Immediate and long-term results of bronchial artery embolisation for life-threatening hemoptysis in bronchiectasis.

Background: Bronchial artery embolization (BAE) has been established as an effective technique in the emergency treatment of life-threatening hemoptysis, but few data concerning long-term results of the procedure are available The aim of this study was to analyze the immediate and long-term results of bronchial artery embolization (BAE) for hemoptysis due to bronchiectasis. Methods: Twenty five patients (aged 28–76 years) who underwent bronchial artery embolization with polyvinyl alcohol particles, gelatin sponge and coil for massive or continuing moderate hemoptysis caused by bronchiectasis were included in the study. These patients were followed up for 3 years. Initially patients were followed up monthly for 6months by clinical examination. Then yearly follow up by clinical and radiological examination. Results analyzed using SPSS 16 version. Results: In our study16 patients (64%) were males. 11 patients (44%) had bilateral bronchiectasis.14 patients (56%) had no rebleeding in the three year follow-up period. Only 8% developed rebleeding within 24hrs.Only one patient (4%) developed massive hemoptysis within one month and died. Other rebleed were very minimal. In our study there was no significant relation with side of bronchiectasis and rebleed. Conclusions: Bronchial artery embolisation can yield immediate and long-term benefit in patients with hemoptysis due to bronchiectasis.

Evaluation of effect of aqueous extract of Enicostemma littorale Blume in streptozotocin-induced type 1 diabetic rats.

The present investigation was undertaken to standardize and study the dose-dependent effect of three weeks treatment with hot and cold aqueous extract of E. littorale (0.5, 1 and 2 g/kg, po) on streptozotocin (STZ) induced type I diabetic (confirmed by histopathology) rats (45 mg/kg, iv single dose). Treatment of rats with STZ produced cardinal signs of diabetes-mellitus like a significant loss of body weight, polyuria and polydipsia. There was also a significant increase in fasting blood glucose levels and AUCglucose associated with decrease in insulin levels and AUCinsulin in STZ-diabetic rats. Treatment with E. littorale hot extract (1 and 2 g/kg) significantly reduced the elevated food intake and water intake, glucose and AUCglucose levels of diabetic rats. There was also a significant increase in serum cholesterol, serum triglyceride in the STZ diabetic rats. Treatment with E. littorale hot extract (1 and 2 g/kg) significantly decreased all these elevated levels in diabetic rats. Hot aqueous extract of E. littorale at 0.5 g/kg produced a significant decrease in serum glucose and triglycerides. At this doses serum cholesterol and AUCglucose were not found to be altered significantly.TLC finger-print profiles were established for the aqueous extract using HPTLC. Swertiamarin, which was used as a chemical marker, was found to be one of the major components in the hot extract while it was absent in cold extract. The results suggest that E. littorale possesses potential antidiabetic activity and improves lipid profile at a small dose of 0.5 g/kg.

Identification and characterization of lipids from endosomes purified by electromagnetic chromatography.

Traditional separation techniques do not yield endolysosomes of sufficient purity to permit detailed biochemical characterization of this important class of intracellular vesicles. Here, we have used a magnetic chromatography technique to isolate the endosomes from rat peritoneal macrophages and studied their lipid composition. Electromagnetic isolation works by retention of colloidal iron containing vesicles on magnetic column. The data suggested that both early and late endosomes were rich in cholesterol, whereas sphingomyelin (SM) and specific phospholipids like phosphatidylcholine. phosphatidylethanolamine, phosphatidylglycerol and phosphatidylserine are enriched in the late compartments. Our results also indicated that the purified fractions are enriched in raft lipids like SM, but not in cholesterol. The endosomal purification method described here yields pure endosomes with little or no contamination from mitochondria and hence could be used for further biochemical and marker analysis, giving insight into mechanisms of endocytic traffic.

Evaluation of free radical scavenging properties of two classical polyherbal formulations.

Two polyherbal formulations of Ayurveda viz., Chandraprabha Vati and Maha yogaraja Guggulu were evaluated for their free radical scavenging properties. Methanolic extracts of the formulations were studied in four different in vitro and ex vivo models. Total phenolic content of Chandraprabha Vati and Maha yogaraja Guggulu was found to be 5.24% and 10.74% respectively. Methanolic extracts of the formulations were good scavengers of all the radicals but there was a difference in the activity of the two formulations in different models. Chandraprabha Vati was a good scavenger of superoxide radical and Maha yogaraja Guggulu was efficient in scavenging nitric oxide (NO), while both inhibited lipid peroxidation efficiently. Free radical scavenging activity of the different extracts can be attributed to the presence of various chemical components including phenolics.

