Search

ObjectiveThe outcome of transcatheter closure in ostium secundum atrial septal defects is determined by the morphology of the defects. Modified techniques such as balloon assistance, pulmonary vein deployment, left atrial roof technique, and so on are used for circumventing the anatomic complexities and increasing the success rates.MethodsWe planned a prospective study looking at the outcomes of transcatheter closure in secundum atrial septal defects with modified techniques in different anatomic complexities identified in transoesophageal echocardiography and their association with outcome of transcatheter closure.ResultsTranscatheter closure was successful in 295 out of 346 (82%) patients with modified techniques. Balloon-assisted technique offered a success rate of 87%. The mean defect size was 34.7±2.78 mm (95% confidence interval (CI) 30.67–43.1 mm) with success and 40.16±4.5 mm (95% CI 32.16–44.7) with failure (p = 0.02). The mean total septal length was 38.11±0.63 (95% CI 35.21–40.56 mm) with success and 42.54±0.34 (95% CI 38.79–43.21 mm) with failure. The defect to septal ratios were 0.82 and 0.94 in success and failure groups, respectively (p=0.02). However, the absence of a retro-aortic margin, septal aneurysm, and multiple defects did not affect the success rate. Deficient inferior vena caval margin, deficient posterior margin, and size⩾40 mm had a high risk of failure with transcatheter closure. The odds ratio for procedural failure was 25.3 (4.3–143.8) in patients with malaligned septum, 8.3(1.4–48.5) with deficient inferior vena caval margin, and 4.1(2.5–19) for size⩾40 mm.ConclusionsThe modified techniques for device deployment offer substantial chances of success in transcatheter closure of secundum atrial septal defects with anatomical complexity (82%). Variants such as defect size of⩾40 mm and deficient inferior and posterior margins have high failure rates with a modified technique.

Neurocysticercosis is an infection of the central nervous system caused by larvae of the pork tapeworm Taenia solium. We report a case of large cyst in the cerebellopontine angle that increased in size under observation and surgery revealed it to be cysticercus. It was removed in toto and patient improved on follow-up.

Spinal schwannomas are benign intradural extramedullary tumors arising from spinal nerve root sheath. They are usually solid or heterogeneously solid. Totally cystic schwannomas are rare entities. Herein, we report a 60-year-old male presenting with backache radiating along the chest wall and weakness of both lower limbs. He had spastic paraparesis. Magnetic resonance imaging revealed a cystic mass in the thoracic region. At operation, the cystic mass was seen to be attached to D4 dorsal rootlets. It was excised in toto and histopathology confirmed it to be a schwannoma. The relevant literature is reviewed.

Retained surgical sponge is an uncommon complication after laminectomy. A 67-year-old male presented with a discharging sinus in the cervical region following cervical laminectomy. Magnetic resonance imaging (MRI) revealed bilateral symmetrical lesions in the paraspinal area. Re-exploration revealed gauze pieces on either side under the muscle. Persistent discharging wound after surgery should arouse the possibility of a foreign body. Because of the rarity of bilateral lesions, the present case is being reported.

The objective of this study was to assess the affect of pallet location on torso kinematics during lifting. Participants transferred 11.3 kg boxes to pallets at two orientations and two distances from a constant lift origin. When reorienting the pallet from 180° to 90°, torso twist, lateral and sagittal torso kinematics increased when palletizing to various locations on the pallet when keeping the pallet distance far. Torso flexion increased slightly at the lowest level on the pallet independent of the pallet distance. When keeping the pallet distance close, torso twist kinematics decreased only when palletizing to the highest and closest position of the pallet. When reorienting the pallet from 180° to 90° adjacent to the lift origin, the best strategy to reduce torso kinematics appears to be to eliminate the transferring of loads to the lowest level of the pallet, and keeping the pallet close to the lift origin. © 2004 - IOS Press and the authors. All rights reserved.

