Auto-Pericardial Mitral Valve Implantation: A Pilot Study.

INTRODUCTION: Developing nations continue to grapple with rheumatic heart disease, particularly in the young. There is a need for an alternative to prosthetic mitral valve replacement in irreparable mitral valves, which avoids the need for anticoagulation and risks of thromboembolism. METHODS: Twelve (12) patients with irreparable severe mitral valve disease underwent auto-pericardial mitral valve implantation from August 2020 to February 2021. The mitral valve leaflets were excised. Autologous pericardium treated with 0.5% glutaraldehyde for 8 minutes was fashioned into anterior and posterior mitral leaflets as per the dimensions on an indigenously designed template based on the studies by Ranganathan and Lam. The pericardial leaflets were sutured onto an appropriately sized mitral annuloplasty ring. The ring with the leaflets was implanted onto the mitral annulus. The leaflets were supported with neo-chordae prepared with Gore-Tex (W L Gore and Associates, Inc. Newark, DE, USA) and polyester sutures to mimic a repaired mitral valve in its structure and dynamics. RESULTS: The mean cross-clamp time was 138±21.7 minutes. None of the patients required re-exploration. On the third postoperative day, a mean mitral valve orifice area of 3±0.47 cm and mean mitral valve gradient of 2±1.04 were observed. None of the patients had any more than 1+ mitral regurgitation. None of them have required a re-intervention for mitral insufficiency to date. DISCUSSION: Auto-pericardial mitral valve re-implantation is a safe and effective procedure for severe, irreparable, mitral valve pathologies. However, the mid-term and long-term results need to be compared with conventional mitral valve replacement with a prosthetic valve in a randomised controlled trial.

The String Puppet Technique to Improve Exposure in Totally Endoscopic Mitral Valve Surgery.

AIM: To determine the feasibility of the string puppet technique as a flexible, dynamic alternative to atrial retractors in totally endoscopic non-robotic mitral and tricuspid valve surgeries. METHOD: Fifty-one (51) consecutive patients were operated on for totally endoscopic mitral valve repair from July 2017 to February 2018. A 3 cm peri-areolar (males) or submammary (females) incision was placed on the right chest. The thoracic cavity was accessed via the fourth intercostal space. A temporary pacing wire was placed transcutaneously as a puppeteering sling in the thoracic cavity under endoscopic vision. Multicoloured sutures were used to expose the right atrium and interatrial septum by weaving and suspending the sutures on the sling. The sling was tightened to pull up the walls of the cardia and manipulate them externally, like a puppet on a string, to improve selective exposure. RESULTS: We were able to obtain adequate exposure of the mitral and tricuspid valves in all patients without the use of atrial retractors. No patient required conversion to sternotomy due to lack of exposure. None of our patients had postoperative mitral regurgitation of more than 1+ over a mean follow-up of 2 years. CONCLUSIONS: The string puppet technique improves exposure of mitral and tricuspid valves in totally endoscopic cardiac surgery. It is safe, effective, easy to perform, and inexpensive.

Effect of preferential solvation and bimolecular quenching reactions on 3OCE in acetonitrile and 1,4-dioxane binary mixtures by optical absorption and fluorescence studies.

Fluorescence quenching and preferential solvation of a coumarin derivative, namely 3-[2-oxo-2-(2-oxo-2H-chromen-3-yl)-ethylidene]-1,3-dihydro-indol-2-one (3OCE), with aniline used as a quencher in solvent mixtures of acetonitrile (AN) and 1,4-dioxane (DX) was carried out at steady state. Suppan's theory of dielectric enrichment was used to understand the nonideality and dielectric enrichment in AN-DX solvent mixtures. The effect of viscosity and dielectric constant variation at room temperature were analyzed. Quenching was characterized using Stern-Volmer plots with an upward curvature. It was found that 3OCE underwent combined static and dynamic quenching that was evident from the quenching rate parameters.

Effect of viscosity and dielectric constant variation on fractional fluorescence quenching analysis of coumarin dye in binary solvent mixtures.

