Five-year survival and complications of thoracic endovascular aortic repair (TEVAR): A single tertiary center registry for all-comers patients

INTRODUCTION

Studies on the mid and long-term outcomes of thoracic endovascular aortic repair (TEVAR) are scarce. This study aimed to investigate the long-term outcomes of TEVAR for all-comers patients with various types of thoracic aortic pathologies, predominantly thoracic aortic dissections and thoracic aortic aneurysms.

METHODS

Between January 2005 and December 2015, 123 consecutive patients with thoracic aortic pathologies underwent TEVAR. The patients were divided into groups based on aortic pathologies (dissections or aneurysms) and the type of procedure (hybrid TEVAR or non-hybrid TEVAR). Mortality, complications, and reintervention rates were compared between these four groups. The Kaplan-Meier curve and the Cox regression analysis were employed to estimate survivals and factors associated with 5-year mortality.

RESULTS

One hundred twenty-three consecutive patients with various aortic pathologies undergoing TEVAR were evaluated. Hypertension (79.7 %) and smoking (39 %) were the most common comorbidities in the study population. The patients were followed up for a mean duration of 58.1 ± 7.1 months to evaluate the postprocedural surveillance. Most complications occurred in the dissection and hybrid groups; however, these differences were nonsignificant. The overall 5-year surveillance and reintervention rates were 65 % and 12.1 %, respectively. A significant difference existed in 5-year survival between the patients with aneurysmal and aortic dissection pathologies based on the log-rank test (P = 0.01). On the other hand, no significant differences were observed in 5-year survival between the patients who underwent hybrid and non-hybrid TEVAR. The Cox regression analysis confirmed that chronic kidney disease, previous coronary artery bypass grafting, age >65 years, platelet counts <150∗ 10³/μL, aneurysmal aortic pathology, and ejection fraction ≤ 50 % were predictors of 5-year mortality.

CONCLUSIONS

The long-term outcomes of TEVAR for various aortic pathologies disclosed that this procedure was well-tolerated in a group of patients with high comorbid conditions. The five-year survival rate of TEVAR for thoracic aortic dissections was more favorable than that for thoracic aortic aneurysms, but there were no significant differences between hybrid and non-hybrid procedures regarding the mortality rate.

The association between different body mass index levels and midterm surgical revascularization outcomes

Background

There are conflicting results regarding the relationship between overweight/obesity and the outcomes of coronary artery bypass graft surgery (CABG), termed “the obesity paradox”. This study aimed to evaluate the effects of body mass index (BMI) on the midterm outcomes of CABG.

Methods

This historical cohort study included all patients who underwent isolated CABG at our center between 2007 and 2016. The patients were divided into five categories based on their preoperative BMIs (kg/m²): 18.5≤BMI<25, 25≤BMI<30, 30≤BMI<35, 35≤BMI<40, and BMI≥40. Patients with BMIs below 18.5 kg/m² were excluded. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. For the assessment of the linearity of the relationship between continuous BMI and the outcomes, plots for time varying hazard ratio of BMI with outcomes were provided.

Results

Of 17 751 patients (BMI = 27.30 ±4.17 kg/m²) who underwent isolated CABG at our center, 17 602 patients (mean age = 61.16±9.47 y, 75.4% male) were included in this study. Multivariable analysis demonstrated that patients with pre-obesity and normal weight had similar outcomes, whereas patients with preoperative BMIs exceeding 30 kg/m² kg/m² had a significantly higher risk of 5-year all-cause mortality and 5-year MACCEs than those with pre-obesity. Additionally, a positive association existed between obesity degree and all-cause mortality and MACCEs. Further, BMIs of 40 kg/m² or higher showed a trend toward higher MACCE risks (adjusted hazard ratio, 1.32; 95% confidence interval, 0.89 to 1.95), possibly due to the small sample size. A nonlinear, albeit negligible, association was also found between continuous BMI and the study endpoints.

Conclusions

Our findings suggest that preoperative obesity (BMI>30 kg/m²) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs. These findings indicate that physicians and cardiac surgeons should encourage patients with high BMIs to reduce weight for risk modification.

