Cardiology--a saga of one hundred years "but, where is the conductor?"--Braunwald, 2003.

Modern Cardiology was born with the birth of ECG invented by Einthoven in 1903. Since then a galaxy of great pioneers in succession led Cardiology through unprecedented landmark achievements to the present state which is as promising as challenging. This article reviews the journey of Cardiology as a speciality in the last one hundred years of its noteworthy life while highlighting the future directions and challenges the specialty is likely to face."

The enigma of the endothelium.

The endothelium was earlier regarded as a relatively inert layer performing rather simple physiological functions. However extensive research has recently revealed that the endothelial layer performs a vast array of functions such as maintenance of vascular tone, control over coagulation and fibrinolysis besides a lot of chemical interactions. More recently, endothelial dysfunction has been implicated as important in the pathogenesis of atherosclerosis, coronary artery disease, myocardial ischemia and post-intervention restenosis. The demonstration that endothelial dysfunction may be reversible by employing various strategies raises the possibility of retarding the progress or even preventing the process of atherosclerosis thereby reducing the risk of acute cardiovascular events.

Comparison of magnified chemiluminescent examination with incandescent light examination and colposcopy for detection of cervical neoplasia.

Magnified Chemiluminescent Examination (MCE) or speculoscopy is a new visual method for detection of cervical neoplasia. It utilizes low magnification and a special "blue-white" chemiluminescent light. The study includes 125 women with unhealthy cervix who were subjected to magnified examination with projected incandescent light (PIL) and chemiluminescent light (MCE). This was followed by colposcopy and directed biopsy from acetowhite areas. Of all 125 subjects, 20 patients showed cervical neoplasia of varying degree on histopathology. MCE could detect 18/20 neoplasias while PIL detected 11/20 cases. Sensitivity of MCE (90%) was significantly superior (P < 0.05) to PIL (55%) in detecting cervical neoplasia. Colposcopy, as compared to MCE, is better than speculoscopy as it facilitates grading of lesions due to higher magnification but antecedent MCE detected the acetowhitening in majority of patients (32/43). However, tendency to "overall" acetowhite lesions was significantly less during MCE when compared with colposcopy. Thus, MCE is a new diagnostic tool which is better than routine incandescent light examination and correlates well with colposcopy.

Prazosin GITS vs sustained release nifedipine in patients with hypertension and abnormal lipid profile: a randomized, controlled, multicenter study. Madras Hypertension Study Group.

OBJECTIVE: To compare the long-term antihypertensive efficacy, tolerability, and metabolic effects of prazosin GITS and a sustained release (SR) preparation of nifedipine. DESIGN: Randomized, controlled, multicenter study of 26 weeks duration. SETTING: Office practices of 24 physicians in Chennai, Tamil Nadu, India. PATIENTS: Males and females, aged 30 to 70 yrs, with hypertension of JNC V stage 1 or 2 at the end of a 2-week placebo run-in period, and an abnormal lipid profile. Sufficient number of patients recruited so that at least 60 complete the entire study. INTERVENTIONS: Prazosin GITS (Minipress XL, 2.5-5 mg once daily) or sustained release nifedipine (Nicardia Retard 10-20 mg twice daily) for upto 6 weeks, continued upto 24 weeks in those showing a pre-defined response (SBP and/or DBP normalized, or DBP fall of at least 10 mm Hg with actual value of DBP < 95 mm Hg). Patients allocated to either of the two interventions by randomization. OUTCOME MEASURES: Percent patients showing pre-defined BP response at week 6; percent patients with DBP < 90 mm Hg, SBP < 140 mm Hg, and both; percent patients with DBP fall > or = 10 mm Hg; mean fall in BP among those receiving treatment for 24 weeks; mean change in blood glucose and serum lipids at the end of weeks 8, 16, and 24 of treatment; frequency and intensity of adverse events judged probably or definitely related to the drug. RESULTS: 54 patients randomized to prazosin GITS group and 52 to nifedipine SR group. Of these, 39 in prazosin GITS group (M 23, F 16; mean age-50. 6 yr, SEM 1.66) and 36 in nifedipine SR group (M 20, F 16; mean age-52.3 yr, SEM 1.71) completed the study. Percent patients with DBP < 90 mm Hg at 24 weeks: prazosin GITS--100%, nifedipine SR--100%; SBP < 140 mm Hg: prazosin GITS--94.9%, nifedipine SR--91.7%; both DBP < 90 mm Hg and SBP < 140 mm Hg: prazosin GITS--92.3%, nifedipine SR--91.7%; percent patients with DBP fall of 10 mm Hg or more at 24 weeks: prazosin GITS--76.9%, nifedipine SR--83.3%. The mean fall in the systolic and diastolic blood pressure from the end-of-placebo-phase values to all the other time points was comparable in the 2 groups. Treatment with prazosin GITS did not produce any statistically or clinically significant change in the metabolic parameters at the end of 24 weeks, while with nifedipine SR there was a significant increase in the serum LDL values at 24 weeks (p = 0.009). Adverse events probably or definitely related to the drug: prazosin GITS--1.9%, nifedipine SR--2.1%. CONCLUSION: Both drugs were equally effective and well tolerated. While prazosin GITS was neutral on serum lipids, use of nifedipine SR was associated with a significant increase in serum LDL cholesterol at the end of 24 weeks.

