INTRODUCTION

Sinus of Valsalva aneurysms (SOVA) are rare conditions in which a portion of the aortic root dilates due to weakness of the aortic wall, which can eventually lead to rupture, leading to a shunt from the aorta into any one of the cardiac chambers. Some patients can present asymptomatically and are diagnosed incidentally, while others can present with precipitous courses with symptoms of chest pain, palpitations and heart failure. When left untreated, these patients have poor prognosis.

CASE DESCRIPTION

A total of six patients are presented in this case series. These patients were seen in a national tertiary hospital from 2018 to 2024. The patients had varied characteristics, with ages ranging from 24-57 years old. Most of the patients were males. The presenting symptoms are also varied, with dyspnea being the most common symptom and a murmur being the most common sign. The most commonly involved sinus was the right coronary sinus draining into the right ventricle, with half of the patients presenting with concomitant ventricular septal defects. Five out of the six patients underwent successful open repair of their ruptured SOVAs and were eventually discharged.

DISCUSSION

Early identification of the cardiac lesion is important to clinch the diagnosis and plan for eventual definitive management. Imaging studies such as transthoracic echocardiogram are needed to visualize the defect, which is classically described as a windsock deformity. Transesophageal echocardiography may present clearer images to assess the anatomy better preoperatively. Medical management is usually done to bridge the patient to more definitive therapy, either through endovascular closure if the anatomy permits it or through surgical repair. Urgent and timely repair is needed to ensure improved survival in these patients.

Human ; Sinus Of Valsalva ; Aneurysm ; Rupture ; Chest Pain ; Heart Failure

Humans ; Retrospective Studies ; Tomography, X-Ray Computed

Background: Little is known about the views of faculty members who train medical students concerning open disclosure. Objectives: The objectives of this study were to determine the views of faculty in a medical school on: 1 what constitutes a medical error and the severity of such an error in relation to medication use or diagnosis; 2 information giving following such an adverse event, based on severity; and 3 acknowledgement of responsibility, remedial action, compensation, disciplinary action, legal action, and reporting to a higher body in relation to such adverse event. Methods: We adapted and contextualized a questionnaire developed from a previous study. The questionnaire had 4 case vignettes that described 1 clear medication error with lifelong disability; 2 possible diagnostic error with lifelong disability; 3 possible diagnostic error without harm; and 4 clear medication error without harm. We invited all faculty members attached to the medical school at the International Medical University to participate in the study. Results: Seventy faculty members took part. Faculty members viewed a medical error as having taken place depending on how clearly an error had occurred (94% and 73% versus 53% and 27%). They viewed cases as more severe based on the severity of complications (85% and 46% versus 5% and 10%). With increasing severity, they tended to attribute responsibility for the event and the duty to disclose towards more senior clinicians. They were also more agreeable with remedial action, compensation, disciplinary action, and reporting to a higher agency. There was no strong evidence of association between these areas and the demographics of faculty members. Conclusions: Faculty members are more likely to perceive an error had occurred depending on the clarity of the circumstances. They viewed severity based on the presence of complications. Severity determined how they attributed responsibility, duty to disclose, and other areas related to open disclosure.

OBJECTIVETo observe the sedative and analgesic effects of transcutaneous electrical acupoint stimulation (TEAS) in patients with artificial abortion operation.

METHODSNinety patients, with American Society of Anesthesiologists (ASA) physical status I - II, and scheduled for artificial abortion operation, were randomly divided into three groups, 30 cases in each group. The patients in group A were treated with TEAS on Neiguan (PC 6) and Taichong (LR 3), in group B with paracervical block anesthesia (BA), and in group c with both TEAS and BA. Continuous monitoring of the mean arterial blood pressure (MAP), heart rate (HR), oxygen saturation and bispectral index (BIS) of the patients lasted to 30 min after the operation. The BIS, Visual Analogue Scale (VAS) during the operation and the adverse reactions after the operation were analyzed.

RESULTSAfter 15 minutes TEAS, the BIS in group A and C were decreased significantly, with no significant difference between the two groups (P > 0.05) and being both better than that in group B (both P < 0.05), which had no significant change. There were no significant differences in the VAS among the three groups (all P > 0.05), while the adverse reactions in both group A and C were lower than that in group B (both P < 0.05).

CONCLUSIONTEAS has sedative and analgesic effect during artificial abortion operation and can decrease the adverse reactions.

Abortion, Induced ; adverse effects ; Acupuncture Analgesia ; Acupuncture Points ; Adult ; Electroacupuncture ; Female ; Heart Rate ; Humans ; Oxygen ; metabolism ; Pain ; metabolism ; physiopathology ; Pain Management ; Pain Measurement ; Young Adult