Cardiac sarcoidosis mimicking arrhythmogenic right ventricular dysplasia with high defibrillation threshold requiring subcutaneous shocking coil implantation

Cardiac involvement in patients with sarcoidosis has been reported in up to 25-39% of patients and is responsible for up to 85% of deaths attributed to the disease, often due to sudden cardiac death. An established diagnosis of cardiac sarcoidosis (CS) portends an ominous prognosis, with an estimated five year-survival of 44%. We report a case that was initially diagnosed as arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), but extra-cardiac biopsies later on were consistent with sarcoidosis and a final diagnosis of CS was made. The patient received an implantable cardioverter defibrillator (ICD) with a subcutaneous lead array implant for high defibrillation threshold (DFT). Exclusive right ventricular (RV) involvement is atypical for CS. The predominant RV involvement based on echocardiogram, cardiac magnetic resonance imaging (MRI) and right precordial electrocardiogram changes can lead to misdiagnosis as ARVD/C based on the modified task force criteria. Cardiac sarcoidosis is an under-diagnosed disease and the delay in its diagnosis and appropriate therapy can lead to a fatal outcome. High defibrillation thresholds have not been previously reported in patients with CS, but given the natural progression of the disease and the limitations in current pharmacotherapy, implanters who diagnose and treat such patients must be prepared to deal with this issue.     

Polymer-assisted synthesis and applications of hydroxyapatite (HAp) anchored nitrogen-doped 3D graphene foam-based nanostructured ceramic framework

In the present work, a hydroxyapatite anchored nitrogen-doped three-dimensional graphene (HAp-N3DG) skeletal network (foam) based nanostructured ceramic framework (CF) was developed through a polymer-assisted solvothermal route. Field emission scanning electron microscopy (FESEM) and transmission electron microscopy (TEM) studies reveal that the nano sized 0D HAp particles are anchored on the N3DG skeletal network with an average size of less than 50 nm. EDX and X-ray photoelectron spectroscopy (XPS) analysis confirmed the presence of Ca, P, O, N, and C. In addition, XPS analysis reveals the existence of N–C bonds in the prepared sample. The X-ray diffraction (XRD) patterns indicate the presence of hexagonal phase hydroxyapatite and the calculated average crystallite size was found to be 12 nm. The developed HAp-N3DG foam based nanostructured CF was found to have a mesoporous structure and the measured specific surface area (SSA) and the mean pore diameter were found to be 64.73 m² g⁻¹ and 23.6 nm, respectively. Electrochemical analysis shows that HAp anchored on nitrogen-doped 3D graphene foam based nanostructured CF has moderate electrochemical activity towards lithium ion charge/discharge. In addition, the prepared material showed adsorption activity values of 204.89 mg g⁻¹ and 243.89 mg g⁻¹ for the volatile organic compounds (VOCs) benzene and toluene, respectively. The present findings suggest that the newly developed HAp anchored nitrogen-doped 3DG (HAp-N3DG) skeletal network (foam) based nanostructured CF material can be used in energy devices and in the removal of volatile organic compounds. Moreover, the present study initiates a new kind of approach in energy device (lithium ion battery-LIB) research and in the removal of VOCs.

Hydroxyapatite anchored nitrogen-doped three-dimensional graphene (HAp-N3DG) skeletal network (foam) based nanostructured ceramic framework (CF) was developed through a polymer-assisted solvothermal route.     

Thoracic trauma trends in Northern India- single center experience

Introduction

Thoracic trauma comprises 10–15 % of all traumas. The incidence and etiological pattern of chest trauma varies from region to region and is related to cultural and socio-political circumstances. This paper details our experience with thoracic trauma in a North Indian state.

Material & methods

All patients who were hospitalized for thoracic trauma from June 2010 to June 2012 in our hospital were enrolled. Data was collected prospectively and analysed. Factors analysed were age, gender, mode of injury, type of thoracic injury, associated injuries, management modalities, and outcome.

Results

The total number of patients was 250. The male to female ratio was about 10:1. The mean age of patients was 36.62 years. Road Traffic Accident (RTA) was the most common mode of chest injury. Motor-bike accident was the most common type of RTA. Majority of patients were managed with tube thoracostomy (183, 73.2 %). One hundred and eighty nine (75.6 %) patients were discharged after recovery. Ten (4.0 %) patients absconded. In all, 29 (11.6 %) patients died, while 22 (8.8 %) patients left the hospital against medical advice. A significant association between presence of associated injury and outcome was observed (p?<?0.001). We found mortality rate was significantly higher in chest injury associated with neurotrauma and abdominal visceral injury.

Conclusion

Chest trauma is a major health problem since it has high morbidity and mortality rate. The majority of patients with simple chest injuries can be managed by tube thoracostomy. According to our analysis; mortality predictors were: RTAs, blunt chest trauma, unstable hemodynamic status upon arrival, neurotrauma, abdominal visceral injury, flail chest, ventilator use, cardiac contusion and complications of therapy.     

Carcinosarcoma of esophagus—a case report and review of literature

Carcinosarcoma of esophagus contains both the carcinomatous and sarcomatous elements. These are rare polypoidal malignancies of esophagus. One such case is presented and available literature is reviewed.     

Comparative evaluation of surgical outcome after removal of impacted mandibular third molars using a Piezotome or a conventional handpiece: a prospective study

Our aim was to compare the use of a conventional rotary handpiece and a Piezosurgical unit for extraction of lower third molars. We studied 40 patients, who were allocated alternately to have the third molar removed with either the handpiece or the Piezosurgical unit. Pain, trismus, and oedema were evaluated at baseline and then postoperatively, together with paraesthesiae, on postoperative days 1, 3, 5, 7, and 15. Damage to surrounding tissue was checked on the same day whereas dry socket was evaluated from postoperative day 3 onwards. More patients complained of pain in the conventional group, they also required more analgesics, and they developed trismus more often than in the Piezosurgery group. There was also significantly more postoperative swelling in the conventional group. Patients were also evaluated using the subjective Postoperative Symptom Severity (PoSSe) scale. Our results suggest that apart from some inherent limitations with the Piezotome, it is a valuable alternative for extraction of third molars.