Frequency of angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis.

Angina pectoris is a frequent symptom of severe valvular aortic stenosis (AS), even in the presence of normal coronary arteries. To determine the prevalence of angiographically significant coronary artery disease (CAD) and its relation to angina pectoris and coronary risk factors in severe isolated valvular AS patients. All cases of symptomatic AS patients who underwent aortic valve replacement and preoperative cardiac catheterization at the Central Chest Hospital between January 1, 1986 and December 31, 1996 were retrospectively analyzed. Excluded were those with multiple valvular disease, aortic regurgitation of grade 2 or more, and prior coronary or valve surgery. A total of ninety consecutive patients with severe AS (64 men and 26 women, mean age 58.94 years, range 38 to 71) were studied. Significant CAD (coronary diameter stenoses > or = 50%) was found in 15 patients (16.7%). Typical angina was present in 66.7 per cent of them but it was also found in 46.7 per cent of the non-CAD patients. This symptom had low positive predictive value (22%). Of the patients without angina (n = 45) 11.1 per cent had significant CAD, The negative predictive value of angina alone was thus 89 per cent. By univariate logistic regression, the statistically significant variables to discriminate those with or without significant CAD were age, history of hypertension, positive familial history of premature CAD, and cholesterol level. However, only age and hypertension were statistically significant by multivariate logistic regression analysis. Coronary arteriography can probably be omitted in severe valvular AS, especially those without a history of hypertension and < 40 years of age in men and < 50 years in women. For all other cases, coronary arteriography is recommended. In our study, angina pectoris is not a significant predictor for associated CAD.

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.

A comparison of two short course tuberculosis chemotherapy regimens, both using Rifater during an intensive phase, with a 3 year follow-up.

Tuberculosis is still a major public health threat in Thailand. The introduction of a short course of chemotherapy at national level might help reduce the magnitude of the problem. In order to assess the efficacy and toleration of two different regimens of chemotherapy under field conditions, a comparative clinically controlled trial was conducted at the Central Chest Hospital in Nonthaburi, Thailand. From January 1988 to August 1990, 199, newly diagnosed, untreated, sputum positive tuberculosis patients were allocated randomly to two treatment groups; in Group A, 97 patients received Rifater daily for the first 2 months, followed by Rifinah daily for 4 months (2 Rifater/4 Rifinah). In Group B, 102 patients received Rifater supplemented by ethambutol daily for the first 2 months followed by thiacetazone and isoniazid daily for 6 months (2 Rifater EMB/6 HT.) Treatment results were very satisfactory in both groups. At the end of treatment conversion rates were 100 per cent in Group A, and 99 per cent in Group B. After a period of 36 months following completion of treatment, relapse rates of 3 per cent for Group A and 4 per cent for Group B were observed. Adverse reactions were minimal in both groups, but acne formation and gastrointestinal symptoms were noticed more in Group B, suggestive of thiacetazone side effects. This study shows that, the 6-months regimen is as effective as the 8-months regimen. Although the 8-months regimen is cheaper, it causes more gastrointestinal disturbance and skin reaction which might led to less patient compliance and result in a lower cure rate.(ABSTRACT TRUNCATED AT 250 WORDS)