PRIMARY SCLEROSING CHOLANGITIS

Z.T.SHIRINOV, B.H.GULIYEV, F.S.IDRISOV

Scientific Centre of Surgery named after M.A. Topchubashev, Baku, AZERBAIJAN

Primary sclerosing cholangitis – is a chronic cholestatic disease of liver of unknown ethyology and characterized by non-suppurative inflammation destruction. Are followed by obliteration sclerosis and segmentary enlargement of bile ducts. Further develop hepatic cirrhosis, fortal hypertension and hepatic insufficiency.

For the first time the disease was mentioned in literature in 1925 by Deibet P. In 1970 the disease was very rare and considered to be a causistics. So far 100 such cases were mentioned in the literature. In recent years endoscopic-Retrograde-cholangio-pancreatogrphic examination was speeded up by the detection of the disease. In 1980 based on Mayo and Royal Free Hospital in every 1-4 person of 100 000 population has primary sclerosing cholangitis. It is encountered most of ll in persons of verage age (40 years). Genetic autoimmune mechanisms are prefered in the ethyology.

Given this into account, in my 22 year clinical practice i consider it my duty to give information on 1 patien with primary sclerosing cholangitis

Patient: XT No 870 admitted on: 04 03 2011

Accoding to the anamnesis he is ill within 6 month. The Disease starts with pains, periodic yellowing of skin and sclera. Periodic infusion, desintoxication tretment had temporary effect. Remission was replaced by exacerbation.

Before the operation the patients was carried out Ultrasound, CT, NMRKT-cholangiogramms, VFEQGDS, ECG, toracic r-gramma, common and biochemical blood tests, and hepatic tests were studied. First of all, the patient ws set the diagnosis of choledochal tumor, mechanical jaundice.

On 09.03.2011 we performed cholecystectomy and choledochal resection jointly with tumor with the application of intubation narcosis after appropriate preoperative preparation, there was placed hepatico-jejuno anastomosis divided by a loop by Roux method on a drainage changed by Saypol Kurian method. Post operative couse was satisfactory, secondary healing of the injury was observed.

In the histologicexamination of the macropreparat primary sclerosing cholangitis diagnosis was confirmed.

The patient was discharged home in satisfactory conditiond, 2 months later he returned to the clinic for the replacement of drainage tube. Life standard is accesses as good. No signs of jaundice and cholangitis were observed.

A CASE OF HEPATOTOXICITY WHICH OCCURRED AFTER PIOGLITAZONE THERAPY AND CO-DIAGNOSIS OF PRIMARY BILIARY CIRRHOSIS

G. SISMAN (1), I. HATEMI (1), G. OZBAY (2), S. OZDEMIR (1)

(8)Istanbul University, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology; (2) Istanbul University, Cerrahpasa Faculty of Medicine, Department of Pathology, Istanbul, TURKEY

Background / Aims: Primary biliary cirrhosis is a progressive autoimmune cholestatic liver disease affecting mainly middle aged women. Genetic and environmental factors are important in the pathogenesis of the disease. Some drug induced primary biliary cirrhosis cases have been reported in the literature. Pioglitazone is a member of the thiazolidinediones, which are used in treating Type 2 diabetes. Some cases of cholestasis induced by piolitazone have been reported. We report here the laboratory and histopathological findings of a patient with cholestatic liver injury which occurred after pioglitazone therapy.

Case Report and Results: A 55-year-old woman was admitted with fatigue, nausea and vomiting. Two months before the admission she had begun receiving pioglitazone. Laboratory tests revealed elevated transaminases and cholestatic liver enzyme levels. Antimitochondrial antibody was positive. Liver biopsy showed portal tract inflammation with predominantly plasmocytic infiltrates, bile duct damage and granuloma formation consistent with the diagnosis of primary biliary cirrhosis.

Conclusions: In this case we suggested the coexistence of pioglitazone induced hepatotoxicity and concomitant primary biliary cirrhosis.

EVALUATION OF TREATMENT HEPATITIS C IN AZERBAIJANIAN PATIENTS

M. H. SOMI , S. NAGHASHI, M. SOLEIMANPOUR, M. J. FARAHVASH

Research Center of liver and gastrointestinal diseases of Tabriz University, Tabriz, IRAN

Introduction: Hepatitis C virus (HCV) constitutes a major public health issue around the world, especially in developing countries. About 200 million people are infected with HCV worldwide, which covers about 3.3% of the world’s population. The effective standard therapeutic regimen for patients with chronic hepatitis C is pegylated interferon plus ribavirin. with duration of therapy and dosing of RBV varying according to the genotype of the virus. RVR as a strong predictor of SVR that can be used to tailor treatment duration. In this study we evaluated the RVR , EVR and EOT(End Of Treatment) rate in patients that refer for treatment from Republic of Azerbaijan to Tabriz university of medical sciences.

Patients and methods: We prospectively studied 40 Azerbaijanis patients with hepatitis c who received PEG-IFN alpha-2a 180 µg plus ribavirin. Treatment was administrated for 24 weeks and 48 weeks for hepatitis C virus (HCV) genotypes 3 and 1, respectively. Demographical data, genotype and number of virus, level of liver transaminas , RVR, EVR,EOT and complication of treatment were data that we was collected.

Results: Mean age of the patients was 42.27±11.42 (26 male (65%) and 14 female (35%)) . Elevated level of AST and ALT was seen in 62.5% (25 cases) and 75.7%(28 cases) of patient respectively. Thirteen patients (12.5%) had abnormal liver ultrasound. The most common abnormality were fatty liver ( 6 cases, 15% ),cirotic pattern( 3 cases,7.5% ) , hepatomegaly(2 cases,55%)and course pattern (3cases,7.5%).Genotypes of 1ab (11 casese.27.5%) , 1b (10 casese.25%) , 1a (4 cases,10% )and 3a (3casese,7.5%) were the commonest genotypes of virus in our patients. Mean range of virus number was (1034178,min=608, max=6080000).Rapid Virological Response(RVR) , EVR and EOT was observed in 100% of our patients. Mild complication was seen only in 25% of patients that anemia(5 cases.12.5%) was commonest complication. After treatment reduction in AST and ALT was seen in all patients with elevated transaminas.

Conclusion: Due to this data( high rate of RVR,EVR,EOT and good compliance in the Azerbaijanis patients) success rate of HCV treatment was good but follow up of Sustained Virological Response( SVR) was suggested for final recommendation.

Date: 2014-12-28; view: 749