Portal hypertension treatment with candesartan plus propranolol for nine months restores normal portal circulation hemodynamic pattern

Post HCV liver cirrhosis is one of the most prominent etiologies behind the abnormal portal circulation hemodynamics. It occurs as a result of distorted balance between portal venous flow [PVF] and intrahepatic resistances [IHR]. PVF is partially controlled by using both specific and non-specific beta blockers [NSBBs] that have insignificant effects on IHR. Angiotensin receptor blockers [ARBs] inhibit the activated hepatic stellate cell [HSC] contraction and thought to reduce the dynamic portion of MR. The study aimed to slow down the venous blood flow and to reduce the IHR of portal vein vasculature to control sequelae of the enhanced post cirrhosis portal venous turbulence. We evaluated the effects of Candesartan plus propranolol compared to each of them individually in management of portal hypertension [PH]. Three groups of 25 patients each, presented with chronic HCV infection and grade II- III esophageal varices [OV], were randomly assigned to one of three treatment regimens: Propranolol or Candesartan or both. Subjects were screened every three month by Doppler Ultrasound for a total of nine months. Damping Index [DI], pulse Pulsatility index [PT], Portal Venous Flow [PVF] Volume, Portal Venous Peak Velocity [PVPV], and Portal Vein Diameter [PVD] were evaluated once every third month. Our study concluded that combined therapy [Propranolol + Candesartan] induced highly significant improvements that led to restoration of normal values of DI, PI, PVF volume and PVPV overtime compared to monotherapy regimens [P>0.001]. Data strongly recommended using Propranolol plus Candesartan in overtime management of portal hypertension

Null genetic risk of ACE gene polymorphisms with nephropathy in type 1 diabetes among Egyptian population

Reported to date, strong evidence exists in multiple studies for genetic predisposing in the development of diabetic nephropathy, and no studies addressed this issue among Egyptian population. The results of angiotensin converting enzyme gene [ACE] in the susceptibility to nephropathy in type 1 diabetes with nephropathy are conflicting. We aim to identify the associations of two ACE gene polymorphisms [PstI, A > G substitution and a 287-bp insertion/deletion] with nephropathy in type 1 diabetes in Egyptian children/adolescents. Our case-control study contained 140 diabetic individuals; 80 diabetic with nephropathy as cases, and 60 diabetic subjects without nephropathy as control group. Amplified DNA from peripheral leucocytes/buccal mucosa was genotyped for using polymerase chain reaction and enzymatic assay. We found no significant differences in the distribution of ACE insertion/deletion and PstI genotypes or allele frequencies were observed between the examined groups. Frequencies of PstI-indel haplotypes were similar in all of our study groups. In both cases and control subjects, ACE activity and microalbuminuria were highest among D/D homozygotes and lowest in I/I homozygotes, while a dissimilar result was seen in PstI polymorphism. Our findings in Egyptian population strongly conclude that there is no association between the ACE gene I/D and PstI polymorphisms with nephropathy in type 1 diabetes

light and scanning electron microscope study of the albino rat ileum after its partial obstruction

Induction of some sort of obstruction could be resorted to as a definitive line of management of some cases of short- bowel syndrome [SBS]. The goal of this study was to clarify the histological and morphometric alterations in the albino rat ileum after its surgically induced partial obstruction. Thirty adult male albino rats [240-250 gm] were used in this investigation. They were divided into two equal groups: control and experimental. Small pieces of the ileum of the control and experimental animals were processed for histological and scanning electron microscope study. The ileum of the experimental animals proximal to the site of obstruction showed an apparent enlargement in the Peyer's patches and an increase in the thickness of both the mucosa and muscle layers. The villi showed significant elongation and thickening. Both widening and deepening of the crypts were detected. There were an apparent increment in the goblet cell number and in the lymphocytic infiltration in both the corium and submucosa. Scanning electron microscopic examination, the microvilli showed scattered areas of shortening and irregular orientation. The surface was more frequently broken by goblet cell orifices. It could be concluded that partial ileal obstruction resulted in hypertrophy of the ileal wall with considerable structural alterations oral to the obstruction site. Thus, a procedure apparently increased the absorptive surface area together with slowing the intestinal transit. These effects could support putting forward this technique into consideration as one of the suggested lines of treatment of some cases of short bowel syndrome to eliminate the patients need for the parenteral nutrition and all its associated complications

