effect of pentoxifylline on hepatocyte growth factor and liver functions in cirrhotic patients undergoing splenectomy and decongestion

High morbidity and mortality rates in cirrhotic patients undergoing intraabdominal surgery underscore the need for identifying a therapy that will decrease postoperative hepatic dysfunction and enhance hepatic regenerative activity. Perioperative administration of pentoxifylline [PTX] is suggested to decrease liver fibrosis and enhance hepatic regenerative activity in cirrhotic patients. Hepatocyte growth factor [HGF] is hepatocyte mitogen, that is suggested to play a role in liver regeneration during injury. The aim of this study is to investigate the value of perioperative administration of PTX on reducing liver injury as reflected by changes in serum level of hepatocyte growth factor [HGF], and standard liver functions in cirrhotic patients undergoing Splenectomy and decongestion. 20 adult patients with cirrhotic liver were randomly allocated into two equal groups. Patients in the first group [PTX Gp], received 300 mg i.v. PTX before induction of general anesthesia followed by 100 mg /h PTX in 500 ml glucose 5% infused in 10 hours. Patients in the second group [control Gp], received 15ml i.v. glucose 5% solution before induction of general anesthesia followed by 500 ml glucose 5% infused in 10 hours. All patients' were Child class A. Hepatocyte growth factor increased significantly at postoperative time when it was compared with preoperative value in control group. Liver enzymes SGOT, SGPT, prothrombin activity, total bilirubin, serum albumin, blood urea and creatinine did not significantly change in the studied groups when postoperative values were compared with preoperative ones or when the studied groups were compared with each other. White blood count and platelets increased significantly postoperatively compared with preoperative values in the studied groups. The current study suggested that perioperative administration of PTX could produce hepatocyte protection during intra-abdominal surgery as hepatocyte growth factor did not significantly increase at postoperative time in PTX group meanwhile, it increased significantly at postoperative time compared to preoperative value in control group. It did not influence liver or kidney functions, as SGOT, SGPT, prothrombin activity, serum albumin, total bilirubin as well as blood urea and creatinine did not significantly change postoperatively compared with preoperative values in both studied groups

Protection of cirrhotic liver during anesthesia

The combination of antioxidant compounds is beneficial to ameliorate hepatotoxicity in cirrhotic patient undergoing general anesthesia as indicated by reduction of the up-regulation of soluble adhesion molecule [sICAM-1] level and other liver functions. Twenty two surgical patients [child class A] divided into two groups. Antioxidant group: received one gm.h-1 of N-acetyl cysteine [Mucomyst] infusion after induction of anesthesia and continuously till the end of surgery. One gram of ascorbic acid [Vitamin C] and 400 IU of -tocopherol [Vitamin E] were administered iv over 10-15 min with closure of rectus sheath. The other group received equal volumes of normal saline during the same periods. Three blood samples were taken from every patient before induction of anesthesia, one hour and one day after surgery for measurement of sICAM-1 and other liver functions [total proteins, serum albumin, alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], total and direct serum bilirubin]. sICAM-1 increased in both groups in the postoperative samples with more increase in saline group [P < 0.05]. Other liver functions showed significant increase in ALT, AST and ALP one hour postoperatively in saline group only. After one day they increased in both groups with more significant elevation in saline group. Serum total proteins, serum albumin, total and direct bilirubin showed no significant changes in both groups. These results proved that the combination of antioxidant compounds during general anesthesia in cirrhotic patient reduce the up-regulation of sICAM-1 which appear to be a good marker for hepatic impairments

three-dimensional analysis of the ramus among three malocclusion groups using conventional radiology

This study was conducted over 57 subjects aiming to analyze the ramus three-dimensionally. Scanora system was used to obtain the ramal transverse width and lateral cephalometric radiog-raphies were used to obtain the other measurements. It was found that there was decrease in the transverse width with the increase of ramal length and gonial angle; whereas the increase was accompanied with the increase in the lateral width. The gonial angle showed increase in both Class II and III cases. The ratio between the lateral width and the corpus length was found to be 0.44. This latter increased in Class II cases and decreased in Class III cases

role of ultrasonography to discriminate between schistosomiasis and virus-related chronic liver disease

The aim of our study was to assess the role of ultrasonography in patients with chronic liver diseases in discriminating between schistosomiasis and viral hepatitis infections in Egypt, an area where these infections are endemic. We assessed 114 patients with chronic liver disease, clinically, ultrasonographically, biochemically, virologically, parasitologically and by liver biopsy. According to histological diagnosis; 7.9% of patients had portal fibrosis, 43% chronic hepatitis, 47.4% cirrhosis and 1.8% hepatic malignancies. Patients with cirrhosis 44 [49.4%] of them had pure HCV infection. The longitudinal diameter of the spleen was significantly higher in patients with cirrhosis- virus related liver disease than those with pure schistosomiasis, while no significant differences were found in the degree of periportal thickening between the two groups. This study shows that ultrasonography alone can not be used as a screening procedure to discriminate between schistosomiasis and viral hepatitis infections in areas where these infections are highly associated, such as in Egypt