Plasma exchange and low-density lipoprotein filtration therapy in heterozygous familial hypercholesterolemia

Six patients with heterozygous familial hypercholesterolemia [FH] [age range 49-59 years] and 10 healthy controls were studied. Diagnosis of FH in this group of patients upon the presence of a history of ischemic heart disease [IHD] started at an early age, tendon xanthoma, strong family history of IHD and raised plasma total cholesterol above 386 mg/dL and low density lipoprotein cholesterol [LDLc] above 190 mg/L. All patients were refractory to diet and drug treatment. Plasma exchange [PE] on seven separate occasions reduced significantly the level of LDL-c with a rise in HDL-c during the first two hours of PE, and reached the baseline in 3 days. However, long term PE, after several weeks does not normalize the level of HDL-c. Using selective LDL-c filtration procedure, in which LDL-c fraction was removed by membrane filtration over a poly alcohol filter, LDL-c was reduced by about 50% and HDL-c was increased by about 60%. Both PE and selective filtration are successful methods of treatment of heterozygous FH

Plasma cross-linked fibrin degradation products [DDimer] in patients with acute myocardial infarction and unstable angina

Plasma D. Dimer level was estimated in 30 patients with acute myocardial infarction [AMI], 10 patients with unstable angina and 10 normal subjects. Significant elevation of mean plasma elevation of mean plasma D. dimer was detected in patients with AMI [703 +/- 92 ng/ml], unstable angina [741 +/- 7 ng/ml]. Compared to normal controls [1177 ng/mL], 7 patients with unstable angina had an elevated plasma D. dimer level above 500 ng/mL, while 3 patients had normal level. The results suggested thrombin generation and fibrin formation and degradation in the AML group. The later changes were also present in the majority of patients with unstable angina [70%]. The presence of prothrombotic state associated with thrombosis may mediate the pathophysiology of most cases of unstable angina. Antiplatelets, anticoagulants and thrombolytic therapy may benefit these groups of patients with an elevated plasma D. dimer level

Non-invasive diagnosis of right ventricular infarction

100 patients with acute transmural inferior myocardial infarction diagnosed by E.C.G. and serum creatine kinase enzyme admitted to intensive care unit were the subject of this study. Right ventricular infarction [RVI] diagnosed by E.C.G. could be detected in 18 patients 8%. The most important ECG findings in patients with RVI were segment elevation and patterns of necrosis [QR, QS] in the right led precordial leads. Among these leads, V4R was the one that had more consistently shown a very high diagnostic sensitivity of RVI. Reading of the right preccordial leads during the first hours of an acute inferior myocardial infarction greatly improves accuracy of the ECG to diagnose RVI, since most of the associated ECG abnormal. were very transient in nature. Hence, a 12 lead ECG with the right precordial leads [V3R to V6R] should be a routine part of the initial evaluation of patients with acute inferior myocardial infarction. Two dimensional echocardiography study of the 18 patients with ECG criteria of RVI showed abnormal wall motion in t he right utricle and interventricular septum, abnormal flattening of the normal curvature of the septum during diastole and right ventricular dilation. Such ECHO findings were also reversible. Early two dimensional ECHO examination of the heart with the xiphosternal approach is a valuable noninvasive method for assessment of right ventricular functions in patients with acute inferior myocarial infraction and suspected RVI

Laboratory diagnosis of pulmonary thromboembolism

Twenty five patients with clinically suspected pulmonary embolism were studied by ventilation-perfusion lung scan [V/Q]. Twenty patients showed positive scan [low, indeterminant, and high probability] and 5 patients had negative scan. Beta-mode ultrasound with Doppler showed evidence of deep venous thrombosis in 50% of cases. Laboratory findings showed a raised plasma cross linked fibrin degradation products [FDPs] above 500 ng/ml in 85.7% of cases with high probability positive lung scan and elevated serum levels of C-reactive protein [CRP] above 50 mg/l in 85.7% of high probability scan. A normal level of serum CRP and/or plasma cross linked FDPs in blood taken within 4 days of onset of symptoms virtually excluded the diagnosis of pulmonary embolism. Other positive laboratory data in cases of pulmonary embolism diagnosed by lung scan were disturbed, arterial blood gases in 90% of cases, raised serum lactate dehydrogenase enzyme above 300 IU/l in 57.2%, aspartate transaminase enzyme above 40 IU/l in 28.6% of cases and low platelet count below 100,000/Cmm in 25% of cases

