Assessment of regional wall motion abnormalities using parametric imaging of real time 3D echocardiography compared to 2D echocardiography: validation by coronary angiography

Identification and quantification of left ventricular regional wall motion abnormalities [RWMA] on echocardiograms is of paramount clinical importance but is still performed by a subjective visual method. we tried a new tool for assessment of RWMA using parametric [PI] of real time 3D Echocardiography [RT3DE] compared to traditional visual assessment of 2D echo [2DE] and validated by coronary angiography. We studied 100 patients scheduled for coronary angiography based on previous history of myocardial infarction [MI] [STMI or NSTMI]. RWMA was assessed by both conventional 2DE and PI of RT3DE according to the 17 segment left ventricular model of the American Society of Echocardiography [ASE].Coronary angiography was performed for all patients. Coronary artery stenosis was considered significant when luminal narrowing of 70% or more was present. The angiographic data of all patients was used as the gold standard to compare the diagnostic ability of both methods for detection of RWMA. There was a good agreement between PI of RT3DE and 2DE in assessment of RWMA of most [5 of 7] segments supplied by LAD, and all 5 segments supplied by LCX and 3 of 5 segments supplied by RCA. PI of RT3DE showed higher sensitivity than 2DE [60.71% VS 47.32%, p 0.001] for detection of RWMA in significant LAD lesion, while there was no significant difference regarding sensitivity of both methods in detection of RWMA in significant LCX or RCA lesions. [66.33%vs 54.00% p=0.074] and [62.77%vs 53.88%, p=0.140] respectively. There was no significant difference between PI of RT3DE and 2DE specificity for LAD, LCX and RCA lesions. [89.68% vs 90.07% p=0.0865], [87.42% vs 89.14%p=0.063] and [79.06% vs 80.62%, p=0.568] respectively. RT3DE showed higher sensitivity, specificity, positive predictive value and negative predictive than 2DE for detection of RWMA in patients with NSTMI in prescense of significant angiographic lesions. [77.8% vs 44.4, p=0.031], [95% vs 83.% p=0.04],[95% vs 88.8%],[60% vs 33.3%] Respectively. We have shown that PI of RT3DE can be used for assessment of RWMA with good agreement to visual assessment by conventional 2DE with better sensitivity to detect RWMA in segments supplied with LAD .PI also has better sensitivity, specificity, positive predictive value [PPV] and negative predictive value[NPV] than 2DE in patients with NSTMI

Post-myocardial infarction sexual dysfunction

Sexuality in the post-cardiac infarction patient is an important, poorly approached area. For 43 non-diabetic, non-hypertensive patients with post- myocardial infarction sexual dysfunction; the erectile function [as measured by direct interrogation and specific questions], sex hormonal profile [radioimmunoassay], cardiac function [New York Heart association Classification], echocardiography and psychological status [as measured by standard tests] were evaluated. Patients mean age was 48.5 years [31- 65 range] and they suffered impotence for at least months. There was inconcordance between the degrees of cardiac dysfunction, sexual dysfunctions and sex hormonal changes. Psychologically, patients showed mostly two maladaptive coping styles; the denier and the cardiac invalid [myths about sudden death during intercourse]; 48% of patients were anxious and depressed. It was concluded that postmyocardial infarction sexual dysfunction is a multifaceted problem. In addition to the involvement of the penile arteries by the atherosclerotic process, the psychological status tops the list of causes which included medications, cardiac dysfunction and others. The communication gap between the patient and his physician who is embarrassed or unknowledgeable about the subject needs to be shunted. Patients should be advised as to the realities of their fears and provided with guidelines for facilitating a satisfying sexual relationship

Diagnostic spectrum of puo in Assiut with emphasis on the diagnostic value of ultrasonography