Effect of Different Blood Groups on Long-Term Outcomes of Surgical Revascularisation

BACKGROUND

ABO blood groups are considered to be associated with cardiovascular disease. Nonetheless, the definite effect of ABO blood groups on the clinical outcome of coronary artery bypass graft surgery (CABG) is still undetermined. We evaluated whether ABO blood groups can predict long-term major adverse cardiocerebrovascular events (MACCE) in CABG patients.

METHOD

In this retrospective cohort study, we retrieved the clinical files of eligible patients treated with isolated CABG in our hospital between March 2007 and March 2016. We divided the patients into four ABO subgroups. The primary study endpoints were the occurrence of all-cause mortality and MACCE during long-term follow-ups. We used Cox regression survival analysis to define the association of ABO blood groups with the occurrence of MACCE.

RESULTS

Of 17,892 patients who underwent isolated CABG, 17,713 (mean age, 61.19±9.47 years, 74.6% male) were successfully followed, and their data used in the final analysis. Our multivariable analysis demonstrated that patients with different blood groups had similar 5-year mortality and 5-year MACCE.

CONCLUSIONS

Our findings suggest that in patients who underwent CABG, ABO blood groups were not associated with long-term MACCE.

Transcatheter tricuspid valve-in-valve implantation with bioprosthetic balloon expandable valve

OBJECTIVES

This study was conducted to evaluate the outcome of the transcatheter valve-in-valve implantation for degenerated tricuspid bioprosthetic valves with transcatheter aortic valves.

METHODS

This retrospective study enrolled all consecutive patients who were considered high risk for reoperations by the heart team and who underwent transcatheter valve-in-valve implantation for degenerated tricuspid bioprosthetic valves in Tehran Heart Center, Tehran, Iran. All the procedures were performed via the transfemoral venous route under echocardiography and fluoroscopy guidance with Edwards SAPIEN transcatheter heart valves (Edwards Lifesciences, Irvine, CA).

RESULTS

Ten patients underwent successful transcatheter valve-in-valve implantation in the tricuspid position without any major complications or need for emergency surgical interventions. The mean age was 54.1 ± 17.1 years, and 8 patients were female. The median follow-up was 19.5 months (16-32.25 mon). The mean period between the last tricuspid valve replacement and transcatheter valve-in-valve implantation was 4.9 ± 2.2 years. The bioprosthetic valves were Hancock in three patients, Mosaic in the other three patients, and Biocor, Pericarbon, Perimount, and Epic in the other patients. After the procedure, the clinical and functional status improved significantly in all the patients. The mean transvalvular gradient decreased from 6.75 ± 2.66 mm Hg to 2.85 ± 0.89 (P < 0.001), and the postoperative tricuspid regurgitation severity decreased significantly in almost all the patients. The hospitalization period after the procedure was 4.4 ± 1.7 days.

CONCLUSIONS

In high-risk patients, transcatheter valve-in-valve implantation seems to be a safe and minimally invasive alternative to reoperations for degenerated tricuspid bioprosthetic valves.

Sonodynamic therapy and common head and neck cancers: in vitro and in vivo studies

Carcinogenesis is a complex multi-stage process associated with abnormal oncogenic signals in various signaling pathways. HNSCC (Head and neck squamous cell carcinoma) includes the majority of head and neck cancers (HNC). Also, HNSCC indicates a tumors heterogeneous group that derives from the squamous epithelium of the oropharynx, hypopharynx, oral cavity, and larynx. The main cancer management approach contains chemotherapy, radiation, and surgery separately or in combination. Each therapeutic approach has a limitation that influences cancer therapy procedures. Different treatment manners, stimuli-responsive therapeutic methods can improve on-target responses and reduce side effects. Sonodynamic therapy (ST) shows promising potential as an alternative treatment for cancer in the last few years. There is a hypothesis that shows ST using sonosenitizer in combination with low-intensity ultrasound (LIUS) could be useful in all kinds of cancer without focusing on specific target proteins, molecules, and/or genes. This review study discussed the application of ST for the treatment, ST mechanisms, and also, advances in the treatment of HNCs approaches in the recent decades.

Effect of persistent opium consumption after surgery on the long-term outcomes of surgical revascularisation

Background

A wrong traditional belief persists among people that opium consumption beneficially affects cardiovascular disease and its risk factors. However, no evidence exists regarding the effect of opium consumption or cessation on the long-term risk of major adverse cardio-cerebrovascular events after coronary artery bypass grafting. We therefore aimed to evaluate the effect of persistent opium consumption after surgery on the long-term outcomes of coronary artery bypass grafting.

