Neurophysiologic and psychometric changes in patients with liver cirrhosis

Because of its prognostic and socioeconomic relevance, interest has focused on SHE, which describes a poorly defined syndrome found in the grey zone between normality and manifest HE. the aim was to study the neurophysiologic and nero psychologic changes in chronic liver diseases to diagnoses subclinical heptic encephalopathy [SHE]. Sixty patients with chronic liver disease 30 had cirrhosis due to chronic HCV [group 1], and 30 patients had liver fibrosis due to Schistosomiasis [alone or with hepatitis] [group2]. and 20 healthy subjects as control [group 3], all were subjected to, clinical examination, assessment of liver function, routine tab., investigations, Abd, US. and EEG and psychometric assessment by [NCT] and symbol [SDT]. NCT abnormal score was found in 46.7% group2. ranging from 42.3% to 75% in Child-Pugh grade A, B respectively, however the control group had normal NCT score. Positive EEG changes were in [60%]and [50%] ranging from [47.05% to 76.92%] and from [46.15% to 75.0%], in group 1 and group 2 in Child-Pugh grade A and B, respectively, while in group 3 EEG was normal in [90%] and non specific changes found in[10%]. EEC changes and psychometric defects were detected in considerable percentage of cirrhotic patients and were related to the severity of liver cirrhosis, so psychometric tests and EEG may be suitable tools for diagnosis of SHE

comparative study of different procedures for the diagnosis of tuberculous ascites

To determine the diagnostic features of tuberculous peritonitis that distinguish it from other causes of ascites, 50 ascitic patients were examined prospectively. The biochemical, bacteriological and immunological properties of ascitic fluid from 11 patients with tuberculosis, 24 patients with hepatic cirrhosis and 15 patients with malignant ascites were compared. High values of adenosine deaminase activity [ADA] and gamma interferon [IFN - gamma] were detected in ascitic fluid of tuberculous patients. The sensitivity, tests of IFN. gamma ADA and PCR in the diagnosis of tuberculous ascites were 90.9%, 81.8%, and 36.3%, respectively while the specificity tests of all were 100%. A significant positive correlation was present between ADA activity and IFN - gamma level in ascitic fluid. The same correlation was detected between ADA activity and total protein concentration. However IFN - gamma was considered superior to ADA in diagnosis of tuberculous peritonitis in cases with decreased ascitic fluid total protein. Laparoscopic peritoneal biopsies in the seven tuberculous patients, revealed histopathologic granuloma and gave positive culture for T.B. It is concluded that, increased ascitic IFN - gamma and ADA arc useful, rapid non invasive screening tests in diagnosis of tuberculous peritonitis, whereas PCR has a limited utility. The best confirmation is by laparoscopic peritoneal biopsy followed by histopathologic and culture studies

study of serum tumor necrosis factor-alpha in patients with chronic viral hepatitis

Recent advances in molecular medicine have focused attention on cyto-kines in the machinery of inflammation and immune response. Tumor necrosis factor [TNF-alpha] is a cytokine produced primarily by activated mono-cytes and lymphocytes. that posses pleiotropic properties. TNF-alpha has been involved in the pathogenesis of diversity of liver diseases including viral hepatitis. The aim of this study was to investigate a group of patients with histologically documented chronic viral hepatitis for the level of serum TNF-alpha with particular attention to its correlation with disease activity. Thirty patients with biopsy-proven chronic Viral hepatitis and ten healthy controls were studied in this work. Cases included 25 males and 5 females with an age range of 23 to 67 years. Controls included 8 males and 2 females with an age range of 25 to 60 years. Cases were classified into three groups: Group I consisted of 6 cases with chronic hepatitis B, Group II 14 cases with chronic hepatitis C and Group III 10 cases with evidence of combined B and C viral infections. Results revealed that serum TNF alpha levels were significantly increased among patients with chronic viral hepatitis compared to controls. TNF alpha significantly correlated with the severity of the activity of viral infection as gauged by the histological activity index [HAI]. There was. however, no statistically significant difference between the three groups of cases and each other. It was concluded that TNF alpha is a better measure of disease activity than conventional bio chemical liver function tests. Moreover monitoring of TNF alpha along with ALT during treatment might provide more precise information of effectiveness of therapy