One hundred patients with pyrexia of unknown origin were studied in Assiut University Hospital. The diagnosis was established in 85 cases; 46 with infections, 19 neoplasms, 14 collagen diseases and 6 miscellaneous causes. Infection is the commonest cause of PUO in Egypt but it is less common in western communities. Tuberculosis tops the list of infections affecting 20 out of 46 cases. It is mostly extrapulmonary causing peritonitis in nine cases, pericarditis in four and miliary in one. Intra- abdominal abscesses were revealed sonographically; seven hepatic, two splenic and one pelvic. Rising agglutination titers were diagnostic in three out of four cases of brucellosis and in five cases of salmonellosis; blood cultures establishing the diagnosis in the remaining cases. Subacute infective endocarditis was diagnosed by blood culture in two cases and by therapeutic test in two cases. Echocardiography did not help to detect valve vegetations in any case of SE. Gall stones were detected sonographically in two women. Malignant lymphoma is the commonest neoplastic cause of PUO. Sonography proved to be inevitable in the diagnosis of retroperitoneal lymphoma with no enlarged peripheral lymph nodes. Sternal aspirate was diagnostic in three cases of leukemia with non-revealing peripheral blood. The incidence of collagen diseases in the series is higher than other local or foreign series suggesting undue delay in their diagnosis. Abdominal sonography was conducted for all patients revealing the diagnosis in 20 cases at initial examination with no false positive results and with two false negative discovered one week later on reexamination. Abdominal sonography revealed the diagnosis in peritonitis, abscesses, lymphoma, malignant liver, liver cirrhosis and all gall stones. It was diagnostic in 43.4% of infections and in 42.5% of neoplastic causes of PUO. It was concluded that repeated abdominal sonography is mandatory in the diagnostic workshop of PUO

Lipid abnormalities in uremia and dialysis

46 chronically uremic non-nephrotic, non-diabetic patients and 20 comparable normal persons were studied. Patients were subdivided into two groups; Group I: 21 undialysed uremic patients. Group II: 25 patients on regular hemodialysis for 14.4 months [3 to 36]. The lipid profile in the undialysed group showed highly significant elevation of total serum triglycerides and very low density lipoproteins [VLDL] cholesterol level. Significant reduction in total serum cholesterol level and highly significant reduction in high density lipoprotein [HDL] cholesterol was found. The reduction in low density lipoproteins [LDL] cholesterol was insignificant. In the hemodialysis group the lipid pattern showed increase in the percentage of hypertrigly-ceridemic patients and in total lipid mean value. Greater reduction took place in HDL cholesterol and LDL cholesterol levels. No significant correlations was found between the different lipid components and the levels of blood urea or serum creatinine. In conclusion: Dyslipoproteinemia is a prevalent metabolic derangement in chronic renal failure [CRF] and ordinary hemodialysis do not correct it. The prevalence of lipid abnormalities might be an important risk factor for the claimed accelerated atherosclerosis. Improving the efficacy of hemodialysis with more complementary dietary intervention, might be helpful for the correction of uremic dyslipoproteinemia

HLA markers and schistosomiasis haematobium

The frequency of HLA antigens was studied in 91 shistosomal patients and was compared with that of 100 comparable healthy controls. Patients were classified into four distinct clinicopatholgical groups: Group I: Simple urinary bilhariziasis [22 cases]. Group II: Hepatosplenic bilharziasis [21 cases]. Group III: Patients with benign bilharizial lesions of the urinary bladder [22 cases]. Group IV: Patients with malignant lesions in a bilharizial bladder [26 cases]. All HLA antigens [28] were present in variable percentages. B[27] was the only missing antigen. B[5], BW[4] and BW[6] were more frequent in patients than in controls. B[5] antigen was significantly higher in patients with benign and malignant lesions of the bladder than those with simple urinary bilhariziasis. Patients with this antigen are considered a high risk people and should be thoroughly followed up if they develop shistosoma haematobium infection. The selective occurence of different shistosomal presentations can be justificably explained on the basis of different susceptibility to the disease due to different genetic backgrounds

