role of duplex doppler ultrasonography in the diagnosis of renal dysfunction and hepatorenal syndrome in patients with liver cirrhosis

Hepatorenal syndrome is the development of renal dysfunction in patients with severe liver disease in the absence of identifiable causes of renal pathology. At least 40% of patients with cirrhosis and ascites will develop hepatorenal syndrome during the course of their disease. The aim of this study was to evaluate the value of renal resistive index [RI] measured by duplex Doppler ultrasonography in detecting early impairment of renal function in patients with liver cirrhosis and also its possible role in detecting patients with a high risk of developing hepatorenal syndrome. The study included 110 patients divided into four groups: group I [30 patients with liver cirrhosis and normal renal function], group II [30 patients with cirrhosis and renal impairment but without hepatorenal syndrome], group III [30 patients with cirrhosis and hepatorenal syndrome] and group IV [20 healthy persons] as control group. All enrolled patients were subjected to full clinical examination, liver and renal function tests, abdominal ultrasonography, and renal duplex Doppler to measure RI. The study revealed that the values of RI were higher among cirrhotic patients without hepatorenal syndrome compared to control ones [0.65+0.002 Vs 0.59+0.002, P<0.001] and also were significantly higher in those with ascites compared to cirrhotic patients without ascites [0.67+0.01 Vs 0.63+0.07, P<0.001]. RI was found to be significantly higher in patients with hepatorenal syndrome [HRS] compared to both cirrhotic patients without HRS and controls [0.74+0.001 Vs 0.655+0.002 and 0.59+0.002 respectively, p<0.001]. All patients in group III had RI 0.70 or more. Three out of 22 patients [13.63%] with ascites in group I had RI 0.70 or more. Also RI 0.70 or more was found in 8 out of 30 patients [26.66%] of group II. We conclude that the increase of RI is closely related to the severity of cirrhosis. RI is a non-invasive means to monitor early renal haemodynamic alteration in cirrhotic patients and a value equal to or more than 0.78 could suggest HRS if other causes that produce renal vasoconstriction are excluded. Also cirrhotic patients with RI equal to or more than 0.70 but without HRS are considered at higher risk for the development of HRS

Estimation of cyclo-oxygenase-II protein in oesophageal mucosa in cases of gastro-oesophageal reflux disease, compared with normal oesophageal mucosa

Cyclo-oxygenase II [COX II] is an inducible enzyme. Its expression is increased during states of inflammation or carcinogenesis. THE AIM of this study was to demonstrate the expression of COX-Il protein in cases of reflux oesophagitis and compare it with normal oesophageal mucosa, Thirty two patients with GORD, and ten controls had an upper gastrointestinal endosopy. Mucosal biopsies were taken from lower oesophagus, and examined histologically for evidence and grading of GORD. COX II expression was evaluated using immunohistochemical staining of the mucosal biopsies. The results Showed a highly significant statistical difference between patients and control subjects in both endoscopic and histopathological findings [P < 0.01], and there was a positive correlation between both procedures [P < 0.001]. There was also highly significant statistical difference between patients and controls as regards all parameters of COX-II expression [P < 0.01]. COX II excpression was positively correlated with the degree of oesophagitis according to the degree of histopathological inflammation [P < 0.001] History of smoking was also associated with higher expression of COX II in all subjects examined [P < 0.01].The of this study showed that there is increased expression of COX II enzyme protein in oesophageal mucosa in cases of oesophagitis and that this might suggest the possibility of a causal relation. It also showed the increased expression in smokers, whether this proves to be of significance still awaits further studies

Human giardiasis as an etiology of skin allergy: the role of adhesion molecules and interleukin - 6

