Assessment of different therapeutic modalities in prevention of variceal rebleeding

To assess the efficacy of some therapeutic modalities in 2ry prevention of oesophageal variceal bleeding and their impact on portal pressure [PP] and survival: 73 patients were included after recovery from the 1[st] attack of variceal bleeding. They were randomly assigned into nadolol group [G1] [n=18], sclerotherapy group [G2] [N=18], combined nadolol and sclerotherapy group [G3] [n=20] and placebo group G4 [n=17]. Portal pressure was significantly reduced in G1 and G3 [P<0.01], and significantly increased in G2 [P<0.05], with insignificant change in G4. Hepatic dysfunction insignificantly affected PP response to different modalities. Significantly less percentage of rebleeders under different therapeutic modalities were encountered after one year from initiation of therapy when compared to placebo. Patients with critical initial PP [15-30 ml saline] showed a significantly lower percentage of rebleeders compared to those with serious initial PP [>30 ml saline], in G1, G2 and G3 [P<0.05]. Larger varices showed higher percentage of rebleeding among the studied groups. As regards one year survival, insignificant difference was observed among the studied group [G1 93.75%, G2 88.88%, G3 88.88%, G4 68.75%]. The combination of nadolol and sclerotherapy made varices to be eradicated by a significantly less number of sessions of sclerotherapy [P<0.01], and an insignificantly lower volume of ethanolamine per session. We concluded that variceal rebleeding can be more or less similarly prevented by nadolol, sclerotherapy or both with the advantage of earlier variceal eradication and better control of PP when nadolol is added to sclerotherapy. The degree of hepatic dysfunction dose not affect PP response to the applied therapeutic modality. Risk of rebleeding is positively affected by pre-treatment PP and variceal size. Survival is insignificantly improved by the applied therapeutic modalities

Serum procollagen III amino-terminal peptide [P III NP]: a non-invasive procedure for assessment of liver fibrosis

Serum pro-collagen III and liver function tests were estimated in 20 healthy subjects and 71 patients with chronic liver disease in a trial to find out its correlation with clinical, laboratory and histological parameters as well as its diagnostic value. From the results obtained, it was concluded that serum P III NP may be a good marker of liver fibrosis and may be used in differentiating fibrotic liver diseases from those with no or minimal fibrosis and may be a good prognostic clinical marker in the assessment of clinical severity of the disease

Prostaglandin E in chronic liver disease: relation to specific pathology

Recent works have substantiated the possible role of prostaglandins [PGs] in the pathogenesis of various manifestations and complications of liver cirrhosis. The relation to specific pathology and hepatic functional class in Egyptians with chronic liver disease is not known. Plasma PGE was measured by radioimmunoassay in 40 males with chronic liver disease compared with 10 healthy controls. Specific liver disease was determined according to histopathologic criteria, Functional class was graded as A, B and C according to Pugh Scale. Plasma PGE [Mean +/- SD ng/ml] was higher in patients with chronic liver disease than in healthy controls [5.12 +/- 1.02 VS 1.61 +/- 0.28, P < 0.01]. Patients with pure cirrhosis and those with mixed cirrhosis had higher levels than those with pure schistosomal [Sch] fibrosis [5.45 +/- 1.15, 5.54 +/- 0.94 VS 4.19 +/- 0.31, P < 0.01] with no significant difference between the two cirrhotic groups. PGE was higher in grade B and C than in grade A [6.13 +/- 0.37, 6.03 +/- 0.32 VS 4.15 +/- 0.30, P < 0.05] with no significant difference between grade B and C. Ascetics had higher PGE than non-ascetics [6.09 +/- 0.28 VS 4.15 +/- 0.30, P < 0.01]. Patients with skin vascular changes had higher levels than those without [6.4 +/- 0.28 VS 4.93 +/- 0.96, P < 0.01]. We conclude that plasma PGE is high in chronic liver disease. Cirrhotics with or without Sch. fibrosis have higher levels than those with pure Sch. fibrosis. Ascites and the functional class of liver disease are determining factors

Plasma prostaglandin E in portal hypertension: effect of suppression by indomethacin

