Lymphocyte subsets and cytokines in ascitic fluid of decompensated cirrhotic patients with and without spontaneous ascites infection

Background: Spontaneous bacterial peritonitis [SBP] is a frequently encountered and important complication of decompensated liver cirrhosis. The immune system plays an important role in the development or eradication of this infection. A number of compositional and functional alterations in immune system cells have been demonstrated in cirrhotic patients: however, there is a lack of knowledge about this issue in ascitic infections

Aim of the study: The aim of the present study was to evaluate lymphocyte subsets and levels of some ascitic and lymphocytic intracytoplasmic cytokines in decompensated cirrhotic patients with or without spontaneous bacterial peritonitis which may help to understand the role of immune system in pathogenesis of SBP and consequently introduction of new therapeutic modalities

Subjects and methods: This case-control study included 50 decompensated cirrhotic patients [37 male. 13 female] from gastroenterology and hepatology unit of internal medicine department; Assiut university hospital with different etiologies. Patients with ascitic polymorphonuclear leukocyte count >/=250/mm[3] and/or positive ascitic bacterial cultures were classified as the 'patients group' [n=25, mean +/- SD of age was 57.84 +/- 6.66 years]. Patients with ascitic poly morphonuclear leukocyte count <250/mm[3] and/or negative ascitic bacterial cultures were classified as the controls group [n=25, mean +/- SD of age was 60.36 +/- 6.51years]. Comparison was made between the patients and controls groups for the following parameters: ascites leukocyte counts and differentiations; ascitic fluid protein; albumin levels and serum-ascites albumin gradients; flow cytometric detection of ascitic lymphocyte subsets [CD3, CD4. CD8, CD4/CD8 ratio. CD19, CD45] and ascitic cytokine TNF-alpha

Results: Ascitic total protein and albumin levels were significantly decreased in patients group. The C4, CD19. CD45 and CD4/CD8 ratio were significantly decreased in the patients group. Furthermore, ascites CD3, CD8 and TNF-alpha levels were significantly elevated in this group. The incidence of renal impairment, gastrointestinal bleeding and hepatic encephalopathy was higher in patients group and there was a significant correlation between TNF-alpha and renal impairment in this group

Conclusion: These results suggest that a cytotoxic, especially Th1, immune response predominates in ascites infections. It also demonstrates that TNF-alpha might he involved in the pathogenesis of ascites infections

Histological features of chronic hepatitis c with persistently normal serum ALT level

Approximately one third of patients with chronic hepatitis C [CHC] injection have normal alanine transaminases [ALT] levels, definition and Meal significance of persistently normal ALT in CHC have been revised. Liver biopsy is usually the most accurate test for assessing the severity of liver disease. To evaluate the liver histological feature of patients suffering from CHC with persistently normal ALT levels. In this study 50 patients with CHC with persistently normal ALT since last six months who enrolled for the antiviral treatment and subjected to liver biopsy for assessing the severity of liver disease. Histological results were scored using the METAVIR system. Mean age of these patients was 40.1 +/- 9.3 years; out of these 39 [78%] were male. Significant fibrosis [F 2-4] in 19 patients [38%] and insignificant fibrosis [stage 0-1] 62%. Cirrhosis [F 4] were present in 6 patients [12%]. The necro-inflammatory changes were grade 1 in 36 [72%] patients and grade 2 in 14 [28%] patients, no patients showed more severe changes. Steatosis were minimal [0-1] in 43 [86%] patients and severe [score 2-3] in 7 patients [14%]. Viral load were weak in 16, [32%] moderte in 27 [54%] and high in 7 [14%] patients, severity of fibrosis were highly correlated to grade of inflammation [P=0.002] and slightly to steals [p=0.048] but no correlated to age, sex, ALT value or viral load. The grade of inflammation were related to age [p=0.011]. Extent of steatosis were not correlated to clinical or laboratory variables. There was no correlation found between the transaminase level and biopsy scores. Approximately 38% of the patients with normal transaminases have fibrosis equal to or greater than stage 2 and 12% have cirrhosis. The grade of inflammation and extent of steatosis is related to the score of fibrosis

