Study of the correlation between; nitric oxide profile, degree of liver injury and structural vascular changes of the gastric mucosa in chronic hepatitis C virus related liver diseases

Nitric oxide [NO] plays an important role in HCV associated hepatic dysfunction and in the pathogenesis of portal hypertension. This study was designed to correlate serum nitrite and nitrate levels with the degree of liver injury and gastric mucosal changes in HCV patients at different stages of the disease. 80 HCV infected patients were classified equally into 4 groups; chronic hepatitis C, Child A, B and C cirrhosis groups. 20 healthy subjects were allocated as a control group. For all patients, serum nitrite and nitrate levels, HCV RNA and liver test profile were evaluated. Liver biopsies for chronic hepatitis C and Child-A cirrhotic patients were obtained for grading, staging and expression of interferon gamma [INF- gamma] and pentosidine. Esophagogastrodudenoscopy to evaluate the degree of portal hypertensive gastropathy [PHG] and expression of vascular endothelial growth [VEGF] by histopathology. Serum NO profile was significantly higher in all HCV infected patients than healthy subjects. A significant correlation between IFN-gamma expression and both of serum NO and viral load. Also, hepatic pentosidine expression was correlating with staging and fibrosis. Also both of serum NO and gastric VEGF were over expressed and correlating with the degree of PHG. In HCV infected patients, serum NO was significantly overexpressed and correlating with the severity of chronic liver disease. Our study supports the role of direct viral cytopathic effect in HCV patients because of the significant correlation of viral load with both of serum NO and hepatic IFN-gamma expression. Pentosidine might be considered a marker of oxidative stress and fibrosis in chronic HCV liver disease

Radiofrequency thermal ablation versus trans-catheter hepatic arterial chemo embolization for hepatocellular carcinoma: follow up with and without giving mistletoe [fraxini 2]

Hepatocellular carcinoma [HCC] represents a major health problem world wide. It accounts for 90% of all primary liver cancers and is the fifth most common malignancy [1]. Evaluation of radiofrequency thermal ablation versus transarterial hepatic chemoembolization with the effect of Viscum [Fraxini 2] on tumour recurrence. 60 patients with HCC were enrolled in the study. Group 1 include 30 patients and were treated with radiofrequency thermal ablation [15 patients of them received viscum 2 by subcutaneous route for 2 years]. Group 11 included 30 patients with HCC and were treated by TACE [15 patients of them received viscum 2 subcutaneously for 2 years]. Group 1 patients showed total ablation in 70% with persistant inactivity during 2 years follow up. Group II did not show significant difference from Group 1 as regards relapse rate nor the performance status. Complications as nausea, vomiting, fever, jaundice, and elevation of transaminases were significantly more encountered with TA CE. Viscum 2 did not significantly arrest tumour recurrence. Non surgical patients with HCC can achieve curative treatment with radiofrequency with minimal side effects. TACE is a palliative treatment option for large HCC

Changes in portal hypertensive gastropathy after endoscopic variceal band ligation and correlation with serum nitric oxide level

We studied 20 patients with Liver Cirrhosis and Portal Hypertension. The aim of the work was to access the impact of endoscopic variceal band ligation on changes in portal hypertensive gastropathy, and to correlate changes with changes in nitric oxide level. Significant improvement in the mucosal wall thickness, number of vessels, total vascular area despite non significant variation in nitric oxide level