Correction of post-palatoplasty velopharyngeal insufficiency by two different techniques

Evaluation the success of 2 different techniques in treating post-palatoplasty residual velopharyngeal insufficiency [VPI]. Prospective study on 48 cases of post-palatopl asty hypernasality. The cases classified into 3 groups according to the type of velopharyngeal closure. Group A had coronal closure pattern and treated by sphincter pharyngoplasty, group B had sagittal closure pattern and treated by pharyngeal flap and group C had circular closure pattern and treated by sphincter pharyngoplasty. Postoperative follow-up by flexible nasopharyngoscopy, auditory perceptual assessment and parent's questionnaire. The incidence of residual VPI after sphincter pharyngoplasty was 11.5% while it was 9% after pharyngeal flap [p value=0.784]. The satisfactory speech improvement was 88.5% for cases underwent sphincter pharyngoplasty and 91% for cases underwent pharyngeal flap [p value=0.784]. The incidence of snoring was 3.8% for cases underwent sphincter pharyngoplasty and 27% for cases underwent pharyngeal flap [p value=0.038]. No cases developed sleep apnea after pharyngoplasty while it was developed in 13.5% after pharyngeal flap [p value=0.089]. No statistically significant difference in outcomes between the 2 procedures for speech assessment score [p value=0.540]. Mobility was detected in the flaps of sphincter pharyngoplasty while the posterior pharyngeal flaps were static. Sphincter pharyngoplasty and pharyngeal flap are good operations for correction of post-palatoplasty hypernasality. But in cases with circular closure pattern, sphincter pharyngoplasty is the operation of choice as it carries low risk of obstructive complications and it is dynamic

arterial access complications of cardiac catheterization

Ninety seven patients were evaluated for the development of access site complications following cardiac catheterization. Cardiac catheterization was done for diagnostic purpose in 66 patients, percutaneous transluminal coronary angioplasty in 15 [PTCA] and PTCA with stenting in 16 patients. The patients were randomly selected for pre-catheter clinical and laboratory evaluation, procedural step recording, post catheterization clinical evaluation and one week post-catheterization follow up. The relative distribution of each complication among the possible risk factor was determined in order to correlate the incidence of complications in relation to the patients related risk factors [age, sex, obesity, diabetes, hypertension and peripheral vascular disease], or the procedural related risk factors [type of procedure; diagnostic or therapeutic, arterial access site, sheath size, duration of procedure and compression time after sheath removal]. The overall incidence of complication was 23. 7%, distributed as follows: 18 hematoma, 2 arterial thrombosis, one pseudoaneurysm and one combined pseudo aneurysm and arterio-venous fistula. There was a significant positive correlation between arterial access site complication and the following patient variables: patient age more than 50 years, the presence of peripheral vascular disease, while signifcant procedural variables included: therapeutic catheterization, sheath size> 8F, diagnostic procedure time> 20 minutes or therapeutic procedure time >60 minutes, ACT>200 seconds, PTT>40 seconds and post procedural compression time less than 12 minutes