Echoguided pair technique in diagnosis and treatment of abdominal hydatid cystic disease in Egyptian patients: clnical and ultrasonographic follow up

The introduction of the percutaneous puncture, aspiration, injection of scolecidal agent and reaspiration [PAIR] technique is gaining an increasing acceptance in diagnosis and treatment of abdominal cystic hydatid disease [CHD]. Thirty-three patients [12 male and 21 female with age between 15 and 70 years] had 46 cysts in liver, spleen and kidneys [75.7%, 18.2% and 6.1% respectively]. Puncture, aspiration, injection of 95% sterile alcohol for 20 minutes and reaspitation [PAIR] was used for treatment of hydatid cysts of different types and sizes. Follow up both clinically and ultrasonographically was done over a period of 2 years. The commonest ultrasound picture was type la [overall echofree] in 80.4%, commonly in the liver [75.7%] mainly in the right lobe [88%]. Improvement of symptoms had occurred its 85% within 3 weeks. As regards ultrasound follow up of 41 non-complicated cysts within the 1[st] six months, was disappearance of 5 cysts, 34 reduced in size and 36 showed different grades of solidification. After 1.5 year 10 more cysts disappeared while the pseudotumour appearance was shown in remaining 26 cysts. Ultrasound follow up of the 5 infected cysts revealed complete cure within a period of 8-16 weeks in 4 of them. The last patient discontinued drainage therapy and was referred to surgery. This makes ultrasound cure reaching 97%. Minor complications were skin reaction only in 2 patients [6%]. No fatal anaphylaxis cyst recurrence or rupture into the peritoneal cavity or bleeding from renal or splenic puncturing. PAIR technique under ultrasonographic guidance is the first choice method for treatment of abdominal CHD especially in the developing countries and inoperable hydatid cysts

Doppler changes in chronic hepatitis C virus Egyptian patients with sustained virological response [SVR]

Duplex-doppler ultrasound is a non-invasive method for the assessment of hepatic haemodynamics beyond conventional gray-scale imaging. The clinical values of the methods used for the grading and staging of chronic hepatitis C virus [HCY] infection and the prediction of hepatic steatosis still have to be determined. Was to study the predictive value of pulse wave Doppler ultrasonography in Egyptian patients treated with interferon and Ribavirin through comparing the heamodynamics before and after treatment as well as the detection of the differences in Doppler parameters in IFN-SYR and IFN-NR patients. This study included 50 Hey patients treated with PEG-IFN and Ribavirin. Thirty six patients showed SYR while the remaining 14 patients were non responders. Real time abdominal ultrasonography was done with special concern on abdominal Doppler. Doppler was done by a single ultrasonographer pre and post treatment with special emphasis on liver heamodynamics [Portal vein diameter, Portal vein flow and mean velocities [PVPV] and [PVMV], portal vein circumference and area, hepatic artery resistance and pulsatility indices [HARI] and [HAPI], as well as splenic vein diameter, splenic artery resistance and pulsatility indices [SARI] and [SAPI]]. Hepatic veins phasicity: [triphasic, biphasic, or monophasic], congestion index [in cm/s], modified hepatic vascular index [in cm/s] [MHI], hepatic vascular index and portal hypetiension index were also measured. All the patients were treated by Pegylated interferon 180 microg/week and Ribavirin 13-15 mg/kg/day for 48 weeks [IfPCR still was positive after 24 weeks of treatment, treatment was discontinued, but the patient remained on follow up]. All patients in the study gave an informed consent. Liver biopsies were done for all patients prior to interferon therapy and at 72 weeks [6 months after the end of treatment] with histopathological grading according to METAYIR score. The chronic Hey infected patients in whom IFN and Ribavirin treatment resulted in complete response [SYR] showed that the mean PVPV was [17.59 +/- 5.79 cm/s] while post treatment was [16.39 +/- 3.76 cm/ s]. HAPI pre treatment was [1.77 +/- 0.7 cm/s], and post treatment was [1.62 +/- 0.46 cm/s], and the HARI pre treatment was [0.61 +/- 0.16 cm/s], while post treatment was [0.61 +/- 0.18 cm/s], with no statistical significant difference in the responder group, while the SVMV showed statistical significant difference pre [18.8 +/- 7.37 cm/s], and post treatment [15.2 +/- 4 cm/s]. Also the SVMV pre treatment was [14.7 +/- 5.71 cm/s], while post treatment was[12 +/- 3.74 cm/s], and this was statistically significant [p<0.05]. Pulse wave Doppler ultrasonography is an easy and non-invasive procedure for evaluating the chronic HCY liver disease, but not effective nor valid to estimate the effect and response to anti-viral therapy

Study of oesophageal motility in Egyptian cirrhotic patients before and after prophylactic endoscopic variceal ligation

