Role of Transesophageal Echocardiography in the Recurrent Biatrial Myxoma of Uncommon Origin

After surgical excision of myxoma recurrence usually happens adjacent to the initial origin site. We report a case of recurrent myxomas in a young male patient that had biatrial recurrence with one tumor originating very unusually from the base of the anterior mitral leaflet. Intraoperative transesophageal echocardiography was instrumental in localizing the site of the origin of left atrial myxoma from the base of the anterior mitral leaflet and in detecting an additional myxoma attached to the wall of the right atrium.

Transoral endoscopic excision of cystic hygroma vestibular approach in adult (novel approach): a case report

Lymphangioma, soft tissue tumor was originally reported by R. Backer in 1828 and “cystic hygroma” name was first given by Wernker in 1834. It can occur in the head, neck, axilla, cervico-facial regions and below tongue. Although it is well recognized in children, it may present in adulthood. Cystic hygroma neck is traditionally removed via an overlying incision near or over the swelling. The resultant scar can be displeasing to an adult. Various endoscopic approach present in literature for excision are via neck, anterior chest, combined or robotic assisted. We here, are reporting transoral endoscope excision of cystic hygroma via vestibular approach. A 51 year old female with swelling over anterior aspect of neck, trans-illumination positive, diagnosis confirmed on CT neck, of size ~4×4 cm was our case. We decided for transoral endoscopic vestibular approach for excision, first of its kind with no assisted approach. Patient discharged after 3 post-operative days (PODs). There was mild seroma which resolved within a week. Transoral endoscopic excision of cystic hygroma via vestibular approach without any assisted approach can be applied in adult. Various approach present in literature for excision of cystic hygroma are via neck, anterior chest or combined or robotic assisted. Hence this approach can be an excellent choice for adult cystic hygroma patients who desire to avoid a neck incision. Transoral endoscopic excision of cystic hygroma via vestibular approach was successfully performed. Patient was satisfied with good cosmosis. It results in good cosmesis and better dissection. Hence can be a new method of excision of cystic hygroma in adult.

A comparative evaluation of fracture resistance of endodontically treated teeth restored with different post core systems: an in-vitro study

PURPOSE: To compare the fracture resistance and the mode of failure of endodontically treated teeth restored with different post-core systems. MATERIALS AND METHODS: Root canal treatment was performed on 40 maxillary incisors and the samples were divided into four groups of 10 each. For three experimental groups post space preparation was done and teeth were restored with cast post-core (Group B), stainless steel post with composite core (Group C) and glass fiber post with composite core using adhesive resin cement (Group D). Control group (A) samples were selected with intact coronal structure. All the samples were prepared for ideal abutment preparation. All the samples were subjected to a load of 0.5 mm/min at 130degrees until fracture occurred using the universal testing machine. The fracture resistance was measured and the data were analyzed statistically. The fracture above the embedded resin was considered to be favorable and the fracture below the level was considered as unfavorable. The statistical analysis of fracture resistance between different groups was carried out with t-test. For the mode of failure the statistical analysis was carried out by Kruskal-Wallis test and Chi-Square test. RESULTS: For experimental group Vs control group the fracture resistance values showed significant differences (P<.05). For the mode of failure the chi-square value is 16.1610, which means highly significant (P=.0009) statistically. CONCLUSION: Endodontically treated teeth without post core system showed the least fracture resistance demonstrating the need to reinforce the tooth. Stainless steel post with composite core showed the highest fracture resistance among all the experimental groups. Teeth restored with the Glass fiber post showed the most favorable fractures making them more amenable to the re-treatment.

Origem das artérias dos nós sinoatrial e atrioventricular em população do sul da Índia: um estudo angiográfico / Origin of the sinoatrial and atrioventricular nodal arteries in South Indians: an angiographic study / Origen de las arterias de los nódulos sinusal y atrioventricular en población del Sur de la India: un estudio angiográfico