impact of splenectomy on the patient's susceptability to infection

Splenectomy, is a procedure that has significantly decreased in frequency as the understanding of its complications increase. Susceptibility to infection is the best-defined and most widely understood complication of splenectomy. The aim was to study the impact of splenectomy on the patients susceptibility to infections, and its effect on morbidity and mortality statistics of patients admitted to fever hospitals. The study included 506 patients admitted to fever hospital and they divided according to history of splenectomy into group 1 of 432 patients with no history of splenectomy and group II of 74 patients with history of splenectomy. The cause and duration of splenectomy, hospital stay, the type and duration of antibiotic prescribed in hospital the diagnosis and the outcome at discharge were the main history items. Chronic liver disease [CLD] was the main cause of splenectomy followed by trauma and Thalassemia 67%, 20% and 12% respectively. No significant difference in blood culture between the 2 group but capsulated organism were more in group II. Respiratory tract infection was the main cause of admission in both groups with a high incidence of respiratory, urinary tract infection, meningitis and pyrexia of unknown origin in group II. Quinolones, Penicillin and Cephalosporins were the commonly used groups of antibiotics with statistical difference in group 2 than group 1. Prolonged hospital stay in group II with high statistical difference than group I [14.07 +/- 8.68 versus 4.57 +/- 3.29] [P<0.001]. The improved outcome were significantly higher in group 1 than group 2 and the not improved outcome [frequent admission, escape from hospital and university hospital referral] were higher in group 2 than group 1 and it correlate with duration of splenectomy

effect of proton pump inhibitors on post endoscopic variceal band ligation complications

The study was done to evaluate the effect of proton pump inhibitors on the complications of variceal band ligation [EVL] and ulcer formation. It was conducted on 46 patients with esophageal varices [EV] asking for secondary prevention. Patients were randomly classified into group I of 22 patients received PPI [pantoprazole 40 mg] and group II of 24 patients received Placebo. Band ligation was done to all patients. Patients contacted after one week to assess for complications and adverse reactions. They re-endoscoped after 2 weeks and at that time the size and number of formed ulcer, chest pain and dysphagia all were assessed. EVL has a greater efficacy and fewer side effects for eradication of large EV with decrease in size and extent of varices. Post band ligation ulcer formation is of low incidence and risk. There is no significant difference in the number [13:15] or the size of the formed ulcer [4.8mm:5.6mm] between the two groups. The post band ligation rebleeding were more in group II than group I. Band ligation has no harmful effect on fundal varices or congestive gastropathy. Post band ligation administration of PPI has no significant effect on post band ulcer formation but associated with low risk of rebleeding

Serum level of beta- endorphin and some lipid parameters in patients with peptic ulcer

Endogenous opioid system like beta-endorphin have a functional role in modulating pain perception. This work was conducted to study the serum level of beta-endorphin and some lipid parameters in patients with peptic ulcer in relation to the site of ulcer, severity and duration of symptoms. The study included 48 patients with peptic ulcer and 15 healthy control. The serum level of beta-endorphin were significantly higher in patients with peptic ulcer than the control [0.475 +/- 0.058 Vs 6.18+1.004 ng/ml] [P<0.001] and the level were elevated in asymptomatic more than symptomatic patients[12.014+1.517 Vs 1.652 +/- 0.23 ng/ml] [P<0.001], acute more than chronic [7.459+1.4 Vs 3.621+0.81] with no difference between gastric and duodenal ulcer [5.284 +/- 1.11 Vs 7.076 +/- 1.67]. The lowest elevation were present in chronic symptomatic patients. Serum total, LDL cholesterol and triglyceride levels were elevated in patients with chronic peptic ulcer more than acute [P<0.001] with no differences between gastric and duodenal ulcer or between symptomatic and asymptomatic patients. Serum HDL-cholesterol levels were elevated in peptic ulcer patients who are acute more than chronic with no differences between gastric and duodenal ulcer or between symptomatic and asymptomatic patients

