[Waldenstrom's Macroglobulinemia in Cryptogenic Cirrhosis]

The coexistence of Waldenstrom's macrglobulinemia and cryptogenic cirrhosis has been rarely reported.We describe a 72-year-old man with compensated cryptogenic cirrhosis whose major clinical presentation was hyperviscosity syndrome. Serum protein electrophoresis revealed the presence of an IgM-kappa spike. Lambda light chain was found in urine. Bone marrow biopsy was performed, which showed at least 22%infiltration with atypical plasma cells. No bone lesion was found. ByWaldenstrom'smacroglobulinemia diagnosis, patient treated with melphalan, thalidomide and dexamethasone. After three weeks of treatment, his symptoms disappeared and serum immunoglobuline M decreased below 1000 mg/dl

Treatment of chronic hepatitis B

The primary goal of therapy in patients with chronic hepatitis B is durable suppression of HBV DNA to the lowest possible level. The threshold of HBV DNA level to initiate therapy is >/= 10[5] copies /ml for patients with HBe antigen-positive and >/= 10[4] copies /ml for patients with HBe antigen-negative chronic hepatitis B. Interferon alpha2b, lamivudine and adefovir dipivoxil are PDA-approved and could all be used as an initial first-line therapy in chronic hepatitis B. It was shown that adding lamivudine to either conventional interferon or peg-interferon did not increase the efficacy of treatment. Also, addition of lamivudine to adefovir had no additional effect in compensated patients. Response rate is about 30-40% with first-line drugs. Peg-interferon, which recently received PDA approval, was associated with an increased response rate. Further long-term studies are required in order to use Peg-interferon as a wide-scale first-line treatment. Treatment strategy is changing towards using prolonged combination therapy with evolving nucleoside analogues with or without an immunomodulatory agent, aiming to eradicate cccDNA

[ effect of Opium addiction on response to major operation stress]

Internal medicine consultants are frequently asked to evaluate patients' tolerance against the stress of an intended surgical operation. Classification of surgical operations to mild, moderate and major is based on the morbidity and mortality rates due to the procedure, duration of procedure and underlying risk factors of the patient. Body response to surgical stress is via some hormonal alterations following the activation of hypothalamo pituarity adrenal axis [HPA] and hormonal changes reflect the degree of surgical stress. Due to high prevalence of addict patients operated in our surgery center and the established effect of opioid agents on HPA, this case - control study designed to detect the effect of chronic opioid usage on body response to major operation stress. Twenty six patients selected for laparatomy, thoracotomy or thyroiedectomy in two equal and matched groups of opium - addict and nonaddict were studied for alterations in serum cortisol, CRP, Glucose and interleukin -6 immediately after the induction of anesthesia and 4 and 24hours postoperatively. The obtained results were analyzed by t-test. Serum cortisol level of addict group 24 hours after operation [288ng/dl] showed significant increase comparing to that of non-addict group [195ng/dl]. The obtained result show more sever response of opium addicts to major surgery stress comparing to non addicts

[ effect of opium addiction on response to major operation stress]

Internal medicine consultants are frequently asked to evaluate patients' tolerance against the stress of an intended surgical operation. Classification of surgical operations to mild, moderate and major is based on the morbidity and mortality rates due to the procedure, duration of procedure and underlying risk factors of the patient. Body response to surgical stress is via some hormonal alterations following the activation of hypothalamo pituarity adrenal axis [HPA] and hormonal changes reflect the degree of surgical stress. Due to high prevalence of addict patients operated in our surgery center and the established effect of opioid agents on HPA, this case - control study designed to detect the effect of chronic opioid usage on body response to major operation stress. Twenty six patients selected for laparatomy, thoracotomy or thyroidectomy in two equal and matched groups of opium - addict and nonaddict were studied for alterations in serum cortisol, CRP, Glucose and interleukin -6 immediately after the induction of anesthesia and 4 and 24 hours postoperatively. The obtained results were analyzed by t-test. Serum cortisol level of addict group 24 hours after operation [288 ng/dl] showed significant increase comparing to that of non-addict group [195 ng/dl]. The obtained result show more severe response of opium addicts to major surgery stress comparing to non addicts