Urotensin II as a novel marker for portal hypertension and bleeding varices: an Egyptian survey

Background and aim: Urotensin II [U-II], a somatostatin-like cyclic peptide, was recently identified as the most potent human vasoconstrictor peptide. We investigated whether serum U-II could be considered a marker for portal hypertension [PHT] and its complications in patients with hepatitis C virus [HCV]-related cirrhosis

Patients and methods: After clinical, ultrasonographic, and endoscopic assessments and exclusion of patients with hypertension or diabetes and cardiac or renal comorbidities, 75 patients with HCV-related cirrhosis were classified into three equal groups. Group A included 25 patients with PHT presenting with bleeding esophageal varices [EV]. Group B included 25 patients with PHT with no history of bleeding EV. Group C included 25 patients without PHT or EV. In addition, 25 apparently healthy volunteers were included as controls [group D]. All participants were investigated for liver tests, Child-Pugh scoring, and serum U-II

Results: Serum U-II was significantly higher in cirrhotic patients with PHT with and without bleeding EV compared with the other groups; also, it correlated with the severity of liver disease [P<0.0001]. U-II, at a cutoff value of 2.07 ng/ml or more, could predict the presence of PHT with 98% sensitivity and 100% specificity [P<0.05], whereas at a cutoff value of 2.51 ng/ml or more, it could predict the presence of bleeding EV with 96% sensitivity and 93.3% specificity [P<0.05]

Conclusion: Serum U-II in HCV-related cirrhosis could be a simple and easy predictor of the presence of PHT and bleeding episodes in patients with EV

Role of biofeedback in patients with functional constipation

Functional constipation with paradoxical puborectalis contraction is still a distressing problem. The aim of this study is to assess the effect of biofeedback therapy in managing such condition. Twenty one patients with any degree of paradoxical puborectalis contraction. [PPC] measured with EMG and /or defecography were included. The patients had ten outpatient training sessions with manometry based audiovisual feedback. All patients were followed up for a median 5 [3-12] months. Three patients couldn't continue the coarse. Eleven patients stated they had improved rectal emptying. A good result was associated with increased stool frequency [P< 0.05], reduction of laxative use [P < 0.02]. A long symptom duration and laxative use were related to poor results. The improved group had less perincal descent [P < 0.02] and a prominent puborectalis impression tended to he more common [P < 0.02]. Conclusion: Biofeedback was successful in 73.3% of patients with PPC with a treatment effect lasting for more than 3 months. The results suggest that biofeedback should be used as the initial treatment for constipated patients with PPC

Role of surgery in chronic constipation personal experience

Patients with chronic constipation may have one of several physiologic disorders, not all of which are amenable to operative therapy. The aim of this study was to test colonic and pelvic floor function preoperatively to identify patients suitable for surgery based on these studies and to determine operative outcome over time. Between 1991 - 1996, 37 patients referred for severe symptoms of chronic intractable constipation underwent colon transit studies, measurement of anal canal pressures and reflexes, electromyography and defectin proctogram. Based on these studies patients were categorized as having slow transit constipation [STC], 8 patients; pelvic floor dysfunction [PFD]. 14 patients, STC + PFD, 2 patients while irritable bowel syndrome, 13 patiens. STC patients underwent abdominal colectomy and ileorectostomy. Cases with pelvic floor dysfunction were managed according to defect. Cases with rectocoele treated by anterior levatorplasty, 5 cases intussuscuption treated with lat. and post. Levatorplasty while 2 cases with empty anal canal and high resting and max. pressure needed anal myectomy and 3 cases with puborectalis spasm did release to the muscle but failed in two cases needed pelvic floor retraining. Among 37 patients referred only 22 patients did surgical procedures. There was no mortality. Prolonged ileus developed in [9%] of cases and bowel obstruction occurred in 9% of patients. On follow up a mean of 16 months after surgery with no constipation in 86% of cases, non was incontinent. The auther concluded that a prospective evaluation of colonic and pelvic floor function reliably delineated constipated patients suitable for operative management or conservative management or for pelvic floor retraing

Laparoscopic cholecystectomy in a safe and effective method in treating acute cholecystitis

In a series of 230 cases, laparoscopic cholecystectomy was attempted in 18 patients having the clinical picture of acute cholecystitis, 4 cases were non-calcular by preoperative sonar which revealed thick edematous wall of the gallbladder in 13 patients. All patients were scheduled for operation 72 hours or less from the attack. There was a significant discrepancy between the clinical picture and the laparoscopic finding of the gallbladder. The average operative time was 105 minutes. Dissection of the gallbladder was done by "fundus first" method in 3 cases. The hospital stay ranged from 18 to 48 hours. Two cases were converted to open surgery because of severe inflammation obscuring the anatomy. No mortality or significant morbidity were reported. It was concluded that laparoscopic cholecystectomy is safe and effective method in treating patients with acute cholecystitis and these patients should not be denied the benefits of laparoscopic cholecystectomy in centers with appropriate experience