Autologous Stem Cells Transplantation in Egyptian Patients with Liver Cirrhosis on Top of Hepatitis C Virus

BACKGROUND AND OBJECTIVES: Use of pluripotent stem cells is an ideal solution for liver insufficiencies. This work aims is to evaluate the safety and feasibility of autologous stem cells transplantation (SCT) in Egyptian patients of liver cirrhosis on top of hepatitis C virus (HCV). SUBJECTS AND RESULTS: 20 patients with HCV induced liver cirrhosis were divided into 2 groups. Group I: included 10 patients with liver cirrhosis Child score > or =9, for whom autologous stem cell transplantation was done using granulocyte colony stimulating factor (G-CSF) for stem cells mobilization. Separation and collection of the peripheral blood stem cells was done by leukapheresis. G-CSF mobilized peripheral blood mononuclear cells (G-CSF PB-MNCs) were counted by flow cytometry. Stem cell injection into the hepatic artery was done. Group II: included 10 patients with HCV induced liver cirrhosis as a control group. Follow up and comparison between both groups were done over a follow up period of 6 months. The procedure was well tolerated. Mobilization was successful and the total number of G-CSF PB-MNCs in the harvests ranged from 25x106 to 191x106. There was improvement in the quality of life, serum albumin, total bilirubin, liver enzymes and the Child-Pugh score of group I over the first two-three months after the procedure. CONCLUSION: SCT in HCV induced liver cirrhosis is a safe procedure. It can improve the quality of life and hepatic functions transiently with no effect on the life expectancy or the fate of the liver cirrhosis.

Comparative study between endoscopic band ligation, alcohol injection and cyanoacrylate injection in management of gastric varices

Haemorrhage from gastric varices [GV] is a serious complication of portal hypertension. The role of endoscopy in the management of gastric varices is still controversial, but the efficacy in management of bleeding oesophageal varices has been greatly enhanced, so, rebleeding rate has been reduced by injection sclerotherapy or band ligation. On the other hand, the management of gastric varices is still a great challenge for endoscopists as traditional methods as vasoconstrictors and balloon tamponade don't effectively reduce the rebleeding rate. The aim of our work was to compare three different endoscopic methods in the management of type I and II gastric varices: [I] gastric variceal obturation using cyanoacrylate, [II] gastric variceal sclerotherapy using absolute alcohol and [III] gastric variceal ligation by rubber [O] bands. The comparison regards the technical ease, efficacy, complications and number of sessions needed to eradicate varices. To fulfill this aim we studied 60 patients with chronic liver disease and gastric varices presented to the central endoscopy unit Ain Shams University Hospital. The patients were categorized into [3] groups: Group I included 20 patients who underwent GV obturation using cyanoacrylate, group II included 20 patients who underwent GV sclerotherapy using alcohol injection, and group III included 20 patients who underwent GV band ligation. All patients were age and sex matched. We excluded patients with type III GV, hepatic encephalopathy, hepatocellular carcinoma and prior history of sclerotherapy, band ligation or shunt operation. Our results showed that, cyanoacrylate obturation of gastric varices was more effective in controlling gastric variceal bleeding than other methods with low number of sessions and low rebleeding rate than G.V. Ligation or alcohol injection. So we conclude that gastric variceal obturation by cyanoacrylate proved more effective and safer than gastric variceal ligation or injection sclerotherapy using absolute alcohol in the management of type I and II gastric varices

Effect of length of oesophageal stump on postoperative gastro-oesophageal function after resection of lower oesophageal carcinoma

