Predictive Value of Absent Septal q Wave in Patients with Significant Stenosis of Proximal Left Anterior Descending Coronary Artery

Aims: There is conflicting data about the predictive value of absent septal q wave in patients with significant stenosis of proximal Left Anterior Descending coronary artery. To clarify the exact role of this simple electrocardiographic sign we conducted this prospective descriptive study. Methods: Patients who were referred for coronary angiography in Milad Hospital between December 2008 and September 2009 were chosen randomly. Standard ECG was performed and reviewed for presence or absence of septal q wave, and then the coronary angiography was done and reported by another cardiologist. Results: Of 148 patients with absent septal q wave in ECG, 85 patients (57%) had significant stenosis of proximal LAD in coronary angiography. Statistical analysis showed that significant stenosis of proximal LAD could be predicted by absence of septal q wave in ECG with sensitivity of 59% and specificity of 47%. However, Kappa statistic (Kappa = 0.36) showed low agreement between them. Conclusion: Absence of normal septal q wave in ECG could be a low value predictor of coronary artery disease mainly significant proximal LAD stenosis

characteristic Findings of primary sclerosing cholangitis on endoscopic Retrograde cholangiography: Which is the Most common Finding?

Abstract Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease and one of the most common indications for cholangiography (ERCP). We undertook this study to clarify whether there is a specific pattern of involvement of the biliary tract in patients with PSC and to evaluate features of PSC disease on ERCP in order to be able to manage this disease better. Methods: This retrospective study included 45 patients admitted to Taleghani Hospital in 2004–2010 and diagnosed to have PSC on the basis of typical cholangiographic findings in combination with clinical and laboratory data. Patients suspected to have secondary sclerosing cholangitis were excluded. Demographic and clinical data were recorded, along with cholangiographic findings and the frequency of large duct and small duct PSC. Results: Forty-five patients of mean age 34.8 (range 15–66) years were included. Twenty-nine patients (64.4%) had inflammatory bowel disease, and the frequency of large duct PSC and small duct PSC was 93.4% and 6.6%, respectively. The intrahepatic ducts alone were involved in 11 (24.4%) patients and the extrahepatic ducts were involved in 14 (31.1%), with 17 (37.7%) patients having both intrahepatic and extrahepatic PSC. Three (6.6%) patients did not have bile duct involvement on ERCP, and their disease was diagnosed by liver biopsy as small duct PSC. The most common type of cholangiographic feature of intrahepatic duct involvement was type 2, found in 15 (33.3%) patients, with type 3 being the most common type of extrahepatic duct involvement and detected in 16 (35.5%) patients. Conclusion: Our study demonstrates that the most common PSC finding on ERCP is involvement of both the extrahepatic and intrahepatic bile ducts, with small duct PSC being less common than large duct PSC

Article Commentary: Predictive Value of Absent Septal q Wave in Patients with Significant Stenosis of Proximal Left Anterior Descending Coronary Artery

Aims There is conflicting data about the predictive value of absent septal q wave in patients with significant stenosis of proximal Left Anterior Descending coronary artery. To clarify the exact role of this simple electrocardiographic sign we conducted this prospective descriptive study. Methods Patients who were referred for coronary angiography in Milad Hospital between December 2008 and September 2009 were chosen randomly. Standard ECG was performed and reviewed for presence or absence of septal q wave, and then the coronary angiography was done and reported by another cardiologist. Results Of 148 patients with absent septal q wave in ECG, 85 patients (57%) had significant stenosis of proximal LAD in coronary angiography. Statistical analysis showed that significant stenosis of proximal LAD could be predicted by absence of septal q wave in ECG with sensitivity of 59% and specificity of 47%. However, Kappa statistic (Kappa = 0.36) showed low agreement between them. Conclusion Absence of normal septal q wave in ECG could be a low value predictor of coronary artery disease mainly significant proximal LAD stenosis

Cholangiographic Features in Opium-Addicted Patients at a Tertiary Hospital in Iran

