Free serotonin [5-HT] levels in Egyptian patients with esophageal and fundal varices

Background: Serotonin appears to be a central physiologic mediator of many gastrointestinal functions and a mediator of the brain-gut connection

Aim: The aim of this study was to determine concentrations of free serotonin in plasma in patients with and without esophageal and fundal varices

Participants and methods: Patients diagnosed with stigmata of chronic liver disease [history, clinical, laboratory, and radiological findings - e.g. jaundice, lower limb edema, hepatomegaly, and splenomegaly] and presenting with gastrointestinal symptoms were included in the study. After upper gastointestinal endoscopy, patients were divided into two groups: group I included 30 patients with liver cirrhosis complicated with varices and group II included 30 patients with liver cirrhosis who did not have varices. Thirty healthy participants served as the control group. All patients were subjected to history taking, clinical examination, laboratory tests, abdominal ultrasound, and upper gastrointestinal tract endoscopy [for group I and II]. Plasma free serotonin was measured by the ELISA test

Results: All groups were age-matched and sex-matched. Estimation of plasma free serotonin showed a highly statistically significant difference between groups [F=59.32, P<0.01]. A serotonin cutoff value of 24 ng/ml was chosen, with 100% sensitivity, 96.7% specificity, 98.3 to discriminate all chronic liver disease patients from healthy controls [area under the curve=0.981]. A cutoff value of 58.0 ng/ml to differentiate between patients with and without esophageal varices, with 80% sensitivity and 86.7% specificity [area under the curve=0.855]. A highly significant stepwise progressive increase in the marker level was recorded through grades of oesophageal varices 2-5 [stage 2, 20.7 +/- 7.7 ng/ml; stage 3, 44.3 +/- 8.9 ng/ml, P<0.01; stage 4, 100.1 +/- 12.4 ng/ml, P<0.01; stage 5, 114.6 +/- 14.7 ng/ml, P<0.05]. There was highly significant difference in plasma free serotonin levels in patients with esophageal and gastric varices compared with those with esophageal varices alone

Conclusion: Plasma free serotonin levels could possibly be used as a noninvasive predictive method for the presence of gastroesophageal varices

Role of cerebrospinal fluid il-8 as a marker for differentiation between acute bacterial and aseptic meningitis

No doubt, the distinguishing between bacterial and aseptic meningitis in the emergency department could help to limit unnecessary antibiotic use and hospital admissions. This study evaluated the role of cerebrospinal fluid IL-8 in differentiating acute bacterial meningitis [ABM] from aseptic meningitis [AM]. A total of 80 hospitalized patients with clinical presentations of suspected acute meningitis were subjected to estimation of IL-8 CSF concentrations. The results showed that CSF IL-8 levels were higher in acute bacterial meningitis than in aseptic ones [p <0.05]. The best cut-off value of CSF IL8 for early diagnosis of bacterial meningitis was 3.6ng/ml with a sensitivity of 82.5% and a specificity of 85.0%

Guided liver biopsy of hepatic focal lesions in chronic liver disease patients: when and why?

Hepatocelluar carcinoma [HCC] is one of the most common malignant neoplasms in the world. To assess the value of the ultrasound or CT guided biopsy of hepatic focal lesion [s] with normal or mild elevation of serum alpha fetoprotein [below 200ng/mL] in the diagnosis of hepatocellular carcinoma. One-hundred twenty one chronic liver disease patients with hepatic focal lesion[s] and serum alpha fetoprotein below 200ng/ml were included in the present study. All patients were subjected to careful history taking and full clinical examinations, laboratory investigations [CBC, liver profile, hepatitis markers and serum AFP level], abdominal ultrasound, abdominal triphasic spiral computed tomography [CT] and biopsy of the hepatic focal lesion[s] guided by ultrasound for histopathological examination. According to the histopathological diagnosis of the lesion, patients were divided into non-HCC group [Group I] and HCC group [Group II] which included dysplastic nodules as well. Group I included a total of 29 patients -20 males [68.9%] and 9 females [31.1%] - aged between 30 and 68 [mean 51.7 +/- 9.3] years. Pathological examination of their liver biopsies revealed 14 cases as chronic hepatitis, 5 cases as liver cirrhosis, 5 cases as adenocarcinoma, 1 case as squamous cell carcinoma 2 cases as hemangioma and 1 case as cholangiocarcinoma and one case of lymphoma. Group II included a total of 92 patients -75 males [81.5%] and 17 females [18.5%] - aged between 36 and 74 [mean 55.0 +/- 8.8] years. Pathological examination of their liver biopsies revealed 88 cases as HCC and 4 cases as hepatic dysplastic nodules. The sensitivity and specificity of triphasic abdominal spiral CT in the diagnosis of HCC were 91.3% and 69.0% respectively, while, the positive and negative predictive values were 90.3% and 72.5% respectively. Guided liver biopsy of hepatic focal lesions in chronic liver disease patients has a valuable diagnostic role in cases with low alpha fetoprotein below 200ng/ml in whom the non-HCC nature is suspected and cases with negative or atypical HCC criteria in spiral abdominal CT