Value of duplex ultrasound to investigate whether large volume paracentesis without infusions is safe, easy and economic in selected cirrhotic patients

In tense or refractory asciites, large volume paracentesis [LVP] combined with intravenous infusions has been suggested as the preferable treatment. Flow volume rate [FVR] of portal vein [PV] and Hepatic artery [HA] were measured before and one day after large volume paracentesis [L VP]. 58 cirrhotic patients with ascites were allocated into 2 groups; group [1]: 28 patients were not infused by isotonic fluids, group [2] 30 patients [divided into 3 equal subgroups 2a, 2b and 2c] were infused by different isotonic solutions as follow saline, hemaccel and human albumin respectively. FVR of PV in group 1, 2a, 2b and 2c before LVP were 1894.4+3.3, 1235.5+7.8, 1253.9+19 and 2172+4,2 ml/mm respectively and one day after LVP they were 2207+11,2, 1666+7.4, 1396+29.3 and 1835+8.7 ml/min respectively. FVR of HA in group 1, 2a, 2b and 2c before LVP were 222,7+3.2, 182.3+4.4, 286.4+5.9 and 238,8+4.1 ml/min respectively. FVR of HA in group If 2a, 2b and 2c after LVP were 541.7+4.2, 329.1+2.9, 289,7+1.7 and 284 4+4.2 ml/min respectively, We conclude that FVR was significantly increased after LVP in the majority of the patients; more in patients non infused as compared to infused patients provided we select probably our patients. LVP less than 5 liters without infusions in selected patients are effective, safe, easy and economic. This research was funded by Theodor Bilharz Research Institute [TBRI] and Egyptian Academy of Research and Technology

Immunoelectron microscopic study of Fc gamma receptors on the macrophages and fibronectin in murine hepatic schistosomiasis

This study dealt with the in vivo determination and distribution of Fc gamma receptors on macrophage, and the fibronectin expression by macrophage, in liver granuloma, in the acute [8 weeks] and chronic [20 weeks] stages of Schistosoma mansoni infection in mice. The application of electron microscopic immunoperoxidase technique delineated the location and distribution of Fc gamma receptors on macrophage surface membrane in both acute and chronic immunomodulated granuloma. In the acute granuloma, it revealed an increased density of Fc gamma receptors on macrophage surface denoting its activation. Whereas in chronic granuloma the Fc gamma receptors on macrophage were demonstrated to be less dense. This diminished expression can be taken as a monitor of immunomodulation and is attributed to diminished expression of the receptors on the macrophage surface itself and not only to decrease in number of cells. Immunoelectron labelling of tissue fibronectin displayed intracellular deposition in macrophage, endothelial cells and fibroblast cells in the 8 weeks granuloma. It decreased in the immunomodulated granuloma in correlation with Fc gamma receptors. Thus understanding of the complex interactions between Fc gamma receptors, fibronectin and macrophage may be helpful in attempts to manipulate fibrous tissue deposition in granulomatous lesions