Plasma and hepatic tissue endothelin-1 levels in cirrhotic patients with and without bleeding varices

Bleeding from varices is the most lethal event in cirrhotic patients. Bleeding esophageal varices contributed to 51.6% of causes of upper gastrointestinal hemorrhage among Egyptians. The potent vasoconstrictive peptide, endothelin [ET] has been suggested to contribute to the pathogenesis of portal hypertension. So, the present study was designed to determine levels of both circulating ET-1 and hepatic tissue ET-1 in cirrhotic patients with and without bleeding varices. Patients suffering from liver cirrhosis, portal hypertension and upper gastrointestinal bleeding due to esophageal and/or gastric varices were included in the study. Patients who had liver cirrhosis but had never bled before were studied as a comparative group. All patients were classifed according to modified Child's classification. Esophago-gastro-dudenoscopy was done to all patients. Liver biopsy was done whenever possible. Material was divided for both histopathological examinations [using hematoxin and eosin stain] and detection of hepatic tissue ET-1. ELIZA determined plasma and tissue ET-1. Seventy-five subjects were included in this study [fifty bleeders from varices and 15 non-bleeders]. Age of patients ranged between 28 and 67 years with a mean of 45.1 +/- 8.5 years. Fifty-two were males and thirteen were females. Ten healthy controls with a mean age of 41.6 +/- 13.8 years had also been studied. They were 8 males and 2 females. There was a statistically significant increase in the level of plasma ET-1 in bleeder group [12.90 +/- 5.51] when compared to the non-bleeder group [7.50 +/- 2.52] [p< 0.05]. In the same time, there was a statistically significant increase in the level of hepatic tissue ET-1 in bleeder group [77.6 +/-14.03] when compared to the non-bleeder group [52 +/-10.56] [p< 0.05]. Plasma endothelin-1 level showed significant correlation with parameters of hepatic function. In conclusion, results demonstrated that plasma and hepatic tissue ET-1 might play an important role in the genesis of bleeding varices seen in advanced liver cirrhosis and portal hypertension

Evaluation of some trace elements in patients with acute myocardial infarction

To evaluate the role of sonic trace elements in acute myocardial infarction [AMI] we studied 60 patients with AMI within the first 24 hours and 20 well matched healthy volunteers. AU were subjected to though history taking, clinical examination, plain chest x-ray, resting ECG, Echo-Doppler and laboratoy analysis .The laboratoy tests included the serum 'level of iron, copper, zinc, selenium, magnesium, eythrocytic glutathion peroxidase[EGP], cholesterol, LDL-C, HDL-C, triglycerides and risk ratio. The patients were followed up during their hospital course for development of complications. The study pointed out a statistically significant increases in serum levels of Iron and copper while statistically significant decreases in serum levels of zinc, magnesium, selenium and EGP in AMI-patients when compared to the control group. The AMI-patients showed a significant positive correlation between the level of serum copper and that of cholesterol, triglycerides, LDL-C and risk ratio, while there was a significant negative correlation to HDL-C. Also, a significant positive correlation between the serum level of zinc and that of cholesterol, LDL-C and risk ratio. However, there was no significant difference between the serum levels of the trace elements and the development of in-hospital complications. the increased serum levels of iron and copper while the decreased that of selenium and zinc play a role in the occurrence of IHD, but has no role in the development of in-hospital complications

Effect of conventional diuretics and angiotensin enzyme inhibitors on some renal functions in converting liver disease

Advanced liver disease is associated with a high incidence of renal failure and the rate of diuresis in non azotemic cirrhotic patients with ascites should not exceed the maximal rate of reabsorption of ascitic fluid to avoid plasma volume contraction and renal hypoperfusion. The reduction of markedly elevated angiotensin II production by an angiotensin converting enzyme inhibitor [Captopril] could suppress hyperalodosteronism without impairment of renal functions. On this assumption captopril could be useful in treatment of ascites. This study was performed on 15 non azotemic patients with ascites. They were given diuretics daily [Furosimide 40 mg once per day, and spironolactone 25 mg t. d. s.] for seven days. This was followed by the addition of captopril 50 mg per day in two divided doses to the previously used diuretics for seven days more. Fractional sodium excretion and creatinine clearance were measured before treatment, after giving diuretics for seven days and at the end of the study. Before treatment nonazotemic patients with ascites showed low fractional sodium excretion value and creatinine clearance. Both parameters were improved after the use of conventional diuretics. Whereas the addition of captopril was followed by significant decrease of the creatinine clearance while the fractional sodium excretion showed no significant change compared to the results obtained after the use of diuretics alone. One could conclude that the use of furosimide and spironolactone in non azotemic cirrhotic patients with ascites is effective and is not followed by impairment of renal functions. Whereas Captopril administration did not increase the fractional sodium excretion and resulted in decrease in creatinine clearance