Cerebral vascular resistance assessed by transcranial doppler ultrasonography in patients with liver cirrhosis

Fifty-five cirrhotic patients graded according to the Child-Pugh classification [Child-Pugh grade A [18 patients], grade B [21 patients] and grade C [16 patients]] as well as 15 healthy controls were the subject of the present study. Nine of the cirrhotic patients had clinical hepatic encephalopathy. The pulsatility and resistive indices and the mean blood flow velocity in the right middle cerebral artery were measured by Doppler ultrasonography in the study population. These measurements were repeated 30 minutes after ingestion of a 400 kcal mixed liquid meal. Cerebral pulsatility and resistive indices were significantly higher in patients with liver cirrhosis than in the controls; whereas, no significant difference could be elicited in mean blood flow velocity in the fasting condition between cirrhotic patients and controls. Moreover, cerebral pulsatility and resistive indices were significantly related with the severity of liver cirrhosis. Also, the pulsatility and resistive indices in the middle cerebral artery showed a significant positive correlation with levels of serum bilirubin and blood ammonia and a negative correlation with serum albumin level in cirrhotic patients. Multivariate analysis showed that levels of blood ammonia and serum albumin were significant independent predictors of the cerebral pulsatility and resistive indices in patients with liver cirrhosis. Patients with hepatic encephalopathy had higher cerebral pulsatility and resistive indices than patients without encephalopathy. Meal ingestion significantly increased the pulsatility and resistive indices and decreased mean blood velocity in the middle cerebral artery in cirrhotic patients, but not in controls suggesting that middle cerebral arterial vasoconstriction, seen in cirrhotic patients, is one of the cerebral artery's homeostatic responses to underfilling of the splanchnic arterial circulation

Liver iron stores, hepatocyte proliferation and DNA ploidy in patients with HCV - Related chronic liver disease: Relation to morbidity and hepatocarcinogenesis

Forty-six HCV seropositive patients [24 patients with chronic hepatitis, 10 patients with liver cirrhosis and 12 patients with hepatocellular carcinoma on the top of cirrhosis] were included in this study. The diagnosis was based on clinical, laboratory and ultrasonographic examinations and was confirmed by the histopathological examination of liver biopsy specimens. In addition, ten normal control liver biopsies obtained from patients operated upon for cholecystectomy were included in the present study. Liver biopsies were examined histologically. A histopathological assessment of chronic hepatitis patients was performed. Hepatic iron was evaluated in liver biopsies using a semiquantitative method after being stained by Perlgyptians Prussian blue reaction. The results of this study showed increased liver iron stores and increased hepatocyte proliferative activity and DNA index in patients with HCV-related chronic liver disease with a close relation to disease progression being more pronounced in HCC patients. Thus, it can be suggested that increased liver iron stores, increased hepatocellular proliferative activity and DNA aneuploidy may be used as risk factors for the development of HCC in patients with HCV-related chronic liver disease. Moreover, as liver iron overload seems to contribute to the development of HCV-related HCC, liver biopsy should not only be practiced to confirm a diagnosis of hepatitis or cirrhosis but also to assess hepatic iron deposits. Also, iron reduction therapy might be recommended in patients with HCV-related chronic liver disease to reduce the risk of progression to HCC

Helicobacter pylori stool antigen test: evaluation of diagnostic accuracy in Egyptian patients with dyspepsia

Thirty-six H. pylori infected patients [proved by positive Grams stained film, rapid urease test, culture and histopathology] as well as ten non-infected patients selected among 120 Egyptian patients presenting with dyspepsia were included in the present study. There was no statistically significant difference between H. pylori positive and negative patients concerning their presenting symptoms. The endoscopic examination revealed that gastritis was more prevalent in H. pylori infected patients. A significant relation was found between the complaint of regurgitation and the endoscopic finding of hiatus hernia as well as between the complaints of heart burn and epigastric pain on one hand and the endoscopic detection of gastritis on the other hand. The histopathological examination of gastric biopsies revealed that gastritis in its moderate degree was more prevalent in H. pylori infected patients than in the controls. Stool specimens collected from 36 H. pylori positive patients and 10 ten non-infected controls were examined by an enzyme immunoassay for the detection of H. pylori antigens [Premier Platinum HpSA]. The HpSA test was positive in 35 out of the 36 H. pylori infected patients and in 2 out of the 10 non-infected cases. The sensitivity and specificity of the test were 97.2% and 80%, respectively. The overall accuracy rate was 93.5%. The positive and negative predictive values for HpSA test were 94.6% and 89%, respectively

Screening tests for diagnosis of cervical lympradenopathy presenting as prolonged fever

During a two years period, 16 cases having cervical lymphadenopathy presenting as prolonged fever were studied in Abbassia fever hospital, Cairo, Egypt. Patients were subjected to careful history, thorough clinical examination, complete blood picture, tuberculin test, chest x-ray, Monospot test, indirect fluorescent antibody test for toxoplasmosis, detection of cytomegalovirus antibodies and lymph node biopsy with histopathological examination. Ten within normal subjects were taken as controls. The patients were grouped on histopathological basis into 5 groups: [1] One [6%] of the cases was non-specific lymphadenitis diagnosed by clinical examination of the scalp and leucocytosis with polymorphonuclear predominance. [2] Reactive lymphadenitis included 6 [38%] of the cases. Infectious mononucleosis cases were diagnosed by clinical triad of fever, pharyngitis and cervical lymphadenopathy, relative lymphocytosis, monocytosis and positive monospot test. Cytomegalovirus case was diagnosed by lymphocytosis, monocytosis and negative monospot test. Toxoplasmosis cases were diagnosed by monocytosis, negative tuberculin test and positive indirect fluorescent antibody test. [3] Granulomatous lymphadenitis comprised 6 [3%] of the cases. Tuberculous cases were diagnosed by high ESR and highly positive tuberculin test. Sarcoidosis cases were diagnosed by negative tuberculin test and presence of hilar lymphadenopathy. [4] Non-Hodgkin lymphoma case [6%] was diagnosed by clinical deterioration and total lymph node biopsy. [5] Systemic infections were diagnosed by clinical examination, blood culture for salmonellae and brucellae, Widal and Brucella agglutination tests. It is concluded from this study that screening tests are important aids in the diagnosis of cases of cervical lymphadenopathy presenting by prolonged fever especially if lymph node biopsy and histopathological examination are not available or contraindicated

Circulating intercellular adhesion molecule-1 in endemic chronic liver diseases

In the present study, an ELISA was used to measure serum ICAM-1 levels in 40 patients with endemic chronic liver diseases and they were correlated with histological changes in the liver and with liver functions. Serum ICAM-1 levels were significantly higher in patients with chronic active liver diseases than in normal subjects and correlated positively with the grade of histological activity. Furthermore, serum levels of ICAM-1 were substantially greater in patients with cirrhosis than in those without cirrhosis. There was also a significant positive correlation between serum levels of ICAM-1 and serum alanine aminotransferase activities. It was concluded that in chronic liver disease, intercellular adhesion molecule-1 serum concentration seems to represent hepatocellular damage. It was suggested that serum ICAM-1 may prove worthy in the investigation, diagnosis and therapeutic monitoring of various inflammatory conditions of the liver