Cruveilhier-Baumgarten syndrome: An efficient spontaneous portosystemic collateral preventing oesophageal varices bleeding

The protective role of large spontaeous portosystemic shunts in oesophageal varices bleeding due to portal hypertension in liver cirrhosis is still debated. A series of 20 consecutive patients with haemodynamically efficient collaterals involving the para-umbilical-epigastric venous route (evaluated by Echo-Doppler flowmetry) is reported. All patients presented absent or mild oesophageal varices at endoscopy. During a mean follow-up period of 23.5 months, no patient developed large varices or experienced variceal bleeding. Hepatic encephalopathy was present in 35% of patients. Haemodynamically efficient spontaneous portosystemic shunts may protect cirrhotic patients from the risk of oesophageal varices forming and bleeding. The diversion of large amounts of blood from portal to systemic circulation correlates with the higher trend of hepatic encephalopathy in these patients.     

Biological effects of aspirin and clopidogrel in a randomized cross-over study in 96 healthy volunteers

BACKGROUND: Some data suggest that biological 'resistance' to aspirin or clopidogrel may influence clinical outcome. OBJECTIVE: The aim of this study was to evaluate the relationship between aspirin and clopidogrel responsiveness in healthy subjects. METHODS: Ninety-six healthy subjects were randomly assigned to receive a 1-week course of aspirin 100 mg day(-1) followed by a 1-week course of clopidogrel (300 mg on day 1, then 75 mg day(-1)), or the reverse sequence, separated by a 2-week wash-out period. The drug effects were assessed by means of serum TxB2 assay, platelet aggregation tests, and the PFA -100 and Ultegra RPFA -Verify Now methods. RESULTS: Only one subject had true aspirin resistance, defined as a serum TxB2 level > 80 pg microL(-1) at the end of aspirin administration and confirmed by platelet incubation with aspirin. PFA-100 values were normal in 29% of the subjects after aspirin intake, despite a drastic reduction in TxB2 production; these subjects were considered to have aspirin pseudo-resistance. Clopidogrel responsiveness was not related to aspirin pseudo-resistance. Selected polymorphisms of platelet receptor genes were not associated with either aspirin or clopidogrel responsiveness. CONCLUSIONS: In healthy subjects, true aspirin resistance is rare and aspirin pseudo-resistance is not related to clopidogrel responsiveness.     

Angiographic Correlates of Different Mechanical Effects During the Dipyridamole Echocardiography Test Shortly After Acute Myocardial Infarction

The aim of this study was to analyze the different mechanical patterns during the dipyridamole echocardiography test (DET) performed in 167 patients 8–10 days after a first myocardial infarction. The results were correlated with coronary angiography. In a first series of 98 patients retrospectively analyzed (group I), four different types of dipyridamole-induced wall-motion abnormalities were observed: (1) worsening of wall motion in the same region showing asynergy at rest (type I); (2) new wall-motion abnormality in a territory adjacent to the resting asynergies and fed by the same vessel (type II); (3) new wall-motion abnormality in a territory adjacent to the resting asynergies, but supplied by a vessel different from the infarct related artery (type III); and (4) new wall-motion abnormality not directly adjacent to the infarct zone (type IV). Type IV asynergies were found in one of 44 patients with single vessel disease and in 14 of 54 patients with multivessel disease (sensitivity 70.4%, specificity 92.3%). Type III asynergies developed in two patients with single vessel disease and in 24 of those with multivessel disease. The frequency and distribution of the four asynergy types were subsequently analyzed in a second prospective series of 69 patients (group II). Type III and IV asynergies were found almost exclusively in patients with multivessel disease (17/34 patients with multivessel disease and 2/35 with single vessel disease) (sensitivity 50%, specificity 94.3%). Combining type III and IV asynergies, an overall sensitivity of 62% and a specificity of 94% for predicting multivessel disease were obtained. The ability of DET to predict specific vessel obstruction was also investigated. A positive correlation was found only for the laterobasal segment (specificity 82% in predicting critical stenosis of the left circumflex artery [LCX]), and for the apical and distal septal segments (specificity 95% and 93% for lesions of the left anterior descending artery [LAD], respectively). A substantial overlap was noted when an attempt was made to distinguish LCX from right coronary artery (RCA) lesions. Nevertheless, new simultaneous wall-motion abnormalities of the posterobasal septal and laterobasal segments were observed in all but one patient with combined lesions of LCX and RCA (specificity 99%). In conclusion, the mechanical patterns of dipyridamole-induced new wall-motion abnormalities correlate with coronary angiography: new remote asynergies are highly specific in predicting multivessel disease, but are not frequent. New asynergies adjacent to the infarct zone can also predict multivessel disease, provided they are located in a different vascular region. The ability of DET to predict specific vessel obstructions was excellent for LAD lesions, but it was less helpful in differentiating LCX from RCA lesions. Nevertheless, new simultaneous wall-motion abnormalities of the posterobasal septal and laterobasal wall predict critical lesions of the LCX and RCA.     

Effect of Glucagon on Pure Human Exocrine Pancreatic Secretion

In this study the inhibitory effect of glucagon on pure exocrine pancreatic secretion obtained by direct drainage of the duct of Wirsung in man is demonstrated. In two experiments carried out during stimulation with secretin and CCK-PZ and in one experiment during secretin stimulation an inhibitory effect on pancreatic secretion was found. This effect was global, affecting both the total volume and the concentration and output of protein and the output of bicarbonate. The greater inhibition, however, occurred in the case of protein.