Doppler Ultrasound under Image Denoising Algorithm in the Diagnosis and Treatment of Fetal Growth Restriction Using Aspirin Combined with Low-Molecular-Weight Heparin

Objective. This study explored the clinical application value of image denoising algorithm combined with Doppler ultrasound imaging in evaluation of aspirin combined with low-molecular-weight heparin (LMWH) on fetal growth restriction (FGR). Method. A two-stage image denoising by principal component analysis (PCA) with local pixel grouping (LPG-PCA) denoising algorithm was constructed in this study. Eighty FGR pregnant women were included in the study, and they were rolled into an experimental group (aspirin enteric-coated tablets + LMWH calcium injection) and a control group (LMWH calcium injection) according to the different treatment plans, with 40 cases in each group. All patients were performed with Doppler ultrasound imaging. The blood flow parameters (BFPs) were recorded and compared before and after the treatment in two groups, including power index (PI), resistance index (RI), high systolic blood flow velocity (S), high diastolic blood flow velocity (D), S/D value, and peak systolic velocity (PSV). In addition, the middle cerebral artery (MCA) BFPs, cerebral placental rate (CPR), amniotic fluid index (AFI) and perinatal outcome (PO) of the two groups were compared. Results. The total effective rate of treatment in group A (87.5%) was greatly higher than that in group B (62.5%), showing statistical difference (P < 0.05). The PI (0.72 ± 0.19), RI (0.57 ± 0.17), and S/D values (2.26 ± 0.43) in group A were dramatically lower than those in group B, which were 0.92 ± 0.21, 0.75 ± 0.14, and 2.64 ± 0.45, respectively (P < 0.05), and the AFI was higher (13.71 ± 2.2 cm vs 11.38 ± 2.16 cm) (P < 0.05). The Apgar score (9.17 ± 0.26), weight (3.57 ± 1.08), and gestational age (38.85 ± 2.50) of group A were all higher in contrast to those of group B, which were 7.33 ± 0.25, 2.61 ± 1.13, and 36.18 ± 2.25, respectively (P < 0.05). In addition, the fetal double parietal diameter (2.4 ± 0.9 mm), femur diameter (2.2 ± 0.6 mm), head circumference (1.2 ± 0.4 mm), abdominal circumference (1.3 ± 0.7 mm), and uterine height (0.8 ± 0.3 mm) in group A were obviously superior to those in group B, which were 1.8 ± 0.4 mm, 1.7 ± 0.5 mm, 0.8 ± 0.2 mm, 0.9 ± 0.4 mm, and 0.4 ± 0.6 mm, respectively, showing statistically observable differences (P < 0.05). Conclusion. Doppler ultrasound based on image denoising algorithm can accurately evaluate the effect of aspirin combined with LMWH on the improvement of FGR and showed good application value.

Mimic high lateral myocardial infarction in chest tetany with mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary spasm; dramatic Oxygen reversal

Rationale: Tetany is a common, serious, well-established endocrinal and metabolic hypocalcemic disorder. Chest tetany is a novel metabolic term in hypocalcemia characterized by acute severe twisting chest pain. Movable phenomenon (Yasser’s phenomenon) is a new phenomenon that is usually associated with hypocalcemia. oxygenation may have a role in the management of coronary artery spasm. Patient concerns: A middle-aged farmer smoker male patient presented to physician outpatient clinic with tetany, mimic high lateral myocardial infarction, mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary artery spasm. Diagnosis: Mimic high lateral myocardial infarction in chest tetany with mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary artery spasm. Interventions: Electrocardiography, oxygenation, IV calcium injection, and echocardiography. Outcomes: Acute dramatic clinical and electrocardiographic improvement had happened. Lessons: The reversal of mirror electrocardiographic change, reversal of ST-segment depression coronary artery spasm, and normalization of Movable phenomenon (Yasser’s phenomenon) after oxygenation. It signifies the role of oxygen in both coronary artery spasm and tetany. Mirror local electrocardiographic change is a novel described expression that may reflect the myocardial polarity in this chest tetany.

