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Laparoscopic Robotic Radical Hysterectomy in an Adult with Congenital Heart Disease: A Case Report and Review of the Literature
No full textPurpose: Non-cardiac surgeries in adults with congenital heart disease are increasing due to improved survival of children with congenital heart disease. There has also been an increase in laparoscopic procedures due to benefits including decreased length of stay and improved quality of life. There have been concerns regarding laparoscopic surgery in patients with congenital heart disease especially with pneumoperitoneum and positioning related to hemodynamic effects. We present a case of laparoscopic surgery in an adult with congenital heart disease who underwent robotic radical hysterectomy and provide a review of the literature.Methods/Results: The case of a 39 year old female with palliated congenital heart disease who underwent laparoscopic robotic radical hysterectomy for cervical cancer was summarized. A review of the literature was performed. Ten surgeries in 9 adult patients were reported with good outcomes. Insufflation pressures were reported in 8 of 10 surgeries and kept at or below 15 mmHg.Conclusions: When performed in centers with experience in CHD, non-cardiac laparoscopic surgery has been shown to be safe and effective. CO2 abdominal insufflation pressures should be reduced as much as possible without compromising visualization, in order to decrease potential negative effects on hemodynamics
Giant Urinary Bladder Visualised on Tc-99m MDP Whole Body Bone Scan
No full textWe herein report an unusual appearance of an extensively enlarged urinary bladder on Tc-99m Methylenediphosphanate (MDP) whole body bone scan of a 67 years old prostate cancer patient with abdominal distension. Due to micturition problem, we inserted urinary catheter and drained 11.5 liters of residual urine. Abdominal distention regressed significantly. On postdrainage images, bladder activity was completely cleaned
Eosinophilic Oesophagitis in Adults: Case History and Literature Review
No full textEosinophilic oesophagitis has become one of the common clinical presentations encountered by gastroenterologists and histopathologists. Despite the huge strides in the understanding of pathogenesis, diagnosis and treatment of the condition over the past decade, data regarding clear management guidelines are still limited. Presented is the case of a 28 years old female who was referred to our endoscopy department with worsening dysphagia. The diagnosis of Eosinophilic oesophagitis was confirmed. This article discusses the clinical presentation, diagnosis and summarise the outlines of management in adults
Evaluation of Eustachian Tube Function by Tympanometry in Patients of Deviated Nasal Septum and Sinonasal Polyposis
No full textObjective: To study the effect of deviated nasal septum (DNS) and sinonasal polyposis (SNP) on eustachian tube(ET) function & whether the function would improve on septal correction and removal of polyp.Patients and Method: A prospective study of 45 subjects of DNS and 25 subjects of SNP. A detail history was taken including symptomatology, predisposing factors, treatment received. Thorough ENT examination was done after meeting all the inclusion and exclusion criteria, otomicroscopy nasal endoscopy and PTA was done whenever indicated. Tympanometry was performed in all cases using impedence audiometer prior to septal correction and removal of polyp and repeated 4 to 6 weeks after surgery. Tympanogram was classified as described by Jerger in 1975, in clinical experience with impedence audiometry. Any improvement in tubal function was noted. In cases where tubal dysfunction persisted, otomicroscopy and nasal endoscopy was performed again to plan the further line of management.Result: Normal eustachian tube function was achieved in 75.55% after septal correction and 74% after polypectomy which was 51.11% and 56% respectively before surgery.Conclusion: This study suggest that chronic nasal obstruction due to deviated nasal septum and sinonasal polyposis is a frequent cause of ET dysfunction. Surgical correction significantly improve tubal function and middle ear ventilation
The Effect of Exercise on Plasma Ghrelin in Obesity
