Comparison of hepatic venous pressure gradient and endoscopic grading of esophageal varices

AIM: To determine the correlation between the hepatic venous pressure gradient and the endoscopic grade of esophageal varices.METHODS: From September 2009 to March 2013, a total of 176 measurements of hepatic venous pressure gradient(HVPG) were done in 146 patients. Each transjugular HVPG was measured twice, first using an end whole catheter(EH-HVPG), and then using a balloon catheter(B-HVPG). The HVPG was compared with the endoscopic grade of esophageal varices(according to the general rules for recording endoscopic findings of esophagogastric varices), which was recorded within a month of the measurement of HVPG.RESULTS: The study included 110 men and 36 women, with a mean age of 56.1 years(range, 43-76 years). The technical success rate of the pressure measurements was 100% and there were no complication related to the procedures. Mean HVPG was 15.3 mm Hg as measured using the end hole catheter method and 16.5 mm Hg as measured using the balloon catheter method. Mean HVPG(both EHHVPG and B-HVPG) was not significantly different among patients with different characteristics, including sex and comorbid factors, except for cases with hepatocellular carcinoma(B-HVPG, P = 0.01; EH-HVPG, P = 0.02). Portal hypertension(> 12 mm Hg HVPG) occurred in 66% of patients according to EH-HVPG and 83% of patients according to B-HVGP, and significantly correlated with Child's status(B-HVPG, P < 0.000; EHHVGP, P < 0.000) and esophageal varies observed upon endoscopy(EH-HVGP, P = 0.003; B-HVGP, P = 0.006). One hundred and thirty-five endoscopies were performed, of which 15 showed normal findings, 27 showed grade 1 endoscopic esophageal varices, 49 showed grade 2 varices, and 44 showed grade 3 varices. When comparing endoscopic esophageal variceal grades and HVPG using univariate analysis, the P value was 0.004 for EH-HVPG and 0.002 for B-HVPG. CONCLUSION: Both EH-HVPG and B-HVPG showed a positive correlation with the endoscopic grade of esophageal varices, with B-HVPG showing a stronger correlation than EH-HVPG.

Effects of oxygen concentration and flow rate on cognitive ability and physiological responses in the elderly

The supply of highly concentrated oxygen positively affects cognitive processing in normal young adults. However, there have been few reports on changes in cognitive ability in elderly subjects following highly concentrated oxygen administration. This study investigated changes in cognitive ability, blood oxygen saturation （%）, and heart rate （beats/min） in normal elderly subjects at three different levels of oxygen [21% （1 L/min）, 93% （1 L/min）, and 93% （5 L/min）] administered during a 1-back task. Eight elderly male （75.3 ＋ 4.3 years old） and 10 female （71.1 ＋ 3.9 years old） subjects, who were normal in cognitive ability as shown by a score of more than 24 points in the Mini-Mental State Examination-Korea, participated in the experiment. The experiment consisted of an adaptation phase after the start of oxygen administration （3 minutes）, a control phase to obtain stable baseline measurements of heart rate and blood oxygen saturation before the task （2 minutes） and a task phase during which the 1-back task was performed （2 minutes）. Three levels of oxygen were administered throughout the three phases （7 minutes）. Blood oxygen saturation and heart rate were measured during each phase. Our results show that blood oxygen saturation increased, heart rate decreased, and response time in the 1-back task decreased as the concentration and amount of administered oxygen increased. This shows that administration of sufficient oxygen for optimal cognitive functioning increases blood oxygen saturation and decreases heart rate.