A Study on Ventricular Late Potentials by Signal Averaged Electrocardiogram in Myocardial Infarction Patients.

Fifty patients who presented with Myocardial Infarction (MI), diagnosed by history, ECG, enzymes were subjected to late potential analysis between 7-10 days post MI by Signal Averaged Electrocardiography (SAECG). There were 42 male and 8 female patients. 34 had anterior wall MI and 16 had inferior wall MI, and all of them had Q wave infarction. History of previous MI in 12, diabetes in 14, hypertension in 34, smoking in 24 and hypercholesterolemia in 8 was noted. Patients were followed up for one year. Late potentials were positive in 10 patients (62.5%) of inferior wall MI and 6 patients (17.5%) of anterior wall MI. Those with episodes of ventricular tachycardia had increased incidence of late potentials. There was no correlation of late potentials and LV function assessed by echocardiography. Thrombolysed group had decreased incidence of late potentials.

Stepping down in asthma.

Beta-2-agonists continue to find a dominant role in all the current guidelines on the management of chronic persistent bronchial asthma. However, the safety of the drugs remains doubtful. Thus, there is a case for review of the “Step up-Step down” approach in the management of chronic persistent bronchial asthma. Based on the currently available experimental and clinical data on bronchial asthma, the authors are of the opinion that chronic persistent bronchial asthma is best managed by a modified “Step I-Step II” approach.

Asymptomatic lymphangitis carcinomatosis due to squamous cell lung carcinoma.

Lymphangitis carcinomatosa most commonly due to primary malignancy originating in the breast, stomach, pleura and prostate but may also originate from the lung itself. It is clinically characterised by progressing dyspnoea with or without cough even at an early stage. We report the case of a patient with squamous cell lung cancer presenting with asymptomatic lymphangitis carcinomatosa.

Chylothorax in a patient with ovarian tumour.

A rare case of chylothorax complicating sex cord tumour of ovary in a young girl is being reported here. It was successfully managed by using a multipronged strategy consisting of chemotherapy, total parentral nutrition and bleomycin pleurodesis.

Shah Waardenberg syndrome.

Intermittent or partial small bowel obstruction in a neonate may be a rare presentation of total aganglionosis. The presence of partial albinism and white forelock should alert the clinician to the possibility of associated Hirschsprung disease as a cause of bowel symptoms. Such a rare association has been called Shah Waardenberg syndrome and is being reported.

BOOP presenting as pseudo-lymphadenopathy.

A case of BOOP presenting with hilar pseudo-lymphadenopathy is reported. Atypical radiology should not preclude diagnosis of BOOP.

Evaluation of oral dipyridamole electrocardiography test in ischaemic heart disease.

Forty-three cases of ischaemic heart disease of the age group 35-72 yrs with positive treadmill test (TMT) results were administered dipyridamole in the morning on empty stomach. Heart rate, BP and ECG were recorded before and every 15 mins after oral dipyridamole upto 2 hrs. ECG was repeated every 5 mins when patients developed angina or ischaemic ECG changes. Oral dipyridamole electrocardiography test (ODET) was found to be positive in 21 (48.83%) cases and majority of them developed ST depression in 25-40 mins and persisted for less than 30 mins. While compared with TMT results patients having chest pain, lower target heart rate (< 75%), shorter time to onset (< 2 mins) of ST depression and longer duration (> 8 mins) of ST depression had significantly higher rates of positivity on ODET than those without these manifestations. There were minor changes in hemodynamic parameter (heart rate, systolic and diastolic blood pressure) and other minor side effects encountered include mild headache and benign unifocal VPCs. Oral dipyridamole is viewed as a safe drug and may be used as a substitute for TMT specially in economically poor and physically disabled patients with significant coronary artery disease.

Prevalence of initial drug resistance in tuberculosis patients attending a chest hospital.

Sputum samples from pulmonary tuberculosis patients attending a hospital for chest diseases and tuberculosis at Jaipur, India were directly subjected to sensitivity tests to detect drug resistance to streptomycin (S), isoniazid (I), rifampicin (R) and ethambutol (Emb) by slide culture technique. Drug resistance was observed to one or more drug in 19.9 per cent of the patients. I resistant organisms were present in 10.1 per cent of patients, S resistance in 7.6 per cent, R resistance in 3.0 per cent and Emb resistance in 2.6 per cent. Resistance was limited to a single drug in 16.7 per cent patients. Drug resistance was unrelated to age and sex of the patients.

Ranitidine--rifampicin interaction.

Newly diagnosed patients of pulmonary tuberculosis (n = 112) were put on a rifampicin-containing drug regimen. Fifty six patients were also given a placebo tablet twice daily while the other fifty-six were given ranitidine 150 mg twice daily. Gastric pH, gastric emptying time, serum rifampicin levels, urinary total and unchanged rifampicin, serum bilirubin and ALT levels were measured serially. Clinical record of adverse symptoms was maintained. Ranitidine increased the basal as well as post-drug gastric pH without altering the gastric emptying time. Concomitant administration of ranitidine and rifampicin did not alter the absorption, metabolism or excretion of the latter but reduced the frequency of gastrointestinal symptoms.

Adverse effects of oral amiodarone therapy.

Oral amiodarone was administered to 38 patients (25 males, 13 females) with mean age of 43.6 years. Ventricular and supraventricular arrhythmias were present in 30 and 8 patients respectively. Amiodarone was given as 400-1200 mg/day for 1-2 weeks as loading dose and then it was maintained as 100-600 mg/day. The mean duration of therapy was 12.4 months. Adverse effects were noted in 21 (55.3%) cases. The commonest adverse effects observed were asymptomatic corneal microdeposits followed by gastrointestinal, cardiac, neurological and cutaneous disturbances. The drug was withdrawn in 2 (5.3%) patients because of nausea and vomiting. One patient died of pulmonary infiltrations. It is concluded that adverse effects are common with amiodarone but are tolerated well, making this drug an excellent choice for treatment of cardiac arrhythmias.

Influence of prior information of drug toxicity on patient compliance.

Sixty patients with pulmonary tuberculosis, who had not received any chemotherapy in the past, were divided into two groups. All the patients were put on isoniazid, rifampicin and pyrazinamide for 8 weeks followed by isoniazid and rifampicin for another 18 weeks. Group A patients were informed of the likely occurrence of anorexia and/or vomiting but Group B patients were not. Routine and default retrieval home visits were given to ensure maximal drug compliance. Drug toxicity related early defaults were significantly less common in Group A patients (1 of 30) as compared to Group B (6 of 30).

Cor-triatriatum with atrial septal defect and bicuspid aortic valve diagnosed by cross-sectional echocardiography.

We report a rare case with a combination of cor-triatriatum, large secundum atrial septal defect and bicuspid aortic valve. The diagnosis was made by cross-sectional echocardiography. A defect was present between proximal (accessory) left atrial chamber and right atrium decompressing the accessory left atrial chamber. The large left to right shunt resulted in severe pulmonary arterial hypertension.

Calcium channel blockers and terbutaline--a positive interaction.

The role of two calcium channel blockers, nifedipine and verapamil was investigated in patients of bronchial asthma. Both the drugs given orally produced an insignificant rise in PEFR, FEF25-75% and FEV1. Given along with terbutaline, however, these drugs produced significantly greater increase in PEFR, FEF25-75% and FEV1 as compared to patients receiving terbutaline alone. The two calcium channel blockers also inhibited the terbutaline induced tremors and palpitation.