effect of oxamniquine therapy on the electrocardiogram and echo cardiogram in patients of active hepatosplenic bilharziasis with and without bilharzial cor-pulmonale

The material of this work comprised 25 cases with active intestinal bilharziasis associating bilharzial hepatosplenomegaly with and without cor-pulmonale. All patients were given pxamniquine with a total dose of 60 mg/kgm body weight twice daily for three successive days. All patients were subjected to Biochemical and haematological studies as well as E.C.G. and echocardiography before, one week and one month after oxamniquine. Compacatative electrocardiography though revealing nonsignificant changes as regards the E.C.G. parameters as minor incidence% of S-T and T wave changes and arrhythmia one week after oxamniquine therapy, corrective reversbility in these parameters was the rule. Echocardiographic assessement for left ventricular performance and for indices of myocardial contractility revealed non significant changes short of denoting left vnetricular dysfunction one week after oxamniquine and moreover reversibility pattern for these changes was evident one month after therapy. A non-significant increase in the pulmonary arterial pressure was observed one week after therapy to diminish one month later on. Non-significant aberrations in liver and renal functions as well as non significant increase in HB, R.B.C.S. and W.B.O.S. were observed one week after therapy together with corrective reversibility for these aberration were demonstrable one month later. Cure rate after oxamniquine therapy was 80% in group of hepatosplenomegaly and in the group of compensated bilharzial cor-pulmonale and 60% in decompensated group of bilharzial cor-pulmonale. A suggestion for further work can be targeted towards a comparative evaluation for efficacy and safety of this drug in therapy of active bilharziasis in compensated and decompensated cardiac patients with cardiac disorders aetiologically non-related to bilharzial infection

Bilharzial oval patterns in rectal and colonic mucosa for patients with urinary bilharziasis

Mucosal biopsies from the rectum and colon of 25 males of pure urinary bilharziasis and negative stools were examined directly in the fresh state for bilharzial oval pattern by a slide compression technique. The method proved valuable in the diagnosis of bilharzial nature of the disease as a supplement to routine urine and stool examination. It has the additional balue of indentifying the species of bilharzia in the different levels of rectum and colon. This showed that the bilharzial oval pattern in patients with pure urinary bilharziasis is dominatly that of pure haematobium and dominant haematobium at 10 cm level as compared to a dominant pattern of pure mansoni and dominant mansoni at cm level irrespective of the presence of recent or past history of anti-bilharzial therapy and finally we can conclude that occuld mansoniasis is common in our locality and is discovered only by mucosal biopsy particularly colonic biopsy

Echocardiographic left ventricular functions after radiotherapy of thoracic malignancies

Twelve patients having intrathoracic malignant tumours presented for radiotherapy were studied for cardiac sequaela of irradiation. Electrocardiography and echocardiography which were followed only in ten cases. Echocardiographic assessmentt has revealed a significant impairment of left ventricular performance and minimal deterioration of left ventricular contractility while clinical criteria were evidently short of detection of such early impairment. On the other hand pericardial thickening was observed in all our patients, while minimal pericardial effusion was observed in 4 out of 10 cases without demonstrable clinical finding. A nonsignificant E.C.G. changes were observed possibly due to a relative smaller dose of radiation. In conclusion it is disclosed that echocardiography is accurate and sensitive tool in early detection of the effects of irradiation on the heart. The use of a smaller dose of radiation and at more longer intervals in those patients with high risk of cardiovascular insults is recommended whenever the malignant lesion allows for that. This can be combined with the use of prophylactic digitalisation in those with clinically evident cardiac disease subjected to radiation therapy

Some biochemical and electrocardiographic observations in patients with xanthelasma

The present study was conducted to evaluate the presence of xanthas as regards wheter it signifies an isolated skin sign or it signifies more an associating selective biochemical and or electrocardiographic changes pointing to the presence or further development of some diseases. The present study comprised 34 patients with xanthelama and 12 patients without xanthelasma. Cases with xanthelasma were classified into: group with uncomplicated xanthelasma [14 cases] and group with complicated xanthelasma [20 cases]. Thorough history taking and clinical examination were done to all patients together with some investigations including: blood sugar curve, blood urea, serum creatinine, serum triglycerides, serum phospholipids serum cholesterol [total and free] and E.C.G. incidence percentage of some clinical findings in relation to the total cholesterol concentration a. groups with xanthelasma complicated by hypertension, diabetes and or ischemic heart disease and with uncomplicated xanthelasma

P-wave changes in bilharzial patients with chronic obstructive pulmonary disease

55 patients with C.O.P.D. including 18 with bilharzial hepatosplenomegaly and 7 patients with bilharzial cor-pulmonale together with 10 normal control individuals were the material of the present study. P.E.F.R. was taken as the criterion of the presence of C.O.P.D. and changes of arterial blood gases as criteria to score the severity of C.O.P.D. P-Wave changes known to score the severity of C.O.P.D. [axis and amplitude] were assessed. The presence of associating hepatosplenic bilharziasis with or without bilharzial cor-pulmonale in patients with C.O.P.D. having matching severity were found to changes the incidence of P-Wave axis and amplitude changes in C.O.P.D. This leads to the conclusion that the P-Wave changes taken as criteria for screening the severity of C.O.P.D. are no longer valid in the presence of associating hepatosplenic bilharziasis with or without bilharzial cor-pulmonale in patients with C.O.P.D

