- Email: [email protected]
Nasal mucosal changes in cirrhotics, a clinico-histopathological study
Category 2: Cirrhosis and its complications, pathophysiology and clinical aspects unchanged at 13.8 4- 3.2 umol/100 g/m.in, whereas the cerebral lactate metabolism decreased from 3.70 4- 4.62 to 2.12 -4- 3.90 umol/100 g/min (p < 0.05), and the cerebral metabolism of oxygen increased from 83 4- 18 to 90 4- 16 umol/100 g/min (p < 0.05). The lactate/pyruvate ratio in the jugular bulb remained unchanged at 19.5 4- 3.8. Conclusion: Acute mechanical hyperventilation with a decrease in PaCO2 down to 3.8 4- 0.3 kPa did not compromise global cerebral oxidative metabolism in patients with FHF.
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CTLA~, RECIPIENT POLYMORPHISMINFLUENCES HCV LIVER DISEASE RECURRENCE FOLLOWING ORTHOTOPIC LIVER TRANSPLANTATION (OLT)
Luca Valenti 1, Vittoria Spatola 1, Erika Fattal, Paola Dongiovannil, Giorgio Rossi 2 , Gemino Fiorelli 1, Luigi Rainero Fassati 2, Silvia Rossana Fargion 1. l lstituto di Medicina Interna Ospedale Maggiore
IRCCS, Milano; 21stituto di Chirurgia dei Trapianti Ospedale Maggiore IRCCS, Milano, Italy HCV infection almost invariably recurs in patients submitted to OLT for HCV cirrhosis and 20% develop cirrhosis. The course of HCV disease in the graft is variable and genetic factors may play a role in determining the severity of recurrence. A negative function polymorphism of CTLA-4, a molecule that inhibits T cell activation, has been associated with increased immunoreactivity. To determine whether CTLA-4 polymorphism influences immulogical response to HCV infection following OLT, 49 consecutive patients submitted to OLT for HCV related end stage liver disease were studied. CTLA-4 polymorphism was determined by PCR and RFLP analysis. Mean follow-up post-OLT was 48.2 + 42 months. The prevalence of CTLA-4 polymorphism was higher in patients submitted to OLT because of HCV related cirrhosis than in normal subjects (57% vs. 38% of subjects carrying the polymorphic allele; P = 0.019). The presence of the polymorphism was associated with a lower viral load after OLT (8.33 + 11 vs. 19.87 + 54 x 106 copies/mi; P < 0.001) and a longer latency between transplantation and evidence of histological recurrence of HCV (8.53 + 23 vs. 4.94 + 4 months; P < 0.0001), whereas the prevalence of cirrhosis was not significantly different (9% vs. 13%). CTLA-4 polymorphism is associated with a more efficacious immunological response to HCV in immunosuppressed patients submitted to OLT but possibly with a more severe disease in immunocompetent subjects.
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RAPID FIBROSIS IN HEPATITISC VIRUS GENOTYPE 4 (HCV4) PATIENTS AFTER LIVER TRANSPLANTATION (LT)
M. Hatem Wali l , Mathis Heydtmann l , Rebecca Harrison 2, Stephen Hubscher 2, Bridget Gunson 1, Davaid Mutimer I . ILiver Unit,
Queen Elizabeth Hospital Birmingham University, Birmingham, West Midland; 2pathology Department, Medical School Birmingham University, Birmingham, West Midland, UK Background: Determinants of liver allograft damage due to HCV recurrence include host, viral, environmental and surgical factors. The outcome of HCV genotype 4 recurrence is unknown. Aim: To examine the outcome of LT for patients with HCV4. Methods: Recipient, donor, and viral factors were studied. Liver biopsies were examined and scored without knowledge of patient HCV genotype. Fibrosis progression after LT was included in a multivariate analysis. Results: 128 patients transplanted for HCV were studied: Genotypes: 28 HCV1, 11 HCV2, 19 HCV3 and 32 HCV4. The groups differed regarding recipient ethnic background (HCV4 patients from Egypt) and donor age (median donor age for HCV4 and HCV non-4 was 51 and 40 years). Five-year survival for patients with HCV4, and non-4 were 80% and 76% respectively (p = 0.5). In multivariate analysis, more rapid fibrosis progression was associated with male gender, advancing donor age, prolonged warm ischaemic time and HCV4 infection. The median fibrosis progression rates were 0.86 fibrosis units per year (range 0 to 7.9) and 1.1 (0 to
43
8.3) in patients infected by HCV non-4 and HCV-4 respectively (p = ns). The expected time to develop cirrhosis in patients with HCV-4, HCV-2/3 and HCV-1 were 5.5, 6.6 and 8.5 year respectively. Conclusion: 5-year survival for Egyptians transplanted for HCV4 is similar to that of non-4 patients, however, more rapid fibrosis may be observed.
