Hepatitis C; validity of alanine aminotransferase levels in predicting histological changes in young asymptomatic patients

Liver biopsy the gold standard for the histological assessment in chronic hepatitis C is an invasive procedure with certain limitations. It was to evaluate the relation of serum ALT levels with the histological changes in healthy blood donors screened positive for HCV. This cross sectional comparative study. It was conducted at department of medicine Combined Military Hospital Lahore, from January to August 2004 It was to evaluate the relation of serum ALT levels with the histological changes in healthy blood donors screened positive for HCV. 76 apparently healthy blood donor soldiers age 20 - 49 years positive for HCV antibodies by third generation ELISA test, evaluated by medical history, physical examination, serum ALT levels, PCR test for HCV RNA and ultrasound abdomen were enrolled. Liver biopsy was done through percutaneous route and histology was graded according to Knodell scoring system. Serum ALT levels showed a skewed distribution with mean of 130.9+96.9 IU/L and median of 8.5IU/L. Eleven patients had normal ALT [<40 IU/L].On histological analysis of liver biopsy specimen 17 had Knodell score 8. Patients with score > 8 were older than the former groups. The difference was significant [p=0.047]. Relation of ALT levels with stage of fibrosis and grade of inflammation was estimated using ANOVA it showed no statistical significance. Patients with stage 1 fibrosis had highest mean serum ALT levels [p=0.108]. No association found between the ALT level and liver biopsy histological score. However patients with normal ALT levels usually had mild necroinflammatory changes

Liver biopsy percutaneous liver biopsy by surecut needle

To study the safety and efficacy of Surecut needle in obtaining the liver tissue by percutaneous liver biopsy. Design: Single centered prospective hospital based study. Department of Internal medicine [Unit-1] and Family ward, Combined military hospital Lahore for more than one year from August 2002 to March 2004. One hundred and fifty patients of either gender having asymptomatic hepatitis C carrier state, healthy blood donors, with positive HCV-PCR were included in study. The patients liver biopsy was done with Surecut needle 16G with patient breath suspended in expiration from the periphery of right lobe of liver. Majority of patients, 135 [90%] were male and 15 [10%] were female. The mean age was 30.3 years with range of 25-55years. In 146[97.31%]patients successful biopsy was done while the biopsy was non-diagnostic in 4[2.69%] patients. Mean core length of liver tissue obtained was Mean+sd[1.2+0.42cm] and histopathologic diagnosis was made in 97.31% cases. Total number of attempts were 1-2. In 99% single attempt was done. No major complications related to procedure was seen. liver biopsy with Surecut needle is safe and effective in establishing the diagnosis of Chronic hepatitis