Objective-To compare the visualisation of bronchopulmonary collaterals and bronchopulmonary collateral blood flow in patients with chronic thromboembolic pulmonary hypertension and primary pulmonary hypertension.Setting--Referral centre for cardiology at an academic hospital. Patients-Nine patients with chronic thromboembolic pulmonary hypertension and 17 with primary pulmonary hypertension. Interventions-Bronchopulmonary collaterals were visualised by selective bronchial arteriography or thoracic aortography. Bronchopulmonary collateral blood flow was estimated by injecting indocyanine green into the ascending aorta and sampling below the mitral valve from the left ventricle. Results-The degree ofpulmonary hypertension was comparable in the two groups. Large bronchopulmonary collaterals were visualised in all the patients with thromboembolic pulmonary hypertension who had bronchial arteriography or aortography or both. None of the primary pulmonary hypertension group studied by aortography had bronchopulmonary collaterals (P << 0 001). All the patients with chronic thromboembolic pulmonary hypertension had significant bronchopulmonary collateral blood flow, which was (mean (SD)) 29-8 (18.6)% of the systemic blood flow. There was no recordable collateral blood flow in 11 of 15 patients with primary pulmonary hypertension. In the remaining four patients the mean value was 1-1 (1l8)% of the systemic blood flow (P << 0.001).Conclusions-Visualisation of bronchopulmonary collaterals by thoracic aortography or by bronchial arteriography, or the demonstration of an increased bronchopulmonary collateral flow, helps to distinguish patients with chronic thromboembolic pulmonary hypertension from those with primary pulmonary hypertension. (Heart 1997;78:171-176) Keywords: pulmonary thromboembolism; primary pulmonary hypertension; bronchial arteries; heart catheterisation The recognition of chronic thromboembolic obstruction of the central, lobar, and segmental pulmonary arteries resulting in pulmonary hypertension is important since this is potentially curable by pulmonary thromboendarterectomy.' On the other hand, the management of the majority of patients with primary pulmonary hypertension continues to be disappointing despite advances in pharmacotherapy and transplantation.2-5 At present, the differentiation of chronic thromboembolic pulmonary hypertension from primary pulmonary hypertension depends mainly on the perfusion-ventilation lung scan and pulmonary angiography. 2 6 7 The risk of pulmonary angiography in patients with severe pulmonary hypertension and the precautions during angiography need special emphasis.1 7 More recently high resolution computerised tomography,8 magnetic resonance imaging,8 pulmonary intravascular imaging,9 and transoesophageal echocardiography'0 have been used for the detection of pulmonary thrombi. The separation of thromboembolic pulmonary hypertension from primary pulmonary hypertension is at times difficult, and made more so by the development of in situ thrombosis of the p...

The diagnosis of tuberculous aetiology in pericardial effusions is important since the prognosis is excellent with specific treatment. The clinical features may not be distinctive and the diagnosis could be missed particularly with tamponade. With the spread of HIV infection the incidence has increased. The diagnosis largely depends on histopathology of the pericardial tissue or culture of Mycobacterium tuberculosis from this tissue or fluid, but patients without haemodynamic compromise do not require pericardiocentesis. Histopathology may, however, show non-specific findings in a significant number. This review is an update on the diagnostic difficulties, current research, and criteria for diagnosis.

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It is known that lifestyle factors affect sporadic miscarriage, but the extent of this on RPL (recurrent pregnancy loss) is less well known. A systematic review and meta-analysis was performed to assess the associations between lifestyle factors and RPL. Studies that analysed RPL in the context of BMI, smoking, alcohol and caffeine intake were included. The primary and secondary outcomes were odds of having RPL in the general population and odds of further miscarriage, respectively. Underweight and women with BMI > 25 are at higher odds of RPL in the general population (OR 1.2, 95% CI 1.12–1.28 and OR 1.21, 95% CI 1.06–1.38, respectively). In women with RPL, having BMI > 30 and BMI > 25 has increased odds of further miscarriages (OR 1.77, 95% CI 1.25–2.50 and OR 1.35, 95% CI 1.07–1.72, respectively). The quality of the evidence for our findings was low or very low. Being underweight and BMI > 25 contributes significantly to increased risk of RPL (general population). BMI > 25 or BMI > 30 increases the risk of further miscarriages (RPL population). Larger studies addressing the effects of alcohol, cigarette smoking and caffeine on the risk of RPL with optimisation of BMI in this cohort of women are now needed.

BackgroundDiameter of coronary artery is an important predictor of outcome after percutaneous coronary interventions and coronary artery bypass graft surgery. There is very limited data available about coronary artery dimensions in an Indian population.AimsTo study the normal dimensions of the coronary artery segments in Indians without coronary artery disease by using quantitative coronary angiography and also to compare the dimensions in Indians with Western.Material and method229 patients who have undergone coronary angiography with entirely normal coronary angiogram were included in our study.ResultsThis study showed the diameter of vessels in males and females when taken together the left main was larger in size followed by proximal LAD, proximal RCA & proximal LCX respectively (4.08 ± 0.44 mm, 3.27 ± 0.23 mm, 3.20 ± 0.37 mm, 2.97 ± 0.37 mm).When the vessel diameter was indexed to body surface area there was no statistical difference between male and female (p value > 0.05). The computed value of proximal coronary artery diameter unadjusted for individual body surface area, when compared to Caucasians showed that Caucasians have larger coronary artery dimensions than Indians. But when the proximal vessel diameter was indexed to body surface area there was no statistical significant difference between Indians and Caucasians (p value > 0.05).ConclusionsWe found that coronary artery size when indexed to body surface area is not statistically different in Indian males and females and compared to Caucasians. However with a smaller body habitus Indians have smaller coronary arteries.