Absolute myocardial blood flow determination using real-time myocardial contrast echocardiography during adenosine stress: comparison with single-photon emission computed tomography.

OBJECTIVE: To assess the feasibility and diagnostic accuracy of real-time myocardial contrast echocardiography (MCE)-derived absolute myocardial blood flow for detection of myocardial perfusion abnormalities compared with simultaneous technetium 99 m sestamibi single-photon emission computed tomography (SPECT). DESIGN: Prospective study. SETTING: Tertiary-care medical institution. PATIENTS: 79 patients with known or suspected coronary artery disease. INTERVENTIONS: Simultaneous SPECT and real-time MCE during adenosine stress. MAIN OUTCOME MEASURES: Absolute myocardial blood flow (MBF, ml/min/g), microbubble velocity (beta, min(-1)), and reserve values. Endpoints included sensitivity, specificity, positive likelihood ratio (LR+) or negative likelihood ratio (LR-) and area under the curve (AUC) of the receiver operating characteristic curve. RESULTS: Reserve measurements were feasible in 975 of 1343 segments (73%); of these, 130 segments (13%) were abnormal by SPECT. MCE perfusion parameters clearly distinguished abnormal from normal segments for beta reserve (1.13 (0.99) vs 2.22 (1.36), p<0.001) and MBF reserve (1.80 (2.29) vs 3.69 (2.79), p<0.001). The beta reserve cut-off of 1.60 provided the following: AUC, 0.787; sensitivity, 82%; specificity, 66%; LR+, 2.40; and LR-, 0.28. The MBF reserve cut-off of 1.90 provided the following: AUC, 0.779; sensitivity, 73%; specificity, 72%; LR+, 2.69; and LR-, 0.37. MBF reserve had an AUC of 0.773 for the left anterior descending coronary artery, 0.885 for the left circumflex coronary artery and 0.739 for the right coronary artery. CONCLUSIONS: Real-time MCE-derived absolute MBF, beta, and reserve values are feasible and accurate for detecting myocardial perfusion abnormalities as defined by SPECT.

First derivative ratio spectrophotometric, HPTLC-densitometric, and HPLC determination of nicergoline in presence of its hydrolysis-induced degradation product.

Three methods are presented for the determination of Nicergoline in presence of its hydrolysis-induced degradation product. The first method was based on measurement of the first derivative of ratio spectra amplitude of Nicergoline at 291 nm. The second method was based on separation of Nicergoline from its degradation product followed by densitometric measurement of the spots at 287 nm. The separation was carried out on HPTLC silica gel F(254) plates, using methanol-ethyl acetate-glacial acetic acid (5:7:3, v/v/v) as mobile phase. The third method was based on high performance liquid chromatographic (HPLC) separation and determination of Nicergoline from its degradation product on a reversed phase, nucloesil C(18) column using a mobile phase of methanol-water-glacial acetic acid (80:20:0.1, v/v/v) with UV detection at 280 nm. Chlorpromazine hydrochloride was used as internal standard. Laboratory prepared mixtures containing different percentages of the degradation product were analysed by the proposed methods and satisfactory results were obtained. These methods have been successfully applied to the analysis of Nicergoline in Sermion tablets. The validities of these methods were ascertained by applying standard addition technique, the mean percentage recovery +/- R.S.D.% was found to be 99.47 +/- 0.752, 100.01 +/- 0.940, 99.75 +/- 0.740 for the first derivative of ratio spectra method, the HPTLC method and the HPLC method, respectively. The proposed methods were statistically compared with the manufacturer's HPLC method of analysis of Nicergoline and no significant difference was found with respect to both precision and accuracy. They have the advantage of being stability indicating. Therefore, they can be used for routine analysis of the drug in quality control laboratories.

Causes of minimal hepatic periportal fibrosis present in Egypt.

