Mandibular primary intraosseous carcinoma arising from long-standing odontogenic keratocyst.

Primary intraosseous carcinoma (PIOC) of the jaw is a rare neoplasm arising from the lining epithelium of odontogenic cysts or de novo from odontogenic epithelial rests that has no communication with the surrounding mucosa of the upper aerodigestive tract. We present a case of PIOC ex-odontogenic keratocyst (PIOC ex-OKC) in a 35-year-old male. Histopathologic examination revealed a cystic lesion with a fibrous capsule lined by corrugated parakeratinized stratified squamous epithelium resting on a basal cell layer composed of columnar cells exhibiting palisaded hyperchromatic nuclei, features consistent with OKC. Surgical treatment consisted of bilateral crestal and crevicular incision, a reflection of the flap, breaking of all OKC locules, creation of a continuous cavity, and fitting of a decompression mold around the mandibular teeth. This case highlights the importance of knowing the features of PIOC and considering PIOC in the differential diagnosis of malignant tumors of odontogenic epithelium for timely surgical treatment.

Ross procedure in neonates and infants: A valuable operation with defined limits.

OBJECTIVE: The Ross procedure is an important tool that offers autologous tissue repair for severe left ventricular outflow tract (LVOT) pathology. Previous reports show that risk of mortality is highest among neonates and infants. We analyzed our institutional experience within this patient cohort to identify factors that most affect clinical outcome. METHODS: A retrospective chart review identified all Ross operations in neonates and infants at our institution over 27 years. The entire study population was analyzed to determine risk factors for mortality and define outcomes for survival and reintervention. RESULTS: Fifty-eight patients underwent a Ross operation at a median age of 63 (range, 9-156) days. Eighteen (31%) were neonates. Eleven (19%) patients died before hospital discharge. Multiple regression analysis of the entire cohort identified young age (hazard ratio [HR], 1.037; P = .0045), Shone complex (HR, 17.637; P = .009), and interrupted aortic arch with ventricular septal defect (HR, 16.01; P = .031) as independent predictors of in-hospital mortality. Receiver operating characteristic analysis (area under the curve, 0.752) indicated age younger than 84 days to be the inflection point at which mortality risk increases. Of the 47 survivors, there were 2 late deaths with a mean follow-up of 6.7 (range, 2.1-13.1) years. Three patients (6%) required LVOT reintervention at 3, 8, and 17.5 years, respectively, and 26 (55%) underwent right ventricular outflow tract reintervention at a median of 6 (range, 2.5-10.3) years. CONCLUSIONS: Ross procedure is effective in children less than one year of age with left sided obstructive disease isolated to the aortic valve and/or aortic arch. Patients less than 3 months of age with Shone or IAA/VSD are at higher risk for morbidity and mortality. Survivors experience excellent intermediate-term freedom from LVOT reintervention.

Review of cysticercosis of maxillofacial region and report of two cases.

Cysticercosis is a parasitic infection caused by the larval stage of Taenia solium, which very rarely manifests in the maxillofacial region. It usually presents as a painless swelling. The most common site for maxillofacial cysticercosis are the tongue and lips. When humans accidently ingest the eggs of Taenia solium, they become the intermediate host, a role which is typically played by pig. This paper describes two cases of cysticercosis cellulosae, presenting as non-tender swelling of left buccal mucosa and left temporalis region respectively. Case reports available on PubMed were searched and a review was performed. Excision of cystic lesion was the treatment modality in majority of published reports. It is emphasised that cysticercosis should be considered in differential diagnosis of solitary painless swellings of oral and maxillofacial region, especially in patients from an endemic region.

Outcomes of Reintervention on the Autograft After Ross Procedure.