No full textBackground and Aim of the Work: Obesity is an important health problem worldwide. Many solutions have been proposed for this problem the most important of which is physical exercise. Exercise affects caloric expenditure signaling to ghrelin-producing cells in the stomach, thereby affecting appetite regulation.This study examined the effect of weight control programs and exercise on plasma acylated ghrelin concentration in obese subjects.Subjects and Methods: 120 obese persons were recruited and randomly assigned into two treatment groups: diet group& diet and exercise group. The first group received low caloric diet for 12 weeks, while the second group was treated with same diet and exercise program every other day for the same period. Complete clinical, laboratory investigations and ghrelin concentrations were assessed at the start and end of the study.Results: In the diet group, the body weight, the BMI, the WHR (Waist hip ratio) and waist circumference were significantly reduced. On the other hand appetite measures, the triglycerides, cholesterol, HDL and LDL serum levels did not change significantly. Acylated ghrelin was significantly increased.In the diet and exercise group, the body weight, the BMI, the WHR, waist circumference, the feeling of hunger, the desire to eat and prospective food consumption score were significantly decreased. Feeling of fullness score and Serum HDL were significantly increased. Serum triglycerides, serum cholesterol, serum LDL and acylated ghrelin were significantly reduced. Higher reduction of BMI was observed in individuals with lower serum levels of acylated ghrelin.Conclusion: Exercise training was associated with highly significant reduction of anthropometric measurements, plasma acylated ghrelin (which was associated with significant reduction of appetite measures), whereas diet intervention alone promoted opposite effects. More reduction in BMI was observed in individuals with lower plasma levels of ghrelin at the start of the study
Outcome of 69 Pregnancies within a Multinational Population with Systemic Lupus Erythematosus in Qatar
No full textThe aim of this study is to determine the frequencies of abnormal pregnancy outcomes in a cohort of patients with systemic lupus erythematosus (SLE). Data of 69 pregnancies of 37 SLE patients were analyzed retrospectively. Lupus activity was assessed based on SLE Disease Activity Index (SLEDAI) criteria. Compared with pregnancies without Lupus nephritis (LN), pregnancies with LN were associated with a higher risk of still birth (p=0.092), higher rate of eclampsia (p=0.103), intrauterine growth restriction (IUGR) (p=0.556), and pregnancy induced hypertension (PIH) (p=0.412). PIH (17.4% vs 11.1%), IUGR (34.7% vs 11.8%), preterm delivery (26.1 % vs 11.8%), still birth (13% Vs 5.6%) and eclampsia (13% Vs 0%), all were observed to be higher in active lupus patients compared to those in remission. However, these differences were not statistically significant (p>0.05). Absence of LN, proteinuria and low complement component 3 (C3) were potential (p<0.15) predictors for live births. Anti-Ro antibodies, high anti-double stranded DNA antibody (anti-dsDNA), and low C3 were strongly associated with pre-term live births and Anti-Ro antibodies was significantly associated with IUGR. In conclusion SLE in pregnancies in a multinational population in Qatar was associated with higher adverse pregnancy outcomes. Disease activity during pregnancy, proteinuria, LN and eclampsia/preeclampsia were all negatively associated with pregnancy outcome such as IUGR, still births and preterm delivery. Laboratory parameters such as presence of Anti Ro/La antibody and low level of C3 were also associated with adverse pregnancy outcome
HBV Serostatus in Patients with Rheumatic Diseases does not differ from General Population in Germany (A Single Center Study)
No full textBackground: Only limited data are available on the prevalence of hepatitis B in patients with proven rheumatic diseases.Objective: To analyse hepatitis B serology in patients with rheumatic diseases with special regard to the underlying disease and degree of immunosuppression.Materials and Methodology: In total, 1,338 patient records were analysed for HBsAg, antiHBs and antiHBc in a cross-sectional, single-centre study between 2011 and 2015. Data acquisition was realized using electronic patient files created during routine care. The main variables considered as predictors for HBV reactivation included (i) the exact type of rheumatic disease and (ii) the