Variance in the treatment of vertebral haemangiomas.

Vertebral haemangiomas constitute an infrequently encounterd entity in clinical practice. Although x-ray, computerised tomography scan and magnetic resonance Imaging scan provide a pathognomic picture confirming the diagnosis of vertebral haemangiomas, angiography constitutes an important tool for diagnosis and helps in deciding and execution of treatment. Various treatment modalities like surgery, radiotherapy, pre-operative embolisation, percutaneous vertebroplasty and intralesional ethanol have been discussed in the setting of asymptomatic vertebral haemangiomas to those presenting with features of cord compression.

Compensator-based intensity-modulated radiotherapy in head and neck cancer: our experience in achieving dosimetric parameters and their clinical correlation.

Aims: To review the Batra Hospital and Medical Research Centre experience of using compensator-based intensity-modulated radiotherapy (IMRT) to treat head and neck cancer.

Materials And Methods: Between October 2003 and August 2004, 18 patients underwent IMRT for head and neck cancer at our institution. IMRT was delivered using partial transmission high-resolution compensator blocks.

Analysis of prognostic variables among patients with locally advanced head and neck cancer treated with late chemo-intensification protocol: impact of nodal density and total tumor volume.

Objective: The aim of the present study was to define the prognostic impact of nodal density (ND) and total tumor volume along with many other tumor, treatment and patient related variables using the late chemo-intensification treatment regimen with conventionally fractionated radiotherapy (70 Gy/7 weeks).

Methods: A total of 74 patients with Stage III and IV biopsy proven squamous cell carcinoma of oropharynx, hypopharynx and larynx were treated with this regimen. ND and total tumor volume was measured on high resolution CT scans for all the patients.

Uterine choriocarcinoma in a postmenopausal woman.

Uterine choriocarcinoma developing in patients beyond reproductive age is a rare occurrence. We report a case of choriocarcinoma of uterine corpus in a 54-yr-old woman after 7 yr of menopause and 25 yr after last child birth. She presented with pain in the abdomen, and on radiological investigation a left uterine adnexal mass of 3.

Late chemo-intensification with cisplatin and 5-fluorouracil as an adjunct to radiotherapy: a pragmatic approach for locally advanced head and neck squamous cell carcinoma.

The aim of this study was to define the feasibility of a late chemo-intensification treatment regimen with conventionally fractionated radiotherapy (70 Gy/7 weeks). Seventy four patients with Stage III and IV biopsy proven squamous cell carcinoma of oropharynx, hypopharynx and larynx were treated with this regimen. Chemotherapy consisted of continuous infusion of 5-FU at 350 mg/m(2)/day and cisplatin as 1h infusion at 10 mg/m(2)/day on days 1-5 of week 6 and 7 of radiotherapy.

Delayed occurrence of restenosis in drug eluting stents: an evidence of delayed healing.

Drug eluting stents have made a significant impact on restenosis. However, there are concerns regarding delayed "catch-up" of restenosis. In this case report we present two such patients with delayed occurrence of restenosis after drug eluting stent implantation.

Management of acute myocardial infarction--primary angioplasty the treatment of choice!

The management goal of acute myocardial infarction is prompt revascularization. Recent years have seen improvements in both pharmacological and mechanical methods of revascularization of the infarct related arteries. This brief review summarises these developments and ongoing efforts.

Mahaim automatic accelerated rhythm: a marker of successful radiofrequency ablation.

Background: Mahaim pathways are characterized by the presence of an accessory pathway potential-the 'M' potential, at the tricuspid annulus. M potential is a very useful guide during radiofrequency ablation of Mahaim pathway. During ablation, an accelerated rhythm with ORS morphology, identical to fully pre-excited QRS complex is observed, and has been labeled as Mahaim automatic rhythm.

Pace mapping for the localization of focal atrial tachycardia arising near the mitral annulus.

Of the various therapeutic modalities available to treat ectopic atrial tachycardia, radiofrequency catheter ablation has shown excellent results. It is usually possible to localize the earliest site of endocardial activation by conventional or newer three-dimensional mapping techniques. We report a case of ectopic atrial tachycardia, wherein the tachycardia was being repeatedly interrupted by mechanical trauma.

Left atrial-coronary sinus dissociation following an attempt at radiofrequency ablation for a left lateral accessory pathway.

Coronary sinus electrograms generally represent the sequence of left atrial activation, and are very helpful in localizing and differentiating left lateral accessory pathway-mediated tachycardia from other supraventricular tachycardias. The activation of the coronary sinus from the left atrium occurs through muscle bridges, which may be discrete or form an intermingled continuum. These muscle bridges, if disconnected, may dissociate the coronary sinus from the left atrium, in which case the coronary sinus electrograms do not represent left atrial activation, and do not help to understand, or may cause misinterpretation of, the mechanism of supraventricular tachycardia.

