Complete esophageal obstruction following endoscopic variceal band ligation

Variceal hemorrhage is a potential complication of portal hypertension. Besides medical management, endoscopic variceal band ligation (EVBL) has emerged as a promising prophylactic tool proving to be superior to sclerotherapy. EBVL is a simple procedure associated with minor complications and short recovery time. In this report, we present a case of a rare complication of complete esophageal obstruction following an EVBL procedure. Given the high numbers of such procedures performed, it is imperative that internists and specialists be aware of this unusual complication

Obesity and right ventricular structure and function: the MESA-RV study

Introduction: The relationship between obesity and right ventricle (RV) has been inadequately studied due to difficulty in imaging its more complex geometry by echocardiography. While obesity associated RV diastolic dysfunction has been shown, inconclusive data exists regarding systolic function. We aimed to determine the association between obesity and RV structure and function by cardiac magnetic resonance imaging (MRI) in a large multi-ethnic cohort. Purpose: We hypothesized that obesity would be associated with greater RV mass, larger RV end-diastolic volume (EDV), and lower RV ejection fraction (EF). Methods: Cardiac MRIs were analyzed from 1973 participants in the Multi-Ethnic Study of Atherosclerosis, which included individuals aged 45-84 years without clinical cardiovascular disease. Participants were divided into 3 categories based on BMI: normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (= 30 kg/m2). Associations with RV measures were determined using multivariable regression. Results: The mean age was 62 ± 10 years, 47% were men. 43% were white, 28% African American, 20% Hispanic, and 9% Asian. In multivariable analyses adjusted for age, ethnicity, gender, cardiovascular risk factors and height, obesity was associated with higher RV mass, larger RVEDV (3.1 g/17% higher & 22.7 ml/20% higher respectively, p < 0.0001) and lower RVEF, mass/EDV ratio (-0.9%, p < 0.05; -8.1 mg/ml, p < 0.0001) as compared to normal BMI category participants. These findings persisted after adjusting for the respective left ventricle (LV) parameter. Within each BMI category, RV mass and EDV were positively associated with BMI while mass/EDV was negatively associated with BMI only in the normal BMI category Figures 1 and 2. Figure 1 Figure 2 Conclusion: In a cohort free of clinical cardiovascular disease, obesity was significantly associated with higher RV mass, RVEDV and lower RVEF even after adjustment for the LV. Future studies should examine the mechanism of this effect on the RV

Brachial Artery Diameter and the Right Ventricle : The Multi-Ethnic Study of Atherosclerosis-Right Ventricle Study

Background: Endothelial dysfunction is associated with left ventricular morphology and long-term cardiovascular outcomes. The purpose of this study was to assess the relationship between both baseline brachial artery diameter and peripheral endothelial function (assessed by brachial artery ultrasonography) and right ventricular (RV) mass, RV end-diastolic volume (RVEDV), and RV ejection fraction (RVEF). Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) performed cardiac MRI and brachial artery ultrasonography on participants without clinical cardiovascular disease. Baseline brachial artery diameter and flow-mediated dilation were assessed. Results: The mean age was 60.9 years, and 49.4% of subjects were men (n = 2,425). In adjusted models, larger brachial artery diameter was strongly associated with greater RV mass (β = 0.55 g, P < .001), larger RVEDV (β = 3.99 mL, P < .001), and decreased RVEF (β = −0.46%, P = .03). These relationships persisted after further adjustment for the respective left ventricular parameters. Flow-mediated dilation was not associated with RV mass or RVEF and was only weakly associated with RVEDV. Conclusions: Brachial artery diameter is associated with greater RV mass and RVEDV, as well as lower RVEF. Changes in the systemic arterial circulation may have pathophysiologic links to pulmonary vascular dysfunction or abnormalities in RV perfusion

Genetic Variation and Structure of the People of Uttarakhand, Central Himalayas, India

The Indian Himalayas, being semi-isolated geographically, provide ideal conditions for population genetics investigations. The main aim of this study is to genetically characterize and analyze the genetic structure of the people of Uttarakhand, a newly created North Indian hill state in the Central Himalayas, using original phenotype and allele-frequency data on a battery of seven red cell enzyme polymorphisms. For this analysis, blood samples were collected from 3,222 unrelated subjects belonging to various endogamous caste populations (Brahmin, Rajput, and Shilpkar) and tribal Bhotia inhabiting seven different districts in the Garhwal (northern) and Kumaon (southern) regions of Uttarakhand. Hemolysates were typed for isozymes of ESD, PGM1, ADA, AK1, GLO1, ACP1, and GPI using standard electrophoretic techniques. The genetic structure of these regional caste and tribal population groups was investigated with the help of different statistical measures. The present biochemical marker results show that the overall genetic constitution of the different populations of Uttarakhand is rather heterogeneous but similar to that of various caste and tribal populations of the neighboring hill state of Himachal Pradesh, situated on Uttarakhand’s western border. The extent of genic differentiation observed in different contemporary populations of Garhwal was twice as high as that of Kumaon. Interestingly, in genetic distance dendrograms of both the regions and of all of Uttarakhand, all the Shilpkar groups are differentiated from the remaining groups of Brahmin, Rajput, and Bhotia. The genetic constitution of the Shilpkar (a scheduled caste population of Uttarakhand) and to a lesser extent that of the Bhotia (a scheduled tribe population of Uttarakhand) are rather different from both the Brahmin and Rajput high-caste populations, which tend to show genetic similarities between them. These observations are corroborated by the known ethnohistory of different populations of Uttarakhand

Correlation between cytological and histopathological examination of the endometrium in abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is a common problem for which women seek gynecological consultation. Endometrial aspiration cytology (EAC) is an acceptable and valuable diagnostic procedure for screening the endometrial status. Aims: The purpose of our study was to describe the spectrum of endometrial lesions along with their cytomorphological features as well as to compare the results of EAC with histopathology of the endometrial curettings obtained as a result of dilatation and curettage (D and C), in order to assess the value of the former and its shortcomings. Materials and Methods: Endometrial aspiration using a menstrual regulation (MR) syringe and a 4 mm Karman′s cannula was performed just prior to D and C in 100 women presenting with AUB. Smears were reviewed for cytomorphological findings and were correlated with the histopathological findings. These findings were categorized as benign endometrium, endometrial hyperplasia, malignancy and inadequate smears. Results: Age of the patients ranged from 19 to 70 years. In our study, the accuracy in diagnosing benign conditions of endometrium, hyperplasia, and malignancy on aspiration cytology were 93.88%, 96.94% and 96.84%, respectively. Conclusions: Endometrial aspiration is an effective, useful and a minimally invasive procedure. With an experienced cytologist, it can be used routinely for the primary investigation of women with AUB, provided all the points of discrepancies are taken care of

Aortocavitary fistula as a complication of infective endocarditis and subsequent complete heart block in a patient with severe anemia

Infective endocarditis has different presentations depending on the involvement of valvular and perivalvular structures, and it is associated with high morbidity and mortality. Aortocavitary fistula is a rare complication. We introduce the case of a 48-year-old female with native valve endocarditis, complicated by aortocavitary fistula to the right atrium, and consequently presented with syncope