Diagnostic evaluation of hepatopulmonary syndrome in egyptian children with chronic liver disease

There are few data on prevalence of hepatopulmonary syndrome [HPS] in children with chronic liver disease [CLD]. This prospective study evaluated the prevalence and diagnostic procedures of HPS in Egyptian children with CLD. One hundred twenty [120] children with CLD were subjected to room-air pulse oximetry in supine and upright position, contrast enhanced echocardiography [CEE] and technetium-99m-labeled macroaggregated albumin [99m]Tc-MAA] perfusion lung scan. Arterial blood gas [ABG] analysis in upright position was performed for all children with identified intrapulmonary vascular dilatation [IPVD]. Clinical, laboratory, imaging and endoscopic data were recorded and analyzed. Hypoxemia was found in 14 cases [11.7%] of the total cohort all of them had IPVD, whereas 6 cases [5%] of the patients had EPVD without hypoxemia. Therefore, HPS and subclinical HPS were diagnosed in 11.7% and 5% of CLD patients, respectively. Only 10 HPS patients had a pathological arterial oxygen saturation [SaOi] in the supine position [<97%] but all showed a pathological SaO[2] decrease [>4%] after changing from supine to upright position.[99m]Tc-MAA perfusion lung scan revealed IPVD in 16.7% whereas CEE detected IPVD in 10% only of enrolled patients. There were strong correlations between shunt index estimated by lung scintiscan and oxygenation parameters in HPS patients. The characteristics of HPS patients were similar to that of non-HPS patients except for clubbing, dyspnea, cyanosis, orthodoexia and bleeding varices that were more associated with HPS patients as well as well as the Child-Pugh grades, which tended toward higher scores in HPS patients

Alterations in colonic mucosal lesions in patients with portal hypertension

Portal hypertensive colopathy [PHC] is a clinical entity in liver cirrhosis. The frequency and profile of colonic mucosal lesions of this entity are not well studied. The aim of this study is to evaluate the prevalence of colonic mucosal changes in patients with liver cirrhosis and their clinical significance. Forty patients with post-viral liver cirrhosis and portal hypertension [PHT] underwent upper gastrointestinal endoscopy as well as a full length colonoscopy to detect changes in colonic mucosa. PHC was diagnosed endoscopically by the presence of vascular ectasia, diffuse hyperaemic mucosa and rectal varices. Biopsies were obtained from the recto-sigmoid area as well as from any abnormal mucosal lesions apart from angiodysplastic areas. Diffuse hyperaemia, angiodysplasia and rectal varices were found in 40%, 32.5% and 17.5% of patients while haemorrhoids in 42.5%, respectively. The prevalence of PHC increased with worsening Child-Pugh class, the mere presence of oesophageal varices while platelet count was significantly associated with angiodysplastic lesions only. None of other upper endoscopic features of PHT was significantly related to PHC. Moreover, history of lower gastrointestinal [GI] bleeding was significantly associated with the presence of rectal varices and haemorrhoids. Colonoscopic features of PHC were significantly associated with the histopathological diagnosis revealing 79% sensitivity and 66.6% specificity. Conclusion: PHC is a frequent finding in patients with PHT. Colonoscopic features suggestive of PHC were in concordance with the histopathological evidence. Although the presence of haemorrhoids is not a feature of colopathy, yet it should be considered together with anorectal varices as a cause of lower GI bleeding

[Frequency of proximal colonic extension of distal ulcerative colitis]

To evaluate the frequency of colonic extension in patients with rectal or rectosigmoidal forms of ulcerative colitis and to look for factors associated with a higher risk of proximal colonic extension. We conduct a retrospective study on cases of ulcerative colitis limited to the rectum and the rectosigmoid followed up at least for 6 months. Colonic extension was defined by apparition of endoscopic features of ulcerative colitis in initially normal segments of the colon. From 1984 to 2004,70 patients with distal ulcerative colitis were studied. Initial location was the rectum in 25 cases and the rectosigmoid in 45 cases. After a mean follow-up of 49,4 months, proximal colonic extension was observed in 7 cases [10%], with an actuarial frequency of 12% at 5 years, 20% at 10 years and 20% at 20 years. Patients with colonic extension had a higher number of relapses compared to patients without extension [4.28 +/- 1,36 vs 1,41 +/- 1,22, p = 0.001]. Age, sex-ratio, initial location, maintenance therapy and diagnosis of refractory distal colitis were not associated with a higher risk of colonic extension. Colonic extension in our population occurs during the first years after the diagnosis of distal ulcerative colitis. Patients with more relapses are at increased risk of proximal colonic extension

