value of serum cholinesterase II in the prediction of hepatic encephalopathy in cirrhotic patients

We investigated serum cholinesterase II activity in cirrhotic patients with and without hepatic encephalopathy [n=40]. The enzyme was found to be insignificantly reduced [p>0.05] in patients without hepatic encephalopathy [n-=20]. By contrast,it was significantly reduced in patients with hepatic encephalopathy [p<0.05] in comparison with both control group and other group of patients. A significant correlation was revealed between enzyme activity and the grade of hepatic encephalopathy [p<0.01]. Statistical analysis did not reveal any significant correlation between enzyme activity and liver function tests in both groups of patients except for serum albumin in patients without hepatic encephalopathy [P < 0.05]. We assessed blood ammonia levels as well in this study, which was found to be less sensitive [35%] than serum cholinesterase activity [70%] in the diagnosis of hepatic encephalopathy. In conclusion, our results indicate that serial estimation of serum cholinesterase II activity is valuable in the prediction of hepatic encephalopathy in cirrhotic patients as the rapid fall in its level is highly suggestive of impending hepatic coma

Ascitic fluid cholesterol in malignant ascites a tumor marker and diagnostic tool

The present study was undertaken to evaluate the use of ascitic fluid cholesterol determination in the differentiation between malignant and cirrhotic ascites. Again, the aim of our study was to further illustrate the value of estimating serum-ascites albumin gradient in differentiating ascites due to cirrhosis from that due to malignancy. This study was carried out on two groups of ascitic patients, the first with cirrhotic ascites and included 13 patients, the second with malignant ascites and included 19 patients. Ascitic fluid cholesterol level was found to be significantly higher in malignant group than in cirrhotic group. Ascitic fluid cholesterol above 48 mg percent was found to have high sensitivity [77.81 percent], high specificity [92.85 percent] and to have the highest diagnostic accuracy [84.37 percent] among all chemical tests used for diagnosis of malignant ascites [namely total proteins; LDH and s-a albumin difference. In evaluating the serum ascites albumin difference, it was found to be significantly lower in malignant than cirrhotic group [P < 0.01]. The diagnostic accuracy with s-a albumin difference < 1.1 gm percent was higher than that with total proteins >3 gm percent. Pare et al, 1983 reported that s-a Albumin was a useful tool in differentiating ascites due cirrhosis from that due to malignancy. Hoef [1981 b] reported stability of the gradient during diuresis

value of ascitic fluid fibronectin in the differentiation of malignant and cirrhotic ascites

The differentiation of malignant and cirrhotic ascites is of considerable importance for further diagnostic and therapeutic approaches. This work was carried out to evaluate the use of ascitic fluid firbronectin concentration to differentiate between malignant and cirrhotic ascites in comparison with two conventional tests namely: ascitic fluid total proteins and ascitic fluid LDH. Eighteen patients with malignant ascites and fourteen patients with cirrhotic ascites were included in this work. Ascitic fluid samples were subjected to the following tests: culture and sensitivity, cytologlc examination, total proteins, LDH, and firbronectin concentration using radial immunodiffusion technique. Total proteins, LDH and firbronectin showed significant differences between both groups with firbronectin having higher diagnostic accuracy than total proteins and LDH