Effect of portal pressure reduction on portal hypertensive gastropathy

To study the effect of reducing portal pressure on the endoscopic as well as histologic features of portal hypertensive gastropathy [PHG], a randomized, controlled, double blind study of 40 patients with portal hypertension secondary to chronic liver disease: schistosomal hepatic fibrosis [SHF] and/or cirrhosis was done. Twenty patients were given oral propranolol at a dose that reduced the resting heart rate by 25 percent and 20 patients were given oral placebo for 6 weeks. The endoscopic and histologic changes in the antrum, body and fundus as well as measurement of splenic pulp pressure [SPP] were studied before and after medication. A significant drop of mean SPP was detected after propranolol therapy compared to placebo [p = 0.003]. After propranolol therapy there was significant histologic improvement in the antrum and body but not the fundus. Endoscopic improvement was significant only in the antrum [P < 0.05]. The data suggest that there was a larger drop of the mean SPP in those who showed histologic improvement [P < 0.05]. Therefore it is suggested that propranolol therapy improves the portal hypertensive gastric mucosal congestion through portal pressure reduction, however other mechanisms may play a role

Intestinal helminthic and protozoal infections and urinary schistosomiasis in Egyptian children

To extend information on the current distribution and frequency of parasitic infections in Egypt, one stool and one urine specimen from 2945 children, aged 6 to 12 years old were examined. The children were from 10 schools, one in Cairo, 2 in Giza Governorate, and 7 in the Nile delat. Frequency rates for S. mansoni by school were 0.3% in Cairo, 8 -15% in Giza, and 3 - 79% in the delta; for S. haematobium, rates were 3% in Cairo, 25 - 71% in Giza, and 0 - 33% in the delta. Rates for strongloidiasis, trichuriasis, and trichostrongliasis were low in each location never exceeding 1%. Frequency rates for ascariasis were 3-31%, ancylostomiasis 3 - 8%, enterobiasis 2 - 22%, hymenolepiasis 4-20%, amebiasis 13-52%. and giardiasis 5-25%. F. hepatica infections [0.01%] were found in Sobtas, and an 8% H. heterophyes infection rate was found in Mataryia

Serum aspartate aminotransferase/serum alanine aminotransferase ratio as a prognostic index in severe acute viral hepatitis

Estimations of serum ALAT, ASAT, ALP, bilirubin, glucose, proteins, urea and creatinine were done in 70 patients [29 females and 41 males] with severe acute viral hepatitis [A,B and nonA-nonB]. The estimations were performed within 10 days of onset of the hepatitis or within 4 days of the diagnosis of fulminant hepatic failure. Twenty six patients died of their acute illness. Results revealed renal failure in 46.2% and 22.7%, hyperglycaemia in 38.5% and 29.5%, while hypoglycaemia in 11.5% and 31.8% in the patients who died and those who lived respectively. ALAT activity was significantly higher in survivors while ASAT did not differ statistically. The ASAT/ALAT ratio was significantly higher in the patients who died in fulminant hepatic failure than those recovered [p<0.001]. The ratio differed significantly between deaths and survivors of both sexes [p<0.005 and p<0.0001]. Calculating 95% confidence intervals, the expected ratios for combined sexes were from 0.65 to 0.77 for survivors and from 1.41 to 1.95 for the non-survivors. The age had no effect on the prognosis [mean 34.04 and 36.9 for the two groups respectively]. Regarding the viral aetiology, hepatitis A virus was absent in the died group, while B and non A- non B had equal occurrence. Thus, the outcome of severe acute viral hepatitis can reasonably be predicted on the basis of ASAT/ALAT ratio

Serum haptglobin level in hepatosplenic schistosomiasis

Measurement of the concentration of serum haptoglobin by RID and electrophoresis as haemoglobin binding capacity in 66 schistosomal patients together with 20 apparently healthy controls showed the following: - The normal values were similar to those of the Mediterranean an countries and not the African ones. - RID technique utilizing polyvalent antisera specific for human Hp is preferred to be applicable for routine assay than the electrophoretic one. - Serum Hp was reduced in schistosomiasis, more so in the advanced stage. The fall may be due to iron deficiency anaemia and intrasplenic destruction of RBCs due to sluggish circulation in the fibrotic congested spleen i.e. a sign of haemolysis. - The elevated values were observed in cases complicated with polyposis coli. The cause may be in part acute phase reaction to inflammatory changes. - No correlation could be detected between serum Hp level on one hand and the degree of anemia, ESR or alpha [2]-globulin on the other hand

