Evaluation of transforming growth factor alpha [TGFn] and tumor necrosis factor alpha [TGFn] in children with acute hepatitis

The present study included 60 children who were recruited from Pediatric Department of National Liver Institute [NLI], Menoufiya University and 20 apparently healthy children from the relatives of patients as a control group. Their ages ranged from 2 to 15 years, they were 49 males and 31 females. The studied children were divided according to their diagnosis into groups each of 20; Group [I] acute hepatitis, Group [II] acute fulminant hepatitis [F. H], Group [III] chronic hepatitis and Group [IV] control group. The mean level of both transforming growth factor alpha [TGF I] and tumor necrosis factor alpha [TNF I] were higher in group II [32.74 +/- 9.98 pg/mL and 116.41 +/- 49.70 pg/ml, respectively] more than the other groups and the difference was statistically highly significant [[P<0.001] and [<0.05], respectively]. The mean of level of [TGFD in FH survivors was [29.23 +/- 5.51pg/mL] compared to deceased ones [20.93 +/- 4.60 pg/mL] but the difference was statistically insignificant [p>0.05]. On the other hand the mean of [TNFI] in the deceased cases was 132.76 +/- 48.81pg/mL compared to 117.93 +/- 19.15pg/mL in survivors but the difference was statistically insignificant [P > 0.05]. Case fatality rate for all FH cases was 80%. In conclusion, the levels of both TGFI and TNFI are significantly higher in fulminant hepatitis more than acute hepatitis cases but with no significance in the progress of the disease. Further studies is recommended to uncover predictors that can differentiate between acute hepatitis and fulminant hepatitis and the progress of the disease

Histopathological and doppler findings in children with liver cirrhosis : a correlation study

Cirrhosis is an end stage state of virtually any chronic liver disease. There is great clinical interest in establishing the diagnosis of liver cirrhosis in children by non-invasive means. The aim of this work is to study the correlation between Doppler ultrasound parameters and hepatic histopathological findings in children with liver cirrhosis in an attempt to test the efficacy of these parameters as non-invasive means in diagnosis of cirrhosis. Patients and methods: Twenty two children admitted to Liver Institute, Menoufiya university for evaluation of unknown liver disease were examined prospectively and blindly with Doppler ultrasound prior to liver biopsy. Doppler studies were also preformed on 20 control subjects. Patients only were later subjected to liver biopsy. Histopathological examination of the biopsy specimens showed established cirrhosis in 11 of 22, early cirrhosis in 5 of 22. and no cirrhosis in 6 of 22 children. In patients group, the portal vein velocity was decreased [p < 0.05], the hepatic artery velocity was increased [p<0.05], and the arterio-portal velocity ratio was increased [p< 0.05] relative to the controls. Also, loss of reverse flow component was present in all established cirrhotic patients. For the criteria of the early and established cirrhotic patients, the sensitivities of the loss of reverse flow component in the hepatic vein, portal vein velocity being less than 20 cm/ s,hepatic artery velocity being more than 60 cm/s, arterio-portal velocity ratio being greater than 3.0 were 68.7%, 68.7%, 87.5% and 81.2% respectively. In established cirrhotic patients, the sensitivities of all parameters were 100%. In early cirrhotic patients, the sensitivities of hepatic artery velocity being more than 60 cm/s and arterio-portal velocity ratio being greater than 3.0 were 60% and 40% respectively. Indicators of parenchymal compliance [LRFC], outflow obstruction [decreased PVV] and arterialization [increased HAV, alteration in APVR] were accurate in the diagnosis of established cirrhosis. Also, HAV and APVR were useful in the diagnosis of early cirrhosis. We believe that on the basis of our data, afferent and efferent flow abnormalities monitored with Doppler ultrasound may be useful in the assessment of Patients with liver cirrhosis