Photo physical properties of fluorescent organic compounds give an immense improved knowledge on characteristics of excited state that is beneficial to devise innovate molecules and understand their performance in particular applications. Coumarin derivatives have been extensively investigated in this regard. This article narrates steady state fluorescence quenching measurements of a coumarin derivative namely 3-hydroxy-3-[2-oxo-2-(3-oxo-3H-benzo[f]chromen-2-yl)-ethyl]-1,3-dihydro-indol-2-one (3HBCD) in a binary mixture of acetonitrile and 1,4-dioxane. Aniline is used as quencher. Fluorescence intensity is large in acetonitrile and decreases as the percentage of 1,4-dioxane in the solvent mixture increases. With modest quencher concentration a deviation towards the x axis is noticed in the Stern-Volmer (S-V) plots. This downward curvature is interpreted as due to the presence of 3HBCD in different conformers in the lowest energy level. Ground state intramolecular hydrogen bonding formation is observed due to the conformational changes in the solute. Figured estimations of various quenching parameters recommend that, while dynamic quenching prompts linearity in S-V plot at lower quencher concentration, increasing quenching efficiency with increasing medium viscosity suggests that reaction is not entirely controlled by material diffusion. Stern-Volmer constant increases with decreasing medium dielectric constant.

Phyto-fabricated silver nanoparticles inducing microbial cell death via reactive oxygen species-mediated membrane damage.

Eco-friendly synthesis of the silver nanoparticles (AgNPs) has a number of advantages like simplicity, biocompatibility, low toxicity in nature over their physical and chemical methods. In the present study, the authors report biosynthesized AgNPs using the root extract of the perennial plant 'Spiny gourd' (Momordica dioica) and investigated their anti-bacterial application with mechanistic approaches. Different biophysical techniques such as UV-Vis spectroscopy, FTIR, XRD, TEM, SAED, and DLS were employed for AgNPs characterization. The synthesized AgNPs were polydispersed, crystalline in nature, with anionic surface (-22.3 mV), spherical in shape with an average size of 13.2 nm. In addition, the AgNPs were stable in room temperature and in different biological buffers. The anti-bacterial activities of AgNPs were studied with respect to the pathogens such as Bacillus subtilis, Staphylococcus aureus (Gram-positive), Pseudomonas aeruginosa, Escherichia coli, Klebsiella planticola (Gram-negative), and Candida albicans. Also, mechanistic studies of AgNPs such as protein leakage assay, nucleic acid leakage assay, ATP leakage assay, ROS accumulation, determination of biofilm degrading activity, measurement of potassium, showing that the synthesized AgNPs are capable of containing a potential application in the antimicrobial therapeutic agents and the pharmaceutical industry.

Re-do pericardial reconstruction of the aortic valve in Brucella endocarditis.

We report a 12-year-old boy who had undergone an auto-pericardial aortic valve implantation 3 years ago for rheumatic aortic regurgitation. He presented with Brucella endocarditis of the auto-pericardial leaflets with new-onset severe aortic regurgitation, congestive cardiac failure and systemic sepsis. He had an aortic root abscess with multiple pseudoaneurysms in relation to the aortic sinus. Following medical stabilisation, he underwent re-do surgery with debridement of the root abscess, closure of the pseudoaneurysms, excision of the auto-pericardial aortic leaflets and reconstruction of the aortic valve with donor pericardium. He had an uneventful recovery and is asymptomatic on follow-up.

Aberrant Aortopulmonary Venous Fistula: An Intraoperative Surprise.

An isolated systemic artery to pulmonary vein arteriovenous fistula is a rare clinical entity. We report a 20-year-old woman diagnosed with myxomatous mitral valve prolapse with severe mitral regurgitation and planned for mitral valve repair. An aberrant aortopulmonary venous fistula was suspected intraoperatively due to flooding of the left atrium with blood from the left inferior pulmonary vein on cardiopulmonary bypass. The mitral valve was repaired successfully. A postoperative computed tomography angiogram revealed an anomalous fistula between the descending thoracic aorta and left inferior pulmonary vein. The patient underwent successful percutaneous device closure of the fistula.

Bi-modal radiofrequency treatment for coexisting neuralgia and neuropathy in adjacent divisions of the trigeminal nerve.

Trigeminal neuralgia and deafferentation neuropathic pain, or trigeminal neuropathy, are different symptomatologies, rarely reported to present together. The case of a 65-year-old gentleman suffering from trigeminal neuralgia of the maxillary and mandibular division is reported. He first underwent an infraorbital neurectomy that was complicated by deafferentation neuropathic pain, whilst his mandibular neuralgia continued. He was treated successfully for both the neuropathic and neuralgic symptoms in the same session using ultra-extended euthermic pulsed radiofrequency treatment for the maxillary division (V2) and radiofrequency thermocoagulation for the mandibular division (V3). This report is novel in describing the use of dual modalities in the same session for two distinct coexisting clinical entities in two different divisions of the same cranial nerve. The use of ultra-extended pulsed radiofrequency treatment for neuropathic pain in this case is also unique. Nearly 2years after the procedure, the patient continues to have complete pain relief.

Fluorescence of Candida in diagnosis of oral candidiasis.

