Clinical and ultrasonographic prediction of Oesophageal varices in liver cirrhosis

Since bleeding from oesophageal varices is a major complication of chronic liver diseases among Egyptians, early diagnosis of portal hypertension and varices may prevent and control bleeding. 139 patients with chronic liver disease of different grades were classified and investigated. 89 with no varices, 27 with small and 23 with large varices. Clinical examination, liver functions, blood picture, hepatitis markers, rectal snips for bilharzial ova, upper gastrointestinal endoscopy and abdominal ultrasonography with Doppler study of portal vein, splenic vein and hepatic artery were done for every patient. The results showed significant relation between presence of oesophageal varices and hepatic coma, spider navi, ascites and increased score of child classification. There was significant positive relation between splenic size and negative relation of liver size and presence or grading of varices. A significant positive relation was found between presence of varices and post hepatitic cirrhosis. A significant increase in total bilirubin, AST, ALT, ALKphos., and decrease in serum albumin and prothlrombin concentration in patients with varices as well as a significant decrease in R.B.Cs, W.B.Cs, Platelets and HP% in the group with varices. Doppler study revealed increase in P. V.D, P. V.C.A, and decrease in P. V.C.I and P. V.M. V in patients with varices. Doppler study on hepatic artery showed good correlation of H .A. P.I, L V.I but not H.A.M. V and the presence of varices. No parameter was found to differentiate small from large varices except splenic size and ascites. This leads to the conclusion that clinical, ultrasonic and Doppler examinations of hepatic patients may suggest the presence of varices without, need for endoscopic examination of every patient

Distribution of P53 and mdm2 genes in patients with hepatocellular carcinoma

50 patients with hepatocellular carcinoma, 36 males and 14 females 14-73 years old were studied in this work. Abnormal values of s.. bilirubin. AST, ALT and alkaline phosphatase were found in 52, 64 and 76% of cases respectively. 70%of cases had AFP levels between 50 and 150ng/dl while 6/had levels below 10ng/dl. 46.had stage 1:36 stage II and 18/had stage III disease. P53 was overexpressed in 46% of cases not related to age or sex. A statistically significant relationship was found between mdm2 overexpression and the stage of the tumor. 42% of cases were P53 positive and mdm2 negative and 24% of cases were P53 negative and mdm2 positive that may indicate that mdm2 overexpression and P53 mutation represent alternative mechanisms for inactivating the same regulatory pathway for suppressing cell growth. Concomitant overexpression of either P53 or mdm2 or both was found to have statistically significant relation with tumour stage indicating that P53 mutation and mdm2 overexpression are alternative mechanisms for inactivating the same pathway for suppressing cell growth. It can be concluded that P53 in activation may be involved in the molecular pathogenesis of HCC and its mutation is late in HCC and its frequency is related to tumour progression mdm2 overexpression has the same significance. Tumors with mdm2 overexpression were devoid of P53 mutations and vice verca; indicating that they represent alternative mechanisms for inactivating the same regulatory pathway for suppressing cell growth

Study of some echocardiographic changes in patients before and after kidney transplantation

Some of the cardiac parameters of 50 patients undergoing regular hemodialysis were studied by M-mode, 2 dimensional and color flow echocardiography, just before then, after successful kidney transplantation. Most of the abnormal pretransplantation echocardiographic findings were improved after kidney transplantation including pericardial effusion, left ventricular dilatation, left ventricular hypertrophy, dilated cardiomyopathy and valvular regurgitation. The improvement also involved end diastolic [diameter/ and volume], end systolic [diameter/and volume], stroke volume, interventricular septal thickness, cardiac output and cardiac index. In some abnormalities e.g cardiac out put and index the improvement was marked in more than 6 months period after transplantation rather than in 3 months period after transplantation; while, in others like left ventricular mass and left ventricular mass index the improvement was marked in both periods

Study of the effect of regular haemodialysis on QTC interval in patients with chronic renal failure

The effect of regular H.D*; on QTc interval was studied in 20 uraemic patients. QTc interval prolongation was found in all patients before dialysis. Haemodialysis significantly shortens QTc interval from 0.34+0.02 to 0.32 +/- 0.029 [P < 0.01]. Similarly H.D. significantly [P<0.001] corrected the observed disturbances in the serum electrolytes [potassium from 6.0 +/- 1.14 to 3.8 +/- 0.7 mmol/I and calcium from 1.1 +/- 0.11 to 1.19 +/- 0.06 mmol/ I]. arterial PH [from 7.36 + 0.32] blood urea from 160 +/- 47.5 to 109 +/- 37.8 mg/dl] and serum creatinine [from 6.3 +/- 2.0 to 4.1 +/- 1.5 mg/dl]. The correlations [r] between these biochemical changes and the changes in QTc interval after dialysis were non significant [P>0.05]. Thus QTc prolongation before dialysis can not be explanined by these biochemical disturbances. A significant reduction in the B.W**. and J.V.P***. [from 72 +/- 13.5 to 71 +/- 12.1 kg and from 5.05 +/- 2.8 to 24 +/- 1.4 cm H20 respectively] were found in all patients after dialysis. This reduction was correlated with the post dialysis QTc shortening [P<0.05]. It is concluded that hypervolaemia, as reflected by B.W. and JVP, through its effect on QTc can be a precipitating factor for arrhythmia and sudden death in dialysis patients. * H.D.= Haemodialysis. * * B.W.= Body weight. * * * JVP = Jugular venous pressure

