Diagnosis of subclinical hepatic encephalopathy in patients with liver cirrhosis

In addition to clinically manifest hepatic encephalopathy, a subclinical stage has been described, This stage can be detected only by psychometric and/or neurophysiological tests. Early diagnosis and treatment of subclinical hepatic encephalopathy [SHE] may improve the daily functioning of the patients. We used two psychometric tests [Number Connection Test and Digit Symbol Test] and electroencephalography [EEG] to detect the prevalence of SHE in 200 patients with stable liver cirrhosis. One hundred age-matched healthy controls underwent the psychometric tests, while only 40 of them shared in the biochemical evaluation of the liver disease. Seventy-sex [38%] of the 200 patients, had SHE. SHE was diagnosed by the presence of at least one abnormal psychometric test and/or abnormal slowing of the EEG. Sixty-six [33%] of the 200 patients, had abnormal results on at least one psychometric test. Old age or low education may cause false positive psychometric tests. Sixty [30%] of the 200 patients, had slowing of their EEGs. A positive correlation was found between the severity of EEG slowing and the severity of liver disease and also the disease duration. It was noticed that some patients had only abnormal one psychometric test or only EEG slowing. This poor overlap between the different tools used for the diagnosis of SHE suggests that the use of a multiple psychometric test battery conjoined with neurophysiologic tests may lead to better and earlier diagnosis of SHE which appears to be prevalent among patients with stable cirrhosis

Prevalence and predictors of renal artery stenosis detected by renal duplex sonography in type 2 diapetes mellitus

Diabetes mellitus [DM] is a risk factor for atherosclerosis that may lead to renal artery stenosis [RAS]. This study aimed to screen type 2 diabetic patients for presence of RAS and to identify the main predictors of its presence. The study included 473 patients [204 males and 269 females], aged 40 years or more with a well established DM of more than 5 years duration. Data about smoking, hypertension, diabetic retinopathy, ischemic heart, cercbrovascular and peripheral vascular diseases, macro and microalbuminuria, impaired kidney function and dyslipidemia were collected using history taking, physical examination and appropriate laboratory investigations. Renal ultrasonography and duplex renal scans were obtained for each patient under standardized conditions to determine the size and volume of the kidneys and to evaluate dynamics of the renal blood flow to diagnose RAS. The prevalence of RAS among all patients was 5.9%, and was 11.7% in those with hypertension. Logistic regression analysis was performed to examine and control for the joint effect of multiple factors potentially predicting presence of RAS. The odds ratio [OR] of RAS for the hypothesized predictors were determined to assess the significance of the association. There was a significant association between RAS and presence of abdominal bruit [OR=11.3], difference of length between the two kidneys [OR=3.4], age of patients [OR= 1.6] and duration of DM [OR= 1.1]. RAS is a common complication in type 2 DM. Type 2 DM patients should be scheduled for regular renal duplex check up and this may be done more frequently in patients with certain features that predict presence of RAS

Non tuberculous bacterial peritonitis in Egyptian patients with ascites

Biochemical, cytological and non tubercoulous bacterial culture of ascitic fluid of 50 patients [25[M], 25[F]. with mean age 35y] with chronic liver diseases admitted to Ahmed Maher Hospital liver unit care, were done for detection of spontaneous bacterial peritonitis [SBP]. Patients were classified into 25 patients with bilharzial hepatic fibrosis and 25 patients with non bilharzial hepatic cirrhosis [viral hepatitis]. The levels of specific gravity and lactic dehydrogenase [LDH] enzyme were higher in bilharzial [mean 1012 and 27.52 mg/dl] than the non bilharzial group [mean 1009 and 26.88 mg. dl] respectively, while there was no marked difference in the levels of ascitic fluid protein contents, ALT, AST, bilirubin and glucose. The cytological examination of the ascitic fluid showed that white cell, PMN and lymphocytic cell counts were higher in non bilharzial [mean 485. 6, 227. 68 and 34. 24 /mm[3]] than the bilharzial group [mean 397.68, 221.68 and 34.12/mm[3]] respectively. Ascitic fluid culture was positive in 9/50 [18%] cases of suspected SBP. [10%] of the non bilharzial group compared to [4%] of the bilharzial group were bacterial culture positive. Single isolated strain was found in [16%] and combined bacterial infection in [2%] of the two studied groups. A good correlation was found between PMN cell count >/= 1000 cell/mm[3] and positive bacterial culture in both groups studied. We concluded that indirect parameters of diagnosis of SBP i. e. ascitic fluid PMN cell count and LDH beside the routine bacterial culture provide rapid diagnosis and alter the bad prognosis of SBP

Study of reflux oesophagitis by endoscopy versus radiology

A comparative study between endoscopic and radiological accuracy and sensitivity in diagnosing different grades of reflux oesophagitis is our aim in this study. After full clinical examination, all patients were subjected to upper gastrointestinal. Endoscopy and radiological examination. Endoscopy was found to be more sensitive and superior to radiology especially in diagnosing early and mild cases of reflux oesophagitis

diagnostic value of endoscopic chromoscopy in upper gastrointestinal lesions

Chromoscopy is a technique by which dyes can be sprayed over the mucosa of gastrointestinal tract three types of dyes used in this study are Lugol's solution, Indigo carmine and Methylene blue. This study showed that chromoscopy is useful in confirming the results al- ready gained by routine U.G.I. endoscopy and also in demonstrating the severity and the extent of the lesion