Ultrasonic evidence of intrahepatic portal vein irregularities in cirrhosis.
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Biomedical subjects
Publications and source records attributed to Y Chawla.
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Anorectal varices in portal hypertension have been little studied: Seventy eight per cent of 72 patients with portal hypertension had anorectal varices shown at flexible sigmoidoscopy. Significantly more patients with noncirrhotic portal hypertension had these varices than patients with cirrhosis (89% v 56%, p less than 0.01).
To compare the efficacy of 3% sodium tetradecyl sulphate (STS) with absolute alcohol (AA), we randomly assigned 52 patients with portal hypertension to one of the two sclerosants. Obliteration of esophageal varices was seen with an almost similar number of sessions (5.2 +/- 1.8 with STS and 4.7 +/- 1.5 with AA). Esophageal ulceration was more common with STS, while severe retrosternal pain was seen only with absolute alcohol. However, there was no statistical significance to these differences. The study suggests that absolute alcohol might be a suitable alternative to STS.
Esophageal stricture is an uncommon complication after fiberoptic endoscopic sclerotherapy, occurring in 10 (3.7%) of 265 patients. Eight patients improved and became asymptomatic after 4 weeks of treatment with antacids and antireflux measures, while another two patients required one dilatation each. We thus divided esophageal strictures after sclerotherapy into two types: one that responds to antireflux measures, and one that requires esophageal dilatation.
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We present three patients with portal hypertension in whom large splenoadrenorenal shunts developed after obliteration of esophageal varices by endoscopic sclerotherapy.
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Glycoproteins on the surface of viral particles present the main target of neutralizing antibodies. The structural proteins of most Flaviviruses are known to elicit neutralizing antibodies and, thus, to help in both the natural resolution of the infection and the protection from challenge with homologous hepatitis C virus (HCV). Because such antigens are associated with the viral clearance in both humans and chimpanzees, we aimed to express the E2/NS1 protein of HCV and to study the role of anti-E2/NS1 antibodies in the natural resolution of HCV infection. The prevalence of anti-E2/NS1 antibodies to recombinant E2/NS1 protein was seen by Western blot in chronic liver disease patients (15 chronic hepatitis and 12 cirrhotic patients), who were positive for anti-HCV and negative for HBV infection. The study also included 2 negative controls (positive for HBV infection and negative for anti-HCV antibodies) and 2 healthy controls (negative for both HBV and HCV infection). Anti-E2/NS1 was present in 20% of the chronic hepatitis and 16% of the cirrhosis patients. None of the controls were positive for anti-E2/NS1 antibodies. Serum samples positive for anti-E2/NS1 antibodies were also positive for HCV RNA by RT/PCR. Accordingly, the presence of anti-E2/NS1 may have very little or no role in the natural resolution of HCV infection.
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1000 pairs of maternal and cord blood samples were collected simultaneously at the time of delivery. 23 (2.3%) of the maternal samples were positive for HBsAg by enzyme-linked immunosorbent assay. HBeAg was detected in 11 (47%) of the 23 HBsAg positive mothers and anti-HBeAg was detected in another 5 samples. HBsAg and HBeAg were detected in 7 (30%) of the 23 cord blood samples from HBsAg-positive mothers, and anti-HBeAg was detected in one of these samples. At follow-up (6-18 months), antigenaemia had persisted in 17 (85%) of the 20 HBsAg-positive mothers and in 9 (45%) of 20 babies born to HBsAg-positive mothers. Seven of the 10 babies (70%) born to mothers positive for both HBsAg and HBeAg had persistent HBsAg in their blood, in contrast to 2 of the 10 babies (20%) born to mothers positive for HBsAg only. However, none of these mothers or their babies were found to have anti-HBeAg at follow-up. We conclude that the presence of HBeAg in mothers' blood enhances vertical transmission of hepatitis B virus infection to their babies.