Can heart rate and Qtc duration be used as a marker of cirrhotic cardiomyopathy? a case control study

To assess the value of QTc prolongation and heart rate variation as a marker of cirrhotic cardiomyopathy and severity of liver disease. This comparative study was conducted on selected patients with cirrhosis of liver, fulfilling inclusion criteria and were enrolled as group 1. An equal number of non cirrhotic patients were enrolled and included in group 2. QTc and heart rate were calculated and compared between the two groups. Analysis of QTc prolongation and increase in heart rate with regard to severity of liver disease was also made. Fifty confirmed cases of cirrhosis of liver were included in group 1 with equal number of age and sex matched non-cirrhotic patients included in group 2 as controls. The mean +/- SEM of QTc in group1 and group 2 were 0.4707 +/- 0.0065 and 0.3893 +/- 0.00542 seconds respectively. The mean +/- SEM of heart rate was 90.50 +/- 2.839 beats/min and 82.85 +/- 2.207 beats/min in group 1 and 2 respectively. The mean of QTc and heart rate in group 1 was significantly higher as compared to group 2 [p=.001 and p=.0179 respectively]. The mean of QTc and heart rate in subgroup 1A, 1B and 1C was not statistically significant. Patients with cirrhosis have a higher mean QTc and heart rate as compared to non cirrhotic adults. Both tests may be useful markers of Cirrhotic Cardiomyopathy

Pattern of upper gastro intestinal malignancies in northern Punjab

To record the number of cases of carcinoma of stomach, geographical location and histological diagnosis presenting to a hospital in northern Punjab. This study was conducted at the department of medicine [GI unit] Fauji Foundation Hospital Rawalpindi. All the patients who underwent upper GI endoscopy and were found to have an upper GI malignancy on histopathology were reviewed for part of the gut involved. Patient demographics including age, sex, and place of residence, clinical presentation, and subsequent histologic diagnosis were recorded. During the study period, 302 cases of upper GI malignancy were seen at our institution, 83 [14.8%] were in patients 40 years of age or younger. Mean patient age was 58 years. The lesion was distal in 43%, proximal in 20% and 7% involved the entire stomach. In 9.8% of the cases, lesser curve was the site. The tumor was located in the upper third, middle third and lower third in 33, 22 and 34.6% respectively. The common presenting symptom in case of carcinoma of stomach was pain epigastrium. Dysphagia was the major subjective complaint in cases of esophageal carcinoma. The common malignant tumor in males was carcinoma of stomach and in females carcinoma of esophagus. Endoscopic screening in subjects suspected of upper gastrointestinal malignancy results in a significant yield of carcinoma. The gastric tumor in distal location [non cardia cancer] is still more common. Asian race is no different from other races as far as the ca stomach is concerned

Intrabiliary rupture of hepatic hydatid cyst: role of ERCP

We report a case of hepatic hydatid cyst presenting with obstructive jaundice following cholecystectomy. ERCP showed intrabiliary cyst rupture with biliary obstruction due to cyst remnants. Endoscopic sphincterotomy was performed and cyst debris removed with complete resolution of symptoms

Coeliac disease: a local perspective

This is an audit of upper gastrointertinal [GI] endoscopies done over 8 years to detect cases of coeliac disease. A cohort of 95 patients was selected for distal duodenal biopsy obtained at upper GI endoscopy on the basis of anaemia, diarrhoea, growth retardation and laboratory findings like low calcium and albumin. Forty-four patients were found to have biopsy findings consistent with the presence of coeliac diseasel It is not an uncommon disorder as is generally thought and underdiagnosis in the community may be due to lack of awareness of varied modes of clinical presentation. To arrive at an early diagnosis a higher index of clinical suspicion may be required