Comparative prospective study of various endoscopic treatments for different grades of escophageal variceal bleeding in Upper Egypt

This study was performed on 120 patients presented with liver cirrhosis and active variceal bleeding in the form of hematemesis or melena or both in Assiut University Hospital. They were 79 male and 41 female aging from 25-70 years. All patients were chosen to be Child-Pugh class B. All patients included in this study were subjected to upper gastrointestinal endoscopy, and one of the following was done to the bleeding esophageal varices: Sclerotherapy with Ethanolamine [Group A,], Sclerotherapy with Histoacryl [Group B], Band ligation, [Group C] and combined scleroligation [Group D] and the varices are classified according to Westaby classification 1982 into grade I, II, III and IV We also follow up endoscopy until obliteration of varices was achieved. The present study was undertaken to compare the different endosco-pic techniques used in active esophageal variceal bleeding, and its efficacy in controlling bleeding from the varices, the rate of rebleeding, the number of sessions done to obliterate the varices, and the complication in the form of esophageal ulceration. From this study, it was suggested that the choice of endoscopic technique used Jar management of bleeding esophageal varices depends on the grade of varices as follow: In Grade II esophageal varices with active bleeding, there was no method of choice, but it is better to start with Ethanolamine injection for control of bleeding ['because it is available easy and cheap technique]. If failed so Histoacryl injection should better second choice. In Grades III and IV esophageal varices with active bleeding, it is better to start with band ligation for the control of bleeding, it ii the method of choice, as i has better control, of bleeding, the least number of sessions, the least rebleeding rate, with no complications and the easiest method of treatment. We also found histoactyl injection although it is the best method of controlling bleeding, it is better to use it only f the other methods are not effective, as it is a very expensive method and used only in the first session or in rebleeding It is hazardous in small varices if not cautiously administered and we also found that scleroligation did not add any benefit over band ligation but more adverse effects and complications were noticed. In conclusion, band ligation was the method of choice for esophageal variceal obliteration among all the other endoscopic techniques as regard all the variables collectively, also we could decrease the cost of band ligation to a minimum degree

Evaluation of the congestion index and other portal vein haemodynamic parameters in portal hypertensive gastropathy

This study was conducted aiming to evaluate the congestion index and other portal vein hemodynamic parameters using Echo-Doppler in portal hypertensive gastropathy patients. 40 patients with liver cirrhosis [20 with esophageal varices and 20 with portal hypertensive gastropathies, 12 mile and 8 severe] in addition to 20 healthy persons as a control subjected to Echo-Doppler study using Hitachi 415 with pulsed transducer 3.5 Mhz. The findings showed that here was a significant increase in the congestion index of the portal vein in cases of portal hypertensive gastropathy than in cases with esophageal varices only. Also, there was a significnat increase in the congestion index in severe gastropathy than mild gastropathy. So, it can be concluded that the congestion index paralleled the severity of portal hypertensive gastropathy and can be used as a simple and safe parameter in following up these patients and to assess the efficacy of therapy

Endothelin-1 plasma level in hepatocellular carcinoma: correlation with alpha-fetoprotein and plasma nitric oxide

There are recent studied that have identified increased level of endothelin-1 in hepatocellular carcinoma [HCC]. One of them implies that the high plasma level of endothelin-1 is pathognomonic of HCC. In the present study, the plasma endothelin-1 level were estimated by radioimmunoassay in 24 HCC patients as well as 42 liver cirrhosis patients comparing both of them with the levels in 20 healthy controls. The results of this study showed a significant increase in the endothelin-1 level in HCC than in liver cirrhosis with no significant correlation with alpha-fetoprotein. At the same time, the positive correlation between plasma level of endothelin-1 and nitric oxide seen in liver cirrhosis was not found in HCC. Also, this study showed increased plasma endothelin-1 level when alpha fetoprotein was not diagnostic in HCC cases. So, it can be concluded that measurement of plasm endothelin-1 level may be useful as tumor marker especially in cases of HCC with normal alpha-fetoprotein

Gastric emptying and anthroduodenal motility study of patients with functional ulcer like dyspepsia: correlation with histopathological findings and helicobacter pylori

13 patients complaining of functional ulcer like dyspepsia and 8 volunteers healthy persons with comparable age and sex were studied for gastric emptying tests by B-mode sonography and antroduodenal study by colored duplex. Gastro duodenoscopy was done for each patient, biopsies were taken from antrum and corpus. The results showed that there is a correlation between delayed gastric emptying and severity of symptoms. Histopathological examination of biopsies sowed chronic gastritis in all cases and H. pylori infection in 92.3%. So, it is concluded that H. pylori may play a role in the pathogenesis of functional ulcer like dyspepsia

approach to the role of nitric oxide in hyperdynamic circulation in liver cirrhosis

