Surgical treatment for adult congenital heart disease.

A total of 1,408 adult congenital heart disease patients (age over 13 years) underwent surgery between 1979 and 1995 at Siriraj Hospital, contributing 33.75 percent to the overall number of congenital heart disease cases (4,172) who underwent surgery in that period. This finding is similar to statistics in the West. The ages ranged from 13.3 years to 72 years, with a mean of 24.06 years. The oldest patient was a 72 year-old man with coronary cardiac chamber fistula. The most common diagnoses in descending order were: atrial septal defect (41.05 per cent), patent ductus arteriosus (16.19 per cent), tetralogy of Fallot (14.06 per cent) and ventricular septal defect (10.87 per cent). These four categories covered 82 percent of the cases. The overall surgical mortality was 1.78 per cent, compared with 3 per cent in patients who had undergone surgery during childhood. Only patients with double outlet of the right ventricle and congenital aortic stenosis, or left ventricular outflow tract obstruction, showed increased risk of death (20 per cent), compared with 5.77 per cent in those cases who had undergone surgery during childhood. The conclusions drawn from the study are that surgical treatment for adult congenital heart diseases showed a low average of surgical mortality of less than 2 per cent in almost every category except double outlet of the fight ventricle and congenital aortic stenosis, for which early surgery is recommend.

Antibody responses to two different yeast-derived hepatitis B vaccines.

Comparative study of antibody responses and adverse reactions after two different yeast derived hepatitis B vaccine administrations was performed. Subjects were 96 medical students who had seronegative for HBV markers. The first group of 47 students received H-B-Vax II® vaccine (MSD) 10 µg and the second group (49 students) received Engerix-B® vaccine (SKF-RIT) 20 µg. the vaccination schedule was two doses one month apart and a booster dose at sixth month. Antibody responses were measured at 1 month after each injection. The result showed that, seroconversion rate after booster dose was 100% in both groups. Anti-HBs titers after first and second doses showed no significant difference among two groups, but after booster dose the anti-HBs geometric mean titer was 3,070 mIU/ml in the first group and 6,634 mIU/ml in the second group, which showed statistical significance. Minor adverse reactions such as local pain, inflammation, itching, and malaise were found.