Spontaneous resolution of intramyocardial hematoma of the left ventricle.

A 40-year-old male with hematoma of the left ventricular myocardium is described. On echocardiography, the hematoma was initially diagnosed as a cyst-like structure located at the apex and adjoining anterolateral wall of the left ventricle. A contrast-enhanced computerized tomography scan and magnetic resonance imaging further confirmed this lesion to be a hematoma. On follow-up, the hematoma gradually subsided and could not be seen on a repeat echocardiography and computerized tomography scan at four weeks.

Isolated congenital coronary arteriovenous fistula.

During the last eight years a total of nine cases of isolated congenital coronary arteriovenous fistula (CAVF) have been diagnosed at our centre. Age of these patients ranged from 11 days to 22 years (mean 6.4 +/- 4.2 years). There were seven male and two female patients. Right and left coronary arteries were the sites of origin in seven and three cases respectively. One patient had two fistulae, one each originating from right coronary artery and obtuse marginal artery. The drainage sites were right ventricle in seven cases and right atrium in two. The pulmonary artery pressure was normal in eight cases and elevated in one case. The pulmonary artery to systemic flow ratio ranged from 1.1:1-2.4:1 in all except the 11 day-old-baby in whom it was 4:1. Pulmonary vascular resistance (PVRI) was below 3.5 in all cases (range 1.0-3.5 units). Surgical ligation of fistula was done in four cases and two patients underwent coil embolisation of fistula. Follow-up is available in five out of eight patients including three cases in whom CAVF was closed. Two other young patients are being followed-up conservatively and all the patients are asymptomatic. CAVF can present at any age; majority of the cases have small left to right shunts and more commonly CAVF arise from right coronary artery. Surgical ligation of fistula is safe in older patients, non-surgical embolisation using coils may be an alternative to surgery in selected cases.

Retardation of coronary atherosclerosis with yoga lifestyle intervention.

BACKGROUND: Yoga has potential for benefit for patients with coronary artery disease though objective, angiographic studies are lacking. MATERIAL AND METHODS: We evaluated possible role of lifestyle modification incorporating yoga, on retardation of coronary atherosclerotic disease. In this prospective, randomized, controlled trial, 42 men with angiographically proven coronary artery disease (CAD) were randomized to control (n = 21) and yoga intervention group (n = 21) and were followed for one year. The active group was treated with a user-friendly program consisting of yoga, control of risk factors, diet control and moderate aerobic exercise. The control group was managed by conventional methods i.e. risk factor control and American Heart Association step I diet. RESULTS: At one year, the yoga groups showed significant reduction in number of anginal episodes per week, improved exercise capacity and decrease in body weight. Serum total cholesterol, LDL cholesterol and triglyceride levels also showed greater reductions as compared with control group. Revascularisation procedures (coronary angioplasty or bypass surgery) were less frequently required in the yoga group (one versus eight patients; relative risk = 5.45; P = 0.01). Coronary angiography repeated at one year showed that significantly more lesions regressed (20% versus 2%) and less lesions progressed (5% versus 37%) in the yoga group (chi-square = 24.9; P < 0.0001). The compliance to the total program was excellent and no side effects were observed. CONCLUSION: Yoga lifestyle intervention retards progression and increases regression of coronary atherosclerosis in patients with severe coronary artery disease. It also improves symptomatic status, functional class and risk factor profile.

Atrioventricular discordance in situs inversus.

