The Effect of Desferrioxamine as supplement to Cefotaxime in the Treatment of Spontaneous Bacterial Peritonitis NA. Seda 1 , M. El-hamamsy 2 , R. El-wakil 3 , M. Al Azizi 4 1 Ain Shams Specialized Hospital, 2 Faculty of Pharmacy,Ain Shams University, 3 Faculty of medicine,Ain Shams University, 4 Faculty of Pharmacy ,Ain Shams University Background: Oxidative damage lead to cell damage, organ dysfunction and death in sepsis. Desferrioxamine (DFX), an antioxidant iron Chelators. The aim was to assess the efficacy of Desferrioxamine supplemented to Cefotaxime in the treatment of Spontaneous Bacterial Peritonitis (SBP) in cirrhotic patients. Methods: thirty patients divided into two groups: Group I (n=15) with SBP and receiving Cefotaxime (1g IV every12 hours) alone and Group II (n=15) with SBP receiving Cefotaxime (1g IV every 12 hours) with desferrioxamine (500mg IM twice daily).All patient were monitored for seven days, their vital organs were screened and their ascitic fluid was assessed completely including microbiological investigations. Results: The concomitant administration of Desferrioxamine with Cefotaxime significantly at (p<0.001)and(p<0.01) improved the therapeutic outcome and the cure rate after 5 days of treatment as compared to patients using cefotaxime only. Conclusions: Desferrioxamine can improve the therapeutic outcome by preventing iron-induced organ damage and inhibiting bacterial growth. Oligella ureolytica is a gram-negative, nonfermenting rod that is infrequently recovered from clinical specimens and is most commonly isolated from the urine of patients with chronic indwelling urinary catheters or other urinary drainage systems. Bacteremia due to this organism is an extraordinary finding. We describe here a case of Oligella ureolytica being detected in the blood of a patient with decompensated cirrhosis. A 51-year-old male man was admitted to hospital with 9-month duration of debility, poor appetite and abdominal distension. Decompensated cirrhosis was diagnosed based on clinical findings such as hepatic face, ascites, edema of lower limbs and icteric sclera. Laboratory results showed positive serum anti-HCV and high serum HCV RNA level. The patient received a therapeutic regimen of pegylated interferon alpha 2a plus ribavirin after being admitted to hospital. During hospital stay, a fever of 2-day duration with shivering occurred to the patient. Three blood cultures were drawn, which all grew Oligella ureolytica in pure culture. The organism was identified by the Viteck 2 Compact (Biomerieux, France). Additional tests for identification resulted positive for nitrate reduction and urea hydrolysis, strongly positive for phenylalaninedeaminase activity and showed no growth at 42.7C. Tests for nitrite reduction and motility resulted negative. The organism was resistant to amikacin, cefoperazone, levofloxacin, piperacillin/tazobactam, trimethoprimsulfamethoxazole, aztreonam, cefotaxime, piperacillin and was susceptible to gentamicin, imipenem, meropenem, and netilmicin. A 14-day of combined therapeutic regimen with cefminox and isepamicin was administered to the patient. Within 2 days, the patient became afebrile. Background: Endoscopic ultrasound (EUS) is often performed in patients with unexplained liver tests to assess the gallbladder, bile ducts and pancreas. An unremarkable EUS exam and negative hepatology workup often leads to a liver biopsy. EUS may provide histopathologic evaluation of the liver in these cases under direct, real-time visualization. Aim: To assess the feasibility and efficacy of EUS guided core biopsy of the liver in a porcine model. Methods: Female pigs were used and live procedures were performed under general anesthesia. A linear echoendoscope was used and the liver identified endosonographically. Transgastric core biopsies of the liver were obtained with a 19 gauge Quick-Core ultrasound biopsy needle (Wilson-Cook) and sent for histopathologic evaluation. Live animals were euthanized at the end of the procedure and necropsy performed. Results: Core biopsies of the liver biopsy were obtained in 4 animals (1 cadaver and 3 live anesthetized). A total of thirteen needle passes were made (mean 3.25; range 2 -4 needle passes per animal) and a visible core of tissue obtained. The maximum length of liver tissue obtained was 10 mm and considered adequate for assessment as more than one such specimen could be obtained. Microscopic evaluation confirmed liver tissue. No complications were noted. Necropsy did not show any evidence of bleeding, perforation or damage to surrounding structures. Conclusion: EUS-guided liver biopsy is feasible and can be performed at the time of routine echoendoscopic exam in select patients undergoing EUS examination for abnormal liver tests. Background: As the common indexes, ALT, AST and PLT play an important role in disease diagnosis, treatment and prognosis. Many researchers suggested that there was inflammatory changes and fibrosis in chronic hepatitis B and C patients whose ALT level was persistently normal. A large sample investigation showed that the serum level of ALT in healthy persons is lower than the normal reference value. This study re-evaluated the normal serum level of ALT, AST and PLT. Methods: 3815 people were enrolled in the study between Sep. and Oct. 2007. The platelet count and serum ALT and AST levels were measured. Frequencies, One-Sample Kolmogorov-Smirnov test and nonparametric tests were used to analyze the difference between age groups, male and female, glucose groups, cholesterol groups and triglyceride groups. Result: In the five groups, there is significant difference in ALT and AST levels between male and female. In group 1, the ALT and AST levels showed a significant difference between different age groups, between different glucose groups and triglycide groups. In the three groups the PLT level is significantly different between male and female, and the