Fundamento: Estudar o suprimento arterial do sistema condutor e sua correlação com a dominância das artérias coronárias em população do sul da Índia. Objetivo: Determinar angiograficamente as origens da artéria do nó sinoatrial (AnSA) e artéria do nó atrioventricular (AnAV) em indianos.Métodos: O estudo incluiu 300 pacientes consecutivos (114 do sexo feminino e 186 do sexo masculino; idade média, 55 anos), habitantes da região costeira ao sul da Índia, submetidos a cineangiocoronariografia devido a sintomas como dor no peito, angina pectoris ou teste ergométrico positivo. As angiografias incluíram ambas as artérias coronárias (direita e esquerda) em posição oblíqua anterior direita e esquerda. A origem da AnSA e AnAV a partir das artérias coronárias foi observada e correlacionada à dominância arterial. Resultados: O nó SA (sinoatrial) recebeu suprimento pela artéria coronária direita (ACD) em 53% dos casos, pelo ramo circunflexo (Cx) da artéria coronária esquerda (ACE) em 42,66% dos casos, e em 4,33% dos casos esse nó foi irrigado por ambas as artérias coronárias. O nó AV (atrioventricular) também recebeu suprimento sanguíneo com mais frequência da ACD (72,33% dos casos) do que do ramo Cx da ACE (27,66%). Surpreendentemente, em nenhum caso este nó recebeu suprimento de ambas as artérias coronárias. Conclusão: Os resultados do presente estudo podem auxiliar os cirurgiões cardíacos, sobretudo em cirurgias relacionadas a valvopatias, devido à franca proximidade entre os ramos nodais e o complexo valvar.

Background: To study the arterial supply of the conducting system and its correlation with the dominance of the coronary arteries in the South Indian population. Objective: To determine angiographically the origins of the sinoatrial nodal artery (SAna) and atrioventricular nodal artery (AVna) in Indians. Methods: The study included 300 consecutive patients (114 females, 186 males; mean age, 55 years) living in the southern coastal region of India, who underwent coronary angiography either for the symptoms of chest pain, angina pectoris or positive Treadmill Test. The angiograms contained both coronary arteries (right and left) in the right and left anterior oblique position. The origin of SAna and AVna from the coronary arteries was observed and correlated with the arterial dominance.Results: The SA (sinoatrial) node was supplied by the right coronary artery (RCA) in 53% of the cases, by the circumflex (Cx) branch of left coronary artery (LCA) in 42.66%, and by both coronary arteries in 4.33% of cases. The AV (atrioventricular) node was also more often supplied by the RCA (72.33% of cases) than by the Cx branch of the LCA (27.66%), and surprisingly in none of the cases was this node supplied by both coronary arteries. Conclusion: The results of the present study may help cardiac surgeons, particularly in surgeries related to certain valvular disorders, due to the proximity of the nodal branches to the valve complex.

Fundamento: Estudiar el suministro arterial del sistema conductor y su correlación con la dominancia de las arterias coronarias en población del Sur de la India. Objetivo: Determinar angiográficamente los orígenes de la arteria del nódulo sinusal (AnSA) y la arteria del nódulo atrioventricular (AnAV) en indios. Métodos: El estudio incluyó 300 pacientes consecutivos (114 del sexo femenino y 186 del sexo masculino; edad promedio, 55 años), habitantes de la región costera al Sur de la India, sometidos a cineangiocoronariografía debido a síntomas como dolor en el pecho, angina pectoris o test ergométrico positivo. Las angiografías incluyeron ambas arterias coronarias (derecha e izquierda) en posición oblicua anterior derecha e izquierda. El origen de la AnSA y AnAV a partir de las arterias coronarias se observó y se correlacionó con la dominancia arterial. Resultados: El nódulo SA (sinusal) recibió suministro por la arteria coronaria derecha (ACD) en el 53% de los casos, por la rama circunfleja (Cx) de la arteria coronaria izquierda (ACI) en el 42,66% de los casos, y en el 4,33% de los casos este nódulo fue irrigado por ambas arterias coronarias. El nódulo AV (atrioventricular) también recibió suministro sanguíneo con más frecuencia de la ACD (72,33% de los casos) que la rama Cx de la ACI (27,66%). Sorprendentemente, en ningún caso este nódulo recibió suministro de ambas arterias coronarias.Conclusión: Los resultados del presente estudio pueden auxiliar a los cirujanos cardíacos, sobre todo en cirugías relacionadas a valvulopatías, debido a la franca proximidad entre las ramas nodales y el complejo valvular.

Epidemiology of disability in a rural community of Karnataka.

