Heart Failure in Children.

Heart failure (HF) in children differs from that in adults in many respects. The causes and clinical presentations may differ considerably among children of different age groups and between children and adults. The time of onset of HF holds the key to the etiological diagnosis. Clinical presentation of HF in younger children can be nonspecific requiring heightened degree of suspicion. The overall outcome with HF is better in children than in adults as HF in children is commonly due to structural heart disease and reversible conditions which are amenable to therapy. The principles of management include treatment of the cause, correction of any precipitating event, and treatment of systemic or pulmonary congestion. Though HF in adults has been the subject of extensive research and generation of evidence-based guidelines, there is a scarcity of evidence base in pediatric HF.

LEOPARD Syndrome with Patent Ductus Arteriosus and Hypertrophic Cardiomyopathy.

A sixteen year old girl presented with history of hemoptysis of one week duration. She had history of dyspnea on exertion and frequent respiratory infections in childhood. She had short stature, hypertelorism, neurofibroma, café au lait spots and multiple lentigines. She had features of severe pulmonary hypertension and differential clubbing and cyanosis. A final diagnosis of LEOPARD syndrome with hypertrophic cardiomyopathy and patent ductus arteriosus (PDA) Eisenmenger syndrome was made.

Blood cyst of the anterior mitral leaflet causing severe mitral regurgitation.

We report a case of blood cyst of the anterior mitral leaflet leading to severe mitral regurgitation and heart failure in a 70-year-old woman with no other factors that could explain the severe mitral regurgitation.

The Local Effect of Alendronate with Intra-alveolar Collagen Sponges on Post Extraction Alveolar ridge Resorption: A Clinical Trial.

INTRODUCTION: Extraction of teeth is followed by resorption of the residual alveolar ridge that continues throughout life resulting in loss of alveolar height and width. Of the numerous techniques that have been used to arrest post extraction alveoloar ridge resorption, the placement of a graft material inside the socket immediately after extraction has been mostly followed. Type 1 collagen is one of the commonly used graft material that prevent resorption by providing dimensional stability to the socket. Bisphosphonates are an anti-osteoclastic drug that prevent resorption by disrupting the membrane ruffling of the osteoclasts. Alendronate a bisphosphonate, is primarily used in diseases with bone loss. It has been used to reduce active bone resorption significantly without interfering with bone mineralization and quality. The need for the study is to examine the inhibitory effect of alendronate on residual ridge resorption when applied locally in combination with type I collagen on alveolar bone immediately following tooth extraction. MATERIALS AND METHODS: Twenty patients with age between 30 and 65 years were selected from the out patient department of The Oxford Dental College and Hospital. The patients were divided into two groups. In the first group after extraction of teeth from premolar to midline the sockets were irrigated with saline and sutured. On the left side type I collagen sponge was placed and sutured. In the other group the right side was treated the same way after extraction as in first group where as in the left side sockets type I collagen soaked in 20 mg/ml of alendronate was placed and sutured. Patients were evaluated clinically for any local irritation as well as radiologically with orthopantomograph X-rays were taken immediately after the extraction, 1 month after extraction and 4 months after extraction to determine the amount of bone loss prevented. RESULTS: The statistically significant bone loss prevented by the collagen alone was 22.8 % and in collagen with alendronate group was 44.38 % at the end of 4 months. CONCLUSION: Type I collagen soaked with alendronate when placed in the socket immediately after extraction of teeth prevents post-extraction alveolar ridge resorption.

Evaluation of mechanical resistance after fixation of mandibular condylar fracture with single and double miniplates: a comparative in vitro study.

OBJECTIVES: To evaluate the efficacy of two plating system in comparison with single plating systemTo study the biomechanical behaviour of single and two plating system when compression load is applied. MATERIALS AND METHODS: Twenty hemimandibles were divided into two groups A and B of ten each. A subcondylar fracture was created. Group A was stabilized by single adaptation plating technique and group B by double adaptation plating technique and both the groups were tested for stability by using universal testing machine. RESULTS: Higher mean displacement was observed in Group A compared to Group B, but the difference in mean displacement between the two groups was not statistically significant (p > 0.05). Higher mean load was recorded in group B compared to group A and the difference in mean load between them was found to be statistically significant (p < 0.001). CONCLUSION: The present study demonstrated that double adaptation plating technique had greater resistance to compression load than single adaptation plating technique and it shows more favorable biomechanical behavior.

An assessment of etiological spectrum and injury characteristics among maxillofacial trauma patients of Government dental college and Research Institute, Bangalore.

