Pulmonary haemodynamic changes after injection sclerotherapy in patients with bilharzial pulmonary hypertension

This work aimed to evaluate the incidence of bilharzial pulmonary hypertension [PH] in patients with ruptured esophageal varices, as well as the value of variceal injection as a therapeutic modality and its effects on pulmonary hemodynamic, among patients with bilharzial PH. Out of 3000 patients with ruptured esophageal varices, 18 only were found to have associated bilharzial. Patients with ruptured varices and bilharzial PH were subjected to emergency sclerotherapy to control bleeding, repeated sclerotherapy to produce variceal obliteration and electrocardiographic as well as Doppler echocardiographic evaluations and estimation of mean pulmonary artery pressure [MPAP] for 3 times [before initial sclerotherapy, 1 week after control of bleeding and 1 week after complete variceal obliteration]. Injection sclerotherapy had resulted in non- significant changes in all the studied electrocardiographic and Doppler echocardiographic parameters among our patients with bilharzial PH. It had resulted also in non significant lowering in MPAP among them

Efficacy of different dosage schedules of praziquantel in active intestinal schistosomiasis

This study is conducted on 420 patients with active intestinal bilharziasis, their age range from 16-60 year. 380 are males and 40 are females. Bilharzial activity was diagnosed after urine and stool analysis and/or rectal and colonic mucosal biopsy. All of them received praziquantel orally as anti-bilharzial drug. They were divided into 4 groups according to the dose of praziquantel given. From the results, it was found that there is insignificant increase in hemoglobin concentration in the first and second groups and significant increase in the third and fourth groups. The increase in hemoglobin concentration after praziquantel therapy may be attributed to improvement of appetite and increased degree of intestinal absorption. Also, it may be attributed to stoppage of bleeding per rectum following treatment

Serum pepsinogen in ulcer and non ulcer lesions

This study comprised 60 patients with ulcer and non ulcer lesions and 20 persons as a control group, with age ranging from 16-66 years. Three biopsies were taken from stomach, antrum and duodenum for pathological studies and radio- immunoassay detection of serum pepsinogens level. The results of this study showed increased level of serum PGI and high PGI/PGII ratio in cases with duodenal ulcers and duodenitis than those of control group, gastric ulcer patients and patients with gastritis. Also we found that elevated serum level of PGII with decreased PGI/PGII ratio in cases of gastric ulcer and patients with gastritis than those of control group, duodenal ulcer patients, patients with non ulcer lesions as patients with duodenitis and gastro duodenitis. Radio immunoassay of serum pepsinogens I and II are considered as a good markers for detection of early gastro duodenal lesions and they are markedly changed in established cases with duodenal or gastric ulcers

Effect of diuretics on some respiratory function tests in bilharzial patients with and without ascites

This work comprised 20 male bilharzial patients, devided into 2 groups, 10 bilharzial patients without ascites, 10 patients with ascites and in addition, 10 healthy subjects as a control group. All cases were subjected to thorough history taking, complete clinical examination and the following investigations: urine and stool analysis, blood urea, serum creatinine, x-ray chest, electrocardiography and ventilatory function tests particulary 1C, ERV, FVC, FEV[1], MVV, FMEF, FMEFT, FEF and AVI. Percutaneous transsplenic portal manometry was done for nonascetic and ascitic group, and the intraperitoneal presure was measured for ascitic group only. Bilharzial patients without ascites have obstructive ventilary defect only, while patients with ascitis has combined obstructive and restrictive defects, and diuretics improved these defects. There is negative correlation between portal venous pressure and intraperitoneal pressure and all ventilatory function tests except FMEFT where the correlation is positive. From the preceeding we can see that diuretics are of value in improving organ funciton not only in the ascitic bilharzial patients but also in the non ascitic cases and wherever oedema is interferring with function i.e. interference with digestion in patients with portal hypertension or ascites, and interference with ventilation due to oedema of the bronchial mucosa

Some platelet functions in patients with diabetes mellitus and hepatosplenic bilharziasis

Our aim was to study platelet count, adhesiveness and aggregation in patients with hepatosplenic bilharziasis and diabetes mellitus. Our material comprised 10 non-ascitic patients with hepatosplenic bilharziasis, 7 uncomplicated diabetes mellitus and 8 patients with hepatosplenic bilharziasis and diabetes mellitus. 5 apparently normal subjects were taken as a control group. All groups were subjected to through history taking, clinical examination, urine and stool analysis blood picture, bleeding and coagulation times, serum creatinine, serum bilirubin, serum glutamic pyruvic tranaminase, fasting blood sugar; platelet count, adhesiveness and aggregation. Platelet count, adhesiveness and aggregation were decreased in patients with hepatosplenic bilharziasis, increased in patients with diabetes mellitus while they were non significantly, changed in patients with hepatosplenic bilharziasis plus diabetes mellitus. So, while diabetic patients should receive antiplatelet drugs like aspirin and dipyridamole; such drugs are contraindicated in patients with hapatosplenic bilharziasis for fear of bleeding and they are not recommended in cases with combined diabetes mellitus and hepatosplenic bilharziasis

