Endoscopic management of bile duct strictures in kasr El Aini gastrointestinal endoscopy unit

Strictures of the biliary system may be benign or malignant, benign biliary strictures mostly occur as a result of surgical injury. Malignant strictures result from a neoplasm arising from the bile duct, ampulla of Vater, liver, gallbladder, or pancreas. Benign biliary strictures respond well after stenting with relief of cholangitis and jaundice. We aim by this study to evaluate the aetiology of Egyptian biliary strictures and the efficacy of its endoscopic management in Kasr El Aini Gastrointestinal Endoscopy Unit, Cairo University. Fifty patients with ERCP-confirmed biliary strictures [19 females and 31 males; age ranged 9-84 years with a mean of56.1 +/- 14.7 years] were included. Patients were subjected to routine laboratory investigations, abdominal ultrasonography, diagnostic and if possible therapeutic ERCP. The most common site of strictures was the distal; [52%], Hilar strictures followed [24%], the third common was mid CBD [14%.] Malignant strictures were present in [37/50; 74%] while benign strictures were present in 13/50 [26%]. The most common cause of malignant strictures was pancreatic carcinoma [15/37; 40.6%] followed by ampullary carcinoma [11/37; 29.7%] and cholangiocarcinoma [11/37; 29.7%]. Endoscopic biliary plastic stenting was done in 80% of cases. Endoscopic biliary drainge is a very effective technique for biliary strictures. Plastic endoprostheses is an effective tool in these strictures beside its low cost.

Blood telomerase activity and DNA dielectric properties in human hepatocellular carcinoma and chronic liver disease

Telomerase activity which restores the length of telomere repeat array is frequently detectable in various malignancies including hepatocellular carcinoma. The aim of the present work is to determine the diagnostic usefulness of the measurement of the telomerase activity and DNA electrical properties in peripheral blood from hepatocellular carcinoma [HCC] and chronic liver disease. In 10 patients with HCC, 13 with chronic hepatitis C, and 7 healthy individuals, we measured peripheral blood telomerase activity by using the telomerase PCR ELISA assay. We examined its sensitivity and specificity in HCC, chronic HCV and its significance in comparison with other tumor markers. Telomerase activity was detected in peripheral blood of 80% in hepatoccllular carcinoma, 15% of chronic hepatitis C patients and absent in control group. A clear correlation between the incident of increased telomerase activity and that of elevated AFP was evident. The dielectric results indicated that the studied DNA has a dielectric dispersion in the frequency range used. The increase in the electrical conductivity and relaxation time for HCC and chronic disease is attributed to the increase of the surface charge density of the DNA macromolecule. It was concluded that detection of telomerase activity in peripheral blood in combination with measurement of dielectric dispersion of DNA could increase the accuracy in diagnosis of HCC and improve the judgment on its prognosis

Magnesium therapy improves thromboelastographic finding in end-stage liver patients

Patients with end stage liver disease are predisposed to hypomagnesemia which may cause bleeding tendency. There are many evidences suggesting that magnesium is a crucial constituent of the blood coagulation cascade and has a pro-coagulant activity. The aim of the study was to assess the effect of magnesium therapy on thromboelastography [TEG] in patients with end stage liver disease. The study was conducted on thirty patients with end stage liver disease in the intensive care unit. Four grams of magnesium sulfate, diluted in normal saline, were infused to all patients. The TEG findings immediately before and 15 minutes after the magnesium infusion were compared. The TEG findings showed general hypocoagulability before magnesium therapy. The R time and K time were shortened significantly from 1090.7 +/- 376.3 [mean +/- SD] to 870 +/- 211.9 sec and from 659.3 +/- 321.6 to 449.3 +/- 319.6 sec respectively [p<0.05]; the Alpha angle and maximal amplitude showed significant increases from 28.1 +/- 11.3 to 373 +/- 12.6 and from 37.8 +/- 11.4 to 46.6 +/- 13.1 mm respectively after magnesium therapy [p<0.05]. Also, serum magnesium level rises significantly from 1.9 to 3.1 mg. dl-1 [p<0.05]. In conclusion, magnesium therapy improved the overall TEG findings in patients with end stage liver disease who show signs of TEG hypocoagulability and hypomagnesaemia. Further studies will be needed to investigate the effect of magnesium therapy and the improvement of TEG variables on clinical outcome of patients

community-based study of viral hepatitis infection in Giza Governorate, Egypt: Seroprevalence, risk factors and associated morbidity

Hepatitis viruses are major causes of acute and chronic liver diseases in Egypt. The aim of this study was to investigate the seroprevalence, risk factors and associated morbidity of viral hepatitis in Giza Governorate, Egypt. The study was conducted in 4 rural and 4 semiurban communities and included 2305 subjects selected by a cluster r and om method. They underwent complete clinical and abdominal ultrasonographic [US] assessment and laboratory tests including stool and urine examination, hemoglobin, ALT estimation and viral hepatitis markers by enzyme immunoassay. The latter included anti-HAV IgG, HBsAg, anti-HBc, anti-HBs, anti-HCV and anti-HEV IgG. Subsets of sera were tested for HBV DNA and HGV RNA by specific PCR. The overall prevalence of anti-HCV was 20.9% [age-adjusted prevalence = 24.5%; CI: 22.7-26.3%] and was significantly rising with age from 10% below age of 20 years to 40% among those above 50 years. The infection rate of hepatitis B virus [HBV] was 57.1% with HBsAg carrier rate of 3.6%. Seropositivity of anti-HBs and anti-HBc was very high [45.8% and 44.7%, respectively] and correlated positively with age with no sex-related difference. Combined HCV and HBV infection was evident in 13% of subjects. HBV DNA was detected in 86% of HBsAg-positive cases and in 20% of HBsAg-negative anti-HBc- and anti-HCV-positive cases. Seromarkers for hepatitis B and C were significantly commoner in semiurban than in rural communities. Dental manipulation and previous parenteral antischistosomal therapy were significant risk factors for hepatitis B and C infection. Anti-HAV was positive in 99.7% whereas anti-HEV was positive in HBV= Hepatitis B virus. CLD = Chronic liver disease. HCC = Hepatocellular carcinoma. US = Ultrasonography. ALT = Alanine transaminase. OR = Odds ratio. CI = Confidence interval. 9.2%. HGV RNA was detected in 16.5% of the studied samples. It was always associated with HBV and /or HCV infection. History of hematemesis was recorded in 1.2% of individuals. US examination revealed hepatomegaly in 19.2% of subjects, splenomegaly in 8.2%, bright liver in 31%, coarse liver texture in 10%, periportal fibrosis in 20% and ascites in 2%. These findings were significantly more common in anti-HCV- and HBsAg-positive subjects. ALT elevation was commonest and highest in individuals with positive HBsAg or with HBV-HCV coinfection. Hepatitis B and C infection and associated morbidity still constitute a great health problem in Egypt. Hepatitis A is holoendemic and hepatitis E is endemic. Hepatitis G is always associated with HBV or HCV infection. Occult hepatitis B should be considered in future studies