Ruptured aneurysm of extracranial carotid artery.

Aneurysm of extracranial carotid artery is an uncommon clinical disease and that presenting as a ruptured aneurysm is extremely rare. This entity represents a challenge to treatment strategy. A 54 year old hypertensive male presented with painful, pulsatile mass in left neck. Duplex scan revealed the ruptured left carotid artery at its bifurcation. Angiogram depicted clear picture of ruptured carotid artery aneurysm. Resection of aneurysm was performed with placement of external carotid shunt. Continuity was maintained with interposition of Dacron graft.

Prevalence of rheumatic fever and rheumatic heart disease in school children in a rural community of the hill region of Nepal.

A survey of school children aged 5 to 16 years living in a rural community of the hill region of Nepal, situated about 15-22 km outside Kathmandu city, was conducted to determine the prevalence of rheumatic fever (RF) and rheumatic heart disease (RHD). Of the 4,816 eligible children enrolled in the selected schools, 4,452 (92.4%) were examined. WHO expert committee criteria (1966) was used for the diagnosis and classification of rheumatic fever. Chest x-ray, electro-cardiography, echocardiography and Doppler study were done in all suspected cases of rheumatic heart disease. Six cases of RHD (1 pure mitral stenosis, 3 mitral regurgitation and 2 combined mitral stenosis and regurgitation) were identified giving overall prevalence rate of 1.35 per thousand. No case with active rheumatic fever could be identified. This is the first study on prevalence of RF/RHD in Nepal. The prevalence rate is lower than that reported from neighbouring countries.