Three Dimensional Quantitative Coronary Angiography Can Detect Reliably Ischemic Coronary Lesions Based on Fractional Flow Reserve

Conventional coronary angiography (CAG) has limitations in evaluating lesions producing ischemia. Three dimensional quantitative coronary angiography (3D-QCA) shows reconstructed images of CAG using computer based algorithm, the Cardio-op B system (Paieon Medical, Rosh Ha'ayin, Israel). The aim of this study was to evaluate whether 3D-QCA can reliably predict ischemia assessed by myocardial fractional flow reserve (FFR) < 0.80. 3D-QCA images were reconstructed from CAG which also were evaluated with FFR to assess ischemia. Minimal luminal diameter (MLD), percent diameter stenosis (%DS), minimal luminal area (MLA), and percent area stenosis (%AS) were obtained. The results of 3D-QCA and FFR were compared. A total of 266 patients was enrolled for the present study. FFR for all lesions ranged from 0.57 to 1.00 (0.85 +/- 0.09). Measurement of MLD, %DS, MLA, and %AS all were significantly correlated with FFR (r = 0.569, 0609, 0.569, 0.670, respectively, all P < 0.001). In lesions with MLA < 4.0 mm2, %AS of more than 65.5% had a 80% sensitivity and a 83% specificity to predict FFR < 0.80 (area under curve, AUC was 0.878). 3D-QCA can reliably predict coronary lesions producing ischemia and may be used to guide therapeutic approach for coronary artery disease.

frequency of nonunion and avascular necrosis in fracture neck of femur in young adults, treated with cannulated screws

Objectives:- The objective of the study was to document frequency of nonunion and avascular necrosis in fracture neck of femur [NOF] in the young adults, treated with cannulated screws

Methodology: It is a descriptive case series study, carried out at Department of Orthopaedic Surgery Sheikh Zayed Hospital [PGMI] Lahore. Forty patients were included in this study, reported within two weeks of injury. All patients with Garden type I, II, III and IV fractures neck of femur, aged from 18 to 55 years, from May 2012 to November 2012 were included with the consent to undergo osteosynthesis with cannulated screws

Results: KOFU [Japan] hip scoring system was used to evaluate results. Total 34 fractures [85%] achieved radiological union on an average of 3 months. Out of these 34 patients, 11 patients were with Garden type I, 10 patients Garden type II, 8 patients with Garden type III and 5 patients with garden type IV fractures had union of fracture. Total 6 patients [15.0%] had complications. Out of these total 6 patients, 2 patients were Garden type III and 4 patients were Garden type IV. All these 6 patients [15%] had nonunion, and 2[5%] patients ended in avascular necrosis of head of femur also but in 4 patients head of femur remained viable. There was no case reported with implant loosening in our all treated cases

Conclusion: With cannulated screw fixation all garden type I and II fractures achieved union and garden type III fractures have minimal frequency of nonunion and garden type IV fractures have variable frequency of nonunion. So cannulated screw fixation is best method of treatment in fracture neck of femur in young adults

Role of tissue harmonic imaging in characterization of cystic renal lesions

To determine the utility of tissue harmonic imaging in evaluating cystic renal lesions and to compare these findings with conventional ultrasound guidance [USG] and CT. Thirty patients, detected with cystic renal lesions on routine USG [over a period of 18 months from July 2004 to December 2005 at the Postgraduate Institute of Medical Education and Research Chandigarh, Chandigarh, India] were included in this study. All patients underwent a conventional gray scale ultrasound study [GSI], followed by tissue harmonic imaging [THI] sonography on the same machine [advance technology limited high definition imaging 5000]. Computed tomography of abdomen was carried out within one week of the ultrasound examinations. All images were evaluated for size, number, and location of lesions. The findings of THI sonography, conventional USG and CT of abdomen were recorded in their respective proformas. The images obtained by GSI, THI, and contrast enhanced CT were also evaluated for image quality, lesion conspicuity, and fluid-solid differentiation. Tissue harmonic imaging showed better image quality in 27 of 34 lesions, improvement in lesion conspicuity was found in 27 of 34 cystic lesions, and an improved solid-fluid differentiation in 30 of 34 lesions when compared to GSI. The THI provided additional information as compared to GSI in 8 patients. The grading of CT scan was significantly higher in overall image quality [p=0.007] and lesion conspicuity [p=0.004], but was non-significant for fluid-solid differentiation [p=0.23]. Tissue harmonic imaging provides better image quality, lesion delineation, and superior characterization than conventional gray scale sonography

Disposition kinetics and urinary excretion of cefpirome after intravenous injection in buffalo calves

We investigated the disposition kinetics and urinary excretion of cefpirome in buffalo calves after a single intravenous administration of 10 mg/kg. Also, an appropriate dosage regimen was calculated. At 1 min after injection, the concentration of cefpirome in the plasma was 57.4 +/- 0.72 microgram/ml, which declined to 0.22 +/- 0.01 microgram/ml at 24 h. The cefpirome was rapidly distributed from the blood to the tissue compartment as shown by the high distribution coefficient values (8.67 +/- 0.46/h), and by the drug's rate of transfer constant from the central to the peripheral compartment, K12 (4.94 +/- 0.31/h). The elimination halflife and the volume of distribution were 2.14 +/- 0.02 h and 0.42 +/- 0.005 l/kg, respectively. Once the distribution equilibrium was reached between the tissues and plasma, the total body clearance (ClB) and the ratio of the drug present in the peripheral to the central compartment (T/P ratio) were 0.14 +/- 0.002 l/kg/h and 1.73 +/- 0.06, respectively. Based on the pharmacokinetic parameters we obtained, an appropriate intravenous cefpirome dosage regimen for treating cefpiromesensitive bacteria in buffalo calves would be 8.0 mg/kg repeated at 12 h intervals for 5 days, or until persistence of the bacterial infection occurred.

Carcinoma larynx in northern India: Clinical spectrum and results of treatment

This study is based on retrospective analysis of 835 patients of carcinoma larynx seen from 1971 through 1985. Anatomical site distribution revealed 451 [54%], 317 [37%] and 15 [2%] patients belonging to supraglottic, glottic and subglottic sites respectively. Majority of the patients [70%] were above 50 years of age. Hoarseness and dysphagia were commonest presenting symptoms in glottic and supraglottic cancers respectively. Patients treated with radical radiotherapy had 5 years disease free survival [DFS] of 83% and 74% in glottic and supraglottic cancers, respectively. Results using combination of surgery and radiotherapy are also presented