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PURPOSE: This study aimed to investigate the correlation between the plasma level of N-terminal pro-B-type natriuretic peptide (pro-BNP) and several known risk factors influencing outcomes after Fontan operations, and to assess whether pro-BNP levels can be used as predictive risk factors in Fontan operations. METHODS: Plasma pro-BNP concentrations were measured in 35 patients with complex cardiac anomalies before catheterization. Cardiac catheterization was performed in all subjects. Mean right atrium pressure, mean pulmonary artery pressure (PAP), and ventricular end-diastolic pressure (EDP) were obtained. Cardiac output and pulmonary vascular resistance were calculated by Fick method. RESULTS: Plasma pro-BNP levels exhibited statistically significant positive correlations with mean PAP (r=0.70, P< 0.001), pulmonary vascular resistance (r=0.57, P< 0.001), RVEDP (r=0.63, P< 0.001), LVEDP (r=0.74, P< 0.001), and cardiothoracic ratio (r=0.71, P< 0.001). The area under the ROC curve using pro-BNP level to differentiate risk groups in Fontan operations was high: 0.868 (95 percent CI, 0.712-1.023, P< 0.01). The cutoff value of pro-BNP concentrations for the detection of risk groups in Fontan operations was determined to be 332.4 pg/mL (sensitivity 83.3 percent, specificity 82.7 percent). CONCLUSION: These data suggest that plasma pro-BNP levels may be used as a predictive risk factor in Fontan operations, and as a guide to determine the mode of therapy during follow-up after Fontan operations.
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BACKGROUND/AIMS: This study compared the therapeutic efficacy of endoscopic band ligation (EBL) with that of electrocoagulation for treating non-variceal, non-ulcer (NVNU) upper gastrointestinal (UGI) bleeding. METHODS: This study included 89 patients who underwent EBL and 56 patients in whom monopolar electrocoagulation was performed for NVNU UGI bleeding. The lesions treated were Mallory-Weiss tear in 91 patients, Dieulafoy's lesion in 42 patients and angiodysplasia in 12 patients. RESULTS: The initial hemostatic rate was 97% in the EBL group and 91% in the electrocoagulation group, but this was not statistically different. Rebleeding occurred in 5 of 89 patients (5.6%) in the EBL group and in 8 of 56 patients (14.3%) in the electrocoagulation group (p=0.07). Thrombocytopenia or prothrombin time prolongation was confirmed to be a significant risk factor for rebleeding. The rebleeding rate in the high risk group was significantly lower than in the EBL group (9% vs. 30%, respectively, p=0.03). The median procedure time was significantly shorter in the EBL group compared with that in the electrocoagulation group (median 5.6 minutes vs. 8.3 minutes, respectively, p=0.04). CONCLUSIONS: EBL and electrocoagulation are both effective for treating NVNU UGI bleeding, and EBL is especially safe and effective for the cases with a high risk for rebleeding.
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No abstract available.
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Non-alcoholic fatty liver disease (NAFLD), the most common liver disease, represents a spectrum of disease including steatohepatitis, fibrosis, and irreversible cirrhosis. Although a "benign" condition, NAFLD is a risk factor eventually leading to fibrosis and to non-alcoholic steatohepatitis (NASH). A number of evidences support an association between NAFLD/NASH and metabolic syndrome. The pathogenesis of NAFLD/NASH and metabolic syndrome seems to have common pathophysiological mechanisms, with focus on insulin resistance as a key factor. This review discusses the new aspects of NAFLD/NASH pathogenesis, and anticipate that such knowledge will eventually serve to the deveolpment of novel treatment strategies for this disease.
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