Efficacy of endoscopic ligation for the prevention of variCeIl rebleeding in cirrhotic patients according to hepatocellular function

Variceal rebleeding is a serious complication of cirrhosis, leading to significant morbidity and mortality. The aim of this work is to eva1ua the efficacy of endoscopic variceal ligation in the prevention of variceal rebleeding in cirrhotic patients and to find out the effect of hepatocellular functions on this efficacy. 60 cirrhotic patients were submitted to full history taking and clinical examination, laboratory investigations, abdominal ultrasound, liver biopsy in selected cases, oesophagogastroduodenoscopy for diagnosis of variceal bleeding and to perform variceal banding. Patients were divided into three groups according to their Child's classification: group A [15 patients], B[20 patients] and C[25 patients]. Regarding grading of esophageal varices there were significant changes in first, second, third and fifth sessions as we go from Child's A to Child's C groups, but there were no significant changes in the fourth session. Endoscopic variceal ligation eradicated esophageal varices in 41 cases out of 60 [68.3%], and failed in 19 cases [31.7%]. 14 cases were eradicated in Child's A group [93.33%]; 15 in Child's B group [75%] and 12 in Child's C group [48%]. The recurrence of oesophageal varices after their obliteration was found in 16 cases out of 41[39%]: 2 cases in Childs'A group [14.3%]; 6 cases were in Childs' B group[40.0%] and 8 cases were in Childs' C group[66.6%]. Esophageal variceal rebleeding in studied patients was found in 18 cases [30%] and classified as 2[13.3%], 4 [26.6%] and 12 [48%] for Child's class A, B and C respectively. The mortality in studied patients was 8 [13%] out of 60: 2[10%] cases were in Child's B group and 6 [24%] cases in Child's C group. Six deaths occurred before completion of EVL therapy, 2 deaths after completion of EVL therapy. Four of them died due to liver failure and 3 of them due to massive haematemesis but one of them died from IHD. Endoscopic variceal ligation is an effective method for the prevention of oesophageal variceal rebleeding in patients with better liver function. Child's C cirrhotic patients had a poor response to treatment. These patients showed statistically significant worse eradication rate, greater rebleeding and mortality rates than Child's AandB patients

Endothelial dysfunction and the risk of atherosclerosis in diabetic patients with microalbuminuria

Endothelial dysfunction is an important pathogenetic factor in both micro- and macrovascular complications of diabetes mellitus [DM]. The significance of microalbuminuria [MAU] and diabetic retinopathy [DR] as early indicators of endothelial dysfunction in the disease remains controversial. We studied 40 patients with type 2 diabetes and microalbuminuria and 20 age and sex matched control subjects. They were subjected to detailed clinical examination, fundus examination and laboratory investigations including measurement of fasting blood glucose, serum lipid profile, blood urea, serum creatinine, plasma endothelin-l [ET-1] and 24 hours urinary albumin excretion [UAE], besides ultrasonographic assessment of post- obstructive flow-mediated endothelium- dependent increase in brachial artery diameter and blood flow and measurement of carotid artery intima- media thickness [IMT]. Features suggestive of endothelial dysfunction [DR, increased ET-1 and impaired vascular reactivity] were prevalent in the diabetic patients. They had, as well, a statistically significant increase in carotid IMT compared to controls [P = 0.000]. Endothelium- dependent dilatation [EDD] of the brachial artery showed statistically significant negative correlations with urinary albumin excretion [UAE] rate, plasma ET-1 and carotid IMT. We conclude that endothelial dysfunction is common in diabetic patients with MAU. ET-1 is a sensitive marker of endothelial activation/dysfunction but it is affected by many variables. Ultrasonographic studies of superficial arteries, if properly performed, can help in delineating both early functional and pathological alterations of atherosclerosis