Evaluation of the triangular cord sign in the diagnosis of biliary atresia.

BACKGROUND: Infantile cholestasis continues to represent a diagnostic challenge. It is very important to diagnose surgically correctable disorders, such as biliary atresia, in a timely manner to prevent progressive damage to the liver. It has been recently suggested that the triangular cord (TC) sign is a simple and useful tool in the diagnosis of biliary atresia. METHODS: We prospectively studied 65 infants presenting with conjugated hyperbilirubinemia (age range: 32-161 days). All patients underwent ultrasonographic examination with a 7.0-MHz transducer (Acuson, Mountain View, CA). The TC was defined as a triangular, or tubular, echogenic density seen immediately cranial to the portal vein bifurcation. RESULTS: The TC sign was identified in 25 infants, and all of them had histologic features suggestive of biliary atresia; the diagnosis was confirmed at surgery by gross morphology of hepatobiliary system, and liver biopsy, with or without intraoperative cholangiogram. Among the 40 patients who did not have the TC sign, 6 had paucity of the intrahepatic bile ducts. Three had alph-1-antitrypsin deficiency, and 31 had neonatal hepatitis. None of the 40 patients who did not have the TC sign developed acholic stools. Seven patients with biliary atresia were followed by ultrasonographic examination for 6 months after the Kasai procedure. The TC sign disappeared in all patients after the surgery; however, the TC sign reappeared in 3 patients who developed progressive cholestasis after the procedure. CONCLUSION: The TC sign is a simple, timesaving, and reliable diagnostic tool in the evaluation of infants with infantile cholestasis. The TC sign may also prove to be helpful in following patients after hepatoportoenterostomy. We suggest a new diagnostic strategy for patients suspected to have biliary atresia. When the TC sign is visualized, the patient should undergo intraoperative cholangiogram to confirm the diagnosis of biliary atresia, reserving percutaneous liver biopsy for those patients in whom the TC sign could not be detected.

Prevalence of HIV infection and AIDS in Egypt over four years of surveillance (1986-1990).

Serosurveys were conducted from April 1986 to March 1990 to determine the prevalence of HIV-1 infections among Egyptians and foreigners. Sera from 29,261 high risk individuals and blood or blood product donors in Egypt, and from 10,326 foreigners were tested for HIV-1 antibodies by a recombinant HIV-1 and a recombinant combination HIV-1/HIV-2 enzyme immunoassay (EIA). Any serum found to be repeatedly reactive by EIA was tested by Western blot for confirmation of HIV-1 infection. The overall prevalence of HIV-1 infection among the Egyptians was 0.18% (54/29,261); of which 4.8% (28/582) were blood and factor VIII recipients, 0.15% (3/1961) drug addicts, 0.18% (3/1650) fever of unknown origin patients, 0.23% (6/2602) sexually transmitted disease patients, 1.9% (5/269) HIV-1 contacts, 0.07% (7/9778) international travellers, and 0.02% (2/12,070) blood/product donors. Evidence of HIV-1 infection was not demonstrated among 349 prostitutes. The prevalence of HIV-1 antibody among foreigners was 0.97% (100/10,326), who were mainly (94%) from other African countries. Among the total 54 HIV infected Egyptians, 20 developed AIDS, and at least 12 have died. Only one of the 100 infected foreigners was diagnosed with AIDS. While the number of AIDS cases has increased in Egypt over 18 months October 1988-March 1990, the overall prevalence of new HIV infections has decreased since 1988 and endemic transmission has not been documented in Egypt.

HIV infection in Egypt: a two and a half year surveillance.

From April 1986 to mid-October 1988, 19,767 blood samples from individuals of 27 Governorates in Egypt were screened for antibodies to HIV-1. Risk groups included: drug addicts, prostitutes, patients with sexually transmitted diseases or fever of unknown origin, blood or blood product recipients, patients with mental disorders, and contacts of HIV-infected persons. Sera from routine blood donors and foreigners were also tested. All samples which reacted repeatedly by commercial ELISAs were assessed by Western blot (DuPont) for confirmation. Results indicated that 139 (0.70%) of the sera produced repeatedly reactive results by ELISA. Sixty-nine of these were confirmed by Western blot as HIV seropositive. This constituted 0.35% of the total population tested. Only 26 (0.15%) of the Egyptians tested were positive and a total of seven sero-positive individuals were classified as having clinical AIDS. All Egyptian blood donors were negative. Data generated during this 2.5-year HIV serosurvey indicate that the prevalence of confirmed HIV infection in Egypt was exceptionally low, and suggest that HIV is not endemic in Egypt, since all 26 sero-positive Egyptians were linked to HIV exposure abroad.

Serological evidence for human immunodeficiency virus type 2 in east Africa.

Infection by human immunodeficiency virus type 2 (HIV-2) has not previously been described in North or East Africa. We examined over 1200 sera of high-risk individuals from three North/East African countries for antibodies to HIV-2. Results indicated that 17 were repeatedly reactive by ELISA; 4 were confirmed by Western blot. Of the 4 confirmed, 2 produced strong reactions to the envelope antigens of HIV-2 but not of HIV-1. One of these subjects was a foreigner from Senegal who was tested while in Egypt and one was a Djiboutian prostitute who was infected presumably prior to October 1987. We conclude that HIV-2 has been introduced into this region and that specific testing of selected individuals for HIV-2 is warranted.