Dedicated transpulmonic approach for the repair of Fallot's tetralogy

Background To share our initial experience with cases of Tetralogy of Fallot (TOF) in whom transpulmonary artery route was exclusively used for repair of the defect. Material & Methods Twenty patients, 11 males and 9 females were carefully selected on the bases of anatomical configuration suitable for repair without trans annular patch. All underwent echocardiography. Angiocardiography was performed in patients. They had no other cardiac vascular anomaly. Results Of the 20 patients, there was one death following massive endotracheal bleeding. Four patients had low cardiac output and required prolonged inotropic support and recovered completely. All 19 survivors have been followed (1–56 months) are with echocardiography. There were no residual or recurrent ventricular septal defect (VSD), significant right ventricular (RV), outflow obstruction or tricuspid regurgitation. Four patient who underwent annualr enlargement have minimal pulmonary regurgitation. Conclusions In selected patients transpulmonic repair of TOF is feasible and safe.     

Particle repositioning manoeuvre in benign paroxysmal positional vertigo: is it really safe?

OBJECTIVE: A prospective study to determine the safety of the particle repositioning manoeuvre (PRM) by analyzing the various complications of the procedure. SETTINGS: Outpatient Department of Otorhinolaryngology, Nehru Hospital, Chandigarh, India. METHODS: Thirty patients with the classic findings of benign paroxysmal positional vertigo (BPPV) were included in the study. Clinical symptoms prior to the procedure were noted. Twenty-nine of them were subjected to PRM, and postprocedural instructions were given to all patients. Various side effects during and following the procedure were recorded. They were classified into early and late based on the period and into major and minor based on severity. All patients were reviewed after 3 days, 7 days, and 1 month. RESULTS: Of the 29 patients, 19 patients (65.52%) had heaviness in the head, with 11 each (37.93%) reporting nausea and imbalance and 9 (31.03%) reporting instability during the procedure. A major complication, asystole, was noted in one patient. The percentage of side effects remained more or less the same in the early phase following the procedure. Only 5 of 29 patients were entirely asymptomatic. Ninety percent were relieved of symptoms by the end of 7 days, with no major complication recorded. CONCLUSIONS: PRM is an easy, effective, and relatively safe procedure. The risk of major complications with PRM, such as arrhythmias and asystole, highlights the need to consider other management modalities for BPPV in certain medically unfit patients.     

Intraventricular rhabdoid tumor

Malignant rhabdoid tumor (MRT) most commonly occurs in kidney. In the central nervous system, cerebellum is the most common site of occurrence. CNS rhabdoid tumors typically occur in small children, do not respond favorably to treatment and are usually fatal within 1-year. Here is reported a 4-year-old child who presented with features of raised intracranial pressure. Apart from papillodema, there were no neurological signs. Imaging revealed a left lateral ventricular heterogeneous mass abutting the foramen of monro, with mild irregular contrast enhancement and hydrocephalus. the child underwent right ventriculo-peritoneal shunt followed by craniotomy and gross total tumor resection. He was discharged 10-days after surgery without any neurological deficits. Histopathology revealed features compatible with rhabdoid tumor. Despite radiotherapy and chemotherapy, the child died of progressive disease 10-months after surgery. the highly malignant nature of this tumor makes early diagnosis essential for aggressive management and prognostication.     

Massive powder aspiration in a toddler

We report a case of aspiration of calcium carbonate powder by a toddler. Bronchoscopic removal of aspirated contents resulted in favourable outcome.     

Magnetization transfer studies of the fast and slow tissue water diffusion components in the human brain

Magnetization transfer (MT) properties of the fast and slow diffusion components recently observed in the human brain were assessed experimentally. One set of experiments, performed at 1.5 T in healthy volunteers, was designed to determine whether the amplitudes of fast and slow diffusion components, differentiated on the basis of biexponential fits to signal decays over a wide range of b-factors, demonstrated a different or similar magnetization transfer ratio (MTR). Another set of experiments, performed at 3 T in healthy volunteers, was designed to determine whether MTRs differed when measured from high signal-to-noise images acquired with b-factor weightings of 350 vs 3500 s/mm2. The 3 T studies included measurements of MTR as a function of off-resonance frequency for the MT pulse at both low and high b-factors. The primary conclusion drawn from all the studies is that there appears to be no significant difference between the magnetization transfer properties of the fast and slow tissue water diffusion components. The conclusions do not lend support to a direct interpretation of the 'components' of the biexponential diffusion decay in terms of the 'compartments' associated with intra- and extracellular water.     

Bootstrap resampling method to estimate confidence intervals of activation-induced CBF changes using laser Doppler imaging

Laser Doppler imaging (LDI) signal and noise characteristics can vary significantly depending upon the underlying vascular caliber. Further, noise characteristics are not constant over time (non-stationary) and can vary during resting and activated conditions in a typical experiment. Since only a limited number of images can be acquired in a single run, concatenation of data from similar experimental trials becomes necessary which can induce further variation in temporal noise due to instrumental response. In conventional statistical analysis methods such as cross-correlation, a fixed significance threshold is generally used (for the entire image) to detect activation assuming constant noise over time and a normal distribution. As a consequence, statistical significance can become strong or weak due to temporal differences in baseline LD noise, which can possibly deviate from a normal distribution. The main emphasis of this study was the application of bootstrap resampling in conjunction with cross-correlation to estimate the confidence intervals on a pixel-by-pixel basis to avoid distributional specifications on the additive measurement error leading to reliable whisker activation-induced CBF changes. At a 95% confidence level, bootstrap resampling followed by confidence intervals for the correlation coefficient distribution increased the number of active pixels by almost 45% when compared to conventional cross-correlation. These pixels were mostly confined to areas with intermediate and large baseline LD flux with considerable deviation from normality. It is suggested that confidence intervals of the bootstrap estimates can lead to unbiased detection of CBF change in the cerebral cortex, particularly in regions with large temporal variation in noise and low CNR.     

Transpulmonary CT-Guided Radiofrequency Ablation of Liver Metastasis

The percutaneous approach for RF ablation of liver lesions high up in the dome is always difficult. The authors describe a transpulmonary approach that may be simpler and safer to use.     

Preoperative computed tomography-guided hookwire needle localization of a peritoneal multilocular inclusion cyst

Preoperative hookwire localization of breast lesions is a well established technique to aid surgeons in localizing breast tumors. We describe the innovative use of a standard hookwire with CT guidance to localize an intraperitoneal inclusion cyst.