Early endothelial dysfunction in insulin dependent diabetics

This study included 60 insulin-dependent diabetic patients. They were classified into 3 groups [each 20 patients]. The first group included patients without microangiopathy, the second included patients with early microangiopathy and the third included patients with late microangiopathy. 20 healthy subjects were chosen as controls. The results indicated that vWF was significantly increased in diabetics without evidence of microangiopathy [normal urinary albumin excretion, no retinopathy and neuropathy] compared to control and in patients with microangiopathy compared to those without. Also, a positive correlation between vWF and systolic blood pressure and urinary albumin excretion was found, but no correlation as regards age, sex and blood sugar at time of blood sampling was found

Short versus long term effect of lithium on pituitary thyroid axis

Although the antithyroid effect of lithium is well known in thyrotoxicosis, there is no general agreement about its effect in euthyroid subjects. Furthermore, the duration of therapy may modify its antithyroid effect. In the thyrotoxic patients, short term use of lithium is effective and safe method to achieve euthyroidism. However, long term use needs close supervision and manipulation of the dose. In euthyroid patients even short term use of lithium is associated with subclinical hypothyroidism which is much more frequent than previously suggested and replacement thyroid therapy should be used from the start so as to avoid subclinical hypothyroidism and prevent fluctuations in the thyroid function that could induce affective disorders

Comparative study of combined therapy in simple obesity

Drug combinations used in small doses are as effective as full doses of individual drugs and produce less side effects. In term of potency, combination of fenfluramine and metformin in the most potent, but in term of absence of tolerance combination of diethyl propion and metformin is the least one to produce tolerance and is the best one to maintain the reduction in body weight. Fenfluramine and metformin combination is the best to be used in android obesity as it produces a significant reduction in W/H ratio which is also well correlated with the reduction in body mass index. Furthermore, it produces a significant reduction in subcutaneous fat [as measured by triceps skin fold and mid arm thickness]. So, a homogenous body fat redistribution can be achieved. The improvement in health indices [blood sugar, serum cholesterol, triglycerides and exercise tolerance] is well correlated with the reduction in body weight. Fenfluramine and metformin combination produces a highly significant improvement in blood sugar so this combination is good for diabetic obese, while fenfluramine and thyroid hormone combination produces significant improvement in serum cholesterol and triglycerides

Pre and post-operative evaluation of patients with prosthetic cardiac valves, clinical and echocardiographic study

This study included 108 patients, in whom 120 mechanical valve prosthesis were implanted in mitral aortic positions or both. They were survived the open heart procedure and followed up for at least 6 months. Clinically, there is dramatic improvement in functional class [Fc] preoperatively; none of the patients were in Fc I, 22 patients were in Fc II [20.3%]. 66 patients [61.1%] were in Fc III and 20 patients [18.5%] were in Fc IV. Postoperatively, 28 patients [25.9%] became in Fc I, 74 patients [68.5%] in Fc II, 6 patients [5.55%] in Fc III and none of the patients became in Fc IV. This clinical improvement is not accompanied by improvement in postoperative left ventricular performance, as mean EF% and FS%. Preoperatively were 60.37 +/- 13.22 and 28.27 +/- 9.35, respectively, and became 59.30 +/- 10.01 and 27.97 +/- 8.24 postoperatively. The dramatic clinical improvement in patients underwent valve replacement could be attributed to the increase in forward stroke volume which is reflected on patient's functional class and not due to improvement in left ventricular function as the sudden return of competency by the prosthetic valve results in increased after load which in turn results in adverse effect on left ventricular function

Doppler assessment of pulmonary venous flow in healthy subjects and in patients with heart disease

The pattern of pulmonary venous flow was studied in 10 normal subjects and 40 patents with heart disease [20 patients with varying degrees of mitral regurgitation and stenosis, 10 patients with old myocardial infarction, and 10 patients with dilated cardiomyopathy]. The pattern of pulmonary venous flow was studied through the left and right upper pulmonary veins and left lower pulmonary vein utilizing transesophageal echocardiography. The severity of mitral regurgitation was assessed by TEE color Doppler maximal regurgitant jet area. Normal pulmonary venous flow by TEE pulsed Doppler was found to be consisted of 4 phases: Atrial reversal [AR] 21.9 +/- 5.36, early systolic [SE] 38.9 +/- 17.18, late systolic [SL] 58.2 +/- 19.14 and diastolic phase [D] 53.5 +/- 15.49 cm/s. In 11 patients with severe MR [jet area >6 cm2 by TEE color Doppler], several of systolic pulmonary venous flow occurred in 8 patients, sensitivity 73%, specificity 100%, positive predictive value 100% [P <0.001]. SL was severed 20 +/- 63.01 cm/s while D was 58.73 +/- 20.88. In 9 patients with mild to moderate MR [jet area <6 cm2] and mitral stenosis, both SL and D were proportionately reduced and peak S/peak D was normal [>1]. In 10 patients with ischemic heart disease [old MI], AR was increased 50.7 +/- 7.13 cm/s. In 10 patients with dilated cardiomyopathy SL was 18 +/- 4.19 cm/s

Value of two dimensional echo-cardiography and color doppler flow imaging in the decision of tricuspid valve repair

This study included forty patients with rheumatic heart disease in whom tricuspid regurgitation was proven by pulsed and color Doppler echocardiography and associated with mitral, aortic or both valve lesions. All patients were subjected to, careful history, clinical examination, ECG, plain chest x-ray, two dimensional, pulsed Doppler echo-cardiography, color Doppler flow imaging and right ventriculography. The results obtained by pulsed Doppler echo-cardiography and color Doppler flow imaging were tabulated and correlated with those of right ventriculography, which was considered as standard[2] Both techniques correlated well with the results of right ventriculography. However, the correlation coefficient calculated for color Doppler, using the ratio of maximal regurgitant jet area over the right atrial area of [0.95] was higher than that of maximal regurgitant area alone [0.88] and that of pulsed wove Doppler [0. 92]. Twenty nine of the previously evaluated patients underwent aortic or mitral valve surgery "open cardiac surgery" after one to six weeks from the date of cardiac catheterization. Twenty four hours before surgery, the 29 patients were re-evaluated using two dimensional echocardiography for measurements of the maximal tricuspid annular diameter, the minimal tricuspid annular diameter, and the percent of shortening of tricuspid annular was calculated. Doppler color flow measurements of tricuspid maximal regurgitant jet area and ratio of maximal regurgitant jet area over right atrial area were done. The results obtained by the two dimensional echo, cardiography and color Doppler imaging correlated well with operative grading of tricuspid regurgitation according to the jet width palpated by the surgeon's index finger. It was found that both two dimensional echo-cardiography and color Doppler flow imaging could predict those patients who were considered to have severe tricuspid regurgitation by the surgeon and hence required tricuspid valveannuloplasty

Histological and histochemical study of the respiratory nasal mucosa in primary chronic atrophic rhinitis before and after silastic implant technique

The histological and histochemical pattern of the respiratory nasal mucosa in primary chronic atrophic rhinitis was studied to evaluate the efficiency of silastic implant technique as a surgical measure for treatment of those patients. The operation was done in ten female patients and were followed up for one year. A marked improvement was found in the surface epithelium and gl and s with a marked improvement of enzymatic activity, which recommended the use of this operation for the treatment of such patients