Persistent left superior vena cava: An anatomical variation.

The persistent left superior vena cava (LSVC) is a common anomaly of congenital heart disease. The presence of LSVC is commonly associated with other congenital cardiac anomalies such as atrial septal defect, tetralogy of fallot, aortic coarctation, ventricular septal defect and very rarely it occurs as an isolated finding. During a routine dissection for undergraduate students, a persistent LSVC along with variation in anterior cardiac vein and right septal pouch (RSP) was observed in heart of an approximately 48-year-old male cadaver. The persistent LSVC was draining into the right atrium via coronary sinus. The persistent LSVC is usually insignificant haemodynamically as commonly it drains into right atrium via coronary sinus, but incidental finding of LSVC is important to surgeons, interventional nephrologists and radiologists before placement of central venous access device. The insertion of central venous catheter via left internal jugular vein is difficult in presence of persistent LSVC. The right superior vena cava was normal. An anterior cardiac vein joined with the right marginal vein to form a common vein. The common vein opened into the right atrium. We also observed a RSP attached to the limbus fossa ovalis inferiorly which is a kangaroo pouch-like structure. A septal pouch is potential site predispose to thrombus formation and is more common on left side. In this case report we discuss embryology, clinical significance and review of literature related to persistent LSVC, anterior cardiac vein and SP.

Normal pressure hydrocephalus after gamma knife radiosurgery for vestibular schwannoma.

Vestibular schwannomas are not uncommon, and gamma knife radiosurgery is one of the treatment options for symptomatic tumors. Hydrocephalus is a complication of gamma knife treatment of vestibular schwannoma, though the mechanism of the development of hydrocephalus remains controversial. We present an unusual case of normal pressure hydrocephalus (NPH) after gamma knife radiosurgery of a vestibular schwannoma in which the timeline of events strongly suggests that gamma knife played a contributory role in the development of the hydrocephalus. This is probably the first case of NPH post radiosurgery with normal cerebrospinal fluid protein. Communicating hydrocephalus should be treated with placement of shunt while non-communicating hydrocephalus can be treated with third ventriculostomy. Frequent monitoring and early intervention post radiosurgery is highly recommended to prevent irreversible cerebral damage.

Prevalence of diabetes mellitus among East Indians in Guyana - abstract

The objective of the study was to determine the prevalence of diabetes mellitus and impaired glucose tolerance (IGT) among Indo-Guyanese in a village in Guyana. A house-to-house survey revealed 278 households with 736 persons above 25 years of age. Excluding known diabetics, 451 of 717 persons (62.1 percent) agreed to undergo an oral glucose tolerance test (75 g of glucose). A two-hour capillary whole blood glucose was measured by reflectance meter and those with blood glucose o 140 mg/dl were retested next day for both fasting and 2-hour blood glucose values. Persons with a fasting blood sugar o 140 mg/dl or 2-hour blood glucose o 200 mg/dl were diagnosed as diabetic; IGT was diagnosed when fasting blood glucose level was < 120 mg/dl and 2-hour sample was between 140 and 200 mg/dl. Prevalence rates for known diabetics was 5.2 percent, for newly diagnosed diabetics 6.3 percent and for IGT it was 4.3 percent. Male to female ratio in diabetics for both known and newly diagnosed cases was 1:2.7. Between 45 and 64 years of age, age-specific prevalence rates for diabetes were 12.7 percent for known and 9.77 for new cases, with corresponding increase in rate for IGT to 7.1 percent. Conclusions: Diabetes mellitus was four to five times more common and IGT was about twenty-fold higher among Indo-Guyanese than in Indians living in India. A greater female susceptibility for diabetes mellitus was also noted. Between 45 and 64 years of age, diabetes mellitus was diagnosed more often, indicating that age is an important risk factor for diabetes mellitus among Indo-Guyanese (AU)