Drill biopsy in the diagnosis of lung lesions.

A high speed pneumatic drill was used to perform 190 percutaneous transthoracic biopsies in 161 patients. The resultant cores of tissue provided a definite diagnosis in 146 patients, giving a success rate of 90.7%. Complications occurred in 58 patients, subcutaneous emphysema being the most common, though only seven patients required active treatment, giving a rate of 3.7% for important complications. One patient died within 24 hours of the biopsy procedure owing to asphyxia resulting from aspiration of the contents of an acutely dilated stomach. Our experience clearly establishes that the drill biopsy as used by us is simple and safe and can be carried out in an outpatient department, yielding better overall results than any other procedure for closed biopsy of the lung currently practised.     

Tricuspid valve repair: a rational alternative

BACKGROUND AND AIMS OF THE STUDY: The prosthetic ring annuloplasty and incompletely encircling suture techniques are effective methods of tricuspid valve repair when the problem is only annular dilatation, but not when organic tricuspid valve disease is present. A surgical technique of valve repair has been developed that is equally effective in correcting purely functional as well as organic valvular incompetence. METHODS: The Manipal method of repairing the incompetent tricuspid valve consists of three steps: (i) anteroseptal commissurotomy and asymmetric 'U-on-side' suture annuloplasty, to push the plane of coaptation of the anterior and septal leaflets into the right ventricle; (ii) a semicircular De Vega-type of plicating suture through the annulus, starting and ending just cephalad to the posteroseptal commissure and extending anticlockwise to a point just caudal to the meridian, to exclude the posterior leaflet; and (iii) tying the plicating suture after positioning a 3M Starr-Edward valve sizer across the tricuspid valve (in an adult), to ensure that the valve orifice is not excessively narrowed. RESULTS: Between July 1986 and January 1997, the Manipal method was used to repair 52 tricuspid valves, always combined with surgery for the mitral and/or aortic valve. Tricuspid stenosis of varying degree was present in 61% of cases. One of two hospital deaths was related to the repaired valve. Although the proportion of patients followed up fell progressively to 33% at 10 years, none of the patients either seen personally or who had replied to a postal questionnaire (78% of total patients) required reoperation for valve regurgitation or obstruction. No patient had more than mild tricuspid regurgitation clinically, even seven and 10 years after tricuspid valve repair surgery. CONCLUSION: This alternative method of tricuspid valve repair is simple to execute, is equally effective in correcting both pure tricuspid regurgitation and organic tricuspid valve disease, and appears to be extremely stable.     

Diabetes in young--unusual case presentation

Diabetes in young is increasing in prevalence with each decade. Phenotypic features like obesity and acanthosis nigricans characterize type 2 diabetes, whereas autoimmune diseases like vitiligo and hypothyroidism suggest type 1 diabetes. We recently encountered a young boy with vitiligo who presented with hyperglycemia, but not associated with ketonuria and has underlying chronic pancreatitis with secondary diabetes. We report the case for its unusual presentation and etiology of the diabetes.     

Tri-foliate pericardial patch repair of supra-valvular aortic stenosis

Conventional aortoplasty procedures do not fully restore the normal anatomy in supra-valvular aortic stenosis (SVAS), which involves the sinus rim as well as the aortic cusps. A tri-sinus repair of this condition is proposed to restore the three intercommissural distances to normal and adequately replace the tissue loss of the sinuses, for a symmetrical reconstruction of the aortic root. Two patients, aged 3 and 11 years, with localized type of supra-valvular aortic stenosis were operated, in May 1994 and February 1996. The aortic stenosing ring was opened up at three points, by extending the incision into all the three sinuses, and the defect was repaired with in situ autologous pericardium, in a tri-foliate fashion. This repair achieved a symmetrical reconstruction of the aortic root and the systolic pressure gradient was completely abolished. Postoperative aortic root angiogram, in the older of the two patients, revealed a normal appearing aortic root. The patients have been followed-up for 51 months and 30 months respectively. Echocardiography showed competent aortic valves in both the patients without any systolic gradient across the aortic valve. A tri-sinus repair of the aorta in SVAS results in a symmetrical reconstruction of the aortic root by restoring the normal intercommissural distances of all the three cusps. It also abolishes the systolic pressure gradient. Autologous untreated pericardium lends itself easily for tailoring into a tri-foliate patch.     

Electrophysiologic effects of encainide (MJ 9067) on canine purkinje fibres

Microelectrodes were used to characterize the actions of a new antiarrhythmic compound, encainide, 4-methoxy-2′-[2-(1-methyl-2-piperidyl)-ethyl] benzanilide, on transmembrane potentials generated by isolated canine Purkinje fibres in tissue bath. Encainide, 1×10^?7 M, had no effect on resting potential (RP) and action potential (AP) of stimulated fibres or automaticity of spontaneously fibres. Encainide (1×10^?6 M) shortened phase 2 and action potential duration (APD) at 50, 75 and 100% of repolarization; AP rate of rise (V?max) decreased only ～15% at 3 h exposure, while RP was unchanged. Higher concentrations also shortened phase 2 and APD, markedly decreased V?mac, depressed the membrane responsiveness curve and increased conduction time. Encainide, 1×10^?6 M, increased ERP/APD₁₀₀. These effects were rapidly reversed by washing with drug-free solution. Encainide (1×10^?5 M) decreased the automatic rate of spontaneously beating untreated fibres and stretch-depolarized fibres, but had little effect on catecholamine-enhanced automaticity. Encainide, 1×10^?5 M, delayed the onset of ouabain toxicity. These findings suggesting that the antiarrhythmic effect of encainide may arise from its depression of V?max and memrane responsiveness, increase in ERP/APD₁₀₀ and inhibition of automaticity, are discussed in light of the similarity of the actions of this new drug to the known properties of lidocaine and quinidone.     

Pulmonary Valve Reconstruction in Absent Pulmonary Valve Syndrome: A New Technique

A bstract Background: In patients with absent pulmonary valve syndrome, the relief of the pulmonary regurgitation at the time of primary repair improves both the early and late results. Though homograft and heterograft valves and conduits have been used for this purpose, both are not easily available and are known for late failure. Monocusp and bicuspid semilunar valves made out of pericardium have their own problems. Hence, a technique of reconstructing an autologous competent 3-cusp valve from the native tissues was developed. Methods : Two posterolateral semilunar cusps were fashioned from the anterior wall of the main pulmonary artery. The anterior cusp was made from autologous pericardium stitched to the autologous pericardial patch used to widen the right ventricular outflow tract. Results : This method of reconstruction was used in two patients aged 9 and 22 years, respectively. Visual assessment and passive testing after reconstruction revealed well functioning neopulmonary valves in both patients. The second patient, who had an unevenful hospital course, showed only mild pulmonary regurgitation at 5 years postreconstruction. Conclusions : As 2 of the 3 cusps are fashioned from the pulmonary arterial wall as a pedicled graft, we believe that they will retain their viability and grow with the pulmonary artery. Simultaneous reduction in the size of the pulmonary arteries will relieve bronchial compression when present. The anterior pericardial cusp, even if it eventually shrivels up, is unlikely to produce serious hemodynamic derangements.     

Total surgical correction of tetralogy of Fallot: Results in 45 consecutive cases

Total surgical correction of the tetralogy of Fallot remains a most challenging and difficult problem in cardiac surgery. The present study, like others, indicates that this lesion can be corrected, and excellent anatomical and haemodynamic results can be obtained with an acceptable mortality.