Role of multi-detector CT in assessment of patients suspected with Chronic Inflammatory Bowel Disease

Background: Crohn's disease and ulcerative colitis evolve with a relapsing and remitting course. Determination of inflammatory state is crucial for the assessment of disease activity and for tailoring therapy .Computed tomography enterography [CTE] has become a main modality for the evaluation of inflammatory bowel disease [IBD]. It simultaneously offers visualization of the small bowel and extra intestinal status, which is helpful for diagnosing IBD. Crohn disease has long segmental enhancing wall thickening related with the eccentric longitudinal distribution. In addition, mural stratification, fibrofatty proliferation, positive comb sign by increased mesenteric vascularity and internal/perianal fistula are characteristics of Crohn disease and can be identified on CTE. Each of CTE findings for the IBDs is helpful for differential diagnosis. The main disadvantage of this technique is the requisite radiation exposure of patients, particularly in young patients. However, recent development of advanced CT techniques is promising for radiation dose reduction without compromising diagnostic image quality

Pulmonary veins potential recording in paroxysmal, persistent atrial fibrillation: prevalence and technical aspects

The focal theory of atrial fibrillation [AF] has tempted the electrophysiologists to try radically curing AF via radiofrequency [RF] ablation. Interventional ablation depended on localizing and precisely recording pulmonary vein potentials [PVPs] from the origins of the 4 pulmonary veins [PVs] and less commonly from the ostia of the superior vena cava [SVC], and coronary sinus [CS]. The present study is intended to assess the prevalence and feasibility of recording PVPs in patients [pts] with paroxysmal and persistent AF. The study included 27 pts, [14M, 13F] of variable age groups [27-62 yrs], mean age 39.3 +/- 10 and highlysymptomatic paroxysmal and/or persistent AF. refractory to more than two antianhythmic drugs. all had normal thyroid functions. All pts were subjected to left atrial mapping after a trans-septal puncture and introduction of 2 catheters, one via an 8F femoral sheeth [the Lasso catheter] a special circumferential pulmonary vein catheter for recording, and the other was the ablation catheter. Pulmonary venography preceded the PV-mapping to localize the site and to delineate the size of PV and hence the diameter of the lasso catheter that will be used. A coronary sinus hexapolar catheter was placed distally in the coronary sinus. PV potentials were mapped in both sinus rhythm [for Rt. PVs] and with distal coronary sinus or left atrial appendicular [LAA] pacing [for left PVs]. An arrhythmogenic PV was defined on the basis of documented ectopy [single or multiple] with or without conduction to the LA. PV potentials can be described as sharp electrical activity superimposed on atrial activity, that can be separated by LAA pacing in the Left sided veins. or recorded without pacing from Rt sided veins. One hundred and four out of 108 PVs were mapped. Pulmonary venous potentials could be recorded in 25 out of 27 left superior PVs [92.6%], 21 out of 26 left inferior PV [80.8%], 20 out of 25-" right superior PVs [80%] and in 19 out of 26 right inferior PVs [73%]. Pts were arbitrarily divided according to age into 2 age groups; 14 below 40 and 13 above the age 40y. Compared to the younger age oup, those above 40 yrs. exhibited significant lower prevalence of PVP [3.6 +/- 0.6 Vs 2.6 +/- 1.3 respectively]. proximal CS and the former was superceded by pacing from LAA. PVPs cou1dnt be recorded in 2 out of 27 LSPVs, 5 out of 26 LIPVs, 5 out of 25 RSPVs. 7 out of 26 RIPVs, Four PVs were not mapped due to technical problems. Three cases were complicated with cardiac tamponade the first due to puncture of the LA appendage with the transieptal needle, the case due to extensive ablation and the 3 due to over anticoagulation. Two ps [7.4%] developed mild pericardial effusion that was asymptomatic and disappeared during follow-up and one developed TIA. No mortality was recorded. Pulmonary vein potential recording is an essential prerequiste for successful RE ablation of focal AF using Lasso technique. Our data point to the feasibility anti safety of recording in non rheumatic cases and stress the importance of the learning curve. Left superior, Left inferior, Rt superior, Rt inferior pulmonary veins in that order of frequency are arrhytbmogenic foci generating PV potentials. Left sided and superior PVs are more frequently a source of PVPs representing triggers that initiate AF than right sided and inferior PVs. The prevalence of PVPs recording progressively declines with aging possibly pointing to the increasing role of micro reentry in the genesis of AF and the diminishing of PV triggers. Identification of PVPs is highly important and could be easily detected without pacing in case of Rt sided PVs and with CS or LAA pacing for left sided PVs. Pacing from distal CS was noted to promote better separation of PVPs from the atrial activity than pacing from proximal CS and the former was superceded by pacing from LAA

HELLP [hemolysis, elevated liver enzymes and low platelet count] syndrome versus severe preeclampsia: a critical care comparative study

We performed this study to assess the clinical spectrum and evaluate the outcome of patients with HELLP-syndrome compared to those with severe preeclampsia but without HELLP managed in the intensive care unit [ICU]. Serum albumin level was measured as a prognostic factor. A prospective clinical and laboratory study that was conducted over 18 months period where sixty seven preecalmptic postpartum women admitted to ICU were studied, and were divided into 2 groups. Group I, 21 patients with HELLP-syndrome, and group II, 46 patients with severe preeclampsia only were compared and contrasted concerning medical and laboratory data. Patients in group-I were older than group II [28.7 +/- 6.6 vs 24.5 +/- 4.6, P < 0.05] and-had higher medical complications than patients in group-I I. Eclampsia 62% vs 20% [odds-ratio = 5.95% C1 = 1.2-20.6, P < 0.01], adult respiratory distress syndrome [ARDS] with respiratory failure 29% vs 4% [odds-ratio=l2.4, 95% CI - 1.2-126.1, p<0.01], multiorgan failure [MOF] 43% vs.4% [odds-ratio = 8.4, 95% CI = 1.4-52,. p<0.01] and mortality 38% vs.7% [odds-ratio=11.6, 95%, CI= 1.9-70.2, p<0.01] respectively. There was no significant difference between both groups concerning disseminated intravascular coagulation [DIC] and circulatory failure. Serum albumin on admission was significantly lower in HELLP syndrome patients [2.2 +/- 0.6 gm/dl] than patients with severe preeclampsia [2.8 +/- 0.6 gm/dI, P < 0.01]. Serum albumin correlated significantly with both MOF [t-value = 2.7, DF = 40, P=0.01] and mortality [t-value = 3.7, DF = 27, p = 0.001]. Preecalmptic patients with HELLP-syndrome are amenable for serious medical complications and higher mortality rate than patients with severe preeclampsia but no HELLP. Serum albumin is lower in patients with HELLP-syndrome and correlates well with the development of MOF and mortality so can be used as a useful predictor of both morbidity and mortality in critically ill preecalmptic patients