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STUDY RISK FACTORS FOR CHOLANGITIS POST HEPAT OLITHIASIS ERCP
Ashraf R. Abul Futuh 1, Waleed Hamed2, Abdel Ghany S oliman 3, Salwa E1-Hadad 4, Mahmoud Omar 5, Sayed E1-Hendawy 6. 1Dept. of
Hepatology & GIT, Mansoura International Hospital Mansoura; 3Asiut University Hospital; 4Ein Shams University, Cairo; 5Theodor, Bilharse Research Institute, Cairo; 6Mansoura University, Egypt; 2Royal Infirmary of Edinburgh, Scotland, UK Recurrent cholangitis is the most common complication of hepatolithiasis leading to biliary stricture, liver cirrhosis, and cholangiocarcinoma. The purpose of this study was to find out the risk factors affecting the rate of cholangitis after treatment of hepatolithiasis. The subjects consisted of 196 patients with hepatolithiasis who had been newly diagnosed and managed. The mean follow up period was 56 months. The cummulative rate of cholangitis was 9.6%/year and was significantly higher in patients with residual stonesthan that without residual stones than that without residual stones (13.8%/year, 4.8%/year respectively). Cholangitis occurred more frequently in patients with disrupted functioin of the sphincter of oddi as a result of management than in that without sphincter disruption (12.9%, 7.1% respectively). The other risk factors were the presence of common bile duct stones before treatment and the recurrent hepatolithiasis during follow up (p = 0.0066, 0.0014 respectively). Biliary stricture had no influence on the rate of cholangitis. The independent risk factors were the presence of residual stones, recurrence of stones, and the disruption of sphincter of Oddi. In conclusion, complete removal of hepatolithiasis, prevention of recurrent stones, and preservation of the sphincter of Oddi can decrease the rate of cholangitis after treatment for hepatolithiasis.
Category 2: Cirrhosis and its complications, pathophysiology and clinical aspects ~-~
NASAL MUCOSAL CHANGES IN CIRRHOTICS, A CLINICO-HISTOPATHOLOGICALSTUDY
Aiaa E. Ibrahim t , Ahmad M. Selit 2, Nahed Samy Khamis 3. 1Internal Medicine Dept, Benha University, Benha; 2ENT Dept, Benha University, Benha; 3Pathology Dept, Ein Shams University, Cairo, Egypt Epistaxis in cirrhoticsis only attributed to disturbed coagulation, fibrinolysis and blood platelets. Forty cirrhotics were studied to detect any local nasal changes. After routine local examination, ENT examination, routine lab testing, liver functions and abdominal ultrasound, nasal biobsy was performed under local anaethesia. Sections were stained by Haematoxilin and Eosin stain. Mucosal vascularization and atrophy were detected in 50% of cases and showed positive significant correlation with each of Child's grade and portal vein diameter. Mucosal atrophy was detected only in 40% of cases clinically. Epistaxis was reported in 30% of cases and showed positive correlation with mucosal vascularization and child's grade. In conclusion: a variety of histopathological changes were reported in cirrhotics correlating well with Child's grade. These changes might be a contributing factor in epistaxis reproted commonly in cirrhotics. We termed these changes 'Hepatic Rhinopathy'. !
[-~
CTLA~, RECIPIENT POLYMORPHISMINFLUENCES HCV LIVER DISEASE RECURRENCE FOLLOWING ORTHOTOPIC LIVER TRANSPLANTATION (OLT)
Luca Valenti 1, Vittoria Spatola 1, Erika Fattal, Paola Dongiovannil, Giorgio Rossi 2 , Gemino Fiorelli 1, Luigi Rainero Fassati 2, Silvia Rossana Fargion 1. l lstituto di Medicina Interna Ospedale Maggiore
IRCCS, Milano; 21stituto di Chirurgia dei Trapianti Ospedale Maggiore IRCCS, Milano, Italy HCV infection almost invariably recurs in patients submitted to OLT for HCV cirrhosis and 20% develop cirrhosis. The course of HCV disease in the graft is variable and genetic factors may play a role in determining the severity of recurrence. A negative function polymorphism of CTLA-4, a molecule that inhibits T cell activation, has been associated with increased immunoreactivity. To determine whether CTLA-4 polymorphism influences immulogical response to HCV infection following OLT, 49 consecutive patients submitted to OLT for HCV related end stage liver disease were studied. CTLA-4 polymorphism was determined by PCR and RFLP analysis. Mean follow-up post-OLT was 48.2 + 42 months. The prevalence of CTLA-4 polymorphism was higher in patients submitted to OLT because of HCV related cirrhosis than in normal subjects (57% vs. 38% of subjects carrying the polymorphic allele; P = 0.019). The presence of the polymorphism was associated with a lower viral load after OLT (8.33 + 11 vs. 19.87 + 54 x 106 copies/mi; P < 0.001) and a longer latency between transplantation and evidence of histological recurrence of HCV (8.53 + 23 vs. 4.94 + 4 months; P < 0.0001), whereas the prevalence of cirrhosis was not significantly different (9% vs. 13%). CTLA-4 polymorphism is associated with a more efficacious immunological response to HCV in immunosuppressed patients submitted to OLT but possibly with a more severe disease in immunocompetent subjects.