Methods

The study population consisted of 28,691 patients (20,924 men, mean age 60.9 years), who underwent coronary artery bypass grafting between 2007 and 2016 at our centre. The patients were stratified into three groups according to the status of opium consumption: never opium consumers (n = 23,619), persistent postoperative opium consumers (n = 3636) and enduring postoperative opium withdrawal (n = 1436). Study endpoints were 5-year mortality and 5-year major adverse cardio-cerebrovascular events, comprising all-cause mortality, acute coronary syndrome, cerebrovascular accident and revascularisation.

Results

After surgery, 3636 patients continued opium consumption, while 1436 patients persistently avoided opium use. The multivariable survival analysis demonstrated that persistent post-coronary artery bypass grafting opium consumption increased 5-year mortality and 5-year major adverse cardio-cerebrovascular events by 28% (hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.06–1.54; P = 0.009) and 25% (HR 1.25, 95% CI 1.13–1.40; P &lt; 0.0001), respectively. It also increased the 5-year risk of acute coronary syndrome by 34% (sub-distribution HR 1.34, 95% CI 1.16–1.55; P &lt; 0.0001).

Conclusions

The present data suggest that persistent post-coronary artery bypass grafting opium consumption may significantly increase mortality, major adverse cardio-cerebrovascular events and acute coronary syndrome in the long term. Future studies are needed to confirm our findings.

Smoking Cessation After Surgery and Midterm Outcomes of Surgical Revascularization

BACKGROUND

Although multiple studies have reported the devastating effect of cigarette smoking (CS) on short-term outcomes of patients who underwent coronary artery bypass grafting surgery (CABG), its effect on long-term outcomes is still questionable. We aimed to evaluate the long-term outcomes of CS cessation after CABG surgery.

METHODS

This retrospective cohort study included all patients who underwent isolated CABG at our center between 2007 and 2016 and were cigarette smokers either just before or at the time of surgery. Patients were stratified into those who continued CS and those who were persistently CS abstinent after CABG. The endpoints of the study were 5-year mortality and 5-year major adverse cardiovascular and cerebrovascular events.

RESULTS

Of 28,945 patients who underwent isolated CABG, 9173 current cigarette smokers (93.5% men; mean age, 58.6 years) met our selection criteria and were included in the final analysis. Of these 3302 patients (40.0%) continued CS after surgery and 5688 patients were persistently abstinent. Multivariable survival analysis demonstrated that CS cessation after CABG, adjusted for major coronary risk factors, could reduce the 5-year mortality by 35% (hazard ratio, 0.65; 95% confidence interval, 0.54-0.77; P < .001) and 5-year major adverse cardiovascular and cerebrovascular events by 18% (hazard ratio, 0.82; 95% confidence interval, 0.74-0.92; P = .001).

CONCLUSIONS

Our study shows that CS abstinence after CABG significantly reduces long-term mortality and number of major adverse events. As a result, patients who smoke should be encouraged to participate in CS cessation programs after CABG surgery.

Transseptal Approach versus Left Atrial Approach to Mitral Valve: A Propensity Score Matching Study

BACKGROUND

Many patients with mitral valve diseases need surgical procedures for the repair or replacement of their mitral valve. There is a great deal of controversy over the outcomes of the transseptal (TS) and left atrial (LA) approaches to the mitral valve. We sought to evaluate the outcomes of each approach more accurately by eliminating the possible biases in case selection and matching.

METHODS

This retrospective study included patients who had surgery for mitral valve diseases via either the TS approach or the LA approach between 2004 and 2011 in Tehran Heart Center. Patients with surgical approaches other than the TS and LA were excluded. To control for the confounding effects, a propensity score matching technique was applied and the patients were matched for 14 demographic and preoperative variables. After the selection of controls, the effect of the TS approach (163 patients) versus the LA approach (652 patients) on the outcomes was presented through odds ratio (OR) with 95% confidence intervals (CI).