Pericardial synovial sarcoma.

A 29-year-old young man presented with acute breathlessness. After investigative work-up he was found to have a massive pericardial tumour. Thoracotomy and near total surgical excision of the pericardial tumour was carried out.

Platelet glycoprotein IIb/IIIa inhibition using eptifibatide with primary coronary stenting for acute myocardial infarction: a 30-day follow-up study.

The results of primary coronary stenting for acute myocardial infarction (AMI) have been reported to improve significantly with the concomitant administration of platelet glycoprotein IIb/IIIa inhibitor abciximab. There are, however, no data available with the use of eptifibatide, a more cost-effective, small-molecule GP IIb/IIIa blocker with a shorter half-life. In a prospective multicenter feasibility and efficacy study, we assigned 55 consecutive patients with AMI being taken up for primary stenting to receive eptifibatide just before the procedure (two boluses of 180 microg/kg 10 min apart and a 24-hr infusion of 2 microg/kg/min).

Sildenafil in the management of primary pulmonary hypertension.

Primary pulmonary hypertension is a rare disorder of unknown etiology with a poor prognosis. There is no cure, and drug therapy is effective in only a few patients. Calcium-channel antagonists and anticoagulants are the mainstay of therapy.

"Y" graft bypass for bilateral coronary ostial aortoarteritis.

A case of bilateral coronary ostial aortoarteritis, which presented with angina pectoris, is reported. Emergency total arterial revascularization was performed using the bilateral mammary artery and radial artery, and the radial artery was hanged "Y" on the left internal mammary artery. The patient was discharged on low-dose steroid.

Elevated serum cancer antigen 125 levels in advanced abdominal tuberculosis.

A 48-yr-old female presented with a 1-yr history of pain in the hypochondrium and epigastrium. All routine investigations and computed tomography (CT) of the abdomen were done. CT findings revealed a well-defined cystic mass in the right ovary, and ascitis with features suggestive of secondaries over the omentum and peritoneal surface.

Correlation between serum magnesium and blood cyclosporine A concentrations in renal transplant recipients.

Background: Low total serum magnesium concentration has been reported in renal transplant recipients on cyclosporine therapy, and this is a risk factor for hypertension and cardiac death. No study is yet available from the Indian subcontinent on the relationship between total serum magnesium and cyclosporine A concentration.

Methods: Blood cyclosporine A and total serum magnesium concentrations were estimated in 31 post renal transplant patients.

Coronary stent implantation without lesion predilatation (direct stenting): our experience with this evolving technique.

Background: Until recently, conventional intracoronary stent deployment required predilatation of the lesion with a balloon. However, "direct stenting" of the lesion without predilatation offers certain theoretical and practical advantages. We assessed the safety and feasibility of direct stenting in a select group of patients who were likely to benefit most from these advantages, namely, those with acute coronary syndromes.

Elective stenting of extracranial carotid arteries.

Objectives: In symptomatic and asymptomatic patients with significant carotid artery stenosis, surgical endarterectomy has been shown to be beneficial when compared with medical management. Carotid stenting is evolving as an alternative technique for treating such patients. This prospective study was designed to assess the feasibility and safety of carotid angioplasty and stenting.

Multi-vessel coronary stenting--procedural results and late clinical outcomes: a comparison with single-vessel stenting.

The purpose of this study was to assess the 1-year clinical outcome of patients with multi-vessel coronary artery disease (CAD) who underwent coronary stenting, and to compare the results with single-vessel coronary stenting carried out during the same period. We evaluated the in-hospital and 12-month clinical outcomes [death, Q-wave myocardial infarction (MI) and repeat revascularization rates at one year] in 384 consecutive patients treated with coronary stents in 2 (92% of patients) or 3 of the native coronary arteries and compared the outcome to 624 consecutive patients undergoing stenting in a single coronary artery between January 1, 1997 and January 31, 1999. The overall procedural success was obtained in 99% of patients with 2- or 3-vessel stenting and 98% of patients with single-vessel stenting.

Intravascular Red Light Therapy after Coronary Stenting Ñ Angiographic and Clinical Follow-up Study in Humans.

In animal models of coronary restenosis, intravascular red light therapy (IRLT) using a diode laser source has been shown to reduce neointimal hyperplasia following balloon-induced injury and coronary stenting. We studied the safety and efficacy of catheter-based IRLT for preventing restenosis after coronary stenting in 22 patients with angina pectoris. IRLT was performed using a diode laser (650 nm) at an energy level of 10 megawatts delivered through a rapid exchange balloon system containing the fiberoptics.