Evaluation of extracorporeal ultrafiltration in the management of refractory congestive heart failure

Refractory congestive heart failure [CHF] usually represents the end stage of cardiac disease in which hypotension and oliguria lead to progressive generalized edema. The aim of the present work was to assess the symptomatic response, hemodynamic benefits and side effects of extra-corporeal ultrafiltration [ECUF] therapy in patients with refractory CHF who failed to respond to conventional anti-failure measures. Sixteen patients with refractory CHF who belonged to class IV of the New York Heart Association [NYHA] classification were included in this study. They were 7 men and 9 women with ages ranging from 32 to 63 yr [mean 47 +/- 9 yr]. The causes of heart failure were: ischemic heart disease in 3 patients, rheumatic heart disease in 5 and dilated cardiomyopathy in 8. All patients had ECUF therapy, 1-6 sessions/patient, each lasting 4-6 hr with an average amount of ultrafiltrate 2.6 +/- 0.4 L/session. All patients had serial: echocardiography, hemodynamic monitoring, chest X-ray, serum electrolyte and hematocrit estimation in addition to routine laboratory tests both pre- and post ECUF. Response to ECUF was considered according to improvement of patients' clinical status, and cardiac and renal functions. Eleven patients were responders [68.5%], 3 were partial responders [18.5%] while 2 were non-responders [13%]. In responder group, edema disappeared, 5 patients [31%] became NYHA class III, with significant diuresis and decrease of body weight. In addition, there was a significant reduction in heart rate, central venous pressure and radiographic cardiothoracic ratio. After ECUF there was a significant increase of serum sodium concentration whereas no-significant changes were observed in serum calcium, potassium, urea or creatinine. By echo cardiography there was a significant reduction in all cardiac chamber dimensions with significant improvement of left ventricular contractility. ECUF offers a reasonably effective and relatively safe method in the therapeutic options of refractory CHF

Circulating angiogenic factors in patients with chronic liver diseases

Platelet-derived endothelial cell growth Factor [PD-ECGF], basic fibroblast growth factor [b-FGF], gangliosides [Gs] and nitric oxide [NO] are angiogenic factors expressed in various cancer tissues as well as non malignant tissues. Little is known about the role of these factors in patients with chronic liver diseases such as chronic hepatitis [CH], cirrhosis, and hepatocellular carcinoma [HCC] with cirrhosis. The levels of these factors were determined in 28 patients with chronic hepatitis, 43 with cirrhosis and 29 patients with HCC. The study also included 18 normal individuals who are comparable to patients in age as a control group. The study revealed that the levels of these angiogenic factors are significantly increased in patients with HCC in comparison with either patients with hepatitis or liver cirrhosis. Moreover, both Gs and NO are also increased in patients with cirrhosis in comparison with controls. In HCC the levels of angiogenic factors reflected tumor burden where they were significantly increased in higher burden. These angiogenic factors are derived from HCC cells as well as inflammatory cells. In cirrhosis the elevation of these factors might be related to the extent of inflammation and angiogenesis in the cirrhotic liver. These factors showed significant positive correlations with liver enzymes in HCC. Assessment of the angiogenic factors in patients with chronic liver diseases would help to follow progression of liver affection. The expression of PD-ECGF in HCC would predict its chemosensitivity