Anatomical variations of human paranasal sinuses: Computed tomographic analysis

The present investigation presents the anatomical variations of the human paranasal sinuses using computed tomography scanning [CT scan]. Paranasal sinus CT scans obtained from 300 subjects [120 male and 180 female] were analyzed. Their ages ranged from 15 to 55 years with a mean age [28.4 +/- 8.79]. The maxillary sinus revealed a number of anatomical variations in 30% of cases. They appeared in the form of septated sinus in 16%, sinus hypoplasia in 10 %, and the presence of a tooth in the sinus in 4% of the cases. Examination of the frontal sinus revealed extensive pneumatization of the sinus in 38% hypoplasia in 26 % and aplasia in 4 % of the cases. CT examination of the sphenoidal sinu reveald sinus hypoplasia in 4%, extensive pneumatization of the sinus in 6% and unseptated sphenoidal sinus in 10% of cases. impression of the optic nerve on the wall of sphenoidal sinus was found in 60% of the cases. The internal carotid artery bulged within the lumen of the sphenoidal sinus in 50% of the cases. Anatomical variations of the ethmoid sinus detected by CT included Aggernasi cell [72%], sphenoethmoidal [Onodi] cell [70%], pneumatized middle turbinate [concha bullosa] [56%], enlarged ethmoid bulla [34%], infraorbital ethmoidal [Hailer's] cell [30%], and paradoxically curved middle turbinate [20%].The uncinate process showed hypoplasia in 24%, elongation in 10%, pneumatization [uncinate bulla] in 8%, lateral deviation in 38% and medial deviation in 28% of cases. . It was concluded that various anatomical variations of paranasal sinuses detected by CT could be of great importance in understanding the pathophysiology of sinus diseases and in avoidance of iatrogenic complications during endoscopic sinus surgery

Anatomical and histological study of human lower esophageal segment

This study was undertaken to determine the anatomical characters of the lower esophageal segment [LES] in man and to establish a correlation between these anatomical features and their physiological properties. Manometric studies of LES were performed in 25 normal volunteers. The end expiratory fundic pressure was taken as zero reference and all values were expressed in mm Hg. The manometric characteristics of the lower esophageal segment were determined. The LES length was measured and divided into four equal quarters. Upper gastro-intestinal endoscopy was performed in 12 normal volunteers using Olympus gastrointestinal fibroptic endoscope GIF-K2 type. Twenty-one human specimens were used for gross anatomical studies of muscular thickness and architecture of the LES using microdissection techniques. For histological examination, 22 adult normal human specimens were used; 10 for longitudinal and 12 for transverse sections. . They were proceeded for paraffin sections and stained with haematoxylin and eosin and Verhoeff's stains. Endoscopic examination showed a sharp line of demarcation between the pinkish mucosa of the stomach and the grayish mucosa of the esophagus. Manometric study showed a higher pressure zone at the LES of the esophagus. The length of this high pressure zone is variable from subject from subject to another. There is an axial asymmetry in the pressure of LES. The pressure is higher in the middle two quarters of the LES than the cranial and caudal quarters. Microdissection and histological techniques showed asymmetry in the thickness of the inner circular muscle layer of the LES. The area of maximum thickness is considered as the gastro-es0phageal ring [GER]. The thickness of the circular muscle layer is tapered above and below the GER i.e there is axial asymmetry. The degree of thickness of the circular muscle layer is variable in relation to the different Walls of the the LES i.e there is radial asymmetry. There was close correlation between manometric records and muscular thickness in the LES. The area of maximum pressure in the middle part of LES coincided with the area of highest thickness of the inner circular muscle layer at the gastroesophageal ring [GER]. The extent of this muscular thickness is equal to the length of the high pressure zone. The lower esophageal sphincter is not a ring sphincter due to the presence of radial asymmetry in the circular muscle layer. In addition, there is an axial asymmetry in the thickness of inner circular muscle layer. The asymmetric muscular thickening at the gastro-esophageal junction is mirrored in the manometric images of the lower esophageal high pressure zone. Manometric assessment of the lower esophageat segment, therefore, reflects muscular structure and architecture of the human gastro-esophageal junction