Abdominal wall abscess secondary to subcapsular tubercular liver abscess.

We report a 22-year-old woman who presented with an abdominal wall lump in the right upper quadrant 15 days after starting antitubercular treatment for right pleural effusion. CT scan revealed a right liver lobe subcapsular abscess communicating vith subcutaneous tissue. Aspiration of pus revealed acid-fast bacilli. She responded to 9 months of antitubercular treatment.

Endoscopic management of anal protrusion of ventriculo-peritoneal shunt.

A 2-year-old male child, who was operated on 18 months earlier for tuberculous meningitis with hydrocephalus by placement of a ventriculo-peritoneal shunt, presented with the lower end of the shunt tube coming out through the anus. Colonoscopy showed the shunt tube coming out through the colon 22 cm from the anal opening. The cranial end, along with a malfunctioning valve, were disconnected surgically, and the shunt was removed endoscopically using a pediatric flexible colonoscope.

Assessment of portal hemodynamics by ultrasound color Doppler and laser Doppler velocimetry in liver cirrhosis.

BACKGROUND: Color Doppler is a noninvasive method for assessing portal hemodynamics. Laser Doppler velocimetry is useful in assessment of microcirculatory abnormalities in portal hypertensive gastropathy (PHG). AIMS: To study portal hemodynamics by color Doppler and gastric mucosal blood flow (GMBF) by laser Doppler velocimetry in patients with cirrhosis. METHODS: Twenty-eight patients with cirrhosis of liver (24 men) and 10 healthy subjects (7 men) were studied. Portal venous blood flow (PVBF) and portal flow velocity (PFV) were assessed by color Doppler at the level where the hepatic artery crosses the portal vein, and GMBF was measured by laser Doppler velocimetry. RESULTS: PVBF (379.5 [102.9] mL/min), PFV (5.3 [1.1] cm/sec) and GMBF (3.5 [0.8] volts) were significantly lower in patients with cirrhosis than in controls. PVBF and PFV were significantly lower in patients in Child class B and C than those in class A. Patients with ascites had significantly lower PVBF, PFV and GMBF than those without; values were also lower in patients with PHG than in those without. History of bleeding had no relation with PVBF and PFV. GMBF showed good correlation with PVBF (r=0.58, p<0.001) and with PFV (r=0.48, p<0.01). CONCLUSIONS: In cirrhosis of liver, PVBF, PFV and GMBF are significantly lower, and the changes increase with increasing severity of liver disease.

Thymosin alpha in the treatment of chronic hepatitis B: an uncontrolled open-label trial.

BACKGROUND: Interferon treatment for chronic hepatitis B has low efficacy and is associated with serious side effects. It is therefore important to assess the role of other drugs in the treatment of this condition. AIMS: To assess the efficacy and safety of thymosin alpha in 20 patients with hepatitis B-related liver disease. METHODS: Patients with chronic hepatitis B, HBV DNA positivity, ALT more than 1.5 times the upper limit of normal and liver biopsy showing chronic hepatitis or cirrhosis were treated with thymosin alpha 1.6 mg subcutaneously twice a week for 6 months. Biochemical and serological markers were assessed pre-treatment, immediately post treatment, and 6 months and 1 year after end of treatment. RESULTS: Of 20 patients, 15 had chronic hepatitis and 5 had cirrhosis on histology; 17 were HBeAg-positive and 3 were HBeAg-negative. Eight patients were interferon non-responders and 12 were naïve patients. Four patients had end-of-treatment response and two additional patients had a delayed response within 6 months of treatment; one responder had a relapse within 1 year of treatment. Overall sustained response rate was 25% (5 of 20). No patient cleared HBsAg. Reduction in ALT levels was observed after treatment and persisted one year later. No significant side effects were observed. CONCLUSION: Thymosin alpha is a safe and effective alternative treatment modality in chronic hepatitis B.