Survival of a case of pre-eclampsia complicated with acute fatty liver of pregnancy and acute pancreatitis.

Acute fatty liver of pregnancy (AFLP) and acute pancreatitis are peculiar complications of pregnancy. When acute pancreatitis occurs co-incidentally with acute fatty liver of pregnancy, mortality is high. Here, we report a case of a 22-year-old lady in her 36th week of gestation, who presented with pre-eclampsia, acute fatty liver of pregnancy and acute pancreatitis. She fulfilled six Swansea criteria for diagnosis of AFLP, and the diagnosis of acute pancreatitis was based on clinical suspicion, elevated pancreatic enzymes and the sonographic appearance of a swollen pancreatic head.

Khat-induced liver injuries: A report of two cases.

Khat is consumed for recreational purposes in many countries, including Yemen, where >50% of adults chew khat leaves regularly. A wide spectrum of khat-induced liver injuries has been reported in the literature. Herein, we report two patients with khat-induced liver injury. Both patients clinically presented with acute hepatitis, one of whom showed radiological evidence of hepatic outflow obstruction. Based on the histological tests, both patients had acute hepatitis, which indicated drug-induced liver injury (DILI) on a background of chronic hepatitis and portal fibrosis; of the two, one presented with symptoms of immune-mediated liver injury.

Differences in phosphatidylcholine and bile acids in bile from Egyptian and UK patients with and without cholangiocarcinoma.

BACKGROUND: Cholangiocarcinoma (CC) is a fatal malignancy, the incidence of which is increasing worldwide, with substantial regional variation. Current diagnostic techniques to distinguish benign from malignant biliary disease are unsatisfactory. Metabolic profiling of bile may help to differentiate benign from malignant disease. No previous studies have compared the metabolic profiles of bile from two geographically and racially distinct groups of CC patients. OBJECTIVES: This study aimed to compare metabolic profiles of bile, using in vitro proton magnetic resonance spectroscopy, from CC patients from Egypt and the UK, and from patients with CC and patients with non-malignant biliary disease. METHODS: A total of 29 bile samples, collected at cholangiography, were analysed using an 11.7-T system. Samples were from eight CC patients in either Egypt (n = 4) or the UK (n = 4) and 21 patients with benign biliary disease (choledocholithiasis [n = 8], sphincter of Oddi dysfunction [n = 8], primary sclerosing cholangitis [n = 5]). RESULTS: Bile phosphatidylcholine (PtC) was significantly reduced in CC patients. Egyptian CC patients had significantly lower biliary PtC levels compared with UK patients. Taurine- and glycine-conjugated bile acids (H-26 and H-25 protons, respectively) were significantly elevated in bile from patients with CC compared with bile from patients with benign diseases (P = 0.013 and P < 0.01, respectively). CONCLUSIONS: Biliary PtC levels potentially differentiate CC from benign biliary disease. Reduced biliary PtC in Egyptian compared with UK patients may reflect underlying carcinogenic mechanisms.

Circulating AFP mRNA as a Possible Indicator of Hematogenous Spread of HCC Cells: A Possible Association with HBV Infection.

BACKGROUND: Circulating alpha fetoprotein messenger RNA (AFP mRNA) has been proposed as a marker of hepatocellular carcinoma (HCC) cells disseminated into the circulation. The specificity of this molecular marker and its correlation with the main HCC clinico-pathological parameters remains controversial. AIM: This case control pilot study has been undertaken to detect the expression of human AFP mRNA in the peripheral blood of patients with HCC and liver cirrhosis (LC), to evaluate its clinical implication and to clarify its relationship with some clinico-pathologic characteristics in HCC. METHODS: Peripheral blood (PB) samples were obtained from 32 patients with HCC (14 patients before treatment and 18 patients after treatment), 15 patients with LC and 10 normal donors. HCC patients with clinically evident extra-hepatic metastasis were excluded. AFP mRNA was amplified from the total RNA extracted from the whole blood by nested reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Circulating AFP mRNA was positive in 25% (8/32) of all HCC patients, 42.9% (6/14) of patients before treatment, 11.1% (2/18) of patients previously treated, and 13.3% (2/15) of patients with liver cirrhosis without HCC. Circulating AFP mRNA detection rate was significantly higher in untreated than in treated HCC patients (p=0.04). There was no significant difference among the other various patient groups (LC Vs HCC all: p=0.31; LC Vs untreated HCC; p=0.11; LC Vs treated HCC; p=1.0). Both patients who tested positive for circulating AFP mRNA in the treated HCC group were in the chemoembolization subgroup (2/8=25%). None (0/5=0%) of post resection as well as radiofrequency subgroups of patients tested positive for circulating AFP mRNA. None of the normal controls tested positive for circulating AFP mRNA. The only variable associated with the presence of circulating AFP mRNA in HCC patients was being hepatitis B positive: 87.5% (7/8) of AFP mRNA positive HCC patients had had clinical evidence of chronic hepatitis B virus (HBV) infection (p=0.01, OR=14, 95% CI=1.46-134.25). None of the other variables (age, sex, HCV infection, Child-Pugh score, liver function indices, serum AFP values and tumor size) was significantly related to the presence of AFP mRNA in HCC patients. No patient with chronic liver disease (CLD) due to HBV infection tested positive for circulating AFP mRNA. CONCLUSION: Using nested RT-PCR assay, circulating AFP mRNA could be detected in HCC patients without clinical evidence of extra-hepatic metastasis as well as in patients with LC. Although the possibility of hematogenous spread of HCC cells cannot be excluded, AFP mRNA expression in blood does not necessarily distinguish between circulating HCC cells and noncancerous hepatocytes. Although this is a small sample size pilot study, our findings imply that HBV infection may be an important contributing factor to the hematogenous spread of HCC cells. HBV infection was strongly associated with AFP mRNA expression in blood of HCC patients. Thorough investigation of this association in a larger series with HBV infection is needed. Also, another larger treated HCC series is needed for the assessment of AFP mRNA expression in blood in relation to specified treatment approaches. Key Words: AFP mRNA , Hepatocellular carcinoma (HCC) , RT-PCR , Chronic liver disease (CLD).