No abstract

A 19-year-old female presented with episodic abdominal pain not related to food intake. She had occasional vomiting but had no gastrointestinal bleed. Routine ultrasound examination picked up aneurysm of the superior mesenteric artery (SMA). Computed tomography angiogram showed stenosis of the origin of the SMA and multiple aneurysms involving the proximal SMA. A large collateral artery also showed aneurysm at its origin. The celiac artery and hepatic arteries were not visualized. Splenic artery was reconstituted through gastroepiploic artery. Multiple collaterals from the phrenic and mammary arteries were seen to supply the liver. Inferior mesenteric artery was dilated, and a large marginal artery was seen joining the superior mesenteric artery. Right renal artery showed mild irregularity at the proximal part (Cover).At surgery the stomach was pale, and no pulsations were felt in the splenic and epiploic vessels. Hepatic artery was thin and felt like a cord. The image in (A) shows the aneurysmal segment of SMA. The aneurysmal segment of the SMA was resected and an aorto-SMA interposition graft with polytetrafluoroethylene was performed. The large collateral artery, which had an aneurysm at the origin, was also resected and reimplanted into the graft. A reversed saphenous vein graft was anastomosed to the graft and to the splenic artery (B). The stomach regained color and good pulsations were felt in the epiploic arteries. Biopsy of the aneurysm sac confirmed fibromuscular dysplasia. Patient had complete symptomatic relief. Postoperative angiogram done 2 months later showed patent grafts with good flow distally. The right renal artery lesion had progressed to cause stenosis (C).Fibromuscular dysplasia or arterial fibroplasia includes a heterogenous group of nonatherosclerotic occlusive and aneurysmal disease. Four types are described, but medial fibroplasia is the most commonly seen. It is more common in young women, and the exact etiology is not known. Renal and carotid arteries are commonly involved. Rarely, mesenteric and peripheral arteries are involved. 1 Stenotic type is amenable for balloon dilatation but the aneurysmal one requires resection and replacement with a graft. 2

BACKGROUND Hypothyroidism is characterised by a low cardiac output due to the decreased heart rate and stroke volume. Systolic and diastolic functions are reduced at rest and during exercise, thus impairing quality of life. In particular, an increased risk of coronary heart disease events and mortality has been reported in young patients affected by subclinical hypothyroidism with TSH >10 mU/L. The aim of the study is to evaluate the cardiovascular system using electrocardiogram and echocardiogram among patients with clinical and subclinical hypothyroidism. MATERIALS AND METHODS A cross-sectional comparative study was conducted for a period of one year on 50 patients attending the Outpatient Medicine Department in our hospital. The 50 patients were made into 2 groups of 25 each, group I are patients with clinical hypothyroidism and group II are patients with subclinical hypothyroidism. The cardiac status of all the patients was assessed by doing ECG and a 2D echo was done to assess their systolic and diastolic function. RESULTS The systolic function was normal in both the groups except for a slight increase in the septal wall and posterior wall thickness of LV among the clinical hypothyroidism patients. There is no statistical significant difference in the diastolic parameters among the two groups (p >0.05), but it proves that there is a diastolic dysfunction, which would be in the starting stage in both the groups. Among the hypothyroid patients, 20% of them had mild pericardial effusion, which was detected through 2D echo, whereas none of the patients with subclinical hypothyroidism had pericardial effusion and this difference was found to be statistically significant (p <0.05). CONCLUSION Doppler echocardiography technique being a simple, reliable and reproducible method for assessment of heart functions has to be routinely done in patients with clinical and subclinical hypothyroidism to detect diastolic dysfunction at an early stage and manage them appropriately in such a way preventing morbidity and mortality due to cardiovascular system.

Hydrogen sulfide is produced endogenously by a variety of enzymes involved in cysteine metabolism. Clinical data indicate that endogenous levels of hydrogen sulfide are diminished in various forms of cardiovascular diseases. The aim of the current study was to investigate the effects of hydrogen sulfide supplementation on cardiac function during reperfusion in a clinically relevant experimental model of cardiopulmonary bypass. Twelve anesthetized dogs underwent hypothermic cardiopulmonary bypass. After 60 minutes of hypothermic cardiac arrest, reperfusion was started after application of either saline vehicle (control, n = 6), or the sodium sulfide infusion (1 mg/kg/hour, n = 6). Biventricular hemodynamic variables were measured by combined pressure-volume-conductance catheters. Coronary and pulmonary blood flow, vasodilator responses to acetylcholine and sodiumnitroprusside and pulmonary function were also determined. Administration of sodium sulfide led to a significantly better recovery of left and right ventricular systolic function (P < 0.05) after 60 minutes of reperfusion. Coronary blood flow was also significantly higher in the sodium sulfide-treated group (P < 0.05). Sodium sulfide treatment improved coronary blood flow, and preserved the acetylcholine-induced increases in coronary and pulmonary blood (P < 0.05). Myocardial ATP levels were markedly improved in the sulfide-treated group. Thus, supplementation of sulfide improves the recovery of myocardial and endothelial function and energetic status after hypothermic cardiac arrest during cardiopulmonary bypass. These beneficial effects occurred without any detectable adverse hemodynamic or cardiovascular effects of sulfide at the dose used in the current study. The aim of the current study was to test potential cytoprotective and anti-inflammatory effects of the novel biological mediator hydrogen sulfide in murine models. Murine J774 macrophages were grown in culture and exposed to cytotoxic concentrations of nitrosoglutathione, or peroxynitrite (a reactive species formed from the reaction of nitric oxide and superoxide). Pretreatment of the cells with sodium sulfide (60-300 µM) reduced the loss of cell viability elicited by the nitric oxide donor compound (3 mM) or by peroxynitrite (3 mM), as measured by the MTT method. Sodium sulfide did not affect cell viability in the concentration range tested. In mice subjected to bacterial lipopolysaccharide (LPS, 5 mg/kg i.p.), treatment of the animals with sodium sulfide (0.2 mg/kg/hour for 4 hours, administered in Alzet minipumps) reduced the LPSinduced increase in plasma IL-1β and TNFα levels. These responses were attenuated when animals were pretreated with the heme oxygenase inhibitor tin-protoporphyrin IX (6 mg/kg). The current results point to the cytoprotective and anti-inflammatory effects of hydrogen sulfide, in cells exposed to nitrosative stress, and in animals subjected to endotoxemia. Introduction It has been previously shown that the two forms of acute cholecystitis, acute acalculous cholecystiti...

BACKGROUND:Apert syndrome is a rare autosomal dominant Mendelian disorder characterized by a set of recognizable patterns of human malformations, having paediatric, plastic surgical, Ortholpaedic and Dental implications requiring early recognition & effective management strategies for good Cosmetic and functional out-come.