IGA nephropathy in schistosoma mansoni infected patients

Of the 43 studied patients with schistosomal nephropathy, 31 were males [72.1%] and 12 were females [27.9%]. Proteinuria was encountered in all patients, hematuria was found in 62.8% and hypertension was detected in 20.9% of patients. Isolated proteinuria without hematuria or hypertension was present in 16.3% of patients. Non of the measured serologic markers was significantly distributed among the three groups of patients apart from significant lowering of the serum C[3] concentration in the group of patients with hepatosplenic schistosomiasis [Group III]. The main renal pathologic lesions were FSGS [39.53%] and MPGN [30.23%], while amyloid kidney was observed in only one case [2.33%]. Renal deposits of schistosomal antigens [CCA and CAA] were found in 15 patients [34.88%]. These patients showed predominant deposits of lgG [46.66%], IgM [73.33%], C[3] [80%] and C[4] [40%] which were significantly higher than that in patients without schistosomal antigens deposits. IgA glomerular deposits were found in 7 [16.3%] patients. All were normotensive males. They had no distinctive clinical, laboratory or pathological features that distinguish them from schistosomal nephropathy patients without IgA deposits

P-wave changes in bilharzial patients with chronic obstructive pulmonary disease

55 patients with C.O.P.D. including 18 with bilharzial hepatosplenomegaly and 7 patients with bilharzial cor-pulmonale together with 10 normal control individuals were the material of the present study. P.E.F.R. was taken as the criterion of the presence of C.O.P.D. and changes of arterial blood gases as criteria to score the severity of C.O.P.D. P-Wave changes known to score the severity of C.O.P.D. [axis and amplitude] were assessed. The presence of associating hepatosplenic bilharziasis with or without bilharzial cor-pulmonale in patients with C.O.P.D. having matching severity were found to changes the incidence of P-Wave axis and amplitude changes in C.O.P.D. This leads to the conclusion that the P-Wave changes taken as criteria for screening the severity of C.O.P.D. are no longer valid in the presence of associating hepatosplenic bilharziasis with or without bilharzial cor-pulmonale in patients with C.O.P.D

Paradoxical interventricular septal movement in patients with bilharzial cor-pulmonale without clinical or phonocardiographic evidences of pulmonary and/or tricuspid regurge

* Twenty eight patients with bilharzial corpulmonale showing no clinical or phonocardiographic evidences of pulmonary and/or tricuspid regurge were the material of the present study. * Interventricular septal motion was studied in all cases and echocardiographic scoring of the degree of pulmonary hypertension was obtained in them. * Abnormal or paradoxical septal motion indicating diastolic overload to the right ventricle was observed in 20%, 22% and 43% of cases with mild, moderate and severe degree of pulmonary hypertension. * Diastolic overloading in these cases is probably due to incipient and clinically occult pulmonary and/or tricuspid regurge whose murmur in beyond the range of human ear audibility. * The presence of diastolic valume overloading in patients of bilharzial cor-pulmonale as evidenced by paradoxical septal motion in the absence of clinically demonstrable pulmonary and/or tricuspid regurge should destract the attention to incipient regurge of either valves

Serum, ascitic fluid and urinary biochemical changes in bilharzial patients with refractory ascites

15 ascites patients with aepatosplenic bilharziasis responding to diuretic therapy were taken as control group. 20 patients with bilharzial hepatosplenic affection and retraciory ascites were the material of the present study. All patients from both groups were subjected to investigations to prove pure bilharzial etiology. In their serum, and serum and ascitic fluid enzymes [GOT, G.P.T., Alkaline phosphatase and L.D.H.], Proteins [Albumin total globulin, Alpha[1], Alpha[2] Beta and Gamma globulin]; glucose, cholestrol, bilirubin [total and direct], B.U.N., creatinine and electrolytes [Phosphorus, calicum, pottassium, sodium and chloride] were assessed. Urinary electrolytes [Phosphorus, calcium, calcium potassium, sodium and chlorid] were also meadured for all. The serum biochemical data of patients with refractory ascites showed that they were in a more advanced stage of hepatocellular damage than patients with non refractory ascitis. The ascitographic picture of biochemical data of both groups showed selective significant differences that can be taken as a parameters to fortell refractoriness of ascites during the follow up of cases in the course of that disease. Selective significant differences in urinary electrolytes of both groups can also be taken as forerunnex to predict refractoriness of ascites. The A/S ratio of different biochemical data in both groups showed selective significant differences that can be taken as a parameters for detection of the impending refractory ascitic stage in the course of bilharzial hepatosplenic affection. The concept of an active role for the peritoneum in ascitogrophic biochemical patterns construction was proposed and discussed

Reversion of oesophageal acid perfusion test results after paracentesis abdominis in ascitic cases of bilharzial hepatic fibrosis

Twenty six patients with hepatosplemc schistosomiasis and tense ascites, having positive acid perfusion test results, were the candidates of this research. All cases were investigated for brtharzlal aetiology, portal pressure manometry, ascitic fluid volume and pressure estimation and oesophageal acid perfusion test were done before and 10 days after slow paracentesis abdominis. The following results were found: 1. Positive correlation between portal and ascitic fluid pressures before and after paracentesis. 2. Both portal and ascitic fluid pressures were significantly reduced after tapping in all patients. 3. The oesophageal acid perfusion test turned negative in 61.53% of patients 10 days after tapping. 4. The degree of portal and ascitic fluid pressure reduction was more significant in the group showed reversion of oesophageal acid perfusion test. 5. While test reversibility was linked to the portal hypotensive effect of tapping, non reversibility was indicative of inefficient non significant tapping. We can conclude from this work the great value of this simple test in indicating and evaluating the success of tapping in lowering the portal and ascitic fluid pressures in bilharzial ascitic patients