Accuracy of pulse oximetry screening for detecting critical congenital heart disease in the newborns in rural hospital of Central India.

BACKGROUND: Congenital cardiovascular malformations are the most common category of birth defects and responsible for mortality in the first twelve months of life. Critical congenital heart disease (CCHD) will be present in approximately one quarter of these children, which requires catheter or surgery intervention in the first year of life. AIM: To determine the accuracy of pulse oximetry for detecting clinically unrecognized CCHD in the newborns. METHODS: Pulse oximetry was performed on clinically normal newborns within first 4 hours of life. If screening oxygen saturation (SpO2) was below 90%, echocardiography was then performed. INCLUSION CRITERIA: All newborns who were admitted in postnatal ward & NICU. EXCLUSION CRITERIA: Out born babies and babies with a prenatal diagnosis of duct dependent circulation. RESULTS: Pulse-oximetric screening was performed on 2110 clinically normal newborns. Low SpO2 (<90%) was found in eight babies seven of them had CCHD, including three neonates with TGA, two with tricuspid atresia, one with tetralogy of fallot and one with transposition of great vessels. A pulse oximetry cut-off value of below 90% for detecting CCHD showed 100% sensitivity, 99.95% specificity, 87.50% positive predictive value, 100% negative predictive value. CONCLUSIONS: Pulse oximetry is safe, feasible and noninvasive, can be used as screening tool for detecting CCHD in clinically normal newborn. If SpO2 is below 90% in clinically normal newborns within 4 hours of birth, urgent echocardiography is suggested to rule out CCHD.

Three-dimensional CT angiography in the evaluation of cerebral arteries in acute hemorrhage.

OBJECTIVE: We conducted this study to demonstrate the value of non-invasive three-dimensional CT angiography (3D CTA) in the detection of a cerebral aneurysm. MATERIAL AND METHODS: A helical CT acquisition was obtained using non-ionic contrast media in 50 patients with 1 mm per second table speed, 1 mm collimation, and pitch 1:1. Axial source images were transferred into a workstation console (Advantage windows GE) and CTA was obtained using MIP (Maximum Intensity Projection) reconstruction. Fourteen patients underwent conventional digital subtraction angiography (DSA) after 3D CTA prior to surgery. RESULTS: A total of 39 aneurysms were detected in 50 patients. All patients with an aneurysm were operated and the presence of aneurysms was confirmed. 3D CTA detected 38 of these 39 aneurysms. In 37 aneurysms, the origin of the aneurysm and aneurysm neck was adequately visualized. 3D CTA was found to be 100% specific and 97.2% sensitive in picking up cerebral aneurysms. 3D CTA was 97% specific in demonstrating the exact origin and showing the neck of the aneurysm. CONCLUSIONS: CT angiography is a simple, quick, and non-invasive technique and can replace DSA in most patients with acute subarachnoid hemorrhage aneurysm for the detection and characterization of aneurysms of the circle of Willis. The relation of the aneurysm with bony landmarks was clearly depicted.

Adult atretic parietal cephalocele.

Atretic parietal cephalocele is a congenital anomaly of childhood with poor prognostic value. The authors report an adult with associated brain malformations (interhemispheric cyst, partial corpus callosum agenesis) - but, interestingly, without any clinical symptoms related to the entity.

Lateral sacral lipomyelomeningocele : a rare anomaly.

Lateral sacral lipomyelomeningocele is a rare spinal developmental anomaly. In the case under report, the fat attached to the neural placode was blending with the gluteal fat externally. The cord was tethered at this level. Multiple bony anomalies and diastematomyelia were associated findings. A case of lateral sacral lipomyelomeningocele with excellent imaging detail provided by the multiplanar magnetic resonance (MR) scan is reported.

Spinal dural AV fistula mimicking a vertebral neoplasm.

A middle-aged man with spinal dural arteriovenous fistula mimicking a vertebral neoplasm of Th11 is described. CT and MR imaging revealed the rare case of extensive vertebral destruction of Th11.

Cervico-dorsal spinal enterogenous cyst.

A case of a histologically proven ventrally situated spinal enterogenous cyst of cervico-dorsal region is reported with magnetic resonance (MR) imaging features. A brief review of literature on the subject is discussed.

Orbital granulocytic sarcoma in acute myelogenous leukemia.

A five year old boy presented with progressively increasing proptosis of the left eye. CT scan showed bilateral extra-conal homogeneously enhancing soft tissue masses, larger on the left side. A possibility of granulocytic sarcoma of the orbit was considered. Diagnosis was confirmed by peripheral smear and bone marrow aspiration. Patient responded to chemotherapy.

Duodeno-jejunal hemangiomatosis.

Diffuse duodeno-jejunal hemangiomatosis in children is a rare cause of bilious vomiting. In the clinical approach to bilious vomiting, tumors of the duodenum come at the end of the differential list--not to mention the rarity of hemangiomatosis. To our knowledge, isolated duodeno-jejunal hemangiomatosis as a cause of bilious vomiting in children is being reported for the first time. We analyse the various imaging modalities available to reach a clinical diagnosis.