This study aimed to elucidate the common causes of minimal periportal fibrosis in Egypt. Out of 50 patients having minimal periportal fibrosis, 22 (44%) had schistosomiasis as a sole aetiology, 33 (66%) had combined schistosomiasis with both HBV and HCV. Rare causes were tuberculosis in 4% of the patients and HIV in 2%. No cause could be elicited in 14% of the patients. It is concluded that although schistosomiasis is the commonest cause of minimal hepatic fibrosis in Egypt, yet it is not the sole aetiological factor.

The value of combined use of N-butyl-2-cyanoacrylate and ethanolamine oleate in the management of bleeding esophagogastric varices.

BACKGROUND AND STUDY AIMS: Recently, tissue adhesive material has been used to improve the initial control of bleeding from huge esophagogastric varices, and to prevent them from rebleeding, in contrast to the conventional sclerotherapy. The present study assessed the value of the combined use of the tissue adhesive substance: N-butyl-2-cyanoacrylate and ethanolamine oleate 5% for management of bleeding esophagogastric varices. PATIENTS AND METHODS: One hundred and fourteen patients with documented active variceal bleeding at the time of endoscopy were alternatively randomized into two groups. The combined therapy group included 58 patients who underwent injection using both cyanoacrylate for large esophageal and gastric varices and a sclerosant agent for remaining varices. The sclerosis, or control, group included 56 patients, who underwent injection with ethanolamine oleate. RESULTS: This study proved the value of the combined therapy for the initial control of all bleeders (the follow-up period ranged from 12 to 32 months). In the sclerosis group, failure of the initial control of bleeding was reported in two cases (3.6%). Recurrent bleeding occurred in 8.6% in the combined therapy group compared to 25% in the sclerosis group (p < 0.01). Two months of therapy was required to achieve complete eradication of varices in 56.5% and 21.4% in the combined therapy and the sclerosis group, respectively. The mean number of sessions needed until the time of evaluation was 2.4 +/- 1.1 in the combined therapy group versus 5.1 +/- 2.3 sessions in the sclerosis group. The difference showed high statistical significance (p < 0.01). Minor complications occurred less frequently in the combined therapy group. Only one patient in the combined therapy group developed portal pyemia after extension of the tissue adhesive material from the site of injection into the portal vein. This patient died of hepatic failure. The mortality in the combined therapy group was lower than that in the sclerosis group (3.5% and 8.8% respectively, p > 0.05). CONCLUSION: The combined use of tissue adhesive and sclerosant materials seems to be the best plan for rapid eradication of esophagogastric varices within a short time, requiring the lowest number of injection sessions and involving minor complications and low mortality.

Detection of Schistosoma mansoni antigen in the liver and antibodies in serum of patients with hepatic schistosomiasis.

Liver biopsies were taken from 28 patients with chronic hepatitic schistosomiasis for histopathological study and S. mansoni antigen detection by indirect immunofluorescence test. Circulating antibodies were estimated by indirect haemagglutination test. Thirteen cases (46.4%) revealed diffuse S. mansoni antigen in the liver blood sinusoids and in the formed granulomata. Circulating antibodies were detected in 21 cases, 11 of them showed antigen in the liver. Five cases only revealed definite granulomatous reactions around bilharzial ova, while the remaining 23 cases showed periportal fibrosis. So, for proper diagnosis of chronic hepatic schistosomiasis, it is recommended to examine the liver for S. mansoni antigen together with circulating antibodies detection.

A study of autoimmunity in schistosomiasis.

Circulating auto-antibodies were estimated in sera of ten normal persons and fifty-four schistosomal patients classified into 3 groups: Group I 20 patients with early S. mansoni infection, Group II 20 patients with post schistosomal hepatic fibrosis and Group III 14 patients with post schistosomal glomerulonephritis. A significant high levels of auto antibodies (antinuclear-antismooth muscle and antimitochondrial antibodies) were noticed in Groups II & III. Anti-ds DNA antibodies were significantly higher in Group III than in the other two groups. It was interesting to notice absence of rheumatoid factor in patients with schistosomal glomerulonephritis which may suggest that RF production may have a protective mechanism in patients with schistosomiasis against development of renal disease.