Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract: A case report and literature review

Hepatic abscess caused by foreign body penetration of the alimentary tract is rare.We report a case of gastric antrum penetration due to a toothpick complicated by liver abscess formation.A 41-year-old man was admitted to our hospital with the chief complaint of upper abdominal pain for 2 mo.Esophagogastroduodenoscopy performed at a local clinic revealed a toothpick penetrating the gastric antrum.Computed tomography(CT)of the abdomen at our hospital revealed a gastricforeign body embedded in the posterior wall of gastric antrum with regional phlegmon over the lesser sac and adhesion to the pancreatic body without notable vascular injury,and a hepatic abscess seven cm in diameter over the left liver lobe.Endoscopic removal of the foreign body was successfully performed without complication.The liver abscess was treated with parenteral antibiotics without drainage.The patient’s recovery was uneventful.Abdominal ultrasonography demonstrated complete resolution of the hepatic abscess six months after discharge.Relevant literature from the PubMed database was reviewed and the clinical presentations,diagnostic modalities,treatment strategies and outcomes of 88 reported cases were analyzed.The results showed that only 6 patients received conservative treatment with parenteral antibiotics,while the majority underwent either image-guided abscess drainage or laparotomy.Patients receiving abscess drainage via laparotomy had a significantly shorter length of hospitalization compared with those undergoing imageguided drainage.There was no significant difference in age between those who survived and those who died,however,the latter presented to hospitals in a more critical condition than the former.The overall mortality rate was 7.95%.

Effect of verapamil on nitric oxide synthase in a portal veinligated rat model: Role of prostaglandin

瞄准：在氮的氧化物上调查 verapamil 的效果(没有) 在一扇门的合成绑扎静脉的老鼠模型。方法：全身、内脏的血液动力学被与 N (w)-nitro-L-arginine (NNA )(80 mg/kg ) 或消炎痛(2 mg/kg ) 在长期的处理上在 verapamil (2 mg/kg ) 的尖锐管理以后在门 hypertensive 老鼠标记微范围的无线电测量。结果：Verapamil (2 mg/kg ) 在一个不足道的变化在门静脉输入在门压力和没有变化伴随的动脉压和心输出量引起了显著下降。建议的这结果 verapamil 没在门引起减小门 hypertensive 老鼠的脉管的抵抗，在 N (w) 之间类似， nitro-L-arginine-treated 和对待消炎痛的组。结论：在有 NNA 或消炎痛的门 hypertensive 老鼠 pretreated，尖锐 verapamil 管理不能减少门压力，不建议那并且前列腺素玩在在门静脉高血压的内脏的动脉的血管舒张的致病的一个重要角色。

Prevalence of HBs Antigen, and HCV and HIV Antibodies in a Young Male Population in Cameroon

Introduction: According to WHO estimates, 57% of cases of liver cirrhosis and 78% of primary liver carcinoma are caused by a hepatitis B or C virus. This study aimed to assess the prevalence of these diseases and HIV among a young male population, according to region. Methods: This was a descriptive cross-sectional study conducted from 17 February to 31 March 2014 in the ten administrative regions of Cameroon. The study included male subjects of Cameroonian nationality aged at least 18 and at most 23, and living in the regions concerned. It excluded subjects that did not match the age, gender, and nationality criteria. For each subject, 10 ml of blood was collected in a dry tube. After centrifugation at 3000 RPM for 5 minutes, the serum was collected for the detection of viral infections. For subjects that tested positive, a confirmatory test was conducted. Results: In total, 4367 subjects were selected, with an average age of 20.46 (+/- 1.17) years. The prevalence of hepatitis B virus stood at 13.01% (with 95% CI: 12.03% - 14.05%). That of viral hepatitis C was 0.30% (95% CI: 0.17% - 0.52%). Co-infection with hepatitis B and C viruses was 0.05% (95% CI: 0.01% - 0.18%). The prevalence of HIV infection was 1.01% (95% CI: 0.74% - 1.36%). Conclusion: The overall prevalence of HBsAg in the population of young males is high. It tallies with the early vertical and horizontal modes of transmission that prevail in our environment.