OBJECTIVES: To determine the prevalence and pattern of disability in all age groups in a rural community of Karnataka. METHODS: A community-based cross-sectional study was conducted during January-December 2004 among 1000 study subjects of all age groups selected randomly from four villages under rural field practice area of a teaching institution. Subjects were interviewed and examined using a predesigned schedule. Percentage prevalence, chi square test and multiple logistic regression analysis were used for statistical analysis. RESULTS: The prevalence of disability was found to be 6.3%. Both physical and mental disabilities are of great concern in this area. 80% of the disabled had multiple disabilities. Knowledge and occupation plays a major role as determinants of disability. Chronic medical conditions are also more common among disabled.

Efficacy of piperonyl butoxide (PBO) as a synergist with deltamethrin on five species of mosquitoes.

Development of insecticide resistance has been a challenging problem for a long time and new solutions are yet to emerge. In this regard, the use of synergist with the insecticide is thought to play a key role in reducing the resistance levels. Present study demonstrates the efficacy of PBO with deltamethrin against the field collected mosquito larvae of five species of Aedes, Anopheles and Culexfrom in and around Mysore.

Spinal cord response to altered fractionation and re-irradiation: radiobiological considerations and role of bioeffect models.

The aim of radiation oncologist is to implement an uncomplicated loco regional control of cancer by radiation therapy. The bioeffect of a physical dose depends on the nature of the tissue, fractionation scheme, dose rate and treatment time. The transformation of absorbed dose into a bioeffect dose is controlled by treatment variables and the radiobiological characteristics of the relevant tissue. Various bioeffect models have been proposed to predict the biological effect of radiotherapy treatments. Dale has proposed extrapolated response dose (ERD) equations for external beam therapy, intracavitary brachytherapy and interstitial brachytherapy. Within the context of the LQ model, the parameter which quantifies the overall biological effect on a given tissue is the biologically effective dose (BED) which is obtained by applying repopulation correction to ERD (Orton). Thames proposed the total effect (TE) concept based on the incomplete repair LQ model which accounts for the biological effect of a fractionated course of radiotherapy. Spinal cord myelitis limits the dose to tumours in the head and neck, thoracic and upper abdominal regions resulting in reduction of tumour control probability. Radiation myelopathy is one of the most devastating complications of clinical radiotherapy. Treatment techniques that are designed to minimize the risk of spinal cord injury are likely to underdose the tumour consequent failure to control the disease. Since radiation myelopathy results in severe and irreversible morbidity, it is important to establish the tolerance dose of the spinal cord. A number of patients have recently been reported to have developed radiation myelopathy following hyperfractionated accelerated radiotherapy. As the survival rates of patients increase, radiation oncologists are more frequently faced with the problem of treatment of late recurrence or second tumours situated within or close to previously treated site. A rationale for taking a decision in treating in such a condition is even more complex than the original condition and requires knowledge of the kinetics of decay of occult injury of the previous treatment. To test the validity of ERD, clinically reported data of altered fractionation to the spinal cord for 7 patients reported by Wong et al, Saunders et al and Bogaert et al, were analysed, ERD values were calculated and compared with compiled clinical literature data of 3233 patients for the incidence of spinal cord myelitis reported by Cohen and Creditor, Wara et al, Abbatucci et al and Jeremic et al for conventional fractionation. ERD values were estimated with alpha/beta of 2.5 Gy for the conventional and altered fractionation data. To test the validity of TE concept for clinical data of re-irradiation tolerance of the spinal cord, the data of the 22 patients compiled by Nieder et al were used. Clinical data compiled from the literature of Cohen and Creditor, Wara et al, Abbatucci et al and Jeremic et al, were used for comparison.

Pyrethroid susceptibility & enzyme activity in two malaria vectors, Anopheles stephensi (Liston) &. A. culicifacies (Giles) from Mysore, India.

