Pulmonary artery diameter and distensibility are correlated to pulmonary pressure and flow in schistosomal corpulmonale

Pulmonary artery diameter [PAD] was reported to be correlated with P. hypertension [PH] in some disease states, but the relations of wall motion distensibility to P. pressure [PPr] and flow [PF] in schistosomal corpulmonale [SchC] were not studied before. 10 patients with SchC, 10 patients with mitral stenosis [MS] and clinically detectable pH, as well as 10 normal controls were studied by Doppler echo. The following data were assessed: PAD in systole and diastole, distensibility = cross sectional area in systole-cross sectional area in diastole [CSAD] / CSAd x 100, mitral valve area [MVA], peak mitral gradient [MG], mean PPr calculated from acceleration time [ACT] and ejection time [ET]- 87 - 152 x [ACT/EY]. In 4 patients, PPr was measured also by catheterization, there was good agreement between PPr as measured by catheter and by this Doppler equation. Results indicated that: PAD > 28 mm was present in 7 patients in group I, and in 2 patients in group II. Distensibility in group I was 41, in group II was 27. In SchC: Distensibility versus PPr r= 0.7, P <0.02, PPr versus Pulm. flow r= 0.76, P <0.01. In MS: MVA 2D versus PPr r= 0.7, P <0.01. It was concluded that in SchC pulmonary distensibility, flow and pressure were correlated together. The increase distensibility and flow may be due to the shunts reported before in SchC

Detection of intrapulmonary shunts in schistosomal corpulmonale

Some patients with schistosomal cor pulmonale [S-Corp] have central cyanosis, the mechanism of which is not known, but two suggestions were reported; opening of foramen ovale or shunts [intrapulmonary vascular dilatations, IPVD] inside the lungs. Evidence of the later mechanism is studied here by two methods: 1- Injection of indocyanine green dye with video recording of contrast enhanced [CE] echo, appearance of dye in left side after 5-6 cycles of appearance in right side is considered a sign of presence of shunt. 2- Blood gas analysis at rest and after 60% O2 inhalation. Ten patients with S- Corp were studied, two with central cyanosis. None had lung fibrosis or COPD. Atrial septal defect or patent foramen ovale was excluded in all cases. Evidence of shunt by CE echo was revealed in the two patients with cyanosis. Two other patients had evidence of shunt by gas analysis, but negative CE echo

poor response of non-ulcer dyspepsia cases to gastric acid suppression and its implications on the theories of pathogenesis

We conducted a randomized controlled trial on 67 patients with non-ulcer dyspepsia to test the efficacy of both H2-Histamine receptors blockers [cimetidine in this study] and conventional antacids in treating these cases. We found that cimetidine was more effective than antacids and placebo in the first week of treatment. It reduced the number of pain attacks by 28.2% in the first week. These effect were not significant in subsequent weeks. Antacids reduced the pain attacks by 12.7% and increased pain-free days by 10.4% which is not significantly different from placebo [12.9% and 12% respectively]. In subsequent weeks, neither cimetidine nor antacids were more effective than placebo. We conclude that the benefit from cimetidine in treatment of non-ulcer dyspepsia is transient and brief, while antacids are of no benefit in such cases. This shows that the non-uclcer dyspeptic syndrome is not dependent on increased gastric acid secretion

hazardous effect of smoking on healing of duodenal ulcers and on their recurrence rate is not dependent on gastric acid oversecretion

In a prospective, randomised study, we examined newly diagnosed cases of duodenal ulceration for the effect of smoking on the healing of ulcers to find out whether a maintenance dose of H2-Histamine blockers may significantly antagonise the harmful effect of smoking on healing, so that we can examine the role of HCI oversecretion in augmenting the harmful effect of smoking. The study included 57 smoking patients with duodenal ulcers diagnosed by gastroscopy and followed for two years. It showed that following initial treatment with Ranitidine, for a course of 8 weeks, the incidence of recurrence after 4 months was 21% in patients maintained on Ranitidine, and 38% in patients maintained on placebo. The difference which is in favour of H2-Histamine blockers maintenance is however statistically insignificant. Recurrence rate 12 months after initiating therapy was 66.6% for Ranitidine vs 74% for placebo maintenance respectively, P = not significant. Six months later, the recurrence rate was 53. 8% for Ranitidine vs 74% for placebo maintenance respectively, P = not significant. Six months later, the recurrence rate was 53.8% for Ranitidine vs 55.5% for placebo maintenance, P = N.S. At the end of the two-year study, the recurrence rate for Ranitidine was 48% vs 51.8% for placebo maintenance group, P = N.S. We conclude that in the first few months after treatment, giving maintenance dose of H2-Histamine to smokers with duodenal ulcers decreased the incidence of recurrence on the short term but not to a satisfactory significant level, while on the medium and long terms [12-24 months], it offers no real benefit. Stopping smoking seems to be an important factor in preventing the recurrence of healed duodenal ulcers, and patients should be advised of that instead of prescribing the drugs that suppress gastric acid

