Mechanical complications following acute myocardial infarction

Objective: To outline the outcome and management of patients with acute myocardial infarction presenting with mechanical complications such as post-infarction ventricular septal defect, mitral regurgitation and left ventricular rupture.Methods: The retrospective study, conducted in September and October, 2010 at the Aga Khan University Hospital, Karachi, included cases from January 1990 to December 2009. Only 18 cases were found who had presented with such complications. They were assessed for demographics as well as pre-operative, per-operative and post-operative management patterns. Data was analysed using SPSS version 17.0.Results: Out of the 18 patients, 10 had post-infarction ventricular septal defect, while 8 had mitral regurgitation defects. The mean time from myocardial infarction to the diagnosis of mechanical complications was 5.28 +/- 4.07 days, and from diagnosis to repair was 2.00 +/- 1.49 days. Overall, there were 3 in-hospital mortalities.CONCLUSION: The optimal timing of surgical intervention has always remained debatable. A high-level of clinical suspicion and earlier intervention can reduce morbidities and mortalities

A modified fuzzy C means algorithm for shading correction in craniofacial CBCT images

CBCT images suffer from acute shading artifacts primarily due to scatter. Numerous image-domain correction algorithms have been proposed in the literature that use patient-specific planning CT images to estimate shading contributions in CBCT images. However, in the context of radiosurgery applications such as gamma knife, planning images are often acquired through MRI which impedes the use of polynomial fitting approaches for shading correction. We present a new shading correction approach that is independent of planning CT images. Our algorithm is based on the assumption that true CBCT images follow a uniform volumetric intensity distribution per material, and scatter perturbs this uniform texture by contributing cupping and shading artifacts in the image domain. The framework is a combination of fuzzy C-means coupled with a neighborhood regularization term and Otsu's method. Experimental results on artificially simulated craniofacial CBCT images are provided to demonstrate the effectiveness of our algorithm. Spatial non-uniformity is reduced from 16% to 7% in soft tissue and from 44% to 8% in bone regions. With shading-correction, thresholding based segmentation accuracy for bone pixels is improved from 85% to 91% when compared to thresholding without shading-correction. The proposed algorithm is thus practical and qualifies as a plug and play extension into any CBCT reconstruction software for shading correction.Comment: 15 pages, published in CMBEBIH 201

Giant pulmonary bulla with mediastinal shift in a 12 1/2 year old girl

Pulmonary bulla in children represent interesting entities. Mostly congenital bronchopulmonary foregut malformations and acquired cysts like pneumatocoeles have also been described. We present a case of a 12 1/2 years old girl with acute onset respiratory distress symptoms harbouring a huge pulmonary cyst exhibiting mass effects, resulting in mediastinal deviation. Following initial workup, cyst excision was carried out which revealed presence of fungal hyphae that was susceptible to Fluconazole therapy post operatively. The case points out how a pulmonary cyst can present in older children with symptoms of respiratory distress and mass effects

Ganglioneuroblastoma of the posterior mediastinum: a case report.

Introduction:Ganglioneuroblastoma is a rare peripheral neuroblastic tumor that is derived from developing neuronal cells of the sympathetic nervous system, and is found mostly, but not exclusively, in babies and young children. Case Presentation: To the best of our knowledge, there have been no previously reported cases of ganglioneuroblastoma of the mediastinum from Pakistan. We present a case of ganglioneuroblastoma in an eight-year-old Pakistani Sindhi boy incidentally found to have a large posterior mediastinal mass that on biopsy initially looked like ganglioneuroma. He underwent successful excision of the mediastinal mass and remained stable post-operatively. Final pathology findings showed a ganglioneuroblastoma. He has remained free of symptoms on long-term follow-up. Conclusions: The rarity of this tumor along with its almost exclusive occurrence in the pediatric population necessitates a thorough investigation of Patients presenting with a symptomatic mass

Aortic dissection or myocardial infarction

Aortic dissection is a rare and a life threatening event. Classically, aortic dissection presents as sudden, severe chest, back or abdominal pain that is characterized as ripping or tearing in nature. However, a timely diagnosis can be elusive in the event of an atypical presentation. So, a high index of clinical suspicion is mandatory for the accurate and rapid diagnosis of aortic dissection. We report a case of a 56 years old male who presented with signs and symptoms of myocardial infarction and was later found to have aortic dissection. This patient was successfully managed with surgery

Is early correction of congenital ventricular septal defect a better option in a developing country

