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We report successful management of left atrial hematoma after ablation of supraventricular tachycardia. A 43-year-old female patient experienced chest pain immediately after radiofrequency ablation of a symptomatic left posterolateral accessory pathway. Transthoracic echocardiography demonstrated a large mass occupying the left atrium. Computed tomography and transesophageal echocardiography results were consistent with posterolateral intramural hematoma. She became hemodynamically unstable, requiring emergent surgery. The mass resolved completely by 6 weeks. (Level of Difficulty: Beginner.), Graphical abstract, This paper reports successful management of left atrial hematoma after ablation of supraventricular tachycardia. A 43-year-old female patient experienced chest pain immediately…

Both three-dimensional (3D) printing and virtual reality (VR) are reported as being superior to the current visualization techniques in conveying more comprehensive visualization of congenital heart disease (CHD). However, little is known in terms of their clinical value in diagnostic assessment, medical education, and preoperative planning of CHD. This cross-sectional study aims to address these by involving 35 medical practitioners to subjectively evaluate VR visualization of four selected CHD cases in comparison with the corresponding 3D printed heart models (3DPHM). Six questionnaires were excluded due to incomplete sections, hence a total of 29 records were included for the analysis. The results showed both VR and 3D printed heart models were comparable in terms of the degree of realism. VR was perceived as more useful in medical education and preoperative planning compared to 3D printed heart models, although there was no significant difference in the ratings (p = 0.54 and 0.35, respectively). Twenty-one participants (72%) indicated both the VR and 3DPHM provided additional benefits compared to the conventional medical imaging visualizations. This study concludes the similar clinical value of both VR and 3DPHM in CHD, although further research is needed to involve more cardiac specialists for their views on the usefulness of these tools.

Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction that is underdiagnosed. Computed tomography coronary angiography (CTCA) is a non-invasive tool for the a...

Epidermoid cyst is a rare developmental cyst of the oro-facial region which results from entrapped epidermal elements with an incidence of 6.9-7% and represents less than 0.01% of all oral cavity cysts. PRF, as a physiologic fibrin matrix, serves as a net to stem cells, especially when an accelerated angiogenesis develops in the fibrin membrane. This aspect is of particular interest in the case of wide osseous defects. The Color Power Doppler detects minute areas of blood flow and the velocity of blood flow in healing bone by recording the change in frequency caused by the moving red blood cells. It demonstrates the progressive formation of new vessels in bone during the initial healing period. As the bone remodelling proceeds, there is a decrease in flow signals.

Background: Cardiovascular disease is a major global health problem reaching epidemic proportions. Along with the developed nations, underdeveloped and developing countries are now facing this burden. Keeping this in mind various emerging risk factors in patients with documented evidence of acute myocardial infarction attending a tertiary care hospital in the Kumaon region of Uttarakhand were studied.Methods: This study is a prospective study done in the department of Medicine, Sushila Tiwari Government Hospital, Haldwani over a period of 2 years. Patients were enrolled from the Medical Emergency/ OPD who had documented evidence of Acute Myocardial Infarction. Informed consent was taken from each study subject.Results: The mean age was 54.27 years (SD- 13.062). Among the risk factors, high triglyceride is significantly higher in younger patients as compare to older patients. Lipid profile distribution when they compare to any addiction, it has been found in the study that LDL is significantly higher in those who were having any addiction. Hypertension was significantly higher in patients who smoke (p=0.04). The major contributing risk factor was any addiction (smoking, alcohol, tobacco consumption in any form) followed by dyslipidemia.Conclusions: The challenge is to develop appropriate strategies to prevent coronary artery diseases and promote healthy lifestyles.

Delayed-onset fibrotic stenosis of the hepatic-vein anastomosis following liver transplantation resulted in ascites and abnormal liver-function tests. The stenosis was treated with balloon dilatation resulting in a clinical improvement; however, this had to be repeated four times in the 9 months after transplantation due to recurrent stenosis. The stenosis was eventually successfully treated with percutaneous insertion of a metal stent. Aspirin 50 mg daily was prescribed for 1 month. The patient was not anticoagulated. The patient remains clinically well at follow up after 18 months.

Common bile duct (CBD) endoprostheses that are inserted at endoscopy are in routine clinical use to decompress the obstructed biliary tract. This case describes the proximal migration of a CBD endoprosthesis into the right anterior duct. An attempt at endoscopic retrieval failed. The endoprosthesis was retrieved by a percutaneous transhepatic approach using an Amplatz goose-neck snare. To the best of our knowledge, use of the Amplatz goose-neck snare has not been reported for this application.

Background: Stenotrophomonas maltophilia infection is gaining importance as an important cause of nosocomial pneumonia due to its characteristic inherent resistance to many broad- spectrum antibiotics. In this study we evaluated the demographic, clinical and microbiological profile of patients with lower respiratory tract infection due to Stenotrophomonas maltophilia. Materials and Methods: A retrospective analysis of 33 patients diagnosed with Stenotrophomonas maltophilia lower respiratory tract infections during a period of two years from 2012 - 2013 was done. Results: The predominant predisposing factor observed was mechanical ventilation in 17(51.5%) cases. Fluoroquinolones were the most effective antibiotic (26;78.8%) followed by trimethoprim-sulfamethoxazole (24;72.7%). Among the 19 patients treated with proper antibiotic, 13(68.4%) showed clinical improvement. Among the 14 patients who did not receive appropriate antibiotic for Stenotrophomonas maltophilia infection, 8(57.1%) showed improvement. Two (6%) had blood culture positive for Stenotrophomonas maltophilia. Mortality rate was 21.2%. Conclusion: Stenotrophomonas maltophilia is emerging as an important nosocomial pathogen with increased risk in patients on mechanical ventilation in ICU. Empiric therapy should include agents active against S.maltophilia such as newer flouroquinolones and trimethoprim-sulfamethoxazole.

To prospectively evaluate pulmonary magnetic (MR) angiography as a diagnostic examination for acute pulmonary embolism (PE).Thirty-six consecutive patients (19 women, 17 men; age range, 28-84 years) underwent pulmonary digital subtraction angiography (DSA) and pulmonary MR angiography. MR angiograms were obtained during suspended respiration and the pulmonary arterial phase of gadolinium-based contrast medium injection. A steady-state gradient-recalled-echo sequence with free induction decay sampling was used. DSA studies were interpreted for the presence of acute PE by two independent radiologists; an adjudicator made the final decision on discordant interpretations.By using DSA, a total of 19 acute pulmonary emboli were depicted in 13 patients. Prospectively, 13 of these emboli were depicted by using MR angiography. MR angiography missed six emboli: Four required the DSA adjudicator to make the decision, and one was in a patient whose MR angiogram was acquired during breathing. Four of these six emboli were small subsegmental emboli, and two were segmental.Performed without pulmonary arterial catheterization, iodinated contrast media, or ionizing radiation, pulmonary MR angiography had a high accuracy for depicting lobar and segmental emboli, but was unable to depict four of five subsegmental emboli.