Comparison of breath-hold 2D phase-contrast with non breath-hold cine phase-contrast MRA in the assessment of azygos venous blood flow in portal hypertension.

Azygos venous blood flow as an index of blood flow through the gastroesophageal collaterals and varices is of value in the prediction of gastrointestinal bleeding. Measurement of azygos venous blood flow has been achieved by non breath-hold (NBH) cine phase-contrast magnetic resonance imaging. The objective of this study was to compare the faster breath-hold (BH) phase-contrast technique with the standard (NBH) cine phase-contrast technique in the measurement of azygos blood flow. Thirty-two cirrhotic patients with esophageal varices were examined by magnetic resonance imaging using a BH technique and a NBH cine phase-contrast technique to measure the flow velocity, flow volume and calibre of the azygos vein at the mid-right atrial level. The flow values were obtained on the velocity image of the phase-contrast study. Values obtained from the two methods were evaluated statistically for the strength and significance of correlation by the Pearson test. Measurement by the BH method performed at full-inspiration as well as end-expiration was also obtained in 15 healthy volunteers. The breath-hold phase-contrast method has significant but weak correlation with non BH cine phase-contrast method in the measurement of azygos venous blood flow volume (r = 0.55, p < 0.01) and flow velocity (r = 0.43, p = 0.01). However, the calibre of the azygos vein gave a strong correlation in these two methods (0.82). In the subgroup of patients whose azygos blood flow velocity was greater than 7.4 cm/s, the correlation of azygos blood flow volume is strong (r = 0.80, p < 0.01). The azygos vein calibre remains highly correlated between the BH and NBH method, in both high flow velocity (r = 0.73) and low flow velocity (r = 0.83) groups. Breath-hold sequence leads to higher values for flow velocity and flow volume in the cirrhotic patients and also the control group. In patients with portal hypertension, BH 2D phase-contrast (PC) magnetic resonance angiography (MRA) could give a comparable estimation of the calibre of the azygos vein as the NBH 2D cine PC MRA but not for azygos flow volume. In patients with high azygos flow velocity, the strong correlation in flow volume between the BH and NBH method suggests that the BH method may be a time-saving alternative to the NBH method.

Economic analysis of celecoxib versus diclofenac plus omeprazole for the treatment of arthritis in patients at risk of ulcer disease.

AIM: To evaluate the economic impact of celecoxib therapy vs. diclofenac plus omeprazole therapy for the treatment of arthritis in Chinese patients with a high risk of bleeding, from the perspective of a public health organization in Hong Kong. METHODS: The medical records of 287 Chinese arthritic patients with a history of bleeding ulcers who had previously participated in a randomised study of celecoxib 200 mg twice daily and extended-release diclofenac 75 mg twice daily plus 20 mg of omeprazole daily for 6 months were reviewed. RESULTS: Compared to the diclofenac plus omeprazole group, the average total direct cost per patient in the celecoxib group showed a significant reduction of 11%, from HK 10,915 (range HK dollars 10,915-57,899) to HK dollars 9714 (range HK dollars 9714-89,770) (P<0.0001) (1 US dollars=7.8 HK dollars). The median direct medical cost for routine management in the celecoxib group was significantly lower (11%) than that for the diclofenac plus omeprazole group [HK dollars 10,915 (range 10,915-28,048) vs. HK dollars 9714 (range HK dollars 6946-26,179) (P<0.0001)]. In patients who experienced recurrent bleeding, the celecoxib group showed a significantly higher median cost of management of recurrent bleeding than the diclofenac plus omeprazole group [HK dollars 8466 (range 572-29,851) vs. HK dollars 23,210 (range HK dollars 12,318-65,823)] (P=0.036). CONCLUSIONS: Celecoxib therapy appears to cost less compared with diclofenac plus omeprazole for treatment of arthritis in Chinese patients with a high risk of bleeding.

Endoscopic assessment of mucosal hemodynamic changes in a canine model of gastric ulcer.

In studying the side effects of sclerosants injected into the gastric submucosa in dogs (N = 7), we noted that 3 ml of absolute ethanol induced a large gastric ulceration. We describe the time course of change in the ulcer size, and suggest that such ulceration can be used for the endoscopic assessment of factors important in ulcer genesis and healing. Endoscopic reflectance spectrophotometric measurement of indices of mucosal hemoglobin concentration (IHB) and oxygen saturation (ISO2) were performed in a separate group of dogs (N = 4) with ethanol-induced gastric ulceration. We found a significant difference (p less than 0.05) in IHB and ISO2 immediately before (97 +/- 8 and 37 +/- 3, respectively) and after (138 +/- 7 and 21 +/- 5, respectively) the ethanol injection. At 24 hours after the ethanol injection, the IHB at the lesion margin (141 +/- 14) was significantly higher (p less than 0.05) than that at the adjacent mucosa (101 +/- 4), whereas the ISO2 measurements were not significantly different in these two locations, 34 +/- 2 and 31 +/- 2, respectively. We conclude that (1) injection of 3 mol of absolute ethanol into the submucosa of the canine stomach provides an animal model of gastric ulceration in which the ulcer can be examined repeatedly with the aid of the endoscope; (2) in this ulcer model, ischemia with congestion (increases IHB, decreases ISO2) precedes the development of gross mucosal ulcerations; and (3) the margin of the established ulceration in this model exhibits hyperemia (increases IHB, normal ISO2) which mimics that of a healing gastric ulcer.