Groin dressing after cardiac catheterization. Comparison between light dressing with thin transparent tape (Tegaderm) and conventional tight/pressure dressing with an elastic adhesive bandage (Tensoplast).

Post cardiac catheterization puncture site care is usually done with a tight pressure dressing by an elastic adhesive bandage (Tensoplast) due to the belief that it should prevent bleeding. The practice is uncomfortable to the patients. The authors compared a new way of dressing using light transparent tape (Tegaderm) to the conventional tight pressure one. 126 post coronary angiography patients were randomized to have their groins dressed either with Tensoplast or with Tegaderm. Patients ambulated 8 hours after the procedures. The groin was evaluated for pain, discomfort and bleeding complications. 49 per cent in the Tensoplast vs 26.9 per cent in the Tegaderm group experienced pain (p value of 0.01). 55.5 per cent in the Tensoplast group vs 11.1 per cent in the Tegaderm group reported discomfort. 4.7 per cent in the Tensoplast vs 1.6 per cent in the Tegaderm group developed bleeding or hematoma. Dressing of the puncture site after cardiac catheterization with Tegaderm was more comfortable than the conventional Tensoplast without any difference in bleeding complications.

Quality of life after coronary stent implantation in Thai population.

Placement of a stent in the coronary has become common practice in Thailand for treatment of Symptomatic Coronary Artery Disease. We evaluated the impact of such a practice on Life Quality in addition to symptomatic improvement by questionnaire interview using the Sickness Impact Profile format. 34 patients from 3 major cardiac centers in Bangkok were randomly selected to participate after having successful coronary stenting procedures. Quality of Life and Symptom of Angina improved dramatically after the index procedure and continued to improve at 6 weeks and 12 weeks evaluation time. We conclude that dilatation with stent implantation of coronary stenosis is beneficial in the Thai Population both in symptoms as well as Life Quality improvement.

Utilization of electron beam CT scan in diagnosis of pulmonary embolism.

Pulmonary embolism is a difficult entity to diagnose clinically and pulmonary angiogram has been the gold standard for the diagnosis. Our objective was to evaluate the usefulness of electron beam (Ultrafast) CT scan in aiding the diagnosis of such an entity, thus avoiding an invasive procedure. Between April 1995 and March 1996 we prospectively studied 20 patients with clinical suspicion of pulmonary embolism by conventional perfusion scan of the lung, by invasive pulmonary angiography and by contrast enhanced electron beam CT scan. Simple statistic correlation between the 3 methods was obtained in regard to sensitivity and specificity utilizing the pulmonary angiogram as the gold standard. The sensitivity and specificity of contrast enhanced electron beam CT scanning was 95 per cent and 100 per cent respectively. The correlation of positive and negative result of all three imaging modalities was 60 per cent. Contrast enhanced electron beam (Ultrafast) CT scan is a good alternative diagnostic modality for pulmonary embolism.

Coronary intervention 1996.

Interventional cardiology, in particular coronary angioplasty has progressed over the recent years. It is one of the three methods in treating coronary artery disease. The authors reviewed the advancement of this technique.

Transcatheter coronary revascularization registry 1995.

In 1995, from 12 participating units, there were 1108 PTCA compared to 697 in 1994, 24 rotational atherectomy and 109 intracoronary stent placements performed. These were complicated by 6 acute myocardial infarction, 10 emergency surgeries and 11 deaths. Success rate was 92 per cent. Indication for transcatheter revascularization were stable angina pectoris in 60 per cent of cases, unstable angina in 18 per cent and post infarct angina in 16 per cent. Thirty cases were done in AMI setting. Of those 1108 vessels approached, 1297 lesions were in native arteries and 9 were in saphenous vein grafts. Most lesions were in AHA/ACC type B category. One hundred and fourteen stents were placed in 109 patients in 1995. Seven stents emboli occurred in addition to one myocardial infarction, 2 CABG, 2 death and 2 major bleeding. Transcutaneous coronary revascularization has increased in number with acceptable results. Coronary stenting was done in an average of 10 per cent of all procedures and also with reasonable complication rates.