Hepatobiliary tuberculosis.

Tuberculosis is known to involve the liver in different ways. The term hepatobiliary tuberculosis refers to the localized form of hepatic tuberculosis as a distinct clinical entity, with signs and symptoms related to the hepatobiliary tract. Its clinical features and the different diagnostic aids used in its diagnosis are reviewed. Plain abdominal radiographs showing diffuse hepatic calcifications seen in approximately 50% of cases are almost diagnostic for hepatobiliary tuberculosis. Liver biopsies obtained either by ultrasound, computed tomography or laparoscopy, showing caseating granuloma usually establish the diagnosis. In the absence of caseation necrosis, a positive acid-fast bacillus (AFB) or culture for Mycobacterium tuberculosis is needed to establish the diagnosis. A polymerase chain reaction assay for the identification of Mycobacterium tuberculosis in liver biopsy specimens is a new development. Treatment is similar to that used for pulmonary tuberculosis. Quadruple therapy (using four anti-tuberculosis drugs) is recommended, generally for 1 year. For patients with obstructive jaundice, in addition to anti-tuberculous treatment, biliary decompression should be performed either by stent insertion during endoscopic retrograde cholangiopancreatology, by percutaneous transhepatic biliary drainage or by surgical decompression whenever feasible.

Ulcer recurrence among Filipino patients: clinical profile and risk factors.

Patients with endoscopic diagnosis of gastric and/or duodenal ulcers who eventually had endoscopic confirmation of ulcer healing after any anti-ulcer medication were entered in a 3 year study to determine ulcer recurrence rate, onset of ulcer recurrence and factors associated with ulcer recurrence. Patients from two participating centres who are not on any maintenance treatment had endoscopic examinations at 3, 6 and 12 months after ulcer healing or at any time of symptom recurrence. There were 144 patients entered into the study. The 1 year recurrence rate observed among 125 Filipino patients who completed the study was 73% wherein 71% occurred within the first six months. This was comparable with those reported in the world literature. Thirty-three per cent of those with recurrent ulcers were asymptomatic. The difference in the recurrence rate between gastric and duodenal ulcers was not statistically significant. The only risk factors found to be associated with ulcer relapse were history of smoking and alcohol intake. CLO test for Helicobacter pylori done in 45 patients with recurrent ulcers were all positive, suggesting a strong association between H. pylori and ulcer recurrence.

[Clinical experience with long-term administration of "essential" phospholipids in chronic active hepatitis. Review of 3 double-blind studies]. / Klinické zkusenosti s dlouhodobým podáváním "esenciálních" fosfolipidu u chronické aktivní hepatitidy. Prehled tri dvojitých slepých studií.

The results from three double-blind studies, obtained after a 12-month treatment with Essentiale or placebo in patients (n = 85) with HBsAg positive or HBsAg negative chronic active hepatitis provide evidence of the clear improvement of the clinical and histological picture in the majority of the patients treated with Essentiale forte.

An open trial on short-term omeprazole therapy for gastric and duodenal ulcers.

Omeprazole, a proton pump inhibitor, is a potent and long-acting gastric acid reducing agent. To assess its short-term efficacy and safety, 27 gastric ulcers (GU) and 40 duodenal ulcers (DU) in 64 patients were treated with 20 mg. Omeprazole was given once daily. At 2 weeks, the healing rate for gastric ulcers was 66% (18/27) and for duodenal ulcers, 78% (31/40). At 4 weeks, the healing rate was 85% and 95% for GU and DU, respectively. Pain relief was achieved after 2 weeks in 62% with GU and 61% in DU. There were no significant side effects noted during the treatment course. Omeprazole is effective and safe in the treatment of gastric and duodenal ulcers.

Chronic hepatitis with fatty change.

Ten patients with clinical features of chronic hepatitis showed on liver biopsy histologic evidence of chronic hepatitis plus predominantly moderate to severe fatty change. No patient had a history of excess alcohol intake, or prolonged intake of hepatotoxic drugs and steroids, and were not obese or malnourished. These cases differ from the reported cases of non-alcoholic steatohepatitis resembling alcoholic hepatitis as they occurred in relatively young health adults, predominantly males, who were not diabetic or obese. Mallory's hyalin in liver was absent in all cases. Ingestion of toxic substances was possible but no history was obtained to account for it. While these could be unusual cases of chronic non-A, non-B hepatitis, this can be only speculation until a serologic test for non-A, non-B hepatitis becomes available. Follow-up of eight patients for 1-3 years with liver biopsy showed that they had a relatively benign course with no evidence of progression to cirrhosis.

Patterns of calcifications and cholangiographic findings in hepatobiliary tuberculosis.

The radiologic findings on conventional examinations (plain films and cholangiograms) in a large group of patients with proven hepatobiliary tuberculosis are reviewed. The plain film findings of large "chalky" and confluent hepatic calcifications or nodal-type calcifications along the course of the common bile duct are suggestive of hepatobiliary tuberculosis. Small, discrete, scattered calcifications may be mimicked by histoplasmosis but can be differentiated from hepatobiliary tuberculosis. Obstructing defects seen on cholangiography are indicative of tuberculosis when adjacent calcifications are present. The patterns of liver calcifications could provide a clue to the diagnosis of hepatobiliary tuberculosis and its differentiation from liver calcifications of various other etiologies.

Hepatobiliary tuberculosis.

Tuberculous involvement of the liver as part of generalized military tuberculosis is well known. It is said to be found in 50-80% of all cases dying from pulmonary tuberculosis (1). However, localized tuberculosis of the liver as a clinical entity and producing large nodules or abscesses have been considered exceedingly rare, even in areas where tuberculosis is relatively common. Leader (2), in an extensive review of the world literature in 1952, documented only 80 cases of hepatic tuberculosis with large abscesses or nodules. Other publications deal with localized tuberculous involvement of the hepatobiliary tract in isolated case reports (1-8). In order to learn more about the clinical manifestation and course of this disease, we therefore prospectively evaluated our total experience on hepatobiliary tuberculosis during the last two decades of our practice.

Endoscopic diagnosis of primary cancer of the liver.

1. 247 cases clinically suspected of primary cancer of the liver were peritoneoscoped during the period of 1970-1978. 2. Peritoneoscopy alone made a correct diagnosis of primary cancer of the liver in 93%. It made an error in diagnosis in 7%. It missed the diagnosis of primary cancer of the liver in 2%. If combined with guided direct vision liver biopsy, the accuracy is almost 100%. 3. It is safe procedure and is an accurate way of ruling out the diagnosis of clinically suspected primary cancer of the liver.