ABSTRACT
Neonatal cholestasis still presents a diagnostic challenge, both from the anatomical and etiologic points of view. Distinguishing intrahepatic from extrahepatic causes of cholestasis is of paramount importance since the latter may be treated by surgery but prognosis depends on the age at which operation is performed. Many tests have been proposed to help in differentiating these two entities, among which are the abdominal ultrasonography [US], magnetic resonance cholangiography [MR cholangiography] and liver biopsy. The aim of this work is to evaluate the usefulness of these methods in the differential diagnosis of neonatal cholestasis. Fifty three patients with neonatal cholestasis were evaluated prospectively through history taking, laboratory investigations, abdominal ultrasound, MR cholangiography in 10 patients, and needle liver biopsy. The collected data were compared to that of the final diagnosis. The final diagnosis was reached through the operative findings, the histodiagnosis of the excised specimens or the clinical course of the disease. Thirty patients were found to have extrahepatic cholestasis [all with biliary atresia] and 23 patients with intrahepatic cholestasis. Sensitivity was 80% for ultrasonography and 90% for liver biopsy in diagnosing extrahepatic cholestasis. Specificity was 83% for ultrasonography and 100% for liver biopsy. Accuracy was 81% for ultrasonography and 94.3% for liver biopsy. Accuracy was 92.4% when both tests were considered together. Biliary atresia was suspected in 5/10 patients by MR cholangiography, but one of them was having sclerosing cholangitis, while another one showed atresia involving only one part of the extrahepatic bile duct [EHBD]. Based on these findings we strongly recommend ultrasonography with definite criteria as the initial investigation tool in the management of neonatal cholestasis, associated with liver biopsy. The use of MR cholangiography in diagnosis of biliary atresia has certain limitations according to its type
ABSTRACT
Background: The liver is the main site where most of glucose metabolic processes take place. It is suspected that partial hepatectomy will alter the glucose homeostasis, so it is mandatory to study the effect of partial hepatectomy on the glucose metabolism. Introduction: the liver exerts multiple complex metabolic functions. Partial hepatectomy, reduces the functioning liver cell mass. The body responds to surgery both locally and generally. The general one includes endocrinal and metabolic response
Aim of the Work: To determine the effect of partial hepatectomy on the glucose metabolism, by performing Glucose tolerance curve
Materials and Methods: 32 rats were included in this work, divided into 4 groups, 8 rats per each [5 were subjected to actual resection and 3 were subjected to sham operation]. First group: glucose tolerance curve [GTC] was done 24 hours after hepatectomy, 2[nd] group the GTC was done 48 hours after hepatectomy, 3[rd] group the GTC was done 72 hours after hepatectomy, and 4[th] group the GTC was done 96 hours after hepatectomy. Two blood samples were taken, pre-operative and post-operative, for determination of blood sugar and liver enzymes. For determination of the GTC, blood glucose was determined 4 times: at [0] time fasting sample, then [1/2 an hour] after an oral glucose meal then at [1 1/2 hours] and at [2 1/2 hours]
Results: There was weight loss in the post-operative period in various groups, that was minimal [8 grams] in the 1[st] group, and maximal [13 grams] in the 4[th] group. The resected segments varied from 30% to 60% of the whole liver mass. The mean liver weight was 3.67% of the whole body weight. In the P.O. period there was elevation of the ALT and AST, which was greater in the 1[st] group and least in the 4[th] group. There was low grade hyperglycemia, and the blood glucose level failed to return to baseline, 2 1/2 hours after the oral meal, in all groups. There were slight changes in the level of the B. sugar between various groups and between the individuals of each group, but not to the significant level
Conclusion: There was postoperative glucose intolerance manifested by low grade hyperglycemia in the early postoperative period with mild diabetic curve despite the reduced functional liver cell mass
ABSTRACT
Background: Pancreas is a deeply seated organ and difficult to investigate. Many studies have appeared comparing Endoscopic Ultrasonography [EUS] with various other pancreatic imaging techniques, and proved that [EUS] has emerged as the most accurate single test for imaging pancreatic disease
Introduction: Many investigators proved that EUS was superior to other investigation modalities, and could be used both as conventional and interventional modality. EUS is capable of evaluating and integrating: mucosal, vascular, ductal and parenchymal abnormalities caused by disease. To obtain information about these 4 types of abnormalities; 4 separate tests are often required: endoscopy for mucosa, venogram or arteriogram for veins and arteries. ERCP for ducts: and CT scan or standard US for parenchyma and lymph nodes
Aim of the Work: To evaluate the value of EUS in pre-operative assessment of pancreatic lesions
Patients and Methods: Thirty patients were included in this study, all of them were diagnostically problematic. All had symptoms related to pancreato-biliary disease, but had either no diagnosis after conventional studies, or probable malignancy with uncertain tumor stage or resection status. All of them were subjected to EUS examination in addition to full clinical examination, laboratory investigations and other imaging modalities [U/S, spiral CT and ERCP]. The imaging findings were compared with both operative and histopathological findings for tumor status and vascular involvement
Results: male to female ratio was 3:2, with high frequency in the age group of 65- years. In diagnosis of pancreatic cancer EUS was able to detect mass that coincide with operative findings and histopathology in 80% of the cases, as compared with US [28 %] and CT [48 %]. In pancreatic cysts, EUS was as sensitive as both US and CT., while in chronic pancreatitis, EUS was more sensitive [100%] than both CT [66%] and US [0%]. EUS was superior to spiral CT in diagnosis of vascular invasion [8 versus 4 respectively], while CT was superior in detecting lymph node involvement [4 versus 8 respectively]
Conclusion: EUS is a good partially invasive modality, more sensitive than other imaging modalities in diagnosis of pancreatic lesions particularly those less than 3 cm in diameter. It can detect chronic pancreatitis in patients where other tests have not shown diagnostic findings. It can predict the unresectable cases and then preclude unnecessary exploration, and so prevent the morbidity and the cost of an unnecessary surgical procedure