Mean Platelet Volume as a Fibrosis Marker in Patients with Chronic Hepatitis C

Background and study aim: Liver biopsy limitations push us to search for new non invasive methods to detect liver fibrosis such as serum markers. The aim of this study is to evaluate mean platelet volume (MPV) as a fibrosis marker in patient with chronic hepatitis C. Patients and methods: 150 patients diagnosed with chronic hepatitis C infection refereed to Tanta Fever Hospital in period from May 2013 to January 2014 and 20 healthy volunteers as a control were included. All of them were tested for Mean Platelet Volume (MPV) in comparison with who done liver biopsy as standard. Results: Statistically significant differences in MPV and Platelet Count were seen in patients with chronic hepatitis C (CHC) compared to healthy controls (MPV: 8.95 ± 1.39fL vs. 7.57 ± 0.68 fl, P-value = 0.043; PC 226.03 ±68.36 vs. 188.9±46.49, P-value = 0.02) Multi-variate Logistic regression analysis shows only 5 variables remained as independent risk factors for fibrosis progression: (MPV, Schistosomiasis, ALT, AST and Prothrombin time). AST (OR 1.11, 95% CI 1.02 to 1.21), ALT (OR 0.92, 95% CI 0.86 to 0.99), PT (OR 2.11, 95% CI 1.15 to 3.88), and MPV (OR 2.28, 95% CI 1.22 to 4.25). Cut-off values were calculated for diagnostic performance, and the cut-off value for MPV was 9.22 fl., sensitivity 75.5%, specificity 62%, PPV 40.3%, NPPV 93.4% and Accuracy rate 61.8%. Conclusion: We suggest that high MPV levels (especially those over 9.22 fl) may help to predict advanced fibrosis in patients with CHC. However, it should not be forgotten that MPV is not a specific marker for fibrosis, and the negative predictive rate seems more valuable to exclude a high fibrosis ratio in patients with CHC

Role guided intraperitoneal port-a-cath insertion in the managment of cancer ovary of fluoroscopic

The use of intraperitoneal [IP] chemotherapy as a treatment for ovarian cancer has been demonstrated to result in improved survival. The aim of this work is to evaluate the applicability and efficacy of fluoroscopic placed intraperitoneal port-A-cath and to assess the response rate to intraperitoneal chemotherapy in cases of ovarian carcinoma. The studied group included, 22 female patients with malignant ovarian cancer whom referred from gynecological surgery and gynecological oncology units to the Vascular and Interventional Radiology Unit, Ain Shams University Hospitals, for peritoneal port-A-cath application. All the patients were known cases of either primary or recurrent ovarian cancer, underwent cytoreductive surgery and referred to us. Intraperitoneal port-A-cath with the aid of fluoroscopy showed highest technical success [91.9%] and lowest complication rate on the long run compared to other methods of peritoneal access. Patients with cancer ovary showed significant improvement of the disease process denoted by changes in the degree of ascites, peritoneal nodules and tumor marker level after receiving combined IV/ IP chemotherapy. Port catheters proved to be the most safe method of long term access to the peritoneal cavity with the lowest complication rate compared to other methods of access to the peritoneal cavity

Value of ultrasonographic and colour coded doppler parameters in diagnosis of hepatitis C related chronic liver diseases, correlation with pathological diagnosis

Liver biopsy is the gold standard for assessment of fibrosis and necroinflammatory changes in chronic hepatitis and cirrhosis. However, the use of biopsy in clinical practice has some limitations related to sample errors and possible complications. Ultrasonography has become the most common and valuable method for assessment of liver disease because of its low cost, easy performance and high acceptability by the patients. It could provide not only valuable information on the morphological changes of the liver but also liver hemodynamics by Colour Doppler flow imaging. To evaluate the relationship between abdominal ultrasonography and selected colour Doppler parameters on one hand and the liver histopathology on the other hand, in patients with Hepatitis C related chronic liver disease. The study was performed on 2 groups: Group [1]: Included 40 patients who presented with Hepatitis C virus [HCV] related chronic liver disease, diagnosed by clinical assessment, biochemical profile, hepatitis markers and liver biopsy. Group [2]: Included 20 healthy subjects as a control group. Both groups were subjected to history taking, full clinical examination and laboratory work up. Abdominal ultrasonography and colour Doppler imaging were done with special emphasis on certain parameters. Among ultrasonographic parameters, there was a high statistical significance for the largest oblique diameter of the right hepatic lobe, GB wall thickness, hepatic parenchymal echopattern together with a functional score formed of serum albumin, bilirubin and TNR to predict the degree of hepatitis inflammation among group 1. The studied Doppler parameters [phasicity of hepatic veins, main portal vein trunk, congestive index of the PV, hepatic artery diameter hepatic artery resistive index, splenic artery diameter and splenic vein diameter] when combined with the functional score could significantly predict the degree of hepatitis inflammation. Ultrasonography and Doppler studies can predict the changes in the liver biopsy but their validity is increased when combined with a functional assessment of the liver condition