serum level in male is higher than female. There is significant difference between different age groups Conclusion: The serum levels of ALT, AST and PLT are all significantly different between male and femal. There is significant difference between different genders and age groups for PLT. The serum level of PLT is higher than the reference value. Background/aims: Myeloproliferative disorders (MPD) (like polycythemia vera, essential thrombocythemia and primary myelofibrosis) are responsible for 50% cases of hepatic venous thrombosis (HVT) and 35% of portal venous thrombosis (PVT) in western series. Latent form of MPD lacks the characteristic blood picture and may be classified as idiopathic thrombotic disorder. A point mutation at Val617Phe of Janus kinase 2 tyrosine kinase gene (JAK2 V617F mutation) occurs in high proportion of the patients with MPD. This non-invasive test with high positive predictive value is now considered to be essential for diagnosis of various MPD. This test may be useful in diagnosing latent form of MPD in splanchnic venous thrombosis Methods: 232 patients with confirmed pyogenic liver abscesses admitted from 1995 to 2007 in our institution were included. There were 145 men and 87 women ranging in age from 19 to 91 years. The medical records were reviewed for clinical, laboratory and radiographic characteristics. Results: Among 232 patients, 81 (34.9%) experienced at least one complication. There were 67 pulmonary (pleural effusion, pneumonia, empyema) complications, 16 septic shock, 12 acute renal failure, 2 abscess rupture, 2 pseudomembranous colitis, and 2 pericardial effusion. The predictive factors for its complications were: systemic inflammatory response syndrome (SIRS, 2 factors), thrombocytopenia ( 80,000/mL), hypoalbuminemia ( 3.0g/dL), elevated AST or ALT (>200 IU/L), hyperbilirubinemia ( > 2.0 mg/dL), K. pneumonia, air within abscess cavity (p<0.05). Conclusions: The incidence of complications in the pyogenic liver abscess was 34.9%. The various predictive factors of complication should be monitored carefully. Further large scaled study should be warranted. Background/Aims: Hepatic iron deposition is a common feature in chronic hepatitis C (CH-C), however, whether it could enhance the progression of fibrosis or not is controversial. The aim of this study was to evaluate the status and significance of hepatic iron deposition in the Korean patients with chronic hepatitis C. Methods: Untreated, 78 CH-C patients who underwent liver biopsy were included. The hepatic iron was assessed by Scheuer's scoring system, and activity, fibrosis, and steatosis were scored by a pathologist in a blind manner to the clinical features. Clinical and laboratory data including serum iron indices, virological, biochemical results were analyzed to search for significant factors associated with hepatic iron deposition. Results: Hepatic iron staining was positive in 26(33%). Among 26 patients with hepatic iron deposition, serum levels of ferritin (p=0.005) and -fetoprotein (p=0.002), and body mass index(BMI) (p=0.039) were significantly elevated. There was no significant association between the degree of hepatic iron deposition and fibrosis stage (p=0.321), although elevated levels of serum hyaluronic acid (p=0.049), -Glutamyl transpeptidase (p=0.028), and prothrombin time (p=0.012) were associated with advanced fibrosis. Conclusions: Hepatic iron deposition in Asian-Pacific CH-C patients seemed to be neither frequent nor related to hepatic fibrosis, but related to obesity. Therefore, phlebotomy might not commonly applicable to this area. Further studies on the pathogenic role of iron in CH-C in Asian-Pacific countries are warranted. A late stage of progressive hepatic fibrosis characterized by distortion of the hepatic architecture, necrosis of hepatocytes and the formation of regenerative nodules contributes to cirrhosis. Limitations like organ donors shortage, high cost, absence of proliferation in cultured hepatocytes, inherent risks of infection, rejection in xenogenic cells and other socio-economical complications emerges advanced regenerative Human hepatic stem cells(hHpSCs) transplantation. hHpSCs are located in the ductal plates in fetal and Canals of Hering in adult livers [Schmelzer et al.(2006) ]. Hepatoblasts, in turn, give rise to the hepatocytic and biliary lineages, the hepatocytes and cholangiocytes [SchmelzerE etal(2006) ].hHpSCs express CD326(EpCAM)marker. Scjelzer etal demonstrated that during embryogenesis 90% of the EpCAM positive cells had hepatoblast phenotype. In animal study, on transplantation of freshly isolated hHpSCs in SCID mice results in mature liver tissue expressing human-specific proteins. Recently, we(Aleem etal 2008)have shown clinical improvement in study in patients with Crigler-Najjar syndrome, Biliary atresia using hHpSCs infusion. In the present study we transplanted hepatic progenitors to five subjects of end stage liver cirrhosis with MELD score >30. hHpSCs were sorted using MACS with CD326 antibody microbeads and infused through hepatic artery via femoral artery catheterization, a safe procedure provided portal pressure to monitor cell infusion route in order to prevent vascular thrombosis. All the patients showed improvement clinical and functional biochemical parameters after first month of cell infusion. Ascites was decreased and changed Encephalopathy grade into normal level was observed. MELD score system falling to normal level from >30 to <22 after infusion. 1 The Aga Khan University patients. The APRI of 1.5 in combination with a cut-off HA of 300 ng/ml can best detect patients with moderate to severe fibrosis (stages 2-4). It has a PPV of 93.7%. Also, for patients without moderate to severe fibrosis, the test is hardly ever positive (specificity of 98.9%). But the APRI of 1.5 in combination with different HA as cut-off points is not possible to detect patients with no or mild fibrosis.