Management of Oral Sub Mucous Fibrosis Using Three Different Flaps: Superficial Temporal, Nasolabial Flap, Buccal Fat Pad Flap Along with Active Physiotherapy- A Comparative Study.

To assess the efficacy of different flaps along with active physiotherapy for comprehensive management of OSMF. A total of 33 patients of oral submucous fibrosis were admitted and surgically treated. All patients were diagnosed with bilateral oral submucous fibrosis of buccal mucosa. All the patients had advanced oral sub mucous fibrosis with interincisal distance less than 20 mm. Eleven patients were treated with buccal pad of fat, eleven with nasolabial flap and eleven patients were treated with temporo-parietal fascia flap. Physiotherapy was started from the 5th postoperative day and the patients were followed regularly for one year to measure maximum interincisal distance. There was a significant corelation between post-operative mouth opening and regular physiotherapy, exercise and quitting of the habit irrespective of type of reconstruction flap used. On the basis of the result obtained from this study, significant improvement in mouth opening was seen in patients who performed aggressive physiotherapy irrespective of the flap used. Thus we conclude along with the surgical treatment, post-operative physiotherapy and cessation of habit are of equal importance for good prognosis in OSMF patients.

Tissue removal by ultrasound evaluation (the TRUE study): the Jetstream G2 system post-market peripheral vascular IVUS study.

BACKGROUND: Balloon angioplasty and stenting of infra-inguinal lesions is limited by poor long-term patency rates. Atherectomy decreases plaque burden and provides an alternative means of revascularizing patients with peripheral arterial disease. The Jetstream G2™ (Pathway Medical Technologies, Inc., Kirkland, Washington) is a newer rotational aspiration atherectomy device, uniquely combining rotablation with aspiration capability. We evaluated the debulking properties of this device by analyzing changes in the plaque volume and composition and vessel size using intravascular ultrasound (IVUS) and virtual histology (VH). Freedom from target lesion revascularization (TLR) at 6 and 12 months was also evaluated. METHODS AND RESULTS: Eighteen patients with peripheral arterial disease requiring intervention (severe claudication despite optimal medical treatment or critical limb ischemia) were treated with rotational atherectomy. The mean age was 69.6 ± 11 years, 66.7% were male, and 44.4% had diabetes. The mean total plaque volume decreased by 56.6 mm³ (479.8 ± 172.5 mm³ to 423.2 ± 156.6 mm³; p < 0.0001), which resulted in a mean luminal volume increase of 64.3 mm³ (148.4 ± 84.1 mm³ to 212.7 ± 72.1 mm³; p < 0.0001). This was achieved without significant Dotter effect with either technique, as evidenced by the virtually unchanged vessel volume before and after treatment (628.3 ± 158.5 mm³ and 635.9 ± 169.0 mm³, respectively; p = 0.22). There was a significant reduction in fibrotic and fibro-fatty plaque volume, with no appreciable effect on necrotic core and dense calcium. There were no reported procedure-related complications and the 6- and 12-month TLR rate was 11% (2/18). CONCLUSION: Atherectomy with the Jetstream G2 system results in substantial plaque volume reduction by removing fibrotic and fibro-fatty plaque. This resulted in substantial luminal volume expansion without concomitant vessel expansion. There were no major procedure-related complications, along with a relatively low 6- and 12-month rate of TLR. Future studies involving a larger number of patients are warranted to examine the potential clinical benefits of this promising technology.

Fulminant giant cell myocarditis and cardiogenic shock: an unusual presentation of malignant thymoma.

Malignant thymoma is rarely associated with giant cell myocarditis. We present a case study that illustrates this association and cardiogenic shock with underlying tamponade. The dramatic presentation of this scenario has not been previously described.

Acute left ventricular remodeling after myocardial infarction on transthoracic echocardiography: a case series.

The authors describe left ventricular myocardial changes on transthoracic echocardiography in patients imaged within 72 hours of acute infarction. Endocardial separation from the mid myocardium, echocardiographic contrast penetration into the myocardium, and regional contrast swirling were observed. This case series also illustrates how contrast imaging may enhance recognition of early postinfarction remodeling.

Current concepts and management strategies in atrial flutter.

After atrial fibrillation, atrial flutter (AFL) is the most important and most common atrial tachyarrhythmia. Atrial flutter describes an electrocardiographic model of atrial tachycardia >or=240/min, with a uniform and regular continuous wave-form. There is classically a 2:1 conduction across the atrioventricular (AV) node; as a result, the ventricular rate is usually one-half the flutter rate in the absence of AV node dysfunction. AFL can be harmful by impairing the cardiac output and by encouraging atrial thrombus formation that can lead to systemic embolization. There are four major concerns that must be addressed in the treatment of AFL: reversion to normal sinus rhythm (NSR); maintenance of NSR; control of the ventricular rate; and prevention of systemic embolization. Our review will highlight strategies for reverting patients back to NSR and then maintaining them in NSR, with emphasis on the recent updates, including the role of ablation in the management of atrial flutter.

