ABSTRACT
Background: The coexistence of Wilson’s disease and autoimmune liver disease in a same patient is a rare entity. Combined treatment with steroid and D-penicillamine may be effective. Aim of the study was analyse the clinical, histological, laboratory profile for patients with chronic liver disease with aim of finding the etiology of the disease.Methods: It is an observational study. Common clinical presentations were evaluated. Laboratory investigations done include complete blood count, renal and liver function tests, prothrombin time, viral markers for hepatitis A, B, C and E, USG abdomen and pelvis, portal Doppler studies and upper GI endoscopy. Specific tests include ANA, AMA, ASMA, Anti LKM-1Ab, serum ceruloplasmin and 24hrs urinary copper were done. Liver biopsy was done in selected patients.Results: Commonest clinical presentation was abdominal distension (80%), abdominal pain (30%), pedal edema (60%), splenomegaly (40%) and upper GI bleed (40%). Laboratory investigation revealed anemia (50%), thrombocytopenia (70%), prothrombin time prolongation in (60%), normal liver function in 60%, abnormal liver function in (40%). Autoimmune markers revealed ANA strong positivity in (40%), mild positivity in (60%). AMA, ASMA, Anti-LKM-1 were negative in all cases (100%). Liver biopsy showed features of autoimmune liver disease and Periportal copper deposition in 80% of cases.Conclusions: Coexistence of Wilson’s disease and autoimmune liver disease is a rare entity and medical treatment with steroids and D-penicillamine simultaneously to be started in these patients.
ABSTRACT
Background: Tumors of the biliary tract show spectrum ranging from benign to malignant lesions. Only 20% of tumors are resectable at the time of presentation. The operative mortality was approximately 5 to 20%. The morbidity rate associated with the surgery is approximately 65%. Options for palliative therapy of biliary tree obstruction include the surgical bypass, percutaneous external drainage/stenting and endoscopic stenting. The aim was to compare the survival pattern of patients treated with biliary Self Expandable Metallic Stents (SEMS) as a palliative procedure to that of patients treated by curative surgery.Methods: This was a retrospective study. 6-months survival pattern were analysed in 20 patients treated by SEMS and compared with that of 10 patients treated with plastic biliary stents followed by curative surgery.Results: Survival pattern analysis was done for all 20 patients with SEMS. 7 patients were in >1-year survival, 5 were in >6months survival, 6 expired within 6months, 2 patients were lost to follow up. Survival pattern was compared with 10 patients who had plastic stents followed by curative surgery. Only 1 patient had survival rate >1year post-surgery, 5 patients expired post-surgery in <6months, 2 patients expired few weeks after plastic stent deployment, 2 patients were lost to follow up.Conclusions: In patients with biliary malignancies with obstruction, biliary SEMS followed up by palliative chemotherapy had better survival rate than patients who had plastic stents followed up with curative surgical procedures.