In this work, the role of adhesion molecules [intercellular adhesion molecule-1 [ICAM-1] and vascular cell adhesion molecule-1 [VCAM-1]] as mediators in the development of skin allergy caused by giardiasis and the controlling role of cytokine interleukin [IL]-6 on these adhesion molecules were studied. The work included 25 symptomatic giardiasis patients with skin allergy manifested by diffuse urticaria, pruritis, wheal and erythema as well as had positive serum anti-giardia immunoglobulin [Ig] E measured as the mean optical density [OD] value by enzyme linked immunosorbent assay [ELISA], employed as an evidence of allergic sensitization [G I]. Those patients were compared with 30 symptomatic giardiasis patients [G II] and 20 apparently healthy control subjects [G III]. Both latter groups had negative serum anti- giardia IgE. The mean OD value of anti-giardia IgE was significantly increased in G I and insignificantly different in G II compared with G III. The serum levels of the soluble forms of adhesion molecules [sICAM-1 and sVCAM-1] and IL-6 were determined by ELISA. SICAM-1 and sVCAM-1 serum levels were significantly increased in G I compared with G III, showing an insignificant difference between Gs II and III. Serum IL-6 significantly increased in G I and G II compared with G III as well as and was significantly higher in G I than G II. Serum IL-6 was correlated positively with serum sICAM-1 and sVCAM-1 in G I

Evaluation of the efficacy of different types of vitamin-D therapy in infantile rickets

Twenty seven infants [18 males and 9 females] whose ages ranged between 6 months and 2 years, showing clinical manifestation of rickets formed the material of this study. They had been cases coming to the out patient clinic of Cairo University Children's Hospital through January to June, 1988. All the cases were subjected to thorough history taking and examination. They were selected so that none of the patients had vomiting or diarrhea or showed any manifestation of protein energy malnutrition. They were free of hepatic and renal diseases, and none of them had been receiving rachitogenic drugs as anticonvulsants, nor had any of them been receiving any treatment for the rickets they had been demonstrating. For investigations they had their serum calcium, phosphorus and alkaline phosphatase level estimated, as well as X-ray wrists done before treatment and 15 days after. Cases were divided into 3 groups, the first group received D-Ca-B12 injection and the second group received one stoss therapy of vitamin D3 [Devarol] injection and the third one received oral active form of vitamin D [one alpha hydroxy D3]. The best results were obtained from the third group followed by the first group

Serum T3 and T4 levels at birth in infants 30-40 weeks gestation

This study included thirty healthy newborn infants whose estimated gestational ages ranged from 30-44 weeks. They were classified into 3 groups: [1] 10 pre-term infants with gestational ages ranging from 30-36 weeks and body weights 1800-2450 gms, [2] 10 full term infants with gestational ages ranging from 38-40 weeks and body weights 2750-3200 gms and [3] Post-term infants with gestational ages ranging from 42-44 weeks and body weights 3000-4000 gms. The mean cord serum T3 values in the three groups were 39.9 +/- 11.15 ng%, 44.9 +/- 13.788 ng% and 66 +/- 3.528 ng% respectively. There was a statistical significant difference between group 1 and 3, group 2 and 3 while there was no significance between group 1 and 2 demonstrating increases of T3 values with increasing both gestational age and body weight. The mean cord serum T4 values in the 3 groups were 10.51 ug%. 10.19 ug% and 9.3 ug% respectively. The difference was statistically insignificant between the three groups. In evaluating T3 and T4 results in a population of low birth weight infants, normative data from full term babies can not be used as screening programs for congenital hypothyroidism. The high percentage of false positives found in premature infants might be decreased by the use of normal values adjusted according to gestational age

Serum cholesterol and phospholipids levels in normal mothers and their newborns

Total lipids, total cholesterol and phospholipids have been determined in paired maternal and foetal sera at parturition in 33 egyptian women who have had uncomplicated pregnancies and normal full term deliveries. Statistically significant lower levels of lipids in foetal as compared to maternal sera were found. The factors that affect the foetal lipid levels, and their correlation with sex and birth weight have been discussed

Importance of chest x-rays in thalassemia major

Chest radiographs of 39 patients with thalassemia major were reviewed. A spectrum of rib changes was noted. Also, the changes in the lungs and cardiac size were inspected.The radiological findings were categorized and their explanations were discussed