Transthoracic doppler coronary flow patterns in patients with anterior myocardial infarction undergoing rescue percutaneous coronary intervention: angiographic, function recovery short and long term clinical correlates

Noninvasive Transthoracic Doppler [TTD] recording is a feasible attractive method to characterize different coronary flow velocity [CFV] patterns, however, its clinical application in the setting of percutaneous coronary intervention [PCI] need to be emphasized. To correlate CFV patterns of left anterior descending artery [LAD] with angiographic data, and to determine its impact on left ventricular [LV] function recovery and clinical outcomes following rescue PCI in patients with anterior myocardial infarction. Forty consecutive patients were studied 12 hours after PCI with stenting using high frequency transducer and 2nd harmonic imaging of LAD, to measure diastolic flow data [peak and mean diastolic velocities [PDV and MDV], deceleration time [DEC], pressure half time [P1/2]], and to record retrograde systolic wave [RSW]. Coronary angiographic data included epicardial flow grade [TIMI], and myocardial blush grade [MB]. LV function recovery was determined by percent changes of Tissue Doppler peak systolic myocardial velocity of middle septum [TDMV]. Clinical outcomes included short term [in hospital-three months], and long term [two years] major cardiac events [MACES]. Following PCI 32 pts achieved TIMI flow grade III flow [80%], while 26 patients had MB grade III [65%]. PDV and MDV were significantly higher in TIMI grade III [43.7 +/- 10.2 vs. 19.9 +/- 4.4 cm/sec p<0.014, and 20.41 +/- 7.8 vs. 11.32 +/- 4.92 cm/sec p<0.007 respectively], while DEC time and P1/2 time were significantly longer in MB grade III [383.96 +/- 82.36 vs. 174.24 +/- 62.92 msec p<0.001, and 134.1 +/- 38.18 vs. 76.9 +/- 15.49 msec p<0.001 respectively]. RSW was recorded in 22 pts [55%]. RSW correlated to lower MB grades than TIMI [14/22 vs. 0/18 P<0.0001 and 4/22 vs. 4/18 p=0.75 respectively], and associated with lower percent changes of TDMV [41.18 +/- 57.81% vs. 160.25 +/- 109.69% p<0.01]. All patients achieved 24 months follow up. Survival free events correlated more to higher grade of myocardial blush and absences of RSW but not correlated with TIMI flow grade [Kaplan-meier survival curve. p=0.0004, 0.007, and 0.32 respectively]. Noninvasive Transthoracic Doppler study of coronary flow provides intimate correlation to essential angiographic, functional, and clinical data in the setting of rescue PCI. Coronary flow velocities correlated with epicardial flow grade while time intervals related to myocardial blush grade. Clear recording of systolic retrograde Have is associated with impaired left ventricular function and poor clinical outcome

Impact of drug-eluting stents on treatment of long lesions in diabetic patients

The study was designed to evaluate in-hospital and mid-term clinical outcomes of drug-eluting stents in treatment of long lesions in diabetic versus non-diabetic patients. We studied 100 diabetic and 200 non-diabetic patients with long lesions >/= 20 mm treated with either Cypher or Taxus stents. The majority of the patients were males with a mean age over sixty years in both groups. Both groups were almost matched as regards demographic and clinical characteristics. The majority of patients in both groups presented with unstable angina [49% diabetics and 46.5% non-diabetics]. The incidence of multivessel disease was higher within the diabetic population The mean lesion length in diabetic group was 34.24 +/- 13.48 mm versus 36.68 +/- 16.32 mm in non-diabetic [p=0.11]. The mean percentage of multiple stents per lesion was 40.5% in diabetic patients versus 46.6% in non-diabetic patients [p=0.16]. The in-hospital Major Adverse Cardiac Events [MACE] rate was 10% in diabetic patients versus 7.5% in non-diabetic patients [p=0.25]. Only 2 patients [0.66%] had subacute stent thrombosis while there was no late stent thrombosis. After a mean clinical follow-up period of 328 +/- 127 days, there was no statistical difference between the two groups, in terms of survival [96.88%for diabetic vs. 98.96%for non-diabetic group at 15 months, p=0.29], While the midterm clinical outcome showed higher rate of MACE in uncontrolled diabetics [23.07%] than controlled diabetics [11.36%][p=0.016]. In selected group of patients, the stenting of long lesion with DES may be a good alternative to surgery with excellent mid-term outcome. Also, diabetes mellitus in the era of Drug-Eluting Stents [DES] has limited impact on outcome after PCI in long lesions when the glycemic state is well controlled