Current concepts in diastolic heart failure.

Heart failure is a highly prevalent condition, particularly among elderly adults and women. In diastolic heart failure-or heart failure with normal ejection fraction-left ventricular systolic function is preserved. Although diastolic heart failure is clinically and radiographically indistinguishable from systolic heart failure, echocardiography can reveal a preserved ejection fraction with abnormal diastolic function. The present article reviews current medical concepts related to diastolic heart failure for medical practitioners, particularly primary care physicians, who play a vital role in the care of patients with heart failure. Treatment options, focusing on calcium channel blockers and angiotensin receptor blockers, are discussed. With early diagnosis and proper management, the prognosis of diastolic heart failure can be more favorable than that of systolic heart failure.

Transient left ventricular apical ballooning syndrome caused by abrupt metoprolol withdrawal.

Transient Left Ventricular Apical Ballooning Syndrome (TLVABS) has been described to occur in response to number of stressful events, drug effects or drug withdrawal. Withdrawal of beta blockade has not been described to precipitate TLVABS. We are describing a case of TLVABS developing after abrupt withdrawal of metoprolol.

Transient apical ballooning: sheep in wolves' garb.

Takotsubo cardiomyopathy is a unique acute cardiac syndrome characterized by typical ischemic chest symptoms, an elevated ST segment on the electrocardiogram, and elevated cardiac disease markers. It is often misdiagnosed as acute myocardial infarction. Coronary angiography usually shows no evidence of obstructive atherosclerotic coronary artery disease. Left ventriculography and echocardiography reveal a peculiar regional systolic dysfunction with akinesis of the midventricle and apex and compensatory hyperkinesis of the basal ventricular segments. This syndrome has been shown to have a distinct temporal relationship with intense emotional stressors, and is characterized by an excellent clinical recovery when appropriate conservative measures are taken during the acute phase of the illness. In this review, we highlight the proposed pathophysiology and clinical manifestations of this recognized reversible form of myocardial failure.

Erythropoietin: new horizon in cardiovascular medicine.

Erythropoietin (EPO), a renal cytokine, regulates proliferation, differentiation and maturation of erythroid cells. Recombinant human erythropoietin (rH-EPO) is well known to correct anemia in patients with chronic renal failure undergoing dialysis. Recent studies have reported several non-hematopoietical effects of EPO. Erythropoietin receptors have been discovered in a variety of tissues, including the cardiovascular system. Recently published data including recent patent documented an enhancement of cardiac function in patients with heart failure receiving EPO treatment. Furthermore, experiments carried out in animal models of ischemia/reperfusion (IR) injury have shown a significant reduction in infarct size following EPO treatment. Other beneficial effects of EPO are related to its pro-angiogenic action on endothelial cells, which might be of potential value in patients with ischemic heart disease. Taken together, these findings suggest that EPO may be clinically useful as an adjunct in the treatment of different cardiovascular conditions, besides the simple correction of anemia. This review will focus on the pleiotropic effects of EPO in the cardiovascular system and its promising novel applications.

Cardiovascular effects of erythropoietin: anemia and beyond.

We did a PubMed and Cochrane Database System review of different studies on the diverse effects of erythropoietin (EPO), focusing mainly on the cardiovascular system. The direct erythropoietic action of EPO is well studied and widely used. Published studies report dramatic improvement in the course of heart failure with EPO treatment. New controlled clinical trials on large and diverse groups of patients are warranted. Antiapoptotic effects of EPO are newly discovered, opening new horizons in both clinical investigation and therapy. The salvage of cardiomyocytes in acute coronary syndromes, limiting the size of myocardial infarction and improving functional recovery, is only one of multiple potential applications of this effect. Derivatives of EPO with selective antiapoptotic properties seem to hold the best prospects for future studies. Heart failure and ischemic heart disease are potential areas where adding EPO to the conventional treatment may be beneficial.

Unusual pulmonary venous flow profile in a patient with mitral valve perforation secondary to bacterial endocarditis.

Pulmonary venous flow patterns have been well described in the literature to assess severity of mitral regurgitation (MR) and the degree of diastolic dysfunction. We report a case of posterior mitral leaflet perforation due to bacterial endocarditis causing an alteration of pulmonary venous flow, not previously described in the literature. This pulmonary venous flow pattern is unique in that it reflects dynamic changes in left atrial pressure in the background of severe MR.