Nitric Oxide and Von Willebrand Factor Levels as Markers of Endothelial Dysfunction in Liver Cirrhosis

Introduction: A number of investigators have shown that endothelial dysfunction in liver cirrhosis can be indicated by increased levels of nitric oxide (NO) and von Willebrand factor (vWF). The cause of this increase is still unclear. It is believe to be correlated with hyperdinamic circulation and endotoxemia, which are common in liver cirrhosis. The Aim of This Study: To compare the levels of NO and vWF in liver cirrhosis patients with those in healthy control subjects, and to investigate whether there is a correlation between levels of NO and vWF with the severity of the disease according to the Child Pugh Criteria Material and Method: This study was conducted from February until June 2001 in 35 liver cirrhosis patients at Dr. Pirngadi and H. Adam Malik Hospital and some private hospitals in Medan. The mean age of patients with liver cirrhosis was 54 + 12.26 years, the youngest being 31 years and the oldest 75 years, and 20 healthy controls while the mean age of the control subject was 55.20 + 13.04 years, the youngest being 31 years and the oldest 76 years. Based on Child Pugh criteria, 9 were classified as Child Pugh class A, 13 in class B, 13 in class C. The criteria for liver cirrhosis were based on clinical examination, laboratory findings and liver ultrasound examination. Cirrhotic patients with hypercolestrolemia, hypertension, heart failure, myocardial infraction, renal failure diabetes, COPD were those on drugs, such as antibiotics and branchodilators were excluded from the study. Result: The mean level of NO in patients with liver cirrhosis was 6.2600 + 4.4456 mM, while the mean NO level in control subjects was 3.2325 + 3.2355 mM, p<0.05. The mean level of NO in Child Pugh class A patients was 6.6889 + 3.9757mM, compared to control p<0.05; in Child Pugh class B the mean level was 4.8308 + 2.4642 mM compared to control p>0.05. There was a significant increase in the level of NO associated with the severity of liver cirrhosis. The mean level of vWF in patients with liver cirrhosis was 399.514 + 175.313% while the mean vWF level in control subjects was 139.100 + 51.144%, p<0.05. The mean level of vWF in Child Pugh class A patients was 231.778 ± 43.8576%, compared to control p<0.05; in Child Pugh class B was 365.846 + 110.034%, compared to control p<0.05, in Child Pugh class C was 549.308 + 164.483%, compared to control p<0.05. There was significant increase in the level of vWF correlated with severity of liver cirrhosis. Conclusion: The level of NO was significant higher in liver cirrhosis patients compared to control subjects, but there was no correlation between the increase in the level of NO with the severity of the disease. The levels of vWF was significantly higher in liver cirrhosis patients compared to control, and there was a correlation between increased levels of vWF and the severity of the disease

Diagnostic Findings and ERCP Treatment in Patients with Obstructive Jaundice During Two Years at H. Adam Malik Hospital, Medan

Background: The methods of ERCP have been used for diagnostic and therapeutic purposes to pass bile fluid and extract stones from the bile duct in patients with obstructive extrahepatic jaundice. Method: A retrospective study was performed on patients with obstructive extrahepatic jaundice patients who underwent ERCP during a two-years time period from January 1999 to December 2000. ERCP was performed with a premedication of 10 mg midazolam, followed by a chollangiography contrast containing 1 mg/dl of Garamicin and 25 mg of Pethidine if sphincterotomy was performed. Results: From 126 patients with obstructive extrahepatic jaundice treated with ERCP, the male to female ratio was 1.86:1. The majority of the (group) of patients were between 51-60 years of age (33.3 % ). The youngest patient (group) was 24 years and the oldest 97 years. The diagnostic study found the following cases: normal 3 cases (2.8%), bile duct stone 46 cases (43.4%), carcinoma of ampula vater 20 cases (18.9%), CBD tumor 7 cases (6.6%), carcinoma of head of pancreas 2 cases (1.9%), diverticle 4 cases (3.8%), duodenal tumor 1 case (0.9%), carcinoma of ampula vater and bile duct stone 1 case (0.9%), SOD 5 cases (4.7%), CBD stricture 1 case (0.9%) and failure 16 cases (15.1%). The patients receivied the following treatment: sphyncterotomy 36 cases (51.4%), stent application 11 cases ( 15.7%), sphincterotomy with stent 18 cases (25.7%) and basket method 5 cases (7.1%)

Diagnostic Findings and ERCP Treatment in Patients with Obstructive Jaundice during two years at H. Adam Malik Hospital, Medan

Background: The methods of ERCP have been used for diagnostic and therapeutic purposes to pass bile fluid and extract stones from the bile duct in patients with obstructive extrahepatic jaundice. Method: A retrospective study was performed on patients with obstructive extrahepatic jaundice patients who underwent ERCP during a two-years time period from January 1999 to December 2000. ERCP was performed with a premedication of 10 mg midazolam, followed by a chollangiography contrast containing 1 mg/dl of Garamicin and 25 mg of Pethidine if sphincterotomy was performed. Results: From 126 patients with obstructive extrahepatic jaundice treated with ERCP, the male to female ratio was 1.86:1. The majority of the (group) of patients were between 51-60 years of age (33.3 % ). The youngest patient (group) was 24 years and the oldest 97 years. The diagnostic study found the following cases: normal 3 cases (2.8%), bile duct stone 46 cases (43.4%), carcinoma of ampula vater 20 cases (18.9%), CBD tumor 7 cases (6.6%), carcinoma of head of pancreas 2 cases (1.9%), diverticle 4 cases (3.8%), duodenal tumor 1 case (0.9%), carcinoma of ampula vater and bile duct stone 1 case (0.9%), SOD 5 cases (4.7%), CBD stricture 1 case (0.9%) and failure 16 cases (15.1%). The patients receivied the following treatment: sphyncterotomy 36 cases (51.4%), stent application 11 cases ( 15.7%), sphincterotomy with stent 18 cases (25.7%) and basket method 5 cases (7.1%). Keywords: ERCP, obstructive jaundic