Usefulness of selective arterial calcium injection tests for functional pancreatic neuroendocrine tumors

The selective arterial calcium injection (SACI) test is useful for patients with functional pancreatic neuroendocrine tumors (F-PNETs). This study evaluated which patients with F-PNETs would benefit from the SACI test. We retrospectively analyzed the preoperative findings of patients on computed tomography (CT), magnetic resonance imaging (MRI), CT angiography (CTA), and the SACI test. Fourteen patients who underwent pancreatectomy between January 1997 and September 2016 for F-PNETs were evaluated. We classified these patients into groups A, B, and C; group A, one tumor detected by either CT or MRI; group B, multiple tumors detected; and group C, the tumor location was accordant on CT, MRI, and CTA, but the SACI test revealed another tumor. In group A, the tumor was also detected by CTA and the SACI test was positive on calcium injection. In group B, the focus tumor among the multiple tumors was detected by the SACI test. In group C, another tumor was identified by the SACI test, whose location was different from that detected using CT and MRI. The SACI test is more useful for multiple F-PNETs on CT or MRI. If CT or MRI detects a single tumor, the SACI test or CTA may be unnecessary.

Cardiac Surgery without Donor Blood Transfusion at a Referral Cardiac Institute in Bangladesh

Background: Blood transfusion is always associated with some hazards despite economic and work burden on laboratory staffs. Pre-donation and blood conservation can help to avoid transfusion related hazards with good posto-perative outcome. Objective: The main objective of this study was to show the varieties of cardiac surgery without donor blood transfusion. Methodology: Patients were selected conveniently. Preoperative proper counseling was done to the guardians of minor and all the adult patients about the procedure and written informed consent was taken accordingly. All patients were operated under cardio-pulmonary bypass (CPB) following a standard protocol through mid-sternotomy, systemic heparinization, antegrade intermittent cold cardioplegic arrest of the heart. After weaning from CPB protamine was administered to neutralize the action of heparin. A pre-operative hemoglobin (Hb) and hematocrit (Hct) measured just before systemic heparinization. One bag of blood drawn from the patient’s body when the Hb and Hct more. Meticulous hemostasis done after weaning from cardio-pulmonary bypass. Both systemic and local tranexamic acid plus calcium injection was given before sternal wires are tighten. All the blood in the cardio-pulmonary bypass machine was returned at the end of operation. Patient’s hemoglobin and hematocrit checked to detect the need for transfusion. All other variables were studied. Results: Ten patients were operated without pre-operative blood transfusion of donor blood. Out of ten patients male=5 female=5, Male:Female=1:1 age range 5-26 years mean ±SD (13±-6.88) years. Preop diagnosis ASD 4/10=40%,VSD 3/10=30% TOF 2/10=20% AVR=1/10=10%. pre-operative Hb Range: 12.4-17.3 gm/dl. Mean ±SD (14.25±-1.66 gm/dl. Pre-operative Hct mean±SD (43.7±4.5). Per-operative Hct during CPB Mean±SD (24.9±4). Post-operative Hb mean ±SD (11.25gm±1.18gm). Post-operative Hct mean ±SD (34.3±3.80). Use of cell saver 1/8(12.5%) Post-operative blood loss for ASD,VSD, TOF and AVR were mean ±SD = 140±20.60ml, 156.44±33.84.320.80±60.22ml and 280 ml respectively. Varieties of ionotropes used were: Dopamine Dobutamin Adrenaline. Single ionotrope Dopa/Dobuta5/10=50% Double ionotrope Dopa/dobuta+Adrin=3/10(30%) tripple ionotrope 2/10(20%). Morbidity and mortality 0%. All the patients were discharged home uneventfully, in hospital outcome was good. Conclusion: In our setup we can do cardiac surgery without pre-operative donor blood use by following blood pre-donation and other blood conservative techniques.] Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 53-58

Adult Nesidioblastosis With Hypoglycemia Mimicking an Insulinoma: A Challenging Case

Introduction: Nesidioblastosis is the primary cause of persistent hyperinsulinemic hypoglycemia in infants but it is a rare entity for the adults. Nesidioblastosis is defined as an increase of pancreatic beta cells in number and in size. Case Presentation: We describe a rare case of nesidioblastosis with positive endoscopic ultrasonography result mimicking an insulinoma. A 35-year-old female patient had hypoglycemic episodes with high insulin level. Her investigation revealed low venous plasma glucose, high insulin and C-peptide level with positive 72-hour fasting test suggestive of hyperinsulinemic hypoglycemia. Abdominal computed tomography did not show any mass lesion. Endoscopic ultrasonography revealed a mass lesion sized as 1 cm in diameter in the pancreas. But, insulinoma like lesion couldn't be found intra-operatively. It was decided to perform distal pancreatectomy. After distal pancreatectomy, nesidioblastosis was diagnosed histopathologically. The patient was free from her symptoms after surgery. Conclusion: This case illustrates difficulties and limitations of imaging modalities and false positive result of EUS in a case of nesidioblastosis. When there is no insulinoma like lesion during operation, operation should be performed as gradient guided pancreatectomy by the way of selective arterial calcium injection test.