ABSTRACT
Background: Regression of ventricular hypertrophy is the restoration of normal ventricular structure and physiology after the hypertrophy has developed. It has been clearly demonstrated that once left ventricular hypertrophy (LVH) is diagnosed, it represents a strong blood pressure independent risk factor for cardiovascular morbidity and mortality. Aims and Objectives: The aim of this study is to compare the effectiveness of different anti-hypertensive agents in reducing LVH in Bangladeshi population. Methods: A prospective observational study was carried out to detect the regression of left ventricular hypertrophy in hypertensive Bangladeshi population using high resolution M-mode echocardiographic study in 110 patients with clinically diagnosed hypertension were included in this study but later 15 patients failed to attend clinic for subsequent follow up. Hence, total number of patient was 95; The mean age (±SD) of these patients were 42 ± 5 and male-female ratio was 8.5:1.5. Out of these 95 patients, 20 were included in Beta-blocker(BB) group, 14 in Angiotensin converting enzyme inhibitor(ACEi) group, 20 in Beta-blocker(BB) + Diuretic(DD), 14 were recruited in Angiotensin enzyme inhibitor(ACEi) + Diuretics(DD) and 13 in Beta-blocker and ACEi group and 14 in BB + ACEI + Diuretic group. We followed these patients after 8 weeks, 6 months, 1 year and 2 years in our clinic. A baseline M-mode echocardiography was done to document LVH. During this follow up, we have measured IVSd, PWd, LVIDd and LVIDs and statistically analyzed SD and P-value for each group by using SPSS software. The duration of study was from 01.07.2005 to 30.06.2008. Results: Comparison of Beta blocker alone and ACEi alone group for LVH regression showed a P value of 0.59. Although this figure did not show a statistically significant value if we increase number of patients in both group we would expect a statistically significant P value in favour of ACEi. BB plus diuretics was compared with ACEi plus Diuretics which showed P value of 0.85. We also compared BB plus ACEi group with BB plus ACEi plus DD for LVH regression which showed a P value of 0.79. Conclusion: Among three groups of anti-hypertensive drugs, angiotensin converting enzyme inhibitor(ACEi) alone has been found to be most effective as compared to Beta blockers when used alone than in combination groups with (Beta blocker plus ACEi plus Diuretics or Beta blocker plus ACEi). Although, these figure was not found statistically significant a clear benefit has been shown in all groups in terms of LVH regression and essentially if the power or size if this is increased a statistically significant value of LVH regression value may be observed in all these groups.
ABSTRACT
As bilateral approach is paramount in chronic total occlusions with retrograde flow, the use of two radial arteries,two femoral arteries or combination technique using one radial and one femoral artery will probably be increasingly reported in the near future. After puncture of opposite groin, a diagnostic 6 Fr catheter is used to intubate the ostium of the contralateral artery. By visualizing the distal vessel in multiple projections, contralateral injections help to direct the progression of the wire in the occluded segment towards the distal true lumen. and confirm the intraluminal position of the wire after the occluded segment. We are reporting a case with chronic total occlusion where we used bilateral femoral access and simultaneous contrast injection to visualize retrograde flow in LAD while opening CTO through ante-grade pathway.
ABSTRACT
A young rickshaw puller admitted in Neurosurgery ward of Mymensingh Medical College Hospital due to ugly looking skull swelling on right side and iatrogenic ulceration on the postero-superior surface of the swelling. He also mentioned that he was not socially well-excepted and facing difficulty in getting married for that ugly lesion and was very unhappy at that time. CT scan was suggestive of fibrous dysplasia of skull bone and no other abnormalities were present on other part of the body. Then complete excision of the mass was done and fibrous dysplasia was confirmed by histopathological study. Two months after surgery he got married and expressed his happiness. In fibrous dysplasia, normal bone is replaced by fibrous connective tissue with varying degrees of osseous metaplasia. It is a benign disorder of bone commonly seen from childhood to the third decade. Virtually any bone in the body can be affected. Regarding investigations, plain radiography in the first line study. CT may be required to assess complex region such as the spine, pelvis, chest and facial skeleton. Histologically, fibrous dysplasia appears as multiple areas of fibrous tissue contained within islands of bone with evidence of both blastic and clastic activity.