Background/Aims. Destructive and metabolic changes in hepatobiliary system have been demonstrated following opium use; however, cholangiographic features of bile ducts in opium-addicted patients with sphincter of Oddi dysfunction are not clearly determined. We described these differences and assessed the effects of opium use on postendoscopic retrograde cholangiopancreatography complications. Methodology. One hundred and nineteen patients with the diagnosis of sphinctre of Oddi dysfunction according to the Geenen-Hogan classification were studied. Eight patients were confirmed opium-addicted and others were nonaddicted. Change of serum amylase concentrations after endoscopic retrograde cholangiopancreatography and clinical diagnosis of addicted and non-addicted patients were compared. Results. Serum concentrations of liver aminotransferases and alkaline phosphatase were similar between the two groups. Serum concentration of amylase before endoscopic retrograde cholangiopancreatography was similar between them, whereas concentration of this enzyme was higher in nonaddicted ones after endoscopic retrograde cholangiopancreatography. Regarding pathologic changes in papilla, opium addiction group in comparison with control group statistically showed more tumoral features (25.0% versus 5.4%) and ulcerated changes (12.5% versus 0.0%). Conclusions. Opium use can increase probability of papilla ulcerative and tumoral changes in patients with sphinctre of Oddi dysfunction. Postendoscopic retrograde cholangiopancreatography serum amylase level may be reduced following opium addiction

Gastrointestinal Lesions in African American Patients With Iron Deficiency Anemia

Background: Iron deficiency anemia (IDA) is a frequent disorder that is associated with many serious diseases. However, the findings of an evaluation of IDA-associated gastrointestinal disorders are lacking among African American patients. Aim: To determine the most prevalent gastrointestinal lesions among African American patients with IDA especially in young men. Methods: We reviewed medical records (n = 422) of patients referred for evaluation of IDA from 2008 to 2012. Iron deficiency anemia was diagnosed using clinical laboratory tests. The results of esophagogastroduodenoscopy , colonoscopy, and pathology specimens along with demographic data were abstracted and analyzed using Stata. Results: The mean age was 61.9 years, and 50.5% were women. In total, 189 patients (45%) had gross gastrointestinal (GI) bleeding. The most frequent diagnoses were gastritis (40%), benign colonic lesions (13%), esophagitis (9%), gastric ulcer (6%), and duodenitis (6%). GI bleeding was significantly more frequent in men ( P  = 0.001). Benign and malignant colonic lesions were significantly more present among older patients: 16% vs 6% ( P  = .005) and 5% vs 0% ( P  = .008), respectively. Colitis was more prevalent in younger patients (⩽50): 11% vs 2% ( P  = .001). In patients with gross lower GI bleeding, the top diagnoses were gastritis (25%), benign colon tumors (10%), and duodenitis (6%). Colon cancer was diagnosed among 15 patients, and all these patients were older than 50 years of age. Conclusions: Gastritis and colonic lesions are most common associated lesions with IDA among African Americans. So bidirectional endoscopy is required for unrevealing of the cause of IDA in asymptomatic patients

Preventive Role of Wire-Guided Cannulation to Reduce Hyperamylasemia and Pancreatitis Following Endoscopic Retrograde Cholangiopancreatography

Background and Study Aims. The usefulness of wire-guided cannulation for avoiding hyperamylasemia and pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) is conflicting, and therefore we designed this study to determine whether wire-guided cannulation reduces the rate of post-ERCP hyperamylasemia and pancreatitis and compare its efficacy to conventional method. Patients and Methods. Seven hundred and forty-eight patients with hepatobiliary diseases consecutively underwent diagnostic or therapeutic ERCP at the unit of Taleghani referral hospital in Tehran. Among them, 546 patients were eligible for wire-guided cannulation and underwent this procedure and others underwent sphincterotome biliary cannulation using contrast injection as the conventional method. Results. Patients in the two groups were comparable in terms of gender and age. Successful biliary cannulation was achieved similary in the guidewire and conventional group (89.2% versus 86.4%) that in 5.4% and 14.1% of them it was difficultly performed, respectively (P=0.003). The main pancreatic duct was more visualized in 99.0% of patients in conventional group in comparison with 79.0% in another group (P<0.001). Multivariate regression analysis showed that wire-guided cannulation had a protective role for post-ERCP hyperamylasemia (OR: 0.336, 95% CI: 0.181–0.623, P<0.001). However, there were no significant differences between the two groups in rates of other procedure-related complications, such as, pancreatitis, bleeding, and perforation. Conclusion. The use of guidewire cannulation in comparison with conventional method can be accompanied with lower post-ERCP hyperamylasemia, and therefore selection of this cannulation technique especially in high-risk group is recommended