European Journal of Cardiovascular Medicine

Objective: To describe coronary artery anomalies (CAAs), with emphasis on clinically significant variants, and to highlight their association with sudden cardiac death (SCD), particularly in young individuals. Materials and Methods: A descriptive overview based on existing clinical observations and literature regarding the anatomical variations of coronary artery origin and course, with particular focus on anomalies involving origin from the opposite sinus of Valsalva and their clinical implications. Results: Most CAAs were found to be benign and incidentally detected during cardiac catheterization. However, anomalies involving the origin of a coronary artery from the opposite sinus demonstrated significant clinical relevance. The interarterial course, where the artery passes between the aorta and pulmonary artery, was identified as the most critical (“malignant”) variant, showing a strong association with an increased risk of SCD, especially in younger patients. Conclusion: While the majority of CAAs are benign, certain variants—particularly those with an interarterial course—carry a high risk of sudden cardiac death. Early recognition and appropriate evaluation of these anomalies are essential for risk stratification and prevention of adverse outcomes.

Background: Thyroid nodules are common endocrine disorders, with most being benign, although a small proportion may be malignant. Accurate evaluation is essential for appropriate diagnosis and management. Fine needle aspiration cytology (FNAC), ultrasonography (USG) with TIRADS classification, and thyroid function tests (TFTs) play a key role in assessment. Aim: To analyze the cytomorphological spectrum of palpable thyroid lesions and correlate findings with sonographic and biochemical parameters. Methods: This prospective observational study included 96 patients with palpable thyroid lesions conducted over two years at K.M. Medical College and Hospital. FNAC was performed and reported using the Bethesda System for Reporting Thyroid Cytopathology. Ultrasonographic evaluation was done using TIRADS classification, and TFTs (T3, T4, TSH) were assessed using chemiluminescence immunoassay. Data were analyzed using SPSS software. Results: Most patients were in the 20–50 years age group (68.8%) and euthyroid (54.2%). Colloid goitre was the most common clinical (67.7%) and radiological (41.7%) diagnosis. Cytologically, benign lesions predominated (45.8%), with colloid goitre being the most frequent finding. Most nodules were classified as TIRADS 1 (69.8%), indicating low malignancy risk. FNAC showed adenomatous nodules as the most common diagnosis (50%), while malignant cases were rare (2.1%). Higher Bethesda categories correlated with suspicious ultrasound features such as hypoechogenicity and microcalcifications. Conclusion: FNAC combined with ultrasonography and biochemical assessment provides a reliable and effective diagnostic approach. An integrated evaluation improves diagnostic accuracy, facilitates early detection of malignancy, and supports appropriate management of thyroid lesions.

Background: Levobupivacaine and ropivacaine are long-acting amide local anaesthetics with favourable cardiotoxicity profiles compared to racemic bupivacaine. While both have been studied individually against bupivacaine for spinal anaesthesia, direct comparison of hyperbaric levobupivacaine 0.5% and hyperbaric ropivacaine 0.75% for perianal surgeries remains unexplored. This study aimed to compare the onset of sensory and motor block, duration of analgesia, and haemodynamic profile of the two agents. Methods: This prospective, randomised, double-blind study enrolled 72 adult ASA I–II patients aged 18–60 years scheduled for elective perianal surgeries under spinal anaesthesia. Patients were randomised into two groups: Group L received 2.0 ml (10 mg) of 0.5% hyperbaric levobupivacaine, and Group R received 2.0 ml (15 mg) of 0.75% hyperbaric ropivacaine intrathecally at the L3–L4 interspace using a 25G Quincke needle in the sitting position. Onset of sensory block (to T12), onset of motor block (Bromage scale 2), and duration of analgesia (time to first rescue analgesic) were the primary outcomes. Haemodynamic parameters and adverse effects were recorded. Results: The onset of sensory block was significantly faster in Group L (3.8 ± 0.9 min) compared to Group R (5.1 ± 1.2 min) (p<0.001). Onset of motor block was also earlier in Group L (5.2 ± 1.1 min vs. 6.8 ± 1.4 min, p<0.001). Duration of analgesia was significantly longer in Group R (148.6 ± 18.3 min vs. 128.4 ± 15.7 min, p<0.001). Haemodynamic parameters were comparable between groups. No significant adverse effects were noted in either group. Conclusion: Hyperbaric levobupivacaine 0.5% provides faster onset of sensory and motor block, while hyperbaric ropivacaine 0.75% offers a longer duration of analgesia. Both agents are safe and effective for spinal anaesthesia in perianal surgeries.