Background: Coronary artery disease (CAD) is highly prevalent in developed countries and is a leading cause of death. Diagnostic imaging plays an important role in the proper assessment and management of CAD. Myocardial perfusion is evaluated by SPECT in most patients today; however, this technique exposes patients to radiation and its diagnostic accuracy is sometimes limited by relatively low spatial resolution and artifacts from photon scatter and tissue attenuation. Scintigraphy defects may not be apparent until 10 g of tissue is infarcted. Thus, because a sizable threshold of damage is required, SPECT may miss small or subendocardial MI. Advances in rapid magnetic resonance imaging technology and its application to cardiac imaging have shown that MR imaging has tremendous potential for evaluation of cardiac disease. Practical advantages of cardiac MRI include the lack of ionizing radiation, a shortened examination time (25 to 40 min), good safety and tolerability profile, and detection of small subendocardial infarcts. Aim: assessment of myocardial viability in patients with chronic coronary artery disease by magnetic resonance imaging in comparison with single photon emission computed tomography (SPECT). Patients and Methods: This prospective study include examination of 10 adult patients (each patient has 3 coronary arteries, so we examined 30 coronary arteries and their myocardial territories) known to have chronic ischemic heart disease in Cairo university by MRI and SPECT with conventional angiography as a standard reference. MRI done by using 1.5T machine, using SENSE (sensitivity encoding) cardiac coil (6 element phased-array coil, receive only), functional cine images, first pass perfusion images and delayed enhancement images were acquired. SPECT study was done by 2-day exercise/rest gated SPECT imaging with Tc-99m sestamibi. Conventional coronary angiography was done using a trans-femoral approach to selectively inject the left and right coronary systems sequentially. The results of cardiac MRI subdivided into three groups: (a) Myocardial ischemia was defined as: either 1-Cardiac segment with motion abnormality or perfusion deficit at first-pass perfusion MR imaging consistent with no hyperenhancement at delayed-enhancement MR imaging. Or 2-Cardiac segment of subendocardial enhancement (25 % thickness scar) with motion abnormality. (b) Myocardial scarring is defined as: either 1-Cardiac segment with myocardial delayed enhancement having ≥ 75% thickness scar. Or 2-Myocardial thickness less than 6 mm in diastole. (c) Mixed myocardial ischemia and scarring is defined as: Cardiac segment with myocardial delayed enhancement of near 50 % (>25% and <75%) thickness scarring. The results of SPECT were obtained by comparison between resting and exercise images to detect areas with fixed defects (scar) and those with reversible defects (ischemia). A defect was considered to be fixed (scarred) when there was no change between the stress and rest images, partially reversible (mixed ischemia and scar) when there ...
Background: Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with advance liver cirrhosis and is associated with significant mortality. Multidrug resistance is an evolving problem in management of SBP. Therefore, early diagnosis and proper selection of antimicrobial therapy are warranted. Objective: Assessment of the accuracy of conventional culture compared to blood culture in diagnosis of SBP and evaluation the role of blood culture in selection of antimicrobial therapy for treatment of SBP. Methods: One hundred unselected consecutive cirrhotic patients with moderate or severe ascitis who were admitted to Internal Medicine Department during the period from October 2016 to April 2017 were included. Diagnostic aspiration of the ascetic fluid was made for each patient. The aspirated samples underwent chemical and cytological analysis as well as inoculation on conventional culture and on blood culture. Positive growths were tested for antibiotic sensitivity. Results: 47 patients (47%) among the 100 cirrhotic patients had spontaneous bacterial peritonitis. Positive growths were detected in 11 patients (23.4%) and in 32(68.1%) patients by using conventional culture and blood culture respectively. By using blood culture as gold stander, the sensitivity, specificity, positive predictive value and negative predictive value of conventional culture were 34.38%, 100%, 100% and 41.67% respectively. All isolated growths were sensitive to meropenem. Resistance to cefotaxime was detected in 20 cases (62.5%). Other tested drugs showed variable degrees of sensitivity. Conclusion: Conventional culture is of low sensitivity in diagnosis of SBP among cirrhotic patients and blood culture should be considered the gold standard for diagnosis of SBP. Multidrug resistance in SBP is common and antibiotic selection should be based on culture and sensitivity tests.
Background: Hepatorenal syndrome is a clinical condition that occurs in patients with chronic liver disease, advanced liver cell failure and portal hypertension characterized by impaired renal function Various variables were studied between survivor and non-survivor groups to detect possible predictors of non-survival. Objective: This study aims to assess outcome of hepatorenal syndrome in Sohag University Hospitals and discover possible predictors of non-survival in these patients. Materials & Methods : This study included 50 patient attented Sohag University hospital from 1 / 4 / 2017 till 1 / 10 / 2017 and Who agreed to share in the study and fulfilling the criteria of hepatorenal syndrome were be studied prospectively to observe clinical outcome Various variables were studied between survivor and non-survivor groups to detect possible predictors of non-survival in hepatorenal syndrome. The diagnosis for cirrhosis was based on history, examination, liver function test, and abdominal ultrasound. In all patients history of jaundice, fever, abdominal pain, abdominal distension, deceased urine output and GIT bleeding was taken. diagnosis of hepatorenal syndrome was according to the International Ascites club criteria (inclusion criteria).Study was divided into 2 groups, survivors and non-survivors. Results: the study shows 14 patients (28%) were survivors, but the remaining 36 patients were non-survivors (72%). the possible predicting factors of mortality included were male sex,having tense ascites, having SBP,hepatic encephalopathy being child score C, type I HRS,with high level ofserum creatinine and urea,low level of serum albumin. These factors were be subjected to multivariate regression analysis.
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