Oesophageal carcinoma is not uncommon. One common goal of curative and palliative resection of oesophageal carcinoma is to achieve good functional outcome. During the last decade, Ivor Lewis operation with intrathoracic oesophagogastric anastomosis has been rising as the operation of choice for lower oesophageal carcinoma. It is wdl known that no oesophageal substitute is able to function as proper as the original organ, the peristalsis of which is essential to propel food into the gastric reservoir. Many authors think that the greater the length of the remaining oesophageal stump the better the postoperative functional outcome. The aim of this work was to evaluate the functional outcome after Ivor Lewis oesophagectomy and gastric pull-up for oesophageal cancer and to correlate the results with the length of the preserved oesophageal stump. Twenty patients [15 males, mean age 60 ys] were studied at the sixth postoperative month by questionnaire, stationary manometry and upper GI endoscopy. The commonest postoperative unpleasant complaints were early postprandial sensation of fullness [70%], diarrhea [40%] and gastrooesophageal reflux disease [GORD] [40%]. GORD was more profound in the left lateral position. According to the actual site of the oesophago-gastric anastomosis away from the central incisors as seen during endoscopy, patients were classified into 2 groups: High anastomosis group [A] with anastomosis lying less than 25cm from the central incisors [i.e. the anatomical length of the oesophageal stump < 10 cm] and low anastomosis group [B] with anastomosis lying at or below 25cm from the central incisors [ie. the anatomical length of the oesophageal stump >/= 10 cm]. It has been found that in low anastomosis group, there was a significant difference between the anatomical length of oesophageal stump and the functional length [as measured by manometry]. Patients in low anastomosis group had significantly better postoperative oesophageal body functions as revealed by better mean peristaltic pressure amplitudes [37 mmHg in group B versus 20.1 mmHg in group A, P < 0.05], better duration of contractions [2.11 sec. in group B versus 1.62 sec. in group A, P < 0.05] and better propagation velocity of the muscular contractions [2.7 mm/sec, in group B versus 2.01 mm/sec, in group A, P < 0.05]. This was reflected clinically by significant increase in body weight and significantly higher proportion of patients regaining their normal preoperative body weight in the low anastomosis group. It has been concluded that, provided oncological rules are not breached, Ivor Lewis operation with low intrathoracic anastomosis gives better functional outcome than high anastomosis in patients with lower oesophageal carcinoma

Early effects of esophageal injection sclerotherapy and band ligation on coagulation and bleeding profile

The present study was performed with the aim of comparing the systemic coagulopathy and bleeding profile following endoscopic variceal sclerotherapy with 5% ethanolamine oleate versus that following band ligation, where they were estimated just before then one hour and 2 hours after the procedure. Twenty patients were randomly allocated into two groups, the ligation group [10 patients],with a mean age of [48.5 +/- 10.9 years] and the sclerotherapy group [10 patients],with a mean age of 44 +/- 8.5 years. In the ligation group, no statistically significant differences were obtained on comparing coagulation and bleeding parameters through out the study time.As regards the sclerotherapy group, on comparing these parameters one hour after the procedure to those just before it, there were significant decrease in platelet count, factor VIII concentration, prothrombin concentration and significant prolongation of prothrombin time, partial thromboplastin time. Non significant results were obtained on comparing the tested parameters 2 hours after the procedure with those one hour after it. While on comparing parameters 2 hours after sclerotherapy to those just before it, there were significant changes of the same parameters changed before, denoting that these changes occuring one hour after sclerotherapy are maintained till the second hour. On comparing both groups of patients with each other, regarding parameters one hour after the procedure to those just before it and also 2 hours after the procedure to those just before it, there were significant prolongation of prothrombin time, partial thromboplastin time and highly significant decrease in prothrombin concentration in the sclerotherapy group. In conclusion, only the group of patients undergoing elective intravariceal sclerotherapy using 5% ethanolamine oleate, showed mild changes in the coagulation and bleeding profile. These changes were found one hour after the procedure and were maintained up to the second hour. Thus, endoscopic variceal ligation appears to be a technique of less negative impact on coagulation and bleeding profiles when compared with sclerotherapy and may be considered as the procedure of choice for treatment of bleeding esophageal varices especially in patients with marked thrombocytopenia and coagulation abnormalities, because in such patients scierotherapy might worsen the preexisting coagulation abnormalities and precipitated haemorrhagic complication

Is gastric emptying altered in obesity? A real-time ultrasonographic assessment

In this study, real-time ultrasonography was used to estimate the rate of gastric emptying both in 30 obese and 20 non-obese healthy Egyptians. All were subjected to full history taking, thorough clinical examination and blood glucose estimation to exclude diabetes mellitus. Body mass index and skin fold were also measured. Abdominal ultrasonography was also done with measurement of the gastric emptying rate after giving 500 ml of fresh tap water. The study showed no significant difference in the half gastric emptying time between obese and non-obese. The mean cross sectional areas of the gastric antrum also showed no significant difference between both groups. It is concluded that gastric emptying rate is not altered in obesity and has no role in its pathogenesis and hence in its treatment. This means that the drugs acting locally on the stomach, by modifying the rate of its emptying, are of no value in the treatment of obesity