A multicentric study to evaluate efficacy and safety of cefetamet pivoxyl in lower respiratory tract infections in Indian patients.

This multicentric, open label, non-comparative study was designed to evaluate the extended spectrum of third generation oral cephalosporin, cefetamet pivoxyl in the treatment of patients with lower respiratory tract infections. This study was conducted among 111 patients with clinical, radiological and bacteriological findings consistent with the diagnosis. After obtaining written informed consent, patients were given cefetamet 500 mg tablet twice a day for 7 days. Cefetamet consistently decreased all clinical signs and symptoms at post-therapy visit. All the treated patients were either cured or improved. Cefetamet was well tolerated with a low incidence of drug related adverse events. The findings of this study indicate that cefetamet pivoxyl was well tolerated and is suitable option for the treatment of patients with lower respiratory tract infection.

Correlation of Braunwald's clinical classification of unstable angina pectoris with angiographic extent of disease, lesion morphology and intra-luminal thrombus.

One hundred consecutive patients (81 male and 19 female) with unstable angina pectoris undergoing coronary angiography were divided according to Braunwald's clinical classification. Seventeen (17%) patients had new onset angina (class I), 68 (68%) sub-acute angina (class II) and 15 (15%) had acute rest angina (class III). Twenty-seven (27%) patients had secondary unstable angina pectoris (class A), 49 (49%) primary unstable angina (class B) and 24 (24%) had post-infarction unstable angina (class C). ST-T wave changes on ECG were present in 54 (54%) while absent in 46 (46%) patients. On coronary angiography, 26 (26%) patients had single vessel disease, 30 (30%) double vessel disease and 39 (39%) patients had triple vessel disease. Five (5%) patients were found to have normal coronaries. Classification of patients according to Braunwald's clinical classification showed single vessel disease to be higher in class I as compared to class II (47% vs 22%; p = 0.04) and classes III (47% vs 20%; p<0.01). Single vessel disease was found to be higher in class C as compared to class B (41.7% vs 16.4; p = 0.01). Double vessel disease was higher in class B as compared to class A (40.8% vs 18.5%, p = 0.04). Triple vessel disease incidence was not found to be significantly different among different clinical classes. Morphology of coronary artery lesions was classified according to Ambrose's classification. Out of the total of 248 lesions in the whole study group, there were 68 (27.42%) concentric lesions, 55 (22.18%) eccentric type I lesions, 23 (9.27%) eccentric type II lesions, 42 (16.94%) multiple irregularity lesions and 60 (24.19%) totally occluded lesions. Concentric lesions were found to be higher in class C as compared to class B (40% vs 19.8%; p = 0.014). Statistically significant difference was not present in the distribution of other morphological type of lesions among different clinical classes. In the whole study group, intra-luminal thrombus was found to be present in 17 (17%) of patients. Distribution of intra-luminal thrombus according to Braunwald's classification showed that none of the patients in class I had intra-luminal thrombus, while 13 (19.1%) patients in class II and 4(26.7%) in class III had intra-luminal thrombus. The difference in the occurrence of intra-luminal thrombus between class I and class II (p = 0.004) and class I and class III (p = 0 .03 was found to be significant. Thus, majority of patients undergoing coronary angiography had primary sub-acute rest angina. Single vessel disease was higher in new onset angina. Patients with unstable angina pectoris and ST-T changes on ECG had higher number of lesions per patient and higher eccentric type I lesions. Intra-luminal thrombus was more frequently encountered with acute rest angina. However, the distribution of different morphological type of lesions on coronary angiography did not differ significantly in different clinical classes of unstable angina pectoris divided according to Braunwald's classification.

Cholecystectomy under regional anesthesia in a patient with total Kartagener's syndrome.

A 41-year-old woman with complete Kartagener's syndrome developed cholecystitis in a left-sided gall bladder. Bilateral diffuse bronchiectasis ruled her unfit for general anesthesia; chronic cough, copious expectoration and dyspnea prevented her from lying down supine for more than a few minutes. Successful cholecystectomy was performed in a semi-reclined position using thoracic epidural anesthesia, the anatomy being the mirror image of that of a gall bladder in normal position. The gall bladder was full of stones and operative cholangiogram revealed a normal but transposed biliary system.

Angiographic severity and morphological spectrum of coronary artery disease in non insulin dependent diabetes mellitus.

Coronary angiographic profile of 75 patients (63 males and 12 females) with noninsulin dependent diabetes mellitus (NIDDM) and CAD was compared with 75 nondiabetic patients (63 males and 12 females) with CAD. No difference was present between the mean age (56.2 +/- 7.4 vs 56.1 +/- 7.7 years; p = NS), presenting complaints (67 unstable angina and 8 stable angina with positive TMT in both the groups) and other coronary risk factors between the two groups. Severity and diffuseness of coronary artery involvement was assessed by a coronary artery score (CAS) using the segmental distribution method for coronary artery lesions. Diabetic patients with CAD had a higher CAS (18.7 +/- 10.3) as compared to the nondiabetic patients with CAD (12.7 +/- 9.6) (p < 0.01). Diabetic patients with CAD had a higher number of TVD [43 (57.3%) vs 31 (41.3%); p < 0.01] while the DVD and SVD was not significantly different. As compared to the nondiabetic group, diabetics had a higher total number of coronary artery lesions (300 vs 200; p < 0.001), a higher lesion per patient ratio (4.0 lesions/patient vs 2.6 lesions/patient; p < 0.001), a higher number of concentric lesions, [151 (50.3%) vs 90 (45%); p < 0.01] and a higher number of multiple irregularity lesions, [36 (21%) vs 27 (9%); p < 0.05]. The diffuse involvement of vessels was not significantly different between the two groups in LAD (12.1% vs 5.3%; p = NS), LCx (14.2% vs 5.8%; p = NS) and RCA (10.5% vs 5.0%; p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)