Detection of Helicobacter pylori infection in Egyptian patients with chronic calcular cholecystitis.

Reports of Helicobacter pylori in biliary tract diseases in humans are very fragmentary, and therefore there is a need for further investigations. This study aims to detect H. pylori in the bile and gall bladder (GB) of patients with chronic calcular cholecystitis (CCC), and to determine the association of H. pylori infection with gallstone type. Thirty patients with CCC admitted for laparoscopic cholecystectomy were investigated, including upper gastro-endoscopy before cholecystectomy. Rapid urease test and histopathological examination were performed on gastric biopsies. The GB specimens were investigated for the presence of H. pylori by immunohistochemistry (IHC). H. pylori antigen in bile was detected by enzyme immunoassay. Chemical analysis of gallstones was performed to determine type. Immunohistochemistry testing showed 73.3% and 66.7% positivity among GB neck and body biopsies, respectively, demonstrating high sensitivity and specificity. A significant association was found between gastric and GB H. pylori positivity (P < 0.01). H. pylori antigen was detected in bile from three CCC cases. The greatest number of stones were of the calcium bilirubinate type. Gall bladder positivity for H. pylori was accompanied by chronic quiescent gastritis (40.9%). In conclusion, H. pylori infection may be an aetiological factor leading to cholecystitis. Gastric colonisation with H. pylori could be a source for GB infection, and the organism may act as a lithogenic component, especially in the context of pure pigmented gallstones.

Endoscopic sclerotherapy of oesophageal varices due to hepatosplenic schistosomiasis. A randomized controlled trial evaluating the effect of adjuvant propranolol therapy.

The relative high incidence of rebleeding during the course of injection sclerotherapy requires attempts at its improvement. Forty consecutive patients with bleeding oesophageal varices underwent either injection sclerotherapy only or injection sclerotherapy with an adjuvant fixed daily dose of propranolol (40 mg tds) in a single-blind randomized controlled trial. They were injected on a weekly basis until varices were eradicated at which time propranolol was withdrawn. Patients were then followed-up for a period of two years. The results showed that ad to a decline in resting pulse rate by a median of 23.9%. Patients undergoing injection sclerotherapy with adjuvant propranolol required fewer injection sessions for variceal eradication than patients undergoing injection sclerotherapy alone (8 versus 11: p > 0.05). Patients undergoing injection sclerotherapy with adjuvant propranolol experienced more variceal recurrences than those undergoing injection sclerotherapy alone (25% versus 13.3%, p > 0.05). Five of 20 patients undergoing sclero-therap with adjuvant propranolol rebleed as compared to 6 of 20 y patients undergoing injection sclerotherapy only (p > 0.05). The probability of rebleeding and survival was similar in both groups (p > 0.05).

Endoscopic sclerotherapy of oesophageal varices due to hepatosplenic schistosomiasis. A randomized controlled trial evaluating effect of sclerosant concentration.

Forty consecutive patients with bleeding oesophageal varices underwent paravariceal injection with 2.5% or 5% ethanolamine oleate in a single-blind randomized controlled trial. Patients were injected on a weekly basis until varices were eradicated and then followed-up for a period of two years. Patients injected with 2.5% ethanolamine oleate experienced a significantly shorter duration of dysphagia and significantly less episodes of fever, ulceration, and luminal narrowing. Patients injected with 5% ethanolamine oleate required significantly less injection sessions to eradicate their varices. However, the probability of rebleeding was significantly lower in patients injected with 2.5% ethanolamine oleate. This study supports the use of ethanolamine in a concentration of 2.5% when injected paravariceally as it is associated with less complications and a lower probability of rebleeding.

Leptin and its relation to weight loss, ob gene expression and the acute-phase response in surgical patients.

BACKGROUND: Patients with cachexia suffer from anorexia, weight loss and hypermetabolism. This study examined the relationship between plasma leptin concentration, leptin gene expression, weight loss and the acute-phase response in a group of surgical patients. METHODS: Body composition, plasma leptin, interleukin (IL) 6, soluble tumour necrosis factor receptor (sTNF-R) 55, sTNF-R75 and C-reactive protein were analysed in a cohort of 28 patients undergoing elective surgery. Subcutaneous and omental leptin messenger RNA (mRNA) was analysed in a subgroup of 14 patients. RESULTS: After adjustment for fat mass (FM), a significant partial correlation coefficient was found between plasma leptin and serum IL-6 concentration (P = 0.037). A positive correlation was found only between plasma leptin and omental leptin mRNA (P = 0.009). Patients with an acute-phase response had a significantly higher level of plasma leptin per unit FM (P = 0.049). Stepwise multiple regression showed that FM (P < 0.0005) and serum IL-6 (P = 0.018) were independent predictors of plasma leptin level. CONCLUSION: Plasma leptin levels appear to be influenced by proinflammatory cytokines. Omental fat may have more influence on plasma leptin than subcutaneous fat. Accelerated weight loss in patients with cancer with an ongoing inflammatory response could be mediated in part by inappropriately high plasma levels of leptin.

