Assessment of esophageal motility disorders in chronic renal failure

In patients with chronic renal failure [CRF] anorexia, nausea, and vomiting are common yet poorly understood symptoms. The study aimed to examine motor function disturbances of the esophagus as well as modulating hormonal factors and its effect on nutritional status in patients with [CRF] .We studied 50 patients stratified into 3 groups: G1: 25 patients with [CRF], on hemodialysis, G2: 25 patients with [CRF], on conservative treatment and G3: ten subjects with abnormal upper GI. Manifestations, but with normal renal functions. S. gastrin and S. albumin were examined in all groups and esophageal manometric assay was done for all. At presentation G1: showed the presence of elevated lower esophageal sphincter pressure and incomplete lower sphincter relaxation with elevated residual pressure on relaxation associated with low percentage of relaxation on wet swallows. In addition to a high amplitude and prolonged duration of esophageal contractions as compared to G3, this was associated with hypergastrinemia and low S. albumin. Moreover G2: showed the same results as for G1, plus a high percentage of uncoordinated contractions as compared to G3, but it lacks high amplitude and prolonged duration of esophageal contractions . We conclude that esophageal motility abnormalities and elevated serum gastrin may be a consequence of [CRF], in addition, elevated serum gastrin may play an important role in initiating these abnormalities and that esophageal manometry should thus be considered for patients with CRF presenting with gastrointestinal upsets

Virtual colonoscopy as a new diagnostic tool in cancer colon

Virtual reality imaging is a new technology that combines helical computed tomography and magnetic resonance [MR] data and advanced three-dimensional graphics software to generate endoluminal perspective images of hollow organs. Computed tomography colonography [Virtual colonoscopy] is an imaging procedure in which a series of helical CT scans of the patient's colon are rendered by computer into slices that can be visualized as serially combined images to provide a three-dimentional tour of the colon. So, this technique has been evaluated, mostly conducted in diagnostic [rather than screening] setting in higher-risk patients. In this work, we try to evaluate the sensitivity and accuracy of virtual colonoscopy as a new modality for colorectal evaluation in patients subjected to traditional colonoscopy and double-contrast barium enema study who are diagnosed as having cancer colon and to correlate the findings of virtual colonoscopy with those of conventional colonoscopy and barium study. This work was conducted on twenty [20] patients, selected among 91 patients of different colonic illness admitted in Mansoura and Banha Gastroenterology Centers. They were thirteen [13] males and seven [7] females with age ranging form 49-75 years; mean age [59.5 +/- 8.6] years. All patients were subjected to complete medical history, thorough clinical examination, routine laboratory tests and special laboratory investigations as carcino-embryonic antigen [CEA] and occult blood in stool. Abdominal ultrasonography, barium double-contrast enema, traditional colonoscopy and virtual colonoscopy were done for all patients. Colonoscopic biopsies were obtained as routine in every case in addition to biopsy from any suspected areas or detected masses. Histopathological examination was done also for every sample. From this study, we concluded that CT colonography [Virtual Colonoscopy] is feasible for the detection of colorectal cancer with high success in sizes more than 10mm and further technical advances will improve the performance of CT colonoscopy and will allow patients available imaging modality for full structural examination of the colon

Serum matrix metalloproteinase-2 in patients with chronic hepatitis C and hepatocellular carcinoma

The present study aimed to examine the possible involvement of matrix metalloproteinase-2 [MMP-2] in the development of liver diseases caused by HCV infection. The serum activities of MMP-2 enzyme were studied by enzyme immunoassay [EIA] in sera from patients with HCV and HCC on the top of HCV. This study included 46 Egyptian patients presenting with either chronic hepatitis C infection [HCV] or hepatocellular carcinoma [HCC]. Eighteen subjects were included as a control group. The serum levels of MMP-2 were found to be significantly higher in both patient groups as compared with the control group. However, there was no significant difference between HCV and HCC patient groups. There was a significant positive correlation between the serum levels of MMP-2 and the severity of the liver disease as shown in its significant relationship with other liver function tests, but no correlation was found with alpha fetoprotein [ALP] levels

Bleeding tendency in liver cirrhosis: Is there a role for vascular endothelial growth factor

Liver cirrhosis [LC] represents a very special and important problem in Egypt because of endemicity of bilhareziasis and its complications. Patients with liver cirrhosis have high bleeding tendency and they may develop petechies, ecchymosis, gastrointestinal bleeding, bleeding gum, epistaxis.etc. Many factors are proposed to explain this bleeding tendency in liver cirrhosis of which platelets abnormalities and alterations of both coagulation and fibrinolytic systems are the most appreciable. Epistaxis is one of the presentation of patients with liver cirrhosis. Nasal mucosal changes were found to be extensive in liver cirrhosis and these changes could not be explained upon the mentioned bleeding abnormalities only. A further pathogenic factor controlling angiogenesis may be added. Vascular Endothelial Growth Factor [VEGF] was claimed to take a part in this situation as it is one of the most important angiogenetic factors in the body. Our study focused to clear up the clinical significant of serum level of VEGF and possible nasal mucosal changes [NMC] as an example for bleeding tendency in such patients. The study included 45 patients with LC and 20 healthy controls. Patients are classified according to Child classification into three groups. Bleeding tendency in the form of epistaxis was the main complaint in a good ratio of patients and it was found to be correlated with vascular nasal changes even in patients with normal bleeding profile in those patients. Serum level of VEGF was directly proportional to the staging of L.C. Our results suggest that VEGF may have a significant new possible role for bleeding tendency in patients with L.C. as shown from its more expression and significant effect on nasal mucoas and submucosa in the form of organization, vascularization and other changes of nasal granulation tissues of those patients. These changes were found to be more and more with progression of the disease