BACKGROUND: After a Ross procedure, a small subset of patients requires reintervention for autograft dilatation or valve insufficiency. We sought to determine the indications, nature, and outcomes of autograft reinterventions in the left ventricular outflow tract after a Ross procedure. METHODS: We retrospectively reviewed the charts of 316 consecutive patients, age 4 days to 70 years, who underwent a Ross procedure at our institution. Of these, 47 patients (15%) required autograft reintervention during a median follow-up of 8.2 years. RESULTS: Forty-seven patients, median age 26 years (interquartile range [IQR], 14.4 to 44.8 years), 32 (68%) men, required autograft reintervention a median 5.5 years (IQR, 1.8 to 9.4 years) after a Ross procedure. In 47% (22 of 47 patients), the autograft valve could be salvaged (15 valve-sparing aortic replacements, 7 valve repairs). The remaining 53% underwent replacement of the root (10 mechanical, 5 homograft) or valve alone (7 mechanical, 3 bioprosthetic). Twenty patients presented without autograft root dilatation 1 year (IQR, 0.5 to 2.9 years) after Ross. Fifteen of them (75%) required valve replacement. The 27 patients who demonstrated root dilatation presented 6.9 years (IQR, 4.5 to 9.7 years; p < 0.01 compared with the nondilated group) after Ross, and 17 (63%) of these valves could be spared (p = 0.01). There was no surgical mortality and 5 (11%) major morbidity events. Patients were followed up for 4.9 years (IQR, 2.1 to 7 years) after left ventricular outflow tract reintervention. For patients whose autograft valve could be spared, 3-, 5-, and 8-year freedom from valve replacement was 92%, 86%, and 86%, respectively. At last follow-up, only 1 patient had greater than mild aortic insufficiency, and all but 1 had normal ejection fraction. CONCLUSIONS: Autograft reintervention after a Ross appears to follow a bimodal distribution. Patients with primary autograft leaflet problems tend to present early without root dilatation and frequently require valve replacement. The autograft valve can be salvaged in the majority of patients who present later with root dilatation. Valve-sparing procedures are durable in the intermediate term and can be accomplished with low morbidity.

Knowledge of Staff Nurses Regarding Immediate Post-Operative Management of Patients Who Have Undergone Commando Surgery.

A descriptive survey was conducted on 60 staff nurses working in Cancer Hospital & Research Institute, Gwalior to identify their knowledge regarding immediate post-operative managemeht of the patients who have undergone Commando surgery. Majority of staff nurses (about 83% of them BSc Nsg), were in the age group of 21-30 years. Staff nurses had good knowledge regarding immediate post-operative Commando care. Comparison of mean, SD and mean percentage of the knowledge showed the highest mean score was 18.64 ± 4.72 which was 54.82 percent of total score obtained by the staff nurses belonging to 1 to 5 year clinical experience, similar to the mean score 18.64 ± 4.72 obtained by the staff nurses had experience less than one year. Lowest mean score of 39.70 percent (13.5 ± 3.53) was obtained by the staff nurses with over 10 years' experience; however for 6-10 years clinical experience, the mean score obtained was 24. Hence it can be interpreted that the staff nurses having less experience have more knowledge. It may be due to gap of education or lack of in-service education programme. No significant association was found between knowledge score and age, sex, education qualification, total clinical experience, oncological ward experience, CNE attended (p>0.05).

Age-Related Outcomes of the Ross Procedure Over 20 Years.

BACKGROUND: The Ross procedure is an alternative for patients with aortic valve disease not amenable to repair. Long-term follow-up after a Ross has demonstrated the need for autograft (left ventricular outflow tract [LVOT]) and homograft (right ventricular outflow tract [RVOT]) reinterventions. We assessed the age-stratified outcomes of the LVOT and RVOT after the Ross procedure performed by a single surgeon during a 20-year period. METHODS: We retrospectively reviewed 305 consecutive patients aged 4 days to 70 years, stratified by age younger than than 1 (n = 41), 1 to 10 (n = 85), 10 to 20 (n = 84), 20 to 40 (n = 59), and older than 40 years (n = 36). Median follow-up was 8.2 years (interquartile range, 1 month to 19.2 years). Primary end points were survival and freedom from reintervention on the LVOT and RVOT. Outcomes were compared by Kaplan-Meier analysis. RESULTS: A total of 173 patients (57%) had prior intervention on their aortic valve, 95 (31%) had isolated regurgitation, 91 (30%) had stenosis, and 119 (39%) had mixed pathology. There were 92 concomitant procedures (43 congenital lesions, 18 aorta, 9 mitral valve). In-hospital morbidity was 11.5% (35 of 305); mortality was 3.6% (11 of 305) and highest in infants. Need for an emergency operation (p < 0.05) predicted mortality in infants. The LVOT reintervention rate was lowest in infants compared with older patients (p < 0.05); conversely, age was directly related to RVOT reintervention (p < 0.01). Autograft encasement in a Hemashield (Atrium, Hudson, NH) tube in patients aged older than 10 years improved 5-year freedom from reintervention on the LVOT from 81% to 91% (p < 0.001). At last follow-up, aortic insufficiency was mild or less in 290 (95%) patients, and heart function was normal in 285 (93%). CONCLUSIONS: The Ross procedure is a safe, effective, and anti-coagulation-free alternative for aortic valve replacement across all age groups. Long-term survival and preservation of heart function are highly favorable. Surgical mortality is related to salvage procedures in infants. When feasible, autograft durability can be improved by using a Hemashield graft for support.

