Conscious sedation as an anaesthetic technique in patients undergoing nonthoracotomy placement of automatic implantable cardioverter defibrillator: an initial experience.

Six adult patients with life threatening recurrent ventricular arrhythmias who underwent non- thoracotomy placement of automatic implantable cardioverter defibrillator under conscious sedation are reported. Our clinical experience, patient satisfaction, recovery profile, complications and cardiologist perception about the technique of conscious sedation is presented and discussed.

Medical arthroscopy--emerging era of rheumatological intervention.

OBJECTIVE: To evaluate the safety and diagnostic value of arthroscopy performed by a rheumatologist. METHODS: Decisions for performing arthroscopy were taken when detailed clinical history-and relevant rheumatological investigations failed to arrive at a definite diagnosis. Arthroscopies were performed under local anesthesia as a daycare procedure. Synovial biopsies taken during procedures were subjected to histopathological examination (HPE). RESULTS: Of the 50 patients enrolled, 39 were males while 11 were females with mean age of 35.5 years. In lower limb oligoarthritis group of patients, three had macroscopic picture of crystal arthropathy, rest of the 29 patients revealed gross picture indicative of non-specific synovitis. While in polyarticular group of eight patients, three had macroscopic picture suggestive of crystal arthropathy (probably polyarticlar gout) while five were indicative of rheumatoid arthritis. In monoarticular disease pattern (n= 10) macroscopic picture findings were as follows- crystal arthropathy-two, tubercular-three, synovial chondromatosis-one and non-specific synovitis-two. HPE of synovium did not correlate in many cases. CONCLUSION: Arthroscopy using a 4 mm scope under local anesthesia in the hands of rheumatologists is a safe daycare procedure. In few cases arthroscopy helped in arriving at a final diagnosis but many patients remained undiagnosed. Both the rheumatologists and the pathologists require further experience in this field.

Exercise-induced ventricular arrhythmias in congestive heart failure and role of ACE inhibitors.

Ventricular arrhythmias are considered to be related to left ventricular (LV) dysfunction. ACE inhibitors though improve LV function their beneficial role on exercise-induced ventricular arrhythmias is not established. To study the effects of ACE inhibitors on exercise capacity vis-a-vis their role on exercise-induced ventricular arrhythmias, 25 patients of congestive heart failure (CHF) of various etiologies in NYHA Class II and III were subjected to a prospective randomised controlled trial. The control group comprising of 12 patients received conventional treatment (digitalis and diuretics) and the test group was given enalapril/captopril in addition as tolerated. They were followed up for 3 months. Exercise testing on treadmill and monitoring of clinical and biochemical parameters were done at the beginning and end of study in all cases. Ventricular arrhythmias observed during exercise and post-exercise for 10 minutes was analysed using Lown's grading for frequency and severity of ventricular arrhythmia. The mean exercise duration showed significant improvement on ACE inhibitor as compared to the control group (p < 0.05) however there was no significant change in the grades of arrhythmia. Serum electrolytes and other bio-chemical parameter were within normal range. It is concluded that effect of ACE inhibitor on improving functional capacity in CHF is independent of it's any effect on exercise-induced ventricular arrhythmias.

QUANTIFICATION OF EXERCISE TOLERANCE IN CONGESTIVE HEART FAILURE AND ROLE OF ACE INHIBITORS.

A prospective randomised controlled trial with captopril/enalapril was carried out on 25 patients with congestive heart failure (CHF) of various aetiologies in NYHA Class II & III to study the effect of Ace inhibitors on exercise tolerance. The control group (Gp-A) comprising of 12 patients received conventional treatment (digitalis and diuretics) and the test group (Gp-B) with 13 patients were in addition given captopril/enalapril as tolerated. They were followed up for a mean period of 101.6+50.6 days (approx 3 months). Ten patients from each group could complete the study. The exercise testing was done on treadmill using a suitable protocol and end-points, at the beginning and end of study. None of the clinical and noninvasive parameters showed significant difference, however the mean exercise duration in Group A improved from 7.84+3.34 to 9.2 +3.16 minute (P <0.05) and in Group B increased from 7.91+4.6 to 10. 92+4.66 minute (p < 0.001). On comparing the benefits of the two groups the difference was statistically significant (P < 0.05). It is concluded that Ace inhibitor improves the exercise tolerance in CHF and the benefit is evident despite any improvement in clinical and noninvasive indices of left ventricular function.

Unusual occurrence of dextrocardia with situs inversus in succeeding generations of a family.

In three cases of dextrocardia with situs inversus affecting a father and his two sons, the father had married his first cousin, the daughter of his father's sister, so that the two sons were the products of a consanguineous marriage. The general and familial incidence of the condition and the genetic influences responsible for it are discussed.