Serum-ascites albumin gradient: a predictor of esophageal varices with ascites.

Other investigators have found that in adults the Serum-Ascites Albumin Gradient (SAAG) to be 1.1 g/dl or greater in the presence of portal hypertension (PTHN) and less than that in its absence. We sought to determine the correlation between the level of SAAG and the complications of PTHN, manifested by the presence of esophageal varices in children with ascites. Our study included 26 patients with cirrhosis, diagnosed by liver biopsy and 14 patients with nephrotic syndrome (NS) diagnosed by established criteria. The SAAG was measured in all patients. The patients with cirrhosis had upper gastrointestinal (GI) endoscopy for assessment of esophageal varices (EV). We found that 84.6% (22 of 26) patients with cirrhosis had High SAAG (> or = 1.1 g/dl) and 15.4% (4 of 26) had low SAAG (< 1.1 g/dl) (p < 0.001). EV was found in 91% (20 of 22) patients with high SAAG and in 50% (2 of 4) patients with low SAAG (p = 0.013). The SAAG differentiated cirrhosis with EV from those without EV (sensitivity = 91%, specificity = 50%, positive predictive value = 91%, negative predictive value = 50% and efficacy = 85%). The high SAAG is a useful means to predict the presence of EV in children with ascites.

Juvenile T waves (a study of 100 normal subjects).

"Juvenile pattern" of T wave inversion in the precordial leads of electrocardiogram was studied in 100 normal healthy Indians of 0 to 70 years of age in both sexes. Incidence of such pattern was observed in 25 subjects upto 19 years of age. Persons of weight/height ratio less than 30% had higher incidence of juvenile T waves. Maximum incidence (48%) of juvenile T waves was observed in the annual income group of Rs. 15000/-. Exercise ECC showed slight flattening of the inverted T waves in V1 to V3 leads in eight subjects only.