Endosonography as a predictive tool for first esophagogastric variceal bleeding

The development of portosystemic collaterals is the central pathophysiological event that leads to variceal bleeding in patients with liver cirrhosis. Endosonography [EUS] is useful to evaluate the fine details of the vascular structures at the gastroesophageal junction. EUS may give a promising chance for predicting upper gastrointestinal bleeding in cirrhotic patients. To evaluate the value of extraluminal gastroesophageal vascular collaterals as predictors of first variceal bleeding. A total of 50 cirrhotic patients with no history of previous upper GI bleeding were recruited into this cohort study. After thorough history taking and clinical examination, they were subjected to upper endoscopy and EUS for assessing the number and size of peri- and para-mural collaterals and perforating vessels. All participants were followed up for 24 months for upper gastrointestinal bleeding. Eighteen out of 50 patients [36%] had at least one attack of upper GI bleeding during the follow up period. All patients had one or more type of extraluminal venous collaterals. Gastric varices [P = 0.02], perigastric collaterals [P = 0.03] and perforators [P = 0.02] were independent risk factors for first variceal bleeding. The presence of 3 or more paraesophageat collaterals and the presence of perforators were significantly higher in bleeders compared to non-bleeders [P = 0.034]. Perigastric and paragastric collateral size were significantly larger in bleeders than non bleeders [P = 0.019 and 0.038 respectively]. Perigastric and paragastric collaterals size more than or equal to 2 mm and 6.20 mm respectively were associated with significantly increased risk of first variceal bleeding. Peri-esophageal and para-esophageal collaterals although present in large diameters in all bleeders than non bleeders, did not reach a statistical significant level EUS may be a promising tool for predicting first variceal bleeding in cirrhotic patients thus justifying primary prevention by band ligation or sclerotherapy

Immunofluorescent detection of apoptosis in chronic viral hepatitis and other liver diseases

Chronic viral hepatitis is a common health problem in many countries including Egypt. The microscopic appearance of chronic viral hepatitis is usually associated with the appearance of eosinophilic structures called apoptotic bodies. Apoptosis is a type of programmed cell death. Abnormalities of apoptosis might contribute to many disease processes, the most important of which is neoplasia. The aim of this work is to study the frequency of apoptosis in cases of chronic viral hepatitis C [HCV], B [HB], pure Bilharzial liver affection, combined Bilharzial and chronic viral hepatitis C in addition to cases of hepatocellular carcinoma [HCC]. Liver biopsies [10 cases of HCV+ve patients, 6 cases HBs Ag +ve patients, 8 cases pure Bilharzial liver affection, 10 cases of combined Bilharzial and HCV, 10 cases of HCC and 6 cases of normal liver tissue obtained from areas adjacent to focal hepatic lesions were used as control]. A modified method of the terminal deoxynucleotidyl transferase- mediated dUTP-biotin nick end labeling [TUNEL] using immunofuorescence [FITC - dUTP] was used to detect apoptosis. Apoptotic index was determined for each case by counting apoptotic cells per 1000 cells in different fields. Apoptotic index for control cases was 0.1 +/- 0.08, cases of HCV 0.23 +/- 0.125, cases of HB 0.25 +/- 0.1, pure Bilharzial cases 0.125 +/- 0.08, combined Bilharzial and HCV cases 0.24 +/- 0.126 and for cases of HCC, it was 0.08 +/- 0.07.The difference between apoptotic index in cirrhotic and non-cirrhotic cases was statistically non significant [P = 0.896]. As a conclusion, we found that the modified TUNEL method using fluorescein isocyanate labeled dUTP was useful and sensitive for detecting apoptosis in the liver. The apoptotic index increases significantly than the control in cases of chronic viral hepatitis C [P = 0.044], B [P = 0.024] and combined HCV and Bilharzial liver affection [P = 0.033]. Apoptosis in pure Bilharzial liver affection does not significantly differ from the control [P = 0.636]. In cases of HCC, apoptosis decreases than the control in a non-significant manner [P = 0.647]. Apoptotic index does not differ significantly between cirrhotic and non- cirrhotic cases

Does schistosomiasis affect cellular proliferation of hepatocytes in hepatitis C infection?

