Transmyocardial laser revascularisation as an adjunct to CABG.

Transmyocardial laser revascularisation (TMLR), a new technique in which the ischaemic myocardium is perfused via laser-created transmural channels, was performed in 116 patients at the Escorts Heart Institute. TMLR was combined with CABG in 104 of these patients. The main indication for the combined procedure was the presence of one or more bypassable vessels along with diffuse disease in the other vessels. The age of the patients ranged from 37 to 73 years. Preoperatively, 53.84 percent of patients had Canadian Cardiovascular Society (CCS) class III angina while 24 percent had class IV angina. The mean LVEF was 46 percent; however, 19 percent of the patients had LVEF < 35 percent. Thirteen patients were operated upon a beating heart without cardiopulmonary bypass. The early mortality was 2.88 percent, 7.69 percent of patients showed elevation in CPK-MB, while 5.76 percent had a rise in Troponin 'T' and 2 percent of patients showed ECG changes. The mean follow-up was 7.6 months. Myocardial perfusion scan showed a step-wise improvement in reversible ischaemia, the perfusion index increasing from 52 percent at 3 months to 91 percent at 12 months. At 12 months, 91.6 percent of patients were angina-free. The Karnofsky score of 46 percent at baseline also increased to 86 percent at 12 months.

Nifedipine induced modulations of intra-thyroidal radio-iodine turnover kinetics in euthyroid and thyrotoxic patients.

Nifedipine induced modulations of intrathyroidal radioiodine turnover kinetics has been studied in euthyroid and thyrotoxicosis individuals. Nifedipine has been found to suppress Amax significantly (p < 0.001), while transit kinetics k1 and k2 are not significantly affected. On the contrary, in the patients with thyrotoxicosis post-nifedipine Amax was not significantly different from pre-nifedipine study, while k1 was slightly suppressed (p < 0.05) and k2 was significantly elevated (p < 0.01). Apparently different Ca+2 dependent control mechanisms are operative in euthyroid and thyrotoxic states. Clinical implications of these observations have been discussed.

Nuclear imaging study of nifedipine induced modulations of central haemodynamics in severe hypertension with and without coronary artery disease.

Acute effects of Nifedipine, a calcium channel blocking agent (CCBA), on central haemodynamics in patients with severe hypertension and angiographically proved coronary artery disease (CAD) has been studied using Nuclear Ventriculography (MUGA). While peripheral vasodilatation leads to significant reduction of systemic blood pressure in all severe hypertensive patients (p < 0.0005 and p < 0.0001), the central haemodynamics did not improve significantly in patients without CAD (p = NS). However, in hypertensive subset of CAD, central haemodynamics significantly improves with rise of global ejection fraction (p < 0.001) and improvement of wall motion abnormalities (p < 0.001).

Thyroid morphometry and intrathyroidal 131-I iodine transit kinetics in Kashmiri population.

Morphometric--kinetic parameters of the thyroid gland in the Kashmiri population, which is geographically, environmentally, socioculturally, anthropologically and ethnically different from that of the main country (Indian republic), have been analysed. Morphometrically, the gland in this population has been found to be significantly larger (p less than 0.001), while kinetically, the A max which is the ordinate-extrapolate of the best-fit RAIU(t) curve, has been found to be significantly lower (p less than 0.01). The majority of other structural and functional parameters were similar to those of the north Indian population.

Effect of clinicobiochemical bias on the sensitivity of nuclear imaging in detecting hepatic malignancies.

A retrospective analysis of the sensitivity of nuclear imaging in detecting hepatic malignancies has been done. Effects of clinical and liver function test bias have been studied on the ascribed sensitivity. The clinicobiochemical bias raises the detection sensitivity from 66.7% to 90.7% (p less than 0.001) but decreases the specificity of nuclear imaging significantly (p less than 0.05).

Aetiological profile of overt hypothyroidism in Indian population.

We analysed the aetiology of hypothyroidism in 144 patients. In these hospital referral data, thyroid surgery and decompensated iodine deficiency were the major known causes of hypothyroidism (19.5% and 15.3% respectively), while in the majority of patients (45.14%) the aetiology was obscure. The idiopathic group had patients who were significantly younger (p less than 0.01), showed a gland size between 2 and 3 SD ranges in significantly higher preponderance (p less than 0.05), and presented with generally higher prevalence rates of signs and symptoms; however, only menstrual disturbances (p less than 0.01), loss/reduced appetite (p less than 0.01) and dry/thickened hair (p less than 0.25) reached statistical significance. Since hypothyroidism has definite and substantial morbidity, these results are of importance to public health and medical personnel for a Bayesian approach to the aetiological diagnosis of hypothyroidism and for ordering specific confirmatory laboratory investigations.

Dissociation of left ventricular end-ejection from end-systole: scintigraphic evaluation and implication.

We have measured the extent and evaluated afterload dependence of temporal dissociation of left ventricular end-ejection from end-systole using count rate dependent scintigraphic method. Good predictability of the dissociation (y) especially in the lower ranges of afterload (x) has been demonstrated (y = 9.1 x -763: r1 0.72: r2 0.55: r3 0.86). Role of the dissociation as the corrective parameter in count rate dependent scintigraphic method for evaluation of left ventricular contractile function (in contradistinction to the ejection function) has been discussed.

Morphometric analysis of thyroid gland in adult north Indian population by nuclear imaging.

A detailed retrospective morphometric analysis of thyroid gland in adult north Indian subjects using scintillation imaging has been done. Many parameters were found to be significantly different as compared to non-Indian population. Utility of this analysis has been discussed.