Pulmonary atresia with intact septum: the use of Conquest Pro coronary guidewire for perforation of atretic valve and subsequent interventions.

OBJECTIVE: To determine the feasibility and safety of the Conquest Pro wire as an alternative to radiofrequency wire for perforation of atretic pulmonary valve and subsequent balloon dilatation and patent ductus arteriosus stenting in patients with pulmonary atresia with intact ventricular septum. BACKGROUND: Radiofrequency valvotomy and balloon dilatation has become the standard of care for pulmonary atresia with intact ventricular septum in many institutions today. METHODS: We report eight consecutive patients in whom we used the Conquest Pro coronary guidewire, a stiff wire normally reserved for revascularisation of coronary lesions with chronic total occlusion, for perforation of atretic pulmonary valve and subsequent balloon dilatation, and stenting of the patent ductus arteriosus. RESULTS: Perforation of atretic pulmonary valve was successful in seven out of eight cases. Radiofrequency valvotomy was employed after failure of perforation by the Conquest Pro wire in one case where the right ventricular outflow tract was broad based and tapered towards the pulmonary valve, and was heavily trabeculated. Failure of the Conquest Pro wire to perforate the pulmonary valve plate was mainly attributed by the failure to engage the wire at the correct position. CONCLUSION: The Conquest Pro wire for perforation and subsequent interventions in the more straightforward cases of pulmonary atresia with intact ventricular septum is effective and safe, simplifying the entire procedure. However, the radiofrequency generator and wires remain essential tools in the paediatric interventional catheter laboratory.

Urinary frequency: going beyond the tract.

Obsessive-compulsive disorder (OCD) is a common anxiety disorder which can be chronic and sustained. An OCD sufferer experiences intrusive and repetitive thoughts, impulses, and behaviors, which ultimately cause extreme discomfort. We report a case of a patient that primarily presented with lower urinary tract symptoms who was subsequently treated with antibiotics. Nonetheless, the symptoms persisted. In subsequent consultations, the patient clarified the compulsive nature of his symptoms and was treated as a case of OCD. Therefore, it is crucial for physicians to correctly identify the nature of the symptoms to manage the disorder properly and to avoid unnecessary consultation and treatment. To the best of our knowledge, this is the first report of other presentations of OCD.

The utilization of small amounts of residual endodontic material for dental identification.

Dental information is one of the three scientific methods of identifying a deceased person. However, when an investigator is faced with dental ante-mortem information that indicates the deceased has had all his teeth extracted, it may be assumed that the dental information will not be useful, especially if no retained roots are visible in the post-mortem triage. The following case report highlights that careful examination including radiography, may reveal specific detailed information which was useful for identification to be established. Two small radiopaque objects were located in the apical area where the upper left canine root apex would have been. The radiopacities size, location, positioning to both each other and to the left maxillary sinus corresponded to ante-mortem radiographs. This case reveals an unusual use of extruded root canal material being of evidential value even though the tooth was extracted.

Assessment of Nipah virus transmission among pork sellers in Seremban, Malaysia.

Between September 1998 and May 1999, 265 cases of encephalitis were reported from among those involved in pig rearing. A few cases were also reported among abattoir workers. This raised questions of the risk of transmission among those who handled raw pork. A serosurvey was conducted among pork sellers in Seremban town, which is about 20 km from one of the pig rearing areas which had reported cases of encephalitis. It was found that out of the 28 pork sellers tested, only one tested positive for Nipah virus antibodies and that this pork seller also worked in an abattoir in the same district, removing the urinary bladders from slaughtered pigs. Based on these findings, it was concluded that the risk of transmission of the virus from handling raw pork appeared to be low.

Spontaneous spinal epidural haematoma associated with aspirin intake.

Spontaneous spinal epidural haematoma (SSEH) is rare. No identifiable cause is found in the majority of cases, while anticoagulation accounts for up to 17 percent of cases. Aspirin-associated SSEH, however, has rarely been described in literature. A 62-year-old man on prophylactic aspirin presented with symptoms of acute cord compression due to spinal epidural haematoma that was confirmed on magnetic resonance imaging. An emergency decompression laminectomy was performed ten hours after the onset of his symptoms. No vascular anomaly was detected. Our patient recovered well and regained full motor and sensory function. Aspirin is unlikely to be the direct cause of SSEH but may predispose to it, with the underlying cause being a locus minoris resistentiae, consisting of a network of weakened epidural veins. Early diagnosis and treatment are essential for a successful outcome.

Identification of cytotoxic constituent of Indonesian sponge Kaliapsis sp. (Bowerbank).

Identification of cytotoxic constituent of Indonesian sponge Kaliapsis sp. has been conducted. The structure identification was judged based on the spectroscopic data, namely, ultraviolet, MS, one and two-dimensional 1H-NMR and 13C-NMR methods. The cytotoxic constituent was identified as 1-(tetrahydro-4-hydroxy-5-(hydroxymethyl)furan-2-yl)-5-methyl pyrimidine-2,4(1H,3H)-dione. This constituent hasn't been isolated from sponges as natural product.