Prolonged intrahepatic cholestasis in patients with schistosomal hepatic fibrosis and chronic viral hepatitis: role of associated active schistosomiasis

Among 50 patients with schistosomal hepatic fibrosis [SHF] and superimposed chronic viral hepatitis [CVH], prolonged intraheptic cholestasis [IHC] was found in 27 patients. In those patients with IHC, the frequency of active S. mansoni infection and serum levels of tumour necrosis factor-alpha [TNF-alpha] were significantly higher than in patients without jaundice [P<0.05]. After 4 courses of praziquantel [PZQ] therapy, there was a significant improvement in the clinical, biochemical and histopathological evidences of IHC in parallel with cure of active schistosomal infection and a significant decrease in serum TNF alpha levels [P<0.05]. In conclusions active S. mansoni infection with subsequent enhanced immune response is a possible etiological factor for the development of prolonged IHC in patients with SHF and superimposed CVH. Repeated course of PZQ therapy may help in the clearance of jaundice in these patients

Cardiovascular autonomic functions in patients with schistosomal hepatic fibrosis

A battery of tests for cardiovascular autonomic functions was performed in 20 patients with schistosomal hepatic fibrosis [SHF] and 20 healthy subjects. The patients with SHF showed significant reductions in the standing-to-lying ratio; the heart rate [HR] variation during deep breathing, the HR response to atropine and the blood pressure [BP] response to isometric handgrip. The Valsalva ratio, cold pressor test and orthostasis were not significantly affected. The severity of liver disease in patients with SHF was directly related to the number of abnormal autonomic tests and inversely correlated with the HR responses to deep breathing and Valsalva maneuver and with the cold pressor test

Gastro-vascular and micro-vascular changes in chronic murine schistosomiasis mansoni: response to propranolol

Histopathologic study of the gastric wall of mice infected with Schistosoma mansoni was carried out at 8, 12, 16 and 20 weeks postinfection [p.i.]. The gastric vascular structures were more sensitive to injury with the progression of liver disease than the glandular cells, with marked submucosal edema and thickening of submucosal and subserosal vessels. By transmission electron microscopy, the mucosal microvessels had thickened basement membrane and conspicuous endothelial cells with granular cytoplasm thrown into numerous intraluminal microprojections and with increased number and size of pinocytotic vesicles. When propranolol was administered orally as 20 mg/kg daily doses for two weeks at 6, 10, 14 and 18 weeks p.i., a striking regression of gastro-vascular and micro-vascular changes has been observed, particularly with early drug therapy. Based on the present study, it can be concluded that "structural autoregulation" of gastric vasculature to the emerging portal hypertension in chronic murine Schistosomiasis mansoni, is a dynamic process that could be reversed by propranolol therapy. This response could, possibly, improve gastric mucosal perfusion and functional abnormalities which may predispose the gastric mucosa to severe damage or hemorrhage

Relationship between thyroid state and eye disease assessed by orbital ultrasonography in patients with Graves' disease

The present study included twenty patients with untreated Graves' disease [GD] with or without Graves' ophthalmopathy [GO] graded according to a clinical eye score [NOSPECS classification] and twenty normal subjects. Extraocular muscle [EOM] involvement [class VI] was clinically apparent in 25% of patients with GD, while orbital ultrasonography detected thickening of one or more EOM in 80% of patients including those with no or early clinical eye disease [class O or I]. In a descending order of frequency, the medial [MR], inferior [IR], superior [SR], and lateral [LR] rectus muscles were thickened. The progression of clinically apparent GO had a positive correlation only with the duration of eye disease and the thickening of SR muscle and of retrobulbar fat [RBF]. Considering thyroid state, overt hyperthyroidism was documented in 16 patients [80%] with GD and most of them had evidence of a concomitant [mostly subclinical] eye disease. On the other hand, 75% of patients with GO detected by ultrasonography demonstrated some abnormality in thyroid function. Although GO was strongly associated with Graves' hyperthyroidism, yet, no definite correlation has been observed between serum levels of thyroid hormones and severity of GO suggesting that the course of ophthalmopathy is independent of the thyroid function. On the basis of the present work, a close liaison between the physician and the ophthalmologist is important for early detection and treatment of eye disease in patients with GD before marked damage to EOM occurs. Orbital ultrasonography is a sensitive, safe and easy technique for screening the presence, but not the severity of GO. Being the most frequent and earliest to be involved and the easiest to measure, the MR muscle could be chosen for ultrasonographic examination in patients with GD