Heme oxygenase-carbon monoxide system in patients with cirrhosis: relation to splanchnic hemodynamics

Carbon monoxide [CO], an end product of the heme-oxygnase [HO] pathway,is a potent vasodilator and an important modulator of vascular cell function. The present work was designed to study the HO-1/CO system in patients with cirrhosis in relation to severity of liver disease, blood viscosity and splanchnic haemodynamics. Plasma HO-1 levels and blood carboxyhaemoglobin [COHB] concentration,an index of CO production were measured in 30 patients with liver cirrhosis and variable degrees of hepatic dysfunction and in 15 healthy subjects as a controls group. Both patients and control were non smokers. Blood viscosity was measured using the red blood cell pipette viscometer. The blood volume of the portal vein,superior mesenteric artery and splenic artery as well as pusatility index of the arteries were measured using doppler ultrasonography. Plasma [HO-1] levels and blood carboxy haemoglobin concentration were significantly higher in patients with liver cirrhosis than in healthy subjects [p< 0.001]. Also, patients who had esophageal varices, history of bleeding varices, portal hypertensive gastropathy and ascites showed significant increase in HO-1/COHB levels compared with those who did not have these complications [p < 0.001]. The increases in plasma HO-1 level and COHB level showed positive correlation with Child-Pugh score, blood viscosity and the increases in the blood flow volume of the portal vein, superior mesenteric artery and splenic artery and inverse correlation with the decreases in the pulsatility index and the resistive index of the arteries in patients with liver cirrhosis [P< 0.05]. Increased HO-1 activity with enhanced endogenous CO generation may play a role in the development of splanchnic vasodilation and serious manifestations of portal hypertension in liver cirrhosis

Anti-Helicobacter antibodies and fasting gastrin concentrations in children with recurrent abdominal pain

Fifty children divided into 2 groups were studied. Group I included 30 children with non organic recurrent abdominal pain [RAP] as defined by Apley and Naish, aged 3.5-11.8 years. Group II [control group] consisted of 20 apparently healthy children with no gastrointestinal symptoms nor signs, aged 4 -10.5 years. All children were subjected to detailed history taking and thorough physical examination, urine and stool analysis, complete blood count and abdominal ultrasonography. Anti-Helicobacter IgG antibodies were investigated by immunoassay and fasting gastrin concentrations were measured using the Double Antibody Gastrin procedure for all children. In the present study, children with and without RAP were well matched for age and sex. The mean fasting gastrin concentration was not significantly related to RAP. Thirty percent [30%] of studied children with RAP were seropositive for H-pylori compared to 15% only of control children. In children seropositive for H. Pylori, there were no significant relations between sex, age and fasting gastrin concentration to occurrence of RAP. Similarly, the relation of sex, age and fasting gastrin concentration to occurrence of RAP was not significant among children seronegative for H. pylori. Evaluation of the differences between seropositive and seronegative children in our study showed that H. pylori infection increased fasting gastrin concentration by more than 100%. It could be concluded that H. pylori is a common infection in our children. It results in a marked rise of fasting gastrin with its possible clinicopathologic consequences. However, H. pylori infection and hypergastrinemia showed no significant causal relationship to RAP at the currently available clinical characteristics

Adrenomedullin level in cirrhotic rats: relationship with renal functions and some vasoconstrictors

Purpose: to assess the role of endothelial factors as adrenomedullin [AM] and nitric oxide [NO] in modulating intrahepatic circulation and the role of NO inhibitors. Also, to investigate their relationship with some renal functions and some vasoconstrictors as norepinephrine [NE] and plasma rennin activity [PRA]. a significant increase of AM levels, plasma and urinary No was observed at both groups of cirrhosis. They significantly declined upon No inhibition. The levels were significantly elevated at cirrhosis with ascites than without ascites. PRA significantly increased in both cirrhotic groups with ascites but insignificantly changed at cirrhotic groups without ascites. NE significantly increased at cirrhotic groups [group II and III]. Both NE and PRA significantly declined upon NG nitro L-argenine methylester [L-NAME] administration. AM levels were negatively correlated to mean arterial pressure [MAP] and glomerular filtration rate [GFR]. While it was positively correlated to NE levels, PRA, plasma and urinary NO metabolites, serum Na+ level and urinary sodium excretion [UnaV]. at cirrhosis, there were significantly increased circulating levels of AM, plasma and urinary NO which could be responsible for the arterial vasodilatation. The mechanism of AM effects could be due to NO release. There were increased levels of NE and PRA due to arterial underfilling which activates a baroreceptor mediated neurohumoral response to counterregulate the vasodilatation. NO inhibition revered haemodynamic changes associated with cirrhosis. This raises the possibility of using long term NO inhibition to correct complications associated with cirrhosis and Bilharzial hepatic fibrosis [BHF]

Partial splenectomy in the treatment of splenic lesions and disorders in infants and children

This study was carried out on 11 infants and children, ranging in age between 26 days and 8 years, with localized benign splenic lesion or splenic disorder indicated for splenectomy. They were one case of wandering spleen, 3 cases of traumatic rupture of the spleen, four cases of thalassemia, one case of Gaucher's disease and one case of splenic cyst. They were treated by partial splenectomy. Lower polar splenectomy was performed in 10 cases while upper polar splenectomy was performed in one case of splenic cyst. All patients passed a smooth post-operative course with no bleeding or life threatening infection. Complications occurred in only 3 cases, one case of traumatic rupture of the spleen suffered in the early post-operative period from atelectasis and left pleural effusion and was treated conservatively while two cases of thalassemia suffered from intra-abdominal collection. In the later two cases, the dexon mesh used to wrap the remaining part of the spleen was accused to invite infection. The platelet count was significantly higher in the early post-operative period [P< 0.001]. Three months later, the platelet count was comparable with preoperative value [P> 0.05]. There was no increase in the number of pitted cells, Howel-Jolly bodies or Heinz bodies in the early or late post-operative period. The pre-operative serum IgM and IgG levels did not significantly differ from their levels in the early and late postoperative periods [P> 0.05]. Tha-lassemic children showed post-operative decrease in transfusion requirements and increased hemoglobin levels. Thus the immunological and hematological functions of the spleen are preserved after partial splenectomy and hence partial splenectomy is considered safe and better alternative to total splenectomy in the treatment of splenic disorders and benign lesions to avoid life threatening infections

Glucose metabolism in chronic viral hepatitis B and C

There have been recently observed an association between chronic hepatitis C infection and diabetes mellitus. This association appears independent of impaired glucose tolerance oftenly observed in cirrhosis. In this study, 40% of patients with CHC had either overt diabetes mellitus [20%] or impaired glucose tolerance [20%]. Glucose tolerance was normal in all patients with CHB. We selected non-obese patients with no history of diabetes mellitus; and had no cirrhosis on liver pathology. The glucose intolerance or diabetic state in our cases may be due to the presence of insulin resistance; as we find a higher level of basal C-peptide, serum iron level and transferrin saturation in patients with CHC as compared to patients with CHB. The association of chronic hepatitis C and diabetes mellitus needs further evaluation