Effect transfusional of iron overload on hepatic fibrosis in Egyptian beta-thalassemia major patients

Multitransfused beta-thalassemia patients constitute a population with high prevalence of Hepatitis C virus [HCV] infection, because of transmission of HCV from infected blood donors. Increased hepatic iron is assumed to potentiate progression towards liver fibrosis in chronic HCV infection. The aim of the present work is to evaluate the potentiating effect of marked hepatic iron overload and chronic HCV infection on hepatic fibrosis in Thalassemia patients. Sixty eight patients, previously diagnosed to have homozygous beta-thalassemia and followed up at the Hematology Clinic of the New Children's Hospital of Cairo University [44 hepatitis C positive and 24 hepatitis C negative patients], were selected to participate in this study after signing a written informed consent. Their age ranged between 6 and 27 years with a mean age of 9.7 +/- 2.1 years and compared to a group of 42 non thalassemic chronic HCV patients whose age ranged between 7 and 27 years with a mean age of 10.9 +/- 1.5 years [control group]. Liver Biopsies were done for all patients for estimation of stage of hepatic fibrosis and liver iron content [LIC]. The results were then correlated to liver function tests and serum ferritin. The stage of fibrosis and LIC were significantly higher in beta-thalassemia patients than the non thalassemia HCV patients [p = 0.005, p<0.0001 respectively]. There was no significant difference between the two groups of thalassemia as regards staging of fibrosis. The degree of hepatic fibrosis was significantly correlated to the LIC in hepatitis negative thalassemic group while it was significantly correlated to serum ferritin in thalasemic patients with positive HCV. Hepatic iron overload has a potentiating effect on hepatic fibrogenesis in beta-thalassemia major. The proper use of chelating agents is of great importance in delaying progression of liver disease in these patients

Endoscopic management of bile duct strictures in kasr El Aini gastrointestinal endoscopy unit

Strictures of the biliary system may be benign or malignant, benign biliary strictures mostly occur as a result of surgical injury. Malignant strictures result from a neoplasm arising from the bile duct, ampulla of Vater, liver, gallbladder, or pancreas. Benign biliary strictures respond well after stenting with relief of cholangitis and jaundice. We aim by this study to evaluate the aetiology of Egyptian biliary strictures and the efficacy of its endoscopic management in Kasr El Aini Gastrointestinal Endoscopy Unit, Cairo University. Fifty patients with ERCP-confirmed biliary strictures [19 females and 31 males; age ranged 9-84 years with a mean of56.1 +/- 14.7 years] were included. Patients were subjected to routine laboratory investigations, abdominal ultrasonography, diagnostic and if possible therapeutic ERCP. The most common site of strictures was the distal; [52%], Hilar strictures followed [24%], the third common was mid CBD [14%.] Malignant strictures were present in [37/50; 74%] while benign strictures were present in 13/50 [26%]. The most common cause of malignant strictures was pancreatic carcinoma [15/37; 40.6%] followed by ampullary carcinoma [11/37; 29.7%] and cholangiocarcinoma [11/37; 29.7%]. Endoscopic biliary plastic stenting was done in 80% of cases. Endoscopic biliary drainge is a very effective technique for biliary strictures. Plastic endoprostheses is an effective tool in these strictures beside its low cost.