We retrospectively analysed the records of 23 patients with atrioventricular discordance in situs inversus and compared them with 121 cases of atrioventricular discordance in situs solitus seen during preceding four years. One hundred and two (70.8%) patients were male. The mean age was 9.3 +/- 10.1 years (range 1 day-48 years). Overall, a ventricular septal defect with pulmonic stenosis (Fallot's physiology) was seen in 76 (56.7%) cases, ventricular septal defect without pulmonic stenosis in 26 (18.1%) cases, atrioventricular valve regurgitation in 25 (17.3%) cases and complete heart block in 13 (9%) cases. Double outlet right ventricle and Fallot's physiology were significantly more common (74.0% vs 32.3% and 91.3% vs 45.0%, respectively; p < 0.005), whereas atrioventricular valve regurgitation and complete heart block were less common (4.3% vs 19.8% and 0% vs 10.7%, respectively; p < 0.05) in patients with situs inversus and atrioventricular discordance as compared to patients with situs solitus. These differences may influence the natural history and treatment options selected for patients with atrioventricular discordance.

Tuberculosis of the breast.

Nowadays, tuberculosis of the breast is relatively rare compared to other forms of extrapulmonary tuberculosis. The incidence of tuberculosis of the breast has decreased mainly due to effective antituberculous chemotherapy. We report two cases of tuberculosis of the breast.

Collateral arteries in the presence of obstructive coronary disease.

BACKGROUND. The clinical importance of coronary collaterals in the presence of obstructive coronary artery disease is not clearly defined. METHODS. We retrospectively analysed the clinical and angiographic features of 100 patients with > or = 90% luminal diameter stenosis involving at least one major coronary artery. Coronary collaterals were graded 0 to 4 (Nitzberg's classification) and studied to determine their influence on clinical parameters. RESULTS. Thirty patients had no collaterals (group I) and 70 showed collaterals (group II). There were no significant differences between groups I and II in age and sex distribution, prevalence of risk factors of coronary artery disease (hypertension, diabetes, smoking, hypercholesterolaemia), duration of symptoms of coronary artery disease and prior myocardial infarction. Groups I and II had similar types (left anterior descending 73% v. 71%; left circumflex 50% v. 50% and right coronary 37% v. 56%) and numbers of arteries involved (one 47% v. 41%; two 47% v. 40%; three 7% v. 19%). Group II had a significantly lower prevalence of rest angina (14% v. 47%, p = 0.002). This difference was also evident when the patients were re-classified according to the extent of flow through the collaterals. Those with good collateralization (Nitzberg grades 3 and 4) had a lower prevalence of rest angina (13%) compared to those with poor collateralization (Nitzberg grades 0 to 2; 35%, p = 0.02). CONCLUSION. Coronary artery collaterals may reduce the incidence of rest angina in patients with obstructive coronary artery disease.

Left main coronary artery compression by dilated main pulmonary artery in atrial septal defect.

Left main coronary artery compression by dilated pulmonary artery in patients with atrial septal defect has previously been reported, but not well characterized. Accordingly, we review retrospectively data of patients with atrial septal defect in whom selective coronary angiograms were done. 41 patients (26 females), aged 47.3 +/- 7.4 years were studied. The pulmonary artery mean pressure was 22.7 +/- 8.3 mm Hg and all patients had left to right shunt ratio of 2:1 or more (mean ratio: 3.9 +/- 1.7). Two patients (4.8%) had left coronary ostial stenosis. There were no clinical or haemodynamic parameters to differentiate the patients with or without these changes. Two patients (4.8%) had coexistent atherosclerotic coronary artery disease. In conclusion, left main coronary trunk compression rarely occurs in patients with atrial septal defect. This information may be relevant in evaluating patients with atrial septal defect.

Angioplasty of total coronary occlusions using combination of intracoronary Probing Catheter and balloon on wire Probe.

We describe our experience with a technique for PTCA of total coronary occlusions using the ultra low profile balloon on wire Probe. An intracoronary Probing Catheter was used to facilitate crossing the stenosis with a guide wire. This was followed by exchanging the guide wire for the Probe into the obstruction for balloon dilatation. This technique was used in 22 consecutive patients undergoing PTCA for chronic total occlusion. The total obstruction could be crossed by guide wire (0.014 flex or 0.016 standard) passed through Probing Catheter in 19 patients (86%). The obstruction could be successfully dilated by the Probe, delivered through the probing catheter, in 17 of these patients. Of the remaining 2 patients, one could be dilated by sequential dilatation using over the wire low profile balloon system and the other one by dilatation with the Probe, respectively. The Probing Catheter technique offers a new method to apply balloon on wire technology to the dilatation of chronic total coronary occlusions with very promising results.

Surgical treatment of total anomalous pulmonary venous connection.

