Comparative study of primary and secondary prevention of bleeding oesophgeal varices

This study included 302 patients with liver cirrhosis and esophageal varices who were classified into five groups; two groups of primary prophylaxis and three groups of secondary prophylaxis. The first group was under propranolol therapy [88 patients] and the second group was the control group [62 patients] with a mean age of 49 years and the mean follow up period was 2.97 +/- 1.88 years for the former and 2.35 +/- 1.1 years for the latter. It was concluded that propranolol is an effective treatment in primary prophylaxis as it decreases the rate of bleeding while increases the need for and the amount of blood transfusion. Also, this study supported the long-term use of propranolol plus endoscopic sclerotherapy for secondary prevention of bleeding esophageal varices

Familial clustering of asymptomatic carriers of HBs Ag and patients with chronic liver diseases or primary liver cancer

Fifty subjects who represented the first degree relatives of 20 patients with hepatocellular carcinoma [HCC], were examined clinically, by real time ultrasonography and serologically for HBsAg and serum alfa-fetoprotein level. HBsAg was positive in 11 patients with HCC. Among their relatives, the percentage of HBsAg-positivity was 24% [12 out of 50] which was significantly higher [P < 0.01] than in the control group. The ultrasonographic picture in eight of the relatives [16%] was suggestive of liver cirrhosis. One of them had-in addition to liver cirrhosis multiple hypoechoic focal lesions which proved pathologically to be HCC. AFP level was abnormally high in 9 of the relatives [18%]. In one who proved to have HCC, the level was > 500 ng/ml. Three females were pregnant in the 1st trimester and another 2 cases were cirrhotic and positive for HBsAg. The difference was statistically insignificant in comparison with the control group in whom one had abnormal AFP. One may conclude that relatives of HCC patients are at risk of developing chronic liver disease and/or HCC. We suggest that relatives of HCC patients must be examined and followed up particularly those who are positive for HBsAg

Endoscopic and histopathologic changes in the proximal intestine in adult patients with chronic diarrhoea

This study comprises a group of 24 cases with chronic or recurrent diarrhoea who were admitted to the Department of Tropical Medicine, Assiut University Hospital. Upper endoscopy demonstrated subtle [in 17 cases] to gross [in 7 cases] changes. Cases with chronic diarrhoea and normal endoscopic findings were not included in the report. Hisotpathologic examination revealed abnormalities in villous architecture as well as the cellular components of the lamina propria in the 7 cases with gross endoscopic changes and in another 7 cases with subtle changes. The final diagnosis in these 14 cases were T.B. enteritis [11 cases], intestinal lymphoma [2 case] and coeliac disease [1 case]. Chronic non specific cellular infiltration in the lamina propria was detected in 6 cases and mild eosinophilic infiltration in another 2 cases, all 8 had mild jejunal mucosal hyperaemia. Diarrhoea was attributed to liver cirrhosis in the former cases and to amoebiasis in the other 2 cases. There remains 2 cases with mild jejunal mucosal hyperaemia that had normal histologic appearance of the jejunal mucosa and the aetiology of diarrhoea was difficult to settle save, being an associate to-irritable bowel syndrome. The use of sterilized peroral colonoscope helped in diagnosis of upper intestinal lesions, allow for biopsy and brought to light the aetiology in most cases with chronic diarrhoea in adults. The contribution of histopathology was indispensable