Virtual colonoscopy in ulcerative colitis: a comparative study

Ulcerative colitis [UC] is an inflammatory disease of the colon and rectum. Many investigations are put for diagnosis and follow up of its course and complications. Virtual reality imaging is a new technology that combines helical computed tomography, magnetic resonance [MR] data and advanced three-dimensional graphics software to generate endoluminal perspective images of hollow organs.Computed tomography colonography [Virtual colonoscopy] is an imaging procedure in which a series of helical CT scans of the patient's colon are rendered by computer into slices that can be visualized as serially combined images to provide a three-dimensional tour of the colon. In this work, we try to evaluate the sensitivity and accuracy of virtual colonoscopy as a new modality for colorectal evaluation in patients who had been subjected to traditional colonoscopy and double-contrast barium enema study and who were diagnosed as having a chronic intermittent ulcerative colitis disease and to correlate the findings of virtual colonoscopy with those of conventional colonoscopy and barium study. This work was conducted on eighteen [18] patients admitted to Banha Gastroenterology unit. They were ten [10] males and eight [8] females with age ranging form 19-41 years; mean age [28.1 +/- 11.5] years. All patients were subjected to complete medical history, thorough clinical examination, routine laboratory tests and special laboratory investigations as carcinoembryonic antigen [CEA] and occult blood in stool. Abdominal ultrasonography, barium double-contrast enema, traditional colonoscopy and virtual colonoscopy were clone for all patients. Colonoscopic biopsies were obtained as a routine in every case. In our study, traditional colonoscopy gave positive data in 100.0%, while virtual colonoscopy gave positive results in 61.1% and barium enema gave positivity in 55.6%. Characteristic features of ulcerative colitis were evident on the 2-D images and the 3-D endoluminal and extraluminal images obtained by virtual colonoscope. From this study, we concluded that CT colonography [Virtual Colonoscopy] is a non invasive procedure feasible lor follow up of ulcerative colitis and could be used to monitor the extent of intestinal inflammations as well as possible complications such as malignant changes, strictures or stenosis in most patients. Further technical advances will improve the performance of CT colonoscopy and will allow patients available imaging modality for full structural changes of the colon

HLA typing in patients with chronic active hepatitis C

Hepatitis C virus infection played the major role in the causation of chronic liver disease in Egypt. Schistosomal patients are considered a high-risk people contributing to hepatitis B, C infection or both. The outcome of hepatitis C virus infection is known to be highly variable and is determined largely by the host immune response, which is in turn restricted by the products encoded by the major histocompatibility complex [MHC]. The principle reasons for discrepancies in the HLA typing results are likely to be disease heterogenecity, racial differences in the distribution of HLA alleles between populations, and in some cases, low number of patients studied. Our present study was carried out on 30 healthy anti-HCV-negative controls, 30 cases of CPH and 30 cases of CAH diagnosed by the presence HCV-RNA by RT-PCR, and liver biopsy detect chronic active and chronic persistent hepatitis. The collected samples were analyzed for LFT, CBC, serum iron, AFP, HLA class I and II. The obtained results were analyzed statistically, and discussed briefly HLA-DR2 antigen was found to be frequently present in patients with CPH while HLA-DR3 antigen was found frequently present in patients with CAH

Chlamydia pneumoniae infection as a risk factor for coronary heart disease

Eighty male patients were selected for this study. Forty of them were diagnosed as having coronary artery disease [CAD] as documented by coronary angiography the remaining 40 patients were confirmed to have acute myocardial infarction. Twenty control healthy persons were included in the study. All sujects were studied by history, clinical examination and investigated for blood sugar, liver and renal function, lipid profile, plasma fibrinogen and chlamydia pneumoniae IgM and IgG. The results showed that C. pneumoniae IgG was statistically significantly higher in patients than control. On the other h and the distribution of IgM in studied cases was 10% in infarction cases and 2.5% in angina cases which are all non significant. As regard patients with other risk factors for coronary heart disease [CHD] in this study as diabetes mellitus, hypertension or high blood lipids, we found that there is no correlation with IgG sero positivity to C. pneumoniae in either angina or infarction groups

Fascioliasis among clinically suspected cases in Qualubia governorate

Two hundred cases complaining foum fever, pallor, right hypochondrial pain, jaundice and diarrhea either separately or in combinations, from Qualubia governorate were subjected to laboratory diagnosis for Fasciola infection using stool examination and ELSA using excretory/secretory [E/S] antigen. The prevalence of fascioliasis was found to range around 10.4% and 35% by stool examination and ELSA respectively. Individuals of all age groups are susceptible for infection, meanwhile, age group from 10 to 29 is more susceptible. Females are more susceptible to Fascioliasis than males [P < 0.05]. ELISA technique using E/S antigen is proved to be much more sensitive than conventionally used stool examination. Fascioliasis Is found to be not uncommon disease in Egypt and high Index of suspicion should be kept in mind of clinician for fascioliasis diagnosis