Risk stratification in patients with coronary artery disease: the impact of aortic stiffness

Identification of individuals at high risk of coronary heart disease and future events is an important challenge for primary prevention of cardio-vascular disease. Intra-vascular ultrasound confirmed. the link between aortic stiffness and coronary atheromatous plaques, beside the proved relation between aortic elasticity and coronary endothelial function. The purpose of the present study was to assess the value of non-invasive assessment of aortic elastic properties by tissue Doppler versus conventional measures in predicting coronary artery disease and long-term risk of major coronary events. 48 pts with documented coronary artery disease [CAD] were compared to 12 pts with normal coronary angiogram. Ascending [A SC] aortic diameters and pulse pressure were used to calculateo aortic stiffness index. Pulsed wave velocity [PWV] measured as the time taken by the pulse wave to travel along the thoracic aorta. Systolic [SW] and diastolic [EW and A W] velocity waves of ASC and descending [DSC.] aortic wall were measured by tissue Doppler imaging. Patients with CAD had significantly higher Aortic stiffness index [14.77 +/- 5.31 vs. 8.94 +/- 1.76, p=0.0001], faster PWV [13.73 +/- 1.25 vs. 5.82 +/- 1.19 mlsec, p=0.0001], and slower ASC aortic wall velocities [SW [8.87 +/- 3.23 vs. 13.02 +/- 1, 3 cm/sec, p=0.003], EW [9.34 +/- 3.14 vs. By multivariate Cox model analysis, aortic stiffness [relative risk: 95% Cl: 6.4-10.6; P=0.001], SW velocity of ASC aorta [relative risk: 95% CI: 6.2-8.1; P=0.001], and PWV [relative risk: 95% CI: 12.5-15.92; P=0.01], were the strongest predictors of progression to any end-point. In patients with coronary artery disease, aortic stiffness properties are independent risk factors and predictors of major coronary events. Tissue Doppler recording of ascending aortic wall velocity is simple, non-invasive measurement of aortic elastic properties with good correlation and comparable prognostic value to conventional aortic stiffness parameters

Early clinical and angiographic outcome of coronary stenting in thrombus-containing lesions

Percutaneous coronary intervention [PCI] and coronary stenting of thrombus-containing lesions have frequently been associated with an increased risk of adverse outcome. However, the strength of this association has varied and with the new antiplatelet agents and stents, it is not clear whether thrombus is still a risk factor after PCi. The study evaluated the early [in-hospital] clinical and angiographic outcomes of patients undergoing coronary stenting in lesions with angiographic evidence of intracoronary thrombus, A retrospective study comparing two groups of patients: Group I included 64 patients who undetwent stent implantation in a single thrombus containing lesion, Group II included 293 patients who underwent stent implantation in a single non-thrombus containing lesion during the same time period [between June 1997 and April 2001]. Both groups were matched as regards the baseline clinical characteristics except that significantly more patients of group I were presented by unstable angina compared with group II: 65.08% versus 47.78% [P<0.01]. Patients with thrombus [Group I] have significantly more RCA as the target vessel; 46.03% vs 30.03% [P<0.01] and significantly more complex lesion morphology; 42.86% vs 26.28% [P<005] compared with patients without thrombus [Group II]. The target vessel size and the baseline percent diameter stenosis were significantly higher In group I than group II [P<0.001 and P<0.01 respectively]. Similarly the largest balloon diameter and the mean number of inflations were significantly higher in group 1 than group II [P<0.001 and P<0.001 respectively]. Significantly more patients in group I received the GPIIb/I1Ia antagonist, tirofiban [Aggrastat] than group Ii; 20.63% vs 4.10% [P<0.001] although its use was rather limited in both groups. The angiographic success was almost identical for both groups 95.24% in group I vs 96.25% in group II. There were no statistically significant differences between both groups regarding all parameters of in-hospital outcomes, However, there was a trend towards more adverse events in group I compared to group II that did not reach statistical significance [Death: 1.59% vs 0.34%, Q-Mi: 3.17% vs 1.71%, Acute closure: 4.76% vs 2.05%, Repeat PCI: 4.76% vs 2.38%, Emergency CABG: 0% vs 0%, and Procedural success: 88.8% vs 94.28%]. Coronary stenting can be safely performed in patients with thrombus-containing lesions with excellent angiographic outcome and acceptable, though less favorable in-hospital clinical outcome