Comparison of pleural fluid cytology and pleural biopsy in the evaluation of pleural effusion.

Pleural fluid cytology and pleural biopsy results were studied in 65 cases of pleural effusion. The efficacy of pleural biopsy in diagnosis of neoplastic and non-neoplastic pleural diseases was compared. Of the 24 cases with confirmatory evidence of cancer, 17(70.8%) has positive cytologic findings in pleural fluid, whereas pleural biopsy was diagnostic in only 13 cases (54.1%). For non-malignant pleural effusion in 41 cases 40(97.5%) has a definite diagnosis (tuberculous pleuritis, acute fibrinous pleuritis or hydatid cyst) which could be made by cytology while only 31(75.6%) out of 41 were diagnosed on pleural biopsy. The study indicates that cytologic evaluation of pleural fluid is more efficaceous in the diagnosis of malignant and non-malignant pleural disease than percutaneous pleural biopsy.

Mortality events amongst non insulin dependent diabetes mellitus patients in Orissa.

In a study over one year, it was observed that mortality amongst hospitalised patients with non insulin dependent diabetes mellitus (NIBDM) was nearly 20%. Those dying within 24 hr were classified as group A, between one day and one week as B, between one week and one month as C, and those after one month as D. There were 31 patients each in groups A and B, 14 in C, and 4 in D. The mean age at death was 61 years in the first three groups. The prevalence of cerebro-vascular accident as a terminal event was similar i.e. 32.2, 35.5 and 35.7 per cent in groups A, B and C respectively; 48% of patients in group A suffered from ischaemic heart disease. Diabetic ketoacidosis was equally prevalent amongst groups A, B and C. Infection was significantly more common in group B (45.2%) than A (P less than 0.05). Nephropathy was observed in 57% of patients in group C as compared to 22.5% in A (P less than 0.02). Cerebrovascular accident and infection were the major causes of mortality in groups B and C (80.7% and 71.4%), whereas ischaemic heart disease and cerebrovascular accident accounted for 80% of deaths in group A.

Histopathological study of xanthogranulomatous cholecystitis.

A total of 418 gallbladders removed surgically as chronic cholecystitis or carcinoma gallbladder were studied retrospectively for the presence of xanthogranulomas which were found in 45 (10.8%). The age of patients with xanthogranulomatous cholecystitis ranged from 15 to 80 yr with a mean of 45.3 indicating an early presentation of the disease in our population. The male to female ratio was 1:8. The gallbladder was invariably thickened and calculi of cholesterol or mixed type were present in all cases. Xanthogranulomatous foci appeared as yellowish nodules 2-15 mm in size, on the mucosal surface. In some gallbladders, the involvement was diffuse and these foci extended to the surrounding structures. Histologically, xanthogranulomas encompassed the full thickness of the gallbladder wall with variable extension into adjacent fat and connective tissue. This entity deserves distinct clinicopathological recognition, particularly because of a possible confusion with malignancy and the associated complications.

(α-Pyridyl) methyl phosphoro-bis-triazolide as a new phosphorylating reagent for internucleotide bond formation.

(α-Pyridyl)methyl phosphoro-bis-triazolide has been found to be a reagent of choice for phosphate protection in oligodeoxyribonucleotide synthesis. The reagent has been used successfully to phosphorylate all the four 5'-and N-protected deoxynucleosides. The resulting 3'-phosphorylated derivatives were found to be fairly stable as either triethyl ammonium salts or cyanoethyl derivatives. The phosphorylated derivatives were used in the preparation of the dimers TpT and d(ApT) in solution phase and a tetramer, TTTT, and a hexamer, d(ATATAT), on solid phase using glass support. The method gave excellent yields. Considerably reduced condensation time (6-9 min) and practically no cleavage of the internucleotide bond during the removal of the group are the advantages.

Glycogen metabolism in human fetal testes.

The ontogeny of glycogen synthetase, glycogen Phosphorylase and α-Dglucosidase, enzymes which are associated with glycogen metabolism and glycogen level has been studied in human fetal testes of gestational age ranging from 14-32 weeks. Glycogen synthetase activity reaches the peak value at 17-20 weeks of gestation, thereafter it decreases. α-D-Glucosidase activity increases with the advancement of pregnancy up to 28 weeks of gestation decreasing thereafter very rapidly. Phosphorylase activity remains more or less constant throughout gestation. The maximum increase in glycogen content at early stages of gestation (17-20 weeks) and gradual reduction with the advancement of pregnancy are correlated with histochemical observation by the periodic acid-Schiff technique.