Portal hypertensive gastropathy [PHG]: clinical, endoscopoc, and portal haemodynamic assessment

Portal hypertensive gastropathy [PHG] is an important complication of both generalized and segmental portal hypertension. The pathophysiology of PHG is still unclear. The aim of this study was to detect the prevalance of PIEIG and factors influencing its development. This study was conducted on 82 patients with portal hypertension. They were divided into 2 groups: Group I [non-bleeders] comprised 31 patients, serves as a control group. Group II [bleeders] comprised 51 patients and were subdivided into: Group IIa 28 patients who were followed up by endoscopic sclerotherapy [[EST] and Group IIb: 23 patients who were followed up by endoscopic band ligation [EBL]. Endoscopy was repeated every 2 weeks till variceal obliteration. All patients were subjected to thorough history taking, clinical examination, laboratory investigations and Doppler ultrasonographic evaluation. In this study the prevalance of PHG was 756%, with no age or sex difference, with increased frequency and severity in patients with child-pugh class B than in patients with class A and C but without statistically significant difference. Again the prevalance of PHG was higher in patients with post-hepatitic cirrhosis than in patients with mixed cirrhosis and patients with pure bilharzial fibrosis but without statistically significant difference. The prevalance and severity of PI-IG was in the presence of esophageal varices, large variceal size, and presence of red signs, while the prevalance and severity was decreased in the presence of gastric varices; however, there were no statistically significant difference. The prevalance and severity of PHG were collectively after endoscopic managment especially with EBL without statistically significant difference. PHG was associated with insignificantly increased portal cross-sectional area, congestion index and portal blood flow. Also, it was associated with decreased portal maximum and mean velocities but the difference was statistically insignificant. We concluded that PHG is quite frequent in patients with cirrhosis, however, the factors studied are not good predictors for its presence

Diurnal pattern of plasma endothelin-1: effect on endothelium-dependent vasodilatation in patients with stable angina pectoris

This study included two groups of patients: Group I included 20 patients with stable angina pectoris [SA] [18 men and 2 women, aged 50.51 +/- 8.29 years] and group II included 20 healthy subjects [17 males and 3 females, aged 48.11 +/- 6.31 years] taken as a control group. Flow-mediated vasodilatation [FMD] of the brachial artery [a surrogate for endothelium-dependent vasodilatation] was determined by ultrasound at 8 a.m. and 8 p.m. Also, carotid artery intima-media thickness [IMT] was determined by ultrasound. The plasma levels of C- reactive protein [CRP] and ET-1 were determined at 8 a.m. and 8 p.m. The study included that the normal subjects had diurnal variation in endothelium-dependent vasodilatation that may counteract other, potentially adverse, diurnal variations in the hemodynamic and other parameters. In contrast, patients with SA showed a loss of this protective mechanism. No diurnal variation in plasma CRP was found to explain this finding. Diurnal variation in plasma ET-1 levels is likely one of the mechanisms involved in the pathogenesis of this phenomenon

Spiral CT detection of coronary artery calcification and increased carotid intimal-medial thickness by carotid ultrasonography: valuable non invasive methods for detecting early coronary artery diseases and atherosclerosis

Currently available non invasive techniques can identify only patients with advanced coronary artery disease [CAD] who manifest myocardial ischemia. Also, the gold standard invasive coronary angiography provides no information on plaque burden other than the extent of luminal obstruction and vascular remodeling phenomenon results in disparity between plaque burden and angiographic stenosis. To evaluate detection of coronary artery calcification [CAC] by spiral CT and increased carotid intimal-medial thickness [IMT] by B-mode ultrasound as non-invasive tools for detection of early atherosclerotic process, so that preventive measures may be instituted before occlusive vascular diseases occurs. 70 subjects with their age 51.68 +/- 10.1 years, divided into: group A include 31 patients with CAD 12 patients have already done coronary angiography, and group B include 39 subjects without evidence of CAD, were subjected to clinical evaluation, some laboratory investigations. E.C.G., X-ray chest, echocardiography, carotid ultrasonography for measurement of carotid IMT and spiral CT scan of heart for coronary calcium scorings [CCS]. Both increased carotid IMT and CAC were detected in 55.7% of total 70 individuals, 83.9% of group A and 33.3% of group B. Significant increase of Carotid IMT and high CCS was detected in patients with angiographyically documented CAD than those with normal coronary angiography. There was a significant positive association between both increased carotid IMT and CAC and some risk factors for CAD e.g. age, male sex, smoking, diabetes mellitus, hypertension, serum cholesterol level and also with ECG evidence of CAD. Detection of coronary artery calcification by spiral CT and increased carotid intima media thickness by ultrasound may represent a valuable non invasive methods for identification of early atherosclerotic process. Spiral CT scan has on advantage over invasive coronary angiography via giving information about plaque burden and vascular remodeling phenomen that does not affect its specificity