Afterload reduction with captopril in chronic aortic regurgitation

The chronic hemodynamic effects of captopril were assessed in 22 asymptomatic patients with a moderate to severe isolated aortic regurgitation [AR] before and 3 months after administration of captopril [50-100 mg/day]. Supine heart rate decreased from 81.8 +/- 13.9 to 74.8 +/- 11.3 beats/min. [P <0.01], supine systolic blood pressure from 143.16 +/- 11.07 to 118.18 +/- 9.2 mmHg [P <0.001], mean wall stress from 796.77 +/- 162.78 to 655.6 +/- 148.69 Kdyn/cm2 [P <0.001] and septal thickness from 10.5 +/- 2.26 to 9.9 +/- 2.06 mm [P <0.05]. Left ventricular [LV] end-systolic and end-diastolic volumes, ejection fraction, shortening, fractional LV posterior wall thickness and LV mass did not change significantly. The degree of AR did not change significantly during the 3-month follow-up period. Captopril in a dose of 50-100 mg daily improves left ventricular afterload in asymptomatic patients with chronic AR, and a longer period of follow up is required to show its effect on LV mass and the severity of aortic regurgitation

Diastolic function abnormalities in young symptomatic diabetic patients assessed by pulsed doppler echocardiography

The objective of this study was to evaluate left ventricular [LV] diastolic function in young asymptomatic insulin-dependent diabetic patients. Thirty young asymptomatic patients [<35 years] and 15 control subjects were included. Patients were not received medications except insulin. Autonomic function tests, fundus examination were used to evaluate diabetic complications. Blood glucose and lipid profile were measured in all patients. M-mode, two-dimensional and Doppler echocardiography were used to study LV systolic and diastolic functions. Peripheral neuropathy was present in all patients and autonomic neuropathy in 23 [73.3%], resting tachycardia in 12 patients [40%], proteinuria in 14 [46.7%], retinopathy in 7 patients [23.3%]. Eight patients [26.7%] had LV diastolic dysfunction represented by decreased E filling and increased A with reversed PE/PA and increase atrial contribution of diastolic filling as compared to other diabetics. There was significant correlation between diastolic dysfunction, diabetic complications [r=0.51, P <0.05] and blood glucose [r=0.49, P <0.05], but not correlated with duration of diabetes or insulin dose. It was concluded that subclinical LV diastolic dysfunction is present in diabetic and is related to microvascular complications and hyperglycemia, but not related to the duration of the disease or insulin dose

Study of plasma d-dimer in coronary heart disease

Thirty patients were included in this study. They were divided into three groups. Group I included 10 patients with stable angina. Group II included 10 patients with unstable angina [UA] and group III included 10 patients with acute myocardial infarction [AMI] together with 10 control subjects. They were studied by measuring D-dimer, fibrinogen level, fibrinogen degradation products, euglobulin clot lysis time and plasminogen level. Fibrinogen was significantly higher in UA. D-dimer was obviously significant in 70% of the AMI and 80% in unstable angina. FDPs were increased, ELT showed significant prolongation and lower level of plasminogen in AMI. D-dimer test can be considered as a simple easy rapid side test for detection of thrombotic or may be prethrombotic conditions

Trabeculectomy as a primary procedure in management of buphthalmos

Two hundred and nine eyes suffering from primary congenital glaucoma were treated by trabeculectomy. They were followed up for at least six months for rise of tension. The tension was controlled in 58.85 percent by one operation, in 20.09 by two operations, and in 8.61 percent by a third operation. The tension could not be controlled in 12.44 percent of cases

Probing through the supper canaliculi in congenital nasolacrimal system obstruction

A series of 24 children with congenital nasolacrimal system obstruction was prospectively randomised into three groups to determine the effectiveness of different modes of non-surgical treatment. Massaging the lacrimal sac in a manner that increased hydrostatic pressure to rupture the membranous obstruction was more effective [with high degree of statistical significance] than simple massage or no massage at all. Of those children requiring nasolacrimal probing, thigh success rate was found in simple obstructions in the nasolacrimal duct. Failure of probing was more common in canalicular obstructions or generally narrow nasolacrirnal duct