Study of the correlation between; nitric oxide profile, degree of liver injury and structural vascular changes of the gastric mucosa in chronic hepatitis C virus related liver diseases

Nitric oxide [NO] plays an important role in HCV associated hepatic dysfunction and in the pathogenesis of portal hypertension. This study was designed to correlate serum nitrite and nitrate levels with the degree of liver injury and gastric mucosal changes in HCV patients at different stages of the disease. 80 HCV infected patients were classified equally into 4 groups; chronic hepatitis C, Child A, B and C cirrhosis groups. 20 healthy subjects were allocated as a control group. For all patients, serum nitrite and nitrate levels, HCV RNA and liver test profile were evaluated. Liver biopsies for chronic hepatitis C and Child-A cirrhotic patients were obtained for grading, staging and expression of interferon gamma [INF- gamma] and pentosidine. Esophagogastrodudenoscopy to evaluate the degree of portal hypertensive gastropathy [PHG] and expression of vascular endothelial growth [VEGF] by histopathology. Serum NO profile was significantly higher in all HCV infected patients than healthy subjects. A significant correlation between IFN-gamma expression and both of serum NO and viral load. Also, hepatic pentosidine expression was correlating with staging and fibrosis. Also both of serum NO and gastric VEGF were over expressed and correlating with the degree of PHG. In HCV infected patients, serum NO was significantly overexpressed and correlating with the severity of chronic liver disease. Our study supports the role of direct viral cytopathic effect in HCV patients because of the significant correlation of viral load with both of serum NO and hepatic IFN-gamma expression. Pentosidine might be considered a marker of oxidative stress and fibrosis in chronic HCV liver disease

Urgent endoscopic sphincterotomy in acute biliary pancreatitis, an alternative to surgery

Thirty-two patients presenting with acute biliary pancreatitis were included, 20 presented early while 12 presented late after 72 hours from onset. Patients were classified using Atlanta and Ranson scoring into mild [20 patients], and 12 patients]. ERCP and urgent endoscopic sphincterotomy were done within 8 hours from admission, while patients were on supportive treatment and high dose of octreotide infusion. Sizable stones were found in 10, biliary gravel in 10, sludge in 4, inflamed papilla only in 5, fasciola fluke in 2 and an ascaris while those presented early showed complete recovery indicating the success of urgent endoscopic sphincterotomy in halting the progression of pancreatitis

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

Study of risk factor for variceal bleeding in schistosomal hepatic fibrosis patients

One hundred and twenty patients with schistosomal hepatic fibrosis and esophageal varices [mean age 34.6 + 10.6] were divided into three groups. Group I included 55 patients with past history of esophageal variceal bleeding episode [s], group II entailed 50 patients with no previous history of bleeding, and group III comprised 15 patients previously submitted to decongestion operation. 30 patients out of the group II were submitted to prophylactic sclerotherapy. Variceal bleeding occurred in 30% of the rest of this group. All patients were followed up for a mean period of 14 +/- 3.2 months [range between 8-21 months]. The most significant risk factors for occurrence of first or recurrent variceal bleeding were; increased age; low prothrombin activity, decreased platelet count, and also high modified Child's score especially in patients with past history of recurrent bleeding. Endoscopically detected factors included, large sized blue varices, with positive red color sign which was found in 90% of patients with recurrent bleeding; and in 100% of patients who bled for the first time during the study period. Increased umbilical vein diameter measured ultrasonographically was found to be an important risk factors in first time bleeders