Clinical laboratory and histopathological features of chronic hepatitis C virus infection in Egypt

Thirty patients, referred consecutively from the laboratory and diagnosed as hepatitis C virus infection both by second generation ELISA and RIBA-II methods, were analyzed. All had elevated serum aminotransferases more than 6 months. Patients were frequently diagnosed incidentally, and about one-third had no symptoms of liver disease and were asymptomatic or had only fatigue. On routine screening, raised serum level of aminotransferase enzymes was detected. On careful abdominal palpation, hepatomegaly was detected in 6% of cases. Patients presented with liver cirrhosis, splenomegaly and endoscopic evidence of varices were all above 40 years and represented 20% of cases. Four patients had positive antinuclear and antismooth muscle antibodies. Hepatic histopathological changes frequently observed in such patients included portal tract lymphoid aggregates, bile duct affection, free sinusoidal lymphocytes and reactive Kupffer cells. Hepatic cell changes included single cell acidophilia, fatty change, dysplasia and multinucleation. Such features were observed in addition to the classic morphological changes of chronic persistent, lobular and active hepatitis. Estimation of serum aminotransferases should be a part of routine laboratory screening tests in Egypt. Detection of immunological markers is important in hepatitis C positive cases, as autoimmune chronic hepatitis may coexist with chronic hepatitis C. Liver biopsy is indicated not only for etiological diagnosis, but also for determining disease activity and stage

Silent myocardial ischemia in patients with diabetes mellitus during exercise tolerance testing

50 patients with diabetes were compared with 20 nondiabetic subjects, with respect to the prevalence of silent myocardial ischemia, by means of treadmill exercise testing. Results of treadmill exercise testing showed ischemia in 14 of the 50 diabetic patients [mean age 49.2 +/- 1.3] and in 2 of 20 nondiabetic control subjects [mean age 49 +/- 6] [28% VS 10%, p <0.05]. Diabetics with "positive treadmill" had a higher serum total cholesterol and lower serum high density cholesterol than "negative treadmill" diabetics. Diabetic patients with retinopathy had a higher prevalence of silent myocardial ischemia [40%] than those who did not [25%, p <0.05]. Diabetics above the age of 40 years should be screened with treadmill exercise testing

Gall bladder volume and function in obese individuals

This study was carried out on 50 obese and 50 average weight females with normal laboratory investigations. Gallbladder volumes were measured in fasting state and 1 1/2 hours after a liquid fatty meal by ultrasonography. The incidence of gall stones in the obese group was 28% compared to 2% in non-obese group. The fasting gallbladder volume in the obese group was [32.7 +/- 8.9] which was significantly higher than non-obese group [16.1 +/- 2.7] and the postprandial volume was also higher in the obese [14.6 +/- 5.02] than non-obese group [2.9 +/- 1.07]. The cases with morbid obesity had significantly larger fasting volume than the rest of obese females [39.3 +/- 12.3 versus 27.7 +/- 4.9] and also larger postprandial volume [25.7 +/- 6.7 versus 11.7 +/- 4.03]. The incidence of gall stones in the morbidly obese was 40% compared to 14.3% in the rest of obese females. The volumes of gallbladder were also significantly higher in android obesity group compared to gynoid obesity, with a higher incidence of gall stones in the android group. It is concluded that gallbladder contractility is impaired in obese females especially in morbid obesity and android obesity

Plasma lipoproteins in patients with acute myocardial infarction

Thirty patients with acute myocardial ifarction [AM] were the subject for this study. All patients were young [mean age 35.3 +/- 3.7 Y.]. and had no diabetes, hypertension or secondary cause for hyperlipidaemia, history of cigarette smoking was present in 28 patients. A family history of coronary artery disease [CAD] was obtained in 8 patients. Non of the patients had xanthomas. 20 Healthy subjects were studied as a control. The mean plasma total cholesterol [TC], low density lipoprotein cholesterol [LDLc] were higher in patients group as compared to normal controls [211.8 +/- 57.7 VS 178.3 +/- 23.7 mg/dL and 140 +/- VS 109.3 +/- 20.4 mg/dL repectively], while the mean high density cholesterol [HDLC] was lower in patient group as compared to normal controls [33.4 +/- 12.4 VS 49.9 +/- 6.7 mg/dL]. The ratio of TCIHDL was higher in patients than controls [6.3 +/- 4.6 VS 3.6 +/- 0.53]. Eight patients with AMI had normal plasma Tc and LDLc, but had a very low levels of HDLc, which indicates that HCLc is a predictive risk factor for CAD independent of Tc or LDLc