OBJECTIVE: To assess and evaluate the effectiveness of early ventricular septal defect (VSD) repair in a developing country by comparing the outcomes in two age groups. METHODS: A total of 39 patients underwent VSD repair at a tertiary care hospital in Karachi over a period of 2.5 years. Patients were divided into Group 1 (years) and Group 2 (2-18 yrs). Perioperative and postoperative variables were reviewed retrospectively for each patient and compared with the development of complications and the effect on postoperative recovery times. The data was analyzed using Mann Whitney test for continuous variables and Fischer\u27s exact test for categorical variables. RESULTS: Mean age at surgery was 10.1 +/- 7.0 months and 108.5 +/- 54.0 months for both groups, respectively. Two patients died. Procedure time was not affected by decreasing age (p = 0.622) but Cardio pulmonary Bypass duration (p = 0.040) and Aortic Cross Clamp time (p = 0.063) were significantly affected. No associated significance was obtained when hospital stay (p = 0.085) was observed. Increased duration of ventilation (p = 0.000) and length of ICU stay (p = 0.003) were highly significant for the younger age group. Presence of residual VSD (p = 0.025) was also significantly affected by lower age. There was no significant difference in the number of patients with complications (p = 1.000) among the 2 groups. CONCLUSION: Age does not increase morbidity rates after VSD repair although postoperative recovery times are increased with decreasing age. Hence, there is no justification in delaying VSD repair

Incidental finding of a giant aortic root aneurysm and its repair

The prevalence of aortic aneurysms is 3-4% in individuals more than 65 years. Age and haemodynamic factors play an important role in the development of aortic aneurysms. Most patients with aortic aneurysms are asymptomatic at the time of discovery. Thoracic aneurysms are usually found incidentally after chest radiographs or other imaging studies. The most common complications of thoracic aortic aneurysms are acute rupture or dissection. Some patients present with tender or painful nonruptured aneurysms. Patients are thought to be at increased risk for rupture and should undergo surgical repair on an emergent basis We document a case of a 66-year-old man who presented with shortness of breath. On evaluation, he was found to have severe aortic regurgitation and large aortic root aneurysm. Patient underwent successful open heart surgery. Aortic root and aortic valve were replaced with valve conduit and coronary arteries were re-implanted. Patient had an uneventful recovery

Earlier surgical intervention in congenital heart disease results in better outcome and resource utilization

Background:Congenital heart disease (CHD) accounts for a major proportion of disease in the pediatric age group. The objective of the study was to estimate the cost of illness associated with CHD pre, intra and postoperatively, among Patients referred to a tertiary care hospital in Karachi, Pakistan. This is the first study conducted to estimate the cost of managing CHD in Pakistan. Methods: A prevalence based cost of illness Study Design was used to estimate the cost of cardiac surgery (corrective & palliative) for congenital heart defects in children Results:The mean age at the time of surgery in group A (1-12 mo age) was 6.08 +/- 2.80 months and in group B (1-5 yrs) was 37.10 +/- 19.94 months. The cost of surgical admission was found to be significantly higher in the older group, p = 0.001. The total number and cost of post-operative outPatient visits was also higher in group B, p = 0.003. Pre and post operative hospital admissions were not found to be significantly different among the two groups, p = 0.166 and 0.627, respectively. The number of complications were found to be different between the two groups (p = 0.019). Majority of these were contributed by hemorrhage and post-operative seizures. Conclusion: This study concluded that significant expenditure is incurred by people with CHD, with the implication that resources could be saved by earlier detection and awareness campaigns

Acute Appendicitis: Relationship of Total Leucocyte Count with Per-Operative Stage

Objective: To correlate total leucocyte count(TLC) with per-operative stage of acute appendicitis. Patients and Methods: This cross sectional study was conducted in department of surgery, Pakistan Institute of Medical Sciences (PIMS) from June 2016 to June 2017. A total 77 patients were included through consecutive sampling technique. Statistical Package for Social Sciences (SPSS) version 20 was used to analyze data. Results: A total of 77 patients were included in the study, among them 47 (61%) were males, and 30(39%) were females. Mean age was 22.25 ± 5.19 years. Mean TLC was 12,900 ± 4087 cells/µL Patients having acute appendicitis were labeled as, acute appendicitis stage I which included 59 (76.6%) patients, Gangrenous appendicitis was named as stage II which included 11 (14.3%) patients. Perforated appendicitis was labeled as Stage III in which 7 (9.1%) patients were inducted. In stage I, mean age was 21.89 ± 5.50 years and mean TLC was 12,344 ± 4162 cells/µl. In stage II, mean age was 22.36 ± 3.90 years and mean of total leukocyte count was 15,072 ± 3497 cells/µl. In stage III, mean age was 25.57 ± 3.50 years and mean leukocyte count was 14,214 ± 4141cells/µl (p-value >0.05). Conclusion: Significant statistical association was not found in patients in different stages of appendicitis with respect to TLC (p value >0.05), although patients in all stages had raised mean TLC with mean TLC highest in patients having stage II (Gangrenous appendicitis)