Serum level of tumor necrosis factor-alpha in patients with hepatic encephalopathy due to chronic liver diseases

Tumor necrosis factor-alpha [TNF-alpha] is involved in many acute and chronic liver disease [CLD]. This work was conducted on 69 patients with CLD [50 patients with overt hepatic encephalopathy [HE] and 19 patients with no evidence of HE] and 13 healthy subjects as a control group. The aim was to assess the serum level TNF-alpha in patients with HE due CLD and to correlate this level with the severity and precipitating factors of HE. All patients and control subjects were subjected to clinical, laboratory and abdominal ultrasonography in addition to measurement of serum level of TNF-alpha. HE was more common in male patients [P<0.002] but not related to the age [P = 0.826]. Serum TNF- alpha level was significantly elevated in patients with CLD in comparison with the control and patients with overt HE than those with no evidence of HE [16.88 pg/ml. 33.85 pg/ml and 78.48 pg/ml] respectively. TNF-alpha was positively correlated to the synthetic liver function but not related to the liver enzyme levels. TNF-alpha was positively related to the severity of liver disease represented by Child-Pugh score [P<0.001] being highest in Child C patients. The serum level of TNF-alpha was significantly correlated to the severity of HE reaching its highest levels in Grade IV. but not related to the precipitating factors of HE. serum level of TNF-alpha was higher in cirrhotic patients with HE and correlates with severity but not the precipitating factors of HE

Diagnostic value of serum fibrosis markers [hyaluronic acid and matrix metaloproteinase-2] as a marker of hepatic fibrosis

Several biochemical markers have shown promise for the detection of advanced fibrosis and cirrhosis. The aim of the present work is to study the diagnostic accuracy of serum hyaluronic acid [SHA] and matrix metaloproteinase-2 [MMP-2] as indicators for the stages of hepatic fibrosis, and to correlate the liver pathology and liver function tests with serum fibrosis markers. Sixty treatment naive patients with chronic liver disease [30 with chronic hepatitis C [CHC] with or without HBV and 30 patients with cirrhosis]. The patients were divided according to Metavir classification of liver biopsy into 3 groups. Group 1 with normal biopsy [12 patients], group 2 -25 patients with mild fibrotic changes [stage 1-2] and group 3 of 23 patients with severe fibrosis [stage 3-4]. SHA level was significantly higher in patients with severe fibrosis than patients with mild or no hepatic fibrosis [378.7 +/- 147.5, 226.2 +/- 123.7and 85.3 +/- 52.2 pg/ml]. [P<0.0001]. MMP-2 was also significantly higher in severe fibrosis [group 3] than gr2 or gr1 [1196.2 +/- 119.5, 918.1 +/- 175.8 and 841.1 +/- 224.5 pg/ml] respectively [P<0.001]. SHA and MMP-2 were not correlated to age, S bilirubin, AST, ALT or spleen size. Group 3 was correlated significantly to the SHA and MMP, platelet count, S albumin and liver size but not correlated to AST, ALT, S. bilirubin or spleen size. The specificity of fibrosis markers SHA and MMP-2 in prediction of severe fibrosis were 94.4% and 90.0% respectively and the sensitivity were higher to SHA 90% than MMP-2 80% but not a predictor of mild or normal biopsy. The cut of value of SHA, MMP-2, platelet count and prothrombin time [PT], in diagnosis of severe fibrosis were 294.84 pg/ml., 1003 pg/ml., 115.084/cmm, 72.116% respectively. Measurement of SHA and MMP-2 can be used to differentiate cirrhotic from non-cirrhotic patient and can be regarded as a useful test in the diagnosis of liver cirrhosis

role of smooth-ended ameloblasts in enamel protein degradation in the rat incisor pigmentation

