Takayasu's disease presenting with pain chest, prolonged pyrexia and pleural effusion.

Takayasu's disease (TD) is a diffuse arteriopathy recognised by various names viz. Takayasu Arteritis, Takayasu's Disease, Takayasu Syndrome, Pulseless Disease, Non-specific Aortoarteritis, Reversed Coarctation, Aortic Arch Syndrome, Aortitis Syndrome, Young Female Arteritis, Idiopathic Arteritis and Martorell Syndrome. Though described about a century ago and with many eponyms, TD yet remains a challenging problem regarding etiopathogenesis, clinical presentation and management. We present a case of TD with pyrexia of unknown origin (PUO), angina and left sided pleural effusion.

Association of major modifiable risk factors among patients with coronary artery disease--a retrospective analysis.

BACKGROUND: The relative importance of various risk factors varies in different regions of India. This was a retrospective study of patients with recently diagnosed coronary artery disease to assess four major risk factors: dyslipidemia, hypertension, smoking and diabetes. MATERIAL AND METHODS: A total of 5748 patients (4952 males, 796 females) with recently diagnosed coronary artery disease were analysed from the records of Heart Hospital along with 8103 controls (6092 males and 2011 females). Absolute lipid levels as well as prevalence of dyslipidemia using the ATP III guidelines were assessed. They were classified into two major groups premature CAD (males < 45 years females < 55 years) and CAD at usual age (males > or = 45 years, females > or = 55 years). RESULTS: The most common pattern of CAD was chronic stable angina (n=2773, 48.24%). Mean total cholesterol (TC), LDL cholesterol and TC/HDL ratio were significantly higher in subjects with CAD compared to subjects without CAD controls. The mean HDL cholesterol and triglyceride levels were similar in both groups. Elevated LDL cholesterol, decreased HDL cholesterol, elevated total cholesterol and abnormal TC/HDL ratios were more common in CAD patients as compared to controls (38.8% vs. 33.14%, 29.3% vs 18.2%, 36.9% vs 32.5% and 59.05% vs 44.3% respectively). However lipid abnormalities were not significantly different in females > or = 55 in CAD vs non-CAD group. Smoking was significantly more common in subjects with CAD groups (30.97% vs. 12.72%) as compared to subjects without CAD (P < 0.0001). It was most common in males with premature CAD (44.1 % P < 0.0001). Hypertension was found in 1036 patients (18.02%) and diabetes in 763 (13.28%) as compared to 1126 (13.9%) hypertensives in non-CAD group and 639 diabetics (7.89%) (P = 0.001), both were more common in males > or = 45 and females > or = 55 as compared to those with premature CAD (p < 0.01). CONCLUSION: Among the risk factors assessed, dyslipidemia (particularly abnormal TC/HDL ratio and elevated LDL cholesterol), smoking hypertension and diabetes were associated with coronary artery disease in decreasing order of prevalence. In premature CAD, dyslipidemia and (in males) smoking are of particular importance.

A study of lipid levels in uncomplicated hypertension.

A number of risk factors for coronary artery disease are known to be present in hypertensive patients, the most important being hyperlipidemia. An analysis of the lipid profiles of 3,182 uncomplicated non-diabetic patients (2,425 males, 757 females) who attended two institutions of Patna city between 1992-1998 was conducted alongwith 4,131 controls. Mean total cholesterol was slightly higher (but statistically significant; p < or = 0.05) in hypertensives (191.8 mg/dL vs 190.1 mg/dL) as compared to the control group; mean total cholesterol-HDL ratio was also higher (4.65 vs 4.48) in hypertensives (p < or = 0.05). As per National Cholesterol Education Programme guidelines, 1,069 (33.6%) patients had cholesterol level above 200 mg/dL while 850 (26.7%) had triglycerides over 200 mg/dL among the hypertensive group. An abnormal total cholesterol-HDL ratio (> 4.5) was found in 1,600 (50.3%) of the hypertensives; this was by far the most common abnormality. With increasing severity of hypertension, the prevalence of elevated total cholesterol, LDL cholesterol and low HDL cholesterol was higher; triglyceride levels were less affected. These results indicate that an abnormal total cholesterol-HDL ratio is the most common variety of dyslipidemia in uncomplicated hypertension.

Echocardiographic detection of cardiac involvement in chronic renal failure.

The aim of this work was to determine the incidence of occult cardiac involvement in chronic renal failure (CRF). 50 adult patients (42 male, 8 female) were subjected to echocardiography (by both M-mode and 2D methods). Pericardial effusion was detected in 15 patients (30%), 2 patients (4%) had dilated left ventricles with poor contractility and sluggish interventricular septum (IVS) movement, suggesting cardiomyopathy. 1 patient (2%) had cardiac calcification involving the aortic valve, 32 patients (64%) had normal echo findings. These findings suggest that echocardiography is an invaluable tool in detecting early cardiac abnormalities in C.R.F., especially in diagnosing small asymptomatic pericardial effusion and cardiac calcification.