Tropical spastic paraparesis in Kerala.

Tropical Spastic Paraparesis (TSP) is an uncommon myeloneuropathy with an insular geographic distribution. In 1985, Human T-lymphotropic virus type I (HTLV-1) was reported to be a possible etiological factor. We did an epidemiological, clinical and virological study of 25 cases of TSP. They were predominantly young adult men, whose duration of illness ranged from 6 months to 15 years. Difficulty in walking, stiffness of legs and paraesthesia of legs were the main symptoms. None had tuberculosis, syphilis, malnutrition or lathyrism. Pyramidal signs of the lower limbs, upper limbs, posterior column involvement and spinothalamic tract dysfunction were the common signs. Laboratory findings and cerebrospinal fluid analysis were normal in most. Myelograms or MRI were normal in all. Only 1 case repeatedly tested positive for HTLV-1 antibodies. None of his relatives had clinical or virological evidence of TSP or HTLV-1 infection. Based on our study, we could not link HTLV-I infection to TSP in Indian cases. Virological testing for HTLV-I infection by polymerase chain reaction may be a better tool to reveal such an association. Our cases were similar to seronegative spinal spastic paraplegia. A related new retrovirus or an altered immune response to HTLV-1 due to environmental or dietary factors are possibilities which require further exploration.

Flail aortic valve--a forme fruste of Marfan's syndrome?

Marfan's syndrome is an autosomal dominant disorder with risk of premature death from rupture of an aneurysm or aortic dissection. A case of acute severe aortic regurgitation due to flail aortic valve in a patient with family history of Marfan's syndrome which may be a form fruste of this syndrome is reported.

Profile of female patients undergoing coronary angiogram at a tertiary centre.

OBJECTIVE: To study clinical profile, risk factors and pattern of coronary artery involvement in females. MATERIAL AND METHOD: Female patients undergoing coronary angiography at Apollo Hospitals, Chennai during 1996-1998 for angina were analysed for risk factors. RESULTS: Out of 5997 angiograms, 660 (11%) were females of which 574 (88%) post-menopausal. 48% had atypical chest pain, 11% had unstable angina, 1% had acute myocardial infarction (MI). Past history of MI was present in 48%. Risks factors were hypertension in 60%, diabetes in 52%, obesity in 41%, dyslipidemia in 32%, family history in 36%. 71% patients used oral contraceptive. None of the patients were smoker, 34.8% pre-menopausal and 72.2% post-menopausal had coronary artery disease. Single vessel disease 33% vs 22.1% two vessel disease 43.3 vs 31.2%. Triple vessel 22.3 vs 46.6% and diffuse disease 10% vs 38.7% was seen in pre-menopausal vs post-menopausal females, respectively. CONCLUSIONS: Family history was the predominant risk factor in pre-menopausal and diabetes mellitus and hypertension in post-menopausal females. Diffuse and triple vessel disease were significantly common in post-menopausal females.

Lorazepam: an adjuvant therapy in patients with seizure and heliotaxis.

Photosensitive epilepsy is a type of reflex epilepsy. Five percent of epileptics are photosensitive, i.e. they show photoconvulsive response (PCR) during intermittent photic stimulation. Patients with photogenic or photosensitive epilepsy have seizures with flickering light. They also exhibit heliotaxis. Sodium valproate and ethosuximide are the common drugs used. Even though benzodiazepines are useful, the specific effect of lorazepam is not mentioned. We report 5 cases of photosensitive epilepsy with inadequate response to usual antiepileptic drugs who had complete or near complete remission with lorazepam.

Usefulness of concomitant nitrate administration for the enhancement of viability detection with myocardial perfusion imaging.

Myocardial viability assessment is crucial in the evaluation of patients who had prior myocardial infarction for revascularisation procedures. Conventional methods include nuclear myocardial perfusion imaging, dobutamine stress echocardiography and positron emission tomography. Utility of nitrate in assessment of viability was assessed. Twenty-five patients with prior myocardial infarction underwent 99mTc-sestamibi single photon emission computed tomography protocol of stress, rest and post 5 mg sublingual isorbide dinitrate. The mean age of the patients was 51.28 years. Eight (32%) had reduction in perfusion defect and increased tracer uptake following nitrate administration. It is concluded that addition of nitrate adds to utility of conventional perfusion imaging in the assessment of myocardial viability.

Primary angioplasty: the past, the present and the future.

Primary angioplasty (PTCA) in acute myocardial infarction has many theoretical advantages including better antegrade flow and reduced intracranial haemorrhage. However the improvement in the mortality and morbidity of primary angioplasty in the randomized trials from sophisticated centres has not been translated to the community setting. Primary PTCA is a suitable alternative to thrombolytic therapy if performed in a timely fashion by persons skilled in the procedure in a suitable laboratory. It is also recommended in patients with cardiogenic shock and in those with contraindications to thrombolytic therapy. Combination of thrombolytics and glycoprotein IIb/IIIa inhibitors with primary angioplasty may form the reperfusion strategy of the future.