Neutrophil phagocytic power in diabetes mellitus

It was found that the phagocytic activity of the neutrophils in diabetic patients was significantly impaired when compared to the control group. But on comparing the 2 uncontrolled groups with each other, we found no significant difference which can explain the presence or abscence of infection. A significant defect in the serum of the uncontrolled diabetics was observed when compared with the serum of controlled diabetics. Also, there was inverse correlation between the phagocytic activity and blood glucose level. Although insulin treatment does not restore the phagocytic power to normal level, but this lowering of blood surgar offers some support to their defensive mechanisms

Combined drug therapy of intestinal bilharziasis with and without polyposis

In endemic areas treatment of intestimal schistosomiasis, especially when complicated with polyposis, is a major medical problem. In the past few years introduction of new drugs gave hope for treatment of such cases. These drugs were mainly niridazole and oxamniquine. Niridazole has to be given repeatedly at two months intervals over a period up to one year. Oxamniquine provides the advantage of short term therapy over 3 days but the cure rate was much lower than niridazole. The two drugs are different pharmacolozically and this encourages us to give both drugs in succession, then simultaneously without accentnation of the side or toxic effects than when either drug was given alone. In this study 493 patients of intestinal bilharziasis, 39 of them with bilharzial colonic polyposis were included, using different schedules of therapy. Niridazole in a dose 4 mg/ kg. B. W. daily for 20 days and oxamniquine 60 mg/kg. B.W. as a total dose divided over 3 days. The best results were obtained when both drugs were given simaltaneously. The cure rate in non polypotic bilharzial cases was 96.5% and in patients with plyposis 64.3%, while the cure rate using oxamniquine alone or using the two drugs in succession starting by either of them gave much less cure rate, [not more than 40%]. We can conchude that the best treatment of intestinal schistosomiasis with or without polyposis is the simultaneous administration of oxamniquine and niridazole in the above mentioned dosage schedule

Leucocytic margination in typhoid and hepatosplenic bilharziasis

Adrenaline injection induced a significant blood cellular changes, which were more at phase I than at phase II except a reverse pattern occurs to platelets, phase II of adrenaline response is not to stimulation of pituitary adrenal axis, the total leucocytic counts were positively correlated with neutrophils and lymphocytes. In bilharzial cases, the maximum adrenaline induced increase of the formed blood elements was larger than in normal persons, negative correlation between grades of splenomegaly and base line level of all formed blood cells, positive correlation between grades of splenomegaly and the maximum adrenalin test can be used a diagnostic of cellular sequenstration in grades II and III bilharzial splenomegaly. Marginal bool of noutrophils is increased and positively correlated with the grades splenomegly and the maximum increase of lymphocytes after adrenaline test was larger than that of neutrophils. A suggestion for lymphocytes margination and was positively correlated with the grade of splenomegaly. In enterica, neutrpenia is due to increase of their marginal pool, relative lymphocytosis may b due to decrease of their margination. The maximum increase of lymphocytes after adrenaline injection was lower than of neutrophils

Immunoglobulin E in some intestinal parasitic infections

48 patients and 10 control subjects were studied. Their ages ranged from 6.5-60 years. 15 patients were bilharzial; 10 non ascitic and 5 ascitic; 9 patients with ascariasis; 6 patients with oxyuris, 6 withgiradiasis; 6 with H. nana and 6 patients with trichostrongyloides. The control group consisted of 10 apparently normal subjects. All cases were subjected ta thorough history taking, clinical examination, urine and stool analyses, sigmoidoscopy and mucosal biopsy, complete blood picture, ESR and immunoglobin E estimation. There was significant increase in IgE levels in all parasitic infections except in H. nana group. The highly significant elevation was found in ascariasis and bilharzial group [specially the non ascitic cases]. The triad of anemia, raised ESR and high level of IgE may be a feature of some parasitic infections; namely bilharziasrs, ascariasis, oxyuriasis and trichostrongyloides. IgE estimation may be a useful parameter in the diagnosis and follow up of cases with bilharziasis as well as other parasites, higher levels being obtained with ascariasis [which can be excluded by stool analysis] and bilharzial cases where diagnosis is sometimes difficult. As individual parasitic infections were found to raise IgE level, it is expected that mixed parasitic infestations may raise IgE and this may be of diagnostic value and usefulness in follow up of these infections

Neutrqphils phagocytic power in chronic asthmatic bronchitis and pulmonary tuberculosis

This work comprised 16 and 14 tuberculous patients in addition to 16 healthy control subjects. All cases were submitted to full history taking, thorugh clinical examination, x-ray chest, laboratory investigations including: urine analysis, stool analysis, blood picture, E.S.R., serum creatinine and post prandial .blood sugar. Sputum smear with Ziehl Neelsens and sputum culture and sensitivty test. Estimation of serum IgA, G, Mi and C[3], and determination of the phagocytic power of neutrophils. The asthmatic and control groups were subjected to pulmonary function tests. The results revealed: mild anaemia with normal leucocytic count in both groups. The phagocytic power of neutrophils was markedly depressed in all patients which is mainly due to cellular defect, rather than humoral as there is normal serum IgA and C[3] and elevated IgM and IgG. The only specification in tuberculous group is elevation of C[3] with no difference in phagocytic power among sputum positive and negative subgroups