External Compression of the Inferior Vena Cava by Tortuous Abdominal Aorta in the Elderly

Budd-Chiari syndrome (BCS) is an uncommon disease caused by obstruction of hepatic venous outflow. This results in centrilobular congestion and necrosis, ultimately leading to fibrosis and cirrhosis of liver. Stenosis of the inferior vena cava (IVC) can be a one of causes of BCS. We report the a case of a 72-year-old woman who presented significant IVC stenosis due to extrinsic compression resulting by a tortuous abdominal aorta which was incidentally detected by echocardiography and successfully treated by stenting. To the date the extrinsic compression of IVC resulting from tortous aorta has never been reported to cause of BCS.

The Additive Beneficial Effects of Ramipril Combined with Candesartan in Hypertensive Patients on Insulin Resistance, Plasma Adiponectin

BACKGROUND AND OBJECTIVES: Ramipril and candesartan have decreased the incidence of new onset diabetes in large scale randomized clinical studies. Because ramipril and candesartan have distinct mechanisms of action in the renin angiotensin aldosterone system, we hypothesized that combination therapy would have additive beneficial metabolic effects in patients with hypertension. SUBJECTS AND METHODS: Thirty-four patients were given ramipril 10 mg and placebo, ramipril 10 mg and candesartan 16 mg, or candesartan 16 mg and placebo daily in a randomized, double-blind, placebo-controlled cross-over trial with three treatment arms and two washout periods (each being 2 months). RESULTS: Ramipril, combination therapy or candesartan significantly increased the plasma adiponectin levels relative to the baseline measurements by 17+/-6% (p=0.038), 25+/-5% (p<0.001), and 14+/-6% (p=0.016), respectively. Combination therapy significantly increased the plasma adiponectin levels more than either ramipril or candesartan alone (p=0.020 by ANOVA). Only combination therapy significantly increased the QUICKI level relative to the baseline measurements (p=0.002). There were no significant correlations between these changes of the metabolic parameters and reduction of the systolic blood pressure (-0.288< or =r< or =0.284) and reduction of the diastolic blood pressure (-0.282< or =r< or =0.190). On multivariate analysis, only the change of adiponectin levels was an independent predictor of the changes in the QUICKI levels (beta=1.549, p=0.040) following combination therapy. CONCLUSION: Ramipril in combination with candesartan increases the plasma adiponectin levels to a greater extent than monotherapy with either drug alone. Only combination therapy significantly improves insulin sensitivity relative to the baseline measurements. The only predictor for the improvement of insulin sensitivity is the increase of plasma adiponectin levels by combination therapy.