Pantalar arthrodesis in a case of chronic subluxated tibiotalar and subtalar joint with secondary arthritis: a case report

Post-traumatic arthritis is the most common cause of ankle arthritis. Pantalar arthrodesis (PA) is a salvage operation that can be used to create a stable and functional plantigrade foot for those who have a painful ankle joint with significant bony destruction and/or malalignment of ankle and hindfoot producing deformities and instabilities not amenable to bracing, orthotic devices or shoes. It is commonly performed as a double staged procedure. We present a case of 50 years old male with chronic subluxated tibiotalar and subtalar joint with secondary arthritis who was operated with a single staged pantalar arthrodesis with a follow up of 6 months. A single staged Pantalar arthrodesis combining both transfibular approach for ankle and olliers approach for triple arthrodesis is an effective surgical treatment option in a case of chronic subluxated tibiotalar and subtalar joint with secondary arthritis

A Pilot Study Evaluating the Role of Ivabradine for Rate Control in Patients With Rheumatic Atrial Fibrillation

OBJECTIVES: Ivabradine may have a role in rate control of atrial fibrillation (AF) due to effects on HCN channels in AV node. We studied role of Ivabradine in rate control of rheumatic AF. METHODS: 80 patients, rheumatic AF, HR \u3e 100 bpm (age 47 ± 11 yrs, AF duration 6.8 ± 2.9 years, rate 131 ± 16 bpm) on maximally tolerated ββ or CCB\u27s, randomized to Ivabradine or escalated ββ/CCB. Ivabradine started @ 2.5 mg BD; increased to 5 mg BD if inadequate response at 1 week (failure to decrease HR \u3c 10% vs baseline). After Holter at 1 month, dose escalated to 7.5 mg BD if needed. RESULTS: Ivabradine resulted in significantly lower HR (81 ± 10 vs 99 ± 9) at 3 months and 6 months (79 ± 8 vs 94 ± 8, p \u3c 0.001). Absolute reduction in HR: 56 ± 15 vs 31 ± 14 bpm and % change in HR: 41 ± 7 vs 24 ± 9%, both p \u3c 0.00001). At 6 months, Ivabradine group had. 1Significantly lower NT Pro BNP (1168 vs 1314 pg/ml), higher 6 min walk distance (410 ± 47 vs 349 ± 54 m, all p \u3c 0.001) 2Better symptom class (EHRA score 1: asymptomatic 84% vs 40%), improvement \u3e1 EHRA class; baseline 60% vs 17% 3Better LA Strain (22.8 ± 2.8% vs 20.6 ± 2.5%) Ivabradine was well tolerated and there was no drug withdrawal. CONCLUSION: Our data suggest that Ivabradine can be an option for rate control in rheumatic AF

RAdiation Dose Attenuation Using RADPAD in CATH Lab for Primary and Secondary Operators – RADAR-CATH STUDY

BACKGROUND: Radiation injury is an important concern for interventional cardiologists and needs to be addressed. RADPAD is a radiation protection drape that has been shown to reduce the radiation exposure of the primary operator (PO). While Indian data on radiation exposure of the PO in the cath lab are scarce, the exposure of the secondary operator (SO) is even less well studied. AIMS: The aim of this study was to evaluate the efficacy of RADPAD drapes in reducing radiation doses in the cath lab for the primary as well as the secondary operator. METHODS: A total of 160 patients (40 patients each with single vessel disease [SVD], double vessel disease [DVD] and triple vessel disease [TVD] undergoing coronary angioplasty, and 40 patients undergoing balloon mitral valvuloplasty [BMV]) were randomised in a 1:1 pattern to undergo a procedure with or without the use of RADPAD. RESULTS: For patients with SVD, DVD and TVD undergoing percutaneous coronary intervention (PCI) and those undergoing BMV, the % reduction with the use of RADPAD reduced the PO\u27s received dose (in mrem) by 65%, 54%, 28% and 67%, respectively, as compared to without RADPAD. The % reduction in relative operator exposure for the PO for the 4 groups was 55%, 34%, 18% and 75%, respectively, with the use of RADPAD. The corresponding % reduction for the SO\u27s received dose (in mrem) was 80%, 63%, 33% and 69% and for relative operator exposure was 74%, 46%, 23% and 76% in the 4 groups, respectively. CONCLUSIONS: RADPAD significantly reduces the radiation exposure of the primary and secondary operator during prolonged complex PCI and BMV procedures

Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis

Objective: Liver biopsy is still needed for fibrosis staging in many patients with non-alcoholic fatty liver disease. The aims of this study were to evaluate the individual diagnostic performance of liver stiffness measurement by vibration controlled transient elastography (LSM- VCTE), Fibrosis-4 index (FIB-4) and NAFLD Fibrosis Score (NFS) and to derive diagnostic strategies that could reduce the need for liver biopsies.Design: Individual patient data meta-analysis of studies evaluating LSM-VCTE against liver histology was conducted. FIB-4 and NFS were computed where possible. Sensitivity, specificity and area under the receiver operating curve (AUROC) were calculated. Biomarkers were assessed individu-ally and in sequential combinations.Results: Data were included from 37 primary studies (n=5735; 45% female; median age: 54 years; median BMI: 30 kg/m2; 33% had type 2 diabetes; 30% had advanced fibrosis). AUROCs of individual LSM-VCTE, FIB-4 and NFS for advanced fibrosis were 0.85, 0.76 and 0.73. Sequential combination of FIB-4 cut-offs

Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients

Background: The aim of this study was to analyse the impact of hiatal hernia repair (HHR) on gastro-oesophageal reflux disease (GERD) in morbidly obese patients with hiatus hernia undergoing laparoscopic sleeve gastrectomy (LSG). Materials and Methods: It is a retrospective study involving ten morbidly obese patients with large hiatus hernia diagnosed on pre-operative endoscopy who underwent LSG and simultaneous HHR. The patients were assessed for symptoms of GERD using a Severity symptom score (SS) questionnaire and anti-reflux medications. Results: Of the ten patients, five patients had GERD preoperatively. At the mean follow-up of 11.70 ± 6.07 months after surgery, four patients (80%) showed complete resolution while one patient complained of persistence of symptoms. Endoscopy in this patient revealed resolution of esophagitis indicating that the persistent symptoms were not attributable to reflux. The other five patients without GERD remained free of any symptom attributable to GERD. Thus, in all ten patients, repair of hiatal hernia (HH) during LSG led to either resolution of GERD or prevented any new onset symptom related to GER. Conclusion: In morbidly obese patients with HH with or without GERD undergoing LSG, repair of the hiatus hernia helps in amelioration of GERD and prevents any new onset GER. Thus, the presence of HH should not be considered as a contraindication for LSG

Dumbbell Shaped Microstrip Broadband Antenna

Abstract In this article, a dumbbell shaped microstrip broadband microstrip antenna with partial ground plane is presented, The overall dimension of the proposed antenna is 20 × 15 × 1.5 mm3 and is fabricated on FR4 substrate which has electrical permittivity of 4.3 and loss tangent of 0.025. FR4 is a low cost and easily available. The thickness of the substrate is 1.5 mm. The impedance bandwidth of the proposed antenna is 151.11 % (3.48 GHz to 25 GHz). The peak gain and radiation efficiency of the proposed antenna are 4.5 dB and 68 % respectively in the operating frequency band. Due to introduction of rings on the edges of the octagon and cutting of circular slots with the rectangular slits in the ground plane the antenna starts resonating from 3.48 GHz to 25 GHz. Simulated results are in good agreement with the measured results. The proposed antenna covers partial frequency range for ultra-wide band applications, 3.5/5.5 GHz WiMAX band, 5.2/5.8 GHz WLAN band, 8/12 GHz X-band, 12/18 GHz Ku -band. It can be used in space and satellite communications etc. Curves of radiation pattern and S-parameter of both simulated and measured results are shown. The impedance curves, surface current, radiation efficiency, simulated return losses, gain, and radiation patterns of the proposed antenna are described in the paper

Laparoscopic management of recurrent pheochromocytoma: A case report

Recurrence of pheochromocytoma after a total adrenalectomy is uncommon. Such recurrent tumours are mostly managed by the open technique, with very few studies reporting laparoscopic management. We hereby report a case of successful laparoscopic management of a recurrent pheochromocytoma after total adrenalectomy for left adrenal pheochromocytoma

Penetrating neck injury: Collaterals for another life after ligation of common carotid artery and subclavian artery

Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially life-threatening hemorrhage but also need profound surgical expertise in management. Development of collateral circulation in neck is well known; however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of penetrating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient presented with no neurological or motor deficits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery

Outcomes in morbidly obese adolescent patients undergoing laparoscopic sleeve gastrectomy in the Indian subcontinent: A retrospective review

Introduction: There is a worldwide increase in the prevalence of obesity among the adolescent population in India from 16.3% in 2001 to 19.3% in 2010. Recent evidence suggests that bariatric surgery leads to resolution of comorbidities and associated long-term complications in adolescent patients with morbid obesity. Aim: The aim of this study is to determine the impact of bariatric surgery on the weight loss and comorbidities of morbidly obese adolescents. Materials and Methods: A retrospective review of the data of 10 adolescent patients, who underwent Laparoscopic Sleeve Gastrectomy at our institute (tertiary care hospital), from July 2009 to July 2016 was carried out. Results: Of the 10 patients, 4 patients had syndromic forms of obesity. The median age was 16.54 years. The median pre-operative weight and height were 112 kg and 154 cm, respectively, with a body mass index of 47.2 kg/m2. There was no intra-operative or post-operative complication except for suspected methylene blue toxicity in one patient which was treated conservatively. Median follow-up period was 1 year (0–5 years). The patients had an increase in excess weight loss (EWL) of 54.5% until the end of 1 year. There was a regain of weight between the 1st and 2nd year, followed by a sustained weight loss achieving 44.8% EWL at 3 years and 60% at the end of 5 years (only two patients followed up at 5 years). Similar results were found in syndromic patients. Among the four diabetic patients, three had complete resolution and one had improvement in diabetes status. Among the three patients with obstructive sleep apnoea, two patients had complete resolution, while one patient had improvement in symptoms. One patient with hypocortisolism improved after surgery with a decrease in the steroid requirement. Among the hypothyroid patients, one patient had a complete resolution, one patient had improvement in hypothyroid status while two patients had no change. Conclusion: Bariatric surgery is effective for morbidly obese adolescents, leading to significant resolutions of comorbid illness