RESULTS

The mean age of the patients was 53.15 ± 12.02 years in the TS group and 52.93 ± 13.56 years in the LA group. Females comprised 119 (73.0%) patients in the TS group and 462 (70.9%) in the LA group. There was a significant association in the prevalence of new postoperative atrial fibrillation in the two groups (OR = 1.539, 95%CI: 1.072-2.210; p value = 0.019). Temporary pacemaker placement had no statistically significant difference between the two groups (p value = 0.418). The TS patients had significantly longer pump (p value < 0.001) and cross-clamp (p value < 0.001) times. The mortality rate was 4.1% (27 patients) in the LA group and 6.1% (10 patients) in the TS group (p value = 0.274).

CONCLUSION

In our study population, the TS approach was associated with higher pump and cross-clamp times as well as risk of postoperative atrial fibrillation, but it did not increase the rates of permanent pacemaker placement, re-operations, and mortality.

Ion-imprinted polymeric nanoparticles as a novel sorbent to separate radioyttrium from Sr target

Radioyttrium (containing 86Y, 87Y and 88Y) was produced by irradiating a natSrCO3 target with 15 MeV proton beam at a current of 30 µA for 12 min. A synthesized ion imprinted (IIP) and control polymer (CP) nanoparticles as sorbents were used for the separation of radioyttrium from strontium. The sorbents were characterized by Fourier Transform Infra-red spectroscopy (FT-IR), Scanning Electron Microscopy (SEM), Energy-Dispersive X-ray spectroscopy (EDX), Thermogravimetric analysis (TGA) and Surface area analysis. Effect of various parameters such as pH, mass sorbent, nature and volume of eluent were investigated on the percent extraction of radioyttrium ion using IIP and CP particles. Chemical and radionuclidic purity were determined by ICP-AES and HPGe detector gamma-ray spectrometry, respectively. The radioyttrium recovery yield was 99.5% and the stable Sr content in the final product was estimated to be 4.5 µg mL−1. In conclusion, the suggested method in this manuscript can be used for the production of other 86/87Y radionuclides.

Laparatomy due to gastrointestinal complications after open heart surgery

AIM

Abdominal complications following open heart surgery remain rare but fatal events with mortality rates of 14.5% up to 100%. Manifestations and managements of these complications are varying. Approximately, 25% of patients with gastrointestinal complications require surgical management with obviously higher mortality risks. The aim of this study was to determine the perioperative prognostic factors of gastrointestinal complications with surgical consequences after cardiac surgery.

METHODS

The study enrolled 15.737 patients who underwent open heart surgery between January 2002 and September 2007. Sixteen (0.1%) persons required laparatomy due to postoperative gastrointestinal complications. Additionally, the preoperative, operative, and postoperative risk factors for this condition were studied.

RESULTS

Among the patients enrolled, 15.737 patients underwent open heart surgery while 16 (0.1%) required laparatomy procedures due to gastrointestinal complications. They were comprised of 11 (68.8%) men and 5 (31.3%) women at a mean age of 62.88±12.56 years. There was a history of hypertension in 9 (56.3%) patients, hypercholesterolemia in 11 (68.8%), renal failure in 4 (25%), previous CABG in 2 (12.5%) and PTCA in 2 (12.5%). Morbidity and mortality were significantly higher in this group of patients with a mortality rate of 68.8% (68.8% versus 1.6%).

CONCLUSION

Our multivariate logistic regression model identified the following parameters to be the prognostic factors for gastrointestinal complications with surgical consequences: a history of previous CABG, previous PTCA, preoperative renal failure, preoperative anticoagulant agent use, valve surgery, combined valve and CABG surgery, and intra-aortic balloon pump requirement with OR of 51.95, 4.623, 26.436, 0.140, 5.43, 11.469 and 3.76, respectively.

Effect of pentoxifylline on preventing acute kidney injury after cardiac surgery by measuring urinary neutrophil gelatinase - associated lipocalin

Background

Based on Acute Kidney Injury Network (AKIN) criteria, we considered acute kidney injury (AKI) as an absolute increase in the serum creatinine (sCr) level of more than or equal to 0.3 mg/dl or 50%. The introduction of Urinary neutrophil gelatinase-associated lipocalin (UNGAL) has conferred earlier diagnosis of AKI. Pentoxifylline (PTX), a non-specific phosphodiesterase inhibitor, can suppress the production of some factors of inflammatory response and presumably prevent AKI. We examined the PTX on the development of AKI in cardiac surgery patients by measuring the levels of UNGAL.

