ABSTRACT
Asymmetrical septal occluder device (ASOD) has made percutaneous closure of ventricular septal defect an easy and effective management option. Although there are reports of aortic and tricuspid valvular regurgitation after deployment of ASOD, only few cases of tricuspid stenosis (TS) has been reported so far in the literature. We report a case of malaligned ASOD that occurred after successful device closure resulting in TS along with mild tricuspid and aortic regurgitation requiring surgical retrieval. Transesophageal echocardiography played crucial role in detecting the cause of tricuspid valve dysfunction besides providing continuous monitoring during the procedure. We intend to emphasize the need of echocardiographic evaluation of the tricuspid valvular apparatus and aortic valve during and after the device deployment even after the successful device closure to prevent this rare complication.
ABSTRACT
The variation in presence of number of nutrient foramen is important in long bones as nutrient foramen gives passage for entrance of nutrient arteries in to the bone. The present study was conducted on total 114 dry human long bones in department of anatomy, Era's lucknow medical college, lucknow. . The aim of the study was to determine the number of nutrient foramen in long bones of upper limb. Ethical approval was procured from the institutional ethical committee. In our study 97.40% humerus bones show single nutrient foramen, and 2.60% humerus bones show double NF, and all the radius and ulna show the single NF. The results of our study is similar with previous studies. The importance of knowledge about NF is very use full in orthopedic surgeries and in micro vascular bone grafting.
ABSTRACT
AIMS: To describe a novel surgical technique of 'lateralization' of superior pole to identify and save external branch of superior laryngeal nerve (EBSLN) during thyroidectomy. SETTINGS AND DESIGN: Prospective, nonrandomized at a tertiary care hospital in a specialized unit. MATERIAL AND METHODS: Over 30 months, 46 patients underwent thyroidectomy using technique of 1) 'Lateralization' of upper pole and dissection of avascular cricothyroid space 2) identification of EBSLN 3) skeletonization and individual ligation of superior thyroid vessels. Identified nerves were classified according to Cernea's classification. Outcomes were number of nerves identified, number of 'at risk' nerves' bilateral asymmetry and incidence of injury assessed by subjective interview and indirect laryngoscopy. RESULTS: Of the 78 dissected superior poles, nerves could be identified in 72 (92.31%). There were 22 (28.2%) type I, 42 (53.54%) IIa and 8 (10.25%) IIb 'at risk' nerves. In 32 patients with bilateral dissections, asymmetry of nerve was noted in 15%. Injury to nerve was not recorded in any of the patients. Average weight of glands was 69.59 g. Thyroidectomy was performed for benign disease in 28, malignancy in 4 and thyrotoxicosis in 14 patients. CONCLUSIONS: With technique of 'lateralization' and 'skeletonization and individual ligation of the superior vessels,' EBSLN identification increases and injury can be prevented. These results relate to the utilization of specific surgical technique and it is reasonable to expect that most surgeons, once familiar with the technique, should be able to achieve similar outcomes.