[Assessment of liver fibrosis by magnetic resonance spectroscopy in asymptomatic children with Chronic Hepatitis C Viral Infection]

Background: Chronic hepatitis C is the most common cause of chronic liver disease and cirrhosis. Egypt is the highest affected country with a prevalence of 22%.In children, seroprevalence of HCV is 0.2% in children less than 11 years of age and 0.4% in children >/=11 years of age

Aim of the work: The purpose of this study was to assess the value of liver biopsy in diagnosis of activity grading and fibrosis staging in early asymptomatic children with chronic hepatitis C virus infection. We also aim to evaluate the use of 1H MRS and DW-MRI in assessment of some metabolic components [Glx/lipid, PME/lipid and Glyu/lipid ratios] and ADC of liver tissues and its correlation to the histopathological changes found in liver biopsy

Subjects and Methods: A cross-sectional study was conducted over a period of two years, included thirty children with asymptomatic chronic hepatitis C virus infection[mean age +/- SD 14.1 +/- 2.8years] and twenty healthy children as controls were included. Anti HCV antibodies, HCV RNA PCR, liver function tests, abdominal ultrasonography, MRS and DW-MRI were done for all cases and controls, Liver biopsy was done for all cases

Results: The results showed that HCV infection was more common in males [83.3%] and 16.7% of patients were obese. There were two significant risk factors for HCV infection in our patients: positive family history of HCV infection[56.7% ofpatients] and history of previous operation [26.7%].There were significant differences in the results of all liver enzymes [ALT, AST and ALP] in cases than controls. The results of METAVIR grades showed 29 cases [96.6%] had activity while 17 cases [56.7 %] had fibrosis and TGF-fbeta1 in liver tissues was positive in 19 cases [63.3%]. The results of MRS and DW-MRI showed significant differences between cases and controls and positive correlations between the results of 1H MRS with the results of liver biopsy [METAVIR Grades, METAVIR Stages and TGF-[beta1]

Conclusion: Early diagnosis of asymptomatic chronic hepatitis C is essential to prevent or delay end stage chronic parenchymal liver disease. TGF-1beta1 in liver tissue may be considered as a useful and better tool than METAVIR score in the assessment of hepatic fibrosis. 1H MRS may be a potential non-invasive helpful diagnostic tool in assessing the staging of asymptomatic chronic hepatitis C as the increase of its metabolites were correlated with histopathological changes. DW-MRI can be considered an effective method in evaluating liver disease activity in chronic hepatitis C

Recommendation: we recommend the use of larger sample size to assess different stages of liver fibrosis and the use of 1H MRS in monitoring treatments

Percutaneous translumibal angioplasty and stenting in treatment of lower limb arterial occlusive disease

To evaluate the role and effectivity of percutaneous transluminal angioplasty [PTA] and stenting in treatment of lower limb arterial occlusive diseases, and to clarify the advantages and limitations of this procedures. 37 patients with chronic lower limb ischemia were included in this study, their age ranged from 42 to 76 years, 29 were males and 8 were females. 35 patients had unilateral lesions while 2 patients had bilateral lesions. The total number of lesions were 51 as there were multilevel affection in some limbs. The patients were suffering from intermittent claudication, ischemic rest pain or ulceration and/or gangrene. All patients were subjected to clinical examination, laboratory investigations, duplex scanning, ankle/brachial index [ABI] measurement and diagnostic arteriography before intervention. Percutaneous translurninal angioplasty [PTA] was done for 26 lesions and stent deployment was done for 25 lesions. Follow up was done for 32 patients [with 45 lesions] at 1, 6 and 12 months using colour Doppler and ABI in all cases and arteriography in recurrent cases. The relation between multiple variables and the patency rates were studied. 48 lesions out of 51 lesions were technically successful [94%] while 3 lesions [6%] were failed to respond. The technical success rate for percutaneous transluminal angioplasty [PTA] was 92.3% while that for stent deployment [96%]. The complication rate was 14.1% in the form of dissection in 2 lesions and inguinal hematoma in 4 limbs. The patency rates at 1, 6 and 12 months were 93.3%, 84.4%and 75.6%, respectively. The patency rates increased in single, short lesions hawing good distal run-off in absence of diabetes, smoking and hyperlipidaemia. The results of this study justify the continuing use of PTA and stent implantation as first line in treatment of chronic lower limb ischemia