Off Pump Complete Revascularization Through Left Lateral Thoracotomy (ThoraCAB): NICVD Experience.

Background: Conventional coronary artery bypass surgery (CABG) is associated with substantial morbidity caused by cardiopulmonary bypass (CPB) and median sternotomy. Here we described an innovative technique to perform complete revascularization through a left lateral thoracotomy without CPB (ThoraCAB). Methods: From September 2005 to December 2008 a total 83 patients underwent ThoraCAB in National Institute of Cardio Vascular Diseases (NICVD). The patient is positioned with the left side elevated to 45 degree. A 6 to 8 inches long incision is made over the left 4th or 5th intercostal space from just medial to the nipple to the anterior axillary line. The left internal mammary artery (LIMA) is harvested as a pedicle graft under vision. Distal coronary anastomosis is completed first on the beating heart using a stabilizer, followed by proximal anastomoses on the descending aorta. Peroperative and postoperative complication the arrhythmia hypotension wound infection death was observed. Results: Complete revascularization was achieved in all patients. The number of grafts averaged 2.18±1.08 per patients. One patient died (1.2%) due to severe respiratory acidosis. One patient (1.2%) was converted to CPB due to arrhythmia. No strokes were observed. Of these patients, 7.2% developed new onset postoperative atrial fibrillation. Conclusion: ThoraCAB has been feasible in the vast majority of the patients requiring CABG surgery. The prevalence of the post operative atrial fibrillation was low. Left lateral thoracotomy offers an attractive and effective alteration to Off Pump median sternotomy.

Artificial neural network and medicine.

The introduction of human brain functions such as perception and cognition into the computer has been made possible by the use of Artificial Neural Network (ANN). ANN are computer models inspired by the structure and behavior of neurons. Like the brain, ANN can recognize patterns, manage data and most significantly, learn. This learning ability, not seen in other computer models simulating human intelligence, constantly improves its functional accuracy as it keeps on performing. Experience is as important for an ANN as it is for man. It is being increasingly used to supplement and even (may be) replace experts, in medicine. However, there is still scope for improvement in some areas. Its ability to classify and interpret various forms of medical data comes as a helping hand to clinical decision making in both diagnosis and treatment. Treatment planning in medicine, radiotherapy, rehabilitation, etc. is being done using ANN. Morbidity and mortality prediction by ANN in different medical situations can be very helpful for hospital management. ANN has a promising future in fundamental research, medical education and surgical robotics.

Relationship between caries status, colony forming units (cfu) of Streptococcus mutans and Snyder caries activity test.

It is a well established fact that dental caries is caused by streptococcus mutans. For qualitative and quantitative analysis of streptococcus mutans, saliva samples are often preferred and are processed according to Kohler and Brathall method. In the present study an attempt is made to relate caries status (caries free, average caries, and rampant caries group) with cfu counts of streptococcus mutans and Snyder test. The streptococcus mutans were isolated using MSB agar and cfu were determined of each individual from different caries groups. The saliva of the same individual was drooled into a culture bottle containing Snyder test agar and extent of colour change was observed after 24, 48, and 72 hours incubated at 37 degrees C. The time and extent of colour change determined the conduciveness of diet. It has been observed that caries free individuals have low cfu count and their diet was mild or moderately conducive, while the individuals having average caries had medium cfu count and their diet was moderately-high conducive. In rampant caries, individuals however the cfu count were high and the diet was highly conducive. In caries free, average caries and rampant caries group 40, 60, and 80 per cent samples showed colour change, in Snyder test up to full length in 72 hours respectively. Thus a definite correlation exists between caries status, cfu count of streptococcus mutans and Snyder caries activity test.

Prevalence of dental caries in nursery school children of Akola city.

A study of prevalence and severity of dental caries was undertaken in seven nursery schools of Akola city in the age group of 5-6 years. A total of 508 children were examined out of which 288 were boys and 220 girls. The examination for dental caries and data collection was carried out as per W.H.O. (1987) criteria. Out of the total 508 children examined 61.41% were observed to be having caries with mean dmft/dmfs of 2.75+/-3.98 & 4.04+/-6.84 respectively. Total 17.91% school children were found to be having decay in either all upper or lower molars. In the high risk caries group 0.98% children were found to be affected with nursing caries and 0.2% children with rampant caries. Only a negligible proportion of filled teeth (1.42%) and missing due to caries (0.14%) was observed in the population. Occlusal surface caries was the most prevalent type of decay (44.71) and the mandibular deciduous second molars were the most affected by caries. Due to high prevalence of dental caries (61.41%) research must be carried out in the direction of identification of the children population at high risk of caries, so that a rigorous preventive programme be implemented.