Bacterial and non-bacterial prostatitis: detection of chlamydia trachomatis, cytomegalovirus and herpes simplex virus

Eighty-six patients with persistent symptoms of chronic prostatitis were screened for possible aetiological organisms affecting the prostate. Our study entailed a culture of expressed prostatic secretion [EPS] for bacteria. A positive culture was obtained in 40 [46.5%] patients with chronic bacterial prostatitis [CBP]. Forty-six patients [53.5%] were negative for a bacterial culture of EPS and therefore categorized as having non-bacterial prostatitis [NBP]. Immunofluorescence study of the EPS revealed that 12 [26%] out of these 46 patients with non-bacterial prostatitis were positive for Chlamydia trachomatis. Prostatic specimens taken by perineal needle biopsy from all patients with non-bacterial prostatitis were tested for vira antigens by immunoperoxidase study [15.2%] of these prostatic biopsies gave positive results for Cytomegalovirus [CMV] antigen, while 3 [6.5%] showed a positive immunoperoxidase reaction for Herpes Simplex virus type II [HSV-2]. In the remaining 24 [27.8%] patients, no definite organism could be isolated. The results demonstrate that chlamydial and viral prostatitis cover a reasonable group of patients with non-bacterial disease in whom the effort should be directed to eradicating these organisms from the prostate

Helicobacter pylori infection in children with chronic abdominal pain

During a six-month period [September 1992 to March 1993],the prevalence of Helicobacter pylori [H. pylori] was assessed in 100 children [age range 3-18 years] with chronic abdominal pain [abdominal pain for longer than 3 months]. Upper endoscopy was abnormal in 33% and gastric antral mucosal histopathology showed gastritis in 62%. Culture, urease test and Gram's stain for H. pylori were positive in 33%, 44% and 44% respectively. Four patients under 5 years of age had gastric mucosal colonization by H. pylori. H. pylori associated with gastric disorder occurred mainly in children older than 5 years. A significant correlation was found between H. pylori gastric colonization and histopathological signs of gastritis. This study suggests a pathogenic role for H. pylori in the development of gastroduodenal diseases and chronic abdominal pain in children in southern

Anaemia associated with chronic glomerulonephritis

Anaemia occurs almost invariably in chronic renal diseases and tends to increase in severity as the level of blood urea nitrogen rise above 70mg per 100ml, and becomes so severe that hemoglobin decreased below 5 grams per 100ml Decreased serum iron was found in some cases with chronic glomerulonephritis. At all times, all patients revealed decreased red blood cell count and increased serum bilirubin level

Role of Epstein Barr virus [EBV] in chronic fatigue syndrome associated with tonsillitis and pharyngitis

To assess the possible role of [EBV] in patients with chronic tonsillitis and pharyngitis, complaining of chronic fatigue syndrome [CFS], we studied 42 of these cases, 38 normal controls, and 37 cases with tonsillitis and pharyngitis but without [CFS] symptoms. Anti [EBV] Ig[G] and anticytomegalovirus [CMV] Ig[M] and Ig[G] were evaluated by an ELISA technique. Ig[M] anti [EBV] was positive in 11.9% and Ig[G] in 57.1% of cases. Ig[G] anti [CMV] was present in only 7.1% of cases. These results were significantly higher than values encountered in controls and may point to the possible role of [EBV] as an aetiologic agent in [CFS] associated with chronic tonsillitis and pharyngitis

Study on HBV and HCV infection in chronic liver disease

The study was conducted on 200 liver cases attending Mattareya Teaching Hospital and Coptic Hospital. They were submitted to clinical examination and laboratory investigations including liver function tests and serological tests for HBs-Ag and anti-HCV. The aim of the study was to assess the role of HBV and HCV infection in chronic liver disease and the development of decompensation. Seroprevalence of anti-HCV was twice as common as HBs-Ag [63.7% and 30.1% respectively]. Seropositive cases for both HBs-Ag and anti-HCV were 6.2%. Most seropositive cases for HBs-Ag were in the active compensated group. Cases positive for HBs-Ag and anti-HCV were mostly decompensated [57%]. Prevalence of seropositive cases with no evidence of active liver disease was 29.2% for anti-HCV, 20.6% for HB- Ag and 14.3% for both. Those patients should be managed by close follow up to prevent the development of progressive liver disease and decrease the risk of infectivity