BACKGROUND & OBJECTIVES: Anopheles stephensi and A. culicifacies are the two major vectors of malaria in Karnataka. These mosquito populations are continuously being exposed directly or indirectly to different insecticides including the most effective pyrethroids. Therefore, there is a threat of insecticide resistance development. We subjected these vectors to larval bioassay using two popular pyrethroids viz deltamethrin and permethrin. An attempt was also made to correlate the activities of certain detoxifying enzymes such as A- esterase, B-esterase, glutathione-S transferase (GST) and glucose-6-phosphate dehydrogenase (G6PD) with the tolerance levels of the two vectors. METHODS: Larval bioassay was carried out following the standard WHO procedure on field-collected larvae. The LC50 and LC90 values were calculated following Probit analysis. Biochemical estimations were done with a U V spectrophotometer and the isozyme studies employing native polyacrylamide gel electrophoresis (PAGE). RESULTS: The results of the larval bioassay revealed that A. stephensi has more tolerance to deltamethrin than A. culicifacies and vice versa for permethrin. Biochemical estimations revealed significantly (P < 0.05) higher levels of A-esterase and GST activity in A. stephensi whereas A. culicifacies showed significantly higher (P < 0.05) levels of B-esterase and G6PD activity. The total larval protein assayed was found to be more (P < 0.05) in A. stephensi. The isozyme profiles also revealed difference in mobility, intensity and the number of bands. INTERPRETATION & CONCLUSION: As these malaria vectors are exposed to different kinds of insecticides, they develop increased enzyme activities to overcome the insecticide pressure. This has enhanced the tolerance level against the pyrethroids tested. Thus, A. stephensi was found to be tolerant to deltamethrin depicting a higher activity of A-esterase and GST enzymes, whereas the higher activity of B-esterase and G6PD has resulted in the development of tolerance to permethrin in A. culicifacies.

Role of esterases and monooxygenase in the deltamethrin resistance in Anopheles stephensi Giles (1908), at Mysore.

Field collected An. stephensi larvae were colonized in the laboratory for 15 generations and acclimatized. An isofemale line was raised from this colony and the larvae were subjected to continuous deltamethrin selection pressure. LC50 and LC90 values were calculated at every generation. The values indicated that at the end of seventh generation the larvae have developed 87 fold tolerance in terms of LC50 value compared with the first generation. The reason for this kind of resistance was analyzed on the basis of differential activity of A-esterase, B-esterase, glutathione s-transferase (GST) and glucose 6-phosphate dehydrogenase (G6PD). A significant correlation (P < 0.05) was observed with B-esterase and G6PD activity with the rise in the LC50 and LC90 values. However no significant rise were observed in the other enzymes tested such as A-esterase and GST. The isozyme analysis of the A-esterase and B-esterase using polyacrylamide gel electrophoresis (PAGE) have shown differential profiles.

Deltamethrin tolerance & associated cross resistance in Aedes aegypti from Mysore.

BACKGROUND & OBJECTIVES: The indiscriminate use of insecticides in public health and agriculture has led to the development of resistance to these insecticides in the vector mosquitoes. To understand the development of resistance to synthetic pyrethroids, selection studies on Aedes aegypti were done at Mysore. METHODS: Ae. aegypti collected from the field were subjected to selection experiment with deltamethrin for 16 generations in the laboratory. Cross resistance test was conducted against permethrin and fenvalerate. RESULTS: Tolerance level was found to increase by 333.83 folds in terms of its LC50 values. Cross resistance of this deltamethrin selected line was tested against permethrin and fenvalerate. The results show that the selected line has developed cross resistance as much as 5.19 and 5.92 folds respectively against permethrin and fenvalerate. INTERPRETATION & CONCLUSIONS: The findings show a continuous elevation in tolerance in Ae. aegypti with increase in deltamethrin selection pressure, and development of cross resistance to other insecticides of the same class. The natural or developed tolerance has its implications in the control of these mosquitoes.

Impact of school-based HIV and AIDS education for adolescents in Bombay, India.

The HIV/AIDS epidemic in India is expanding rapidly. The present study is a pre-test-post-test evaluation of a school-based HIV/AIDS educational program. The pre-test was administered to 2,919 students regarding modes of transmission and prevention of HIV/AIDS. An education program was instituted for one half school day at ten secondary schools. Principals of two schools refused to participate. One month later, the post-test was administered to 2,400 students. Before the educational intervention only 50% of the students knew that HIV/AIDS is transmitted sexually, only 34% knew that there are no medicines that cure HIV/AIDS and 24% thought that HIV is transmitted by mosquito bites. After the intervention, 95% of the students knew that HIV/AIDS is transmitted sexually, 92% knew that there is no HIV/AIDS cure and 76% knew that HIV/AIDS is not transmitted by mosquitos. There was a substantial increase in correct knowledge about HIV/AIDS among students after our single educational program. This suggests that school-based educational programs for adolescents in India can succeed in providing basic information regarding HIV/AIDS.