extent of therapeutically induced immunosuppression.Results: Overall, 5.6% of patients (n=76) had proven contact with hepatitis B (antiHBc positive), and antiHBs were not detected in 1.3% (n=18). The rate of vaccinated subjects was 7.8%. Chronic hepatitis B was newly diagnosed in 3 patients (0.2%). In addition, 70.3% of patients were treated during the course of rheumatologic disease previously or currently with glucocorticoids, 85.2% with disease-modifying anti-rheumatic drugs (DMARDs) and 20.1% with a biologic agent (e.g., anti-IL-6, anti-TNFalpha, anti-CD20, CTLA4Ig or anti-IL-12/23).Conclusion: Prevalence of hepatitis B serostatus in the analysed rheumatic patients regarding HBs-Ag and antiHBc with or without antiHBs does not differ from the data published for the general population in Germany. However, the rate of hepatitis B vaccinated patients was lower. In general, up to 1.3% (antiHBc +, antiHBs -) exhibited an increased risk of reactivation of hepatitis B when undergoing immunosuppressive therapy
Estimation of Ejection Fraction with Ventriculography Versus Echocardiography in Patients Referred for Cardiac Surgery
No full textAim: The aim of this study was to compare the estimation of ejection fraction (EF) by ventricuography (VG) and echocardiography (ECHO) in patients referred for surgery and to validate the results by comparison with other published data.Methods: One hundred patients who underwent VG prior to surgery were subjected to a trans-thoracic ECHO. Radiographers calculated the EF by tracing the outer border of the ventriculogram during systole and diastole. A single cardiologist, who was blinded to the angiogram result, measured EF during trans-thoracic ECHO using the biplane Simpson’s method.Results: EF was significantly higher by VG versus ECHO for the whole group (67.9±13.2 vs 55.7±8.5, p=0.000). In 81 patients the EF estimated at VG was higher than that calculated at ECHO (71.7±10.2 vs 55.9±7.2, p=0.000). In 19 patients the EF estimated at VG was lower than that calculated at ECHO, but the difference was not significant (51.8±12.9 by VG vs 55.4±12.8, p=0.387). In 13 patients, with an EF less than 50% on VG, the correlation with ECHO was very good (42.0±9.0 vs 42.0±8.3, p=0.995). Two patients with an EF fraction under 30% had similar measurements by VG and ECHO. The EF range as measured by ECHO was consistent with published data.Conclusion: Ventriculography overestimates EF when compared with ECHO. When EF is less than 50% on VG, ECHO findings were similar. The value of ventriculography in patients referred for cardiac surgery is now being brought into question when ECHO, a better and less invasive test that measures EF, is available
Using Synchronized Audio Mapping to Track and Predict Velar and Pharyngeal Wall Locations during Dynamic MRI Sequences
No full textPurpose: The purpose of this study is to demonstrate a novel innovative computational modeling technique to 1) track velar and pharyngeal wall movement from dynamic MRI data and to 2) examine the utility of using recorded participant audio signals to estimate velar and pharyngeal wall movement during a speech task. A series of dynamic MRI data and audio acoustic features were used to develop and inform a Hidden Markov Model (HMM) and Mel-Frequency Cepstral Coefficients (MFCC) model.Methods: One adult male subject was imaged using a fast-gradient echo Fast Low Angle Shot (FLASH) multi-shot spiral technique to acquire 15.8 frames per second (fps) of the midsagittal image plane during the production of “ansa.†The nasal surface of the velum and the posterior pharyngeal wall was identified and marked using a novel pixel selection method. The error rate was measured by calculating the accumulation error and through visual inspection.Results: The proposed model traced and animated dynamic articulators during the speech process in real-time with an overall accuracy of 81% considering one pixel threshold. The predicted markers (pixels) segmented the structures of interest in the velopharyngeal area and were able to successfully predict the velar and pharyngeal configurations when provided with the audio signal.Conclusion: This study demonstrates a novel and innovative approach to tracking dynamic velopharyngeal movements. Discussion of the potential application of a predictive model that relies on audio signals to detect the presence of a velopharyngeal gap is discussed