Immunoglobulins in chronic salmonellosis complicating hepatosplenic schistosomiasis

Forty hepatosplenic schistosomal patients suffering from prolonged recurrent fever were divided into 3 groups according to the results of blood cultures and Widal agglutination test. Urine and stool cultures, blood film examination, specific agglutination tests for other bacteria, cytologic examination beside other routine investigations were performed to all. Estimation of immunoglobulins [IgG, IgA, IgM and IgE] levels utilizing SRID plates. Results revealed the following: leucocytosis in cases with positive blood cultures and Widal agglutination test. Urine and stool cultures for salmonella organisms were negative. Seven out of the eight cases whose blood cultures and widal test were positive, had S. jara typhi A and the remaining one had S. typhi, their widal titres were high. Cases with high widal agglutination titre and negative blood cultures were considered as having salmonellal infection. The remaining cases negative for their fever proved to be due to urinary tract infection, malaria and neoplastic diseases. Widal test can be considered as suggestive rather than diagnostic, though it is more valuable when negative. The IgA level did not differ statistically between the studied groups or from values reported in hepatosplenic schistosomiasis without fever. The IgG and IgM levels were higher in cases with positive blood cultures and widal test than cases with positive widal test only or those with negative blood cultures and widal test. The IgE level was higher in the salmonella positive group than the negative one, though its level was lower than the schistosomal cases without fever. Chroncity of salmonellosis in these cases cannot be explained by humoral immunosuppression

Renal failure in acute vival hepatitis

Fifty five patients with acute viral hepatitis, 6 of them had fulminant hepatic failure were studied with regard to incidence and types of complicating renal insufficiency. Renal failure was considered to be present when the serum creatinine and/or urea were 227 umol/1 and 12 mmol/1 respectively. Of the patients with acute viral hepatitis 6[12.27%] developed renal failure. In 5 the type was acute tubular necrosis and in one indeterminable. Of the patients with fulminant hepatic failure 5 [88.33%] had renal failure, of these 2 had acute tubular necrosis and in the remaining 3 the type was indeterminable. Hyponatraemia, relative high serum potassium and low urinary potassium was found in fulminant hepatic failure. Creatinine clearance < 25 ml/min was indicative of had prognosis, all patients died. The biochemical liver function test revealed significantly higher AST/ALT ratio in fulminant hepatic failure compared to acute viral hepatitis group. Its value in the prediction of the out-come of the disease has been confirmed. Fulminant hepatic failure occurred as a complication of all the 3 types of hepatitis. The mechanism of renal failure may be the reduced renal blood flow resulting from the vasoconstrictor effect of gut endotoxins which escape the kupffer cell filter

Plasma fibrinogen and fibrin degradation products in hepatosplenic schistosomiasis

Plasma fibrinogen and fibrin degradation products [FDP] were estimated in 40 hepatosplenic schitosomal patients together with 20 apparently healthy normal controls. The results showed plasma fibrinogen level within the conventional range of normality and significant elevation of [FDP] in hepatosplenic schistosomal patients [p < 0.01]. the coagulation and bleeding times were within normal range while the prothrombin time was prolonged with reduction in the prothrombin percentage and significant low platelets count. The plasma fibrinogen change appears to be due to an increase in its catabolism which is matched and out-weighed by increased systhesis. This increase in synthesis is shared as part of the acute phase response with other glycoproteins synthesized by the liver

C-reactive protein level in schistosomiasis

C-reactive protein CRP as well as total and electrophoretic pattern of serum proteins, erythrocyte sedimentation rate [ESR] and liver function tests were measured in 56 schistosomal patients and in 20 normal controls. Results indicate that ESR, alpha[1], alpha[2] and gamma-globulins, alkaline phosphatase, gamma glutamyl transferase and aspatate aminotransferase were increased while albumin was decreased. CRP was increased in 25% of simple schistosomal patients and in 80% of patients with hepatossplenic involvement. Cases with schistosomal polyposis coli showed the highest increase. Positive correlation was observed between CRP on one hand and ESR and alpha[2] globulin on the other hand, and negative correlation was found between CRP and albumin. The significance of CRP to phagocytosis, complement and platelet aggregation and its relation to the disease were discussed as well as the other associated infections and complications