Successful treatment of early postinfarction massive ventricular septal rupture and cardiogenic shock

A 65 years old woman presented to the ER with vomiting and severe retro-sternal chest pain for twelve hours. She was extremely dyspneic with a respiratory rate of 32/min, heart rate of 120/min, blood pressure of 70/50 mmHg and 02 saturations of 91% on 15 liters by face mask. She had bilateral crepitations upto mid lung zones bilaterally and had pan systolic murmur and had cool extremities with no pedal pulses. ECG showed massive anterior ST elevation myocardial infarction. An emergent echocardiography showed dilated right ventricle, and a large ventricular septal rupture anteriorly with severely reduced LV function. Patient was intubated, taken to the cardiac catheterization lab. An IABP was placed and on angiography large ventricular septal rupture was identified along with complete LAD occlusion. Median sternotomy was performed and patient was placed on cardiopulmonary bypass. The anterior infracted portion was excised and large anterior VSD was identified. The edges were debrided and then a large 7.5 cm defect in the anterior interventricular septum was identified. A Dacron patch was sewn along the edges of the VSD with interrupted plegeteted ethibond sutures and then the free wall of the LV and RV were brought together with plegeted prolene sutures; thus sandwitching the patch and closing the ventricular free wall also. LAD was grafted with a vein graft. IABP was removed after 48 hours and the patient was extubated. The rest of the hospital stay was unremarkable and patient was discharged home in 10 days

Characteristics and etiology of zygomatic complex fractures

This study aims to determine Etiology and Characteristics of Zygomatic complex fracture [ZMC]. Forty patients of zygomatic bone fracture were evaluated by history, clinical and radiological examination. The most common cause of ZMC fractures was road traffic accident [RTA] 52.5%[n=21], followed by fall 17.5% [n=7], fire arm injury [FAI] 15%[n=6], interpersonal violence [IPV] 7.5%[n=3], occupational trauma and sport injuries 5%[n=2] and 2.5%[n=1] respectively. The most common characteristic of ZMC fractures recorded in this study was flattening of cheek, 92.5%[n=37] and subconjunctival hemorrhage 92.5%[n=37] respectively, followed by abnormal nerve sensibility 90%[n=36],periorbital ecchymosis 87.5%[n=35], epistaxis 55% [n= 18], limited mouth opening 50% [n=20] and diplopia 27.5% [n=11]. The most common characteristic of ZMC fractures was flattening of cheek and subconjunctival hemorrhage, because the zygomatic complex bone is very prominent and easily expose to traumatic forces and subconjuctival hemorrhage can easily occurs even if there is a minor tear of periosteum. The most common cause of ZMC fractures was RTA because of bad road conditions, poor road traffic sense in road users plus seat belt legislation was not enforced in this part of the world

Characteristics and etiology of radicular cyst - a study

Radicular cyst is one of the late sequelae of untreated pulpal necrosis often caused by dental trauma and caries. It develops slowly and gradually but symptomlessly, and involves many adjacent sound teeth endangering their vitality and even prognosis.The objectives of this study were to determine the site, age and sex distribution as well as to know the ratio of trauma to caries in the occurrence of Radicular cyst. Fifty [50] patients were included in study after taking history, clinical examination, radiological findings, aspiration test and biopsy report. 38 cases occurred in maxilla while 12 in mandible with ratio 3.1:1. In maxilla, the offended tooth was anterior in all 38 cases. So the favoured site was maxillary anterior teeth. The peak frequency was in 3rd decade with mean age of 23 years. There was slight male predilection as like other international studies. The ratio of trauma to caries was 4.3:1 in both jaws, 10:1 in maxilla and 1:1 in mandible. The increased ratio of trauma to caries indicates the neglecting attitude of our patients to dental treatment and demands their awareness and education about the untreated dental trauma.This study will help professionals to know the hazards of untreated dental trauma as well as their consequences. It will also help in early diagnosis and management of radicular cyst to reduce its morbidity