Large-Volume Paracentesis in Patients with Cirrhotic Ascites: Does It Increase the Risk of Serious Bleeding and the Need for Transfusion?

Background: Liver cirrhosis is the most common cause of ascites. For cirrhotic ascites that does not respond to diuretics and salt restriction, large-volume paracentesis is an alternative option. Methods: A retrospective cohort study of patients admitted to the Day care unit at King Abdulaziz University Hospital for therapeutic paracentesis of cirrhotic ascites was performed from March 2013-April 2014. The demographic data and results, including the platelet count, hemoglobin level, prothrombin time (PT), international normalized ratio (INR), serum creatinine, serum albumin, and bilirubin levels, were recorded. We recorded all of the bleeding episodes. Results: We recorded 118 admissions for 13 patients. Nine of them were male (69.2%), and the mean age was 58.6 ± 15.8 years. All patients had a Child-Pugh score of C. The platelet count was lower than normal for 78 admissions (66.1%), and the PT was prolonged for 99 admissions (84%). Three episodes of bleeding occurred in our cohort, all of which were mild and controlled by the local application of pressure. One patient required a platelet transfusion for severe thrombocytopenia, low platelets count was associated with elevated creatinine and low albumin levels (P = 0.014 and 0.003, respectively). Similarly, a prolonged PT was associated with low albumin, high bilirubin, low platelet, and high creatinine levels (P = 0.013, < 0.001, = 0.006, and < 0.001, respectively). Conclusions: Large-volume paracentesis is associated with only a small risk of bleeding in patients with cirrhotic ascites, and a transfusion of fresh frozen plasma (FFP) and platelets is not needed for the majority of patients.

胆固醇结石病人肝脏脂质代谢异常的分子生物学研究

目的:研究导致胆石病人胆汁胆固醇过饱和的肝脏胆固醇和胆汁酸代谢途径中的分子生物学改变。方法:收集22例胆石病人和13例无胆石病的对照病人肝脏活检组织、胆囊胆汁和血浆。采用实时定量PCR检测肝脏基因表达,采用Western印迹法测定蛋白含量。结果:胆石病人较对照组ABCG5/ABCG8和LXRα基因的mRNA表达水平分别增加51%、59%和102%。肝脏SRBI的mRNA和蛋白含量均增加。结论:胆石病人ABCG5/ABCG8基因表达上调,可能与LXRα表达增加促进相关,这些异常是导致胆汁胆固醇过饱和的原因。此外,胆汁中过多的胆固醇可能来源于经肝脏高密度脂蛋白受体SRBI的摄取,而不是由于肝脏合成和酯化的异常。

Helicobacter pylori may be an initiating factor in newly diagnosed ulcerative colitis patients: A pilot study

AIM To directly visualize Helicobacter pylori(H. pylori) by the highly sensitive and specific technique of immunohistochemical staining in colonic tissue from patients newly diagnosed with ulcerative colitis(UC).METHODS Colonoscopic biopsies from thirty patients with newly diagnosed UC and thirty controls were stained with Giemsa stain and immunohistochemical stain for detection of H. pylori in the colonic tissue. Results were confirmed by testing H. pylori Ag in the stool then infected patients were randomized to receive either anti H. pylori treatment or placebo.RESULTS Twelve/30(40%) of the UC patients were positive for H. pylori by Giemsa, and 17/30(56.6%) by immunohistochemistry stain. Among the control group 4/30(13.3%) and 6/30(20 %) were positive for H. pylori by Giemsa and immunohistochemistry staining respectively. H. pylori was significantly higher in UC than in controls(P = 0.04 and 0.007). All Giemsa positive patients and controls were positive by immunohistochemical stain. Four cases of the control group positive for H. pylori also showed microscopic features consistent with early UC.CONCLUSION H. pylori can be detected in colonic mucosa of patients with UC and patients with histological superficial ulcerations and mild infiltration consistent with early UC. There seems to be an association between UC and presence of H. pylori in the colonic tissue. Whether this is a causal relationship or not remains to be discovered.

