Serum alkaline phosphatase isoenzymes as a marker for liver disease

The activity of total alkaline phosphatase [total ALP] and its isoenzymes were examined in 10 healthy control subjects, 7 patients with chronic hepatitis, 11 patients with bilharzial hepatic fibrosis [BHF], 6 patients with obstructive jaundice, 7patients with primary liver cancer and 9 patients with liver metastasis by the methods of heat inactivation and cellulose acetate electrophoresis. Results showed a significantly higher mean values of total ALP and liver ALP in all patients in comparison to the control subjects, in obstructive jaundice in comparison to patients with chronic hepatitis BHF and in liver malignancy. Biliary ALP was not detected in healthy control subjects nor in patients with chronic hepatitis while it was present in 9% of patients with BHF, in 100% of patients with obstructive jaundice, in 57% of patients with hepatoma and in 89% of patients with liver metastasis. Intestinal ALP was not detected in patients with primary hepatic carcinoma while it was present in 20% of healthy control subjects, in 28% of patients with chronic hepatitis, in 36% of patients with BHF, in 50% of patients with obstructive jaundice and in 11.1% of patients with liver metastasis. In cases of obstructive jaundice and liver malignancy, there was a positive correlation between total ALP and both biliary ALP and GGT also between biliary ALP and GGT. These results demonstrated that ALP isoenzyme analysis are highly helpful in the characterization of hepatic disorders, and the biliary ALP isoenzyme is a good marker for the detection of liver malignancy and obstructive jaundice as well as it correlates significantly and positively with GGT in these patients

Circulating platelet aggregates indices and coagulation profile in pre-eclampsia

Variable hemostatic parameters were investigated in 30 preeclamptic women [classified into mild and severe cases] and in 15 normal healthy pregnant women. Each was subjected to the following: BT, CT, PT, PTT, FDPs, plasma fibrinogen platelet count and detection of circulating platelet aggregates indices. In cases of mild preeclampsia, a highly significant prolongation of BT, reduction of platelet count, increase in plasma fibrinogen, FDPs and decrease in the circulating platelet aggregates indices were found. In cases of severe preeclampsia, the following was detected: A highly significant prolongation of BT, CT, PTT, reduction in plasma fibrinogen level, platelet count and in the circulating platelet aggregates indices. Significant increase in FDPs and prolongation of PT were also found. In conclusion, increased circulating platelet aggregates indicating platelet hyperactivation were found in preeclampsia. Fibrinogen level was found to be the basic indicator for the degree of compensation in preeclampsia as most cases with low fibrinogen had a bleeding tendency

Glutathione and glutathione reductase in anaemia of malignancy

To verify the role of glutathione in the incidence of anaemia in malignancy, 56 subjects were admitted in this study and classified into 5 groups: 20 healthy subjects [group I], 10 patients with cancer urinary bladder [group II], 10 patients with cancer breast [group III], 10 patients with acute lymphoblastic leukaemia [A.L.L.] [group IV] and 6 patients with other different malignancies [group V]. All subjects were subjected to the following investigations: complete blood count [C.B.C.], reticulocyte count, determination of reduced and oxidized glutathione [G.S.H] and GSSG] in red cells and plasma, G.S.H. stability test, quantitative determination of glutathione reductase enzyme [G.R.] in red cells and plasma and quantitative determination of glucose 6-phosphate dehydrogenase [G-6PD]. Alteration in enzyme activity in plasma G.R. in A.L.L. cases and in various malignancies with or without chemotherapy was obtained. Plasma G.S.S. stability were elevated significantly in cases under chemotherapy. Another significant alteration was found in red cell G6PD in cases of A.L.L. and cancer cases receiving chemotherapy. We conclude from this study that the alterations found in malignancy may affect the state of anaemia. Oxidized glutathione [GSSG] could be used as a guide for prognosis in malignant cases as it was changed only after chemotherapy, together with glutathione stability [GSH stab.]

Some immunological studies in bilharzial splenectomized patients

One hundred patients suffering from Bilharzial splenomegaly and 50 patients of them performing splenectomy were studied as regards the changes in the leucocytic count, T-lymphocytes percent, the serum immunoglobulins [IgG, IgM, IgA] and the complement system [C[3], C[4]]. All patients in our series were investigated for Hepatitis B surface antigen and the results were correlated to the state of complement system [C[3]], C[4]]. The Bilharzial splenomegaly group [group Il] showed a highly significant increase of serum immunoglobulins in correlation to the normal healthy control group [group I]. The serum C[3], level in Bilharzial splenomegaly group was not significantly changed than the normal control group. However serum C[4] was significantly reduced. The total leucocytic counlt was significantly decreased in group [II] than group [I]. The absolute lymphocytic count was non significantly changed while percent E-rosette forming T-cells was highly significantly decreased in group II than group I. The splenectomized group [group III] exhibited a highly significant elevation of serum immunoglobulins [IgG, IgM only] in comparison to control group. The splenectomized patients showed a significant elevation of the complement system as well as leucocytic count and percent E-rosette forming T-cells in contrast to patient's group I. Post-splenectomy, the serum IgM was significantly decreased and percent E-rosette forming T-cells was highly significantly reduced than the preoperative values. Patients suffered from Bilharzial splenomegaly with positive Hepatitis B surface antigen [HBsAg] showed a highly significant reduction of the complement system C[3] Our study is aiming to give an idea about the effect of splenic schistosomiasis on the immunological profile and the changes that may occur after splenectomy. It is a common endemic disease in our country that needs a good evaluation for all its side effects in order to predict its complications pre and post-operatively. We advise to do the immunological profile before splenectomy in Bilharzial splenomegaly and to preserve the spleen whenever possible in order to maintain its major function for the body immune defensive mechanisms both the cellular and humoral types

Peritonitis among peritoneal dialyzed patients

Peritonitis is the main complication of peritoneal dialysis and it is still a great source of morbidity. Most infections are caused by skin commensals and it is suspected that most episodes are secondary to a breakdown in technique. Thirty patients of end stage renal failure who were undergoing continuous ambulatory peritoneal dialysis [CAPD] in Zagazig University Hospital, at the period from January to July 1990, were subjected to bacteriological examination of peritoneal fluid, They were divided into two groups. Group [1] included 15 patients without peritonitis and group [Il] included 15 patients with peritonitis. This study revealed a significant increase of the total leucocytic count and neutrophilic predominance [among group [Il] compared to group [I], representing t= 3.6 and 7.07 respectively and P<0.01], Other studied parameters as peritoneal fluid glucose and chloride, serum creatinine and urea showed nonsignificant changes P>0.05. The episodes of peritonitis were caused by Gram positive bacteria in 92.3% of which 53.3% were due to Staphylococcus epidermidis, 20% Staphylococcus auerus and 6.6% Diphtheroids species. While Gram negative organisms accounted for 30.8% of total infections, E.coli [13.3%], each Klebsiella and Citrobacter accounted for [6.6%]. There were two episodes [13.3%] of all cases, their cultures were negative and in another two cases [13.3%] there were fungal isoletes Amikacin, cefotaxime and rifampicin were the most effective antibiotics used in antibiotic sensitivity testing while the least effective antibiotics were ampicillin, carbenicillin and chloramphenicol. From this study, strict aseptic procedures and a well trained team for continuous ambulatory peritoneal dialysis exchange, should be recommended to decrease the occurrence of peritonitis