~
RAPID FIBROSIS IN HEPATITISC VIRUS GENOTYPE 4 (HCV4) PATIENTS AFTER LIVER TRANSPLANTATION (LT)
M. Hatem Wali l , Mathis Heydtmann l , Rebecca Harrison 2, Stephen Hubscher 2, Bridget Gunson 1, Davaid Mutimer I . ILiver Unit,
Queen Elizabeth Hospital Birmingham University, Birmingham, West Midland; 2pathology Department, Medical School Birmingham University, Birmingham, West Midland, UK Background: Determinants of liver allograft damage due to HCV recurrence include host, viral, environmental and surgical factors. The outcome of HCV genotype 4 recurrence is unknown. Aim: To examine the outcome of LT for patients with HCV4. Methods: Recipient, donor, and viral factors were studied. Liver biopsies were examined and scored without knowledge of patient HCV genotype. Fibrosis progression after LT was included in a multivariate analysis. Results: 128 patients transplanted for HCV were studied: Genotypes: 28 HCV1, 11 HCV2, 19 HCV3 and 32 HCV4. The groups differed regarding recipient ethnic background (HCV4 patients from Egypt) and donor age (median donor age for HCV4 and HCV non-4 was 51 and 40 years). Five-year survival for patients with HCV4, and non-4 were 80% and 76% respectively (p = 0.5). In multivariate analysis, more rapid fibrosis progression was associated with male gender, advancing donor age, prolonged warm ischaemic time and HCV4 infection. The median fibrosis progression rates were 0.86 fibrosis units per year (range 0 to 7.9) and 1.1 (0 to
43
8.3) in patients infected by HCV non-4 and HCV-4 respectively (p = ns). The expected time to develop cirrhosis in patients with HCV-4, HCV-2/3 and HCV-1 were 5.5, 6.6 and 8.5 year respectively. Conclusion: 5-year survival for Egyptians transplanted for HCV4 is similar to that of non-4 patients, however, more rapid fibrosis may be observed.
~-]
STUDY RISK FACTORS FOR CHOLANGITIS POST HEPAT OLITHIASIS ERCP
Ashraf R. Abul Futuh 1, Waleed Hamed2, Abdel Ghany S oliman 3, Salwa E1-Hadad 4, Mahmoud Omar 5, Sayed E1-Hendawy 6. 1Dept. of
Hepatology & GIT, Mansoura International Hospital Mansoura; 3Asiut University Hospital; 4Ein Shams University, Cairo; 5Theodor, Bilharse Research Institute, Cairo; 6Mansoura University, Egypt; 2Royal Infirmary of Edinburgh, Scotland, UK Recurrent cholangitis is the most common complication of hepatolithiasis leading to biliary stricture, liver cirrhosis, and cholangiocarcinoma. The purpose of this study was to find out the risk factors affecting the rate of cholangitis after treatment of hepatolithiasis. The subjects consisted of 196 patients with hepatolithiasis who had been newly diagnosed and managed. The mean follow up period was 56 months. The cummulative rate of cholangitis was 9.6%/year and was significantly higher in patients with residual stonesthan that without residual stones than that without residual stones (13.8%/year, 4.8%/year respectively). Cholangitis occurred more frequently in patients with disrupted functioin of the sphincter of oddi as a result of management than in that without sphincter disruption (12.9%, 7.1% respectively). The other risk factors were the presence of common bile duct stones before treatment and the recurrent hepatolithiasis during follow up (p = 0.0066, 0.0014 respectively). Biliary stricture had no influence on the rate of cholangitis. The independent risk factors were the presence of residual stones, recurrence of stones, and the disruption of sphincter of Oddi. In conclusion, complete removal of hepatolithiasis, prevention of recurrent stones, and preservation of the sphincter of Oddi can decrease the rate of cholangitis after treatment for hepatolithiasis.
Category 2: Cirrhosis and its complications, pathophysiology and clinical aspects ~-~
NASAL MUCOSAL CHANGES IN CIRRHOTICS, A CLINICO-HISTOPATHOLOGICALSTUDY
Aiaa E. Ibrahim t , Ahmad M. Selit 2, Nahed Samy Khamis 3. 1Internal Medicine Dept, Benha University, Benha; 2ENT Dept, Benha University, Benha; 3Pathology Dept, Ein Shams University, Cairo, Egypt Epistaxis in cirrhoticsis only attributed to disturbed coagulation, fibrinolysis and blood platelets. Forty cirrhotics were studied to detect any local nasal changes. After routine local examination, ENT examination, routine lab testing, liver functions and abdominal ultrasound, nasal biobsy was performed under local anaethesia. Sections were stained by Haematoxilin and Eosin stain. Mucosal vascularization and atrophy were detected in 50% of cases and showed positive significant correlation with each of Child's grade and portal vein diameter. Mucosal atrophy was detected only in 40% of cases clinically. Epistaxis was reported in 30% of cases and showed positive correlation with mucosal vascularization and child's grade. In conclusion: a variety of histopathological changes were reported in cirrhotics correlating well with Child's grade. These changes might be a contributing factor in epistaxis reproted commonly in cirrhotics. We termed these changes 'Hepatic Rhinopathy'. !