Ostial left main stenosis due to takayasu arteritis: multimodality imaging and surgical ostioplasty.

Takayasu's arteritis is an inflammatory process, involving larger blood vessels-namely the aorta and its branches. The majority of these patients present with symptoms of vascular obstruction. We report a case of a 38-year-old Chinese female who presented with one month history of angina pectoris as the initial manifestation. Coronary angiography showed 99% ostial left main coronary stenosis. The diagnosis was first suspected in the operating room by TEE and subsequently supported by laboratory studies and aortic biopsy. The technique of myocardial revascularization was altered and she underwent patch ostioplasty of the left main coronary artery and aortic valve repair to correct aortic regurgitation.

Left ventricular pseudoaneurysm due to embolic myocardial infarction in infective endocarditis: real time three-dimensional transesophageal echocardiographic evaluation.

We report a case of a 63-year-old woman who presented with infective endocarditis and developed a pseudoaneurysm (PA) of the left ventricle presumably as a result of an embolic infarct. The diagnosis was made by typical features of PA on tranesophageal echocardiography and color Doppler studies. In addition, three-dimensional transesophageal echocardiography showed the narrow neck of the PA. Findings were confirmed at surgery and she was discharged after successful repair.

The role of cardiovascular computed tomographic angiography for coronary sinus mitral annuloplasty.

BACKGROUND: The coronary sinus (CS) travels in close proximity to the left circumflex (LCX) artery. Percutaneously placed CS devices used to treat mitral regurgitation (MR) therefore have the potential to impinge upon the LCX arterial distribution and compromise coronary flow. OBJECTIVES: In this study, we sought to analyze the anatomic relationship between the CS, LCX and mitral annulus (MA) in patients with right dominant (RCD), left dominant (LCD) and codominant (CCD) arterial systems using a novel systematic approach. METHODS: We retrospectively studied 102 normal patients (46 females) and 27 consecutive patients (5 females) with ischemic severe MR. All patients underwent cardiovascular computed tomographic (CCT) angiography with a 64 multidetector scanner for clinical indications. Images were analyzed using a GE Advantage workstation, version 4.4, capable of advanced image processing and manipulation. RESULTS: In patients with a normal mitral valve, the LCX initially crossed under the coronary sinus/great cardiac vein (CS/GCV) in 74% with RCD, 83% with LCD and 97% with CCD. In patients with ischemic severe MR, the LCX initially crossed under the CS/GCV in 96%. CONCLUSIONS: The majority of patients, especially those with a CCD, have the LCX initially coursing under the CS/GCV. CCT data analysis using our newly established method is an excellent tool to evaluate the anatomic course of the LCX in patients being evaluated for percutaneous CS device placement.

Vagal-sparing esophagectomy: the ideal operation for intramucosal adenocarcinoma and barrett with high-grade dysplasia.

OBJECTIVE: Our aim was to compare outcome of vagal-sparing esophagectomy with transhiatal and en bloc esophagectomy in patients with intramucosal adenocarcinoma or high-grade dysplasia. SUMMARY BACKGROUND DATA: Intramucosal adenocarcinoma and high grade dysplasia have a low likelihood of lymphatic or systemic metastases and esophagectomy is curative in most patients. However, traditional esophagectomy is associated with significant morbidity and altered gastrointestinal function. A vagal-sparing esophagectomy offers the advantages of complete disease removal with the potential for reduced morbidity and a better functional outcome. METHOD: Retrospective review of outcome in patients with intramucosal adenocarcinoma or high grade dysplasia that had a vagal-sparing (n=49), transhiatal (n=39) or en bloc (n=21) esophagectomy. RESULTS: The length of hospital stay and the incidence of major complications was significantly reduced with a vagal-sparing esophagectomy compared with a transhiatal or en bloc resection. Further, postvagotomy dumping and diarrhea symptoms were significantly less common, and weight was better maintained postoperatively with a vagal-sparing esophagectomy. Recurrent cancer has developed in only 1 patient. CONCLUSION: Survival with intramucosal adenocarcinoma or Barrett's with high-grade dysplasia is independent of the type of resection. A vagal-sparing esophagectomy is associated with significantly less perioperative morbidity and a shorter hospital stay than a transhiatal or en bloc esophagectomy. Further, late morbidity including weight loss, dumping, and diarrhea are significantly less likely after a vagal-sparing approach. Consequently a vagal-sparing esophagectomy is the preferred procedure for patients with intramucosal adenocarcinoma or high grade dysplasia.