Serum paraoxonase and arylesterase activities for the evaluation of patients with chronic hepatitis.

The sensitivity of standard biochemical tests for liver function is low and insufficient for a reliable determination of the presence or absence of liver disease. The aim of the present study was to investigate serum paraoxonase and arylesterase activities and lipid hydroperoxide (LOOH) levels, and to find out that whether the measurement of serum paraoxonase and arylesterase activities would be useful as an index of liver function status in chronic hepatitis (CH). Fourty-four patients with CH (24 CHB and 20 CHC) and 38 controls were enrolled. Serum paraoxonase and arylesterase activities were detected spectrophotometrically. LOOH levels were measured by the FOX-2 assay. Serum paraoxonase and arylesterase activities were significantly lower in patients with CH than controls (p < 0.001 for both), while LOOH levels were significantly higher (p < 0.001). Paraoxonase and arylesterase activities were inversely correlated with LOOH levels (r = -0.394, p < 0.05; r =-0.362, p < 0.05, respectively). Fibrosis scores of CH patients were significantly correlated with paraoxonase and arylesterase activities and LOOH levels (r =-0.276, p < 0.05; r = -0.583, p < 0.001 and r = 0.562, p < 0.001, respectively). Our results indicated that decrease in the activities paraoxonase and arylesterase may play a role in the pathogenesis of CH. In addition, serum paraoxonase and arylesterase activities measurement may add a significant contribution to the liver function tests.

Ascaridia numidae (Leiper, 1908; Travassos, 1913) in Rock Partridge (Alectoris chukar) in Turkey.

This report present first case of Ascaridia numidae isolated from three dead rock partridges (Alectoris chukar) with stressing morphological characteristics and its responsiveness to the medical treatment. A. numidae was confirmed by presence of one papilla on the posterior region of the preanal sucker and a total of 10 pairs of the caudal papillae. In necropsy, a total of 680 (282 male and 3,988 female) A. numidae and 289 (147 male and 142 female) Heterakis dispar were isolated from all partridges. Females were 11.20 mm longer and 0.22 mm wider than males. There was no difference in length of oesophagus (2.27 mm). Lengths of the spikules were equals and ranged from 2.08 to 2.93 according to the body size. Vulva was located in medial line and the mean egg size was 0.10 x 0.06 mm. Faecal samples from live birds from the same farm contained Ascaridia spp. and Heterakis spp. eggs. No eggs were encountered 1 week after oral administration of a single dose of levamisole (30 mg/kg), but 3 months post-medication. In conclusion, this is the first case reporting A. numidae in exotic birds in Turkey. A. numidae has unique papillae that are distinguishable from the other ascarids and is responsive to medical treatment as long as hygienic conditions are maintained.

Magnetic resonance cholangiopancreatography in cholestatic diseases.

BACKGROUND/AIMS: To evaluate the usefulness of magnetic resonance cholangiopancreatography in cholestasis. METHODOLOGY: Sixty-seven patients with cholestasis underwent ultrasound and magnetic resonance cholangiopancreatography, subsequently. The results of ultrasound and magnetic resonance cholangiopancreatography were interpreted by two independent radiologists. RESULTS: According to ultrasonographic findings intra- and extrahepatic cholestasis were diagnosed in 62.7% and 37.3% of patients, respectively. Magnetic resonance cholangiopancreatography revealed intra- and extrahepatic cholestasis in 52.2% and 47.8% of patients at the same group, respectively (p=0.016, kappa=0.789). Endoscopic retrograde cholangiopancreatography was indicated in 37.3% of patients (22.4% diagnostic, 14.9% therapeutic) according to ultrasonographic findings. However, 41.8% of patients had indication for endoscopic retrograde cholangiopancreatography following magnetic resonance cholangiopancreatography in the same group. In 20% of patients who needed diagnostic endoscopic retrograde cholangiopancreatography according to ultrasonographic findings, endoscopic retrograde cholangiopancreatography wasn't indicated after magnetic resonance cholangiopancreatography. Similarly, 8.9% of patients who didn't have indication for endoscopic retrograde cholangiopancreatography according to ultrasonographic findings underwent endoscopic retrograde cholangiopancreatography (p=0.508, kappa=0.72). CONCLUSIONS: Magnetic resonance cholangiopancreatography is valuable in diagnosis of extrahepatic cholestasis in patients suspected with intrahepatic cholestasis according to ultrasonographic findings. Magnetic resonance cholangiopancreatography does not prevent endoscopic retrograde cholangiopancreatography requirement significantly in patients who need diagnostic endoscopic retrograde cholangiopancreatography following ultrasonography.

Development of sarcoidosis during interferon alpha 2b and ribavirin combination therapy for chronic hepatitis C--a case report and review of the literature.

Sarcoidosis is a chronic granulomatous multisystemic disorder of unknown aetiology. Although interferon gamma has been implicated in the pathogenesis of sarcoidosis, only a few cases of sarcoidosis associated with interferon alpha therapy have been reported. We report a case with chronic hepatitis C (CHC) who developed sarcoidosis after the treatment by interferon alpha and ribavirin. The combination therapy of interferon alpha and ribavirin was given to a 50-year-old female with CHC who had not responded to a previous treatment by interferon alpha. She has been admitted with non-productive cough, dyspnoea and fever 11 months after the initiation of combination therapy. Chest x-ray and thorax computed tomography revealed bilateral hilar masses and nodular infiltrations in the lung parenchyma. Pulmonary function test showed a mild restriction. Biopsy of mediastinal lymphadenopathy revealed noncaseating granuloma. She was diagnosed to have pulmonary sarcoidosis at stage II, and the combination treatment was discontinued. Her symptoms regressed after inhaler steroid treatment. Six months after the diagnosis of sarcoidosis, the patient was asymptomatic and a complete sustained response to hepatitis C was achieved. During the three years of follow-up, both pulmonary sarcoidosis and hepatitis C have not recurred. We suggest that sarcoidosis may develop in chronic hepatitis C patients during interferon alpha and/or ribavirin treatment, and diagnostic tests for this adverse effect should be performed during the follow-ups.

Selective spleen scintigraphy in the diagnosis of polysplenia syndrome.

This report describes a case of polysplenia syndrome diagnosed by selective spleen scintigraphy. This syndrome is rarely encountered in the elderly. It is characterized by multiple splenuncules with a number of associated congenital anomalies involving the cardiovascular system and the viscera. The differential diagnosis of these intra-abdominal masses can sometimes be difficult and can be confused with lymphadenopathy or metastases. Furthermore, biopsy of the splenuncules may be hazardous. The diagnosis of polysplenia can be established in most instances by (99)Tc(m) labelled heat-denatured red blood cell selective spleen scintigraphy without biopsy.