Non-invasive predictors of portal hypertension in patients with hepatitis C virus related hepatocellular carcinoma

The reference standard for portal venous pressure measurement which is clinically important for estimating the feasibility of resection of hepatocellular carcinoma is the hepatic venous pressure gradient, which is invasive and expensive. The present study evaluated the noninvasive parameters for assessment of portal hypertension in Child A patients with hepatocellular carcinoma on top of hepatitis C virus. A total of 112 patients were subjected to clinical assessment, biochemical assay, ultra- sonographic Doppler study, triphasic spiral abdominal computed tomography, upper gastrointestinal endoscopy and hepatic venous pressure gradient measurement. According to hepatic venous pressure gradient measurement, they were classified into groups: GI: 58 patients with hepatic venous pressure gradient <10 mmHg and GII: 54 patients with hepatic venous pressure gradient >/= 10 mmHg. Significant variables in univariate analysis were included in a multivariate analysis to establish a model for prediction of clinically significant portal hypertension. Results showed that portal vein diameter >/= 1.3 cm, mono or biphasic pattern of flow in hepatic veins and Giannini index /= 10 mmHg. A model with highest likelihood ratio and good fitness was created. This prediction model was displayed by the receiver operating characteristic curve and under the curve area was 0.969 [0.938-1]

Cognitive dysfunction in patients with chronic hepatitis C: a psychometric and magnetic resonance spectroscopic study

Patients with chronic hepatitis C virus [HCV] infection frequently describe neuropsychological symptoms and there is a growing body of literature on cerebral dysfunction occurring at an early stage of chronic HCV infection. The aim of the present study was to elucidate whether patients' subjective impression of cognitive impairment was accompanied by objective evidence of cerebral dysfunction. 12 Patients with chronic hepatitis C virus infection with compensated liver function were recruited from Ain-Shams university hospitals. Another 8 healthy controls matched for age and sex were recruited from available hospital staff or patients relatives. Patients with potential risk factors for cognitive impairment were excluded. All patients and controls underwent clinical assessment, laboratory test, abdominal ultrasound, neuropsychological assessment, digital electroencephalography [DEEG], brain MRI and MR spectroscopy [MRS]. DEEG of all 12 patients revealed normal background with well formed alpha waves with no focal or generalized slowing and no epileptic activity. Psychometric assessment revealed that attention and sustained attention was affected in 6 patients [50%], short term memory was affected in 4 patients [33.5%], psychomotor speed and learning ability was affected in 4 patients [33.5%] and immediate verbal and visual memories were affected in 6 patients [50%]. Depression was absent in all patients. The MRI brain of all patients revealed no abnormalities. On intermediate echo sequence of MRS, the HCV group showed significant decrease in N-acetylaspartate/creatine ratios [NAA/Cr ratio] in frontal white matter [P < 0.05]. Mild, statistically non significant, elevation of choline/creatine ratios predominantly in basal ganglionic [BG] region was noted on both short and intermediate echo sequences. On short echo sequence of MRS, the HCV group showed a mild, statistically non significant, increase in myoinositol/creatine in frontal white matter region as compared to controls. Thus, there is a suggested reduction of normal neurons and accentuation of gliosis in frontal white matter together with membrane degradation in BG in patients with hepatitis C virus infection. Agreement between psychometry and MRS revealed a significant agreement between decreased NAA/Cr and impaired attention and sustained attention, immediate verbal memory and immediate visual memory [P < 0.05]. HCV infection itself is associated with changes in the brain, even in the absence of hyperammonemia. Specifically, HCV-infected individuals may have deficits in cognitive functions such as attention, working memory, and speed of information processing. They also have abnormalities on magnetic resonance spectroscopy [MRS] that favor the organic explanation of the patients' mental symptoms

Sclerotherapy of gastric varices with histoacryl

Sclerotherapy was performed for 19 patients with gastroesophageal varices and one with isolated gastric varcies along one to two sessions using one to 3 ampoules of Histoacryl for each varices. The efficacy of Histoacryl in obliteration of the varices either during active bleeding or elective injection was studied. Three patients with active bleeding from gastric varices were injected with Histoacryl and bleeing was successfully stopped without incidence of rebleeding. The incidence of rebleeding and/or other complications during follow-up period that ranged between 5 and 10 months [mean 7.75 +/- 1.99] were assessed. From these results it can be concluded that Histoacryl is an effective line of treatment in definitive control of acute gastric variceal bleeding, in elective obliteration of varices and in prevention of rebleeding in all patients. It has no serious complications when used by expert hands