Spirometric plus left ventricular and pulmonary blood flow echocardiographic findings in patients with scleroderma before and after sildenafil

Systemic sclerosis [scleroderma] is a chronic debilitating disease that is caused by the occurrence of fibrotic changes and vascular abnormalities at various levels such as: Skin, lungs, kidneys or heart. Lung involvement in scleroderma is one of the leading causes of mortality in this disease. Sildenafil inhibits phosphodiesterase type 5, an enzyme that metabolizes cyclic guanosine monophosphate, thereby enhancing the cyclic guanosine monophosphate-mediated relaxation and growth inhibition of vascular smooth-muscle cells, including those in the lung. We hypothesized that chronic oral administration of the phosphodiesterase-5 inhibitor sildenafil could improve the pulmonary haemodynamics in Systemic sclerosis [Ssc] patients. To investigate the use of sildenafil, detect the effect of sildenafil on the left ventricular function and the pulmonary blood flow echocardiographic parameters and pulmonary functions in a series of SSc patients. Twenty three systemic sclerosis cases were selected for the study. All patients were subjected to clinical evaluation, laboratory investigations, plain chest X-ray, ECG, basal pulmonary function tests and basal echocardiographic assessment. One week of therapy with oral sildenafil 75mg/day in three divided doses was given to the patients, after which they were subjected to a second assessment of respiratory function tests and echocardiography. Sildenafil therapy resulted in the following changes: Mitral E/A was significantly increased [p<0.05]. This was further supported by a significant drop of the pre-ejection period [p<0.001] after using sildenafil. There was a significant rise in acceleration time and the ratio between it and ejection time in both aortic and pulmonary Doppler. Also there was a significant decrease in pulmonary artery diameter [p<0.001], maximal pulmonary flow velocity [p<0.001], pulmonary integral area under the curve [p<0.001] and mean acceleration [p=0.007]. Some ventricular contractility indices as the posterior wall excursion [p=0.001], inter-ventricular septal excursion [p=0.043], velocity of posterior wall excursion [p<0.001], velocity of interventricular septal excursion [p<0.001] showed statistically significant increase. The left ventricular internal dimensions and volume in diastole showed a significant drop [p=0.001, p=0.002 respectively], there was a significant increase in the interventricular septum thickness in systole and diastole [p<0.05] with a borderline significant increase in posterior wall thickness in systole [p=0.05]. Spirometric studies showed a statistically significant increase in FEV[25-75] after the use of sildenafil, [p<0.05] which denotes improvement of airway obstruction. Sildenafil improved left ventricular systolic and diastolic functions and may improve pulmonary blood flow in patients with systemic sclerosis. PDE-5 inhibitors are efficacious in scleroderma-associated pulmonary hypertension

Metabolic super scan in patients with hyperthyroidism: does it have a clinical significance?

Hyperthyroid patients complain of generalized bony aches, which are frequently overlooked due to the more prominent symptoms from cardiovascular and nervous disturbances. Hyperthyroid patients are expected to have abnormal bone metabolism as part of the generalized hypermetabolic status. To verify the presence of metabolic bone supcrscan features in various groups of hyperthyroidism. Secondly, to correlate these superscan features with the various lab results in hyperthyroid patients. Forty-Five patients confirmed to have hyperthyroidism by clinical and lab results were enrolled in this work. In all patients [99m]Tc-pertechnetate thyroid scan with uptake was acquired. In a different day, total body bone scan was acquired 3 hours post IV injection of 15-25mCi of [99m]Tc-MDP. Serum FT3, FT4, TSH, Ca, ALP and PTH were monitored in all patients as markers of thyroid and bone metabolism. 10 cases with no thyroid diseases were included as a control group. Patients with thyroiditis or long history of antithyroid drugs for more than one year were excluded from the study. The studied patients were subdivided into Graves' disease [n=30], Toxic Nodular Goiter [TNG] [n=10] and Autonomous toxic adenoma [AT] in 5 cases. The TSH for the whole group was 0.003 +/- 0.002IU which was significantly suppressed compared to the control group 1.660 +/- 0.222IU. The TSH values for Graves' were 0.002 +/- 0.001IU, TNG 0.004+0.001IU and 0.007 +/- 0.002IU for AT with significant differences [p<0.001 for all]. The thyroid uptake values for the whole group were 17.24 +/- 4.65% which was significantly higher than controls 2.50 +/- 0.53% [p<0.001]. The uptake for Oravcs' 19.92+2.36% was significantly higher than TNG and AT groups [p<0.001 for both]. Metabolic superscan [MSS] was present in 90% [27/30] of the Graves' cases. On the other hand, MSS was present in only 2 patients [20%] from the TNG and in none from the AT group. There were no significant differences regarding Ca, ALP and PTH between the Graves, and non-Graves' groups [p>0.05 for all]. Disturbances in bone metabolism are present mainly in Graves' disease and not in all cases of hyperthyroidism. The addition of the Bone scan to the diagnostic work-up patients with Gravs' is a sensitive indicator for metabolic bone changes and could help in the future management and follow up for this group of patients