Paradoxical interventricular septal movement in patients with bilharzial cor-pulmonale without clinical or phonocardiographic evidences of pulmonary and/or tricuspid regurge

* Twenty eight patients with bilharzial corpulmonale showing no clinical or phonocardiographic evidences of pulmonary and/or tricuspid regurge were the material of the present study. * Interventricular septal motion was studied in all cases and echocardiographic scoring of the degree of pulmonary hypertension was obtained in them. * Abnormal or paradoxical septal motion indicating diastolic overload to the right ventricle was observed in 20%, 22% and 43% of cases with mild, moderate and severe degree of pulmonary hypertension. * Diastolic overloading in these cases is probably due to incipient and clinically occult pulmonary and/or tricuspid regurge whose murmur in beyond the range of human ear audibility. * The presence of diastolic valume overloading in patients of bilharzial cor-pulmonale as evidenced by paradoxical septal motion in the absence of clinically demonstrable pulmonary and/or tricuspid regurge should destract the attention to incipient regurge of either valves

Q-TC interval variations after portal decompression with different shunt operations in hepato-splenic schistosomiasis

1: 23 patients of hepato-splenic bilharziasis with history of ruptured oesophago-gastric varices belonging to child's classification A. were subjected to portal decompression by shunt operations comprising 5 patients for interposition mesocaval shunt and 18 for distal Lieno-renal. 2. Pre-operative biochemical, hematologic, electrolytes, radiology, endoscopic E.C.G. and pathology studies as well as percutaneous trans-splenic portal manometry were carried out for them. 3. Post-operative biochemical and E.C.G. assessement were done for all patients. Follow up portal manometry for patients subjected to mesocaval operation and endoscopic assessement of the varices for patients subjected to Warren's operation were done to evaluate portal decompression. 4. An important comparative follow up E.C.G. finding was progressive significant shortening of Q-1c interval 3 and 6 months after Warren's, but not mesocaval operations, the causes of which were discussed. 5. Such finding can offer valuable achievement as regard assessment of emodynamic efficacy of the type of shunt concerning portal decompression portal perfusion, a non-invasive E.C.G. follow up tool to evaluate persistance of shunt patency and finally a possible indicator for shunt occlusion

Serum, ascitic fluid and urinary biochemical changes in bilharzial patients with refractory ascites

15 ascites patients with aepatosplenic bilharziasis responding to diuretic therapy were taken as control group. 20 patients with bilharzial hepatosplenic affection and retraciory ascites were the material of the present study. All patients from both groups were subjected to investigations to prove pure bilharzial etiology. In their serum, and serum and ascitic fluid enzymes [GOT, G.P.T., Alkaline phosphatase and L.D.H.], Proteins [Albumin total globulin, Alpha[1], Alpha[2] Beta and Gamma globulin]; glucose, cholestrol, bilirubin [total and direct], B.U.N., creatinine and electrolytes [Phosphorus, calicum, pottassium, sodium and chloride] were assessed. Urinary electrolytes [Phosphorus, calcium, calcium potassium, sodium and chlorid] were also meadured for all. The serum biochemical data of patients with refractory ascites showed that they were in a more advanced stage of hepatocellular damage than patients with non refractory ascitis. The ascitographic picture of biochemical data of both groups showed selective significant differences that can be taken as a parameters to fortell refractoriness of ascites during the follow up of cases in the course of that disease. Selective significant differences in urinary electrolytes of both groups can also be taken as forerunnex to predict refractoriness of ascites. The A/S ratio of different biochemical data in both groups showed selective significant differences that can be taken as a parameters for detection of the impending refractory ascitic stage in the course of bilharzial hepatosplenic affection. The concept of an active role for the peritoneum in ascitogrophic biochemical patterns construction was proposed and discussed

Reversion of oesophageal acid perfusion test results after paracentesis abdominis in ascitic cases of bilharzial hepatic fibrosis

Twenty six patients with hepatosplemc schistosomiasis and tense ascites, having positive acid perfusion test results, were the candidates of this research. All cases were investigated for brtharzlal aetiology, portal pressure manometry, ascitic fluid volume and pressure estimation and oesophageal acid perfusion test were done before and 10 days after slow paracentesis abdominis. The following results were found: 1. Positive correlation between portal and ascitic fluid pressures before and after paracentesis. 2. Both portal and ascitic fluid pressures were significantly reduced after tapping in all patients. 3. The oesophageal acid perfusion test turned negative in 61.53% of patients 10 days after tapping. 4. The degree of portal and ascitic fluid pressure reduction was more significant in the group showed reversion of oesophageal acid perfusion test. 5. While test reversibility was linked to the portal hypotensive effect of tapping, non reversibility was indicative of inefficient non significant tapping. We can conclude from this work the great value of this simple test in indicating and evaluating the success of tapping in lowering the portal and ascitic fluid pressures in bilharzial ascitic patients