Proteolysis-inducing factor regulates hepatic gene expression via the transcription factors NF-(kappa)B and STAT3.

A novel protein, proteolysis-inducing factor (PIF), has been isolated from the urine of patients with pancreatic cancer and is capable of inducing muscle proteolysis in vitro. Only adult skeletal muscle and liver exhibit substantial binding of PIF. We have investigated the effect of PIF on hepatic gene expression. Primary cultures of human hepatocytes and the human cell line HepG2 were incubated in the presence of PIF to assess its effects on hepatic transcription factors, proinflammatory cytokine production, and acute phase proteins. PIF activates both the transcription factors NF-kB and STAT3, which result in the increased production of IL-8, IL-6, and C-reactive protein and the decreased production of transferrin. The function of PIF, beyond muscle degradation, is unknown but here we show that it is involved in hepatic gene expression, and is thus likely to be involved in the proinflammatory response observed in cachexia. These results may also suggest a potential role for PIF during embryonic development. The expression of PIF peaks during the embryonic period E8 to E9, a stage that is crucial in the development of skeletal muscle and liver and during which both NF-kB and STAT3 activation can also be observed.

Endoscopic therapy of fascioliasis resistant to oral therapy.

BACKGROUND: We present an endoscopic approach to patients with fascioliasis resistant to oral pharmacotherapy. A staged study was performed in which the effect of flushing the biliary system with a fasciolicidal solution was evaluated. METHODS: In phase I of the study, four agents (povidone iodine, potassium permanganate, chlorhexidine, and sodium bicarbonate) were tested in vitro for their effect on Fasciola worm viability. In phase II, patients resistant to oral pharmacotherapy for fascioliasis were referred for endoscopic retrograde cholangiopancreatography and flushing of the biliary system with the solution found to be most effective in phase I. RESULTS: Povidone iodine proved to be the most effective solution against Fasciola worm viability. Nine patients had the biliary system flushed with povidone iodine. The presence of a Fasciola worm was demonstrated in the bile duct of all patients. In one patient an extra worm was found in the gallbladder. All patients were negative for Fasciola ova on repeated follow-up stool examination. CONCLUSIONS: We recommend washing the biliary system of patients with fascioliasis resistant to oral pharmacotherapy with povidone iodine because it is effective against the worms in the bile ducts and gallbladder and usually leaves the patient with an intact papilla.

Experimental clogging of biliary endoprostheses. Role of bacteria, endoprosthesis material, and design.

The major problem facing patients treated with biliary endoprostheses is their frequent clogging, necessitating their exchange. Clogged endoprostheses contain mainly bacteria embedded in an amorphous proteinaceous material with the occasional presence of food fibres. We studied this problem in an in vitro model, evaluating the role of bacteria, endoprosthesis design, and material in sludge formation. We found endoprostheses perfused with artificially contaminated bile to contain significantly more sludge than those perfused with sterile bile (p less than 0.05). The amount of sludge varied with the bacterial species used. Endoprostheses perfused with bacteria producing beta-glucuronidase were not associated with a particularly large amount of sludge. Endoprostheses with side holes contained significantly more sludge than those without (p less than 0.05). Furthermore, endoprostheses made of material with a low friction coefficient, such as Teflon, contained significantly less sludge than endoprostheses made of materials with a higher friction coefficient, such as polyethylene and polyurethane (p less than 0.05). These results emphasize the role of bacteria in endoprostheses clogging and clearly demonstrate the harmful effect that side holes have on endoprosthesis function.

Clogging and other complications of endoscopic biliary endoprostheses.

This study included 236 patients treated with endoscopic biliary endoprostheses. Malignant strictures were responsible for the obstruction in 87% of the patients. The 1-week and 1-month mortality for patients with malignant strictures was 10% and 22%, respectively, whereas that of patients with benign conditions was 3% and 10%, respectively. The major complication encountered was the frequent hospital readmissions of patients owing to clogging of their endoprostheses. Late clogging had an overall occurrence of 33% and presented with recurrence of jaundice with or without fever or pain. Late signs of cholangitis occurred in 15% of the patients, whereas other late complications were rather infrequent. Although 10-french endoprostheses had a significantly longer patency period than 7-french--that is, 6 months versus 2 months (p = 0.01)--the proportion of patients in whom clogging occurred was nearly the same, 30% for 10-french and 32% for 7-french endoprostheses.

Clogging of biliary endoprostheses. A morphologic and bacteriologic study.

The main problem encountered with the use of biliary endoprostheses is their tendency to clog, which necessitates their exchange. We studied this problem by performing light and electron microscopy and bacterial cultures on both unused and clinically used endoprostheses. These examinations showed several basic defects in their manufacture, such as irregular inner surfaces and badly constructed side holes. The deposit that ultimately led to their occlusion was found mainly to be concentrated around the side holes. Minimizing the amount of material, bacteria, and plant fibres adhering to the endoprosthesis is the desired goal and may be achieved by improving their manufacture and design.