Revalence of anti-hepatitis C and hepatitis B among patients with viral hepatitis in Egypt

Serum sample of 70 patients with viral hepatitis without obvious parenteral routes of viral transmission were tested for anti-hepatitis C virus antibodies [HCV] and hepatitis B virus markers [HBV]. Overall prevalence of anti-HCV was 17.1% and for any anti-HBV markers 64.2%. anti-HCV was more likely to be positive in subjects positive for any HBV marker [20% of subjects positive for HBV marker had anti-HCV antibodies]. Anti-HCV antibodies was positive in 21% hepatitis surface antigen positive patients. These results suggest that HCV and HBV may have similar routes of spread in the community and anti-HCV might be a clinical index of active HCV infection

Angiodysplasia in patients with chronic renal failure

Upper gastrointestinal endoscopy was done for 30 patients with chronic renal failure and 13 normal controls. Multiple gastroduodenal angiodysplastic lesions were found in 3 patients [10%] and one of them had hematemesis prior to diagnosis. 36.6% of patients with CRF were found to have gastritis, 30% had duodenitis and 23.3% had esophagitis. History of upper GIT bleeding could be obtained from 3 patients. Angiodysplasia, although uncommon, should be considered in the differential diagnosis of both occult and overt upper GIT bleeding in patients with chronic renal failure

Protein C values in young patients with acute myocardial infarction

Protein C is a recently described regulator of frinbrinolysis. Protein C was assayed in 20 young patients with acute myocardial infarction and 10 healthy controls. The mean protein C value was significantly higher in patients with acute myocardial infarction [137% +/- 17.8] than controls [86.4% +/- 6.7].The increase in protein C after myocardial infarction counteracts the increase in procoagulatory factors such as factor VII and fibrinogen, thus maintains an equilibrium between coagulation and fibrinolysis

Gastroesophageal reflux in bronchial asthma

Of 50 patients with bronchial asthma routinely examined with esophageal endoscopy, 70 percent were found to have histological evidence of gastroesophageal reflux [GER]. These data suggest that GER may be a precipitating factor to asthma and it should be sought in the treatment-resistant asthmatic patients, even if no gastrointestinal symptoms are evident. Intensive antireflux treatment may improve asthma and surgical restoration of lower esophageal sphincter has proved to be curative in other reported studies

Apolipoproteins in endemic liver cirrhosis

The lipid profile was studied in fifty patients with liver cirrhosis. 6 of them had evidence of ischemic heart disease [IHD]. Fifteen matching persons served as controls. 5 of them had IHD. There was significant low apo A, apo AIl, apo B and HDLC in cirrhotics compared to normal controls. The risk rations for atherosclerosis Apo B/Apo A1 and total cholesterol /HDLC were below the standard risk for IHD in cirrhotic patients. The total cholesterol as well in cirrhotics was in the average ideal range for adults. The 5 control cases with IHD showed a lipid pattern which correlate with high risk for coronary atherosclerosis in the form of low Apo A1 /Apo B and increased TC/HDLC ratio. Changes in apolipoproteins in liver cirrhosis may play a role in protection of cirrhotic patients from atherosclerosis

Candida albicans infection of peptic ulcer

Endoscopic samples from 23 cases with gastric ulcers and 20 cases with duodenal ulcers were studied for the prevalence of Candida albicans using Gram stain and germ tube test. Cases were selected on the basis of paucity of ulcer symptoms and little response to medical to medical therapy. Fungal material was found in ulcer base in 51% of cases. Fungal gastric ulcers tended to be larger in diameter and more often suspected to be malignant, and occurs in older age group. There was no difference in treatment regimens between fungal ulcers and non- infected ulcers. With the present state of knowledge anti-fungal agents advised when ulcers are colonized by Candida in non elderly patients without underlying diseases

Augmented hageman factor and prolactin titres in patients with acute myocardial infarction

High titres of prolactin and increased Hageman factor coagulant activity was observed in 18 patients with acute myocardial infarction. There is a direct correlation between plasma prolactin titre and coagulant activity of Hageman factor. These data support the evidence in animal models that prolactin can raise Hageman factor titre. Possibly by increasing hepatic protein synthesis. Whether an elevated coagulate activity of Hageman factor plays a role in the pathogenesis of thrombosis in myocardial infarction is uncertain