[Correlation between serum level of endothelin I, portal hypertension and hepatopulmonary syndrome among cirrhotic patients]

Increased Endothelin I [ETI] activity may contribute to the complications of cirrhosis and portal hypertension. The main aim of this study was to determine the role of Endothelin I in cirrhotic patient with portal hypertention and hepatopulmonary syndrome. Fifty patients with biopsy proven cirrhosis and 50 normal healthy controls were selected for study. After getting informed consent, two dimensional echocardiography, chest x-ray and pulmonary function test have been done for all cirrhotic patients. Patients with cardiac and pulmonary disease history were excluded from the study and the cirrhotic patients who had proved to have intra-pulmonary vascular dilatation in their contrast echocardiogram were classified as the positive HPS. A total of 100 subject [60 males and 40 females in both case and control group] enrolled in the study. Among cirrhotic patients, 10 subjects with clinical and 7 subjects with sub clinical HPS were detected. The most common etiology of cirrhosis was HBV. Hepatopulmonary syndrome was significantly higher in class C [P=0.007]. There was no significant difference between plasma ETI level in both clinical and subclinical HPS compared to other cirrhotic patients. ET I levels in cirrhotic patients [2.29 pg/ml] were significantly higher in cirrhotic patients compared to that of normal healthy controls [0.85 pg/ml] [P = 0.038]. The effects of HPS on cirrhotic patient's survival are unclear. As to other studies, we found significant increase in plasma Et I level in cirrhotic patients rather that normal subjects, but in contrast to previous study we found no relation between Et I level and HPS. Only further studies with further numbers of cirrhosis-caused HPS patients may bridge up the gap between scientific effort and credibility in this field

[ comparative study on opium withdrawal of buprenorphine and clonidine]

Opium abuse and addiction is a worldwide problem and application of a method, both cost effective and with less side effect, to shorten the opioid detoxification period is on increasing demand. To compare the efficacy of Buprenorphine and Clonidine in treatment of opium withdrawal. This study was a randomized, double blind, parallel group, clinical trial performed on out-patients referred to either psychiatric ward at Amirkabir hospital or private clinics in 2005. The patients, initially divided into two groups of 38 members, were assessed for both the efficacy and side effects. Statistical analysis was performed using descriptive statistical tests, K[2] test, and also the correlation severity by relative risk analysis [R.R]. Thirty six [94.8%] subjects in Buprenorphine group and 32 [84.3%] in clonidine group completed the detoxification program, successfully. Relapses were observed in 2 and 6 cases of Buprenorphine and Clonidine groups, respectively. The difference was statistically insignificant [p= 0.13]. The side effects including hypotension, headache, sedation, dizziness, dry mouth, nausea, and constipation during the 10-day detoxification periods in Clonidine group was more severe and intolerable than in Buprenorphine group. Conversely, the sweating, as another side effect, was found to be more pronounced in Buprenorphine group than in Clonidine group. Buprenorphine and Clonidine showed similar effects in managing opium withdrawal, yet the withdrawal symptoms of opium was found to be more tolerable with Buprenorphine than Clonidine. Also, less side effects were observed with Buprenorphine