Suphot Srimahachota

Skin injuries in interventional procedures

Radiation-induced skin injuries to patients in interventional procedures have been reported since the early 1990s, but the number reported is far less than what might be occurring around the world. There is a gross lack of awareness resulting in patients suffering. A case of severe injury observed in multiple percutaneous coronary interventions for chronic total occlusion is reported in this paper. Further, the paper summarises the existing knowledge on radiation dosimetry in interventional procedures, factors involved in skin injury, guidance on detection, and avoidance and management of injury when it occurs. Information on a recently launched international anonymous reporting system of the International Atomic Energy Agency is also included.

Eye lens dosimetry and the study on radiation cataract in interventional cardiologists

PURPOSE To determine the eye lens dose of the Interventional Cardiology (IC) personnel using optically stimulated luminescent dosimeter (OSLD) and the prevalence and risk of radiation - associated lens opacities in Thailand. METHODS AND RESULTS 48 IC staff, with age- and sex- matches 37 unexposed controls obtained eye examines. Posterior lens change was graded using a modified Merriam-Focht technique by two independent ophthalmologists. Occupational exposure (mSv) was measured in 42 IC staff, using 2 OSLD badges place at inside lead apron and at collar. Annual eye lens doses (mSv) were also measured using 4 nanoDots OSL placed outside and inside lead glass eyewear. The prevalence of radiation-associated posterior lens opacities was 28.6% (2/7) for IC, 19.5% (8/41) for nurses, and 2.7% (1/37) for controls. The average and range of annual whole body effective dose, Hp(10), equivalent dose at skin of the neck, Hp(0.07) and equivalent dose at eye lens, Hp(3) were 0.80 (0.05-6.79), 5.88 (0.14-35.28), and 5.73 (0.14-33.20) mSv respectively. The annual average and range of eye lens dose using nano Dots OSL showed the outside lead glass eyewear on left and right sides as 8.06 (0.17-32.45), 3.55(0.06-8.04) mSv and inside left and right sides as 3.91(0.05-14.26) and 2.44(0.06-6.24) mSv respectively. CONCLUSION Eye lens doses measured by OSLD badges and nano Dot dosimeter as Hp(10), Hp(0.07) and Hp(3). The eyes of the IC personnel were examined annually by two ophthalmologists for the prevalence of cataract induced by radiation.

Undetected Large Aortopulmonary Window in an Adult: A Confluence of Great Vessels

ology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; yCardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; and the zDivision of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Manuscript received May 1, 2013; accepted May 7, 2013. Journal of the American College of Cardiology Vol. 62, No. 19, 2013 2013 by the American College of Cardiology Foundation ISSN 0735-1097/

Rare angiographic and echocardiographic findings of an aortic arch interruption in a patient with differential cyanosis

36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2013.05.097

Transcatheter treatment of iatrogenic brachiocephalic-jugular arteriovenous fistula and aortopulmonary artery fistula: A case report

A 23-year-old lady with a 3-year history of undiagnosed murmur and progressive dyspnoea was referred to our institution for a percutaneous patent ductus arteriosus (PDA) closure. Physical examination revealed differential cyanosis with an oxygen saturation in the upper and lower extremity of 95 and 86%, respectively. A loud P2 with a grade 3/6 systolic murmur …

Very late presentation of anomalous origin of the left coronary artery from the pulmonary artery: case report

Iatrogenic arteriovenous fistula is not a common complication of central venous catheterization. Duct occluder devices have been developed for patent ductus arteriosus occlusions but they may be used for arteriovenous fistula closures. We report a case of iatrogenic brachiocephalic‐jugular and aortopulmonary artery fistulas after central venous catheter insertion. The fistulas were successfully managed with duct occluder devices. Due to increasing number of central venous catheterizations, physicians should be aware of this uncommon complication. Transcatheter closing of brachiocephalic‐jugular and aortopulmonary artery fistulas by duct occluder devices seems to be a safe and feasible form of treatment.

Short-term effects of an intensive lifestyle modification program on lipid peroxidation and antioxidant systems in patients with coronary artery disease

BackgroundAnomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly. The enlarged right coronary artery provides retrograde collaterals to supply the left ventricle then preferentially directs into the lower pressure pulmonary artery system causing coronary steal phenomenon. Few patients who survive through adulthood without surgery must have abundant, well-formed functioning collaterals with adequate perfusion of the left ventricle. We present the oldest reported patient with ALCAPA to undergo corrective surgery.Case presentationA 79-year-old woman presented with a 3-months history of worsening shortness of breath and orthopnea. Physical examination discovered a soft continuous murmur at the left upper chest. Transthoracic echocardiography demonstrated an unusual, tubular-like structure inside the interventricular septum with a turbulent flow from color Doppler. Moreover, there was a severe mitral regurgitation from posterior mitral leaflet restriction associated with ventricular remodeling in combination with mitral annular dilatation. Coronary angiography and coronary computed tomography angiography established the diagnostic hallmark of ALCAPA syndrome. Stress cardiovascular magnetic resonance perfusion imaging demonstrated no myocardial ischemia suggesting adequate collateral circulation. Remarkably, there was a left coronary ostial stenosis, which served as a protective mechanism against myocardia ischemia by limiting the steal effect. The patient successfully underwent the ligation of anomalous artery at its origin in combination with bioprosthetic mitral valve replacement. Her postoperative course was uneventful.ConclusionsThis case utilized multimodality imaging for delineating the course of abnormal vessels and helping to formulate therapeutic decision.