BACKGROUND: Many pathogenic fungi fluoresce in hematoxylin and eosin stained sections, and Papanicolaou (PAP)-stained smears under ultraviolet illumination. In theory, this phenomenon could aid in the diagnosis of common fungal infections without the delay which is usually associated with special stains. OBJECTIVE: To evaluate the role of fluorescence as a rapid screening technique for oral infections caused by Candida organisms in exfoliative smears of oral candidiasis. MATERIALS AND METHODS: Two smears and one swab were collected from each of 62 clinically diagnosed cases of oral candidiasis. Smears were stained with (PAP) and periodic acid-Schiff stain (PAS). Both smears were evaluated under light microscopy (LM). Later, PAP smears were observed under fluorescent microscopy (PAP-FM). The swab was inoculated on Sabouraud's agar plate. Each technique was evaluated for sensitivity and specificity. RESULTS: It was found that the PAS-stained smears were more reliable for detection of Candida species than other methods (sensitivity = 100%; specificity = 66.7%). The PAP-LM and PAP-FM showed less sensitivity (67.9% and 85.7%) and specificity (66.7% and 33.3%), respectively. Combined results of both light and fluorescent microscopy of PAP (LM + FM) showed increased sensitivity (89.3%) but reduced specificity (16.7%). CONCLUSION: PAP autofluorescence is less sensitive than PAS, still it accentuates the distinct morphological features of Candida.

Atrial natriuretic factor activates membrane-bound guanylate cyclase of chief cells.

The present study examined the effect of atrial natriuretic factor (ANF) on cGMP generation by dispersed chief cells from guinea pig stomach. ANF caused a rapid dose-dependent increase in cGMP, a 7-fold increase in cGMP caused by 1 microM ANF, with or without 3-isobutyl-1-methylxanthine present. Methylene blue reduced cGMP in response to nitroprusside but not ANF. Guanylate cyclase activity of a chief cell membrane fraction doubled in response to ANF, but was not affected by nitroprusside. ANF had no effect on guanylate cyclase activity of the soluble fraction of lysed chief cells. Dose-response curves for whole cell cGMP production and membrane guanylate cyclase activity in response to ANF were closely related. These data indicate that ANF increases chief cell cGMP production by activating particulate guanylate cyclase, providing functional evidence that chief cells possess surface membrane receptors for ANF.

Fine-needle aspiration cytology of sinus histiocytosis with massive lymphadenopathy: a case report.

Cytological findings of sinus histiocytosis with massive lymphadenopathy (SHML), involving bilateral cervical lymph nodes of a 12-yr-old boy, are presented here. A striking feature was the presence of large histiocytes with abundant pale cytoplasm containing well-preserved lymphocytes, plasma cells, and occasional neutrophils, scattered in a background of reactive lymphoid cells. Subsequent open biopsy of the lymph node mass confirmed the cytologic findings. Cytologic features of SHML are virtually diagnostic and can negate the need for an open biopsy in most cases.

Cytologic diagnosis of a melanotic neuroectodermal tumor of infancy occurring in the cranial bones.

Melanotic neutroectodermal tumor of infancy (MNTI) is a rare, usually benign tumor commonly occurring in the maxilla. MNTIs at unusual sites like the cranium clinically mimic malignant small round cell tumors. Consequently, a correct preoperative cytologic diagnosis of MNTI at these sites helps in the surgical management of the patient. We report on a cytologically diagnosed case of MNTI in the frontotemporal region of the skull in an infant. Aspirates from the lesion were cellular, with a bimodal population mainly of small neuroblast-like cells admixed with a few large epithelioid cells with melanin granules. In the present case, following the cytologic diagnosis a wide local excision was carried out, and the histologic examination confirmed the cytologic diagnosis. Diagn. Cytopathol. 1999;21:280-283.

Fine needle aspiration of tophi for crystal identification in problematic cases of gout. A report of two cases.

BACKGROUND: The definitive diagnosis of gout is best established by demonstration of monosodium urate (MSU) crystals in the synovial fluid or biopsy. Fine needle aspiration cytology (FNAC) of tophi can play a crucial role in diagnosis. CASES: A 36-year-old chronic alcoholic male developed subcutaneous nodules on both malleoli without a history of arthropathy and with normal serum uric acid levels. FNAC of the nodules demonstrated stacks and sheaves of needle-shaped crystals of MSU. A 50-year-old diabetic male developed multiple nodules on the feet. He gave a past history of painful athropathy. A roentgenogram of the feet was suspicious for gout; however, joint aspiration failed, and the serum uric acid levels were normal. At this juncture FNAC of the feet tophi clinched the diagnosis of gout. In both cases, polarization of needle washings (wet mount) and the fixed, Papanicolaoustained smears showed negatively birefringent, needle-shaped crystals of MSU, thus confirming the diagnosis of gout. CONCLUSION: FNAC of gouty tophi is an easy alternative to synovial biopsy and joint fluid analysis. It is simpler, easier and less painful. As crystals are preserved in stained smears, they can be employed for polarization and confirmation of gout.

