ACCURACY OF SERUM – ASCITES ALBUMIN GRADIENT IN THE AETIOLOGICAL DIAGNOSIS OF ASCITES

50 adults with ascites admitted to our hospital were studied. Simultaneous samples of ascitic fluid and blood were collected and subjected to analysis including ascitic fluid total protein and serum ascites albumin gradient The cut off value of serum-ascites albumin gradient for differentiating between high and low gradient was taken as 1.1 gm % and of ascitic fluid protein for differentiating exudate and transudate as 2.5 gm%. The sensitivity, specificity, positive predictive value and negative predictive value of high gradient and transudative ascites in diagnosing portal hypertension were 943%, 60%, 84.6%, 81.8% and 62.9%, 133%, 91.7% and 50% respectively. High gradient ascites is a sensitive test in the diagnosis of portal hypertension as a cause of ascites. The exudate-transudate approach has severe limitations in the differential diagnosis of ascites.KEY WORDS: Albumin Gradient, Ascites, High Gradient Ascites, Serum-Ascites     

Comparison of Right– and Left–Sided Pectoral Implantation Parameters with the Jewel Active Can Cardiodefibrillator

A total of 1,207 patients received a Medtronic jewel active, can ICD (models 721BC, 7219C), with a Transvene had in 97 centers in Europe and North America. Nineteen implants were from the right pectoral region. Patients with right–sided ICDs did not differ in terms of mean age. % male, left ventricular ejection fraction, New York Heart Association Functional Class, antiar–rhythmic drug therapy, indication for the implantable cardioverter defihrillator, and R wave values at implantation, but tended to have slightly higher pacing thresholds (1.2 ± 0.5 V vs 1.0 ± 0.6 V, P = 0.012) and higher defibrillation thresholds (14.7 ± 6.4 J vs 11.5 ± 6 J, P = 0.11) compared with patients with left sided implants. Patients with right–sided implants had a longer implantation time compared with patients with left–sided implants (118 ± 70 minutes vs 91 ± 46 minutes, P = 0.074). In follow–up, 5 patients with right–sided implantation received successful therapy for either ventricular fibrillation, (8 episodes) or ventricular tachycardia (5 episodes). No ineffective therapy from the device was delivered in any patients with right–sided implantation. Right–sided pectoral implants are feasible with the Medtronic Jewel active can ICD.