Monitoring heparin effect in patients at risk of DV thrombosis

This work was designed to find out the optimal investigation [s] for monitoring heparin therapy. 50 patients, 25 males and 25 females, suffering from various cardiopulmonary diseases having or at risk of deep venous thrombosis admitted to ICU of Ain Shams University hospitals were treated with intermittent [4 hourly] I.V. heparin therapy. Blood samples were withdrawn before, 1, 2, 3 and 4 hours after heparin injections and the samples were analysed for ACT, APTT, IT and factor X[a] assay as well as protamine sulphate titration for heparin level and in vitro estimation of heparin level in plasma by APTT and IT. We found that ACT is the most practical and reliable test for monitoring heparin effect as it correlated significantly with heparin level using protamine titration test. It is especially useful when APTT and TT were paralyzed. On the other hand, factor X[a] assay is very unreliable as it measures mainly the anti-X[a] activity of heparin without the antithrombin effect. It was also found that therapeutic levels 3 hours after heparin injection were not significantly different from pre - injection levels denoting increase risk of thrombosis. Thus intermittent schedule for heparin injection is unreliable method of anticoagulation in patients at risk of D.V.T, pulmonary, or coronary embolism

Ascitic fluid cholesterol in malignant ascites a tumor marker and diagnostic tool

The present study was undertaken to evaluate the use of ascitic fluid cholesterol determination in the differentiation between malignant and cirrhotic ascites. Again, the aim of our study was to further illustrate the value of estimating serum-ascites albumin gradient in differentiating ascites due to cirrhosis from that due to malignancy. This study was carried out on two groups of ascitic patients, the first with cirrhotic ascites and included 13 patients, the second with malignant ascites and included 19 patients. Ascitic fluid cholesterol level was found to be significantly higher in malignant group than in cirrhotic group. Ascitic fluid cholesterol above 48 mg percent was found to have high sensitivity [77.81 percent], high specificity [92.85 percent] and to have the highest diagnostic accuracy [84.37 percent] among all chemical tests used for diagnosis of malignant ascites [namely total proteins; LDH and s-a albumin difference. In evaluating the serum ascites albumin difference, it was found to be significantly lower in malignant than cirrhotic group [P < 0.01]. The diagnostic accuracy with s-a albumin difference < 1.1 gm percent was higher than that with total proteins >3 gm percent. Pare et al, 1983 reported that s-a Albumin was a useful tool in differentiating ascites due cirrhosis from that due to malignancy. Hoef [1981 b] reported stability of the gradient during diuresis

value of ascitic fluid fibronectin in the differentiation of malignant and cirrhotic ascites

The differentiation of malignant and cirrhotic ascites is of considerable importance for further diagnostic and therapeutic approaches. This work was carried out to evaluate the use of ascitic fluid firbronectin concentration to differentiate between malignant and cirrhotic ascites in comparison with two conventional tests namely: ascitic fluid total proteins and ascitic fluid LDH. Eighteen patients with malignant ascites and fourteen patients with cirrhotic ascites were included in this work. Ascitic fluid samples were subjected to the following tests: culture and sensitivity, cytologlc examination, total proteins, LDH, and firbronectin concentration using radial immunodiffusion technique. Total proteins, LDH and firbronectin showed significant differences between both groups with firbronectin having higher diagnostic accuracy than total proteins and LDH

Serum sodium and potassium in asthmatic children

The pathophysiological basis of bronchial asthma is related to bronchial hyperreactivity. Serum sodium and potassium homeostasis may be disturbed during the course of bronchial asthma. Fifty asthmatic children were included in this study as well as thirty normal controls in the same age group. Complete blood picture, peak expiratory rate by peak flow meter, laboratory estimation of serum sodium and serum potassium by atomic absorption spectrophotometry were done for all patients twice during attack, in-between attack and also for the controls. There was a significant decrease in PFR measured for the asthmatics during and in-between the attacks compared to normal [P<0.005]. Serum sodium and potassium are significantly decreased during the attacks when compared with controls and cases in between the attacks