Materials and methods

We performed a double blind randomized clinical trial, enrolling 28 consecutive patients undergoing elective coronary artery bypass graft (CABG) surgery. Patients were divided into two groups, one to receive PTX 5 mg/kg intravenous bolus injection, followed by 1.5 mg/kg/h continuous intravenous infusion until 3 hours after cessation of CPB and the other group received placebo. UNGAL was measured before, 3 and 24 hours after surgery. In addition serum creatinine was measured before and 24, 48, 72 and 96 hours after surgery and C-reactive protein (CRP) only 24 hours postoperatively.

Results

Both groups did not differ in demographic and baseline characteristics. 12 patients developed AKI 48 hours after surgery; 5 of them were in the intervention group and 7 in the control group (p= 0.445). There was an increase of UNGAL in both groups postoperatively, although not significant. Mean sCr was significantly increased in the control group at 24 and 48 hours after surgery (24-h mean: 0.79 ± 0.18 mg/dl vs. 1.03 ± 0.43 mg/dl, P value = 0.02; 48-h mean: 1.17 ± 0.24 mg/dl vs. 0.98 ± 0.20 mg/dl, P value = 0.03, respectively). PTX had a positive effect in preventing AKI reflecting in changes in sCr, and the increase of UNGAL was consistent with the emergence of AKI (Pearson's correlation = 0.30).

Conclusion

Our study demonstrates a weak correlation between UNGAL and sCr after cardiac surgery. The rise of UNGAL in these patients may be reduced by administration of PTX although we did not show significance. PTX could reduce the occurrence of AKI as determined by attenuation of sCr rise without causing hemodynamic instability or increased bleeding. Overall, we suggest future studies with larger sample sizes to elucidate this effect and determine the different aspects of administrating PTX.

Trial Registration

ISRCTN: IRCT138807302622N1

Effect of gender and type 2 diabetes mellitus on heart rate recovery in patients with coronary artery disease after cardiac rehabilitation

AIM

The purpose of this study was to clarify whether type 2 diabetic patients with coronary disease are subject to similar benefits on heart rate recovery (HRR) as non-diabetic coronary individuals after cardiac rehabilitation, assessing separately male and female subjects separately.

METHODS

Data used for the analyses were from an eight-week phase II cardiac rehabilitation including 284 patients with ischemic heart disease who were managed at Tehran Heart Center between July 2004 and January 2006. The heart rate parameters were compared between diabetic and non-diabetic subjects before and after cardiac rehabilitation. Diabetic and non-diabetic patients had similar age and left ventricular ejection fraction.

RESULTS

Among men, non-diabetic patients achieved greater improvement in peak heart rate and HRR. Additionally, lower resting heart rate was found in non-diabetic men after rehabilitation. In women > or = 50 years, there was no significant difference between diabetic and non-diabetic. The non-diabetic women < 50 years showed significantly higher peak heart rate and HRR compared with diabetics women.

CONCLUSION

These results indicate that the benefit of cardiac rehabilitation in HRR is significantly lower in type 2 diabetic men. Improvement of HRR is not associated with diabetic status in women > or = 50 years. The response to cardiac rehabilitation in women may appear to be more influenced by age at menopause rather than diabetes mellitus.

Effects of body mass index on early outcome of coronary artery bypass surgery

AIM

Obesity is commonly thought to be a risk factor for morbidity and mortality after cardiac surgery. The aim of the present study is to evaluate the effects of variations in body mass index on in-hospital outcome of coronary artery bypass grafting (CABG).

METHODS

The authors conducted a retrospective review of 10191 consecutive patients who had undergone isolated CABG at the center from February 2002 to November 2006. Patients were divided into four groups according to Body Mass Index (BMI). Underweight patients (BMI<18.5 kg/m(2)) were assigned to group 1 and obese patients (BMI 30 kg/m(2)) were put into group 4. Patients with normal BMI and those who were overweight were placed in group 2 and 3 respectively.

RESULTS

Analysis of the BMI groups showed: of 10191 patients 0.7% was underweight; 31.2% of cases had normal BMI, 47.1%; overweight and 21.0% were obese. Compared with other groups, the members of the obese group were younger, included more women and were more likely to have all the risk factors for coronary artery disease except for cigarette smoking (P<0.0001). The underweight patients had an excess of left main coronary artery disease, previous history of myocardial infarction. In-hospital mortality did not show any difference between groups (P=0.46). There was a significant increase in postoperative gastrointestinal complications among the underweight group in comparison with other groups (P=0.027).

