Left ventricular mass regression after aortic valve replacement with the TTK Chitra™ monoleaflet tilting disc valve

Objective

To study the extent of left ventricular (LV) mass regression in aortic stenosis after aortic valve replacement with the TTK Chitra™ tilting disc valve.

Methods and materials

This study included patients with severe isolated aortic stenosis (AS), admitted in our department. They had aortic valve replacement (AVR) with the TTK Chitra™ tilting disc valve, between January 2008 and December 2010. Data were collected from consecutive forty-eight patients. LV mass and diametric and functional parameters were recorded preoperatively and compared with echocardiography after 3 months, 6 months, then yearly, up to 3 years.

Results

70.8% of the patients were males and 29.2% were females. The mean duration of illness was 37.92 ± 25.87 months. The mean LV ejection fraction increased 3 months after surgery (61.56 ± 10.10% to 69.31 ± 9.34%) with a sustained increase for the next 3 years. The mean LV end-diastolic diameter decreased (50.16 ± 6.05 mm to 45.69 ± 5.93 mm) after 3 months of surgery, with a sustained decrease for the next 3 years. The mean LV end-systolic diameter decreased (32.84 ± 6.96 mm to 29.41 ± 5.86 mm) after 3 months of surgery and then showed a sustained decrease for the next 3 years. The LV mass assessed with echocardiography regressed from 324.65 ± 97.77 g before surgery to 252.64 ± 71.12 g after 3 months and then showed a sustained decrease over the next 3 years.

Conclusion

Significant LV mass regression occurred after AVR with the TTK Chitra™ valve. The maximum reversal was found to be within the first 3 months after surgery with sustained beneficial improvement for the next 3 years.

The association of hyperhomocysteinemia with acute post-operative complications following coronary artery bypass grafting

BACKGROUND

Hyperhomocysteinemia is associated with an increased risk for cardiovascular diseases. The influence of hyperhomocysteinemia on post-operative events, after coronary artery bypass surgery graft, is less studied.

METHODS

This cross-sectional study aimed to determine if hyperhomocysteinemia was associated with post-operative complications in patients < 50 years who underwent off-pump coronary artery bypass graft for coronary artery disease. A set of major post-operative complications were considered as primary outcome measures. The independent effect of hyperhomocysteinemia and other risk factors in the incidence of post-operative complications was determined by multivariate analysis.

RESULTS

The mean homocysteine levels among the study participants who had post-operative complications were significantly higher than those without post-operative complications (17.37 mmol/L vs. 12.84 mmol/L). On multivariate analysis, hyperhomocysteinemia, diabetes mellitus, and higher body mass index (> 25) were significant predictors of adverse events during the post-operative period.

CONCLUSION

Hyperhomocysteinemia was a significant predictor of immediate post-operative adverse events after coronary artery bypass surgery graft. Necessary precautions and management strategies have to be evolved for these high-risk subsets.

Measuring Severity of Attributes That Create Vulnerabilities in Websites and Software Applications Using Two Way Assessment Technique

Inadequacies and faults that are the reason of vulnerabilities are hazardous for the websites. The authors' chief intention is to trim down those assailon websites by restraining the attributes accountable for these assails. This article categorizes those cases/ attributes into 10 categories and arranges them inpriority according to their severity. These attributes influence which contributes to losses in terms of monetary as well as humanity. By prioritizing these attributes, web designers as well as users will check twice on these aspects before entering confidential information into the website. The opinion of different web designers and experts of different companies was captured to prioritize these attributes using an analytical hierarchical process and two way assessment methods so that the loss should be minimized. Research confirms that total severity measure aids the severities of these attribute's contribution towards vulnerabilities. The findings of the two way assessment technique show that there is only one such attribute which happens to be extremely severe in comparison to other attributes and needs imperative consideration while designing websites and also by users before entering their confidential credentials on a website to curtail the losses caused by black hat guys.

Primary malignant intestinal lymphoma

BACKGROUND

Primary malignant intestinal lymphoma is an uncommon gut malignancy. Its incidence has been increasing over the past century. We in this study attempt to define its clinico-pathological profile and to share our experience with multidisciplinary approach to management.

METHODS

Our experience of seven patients with a diagnosis of primary intestinal lymphoma over a period of 22 months is presented here. All the cases were followed up prospectively over a period varying from 8 months to 20 months.

RESULTS AND CONCLUSIONS

Of the 7 patients 4 were males and 3 females (mean age 56.3 years). Acute intestinal obstruction was the commonest presentation. Imaging modalities revealed abnormality in all the cases but were rarely diagnostic. Most patients presented at an early stage when the disease was confined to the bowel. The commonest site was the large intestine (42.6%) especially the caecum. Diffuse large cell, high grade tumour were found to be the commonest histological type. Surgery followed by adjuvant chemotherapy gave good results.