Rats were perfused with glutaraldehyde. The lower incisors were dissected free. Mid-sagittal slice was cut through the entire incisor, deimneralized. The pigmentation zone was isolated and further sliced into cross sections. These sections were incubated for CMPase. CMPase reaction product were associated with the lateral cell memberane of subclass II and Subclass III. This localization confirm the role of extracellular space of SM as a route of enamel proteins during maturation

Initial experience in valvuloplasty for mitral valve disease at Ain-Shams University, Cairo

From Feb., 1989, through Dec., 1990, 47 patients with mitral valve disease [mean age 31 +/- 18 years] were subjected to comperehensive mitral valvuloplasty. Twenty-eight patients had pure or predominant regurgitation. Mitral valve insufficiency was due to rheumatic disease in 42 patients [89%] and degenerative disease in 5 [11%]. The patients were divided into three functional groups: type I [normal leaflet motion], groups: leaflet motion], 5 patients [11%]; type II [leaflet prolapse], 28 patients [49%]; and type III [restricted leaflet motion], 14 patients [30%]. Almost all patients [80.5%] were in New York Heart Association Functional Class III or IV and 20% had atrial fibrillation. The techniques used included commissurotomy with or without splining of chordae and/ or papillary muscle [24 patients], shortening plasty of anterior leaflet chordae tendineae [15 patients], resection of secondary, tertiary, and basal posterior leaflet chordae [15 patients], prosthetic ring annuloplasty [8 patients], quadrangular resection of mural leaflet with sliding leaflet technique [8 patients], transposition of chordae [6 patients], and sliding plasty of papillary muscles [5 patients], anterior transposition of posterior papillary muscle [1]. Additional procedures were performed in 29 patients including tricuspid repair in 19 and aortic valve replacement in 10. Valve function after valvuloplasty was assessed clinically and echocardiographically. Eighty-four percent of the patients had a good immediate result. Current operative mortality is 4.25%, and no late mortality. Reoperation was required in two patients [4.25%], mostly in the first three months. Neither thromboembolism nor infective endocarditis were present. There have been no late recurrences of insufficiency. Mitral vavuloplasty is an excellent alternative to valve replacement in patients with mitral valve disease

effect of type II noninsulin-dependent diabetes mellitus on insulin binding to isolated adipocytes

In a trial to follow the mechanism of insulin resistance in type II diabetes mellitus, this study had been performed on 17 male diabetic patients and 17 male persons served as a control group matching the same age, weight and special habits. The diabetic groups showed both hyperglycaemia and hyperinsulinaemia [P 0.001 and P 0.001] comparing to the control groups. Insulin binding to isolated adipocytes prepared from subcutaneous fat after appendicectomy was measured. It showed a significant decreased ability of adipocytes to bind insulin in diabetic patients comparing to the control [P 0.05] group. This decrease in insulin binding could be accounted for by decreased numbers of insulin receptor sites per cell. On the other hand the insulin of diabetic patients was easily to be degraded comparing to the control group [P 0.001]

Influence of the pineal extract and melatonin on the estrous cycle of the mice

This work was undertaken to study the effects of daily injections of pineal extract of camel and melatonin for 21 days on the estrous cycle in mice. Daily injections of either 1.5 ml pineal extract or 100 micro g. melatonin -significantly reduced the number of the estrous cycles per animal and the length of these cycles were significantly prologed. Days in proestrus and estrus were significantly decreased. Days in metestrus were not affected. All animals injected with either pineal extract or melatonin spend proportionately more significant time in diestrus phase. When the animals were paired with fertile males, mice seemingly mated as soon as they came into estrus. However, both pineal extract and melatonin treatment inhibited fertile matings. Pineal extract and melatonin showed no effect on the induced estrous cycles when oestradiol and progesterone were given with these agents in ovariectomized mice. Both pineal extract and melatonin significantly increased the release of oestradiol and progesterone. Histological examination of the ovaries of pineal extract and melatonin treated animals revealed the presence of several graafian follicles in different stages of maturation. The interstitial tissue dominate the ovary. The results showed that the estrous cycles of mice were interrupted and ovulation decreased after daily injections of either pineal extract or melatonin for 21 days. It is concluded that pineal gland plays an important physiological role in the regulation of ovarian function as well as estrous cyclicity in female mice. Also, melatonin may be one of the factors modulating the effect of pineal gland on estrous cycle