CONCLUSIONS

According to this study, obese patients undergoing CABG are not at a greater risk of perioperative death and other adverse outcomes compared to normal weight. After CABG, underweight patients are at higher risk of developing gastrointestinal complications compared to normal patients.

Concomitant carotid endarterectomy and coronary artery bypass grafting versus staged carotid stenting followed by coronary artery bypass grafting

AIM

Significant carotid stenosis (>or=70%) in patients undergoing coronary artery bypass grafting (CABG) can increase the risk of perioperative cerebral vascular accident (CVA). In this study, we compared the results of two common operative strategies: concomitant carotid endarterectomy and CABG versus carotid stenting and CABG.

METHODS

This cohort study was conducted from January 2001 to September 2006. Significant carotid artery stenosis was detected in patients who were candidates for CABG at the Tehran Heart Center. The stenosis was detected by carotid Doppler screening and was confirmed by magnetic resonance angiography. Reluctant patients or those with previous major CVA, significant bilateral carotid stenosis and intracranial lesions were excluded. Patients were divided into 2 groups. Group A underwent concomitant carotid endarterectomy and CABG (n=19), while carotid stenting and CABG were done in group B (n=28).

RESULTS

The mean age in group A was 67.37+/-7.09 years and 65.57+/-8.13 years in group B. The mean hospital stay (days) was 18.68+/-7.95 in group A and 26.35+/-77.04 in group B (P=0.01). The median charge was dollars 252.79 in group A and dollars 2206.66 in group B (P <0.0001). There was a significant difference in frequency of hypotension and bradycardia between the 2 groups (P <0.05). There were 2 cases of in-hospital mortality in each group (10.5% and 7.1%, respectively). Two postoperative strokes occurred in group A and 3 in group B (10.5% and 10.7%, respectively).

CONCLUSION

Concomitant carotid endarterectomy and CABG is as safe as carotid stenting and CABG, with fewer neurologic events and less hypotension, bradycardia, cost and shorter hospital stay.

Early mortality predictors in coronary artery bypass grafting patients required intra-aortic balloon pump in perioperative and postoperative periods

AIM

The intra-aortic balloon pump (IABP) is commonly used for decreasing myocardial oxygen demand by systolic unloading in perioperative heart failure. The aim of this study was to determine perioperative prognostic factors for in-hospital mortality in coronary artery bypass grafting patients who received the intraaortic balloon pump.

METHODS

A total of 271 patients who underwent coronary artery bypass grafting and received intra-aortic balloon pump perioperatively between January 2002 and September 2006 were studied. The preoperative, operative and postoperative risk factors for early death were evaluated.

RESULTS

Early mortality rate in the study population was 17.3%. From variables entered into multivariate logistic regression the following parameters were identified as prognostic factors for early death: left main disease, diabetes, postoperative renal failure and cardiac arrest (P<0.05). The minor and major intra-aortic balloon pump related complications were not significant in univariate and multivariate analysis and its rate was 3.6%.

CONCLUSION

According to our study the mortality of IABP group is low compared to other studies, as well as IABP-associated complications. Also it revealed that there is no correlation between IABP-associated complications and early mortality.

Capillary gas chromatographic determination of phenylpropanolamine in pharmaceutical preparation

Analytical procedure has been developed for the gas chromatographic determination of phenylpropanolamine (PPA) using trifluoroacetylacetone (FAA) as derivatizing reagent. Elution is carried out from the column HP-5 (30 mx0.32 mm i.d.) with film thickness 0.25 microm at initial column temperature 70 degrees C for 5 min, followed by heating rate 10 degrees C/min up to 120 degrees C. Injection port temperature was maintained at 270 degrees C. Nitrogen flow rate was 2 ml/min and detection was by FID. The linear calibration curve was obtained with 30-150 microg/ml PPA with detection limit of 6.0 microg/ml. The method was used for the determination of PPA from Sinutab and Tavegyl-D tablets. The relative standard deviation (R.S.D.) for the analysis of pharmaceutical preparation was obtained within 0.4-0.9%.