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Shirodkar C.G.,Yashoda Super Specialty Hospital | Venkategowda P.M.,Yashoda Super Specialty Hospital | Amte R.,Yashoda Super Specialty Hospital | Rao S.M.,Yashoda Super Specialty Hospital
Annals of Tropical Medicine and Public Health | Year: 2015

Dengue viral infection is one of the differential diagnoses in patients having fever with thrombocytopenia. Early diagnosis and timely supportive treatment form the basis for the successful management of these patients. Dengue infection associated with cyanotic congenital cardiac disease makes management more difficult and is associated with a fatal outcome. We report a case in which the patient presented with fever and thrombocytopenia diagnosed to be a case of dengue infection (NS-1 antigen-positive) and associated cyanotic congenital heart disease (double inlet left ventricle/univentricular heart). The patient was successfully managed with fluids and platelet transfusion. This case report mainly emphasizes the difficulties faced in hemodynamic monitoring and supportive management during the acute course of the disease.

Subramanian S.,Yashoda Super Specialty Hospital | Srinivas C.,Yashoda Super Specialty Hospital | Ramalingam K.,Yashoda Super Specialty Hospital | Babaiah M.,Yashoda Super Specialty Hospital | And 12 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: To evaluate, with a dosimetric and clinical feasibility study, RapidArc (a volumetric modulated arc technique) for hypofractionated stereotactic radiotherapy treatment of large arteriovenous malformations (AVMs). Methods and Materials: Nine patients were subject to multimodality imaging (magnetic resonance, computed tomography, and digital subtraction angiography) to determine nidus and target volumes, as well as involved organs at risk (optical structures, inner ear, brain stem). Plans for multiple intensity-modulated arcs with a single isocenter were optimized for a fractionation of 25 Gy in 5 fractions. All plans were optimized for 6-MV photon beams. Dose-volume histograms were analyzed to assess plan quality. Delivery parameters were reported to appraise technical features of RapidArc, and pretreatment quality assurance measurements were carried out to report on quality of delivery. Results: Average size of AVM nidus was 26.2 cm 3, and RapidArc plans provided complete target coverage with minimal overdosage (V 100% = 100% and V 110% < 1%) and excellent homogeneity (<6%). Organs at risk were highly spared. The D 1% to chiasm, eyes, lenses, optic nerves, and brainstem (mean ± SD) was 6.4 ± 8.3, 1.9 ± 3.8, 2.3 ± 2.2, 0.7 ± 0.9, 4.4 ± 7.2, 12.2 ± 9.6 Gy, respectively. Conformity index (CI 95%) was 2.2 ± 0.1. The number of monitor units per gray was 277 ± 45, total beam-on time was 2.5 ± 0.3 min. Planning vs. delivery γ pass rate was 98.3% ± 0.9%. None of the patients developed acute toxicity. With a median follow-up of 9 months, 3 patients presented with deterioration of symptoms and were found to have postradiation changes but responded symptomatically to steroids. These patients continue to do well on follow-up. One patient developed headache and seizures, which was attributed to intracranial bleed, confirmed on imaging. Conclusion: Hypofractionated stereotactic radiotherapy can be successfully delivered using the RapidArc form of volumetric arc technology for intracranial AVMs. The quality of delivery and calculated parameters are in agreement with each other and are in line with published reports for other sites. © 2012 Elsevier Inc.

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