Clinical and angiographic characteristics of left main coronary artery disease, a retrospective study

Left main coronary artery [LMCA] disease represents important and serious portion of coronary artery disease [CAD]. The aim of this study is to estimate the incidence of LMCA disease among patients with CAD undergoing coronary artery angiography and to evaluate clinical characteristics of patients with LMCA disease. The study involved review of clinical notes and coronary angiography of 1020 patients with CAD in Ibin Al Bitar hospital for cardiac surgery between April and September 2004. This review included evaluation of electrocardiogram [ECG], echocardiogram [ECHO], ECG exercise test [EET] and coronary angiography. Among 56 patients proved to have left main coronary artery [LMCA] disease, 40 patients had complete data available which were studied. Mean age of patients with LMCA disease was 60 +/- 8.07 years, 82% of them were males, 62% were smokers, 40% were diabetics and 55% were hypertensive. In this group 62.5% of patients with LMCA disease presented as acute coronary syndrome [ACS] and 37.5% as chronic stable angina [CSA],normal left ventricular [LV] function was found in 75% of patients and 40% hade normal electrocardiogram [ECG]. Patients with LMCA disease who hade distal involvement represented 75%. 15% hade diffusely diseased LMCA, right coronary artery [RCA] was involved in 80% of patients and those with RCA involvement were more commonly presented with ACS [78%], while those without RCA involvement presented more as CSA. Those patients who underwent ECG exercise test had poor functional Capacity, with mean exercise duration of 3.7 +/- 2.3 minutes and mean metabolic equivalents [METs] of 4.5 +/- 2.46. The tests were positive in 76.9% of patients, inconclusive in the rest but no negative tests were recorded. No significant differences were observed between those patients with ACS and those with CSA in regard to patients' characteristics. LMCA disease is not uncommon among those with CAD, it occurs in patients with multiple cardiovascular risk factors. Patients with LMCA disease usually have poor functional capacity and their ETTs are commonly positive and of high risk score. Involvements of right coronary artery [RCA] in addition to LMCA render the patients more unstable

role of free to total prostate specific antigen [PSA] and PSA density in improving the specificty of prostate cancer screening

The diagnostic value of serum prostate specific antigen [PSA] is limited by its lack of specificity. Measurement of the free to total PSA ratio [f/t PSA] and determination of PSA density [PSAD] has been used to improve the diagnostic accuracy of PSA. A total of 122 patients above the age of 50 years with a total serum PSA ranging between 4.1 - 10.0 ng/ml were screened for prostate cancer detection. All patients were subjected to total and free serum PSA concentrations with calculation of the f/t PSA ratio, digital rectal examination [DRE], transrectal ultrasound [TRUS], determination of PSAD and TURS- guided prostatic biopsy. Prostate cancer was diagnosed in 38 patients [31.15%] while benign prostatic hyperplasia [BPH] was confirmed in 84 patients [68.85%]. Mean f/t PSA ratio was significantly lower in patients with prostate cancer compared to those wih BPH [12.89 versus 23.18, p = 0.001]. At f/t PSA cutoff point of