Mitochondrial alterations in children with chronic liver disease

Over recent years it has become apparent that the hepatocyte mitochondrion functions both as a cause and as a target of liver injury. Resultant dysfunction of mitochondria yields deficient oxidative phosphorylation, increased generation of reactive oxygen species, impairment of other metabolic pathways and activation of both necrotic and apoptotic pathways of cellular death. Methods: This study was conducted on 26 children and adolescents with chronic liver disease who presented to or were following up in the Pediatric Hepatology Clinic, Children's Hospital, Ain-Shams University. They were divided into three groups according to the aetiology of liver disease [GI= patients with Wilson's disease [WD], GII=patients with chronic hepatitis C, GIII=patients with chronic liver disease other than Wilson's and chronic hepatitis C].Ultrasound-guided gun liver biopsies were performed, under local anaesthesia for all the 26 patients, using a modified 18-gauge truecut needle. Two liver biopsy cores were taken from each patient. One for light and electron microscopic examinations and the other was immediately immersed in liquid nitrogen to be frozen and used for studying mitochondrial DNA deletions by PCR Liver steatosis was higher in the group of patients with Wilson's disease and other liver disease. Electron microscopic examination of the mitochondria revealed significant mitochondrial pleomorphism in patients with Wilson's disease and patients with chronic hepatitis C infection. Enlarged mitochondria were found to be more prevalent among patients with chronic hepatitis C infection. Three of our patients [11.53%] had mitochondrial DNA deletions. We developed scoring system for mitochondrial affection in our patients, 7 patients [32%] were considered to have mild mitochondrial affection, 9 patients [41%] had moderate mitochondrial affection, while 6 patients [27%] had severe mitochondrial affection. Four of the studied patients had no mitochondrial affection. Conclusion: Mitochondria affection is common in chronic liver disease. This mitochondrial affection might be responsible for some of the chronic liver disease manifestation such as easy fatiguability and steatosis

Percutaneous inferior vena cava filters 3 years experience

This is a retrospective study of 22 patients in whom a Titanium Greenfield Vena Cava filter was placed, between 1992 and 1994. Indications for placement were mainly for patients with deep venous thrombosis or pulmonary embolism with either anticoagulant failure or contraindication. Several technical difficulties and complications are described along with the suggestion about how best to avoid them. A comparison between this type of filter and the stainless steel model is described and showed the superiority of the titanium model. Mortality rate was 4.5% [1 case], and on long term follow up 1 case had recurrence of pulmonary embolism and no cases showed signs of venous stasis or vena cava occlusion. It was concluded that, the use of the titanium filter compares favorably with reports in the literature and is improving as experience is gained. Careful estimation of the cost benefits of using this device is needed as indication for it's use and confidence of the physician increases