Role of CT virtual colonoscopy in diagnosis of colo-rectal neoplasms

Purpose: to assess the role of CT colonography [virtual colonoscopy] as a non-invasive imaging technique in detection and diagnosis of colorectal neoplasia using conventional colonoscopy and/or operative findings as a reference standard, as well as highlighting its advantages and possible pitfalls

Methods: sixty patients were examined by CT after standard bowel preparation, rectal insufflation and IV contrast injection. Imaging was performed in both supine and prone positions. Evaluation consisted of review of the transverse CT images, sagittal and coronal reformations and 3D endoluminal lmages. CT colonographic findings were correlated with standard conventional colonoscopic and/or operative findings

Results: Virtual colonoscopy correctly identified all 6 carcinomas [100%], 12 out of the 13 polyps that measured 10mm or more [92.3%], 19 of the 23 polyps that measured 6 - 9 mm [82.6%] and 28 out of 48 polyps that measured 5mm or less [58.3%]. There were 11 false positive findings of polyps by virtual colonoscopy and no false positive findings of cancer. Virtual colonoscopy also detected 35 incidental extracolonic findings in 25 patients while non were detected by conventional colonoscopy. 17 of the 24 patients who had no lesions during conventional colonoscopy were considered free of lesions by CT colonography yielding a per-patient specificity of 70.8%

Conclusion: CT colonography has high sensitivity for the detection of clinically important polyps and cancer as well as multiple advantages over conventional colonoscopy in imaging of colorectal neoplasms

Detection of helicobacter pylori infection among patients with sickle cell disease

Sickle-cell disease [SCD] is an inherited blood disorder characterized by red blood cells that assume an abnormal, rigid, sickle shape. Children with SCD are at an increased risk for certain bacterial infections. Helicobacter pylori [H. pylori] infection is usually acquired during childhood and manifested by recurrent abdominal pain. The prevalence of H. pylori infection in SCD is unknown, but patients may be at increased risk for H. pylori-induced Peptic ulcer disease and complications due to pre-existing anemia and increased non-steroidal anti-inflammatory drug use

Objectives: the aim of this study is to detect the association between H. pylori infection and recurrent abdominal pain in SCD patients

Subjects and Methods: this case -control study was undertaken for 24 SCD patients and 24 non-SCD patients attending the internal medicine outpatient clinics and complaining from dyspepsia with/ or without recurrent abdominal pain. Each sample is tested for detection of H. pylori stool antigen using H. pylori Device. Infection was also diagnosed by using the I4c-urea breath test

Results: the rate of H. Pylori infection in SCD patients is 79.2 % compared to 54.2% in non SCD patients. There is statistically significant relation between H. pylori infection and recurrent abdominal pain among SCD patients

Conclusion: H. pylori infection can explain the recurrent abdominal pain in some cases of SCD patients

Role of western blotting in serological diagnosis of helicobacter pylori infection

Background: Helicobacter pylori [H.pylori ] is the key pathogen for gastroduodenal diseases. The clinical outcome of H.pylori infection is influenced by the presence of strain-specific virulence factors that are usually detected by the presence of specific anti-H.pylori antibodies in serum. Apart from the detection of these antibodies by enzyme-linked immunosorbent assay [ELISA], it is desirable to obtain additional information concerning the presence of certain virulence factors of H.pylori that could be detected by immunoblot analysis

Objective: the aim of this work was to evaluate if blotting can replace the need for invasive endoscopy for diagnosis of virulent H.pylori infection , compare between it and ELISA as serodiagnostic test, and to focus on identifying factors and markers that define high-risk patients in whom H.pylori infection needs to be eradicated

Subjects and Methods: 19 dyspeptic patients were subjected to upper gastrointestinal endoscopy to obtain antral biopsy, direct urease test and culture of biopsy on specific media . Sera were obtained from the patients for IgG examination by ELISA and western blotting

Results: Western blotting was more sensitive [100%] than ELISA [sensitivity 81.8%], but specificity was the same for both [87.5%]. Only western blotting was able to detect antibodies to virulence antigens especially cytotoxin associated antigen [CagA] and vacuolating cytotoxin antigen [VacA]

Conclusion: Western blotting is a highly sensitive noninvasive test to diagnose toxigenic H.pylori infection. So that unnecessary gastroscopy and treatment can be avoided

Plasma and hepatic tissue endothelin-1 levels in cirrhotic patients with and without bleeding varices

Bleeding from varices is the most lethal event in cirrhotic patients. Bleeding esophageal varices contributed to 51.6% of causes of upper gastrointestinal hemorrhage among Egyptians. The potent vasoconstrictive peptide, endothelin [ET] has been suggested to contribute to the pathogenesis of portal hypertension. So, the present study was designed to determine levels of both circulating ET-1 and hepatic tissue ET-1 in cirrhotic patients with and without bleeding varices. Patients suffering from liver cirrhosis, portal hypertension and upper gastrointestinal bleeding due to esophageal and/or gastric varices were included in the study. Patients who had liver cirrhosis but had never bled before were studied as a comparative group. All patients were classifed according to modified Child's classification. Esophago-gastro-dudenoscopy was done to all patients. Liver biopsy was done whenever possible. Material was divided for both histopathological examinations [using hematoxin and eosin stain] and detection of hepatic tissue ET-1. ELIZA determined plasma and tissue ET-1. Seventy-five subjects were included in this study [fifty bleeders from varices and 15 non-bleeders]. Age of patients ranged between 28 and 67 years with a mean of 45.1 +/- 8.5 years. Fifty-two were males and thirteen were females. Ten healthy controls with a mean age of 41.6 +/- 13.8 years had also been studied. They were 8 males and 2 females. There was a statistically significant increase in the level of plasma ET-1 in bleeder group [12.90 +/- 5.51] when compared to the non-bleeder group [7.50 +/- 2.52] [p< 0.05]. In the same time, there was a statistically significant increase in the level of hepatic tissue ET-1 in bleeder group [77.6 +/-14.03] when compared to the non-bleeder group [52 +/-10.56] [p< 0.05]. Plasma endothelin-1 level showed significant correlation with parameters of hepatic function. In conclusion, results demonstrated that plasma and hepatic tissue ET-1 might play an important role in the genesis of bleeding varices seen in advanced liver cirrhosis and portal hypertension