A possible role of vasodilating prostaglandins [PGs] in the pathogenesis of circulating abnormalities of cirrhosis as well as in portal hypertension and renal function status was studied. Plasma PGE [by radioimmunoassay RIA], percutaneous trans-splenic portal manometry and 24 hours creatinine clearance [CrCl] were measured in 40 males with chronic liver disease [20 ascitics and 20 non-ascitics] before and after one day oral indomethacin 50 mg/8 hours] administration. Portal pressure [PP] was graded as moderately and severely raised. Ascitics had higher plasma PGE [P < 0.001] and lower CrCl [p < 0.01] than non-ascitics. PP was not significantly different in ascitics and non-ascitics plasma PGE was not significantly different in patients with moderate compared to those with severe portal hypertension. Indomethacin induced a reduction in PGE in both ascitics [from 6.09 +/- 0.29 to 2.83 +/- 0.43 ng/ml, P < 0.01] and non ascitics [from 4.15 +/- 0.31 to 2.87 +/- 0.29 ng/ml, P<0.001] and in patients with moderate portal hypertension [from 4.85 +/- 1.06 to 2.82 +/- 0.33 ng/ml, P < 0.001] and those with severe portal hypertension [from 5.19 +/- 1.02 to 2.85 +/- 0.38 ng/ml, P < 0.001]. PP was reduced in ascitics [from 30.2 +/- 5.23 to 26.0 +/- 4.67 cm saline, P < 0.001] and non-ascitics [from 28.05 +/- 3.96 to 25.15 +/- 3.51 cm saline, P < 0.001]. CrCl was reduced in ascitics [from 98.6 +/- 7.15 to 64.8 +/- 4.9 ml/min, P < 0.001] and non ascitics [from 105.15 +/- 7.01 to 90.5 + 6.12 ml/ mill, P < 0.001]. Plasma PGE, PP. and CrCl decrements [J] were higher [P < 0.001] in ascitics than in non-ascitics [3.29 +/- 0.42 vs 1.28 +/- 0.24 ng/ml, 4.2 +/- 1.1 vs 2.9 +/- 0.91 cm saline and 33.8 +/- 0.04 vs 14.2 +/- 3.78 ml/min, respectively]. In both ascitics and non-ascitics JPGE, JP and JCrCl were positively intercorrelated [P <0.01]. Plasma PGE contributes in the pathogenesis of portal hypertension, although it does not determine its severity. PGE synthesis inhibition by indomethacin affectively reduces PP. Adversely, it reduces glomerular filtration rate especially in ascitic patients

Acute phase reactants in chronic renal failure

The serum levels of acute phase reactants [C-reactive protein, CRP, haptoglobin, HPT and alpha-1 acid glycoprotein, AAG] were studied in 20 patients with chronic renal failure [CRF], 10 of them on regular hemodialysis [HD] and 10 patients under conservative treatment and 10 normal subjects as controls. The mean serum levels of CRP, HPT and AAG in patients either on HD [before and after HD] or under conservative treatment were compared with those of control group. The mean serum level of CRP in HD group [before HD] was significantly higher than that of the conservative group, while no significant difference was observed between the mean serum levels of AAG in both groups. A significant +ve correlation between serum levels of CRP and the time of HD was detected, while +ve correlation was observed between serum levels of both HPT and AAG and both blood urea and serum creatinine levels of the conservative group. It is concluded that AAG [alpha-1 acid glycoprotein] may be considered a specific acute phase reactant in hemodialysis patients, while HPT [haptoglobin] like CRP [C-reactive protein], can not be recommended as an acute phase reactant in these patients because of unacceptably high false positive rate. In the uremic patients under conservative treatment, the CRP maintains its specificity as an acute phase reactant, then comes the AAG whose level is correlated with the degree of renal impairment. On the contrary, HPT cannot be recommended because of high false positive rate

Study of procollagen III peptide in sera of patients with fibrotic liver disease

Serum P III NP levels were measured in 71 patients with chronic liver diseases and in 20 healthy subjects as control. Serum P III NP mean value was significantly elevated in all diseased group compared to control [P <0.001]. Serum P III NP mean values were significantly increased with increased grade of hepatic fibrosis and it was the best parameter to correlate with the degree of fibrosis [r = + 0.88, P < 0.001]. According to the histopathological diagnostic criteria serum P III NP mean values were significantly elevated in fibrotic liver diseases [pure bilharzial fibrosis, cirrhosis, CAR, hepatoma] compared to diseaeses with no or minimal fibrosis [fatty liver, CPH], while no significant difference was found between patients within the same category of fibrosis

Analysis of hospital administration statistics in medicine departments in Zagazig University Hospital

This study was carried out in the medical department of Zagazig University hospital during the year 1985 to study the administrative statistics of the hospital. The data were collected from the statistic department of the hospital and examined files of the patients from the administrative and management department of the hospital. It was found that the majority of patients treated in out-patient clinics and admitted were in the general medicine department. They were mostly males aged from 20 to 40 years. The rest of patients were in the intensive care unit, cardiology and neurology departments aged from 40 to 60 years. Those patients exhausted 64655 hospital days. The average length of stayement was 13.82 days. The bed occupancy rate was 84% The average turn-over rate was 21.8. The long stayement, low occupancy rate and low turn-over rate might be attributed to the bad and/or lack of equipment [50.7% of them were non-functioning in some departments. In coordination between the laboratory and X-ray departments with other departments was one of the causes. On the average 82.1% only of the requested investigations were performed of which 70.1% only were received