Low - dose dobutamine stress echocardiography for assessment of myocarodial viability in patients with old myocardial infarction

Sixty patients with old myocardial infarction were included in this study. Echocardiography was done to assess the segmental wall motion abnormalities at rest. Dobutamine stress echocardiography test was done for all patients at dose of 5 mug/kg/min. for 5 minutes and 10 mug/kg/min. for 5 minutes. Thallium-201 myocardial scintigraphy was done for all patients. The same 20 segments division model used for dobutamine analysis was also applied to match echocardiographic finding. Thallium uptake in each myocardial segment was graded on a 5-point semiquantitative scale [from 0=absent to 2=normal]. A segment was considered viable if the assigned thallium score was 1 or higher [normal uptake or only mild moderate defect] in any of redistribution or reinjection images. From the results obtained, it was concluded that low-dose dobutamine echocardiography is a safe and useful tool in assessment of viable and non-viable myocardium

Muscle cramps in patients with liver cirrhosis

Muscle cramps are involuntary, painful, visible, or palpable muscle contractions of abrupt onset, generally occurring at rest and are often nocturnal. The pain and contraction resolve spontaneously in seconds to several minutes. The calf is the area most commonly affected, but may affect fingers and hands. The reported prevalence of true muscle cramps in cirrhotic patients varies from 22 - 88%. Clinically; significant muscle cramps occur less frequently [8 - 20%]. Thirty patients were chosen for this study to estimate the prevalence of muscle cramps among patients with liver cirrhosis irrespective of the etiology, to find the role of zinc in the pathogenesis of cramps in patients with liver cirrhosis and to find the relation between the clinical; laboratory; ultra-sonography of the liver and muscle cramps. They were divided into two groups: Group [A] twenty patients with liver cirrhosis were further subdivided according to the presence or absence of muscle cramps into: Sub-Group [A1]: included 14 patients with liver cirrhosis and muscle cramps [7 males and 7 females] with a mean age of 56.5+/-5.25 years. Sub-Group [A2]: included 6 patients with liver cirrhosis without muscle cramps [5 males and 1 female] with a mean age of 57.5+/-4.37 years. Group [B] included 10 patients with congestive heart failure [6 males and 4 females] with a mean age of 55.6+/-11.32 years. Results revealed that muscle cramps was more prevalent in patients with liver cirrhosis, compared to patients with congestive heart failure [70% vs 20% with P< 0.01]. There was a significant relation between the frequency of occurrence of cramps and the presence of haematemisis, Jaundice, ascites, splenic size, portal vein diameter, low serum albumin, high serum bilirubin and low serum sodium, calcium, as well as there was a significant relation between a low serum zinc level and the occurrence of cramps in liver cirrhosis. There was no relation between liver enzyme and serum alkaline phosphatase and cramps in liver cirrhosis. On conclusion muscle cramps are a common symptom in patients with cirrhosis and can be triggered by many factors especially a low serum zinc level

Plasma level of plasminogen activator inhibitor-1 and C-peptide in correlation with coronary artery disease severity

Tissue plasminogen activator [t-PA] has been shown to be a promising agent in the treatment of coronary artery thrombosis associated with acute myocardial infarction [AMI]. A rapid inhibitor of t-PA has also been identified in human plasma, and plasma level of this inhibitor have been reported to be increased in patients with coronary artery disease [CAD]. Plasma level of Plasminogen Activator Inhibitor-I and C-Peptide were measured in 50 patients with myocardial infarction [MI] [12 patients with acute MI and 38 patients with old MI], 38 patients were males and 12 patients were females, their age ranged between 48 and 60 years [mean 55]. Coronary angiography was done in all patients to determine the severity of their coronary artery disease [CAD]. The patients were divided into single vessel disease 23 patients [46%] or multivessel disease 27 patients [54%]. According to the number of vessels involved and the results of plasma level of PAI-1 and C-Peptide correlated with the severity of CAD. Plasma level of PAI-1 and C-Peptide in patients with CAD were significantly higher than in 20 control subjects. High significant correlation was found between levels of PAI-I and C-Peptide and the severity of CAD. This study confirmed the significant correlation between plasma level of mean PAI-1 and C-Peptide and the severity of coronary artery disease documented by coronary angiography

Hemodynamic exercise response in rheumatic mitral stenosis: an echo-doppler study

The effects of exercise on patients with rheumatic mitral stenosis were investigated using echocardiography. Twenty-five patients in sinus rhythm with no contraindication to exercise were subjected to sub-maximal treadmill exercise according to modified Bruce protocol. A heterogeneous response depending mainly on the degree of mitral valve destruction was noticed. Patients with the same valve areas at rest did not have the same response to exercise. This might explain the difference in severity of symptoms in patients with the same valve areas at rest. It has been concluded that hemodynamic exercise response in patients with mitral stenosis evaluated by Doppler echocardiography immediately after sub-maximal exercise treadmill test is a useful method for evaluation of these patients and gives a better insight of the disease

Fibronectin, laminin and complement C3 estimation in chronic renal failure before and after hemodialysis: a possible role in the pathogenesis

Nineteen patients with chronic renal failure [nine cases with cancer bladder and ten cases with other etiological causes] were studied. Plasma fibronectin, laminin and C3 were checked before and after hemodialysis. The plasma fibronectin, laminin and C3 were significantly reduced in chronic renal failure [CRF] before hemodialysis than in the controls, while fibronectin was significantly reduced in patients with CRF due to cancer bladder after hemodialysis. These changes may be a possible cause of rapid invasiveness of cancer bladder with metastatic formation and repeated infection in patients with CRF. The results were discussed

Islet cell antibodies in diabetes mellitus

It was aimed in this work to determine the incidence of antibodies to islet cells [ICA] in the serum of patients with type I and type II diabetes mellitus. In insulin dependent diabetic patients [IDDM] [40 percent] of patients were positive and the prevalence of ICA is .strongly dependent on the duration of diabetes. In non-insulin dependent diabetics [NIDDM] ICA were found in 10 percent of patients without significant difference in relation to the duration of diabetes. In contrast no ICA were found in the control subjects

Study of thyroid functions in controlled insulin dependent diabetes mellitus

Thyroid function was studied in 20 controlled insulin-dependent diabetic patients, who were all judged to be clinically euthyroid. In comparison to normal subjects, T3, T4, T3/T4 ratio, T3 uptake%, Free T3, Free T4 add Free Thyroxin index [FTI] did not show significant change [P > 0.05]. However, TSH value showed significant increase [P < 0.05]. Binding of I [125] T3 to lymphocyte nuclei showed significant increase indicating increased T3 nuclear receptor sites. These findings represent a beneficial adaptive homeostatic mechanism that should not be disturbed by thyroid treatment but by good control of diabetes