infarcts, mapping coronary arteries and so on. Evaluation of congenital heart disease (CHD) is an important application of Cardiac MRI since the morphological details of chambers, septum, defects and anomalous connections are depicted accurately. Besides, flow information across valves, chambers, outflow tracts and shunts are also provided. This article describes our experience in the use of cardiac MRI in congenital heart disease.Key Words: Cardiac MRI, Congenital heart disease, Cyanotic and Acyanotic heart disease     

Lack of awareness of Hepatitis B screening and vaccination in high-risk groups

Background/aim Hepatitis B virus (HBV) vaccination rates are insufficient in high-risk patients worldwide. This study aimed to investigate the screening, immunization, and vaccination rates in three high-risk groups for HBV infection: allogeneic hematopoietic stem cell transplantation (AHSCT), renal transplantation (RT), and chronic hepatitis C (CHC) groups. Materials and methods The serological data of consecutive patients between 2014 and 2019 were reviewed using the hospital database. Results The HBV screening rates were 100.0%, 90.4%, and 82.4% in the AHSCT, CHC, and RT groups, respectively (p = 0.003). The immunization rates against HBV through either previous exposure or vaccination were 79.5%, 71.7%, and 46.5% in the AHSCT, RT, and CHC groups, respectively (p < 0.001). The HBV vaccination rate was significantly low in the CHC group (71.5%, 69.0%, 34.6% in the AHSCT, RT, and CHC groups, respectively, p < 0.001). If patients lost their immunity due to immunosuppressive therapy were accounted, the vaccination rates increased to 95.2% in the AHSCT group and 72.9% in the RT group. The rate of annual screening for HBV status was 97.9% in the AHSCT group, but it was only 23.9% in the RT group. Conclusion HBV screening and vaccination rates were significantly lower in the RT and CHC groups than in the AHSCT group.     

Risk factors for infection in Malaysian patients with systemic lupus erythematosus

To determine the incidence, types and risk factors for infection in systemic lupus erythematosus (SLE) patients in Kuala Lumpur, Malaysia, we retrospectively reviewed the medical records of 102 patients with definite SLE attending a specialist clinic. Details of major infections (pneumonia or severe infection requiring intravenous therapy) and minor infections, and their time of onset in relation to immunosuppressive therapy and disease flares were recorded. There were 77 major and 163 minor infections during 564 patient-years of follow-up. In the month following a course of pulse methylprednisolone, the incidence of major infection was 20 times higher and the incidence of minor infection was 10 times higher than at other periods (p&lt;0.0001). In the month after disease flare, the incidence of major infection was 10 times higher and the incidence of minor infection six times higher than at other times (p&lt;0.0001). After allowing for methylprednisolone therapy and disease flares, there was no increase in the rate of infections during treatment with azathioprine, oral or intravenous cyclophosphamide. There was no effect of renal involvement on infection rate.      

Intravascular Low Power Red Laser Light as an Adjunct to Coronary Stent Implantation Evaluated in a Porcine Coronary Model

BACKGROUND: It is believed that restenosis following coronary interventions is the result of endothelial denudation that leads to thrombus formation, vascular remodeling, and smooth muscle cell proliferation. We previously demonstrated that low power red laser light (LPRLL) irradiation enhances endothelial cell growth in vitro and in vivo and reduces restenosis in a small animal model. The present study investigated the effectiveness of intravascular LPRLL therapy in the reduction of restenosis following stenting in a porcine model. METHODS AND RESULTS: Stents were placed in the right coronary artery of domestic cross-bred pigs. After stent deployment, an additional inflation was performed with the laser-balloon. In group I (n = 18) no LPRLL was used; group II (n = 10) received LPRLL dosage of 10 mW for 1 minute; group III (n = 10) received LPRLL dosage of 34 mW for 1 minute. Quantitative coronary analysis of the stented vessel was performed before, immediately after stenting, and at 6 weeks. The pigs were sacrificed and histologic and planimetric analysis conducted. At 6 weeks, minimal luminal stent diameter was significantly narrower in the control group compared to the higher dose group (p < 0.05), late loss correlated inversely proportional to the dose used (r = 0.9; p < 0.03), these results were confirmed by morphometric analysis. Neointimal area was also significantly decreased in the higher dose group. CONCLUSIONS: Intravascular LPRLL contributes to reduction of angiographic restenosis and hyperplastic reaction in this animal model and seems to be dose dependent.     

Experimental Evaluation of a New Single Wire Stainless Steel Fishscale Coronary Stent (Freedomª)

Recent randomized clinical trials revealed a significant reduction in angiographic restenosis rates when adjunctive stenting was performed after conventional coronary balloon angioplasty. Current approved coronary stents are however hampered by their rigidity, limiting their trackability in tortuous vessels and furthermore, needing high pressure deployment for optimal vessel apposition. New coronary stents are currently under development, using more biocompatible metal alloys and/or designs which better align to the vessel wall at moderate deployment pressures. We evaluated the safety, efficacy, angiographic and histological effect of a new stainless steel fishscale designed stent (Freedoma, Global Therapeutics, Co., USA) in a porcine coronary and peripheral artery model. Implantation in the right coronary artery was successful in all 20 pigs. Control angiograms at 6 weeks follow-up demonstrated patent vessels and morphologic evaluation showed only a mild fibromuscular neointimal response resulting in an area stenosis of 28.7 +/- 0.18% and a mean neointimal hyperplasia of 0.18 +/- 0.25 mm. Comparison with the Palmaz-Schatza coronary stent in a porcine peripheral artery model demonstrated similar quantitative angiographic and morphologic vessel analysis results. Also the morphometric data were comparable. Area stenosis: Palmaz-Schatz: 37 +/- 0.24%, Freedom: 21 +/- 0.14%, p = 0.07. Mean neointimal hyperplasia: Palmaz-Schatz: 0.33 +/- 0.24 mm, Freedom: 0.18 +/- 0.08 mm, p = 0.08. CONCLUSION: Freedom coronary stent implantation in a porcine model resulted in a high procedural success without subacute thrombotic occlusions, despite no further anticoagulation nor antiplatelet therapy. Six weeks histopathological and morphometric evaluation demonstrated only a mild fibromuscular neointimal hyperplasia.     

Recombinant rat stem cell factor synergizes with recombinant human granulocyte colony-stimulating factor in vivo in mice to mobilize peripheral blood progenitor cells that have enhanced repopulating potential

Splenectomized mice treated for 7 days with pegylated recombinant rat stem cell factor (rrSCF-PEG) showed a dose-dependent increase in peripheral blood progenitor cells (PBPC) that have enhanced in vivo repopulating potential. A dose of rrSCF-PEG at 25 micrograms/kg/d for 7 days produced no significant increase in PBPC. However, when this dose of rrSCF-PEG was combined with an optimal dose of recombinant human granulocyte colony-stimulating factor (rhG-CSF; 200 micrograms/kg/d), a synergistic increase in PBPC was observed. Compared with treatment with rhG-CSF alone, the combination of rrSCF-PEG plus rhG-CSF resulted in a synergistic increase in peripheral white blood cells, in the incidence and absolute numbers of PBPC, and in the incidence and absolute numbers of circulating cells with in vivo repopulating potential. These data suggest that low doses of SCF, which would have minimal, if any, effects in vivo, can synergize with optimal doses of rhG-CSF to enhance the mobilization of PBPC stimulated by rhG-CSF alone.