rare case of thiamine-responsive megaloblastic anaemia syndrome: a disorder of high-affinity thiamine transport

A three years old boy presented with sensory neural hearing loss since birth, Diabetes mellitus and anaemia. On investigation he was found to be suffering from Thiamine Responsive Megaloblastic Anaemia [TRMA] a very rare condition diagnosed in our settings

Free radial artery as an alternate conduit in CABG

This study was under taken to explore the potential of the Free Radial Graft as a safe efficient and suitable alternative conduit in coronary artery bypass grafting incase of in availability of the more established conduits like the IMA and Great Saphenous Vein graft especially in redo surgery. This prospective randomized single center trial was conducted on three groups of patients under going CABG. The study was conducted from 1st January 1999 to December 2002.The first group A [n=15 with mean age of 47.05'8.35years] Radial artery was used for grafting in Right and Left sided grafts except the LAD. In the second group B [n=15 with a mean age of 54.80'11.14 years] Great Saphenous Vein was used for grafting in Right and Left sided grafts except the LAD. In the third group C [n=20 with a mean age of 55.93' 11.14 years] IMA was only grafted to LAD. Proximal ends of both the GSV and the Radial Artery were anastomosed to the Aorta. All patients were male. Follow up was done in these patien ts both by non invasive and invasive methods such as ETT, Thallium scan, Angiography. Comparison was mainly done between the Radial artery and the Great Saphenous Vein taking as granted that the IMA g the best graft for the LAD in all cases. IMA was always applied to LAD in all patients in the three groups. In group [A] Radial Artery was grafted to RCA in 5 [33.3%] pts. Diagonal in 4 [26.7%]pts. Obtuse Marginal 12[80%] pts. And PDA 3 [20%] pts. In group [B] Great Saphenous Vein was grafted to RCA in 6[40%]pts. Circumflex 1[6.7%]pts. Diagonals 2 [13.3%] pts. Obtuse marginals 6 [40%] pts. And on PDA 4[20%] pts. All patients were regularly followed up for 18 months to 24 months. Post operative angina was reported in 2 [13.3%]pts. in group A and 5[33.3%] pts. In group B [p=0549]. ETT was done in all these pts. Was positive in 1[6.7%] in group A and 2 [13.3%] in group B [p=0.309]. Thallium scan was done in all the study population and was found positive in 4 [26.7%] in group A and 5 [33.3%] in group B Patients[p=0.265]. Coronary angiograms were done on 10 patients out of each group. In group A the grafts were patent in 9 patients [90%]. In the group B the grafts were found patent in 8 [86%] patients.[p=0.543]. Moderate Graft stenosis was found in 01 patient in group B and none in group A [p=0.35]. Totally blocked grafts were found in 01 patients in each group [p=1.00]. On the basis of this study early results suggest that Radial Artery graft is a suitable, safe, and potentially effective alternative in CABG patients. Early graft patency in patients receiving RADIAL ARTERY grafts is comparable to those receiving Saphenous Vein grafts, It may prove an excellent alternative for those who do not have the traditional conduits available due to any reason. However this short follow up period is not sufficient to come to a firmly conclusive result. A long term study with graft angiography is required to prove the efficacy of this conduit for future use