Evaluation of paediatric pulmonary vein stenosis by cardiac CT angiography: a comparative study with transthoracic echocardiography and catheter angiogram.

AIM: To compare prospective electrocardiogram (ECG)-gated cardiac computed tomographic angiography (CCTA) with transthoracic echocardiography (TTE) and cardiac catheter angiography (CCA) for paediatric pulmonary vein (PV) stenosis. MATERIALS AND METHODS: Retrospective chart review was undertaken of all patients who underwent CCTA for PV evaluation over a 4-year period. Patient demographics, findings of CCTA, TTE, and CCA, as well as interventions performed, were recorded for each PV. RESULTS: Thirty-five patients were included (23 male patients). All patients had a prior TTE with time interval between TTE and CCTA ranging from 0 to 90 days. CCTA detected 92 abnormalities in 32 patients. TTE missed 16 PV abnormalities (16/92, 17%), detected 37 abnormalities with certainty (37/92, 40%), and was suggestive in 39 abnormalities (39/92, 42%). CCTA was negative for PV abnormalities when TTE was positive or suspicious in three patients. Nineteen patients underwent CCA (18 patients with 52 abnormalities and one patient with normal PV), confirming CCTA findings. Thirty-nine were treated with angioplasty/stenting (39/52,75%). Failed recanalisation occurred in three PVs (3/52, 6%) and no intervention was attempted for the rest as the gradient was not significant (10/52,19%). Nine patients underwent surgical repair (26/92, 28%). Five patients (14/92, 15%) were managed with no intervention based on CCTA findings and poor clinical prognosis. CONCLUSIONS: CCTA plays an important role in detecting paediatric PV stenosis and identifies additional findings compared to TTE that have direct surgical/interventional implications. CCTA complements TTE in imaging these patients and helps guide management.

Clinical profile of non-O1 strain-O139 of Vibrio cholerae in the region of Ambajogai, Maharashtra.

OBJECTIVES: To study clinical profile of the newly emerged novel strain non-O1, O139 of Vibrio cholerae, in the region of Ambajogai, District Beed of Maharashtra. METHODS: Out of 208 patients of acute gastroenteritis, 41 revealed to be positive for Vibrio cholerae by recommended method of stool examination. All the strains were sent to National Institute of Cholera and Infectious Diseases, Calcutta for confirmation. RESULTS: Out of 41 cases, 12 were of Vibrio cholerae O1, 29 Non-O1, of which nine found to be O139 strain. All patients were from 2-80 years of age with low-socioeconomic status and maximum incidence was in August (64.70%), presented with severe rice watery loose motions. Vomiting was observed in 26 (63.41%), more so in patients of O139 infection (88.88%) than four (33.33%) of O1 infection. Sweating was observed in three patients (33.33%) of O139 infection, cramps in gastrocnemis muscles in three patients (33.33%) of O139 infection and two (16.66%) of O1 infection. Signs of dehydration were mild to moderate in four patients (33.33%) of O1 infection; severe dehydration in six (66.66%), moderate in two (22.22%) and mild in one patient (11.11%) of O139 infection. While dehydration was severe in four (20%), moderate in one (5%) and mild in three patients (15%) of Non-O1 infection (excluding O139 cases). Clinical features were more severe in patients of serotype O139 than the patients of O1 and Non-O1 (excluding O139 cases). However all patients responded to intravenous fluids, oral rehydration and antibiotics (tetracycline) within 24-48 hours without any mortality. CONCLUSIONS: This study reflects the first emergence of Non-O1, strain O139 during the year 1997 with severe and critical clinical features in Ambajogai region causing high morbidity in the form of severe dehydration and peripheral circulatory collapse which requires early and correct diagnosis and prompt treatment.