Much of the intervention research for prevention of occupational low back injuries has focused on reduction of torso flexion and the external moment. Little is known about prevention strategies for torso twisting and lateral bending. It was hypothesized that increasing the distance between the lift origin and the pallet would require subjects to take an extra step, and reduce the torso kinematics and resulting LBD Risk. Fifteen males transferred 11.3 kg boxes from a constant origin to a destination pallet at two different distances. Analysis of Variance results indicated that increasing the pallet distance from the lift origin resulted in increases in velocities and accelerations, and the LBD risk at the lower regions of the pallet. These results suggest that increasing the pallet distance from the lifting origin does not appear to be an effective intervention strategy to reduce the risk of occupational LBD associated with torso kinematics.

Cystic glioblastoma multiforme (GBM) is a rare disease whose exact prevalence is unknown. Glioblastoma is usually seen as a unilateral solid tumor more commonly in the supratentorial compartment. The presence of cyst in the GBM is rare. Bilateral large cystic GBM is still rarer and we report such a case. An 83-year-old female was admitted with right hemiparesis and inability to speak for the last 4 days. There was no history of headache or seizures. On examination, there was increased tone on the right side with hemiparesis and aphasia. Magnetic resonance imaging revealed large enhancing cystic lesions measuring 4 × 2.8 × 3 cm and 4.5 × 4 × 3.5 cm in the right and left frontal regions respectively with surrounding edema [Figure 1]. Radiological possibilities suggested were glioma with differential diagnosis of abscess and metastasis. Burr-hole aspiration revealed hemorrhagic fluid and biopsy of the cyst wall confirmed the diagnosis of GBM. Attendants were explained the prognosis and did not give consent for definitive surgery. Patient died within 5 months of discharge from the hospital.

Two adults, 31 and 20 years of age, developed supratentorial metastasis 3½ years and 11 months, respectively, after gross total removal of their posterior fossa medulloblastoma. The first case developed spinal metastasis as well. Both had undergone craniospinal irradiation. Case 1 underwent laminectomy and case 2 underwent craniotomy because their presenting symptoms required so.

Background Free-living amoebae are known to cause fatal granulomatous encephalitis in immunocompromised individuals. They are also known to present as multifocal parenchymal lesions, pseudotumoral lesions, meningeal exudates, hemorrhagic infarcts, and necrosis in the brain. However, Acanthamoeba infection in an intracranial ependymal cyst has not been reported in the literature. Case Description A 25-year-old immunocompetent man presented with a suspected interhemispheric arachnoid cyst. The cyst fluid turned out be infected with Acanthamoeba. The patient was treated successfully with decompression of the cyst with combination chemotherapy. Conclusion Acanthamoeba may cause secondary infection in an underlying brain cyst. A suspicion of such an infection must be raised in the presence of altered nature of CSF consistency. The aggressive chemotherapy is the only hope for favorable outcome. The dilemmas associated with the diagnosis and treatment are further discussed.

Intervention research for prevention of occupational low back injuries has focused on the effects of reducing extreme torso flexion and the external moment. Little is known about prevention strategies for torso twisting and lateral bending. The objective of this study was to assess the effect of pallet distance with regard to a constant lift origin on the torso kinematics and a measure of low back disorder risk. Fifteen male participants transferred 11.3 kg boxes from a constant origin to six different regions on a pallet. Two pallet distances with regard to the lift origin were investigated. ANOVA indicated that increasing the pallet distance resulted in increases in torso kinematics (velocities and accelerations) as well as a measure of risk of low back disorder. The increases in torso kinematics (e.g. twisting and lateral awkward postures and bending velocities) occurred mostly at the lower height regions on the pallet. It is concluded that increasing the pallet distance with regard to the lifting origin, with the intention to influence the participant to take a step during a palletizing task does not appear to be an effective intervention strategy to reduce the risk of low back disorder associated with torso kinematics.

A 22-year-old man presented with a large, soft, compressible swelling in the right occipito-parietal region. Fine needle aspiration cytology revealed blood only. The lesion was excised and histopathology studies revealed it to be a diffuse neurofibroma.