Renal functions in leprosy

Renal functional status was evaluated in 64 leprotic patients. Diminished endogenous creatinine clearance [ECC] and proteinuria were the common abnormalities detected. 77.7% of lepromatous leprosy, 88.8% of tuberculoid and 81% of borderline leprosy patients had proteinuria. Microscopic hematuria was present in 50% of lepromatous, 37.8% of borderline and in 44.4% tuberculoid leprosy cases. Serum creatinine was insignificantly increased only in one case. Blood urea was found to be marginally increased in a few patients although not to a statistically significant degree. Renal impairment did not bear any relation to the duration of illness in the studied patients. Patients below the age of 35 showed significantly higher incidence of renal impairement than patients above this age

heart in psoriasis

The heart in psoriasis has been approached very scarcely in the literature. Very few case reports have been published. Echocardiographic measurements to 89 patients with advanced psoriasis [collected over 3 years period] were compared to 80 comparable individuals. Diabetic and hypertensive patients were excluded. The mean age of patients was 42.4 [range 5-74] and 71% of them were males. The patients showed an insignificantly lower ejection fraction 9.62 +/- 0.8% versus a control value of 0.68 +/- 0.4% a significantly bigger left ventricular mass [102 +/- 18 gm/m[2] versus a control value of 94 +/- 16 gm/m[2]]: a thicker interventricular septum [1.2 +/- 14cm versus a control value of 0.92 +/- 11cm] a significantly larger aortic root dimensions [3.7 +/- 0.9 cm versus a control value of 3.1 +/- 1.1cm] and a significantly thicker aortic root wall [6.3 +/- 1.2 mm versus a control value of 5.7 +/- 1.1mm]. Although the measurements did not exceed the normal values but it did differ significantly from the controls. The pattern of involvement of the myocardium did not fit with any of the three known categories of cardiomyopathy. In psoriasis the left ventricle and the aorta are involved; either as a cause and effect or by the same mechanism of damage

Measurement of pyuria by three different techniques and their relation to bacterial count

Pyuria was determined by three different methods and compared with the results of bacterial count. 278 urine specimens were subjected to detection of pyuria using the hemocytometer, per HPF method in uncentrifuged urine and per HPF in centrifuged urine. The results were compared with the bacterial counts in the same urine specimens. The hemocytometer readings correlated significantly with the bacterial count results, while the other two methods did not correlate similarly. In correlating high power field [HPF] counting of pus cells in uncentrifuged urine samples with the bacterial count we got high false positive results. With the centrifuged urine samples there are both high false positive and false negative results. Valid data are easily and accurately obtainable by quantitative urinalysis [Hemocytometer] of uncentrifuged urine specimens

Infective organisms causing urinary tract infection in Egyptian males and females

139 adult non diabetic urology clinic symptomatizing patients [78 males and 63 females] were studied. All males were circumcised and all females were non pregnant. Each patient provided a midstream urine specimen for identification of urinary pathogens. The commonest organisms causing urinary tract infection in Egyptian males and females in descending order of frequency were E. coli [56.8 percent], stapfaylococcus saprophyticus [20.3 percent], Proteus [10.9 percent], Klebsiella [6 percent] and streptococcus faecalis [6 percent]. The contaminants of the urine specimens were: gram-positive organisms in 87 percent of cases of which 76.6 percent are coagulase negative staphylococci and 10.4 percent are streptococcus faecalis. The gram negative organism causes 13 percent of cases all of which are E. coli

clean-catch midstream void procedure in Egyptian men and women

Four groups of symptomatizing urology clinic non diabetic adults, categorized according to their sex [76 men and 63 women] and to whether the external genitalia are cleansed or not were asked to provide two urine samples, initial and mistream. All men were circumcised and all women non pregnant. The rates of true bacteriurea [growth of 10[4]- or greater colony-forming untis/1 ml urine with a single predominant species] and contamination [growth of 10[3] or greater colony-forming untis/1 ml urine with two or more colonial types] were compared in the various collection technique subgroups. For male patients neither cleansing of the urethral meatus, nor the collection of a midstream specimen affected the bacteriurea or contamination rates [P > 0.05]. In female patients, cleansing significantly increased the negative results especially in the midstream void. The collected data suggest that only for female patients the complex clean-catch midstream void is essential for obtaining urine specimen for culture