Predictors of multivessel coronary artery disease using dobutamine stress echocardiography

The detection of multivessel coronary artery disease [MVD] is of paramount importance to cardiologists as such group of patients carry a poor prognosis and benefit to a great extent from more aggressive treatment strategies. The value of Dobutamine stress echocardiography [DSE] has been evaluated in the diagnosis of coronary arty disease [CAD], but few studies have been performed to assess the predictors of MVD during this test. this study was designed to determine the clinical, electrocardiographic predictors of MVD during DSE. this study included 51 patients with suspected CAD who underwent clinically indicated coronary arteriography, with DSE performed within 8 weeks of the angiographic study. Different clinical, electrocardiographic and echocardiographic predictors of MVD were assessed using multivariate analysis. Diabetes mellitus [DM], hypertension [HTN], and dyslipideamia were the most prevalent risk factors among patients with MVD. Coronary angiography revealed that 17.5% of patients had normal or non-significant lesion, 39.4%had single vessel disease [SVD], 19.6% had two-vessel disease [2VD] while 23.5% had MVD. DSE had a sensitivity of 96% and 68% for MVD and SVD respectively while the specificity was 85% and 53% respectively. Multivariate analysis showed 5 variables to be independent predictors of multivessel CAD including: History of DM [p=0.031], history of previous myocardial infarction [MI] [p=0.013], electrocardiographic ST-T changes in more than one vascular territory [p=0.0001], segment wall motion [SWM] abnormalities in more than one vascular territory [p=0.008], and SWM score index more than 1.7 [p=0.010]. DSE is a reasonably sensitive and specific non-invasive tool for the diagnosis of CAD, particularly MVD. History of DM, history of previous MI, electrocardiographic ST-T changes in more than one vascular territory, SWN abnormalities in more than one vascular territory, and SWM score index more than 1.7 are all independent predictors of MVD

Parathyroid allotransplantation in patients with post-thyroidectomy severe hypocalcemia without antirejection therapy

In this study, 10 patients with manifestations of severe hypoparathyroidism were treated with allograft transplantation of parathyroid tissue from unrelated donors. Prednisolone was given one day preoperatively and was maintained for two days after operation. In the first two weeks after transplantation, gradual elevation of the serum calcium level was noticed in most of the patients and it was maintained for a period of three months. From this study, it was shown that allotransplantation of the parathyroid gland is a very effective method to improve the symptoms and lessen the medications of patients with post thyroidectomy manifestations of hypoparathyroidism