Management of unstable angina

One-hundred and seven patients with unstable angina were treated between 1981 and 1987. Platelet dysfunction and elevation of fibrinogen was observed. The efficacy of aspirin, dipyridamole and heparin on coagulation profile is compared. Left main disease was seen in 11.4 per cent. Left anterior descending was occluded in 90.7 per cent. Aortocoronary bypass graft using saphenous vein graft was carried out on all patients. On an average, each patients received 3.5 grafts. Emergency surgery was done in nineteen. Associated ventricular aneurysm was resected in nine. Thirteen patients died. Operative mortality decreased to nil in 1986–1987. Perioperative infarction was seen in five patients. Clinical improvement was seen in 80.3 per cent and 48.9 per cent were asymptomatic. Actuarial survival was 92 per cent after six years. Postoperative coronary angiography in 28 patients showed patency of grafts in 18, partial patency in six and occlusion in four. Aspirin was found useful after surgery to relieve angina. Spiroergometry and Thallium²⁰¹ scintigraphy was useful to assess medical and surgical treatment.     

BIOLOGY OF NEUROCYSTICERCOSIS – PARASITE RELATED FACTORS MODULATING HOST RESPONSE

Neurocysticercosis, caused by infestation of the nervous system by the larval form of Taenia solium, continues to baffle the neurologist, because of varied clinical manifestations. A large body of the literature related to this disease is clinically oriented, enough attention has not been given to parasite related factors modulating the host response. Using immunohistochemical techniques, three features related to the biology of the Cysticercus cellulosa e were studied. Firstly, to the question as to which part of the worm is recognised by the host immune system, the surface glycoprotein is found to be immunolabelled by the CSF from patients of neurocysticercosis. This surface protein is depleted following specific antihelmenthic therapy, thus accounting for a fall in anticysticercal antibosy level in the CSF. Secondly, the cysticercal cyst, by immunochemical and histochemical methods, is found to have “ACTH like” molecule in the body wall and has neurotransmitter and mitochondrial metabolic pathways similar to the host, facilitating the immune evasion and successful parasitisation. Finally, Cysticercus cellulosae is found to contain a “peptide” opening the blood brain barrier at the arteriolar level when injected into mice intravenously. Similar phenomenon may be functional in the patients as well, resulting in cerebral oedema, especially following praziquintel therapy.KEY WORDS: Cystericercus cellulosae, I mmunohistochemistry, Blood Brain Barrier, Immune evasion, Parasite metabolism     

Radiofrequency modified maze procedure for chronic atrial fibrillation

Background We studied the effectiveness of Radiofrequency (RF) modified maze in early and late restoration of sinus rhythm in patients with rheumatic heart disease (RHD). Methods We studied 84 patients with RHD over 23.6±12.5 months after the RF modified maze and another group of 64 patients over six months after valvular surgery alone (the Non-Maze group). Any thromboembolic episodes and NYHA class of the patient were recorded. The short term survivors in sinus rhythm, underwent stress test and echocardiography for atrial transport function at 3–6 months after surgery. Results In the Maze group, sinus rhythm was restored in 60/70 patients (85.71%) immediately and sustained in 55/70 patients (78.57%) over the follow-up as against an immediate conversion rate of 5.3% (5/53 patients, p<0.001) in the Non-maze group. The additional Cardiopulmonary (CP) bypass time (p=0.13) and cross clamp time (p=0.511) needed for maze is not statistically significant. Left atrial (LA) transport function was preserved in 41/51 patients (80.4%) and Right atrial (RA) transport function in 51/51 patients (100%). Stress test showed good chronotropic response in all the 41 patients in whom it was performed. In the Maze group one patient presented with acute valve thrombosis and subsequently, succumbed to it. In the non maze group 3/55 patients (5.66%) were hospitalized for stroke. No patient needed permanent pacemaker nor was sinus node dysfunction seen. The immediate postoperative morbidity and mortality was comparable in the two groups. Conclusions The RF modified maze is safe, effective and brief without any additional risk. It restores sinus rhythm in the majority, however there is an attrition in some.     

Extensive Mongolian Spots with Autosomal Dominant Inheritance

Background

Mongolian spots are benign skin markings at birth which fade and disappear as the child grows. Often persistent extensive Mongolian spots are associated with inborn error of metabolism. We report thirteen people of the single family manifested with extensive Mongolian spots showing autosomal dominant inheritance.

Case Presentation

A one day old female child, product of second degree consanguineous marriage, born by normal vaginal delivery with history of meconium stained amniotic fluid and birth asphyxia. On examination the child showed extensive bluish discoloration of the body involving trunk and extremities in both anterior and posterior aspects associated with bluish discoloration of the tongue. A detailed family history revealed most of the family members manifested with extensive bluish discoloration of the body soon after birth which faded in the first few years of life and completely disappeared by puberty. Thus it was diagnosed to be extensive Mongolian spots with an autosomal dominant inheritance.

Conclusion

Knowledge about the natural history of extensive Mongolian spots, their inheritance and association with certain metabolic diseases mainly IEM and Mucopolysaccharidosis aids in the diagnosis and in order to improve the patient''s prognosis.     

A qualitative study on the adverse reactions of mass treatment for lymphatic filariasis in Orissa,India

ObjectiveTo describe the perceptions of community members and programme partners regarding severity, management and impact of adverse reactions on mass drug administration (MDA) compliance.MethodsBased on various qualitative data collected from five districts of Orissa, India, where MDA had been implemented during 2002 and 2004. The qualitative surveys included focus group discussions with community members and health workers, and semi-structured interviews with key informants in the community, medical officers at primary health centres, district level health officers and private practitioners.ResultsIt showed that many people suffered from adverse reactions, though the reactions were not serious. The paper reported different ways of management of adverse reactions at the community level. The impact of adverse reactions on MDA compliance was serious, as many people did not consume the drug due to fear of adverse reactions. The rumours of adverse reactions and news in media deterred people from consuming the tablets.ConclusionAll categories of respondents indicates the need of more information to address the problem of adverse reactions during MDA. The present paper warrants incorporating the messages on adverse reactions during health communication and social mobilization campaigns of MDA.