Circulatory abnormalities arising in cirrhosis increased cardiac output and, possibly, heart rate coupled with reduced systemic vascular resistance, and possibly arterial pressure could result from peripheral vasodilatation. The locally acting vasodilator nitric oxide has recently been implicated as a possible mediator in the vasodilatation observed in cirrhosis. To investigate this hypothesis, total of 51 patients with liver cirrhosis were recruited in the present investigation, 14 had hyperdynamic circulation [HDC] and 37 had no manifestations of HDC the study also included 20 completely healthy controls. In each participant, serum and urinary nitric oxide [NO], urinary cyclic guanosine monophosphate [cGMP] excretions, serum endotoxin and C-reactive protein were determined. The study revealed significantly increased levels of serum NO, endotoxin and C-reactive protein as well as urinary excretions of NO and cGMP in patients with cirrhosis compared with controls. Patients with HDC had significant increase of all bioindices expcept C-reactive protein. Significant positive correlation existed between urinary CGMP, urinary NO, serum NO, endotoxin C-reactive protein. These findings would indicate that bacterial endotoxin rather than cytokines induce NO synthase expression in vessel walls with sustained NO release. The released NO through activation of guanylate cyclase, leads to increased intracellular cGMP concentrations and induces vasodilatation and hypotension. Inhibition of NO synthesis in these patients could be achieved by reduction of endotoxaemia through sterilization of the intestine. This would result in restoration of sensitivity to vasoconstrictors and reverse the haemodynamic abnormalities in liver cirrhosis

Clinical and radiological studies in rheumatoid arthritis and its seronegative variants and their relation to HLA antigens

One hundred patients with rheumatoid arthritis [RA] or its variants and 100 age and sex matched controls were typed for HLA antigens, HLA-DR4 was found significantly more frequent in RA patients as a whole, 55% compared to 2% for controls. DR4 positive patients exhibited the more severe and aggressive form of the disease evidenced by a longer duration of stiffness, early appearance of radiological changes and severe bony destruction and higher articular index compared to those with other antigens. HLA-DR2 and DR7 were found to be negatively correlated with RA patients as they were detected in lower frequency in RA pts. Compared to controls especially in those with peripheral joint involvement i.e. they are protective antigens. A positive family history of rheumatoid disease was detected in 80% of DR4 the + ve oners. HLA-DR3 was found at a higher frequency among patients with nodules and correlated with high titres of rheumatoid factor, higher C-reactive protein levels and positive antinuclear factor. In seronegative RA groups HLP-DR5 was significantly higher compared to controls while HLA-DR4 was more significantly more frequent in seropositive juvenile arthritis compared to controls HLA-B27 were more frequent in those with ankylosing spondylitis than the controls. The other antigens of A,B and C loci showed no significant correlations

Liver affection in lichen planus

58 lichen planus patients with hepatomegaly of unapparent cause subjected to thorough clinical examination, ultrasound screening, liver function tests hepatitis B markers, antinuclear and antimitochondria antibodies were studied. Ultrasound examination showed a fine hyperechoic parenchyma. Abnormal liver function tests in 50% of cases studied in the form of a significant increase in total and direct serum bilirubin, alkaline phosphatase, aspartate transminase and alanine transaminase compared to controls. Hepatitis B markers were positive in 17 patients out of 58 cases studied [29.3%]. Antinuclear antibody was positive in 3 patients [5.1%] while the antimitochondrial antibody was negative in all studied cases. From these data we can say that in our patients with lichen planus, liver affection can be present in the from of hepatitis [viral B or auto immune] in 34.4% of cases studied and not in the form of primary biliary cirrhosis

Some platelet disorders in chronic idiopathic thrombocytopenic purpura and chronic myloid leukaemia

Thirty in-patients in the Department of General Medicine of Assiut University Hospital with thrombocytopenia were studied before treatment, twenty patients with chronic idiopathic thrombocytopenic purpura and ten patients with chronic leukemia [nine had chronic myeloid leukemia and one with lymphocytic leukemia]. The study also included ten normal individuals served as controls. Careful history and clinical examination were carried out for every patient and normal individual complete blood picture, bleeding time, clot retraction, prothrombin time, kaolin cephalin clotting time, platelet volume study including mean platelet volume and platelet volume distribution and platelet factor-3 availability were done. Statistical analysis of the results showed that patients with chronic idiopathic thrombocytopenic purpura had significantly prolonged bleeding time and reduced clot retraction, but there was no significant difference in prothrombin and kaolin cephalin clotting times between patients and normal individuals. They also had significantly increased mean platelet volume which varied inversely in linear pattern with platelet count. This linear inverse relation in chronic idiopathic thrombocytopenic purpura was the same in the control group. There was significantly increased mean percentage of microplatelets [3-6 FL] and large platelets [13 FL]. Also, 60% of patients with chronic idiopathic thrombocytopenic purpura had diminished platelet factor-3 availability. This analysis showed that patients with chronic leukemia had significant prolongation in bleeding time and reduction in clot retraction. They also had significant prolongation in prothrombin time and platelet volume study. Patients with chronic myeloid leukemia revealed significant increase in the mean platelet volume and in the mean percentage of large platelets [13 FL]. There was also a linear inverse relation between the mean platelet volume and platelet count. Platelet factor-3 availability was diminished in 70% of patients