Effect of exogenous melatonin on gonadal functions in mature male rats

To study the effect of melatonin on the gonads, seminal vesicles and prostates, melatonin was injected subcutaneously [at 3 p.m] into mature male rats in a dose of 50, 100 and 500 ug. daily for 20 days. A significant decrease [P < 0.01] in the average weight of the testes occurred in the groups treated with the second and third dose of melatonin. A moderate inhibition of spermatogenesis and spermatocytogenesis in most tubules of the testes in the groups treated with lowest dose was observed. Drastic inhibition of spermatogenesis and spermatocytogenesis in the tests of treated groups with the second and third doses was noticed. The number of leydig cells and the diameter of seminiferous tubules were significantly decreased [P < 0.01] in first dose] and [P 0.001 in the second and third doses.] A highly significant decrease [P < 0.001] in the average weights, drastic hypoactive and atrophy of seminal vesicles and prostates in all treated groups was noticed. A significant decrease [P < 0.01] in serum testosterone of the group treated with the lowest dose, and the results of moderate and highest doses were below the sensitivity of the curve [less than 0.3 ng/ml]. From this work, it is clear that the suppressive effects of melatonin on gonadal functions was dose dependant. A maximum inhibitory action resulted from injection of the moderate dose. The suppressive effects of melatonin on gonadal functions may be due to a direct effect on the gonods. Also, may be due to suppression of the gonadotrophin hormone or reduction of the gonadotrophin releasing hormone from the hypothalamus by endorphin. May be also, due to decrease of the prolactin hormone which decreased the sensitivity of LH and FSH receptors in the testes

Mechanism of decreased pressor responsiveness of estradiol in pregnant rabbits

The mechanism of decreased pressor responsiveness to oestradiol during pregnancy was examined in rabbits. Oesdtradiol injection resulted in a rise in mean arterial pressure [MAP] greater in nonpregnant than pregnant animals. Rabbits 25 days pregnant, showed marked blunting of the pressor response to oestradiol, whereas after 5 days of pregnancy there was a normal response and at 15 days an intermediate pressor response. Following treatment with indomethacin, sensitivity to the hypertensive action of oestradiol was perceptibly increased only in pregnant rabbits. Prostaglandin F2alpha [PGF2alpha] injection casued a significant decrease in MAP and vascular sensitivity [mean diastolic pressure] greater in nonpregnant than in pregnant rabbits. Plasma level of sodium was significantly increased after oestradiol and showed a nonsignificant change after PGF2alpha. Plasma level of potassium showed a nonsignificant change after the injection of oestradiol and PGF2alpha. Histological examination of renal or adrenal tissues of rabbits injected with oestradiol showed a picture similar to those of pregnant animals. Juxtaglomerular apparatus and zona glomerulosa showed signs of increased activity. There were no significant histologidal changes in the renal or adrenal tissues after PGF2alpha injection in oestradiol-treated rabbits when compared with those treated with oestradiol only. The only detect able change was the greatest increase in vascular sensitivity. These observations showt hat the altered responsiveness to oestradiol in pregnant rabbits appears to be - related to hyporesponsiveness angiotensin II and to an increased synthesis of vasodilator prostaglandins. There may be two of the mechanisms by which the maternal circulation adapts to pregnancy

Sex hormones in men with myocardial infarction

The study included twenty male patients with acute myocardial infraction, and twenty matched normal subjects as controls. Serum levels of testosterone, estradiol [E2], progesterone, follicle stimulating hormone [FSH], Leutinizing hormone [LH]; and prolactin estimated in both patients and controls. The mean serum testosterone and estradiol were significantly decreased in patients compared with control group [P < 0.01 and P < 0.001 respectively]. Serum progesterone, follicle stimulating hormone and leutinizing hormone were significantly increased [P < 0.01,P < 0.001, and P < 0.05 respectively]. Mean serum prolactin level was not significantly different [P < 0.1]. Hence, we concluded that alterations in endogenous sex hormones are significantly associated with acute myocardial infarction