BACKGROUND: Maxillofacial injuries pose a therapeutic challenge to trauma, maxillofacial and plastic surgeons practicing in developing countries. This was a retrospective study carried out to determine the incidence, etiology, injury characteristics of maxillofacial injuries reported at our centre. PATIENTS AND METHODS: The data for this study were obtained from the medical records of 689 cases reported to our centre during the period from 2006-2009. Records of patients who were either treated in the emergency room as outpatients or the Department of Oral and Maxillofacial Surgery as inpatients were analyzed and were subjected to statistical analysis using statistical package for social sciences (SPSS) for Windows version 17.0. Data was summarized in form of proportions and frequency tables for categorical variables and was subjected to Chi-Square test. RESULTS: Out of 689 patients, 75.9% were male and 24.1% were female. 42.5% of the patients were in the age group of 21 to 30 years. Road traffic accidents accounted for the majority (74.3%) of cases of maxillofacial trauma. Mandible was seen as the most commonly fractured bone (50.3%) and 53.8% head and neck injuries were most common among the associated injuries. CONCLUSION: Road traffic accidents were clearly the most prevalent etiological factor for maxillofacial trauma. Measures on prevention of road traffic crashes should be strongly emphasized in order to reduce the occurrence of these injuries.

Efficacy of 2-mm locking miniplates in the management of mandibular fractures without maxillomandibular fixation.

BACKGROUND: The management of trauma has evolved greatly over the past many years. Various bone plating systems have been developed to provide stable fixation of mandibular fractures. The introduction of the locking plate/screw system has offered certain advantages over the conventional plating systems. This system does not require intimate adaptation of the miniplates to the underlying bone and has greater stability. This study evaluates the efficacy of locking miniplate/screw system in the treatment of mandibular fractures without maxillomandibular fixation. MATERIALS AND METHODS: This was a prospective study analyzing 20 patients with undisplaced or minimally displaced mandibular fractures, who reported to Department of Oral and Maxillofacial Surgery, Government Dental College and Research Institute, Bangalore. The selected cases were treated by open reduction and internal fixation using the 2.0 mm locking plate/screw system. RESULTS: Open reduction and internal fixation with the 2.0 mm locking plate/screw system were achieved in all the 20 cases with satisfactory stability of the fracture fragments. The system was found to be reliable and effective intraoperatively. Only two complications were noted in the study. CONCLUSION: The locking miniplate system was found to be reliable and effective in management of mandibular fractures without postoperative intermaxillary fixation, however further studies with more sample size is required.

A rare association of Ebstein's anomaly of tricuspid valve with rheumatic mitral stenosis.

Mitral valve abnormalities have been described in Ebstein's anomaly, but acquired rheumatic mitral valve disease is an extremely rare association. We describe a classical case of Ebstein's anomaly of tricuspid valve with severe rheumatic mitral stenosis. This patient had mild mitral regurgitation, pulmonary hypertension and atrial fibrillation.

Severe hypoglycemia due to poorly differentiated hepatocellular carcinoma.

Hypoglycemia is a well documented paraneoplastic syndrome of hepatoma. Hypoglycemia as sole presentation is very rare. We report a case of poorly differentiated hepatoma with multiple lung metastases presenting with recurrent hypoglycemic seizures as the only manifestation four months before the diagnosis of the tumour.

Congenital complete heart block and maternal connective tissue disease.

Congenital complete heart block can be isolated or can occur in association with other structural heart diseases. Isolated congenital complete heart block (CCHB) is due to transplacental transfer of autoantibodies from mothers with connective tissue disease. Congenital heart block is usually complete, but incomplete blocks, sinus bradycardia and QTc prolongation are also reported. Anti SS A and Anti SS B antibodies transferred from mothers have inflammatory and arrhythmogenic effects in the fetal conduction system. Cardiac manifestations reported include dilated cardiomyopathy, endocardial fibroelastosis and mitral insufficiency. Low ventricular rate, QT prolongation and arrhythmias on monitoring are high risk features. CCHB has a mortality of 30%, and 60% of infants require pacemaker therapy. Fetal echocardiography is useful in early diagnosis. Prophylactic steroid therapy is controversial. Beta adrenergic agonists were tried in mothers with fetuses having congenital heart block to increase fetal heart rate. Early pacemaker therapy is indicated in patients with symptomatic bradycardia and ventricular dysfunction. The indications for pacing in congenital heart block continue to evolve with advances in techniques and most of these children will ultimately require permanent pacemakers by adulthood.