Pro- brain natriuretic peptide [pro-BNP] in cirrhotic patients as a marker of cirrhotic cardiomyopathy

This study was conducted to determine the significance of Pro-brain natriuretic pepitde [Pro-BNP] measurement as a marker of cirrhotic cardiomyopathy in cirrhotic patients. Thirty patients with liver cirrhosis were enrolled in this study. Diagnosis depended on history taking, clinical examination, laboratory testing, abdominal ultrasonography and liver biopsy when applicable. Echocardiography was done to all patients and depending on its results, patients were divided into 2 groups. The first group included 15 patients with liver cirrhosis with no cardiomyopathy and the second group included 15 patients with liver cirrhosis and cardiomyopathy proved by echocardiography. In addition to a control group consisted of 15 age and gender matched healthy individuals. Blood samples were taken for laboratory investigations other samples were taken heparinized of 2m1 to detect level of pro-BNP in blood. Pro-BNP was significantly elevated in patients with cirrhotic cardiomyopathic when compared with group of cirrhotic non cardiomyopathic arid with control group [p<0.01]. Also, pro-BNP is related with severity of liver cirrhosis [Significantly related with Child scoring. serum albumin, serum bilirubin]. Pro-BNP was significantly related to SWT, PWT, left atrial diameter and fractional shortening. In conclusion, markedly-elevated pro-BNP is considered a reliable marker for cirrhotic cardiomyopathy and not hyperdynamic circulation that occurs in liver cirrhosis. Upon its clinical significance SWT may be used as a marker for detection of cardiac dysfunction in advanced cirrhotic patients

Endoscopic control of bleeding gastric fundal varices by butyl cyanoacrylate

The present retrospective study aimed to determine the safety and efficacy of using butyl cyanoacrylate to control bleeding from gastric fundal varices. A total of 249 patients presented with bleeding from fundal varices underwent endoscopic injection of cyanoacrylate for hemostasis. Indications for treatment included chronic liver disease and portal hypertension, hematemesis and/or melena and gastric fundal varices at index endoscopy showing active bleeding or an overlying clot with no endoscopic evidences of bleeding from other sources. Injection therapy was administered as the first active measure. Cyanoacrylate was mixed with lipiodol [1:1] and injected strictly intravariceal through a Teflon injection device. The study concluded that cyanoacrylate injection to control gastric fundal variceal bleeding has been found to be remarkably safe and highly effective. An experienced team is always required