Fourteen infants ranging in age from 18 days to 10 months (median age = 4 months) underwent surgical repair of total anomalous pulmonary venous connection (TAPVC) between September, 1988 and December, 1989. The anomalous drainage was supracardiac in nine, cardiac in two, infracardiac in one and mixed in one. One patient had a complex type of TAPVC. There were two hospital deaths, one a critically ill three week old infant with obstructed infracardiac TAPVC and the other with complex TAPVC. There was no late death. All twelve survivors are in NYHA functional Class 1. Postoperative echocardiography revealed unobstructed pulmonary blood flow in all of them. Surgical correction of TAPVC in infancy has been performed with gratifying results. A high index of suspicion, early diagnosis, prompt referral and an aggressive surgical approach are essential for success in this otherwise lethal condition.

Profile of coronary artery disease in Indian women: correlation of clinical, non invasive and coronary angiographic findings.

Clinical and risk factor profile of 101 consecutive female patients subjected to coronary angiography was analysed. Coronary angiography showed single vessel disease (SVD) in 15.8 per cent, double vessel disease (DVD) in 12.9 per cent, triple vessel disease (TVD) in 39.6 per cent and normal coronary arteries (NC) in 30.7 per cent. Risk factor profile in patients with angiographic coronary artery disease (group II) included hypertension (HT) in 52.9 per cent, diabetes mellitus (DM) in 44.3 per cent, post menopausal state in 84.3 per cent, positive family history in 51.4 per cent, obesity in 58.3 per cent, low density and high density lipoprotein ratio (LDL/HDL) more than 3.0 in 58 per cent and smoking in 4.3 per cent. Risk factors in 31 patients with NC (group I) included HT in 29 per cent, DM in 6.5 per cent, positive family history in 45.2 per cent, obesity in 45.2 per cent, post menopausal state in 48.4 per cent, LDL/HDL ratio more than 3.0 in 30 per cent and smoking in none. The clinical presentation in group II was unstable angina in 64.3 per cent, stable angina pectoris in 24.3 per cent, myocardial infarction in 4.3 per cent and atypical chest pain in 2.8 per cent. In group I half the patients presented with atypical chest pain. The other modes of presentation included unstable angina 25.8 per cent, stable angina pectoris in 16.2 per cent and myocardial infarction in 6.5 per cent. Predictive value of exercise electrocardiography (Ex ECG) or exercise radionuclide studies (Ex RNU) was 61.7 and 68.4 per cent respectively. DM, post-menopausal state and LDL/HDL ratio more than 3 were significant risk factors in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Restenosis after successful coronary angioplasty in single vessel disease.

One hundred and ninety five patients who underwent successful percutaneous transluminal coronary angioplasty (PTCA) for single vessel disease and have been followed up for more than 6 months are being reported. Angiography was done routinely in first 20 patients (Group 1) 8 to 15 weeks (mean 9.6 weeks) after PTCA. Restenosis (loss of 50% of the initial improvement in luminal diameter) was seen in 4 patients (20%). The remaining 175 patients (Group II) have been followed up clinically and subjected to serial exercise testing. Coronary angiography was performed only if symptoms and/or objective evidence of ischemia recurred. In this group, restenosis suspected clinically and confirmed by angiography occurred in 37 patients (21%), 2 to 23 weeks (mean 12.5 weeks) after PTCA. The restenosis rate for the entire patient population was 21%. In general the restenosed lesions were longer and tighter than the lesions before PTCA. A comparison of 41 patients with restenosis with those who did not have clinical restenosis revealed a proximal left anterior descending artery (LAD) involvement (66% vs 31%, p = 0.01), crescendo unstable angina (37% vs 16% p = 0.05), length of pre PTCA stenotic lesion greater than or equal to 1 cm (41% vs 27.5%, p less than 0.05), absence of intimal haziness in immediate post PTCA angiogram (27% vs 16%, p less than 0.05) and residual stenosis greater than or equal to 25%, (34% vs 14% p less than 0.05) in the restenosis group. Repeat PTCA was done in 30 patients with a 96% success rate; 4 patients required coronary artery bypass grafting (CABG). Restenosis after PTCA is a significant problem in our experience.(ABSTRACT TRUNCATED AT 250 WORDS)