ABSTRACT
Background: Portal hypertension, which occurs as a consequence of liver cirrhosis, leads to splenic vasodilatation and alterations in the systemic circulation. Arterial vasodilatation in the splanchnic circulation appears to play a central role in hemodynamic changes and in the decline in renalfunction in cirrhosis. Peripheral vasodilatation, which occurs as a part of alterations in the systemic circulation, may decrease the renal blood flow and subsequently raise plasma renin activity. Midodrine is a agonist and acts as a peripheral vasoconstrictor; therefore, it may reduce plasma renin activity and improve renal function
Aim of the work: The aim of the study was to evaluate the relationship between renal resistive indices [RIs]in cirrhotic patients before and after oral administration of 7.5 mg midodrine three times dailyfor 3 days
Patients and methods:The study was conducted on 40 patients with liver cirrhosis and ascites and on 40 healthy controls from October 2014 to March 2015 at Al Azhar University Hospital, Assiut, where allpatients were subjected to history and clinical examination as well as to routine investigations such as total bilirubin, albumin, international normalized ratio, and serum creatinine. Patients underwent an abdominal ultrasound with duplex Doppler examination of the kidneys, and RIwas calculated before and 3 days after oral intake of midodrine
Results: Patients with liver cirrhosis and ascites had significantly higher RI in the right kidney[0.69 +/- 0.101 vs. 0.57 +/- 0.055, P < 0.001] and in the left kidney [0.69 +/- 0.097 vs. 0.59 +/- 0.047,P < 0.001] compared with healthy controls. After oral administration of midodrine for 3 days,RI showed significant improvement [RI = 0.928, P < 0.001] in the right kidney and in theleft kidney [R = 0.993, P < 0.001]. RI had significant positive correlation with Child-Pughscore [R = 0.75, P < 0.001, in the right kidney and R = 0.75, P < 0.001, in the left kidney] and significant positive correlation with Model for End Stage Liver Disease score [R = 0.536,P < 0.008, in the right kidney and R = 0.487, P < 0.005, in the left kidney]
Conclusion: Oral midodrine improved renal hemodynamics as assessed by RI in cirrhotic patients. RI is correlated with severity of liver disease as assessed by Child-Pugh and Model for End StageLiver Disease scores
ABSTRACT
The aim of this study is to characterize the clinical presentation, endoscopic pictures and pathological features of a series of patients with Brunner's gland adenomas. 7 patients out of 508 patients subjected to upper gastrointestinal endoscopy and duodenal biopsy for various gastrointestinal symptoms had underlying Brunner's gland adenomas. The patients [3 men and 4 women] presented in their 6th and 7th decades of life, with hematemesis [3 patients], melena [4 patients] or symptoms of intestinal obstruction [2 patients]. 2 patients presented with acute gastrointestinal bleeding and the remaining 5 patients presented with symptoms of more than 2 months. The majority of patients had blood hemoglobin level of less than 11 gm/dl and 3 patients required blood transfusion. Endoscopically, the lesion appeared as a polyp with a diameter ranged from 0.5 to 5 cm, covered by intact duodenal mucosa in the majority of cases. The first part of the duodenum was the site of predilection in 5 [71.5%] patients Histologically, the lesion appeared as submucosal circumscribed lobulated proliferation of Brunner's glands. Surgical excision of the tumor in 4 patients achieved complete cure
Subject(s)
Humans , Male , Female , Adenoma , Gastrointestinal Hemorrhage/etiologyABSTRACT
This study included one hundred and sixteen tuberculous patients [all proved to have active tuberculosis of different forms] as well as twenty non-tuberculous persons served as controls. Both groups were subjected to dual skin testing using typical mycobacterial antigen [PPD-T] as well as five different atypical mycobacterial antigens. There were no significant differences between responders to [PPD-T]in both groups. The response to atypical antigens was higher in tuberculous lymphadenitis [47%] than pulmonary tuberculosis [30%]. The greatest response was to M. fortuitum and M. avium, while the response to M. gordonae was minimal. Positive skin testing for atypical mycobacteria was recorded in a high percentage among diseased and healthy persons. Its presence means previous exposure to the organisms rather than disease. Atypical mycobacterial infection might have a role in resistant cases of tuberculosis to anti-mycobacterial drug therapy. Bacterial cultures and identification of the organisms are recommended in the tuberculous patients