The aim of this work is to study oesophageal motility in non bleeding cirrhotic patients before and after endoscopic ligation of oesophageal varices. This study was conducted on 90 subjects as follows: Group [I]: 50 patients with liver cirrhosis and large oesophageal varices [i.e. grade III, IV]. Group [II]: 20 patients diagnosed with liver cirrhosis but without oesophageal varices. Group [III]: 20 healthy volunteers. Written informed consent was obtained from all subjects. Complete laboratory investigations were done as well as abdominal ultrasonography, upper endoscopy and oesophageal motility was done by stationary and rapid pull through manometery using a low compliance pneumohydraulic perfusion system. EVL was done in 50 patients [Group I]. Oesophageal motility before EVL revealed that there was a significant decrease in the amplitude of the contractive wave at the middle and the distal oesophagus and there was an increase in the wave velocity in the distal oesophagus with significant increase in the abnormal waves with no effect on wave duration. Ascites had no effect on the oesophageal motility and the LES pressure; also there was no significant difference in patients in terms of Child Pugh grading. Oesophageal motility after EVL revealed no significant decrease in the amplitude of the contractive wave at the middle oesophagus, and the decreased amplitude in the distal oesophagus before EVL was returned to the level of normal healthy control. Also, there was increase in the velocity of wave after EVL in the distal oesophagus with no effect on wave duration. Prophylactic EVL is an effective method for primary prophylaxis of oesophageal varices with no serious complications. EVL normalized oesophageal motility and if it induced abnormal oesophageal motility, it was of little clinical significance and reversible

Percutanous ablative therapy for HCC: a comparison of three modalities

This study was performed on 78 patients having liver cirrhosis with 91 focal hepatic lesions detected by ultrasound and proved histopathologically to be HCC [biopsy and/or fine needle aspiration cytology; FNAC]. They were 70 males and 8 females their ages ranged between 37 and 75 years old. Patients were classified into three groups, Group A was formed of 32 patients with 37 focal lesions where they received RFA. Group B encountered 25 patients with 26 focal lesions and they received PAI Group C included 21 patients with 28 focal lesions were treated by PEI. Complete ablation was assessed by re-biopsy and/or FNAC, triphasic CT and AFP serum level. As regards the outcome of therapy in group A, complete ablation was achieved in 14/18 [78%] for lesions

Is there a role for islet cell antibodies [ICA] in hepatitis C virus-diabetes mellitus mysterious link?

There is an increasing evidence of strong association between hepatitis C virus [HCV] and diabetes mellitus particularly, non-insulin dependent diabetes mellitus [NIDDM], the cause of which is still obscure. Autoantibodies of different types have been screened in-patients with HCV. The presence of islet cell antibodies was conducted to clarify the possible role of ICA in this association and to find any correlation between ICA and other autoantibodies. We studied 48 patients with HCV as diagnosed by RIBA II and PCR. Patients were divided into group I [NIDDM group] and group II [Non diabetic group]. Group I comprised 14 males and 10 females with a mean age of 39,75 +/- 6 years, group II comprised 16 males and 8 females with a mean age of 39.60 +/- 5.8 years. Non of the patients received antiviral therapy. They were tested for: Blood glucose, liver functions [ALT, AST, Alkaline Phosphatase, Albumin and Prothrombin time]. The following non organ-specific autoantibodies were screened: Anti-mitochondrial antibodies [AMA], anti-smooth muscle antibodies [ASMA], and antinuclear antibodies [ANA]. Islet cell antibodies [ICA] were screened in their sera by indirect immunoflurescence test [Inova Lite, Research kit]. The results of the study showed relatively increased prevalence of ICA in group I [33.3%] than in group II [12.5%], but the difference was statistically non significant [P > 0.05], In group I A MA, ASMA and ANA were positive in 8.3%, 41.6% and 20.8% respectively, while in group II they were positive in 8.3%, 37.5%. and 16.7% respectively, with no statistical significant difference between both groups. ICA correlated significantly with ASMA in both groups and with ANA only in group II. No correlation was detected between ICA and AMA. Neither ICA nor other studied auto-antibodies did correlate to any of the studied liver functions, in group I, ICA did not correlate to either patient's age, sex or family history of diabetes. In [1] The HCV-Diabetes Mellitus Link deserves careful evaluation, [2] ICA alone could not explain the relatively high incidence of diabetes mellitus in HCV patients, [3] ICA might be present in the sera of HCV patients as a part of immune disturbances present in the disease. [4] There is a significant correlation between ICA and ASMA, [4] HCV might trigger an autoimmune phenomena that persist even after cessation of the disease activity, [5] other possible mechanisms for HCV-diabetes mellitus link might be: iron overload, metabolic effect, receptor and /or post-receptor effect, viral pancreatitis or HLA association