The role of schistosomal co-infection with HCV in affecting the course of chronic viral hepatitis is not clear. This study aims at evaluating the effects of schistosomal co-infection on histopathoiogical changes as well as cellular proliferation in liver biopsies of HCV infected patients. The study included 49 cases of chronic liver disease [14 cases of pure hepatitis C [HCV], 26 cases of combined HCV and shistosomiasis and 9 cases of pure schistosomal hepatic affection] .Histopathoiogical assessment of liver biopsies in cases of chronic viral hepatitis was done according to the Ishak's modification of Knodell's score for grading and staging system. Cellular proliferation was evaluated by immunohistochemical staining with the proliferation marker ki-67 [MIB-1] as well as by counting the mean number of argyrophilic nu-cleolar organizer regions [Ag NOR[s]]. Of the 14 cases of pure HCV, 9 cases [64.3%] showed minimal to mild chronic hepatitis and 5 cases [35.7%] showed moderate to severe chronic hepatitis.4 cases [28.6%] were cirrhotic. On the other hand,16 out of 26 cases of combined HCV and schistosomal infection [61.5%] showed minimal to mild chronic hepatitis while 10 cases [38.5%] showed moderate to severe chronic hepatitis. 8 cases [30.76%] were cirrhotic. These figures did not differ significantly from those of pure HCV infection with pvalues [0.236], [0.111] and [0.863] respecrively. As regards cellular proliferation, by using the immunohistochemical marker ki-67 [MIB-1], cases of pure HCV showed nuclear staining in 8/14 cases [57.14%]. The mean proliferation index PI was [5.14 +/- 5.66].In cases of combined HCV and schistosomal affection, 16 out 26 cases [61.5%] showed positive staining with PI [5.6 +/- 5.9]. The difference between the two groups was non significant [p=0.834]. In the group of pure schistosomal affection of the liver, 4/9 cases [44.4%] showed positive staining.The PI of this group was [3.11 +/- 4.25]. This figure does not differ significantly neither from the group of pure HCV [p = 0.254] nor from the group of combined HCV and schistosomiasis [p=0.195]. By using the traditional method for assessment of cellular proliferation by counting the mean number of Ag NOR[s], in the group of pure HCV, the PI was [1.62 +/- 0.13], that of combined HCV and schistosomiasis was [1.61 +/- 0.13] while that of pure schistosomal hepatic affection was [1.57 +/- 0.09]. The difference between the three groups was statistically not significant. This work shows that on the histopathological level, schistosomiasis does not significantly affect hepatic lesions induced by HCV. Moreover; shistosomiasis does not alter the proliferation index of hepatocytes of HCV infected patients. This work showed also that on assessing cellular proliferation, both the immunohistochemical method using ki-67 and counting the mean numbers of Ag NOR[s] give similar results

Acute myocardial infarction, clinico epidemiological study

A retrospective study was undertaken of the medical records of 58 patients admitted to AI Nawa Hospital and Royal Commission Medical Centre during the period November 1986 to November 1991 and attempts were made to provide dataline base as regarding the incidence of acute myocardial infarction in ranbu area. We analyzed the prevalence of known risk factors as smoking, the prevalence of major contributory factors like hyperlipidemia and the prevalence of associated diseases like diabetes mellitus, hypertension and if previous ischemic heart disease. Even though new research has suggested genetic involvement in IHD, surprisingly in our study there was no documented family history of ischemic heart disease in any of our 23 Saudi patients, but 26% of the non Saudi group gave definite family history of ischemic heart disease. Of all the patients 8 [13.8] died in hospital from AMI related complications e.g. cardiogenic shock, cardiac arrest and severe congestive heart failure. Over 30 month follow up, it was found that age over 60 years, severe CHF and non compliance to treatment were influencing long term survival adversely. We hope to compare our findings with other studies of similar achieve conducted elsewhere in the Kingdom, so that there will be a definite revealing of common risk factors, contributory factors, associated illness, so that the long term survival, land inhospital mortality can be favourably influenced in the future