A study on non invasive predictors of large esophageal varices using clinical, laboratory and imaging parameters.

Portal hypertension- a major hallmark of cirrhosis is defined as a portal pressure gradient exceeding 5-10 mm Hg. In portal hypertension, portosystemic collaterals decompress the portal circulation and give rise to varices. Development of esophageal varices and gastrointestinal bleeding represents a serious consequence in patients with portal hypertension. At the time of diagnosis of liver cirrhosis, esophageal varices are present in about 40% of patients with compensated disease and in 60% of those with decompensated disease and ascites. In patients with liver cirrhosis who do not have detectable esophageal varices, the latter appear at a rate of nearly 5% per year. Also, the size of varices tends to increase with time. It has been estimated that among those with small esophageal varices, nearly 12% progress to large varices annually. The annual incidence of first variceal bleeding has been estimated to be around 4% in non-selected patients with cirrhosis of the liver who have not bled previously. It has been shown that the risk of variceal bleeding is related to the size of esophageal varices, 8 with large esophageal varices being at a greater risk; this is possibly due to a higher variceal wall tension in large esophageal varices. Thus, annual incidence of gastrointestinal bleeding is only 1–2% in patients without varices, 5% in those with small esophageal varices and 15–20% in patients with large esophageal varices

Low incidence of positive smooth muscle antibody and high incidence of isolated IgM elevation in Chinese patients with autoimmune hepatitis and primary biliary cirrhosis overlap syndrome: a retrospective study

<p/> <p>Background</p> <p>Up to now, few data are available regarding the clinical characteristics of autoimmune hepatitis and primary biliary cirrhosis overlap syndrome. The study was to investigate and analyze the prevalent and clinical features of Chinese patients with this disease.</p> <p>Methods</p> <p>Clinical data on patients diagnosed as autoimmune hepatitis and primary biliary cirrhosis overlap syndrome in our hospital from January 2001 to December 2006 were collected and analyzed.</p> <p>Results</p> <p>Overlap syndrome of autoimmune hepatitis and primary biliary cirrhosis accounted for 10.33% of patients with autoimmune liver diseases during the past six years. For these patients with overlap syndrome, xanthochromia, lethargy and anorexia were the predominant complaints; a low incidence (14/146) of smooth muscle antibody positivity and a high incidence (37/89) of isolated IgM elevation were the main serological characteristics.</p> <p>Conclusions</p> <p>Overlap syndrome of autoimmune hepatitis and primary biliary cirrhosis was not rare in Chinese patients with clinical manifests of autoimmune liver diseases. Overlap of the diseases should not be disregarded when isolated IgM elevation was exhibited, and smooth muscle antibody might have little diagnostic significance in the overlap syndrome. If it was difficult to make a definite diagnosis, liver biopsy was necessary.</p

Pancreas divisum and choledochal cyst

Pancreas divisum (PD) is the most common congenital variant of the pancreas, affecting 5% to 14% of the population. The ventral duct only drains the ventral pancreas through the major papilla, whereas the majority of the pancreas drains via the dorsal duct through the minor papilla. We report the case of a 21-year-old woman with recurrent acute pancreatitis who presented with the rare finding of choledochal cyst and pancreas divisum (PD). She underwent minor papilla sphincterotomy and pancreatic duct stenting. Comparable literature findings of PD and choledochal cyst are discussed with regard to the presented case

Immunogenicity and safety of hepatitis B vaccine (Shanvac-B) using a novel pre-filled single use injection device uniject in Indian subjects

BACKGROUND: Hepatitis B is a major public health problem, which has now been controlled to some extent by vaccination especially with the recombinant hepatitis B vaccine, which has been proven to be safe and efficacious since its introduction in the 1990s. But problems of unsafe injection practices still persist. Now newer delivery devices like uniject are available for making vaccination very safe. OBJECTIVE: To evaluate the immunogenicity and safety of the Hepatitis-B (Shanvac-B) vaccine in Uniject pre-filled device administered to healthy adults and infants at 0, 1, 2 months schedule. METHODS: A total of 122 healthy subjects (62 adults and 60 infants) were administered three doses of the recombinant Hepatitis-B vaccine using Uniject pre-filled device. Blood samples for antibody titer estimation were taken before vaccination and 4-6 weeks after third dose. Subjects, parents or guardians were given diary cards to record any adverse reactions. RESULTS: Protective immune responses to the vaccine were seen in 96.4% of adults and 100% of infants who completed the study. The Geometric Mean Titers (GMT) in adults and infants were 518.5 and 385.41 mIU/ml respectively. Mild fever, itching, and swelling at injection site were the most common side effects observed. CONCLUSION: The safety and immunogenicity of the Hepatitis B Vaccine in the novel pre-filled device Uniject was effectively demonstrated in the present study

Intranet based telephone directory software

This document is a step-by-step manual to educate the user on working with NAVs telephone directory on the intranet. This system discussed here is an improvement over telephone directory which used Java and Applet for connectvity. Our new system uses Java, Servlet and Oracle