Effect of peptide pineal extract and melatonin on serum thyroxine [T4], triiodothyronine [T3], cholesterol, triglycerides and hepatic cholesterol in rats

In the present work, fifty adult male albino rats were divided into five groups, 10 animals each. Group I was kept as control. Group II, III and IV were subjected to a daily intraperitoneal injection for 21 days with [1,2 and 3 ml] of peptide pineal extract of camel [melatonin-free extract] respectively, group V was injected intraperitoneally with with 50 ug melatonin for the same period. A significant decrease in serum levels of thyroxine [T4], triiodothyronine [T3] cholesterol and hepatic cholesterol were produced from injection of peptide pineal extract and melatonin. A non significant decrease in serum triglycerides was obtained after treatment. In the present work, the suppressive effect of melatonin free pineal extract of camel on the serum levels of T4, T3, cholesterol, triglycerides and hepatic cholesterol was dose dependent. The suppressive effect of pineal extract and melatonin on serum levels of T4 and T3 may be due to suppression of TRH release, TSH regulation at level of pituitary and also may be due to suppression of thyroid secretion directly and/or acceleration of thyroid hormone disposal. The depressive effect of pineal extract and melatonin on serum levels of cholesterol, triglycerides and hepatic cholesterol may be due to increased rate of hepatic synthesis, destruction and intestinal excretion of cholesterol, or may be due to increased lipoprotein lipase activity. The present study suggest that, changes in lipids are not secondary to changes in thyroid hormones, but may reflect separate mechanism over cholesterol and triglyceride metabolism exerted by melatonin-free pineal extract and melatonin

Histochemical classification of human minor labial salivary glands according to their glycoprotein content

There is debate about the nature of the secretory cells in human labial salivary glands. Histologically, two types of acinar cells were observed. The predominant mucous acini, few basophilic serous acinar cells were detected. Histochemical differentiation of these cells according to their neutral and acidic mucopolysaccharides content using PAS, AB pH 1 and AB pH 2.5 stain revealed the presence of three types of acinar cells, i.e. cells rich in both neutral and acidic mucopolysaccharides, cells rich in either neutral or acidic mucopolysaccharides and cells contain neither neutral nor acidic mucopolysaccharides. The first type constitutes the major component of the gland

Renal responses to halogenated anaesthetics

Creatinine, urea, sodium potassium, sugar and blood osmolality were determined in sixty patients under anaesthesia [halothane group: 20 cases; enflurane group: 20 cases and methoxyflurane: 20 cases]. The significant results obtained were: in halothane group, there were increase in excretion of creatinine; sodium and potassium in urine; blood urea and urine volume in the first postoperative period. In the group of enflurane, sodium and potassium excretion in urine in the first day were decreased. Blood urea increased at the operative and third postoperative days. With methoxyflurane, the excretion of creatinine in urine was much reduced at the third and seventh postoperative days. Serum sodium decreased, while blood urea increased in the day of operation

Fluoride formation and excretion following halothane, enflurane and methoxyflurane anesthesia

Serum and urine fluoride and serum uric acid were determined in sixty patients receiving halothane, enflurane and methoxyflurane [20 in each group]. On the day of operation, there was significant increase in serum uric acid and fluoride concentration with methoxyflurane, while in halothane and enflurane groups fluoride in serum and urine were significantly elevated. Serum uric acid decreased to preoperative level, in the three anaesthetics at the third and seventh postoperative days. The increased level of fluoride with the three anaesthetics still persisted in methoxyflurane group, while it was disappeared at the seventh postoperative day in the other two groups. Regression analysis revealed no correlation between serum uric concentration and level of fluoride in the blood with methoxyflurane