Pyogenic liver abscess associated with large colonic tubulovillous adenoma

生脓肝脓肿通常与许多疾病联合发生。很少，肝脓肿作为结肠的 tubulovillous 腺瘤的介绍表明被报导了。除了一个人有糖尿病(DM ) 的历史之外，没有肝胆管疾病或另外的明显的病原学，我们报导生脓肝脓肿的二个案例。在有 DM 的病人的病原体是克雷白氏杆菌属肺病(KP ) 。在两个，病人，，肠塞痛大约二～三个星期在肝脓肿的诊断以后发展了。结肠镜检查在两个盒子中与 tubulovillous 腺瘤的病理检查所见揭示了大息肉样瘤。二个教训从这二个案例被接受：(1 ) 一个内在的原因应该好攻击地与起因不明的肝脓肿在病人被调查；(2 ) DM 能是病原学然而并非 KP 肝脓肿的必然唯一的原因之一。

NS-398 induces caspase-dependent, mitochondria-mediated intrinsic apoptosis of hepatoma cells

The present study was conducted to investigate whether mitochondrial pathway of apoptosis is involved in cyclooxygenase-2 (COX-2) inhibitor-induced growth inhibition of hepatoma cells. The growth rate and pattern of NS-398 (selective COX-2 inhibitor)-treated Hep3B hepatoma cells were analyzed by microscopic examination, DNA fragmentation gel analysis and flow cytometry followed by the cleavage of down-stream caspase 3 and the release of cytosolic fraction of cytochrome c assessed by Western blot analysis. NS-398 induced the growth inhibition of hepatoma cells depending on the concentration of this COX-2 inhibitor and time sequence. Ladder patterned-DNA fragmentation and cytometric redistribution to sub-G1 phase in cell cycle were revealed in NS-398-induced growth inhibition of hepatoma cells. Cytochrome c was translocated from mitochondria to cytosol in time-dependent manner following NS-398 treatment to hepatoma cells. COX-2 inhibitor induces the growth inhibition of hepatoma cells via caspase-dependent, mitochondria-mediated intrinsic apoptosis pathway. These results strongly suggest the possibility of therapeutic implication of COX-2 inhibitor in HCC.

Predictors of Spontaneous Bacterial Peritonitis in Patients with Cirrhotic Ascites

Background and Aims:Spontaneous bacterial peritonitis(SBP)is a serious complication of liver cirrhosis and a prognostic model to predict it is needed.This study was designed to test the ability of different laboratory tests and the new scoring system by Wehmeyer and colleagues(consisting of age,C-reactive protein(CRP)and platelet count)to predict it.Methods:Three-hundred patients admitted to the National Liver Institute,University of Menoufia,Egypt(2015-2016)with liver cirrhosis and ascites were included in our study.SBP was diagnosed if ascetic neutrophil count was≥250/μL with no sign of secondary peritonitis.Results:The patient population had age range of 29-81 years old,was 60%men and showed a majority(91.7%)with primary cause of liver disease being hepatitis C.By univariate analysis,associations with age,total bilirubin,aspartate aminotransferase level,creatinine level,international normalized ratio,model for endstage liver disease score,total leucocytic count,platelet count and CRP level were significant.By multivariate analysis,independent predictors were age,platelet count and CRP level(p=0.004,0.013 and<0.001,respectively).CRP at a cut-off point≥13.5 mg/L could predict SBP(sensitivity of 86.4%and specificity of 66.0%).Wehmeyer's SBP scoring system was predictive(p<0.001);only 4%of patients with 0 score developed SBP(CRP cut-off of 30 mg/L),while 92.8%with score of 3 or 4 developed SBP.By using our modified Wehmeyer score with CRP cut-off value of 13.5 mg/L,no patient with 0 score developed SBP.Conclusions:Age,CRP level and platelet count are independent predictors for SBP and a scoring system including them could easily predict the condition.SBP diagnosis could be excluded in patients with 0 score,using CRP cut-off value of 13.5 mg/L.