Clinical and electrocardiographic variables predictive of early and late outcome in unstable angina

Fifty patients with unstable angina were studied to define the clinical and electrocardiographic variables predictive of outcome. Based on clinical presentation, patients were stratified into the following types: IA [new onset angina], IB [crescendo angina], IC [angina at rest], II [prolonged angina 20 minutes with ST-T changes on EKG], III [post infarction angina]. Patients were divided into two groups according to the occurrence of complications as acute myocardial infarction, serious arrhythmia [ventricular tachycardia or fibrillation] or death. Nine patients developed complications [group II], five had AMI and four died. Treadmill exercise testing was done in 19 patients if resting EKG was normal or after improvement. Silent ischemia was present in 11, all had no complications and symptomatic [painful] ischemia was noted in eight, two of them were among the complicated group. Patients with unstable angina managed in hospital have an incidence of AMI or death of 18% during a follow-up period of 1 to 27 months [mean 9 +/- 7]. Predictors of a worse prognosis were older age, presence of prolonged chest pain and heart failure. A point score system was developed for better prediction of outcome depending on the following clinical and electrocardiographic variables: Age, history of hypertension, smoking cigarettes, diabetes mellitus, hyperlipidemia, chest pain duration of 20 minutes or more, presence of previous infarction and/or presence of EKG ST-T changes, ventricular premature beats, elevated cardiac enzymes, presence of heart failure. A point value of 0 or 1 is assigned to each variable 0 = absent, 1 = present. Each patient's total score was determined by summing the point values of the 10 variables. A score of 5 or more increased the predictive value of a complicated course. Treadmill exercise testing in some of these patients revealed that silent ischemia does not have a worse prognosis than painful or symptomatic ischemia. It was concluded that this score system helps for better prediction of the course of unstable angina and for selection of patients to be admitted to ICU

prevalence and correlates of echocardiographic left ventricular hypertrophy in hypertensive patients

Sixty-one patients with systemic hypertension [HT] aged 28 to 75 years were studied by echocardiography to determine left ventricular hypertrophy [LVH] and its correlates. Fifteen normal controls were studied, also. Patients were divided according to blood pressure [BP] into three classes: Mild, moderate and severe HT. They were divided also according to left ventricular mass index [LVMI] into three groups: Group 1 [LVMI <95 g/m2 [=normal + 2 SD]], group 2 [LVMI 95-120 g/m2] and group 3 [LVMI >120 g/m2 [LVH group]]. Incidence of LVH was 75% [12 out of 16] in severe HT patients, 29% [6 out of 21] in moderate HT, and 4% [1 in 24] in the mild HT patients. Total 31% [19/61]. In the 19 patients with LVH, ECG revealed LVH in 7 [37%], but revealed LVH in 7 other patients. Percent fiber shortening [% FS] was 29% or less in 7 [37%]. Vcf was 0.9 or less in 10 [53%]. Diastolic function was assessed by LV posterior wall velocity in diastole [PWVD], it was 78 +/- 21 mm/s in LVH group, 93 +/- 23 in group 1 and 121 +/- 28 in normotensive controls [P <0.05 and <0.0001, respectively]. In conclusion, LVH was detected by echo in 31% of HT patients and was significantly related to the level of BP. ECG revealed LVH in 14 patients; systolic dysfunction was detected in 53% and 37% as assessed by Vcf and% FS, respectively. Diastolic function was significantly lower in LVH than in hypertensive patients without LVH

Efficacy of amiodarone therapy for ventricular tachycardia: role of electrophysiologic study

Amiodarone is an effective antiarrhythmic agent for treating recurrent ventricular tachyarrhythmia [VT]. It has been suggested that despite failure to suppress initiation of VT, amiodarone frequently prevents recurrent clinical episodes, hence electrophysiologic testing is of little value in evaluation of long-term amiodarone therapy. Sixty-four patients with sustained ventricular tachycardia [VT-S] continuously treated with amiodarone were studied. Electrophysiologic study was done in 61 patients. It was found that in patients with VT-S with or without VF refractory to other antiarrhythmic agents, amiodarone proved to be highly effective in preventing VT-S or VF. Electrophysiologic testing was effective in determining the success of chronic therapy, and complications necessitating discontinuation of the drug occurred in 8%