Cytodiagnosis of simple and proliferating trichilemmal cysts.

OBJECTIVE: To elucidate the cytologic findings in simple trichilemmal (pilar) cysts and proliferating trichilemmal cysts (pilar tumors) and the clinical importance of these lesions. STUDY DESIGN: Aspirates from 12 simple pilar cysts and three pilar tumors, all histologically confirmed, were analyzed with a view to elaborating on specific cytologic features enabling a distinction from epidermal cysts and other adnexal tumors. RESULTS: Aspirates from pilar cysts showed two different pictures, depending on the age of the cyst. Young pilar cysts showed aspirates with an abundant background of blotchy keratin with or without calcification and inflammation. Older (degenerating) cysts showed oily fluid debris with cholesterol crystals and inflammatory cells. The epithelial component was sparse, and only an occasional syncitial cluster of small squamoid cells was seen. As opposed to this, epidermal cysts usually showed a cleaner background, with very cellular aspirates containing many nucleate and anucleate squames, keratin flakes, platelike crystals and no calcification. The pilar tumors showed a lesser amount of keratin as compared to pilar cysts and yielded large and small clusters of squamoid and basaloid cells, a few of which showed an abrupt association with anucleate, keratinized globules. CONCLUSION: The cytologic diagnosis of a pilar cyst should be made especially in scalp cysts, which yield either abundant, blotchy keratin or oily, cholesterol-rich debris with a sparse epithelial component and which lack a mixture of anucleate and nucleate squames. On aspiration, pilar tumors yield comparatively more cells and less keratin and show small, basaloid or squamoid cells abruptly associated with keratin globules. The cytologic diagnosis of pilar cysts is important because these cysts recur if incompletely excised and often undergo transformation to pilar tumors. Similarly, pilar tumors often clinically mimic squamous carcinomas, and hence there is a need to outline definitive cytologic features.

Ectopic ovarian pregnancy--a case report.

Ectopic pregnancy is an increasingly important health problem. We report a rare ovarian ectopic pregnancy which was diagnosed clinically and confirmed pathologically.

Pediatric liquid medicaments - Are they cariogenic? An in vitro study.

AIM: Young and chronically sick children receive a variety of oral liquid medications on a routine and regular basis. These pharmaceutical preparations are cariogenic and acidogenic in nature. Hence, the present study was taken up to determine the cariogenic potential of the commonly prescribed pediatric liquid medicaments. MATERIALS AND METHODS: Eight commonly used pediatric liquid medicaments (PLM) were selected and their endogenous pH was measured using a pH electrode meter. The sugar content in them was estimated using High Performance Liquid Chromatography (HPLC). The effect of PLM on Streptococcus mutans was assessed by the ditch plate method. RESULTS: The pH of the liquid medicaments ranged between 6.05 (Salbid(®)) and 7.71 (Theopid(®)). Sucrose was observed in 7 PLM and glucose in 5 PLM. The highest concentration of sucrose was seen in Crocin(®). The lowest concentration of sucrose was seen with Althrocin(®). Both the antibiotic PLMs inhibited the S. mutans growth. Zevit(®) promoted the growth of S. mutans. CONCLUSION: The pH and concentration of sugars of pediatric liquid medicaments can pose as a threat to dental health, especially in chronically sick children, who are on long-term medications.

Sinus pericranii presenting with macrocephaly and mental retardation.

We present a rare case of right parietal sinus pericranii in a 2-year-old female child who presented with a compressible swelling on the right side of the scalp since 3 months of age, with a large head. Magnetic resonance imaging along with venography and conventional angiogram was performed, which confirmed the diagnosis.

A forgotten foreign body in the frontal sinus.

A 46-year-old female patient presented with a discharging wound over the nasal bridge, near the medial end of the right eyebrow of 2 months duration. She did not give any history of trauma or surgery in the past. Wound exploration showed a glass piece in the floor of the right frontal sinus. After showing the glass piece, patient remembered road traffic accident she had at the age of 18 years. Patient was asymptomatic for 28 years.To our knowledge, this is the longest retained case of asymptomatic foreign body in the frontal sinus reported in the world literature. Case report and a review of literature concerning foreign body in the frontal sinus are presented.