INTRAVASCULAR OESOPHAGEAL VARICEAL PRESSURE (IOVP) AND VARICEAL BLEEDING RISK

D.Taranto,N.Caporaso,R.Suozzo,M.Coltorti Istituto di Medicina Generale e Metodo- 1ogia Clinica - I Facolta di Medicina e Chirurgia- Universitd di Napoli

The endoscopic score of oesophageal hemorrhagic risk is the most common predictive index of rupture of oesophageal varices. However, this predictivity is not always accurate. The aim of this study was to evaluate whether IOVP can serve as an adjunctive parameter predictive of variceal bleeding. Methods:39 patients with l iver cirrhosis (22 M; 17 F; median age 55 years) were studied. IOVP was evaluated according to Staritz et al. Results:l) IOVP was 19+9 mmHg (mean + SD).2)IOVP significantly correlated with percentage of oesophageal lumen occupancy (r=O.57;P 0.01) and with the endoscopic score of the variceal hemorrhagic risk evaluated according to Beppu et al. (r=O.49;P 0.01). 3)Mean values of IOVP were s i g n i f i c a n t l y higher (P 0.01) in Child B and C pat ients than in Child A pat ients (23.4 and 23.6 vs 17.1 mmHg respectively).4)lOVP values were s i g n i f i c a n t l y higher in pat:ents with gastr ic varices (P O.01).5)Prel iminary data show that a low endoscopic score ( -1.5) toge- ther with a high IOVP( 20 mmHg) has a high corre la t ion with oesophageal var iceal bleeding than each parameter alone. In conc lus ion: l ) IOVP is pos i t i ve l y correlated w:th a)size of oesophageal varices b)endoscopic score of r isk of var iceal bleeding c )en t i t y of l i ve r dama- ge evaluated according to Child-Pugh c r i t e r i a . 2) IOVP may add to the pred ic t ive value of the endoscopic score of r isk of var iceal bleeding.

DETECTION OF PRE-S 2 AND ITS ANTIBODY IN SERUM FROM PATIENTS WITH FULMINANT TYPE B HEPATITIS (FH-B). N.Tassopoulos 1, A.Budkowska2~ S.Hadzixannis3. Western At t ica General Hospital , Athens, Greece:zINSERM U 131, Clamart, France and 3Academic Dept. of Medicine, Hippokration General Hospital , Athens, Greece.

Detection of pre-S 2 in serum from patients with benign acute hepa- t i t i s B is correlated wel l with the presence of act ive rep l i ca t ion of HBV, whereas the appearance of ant i -pre-S 2 is usual ly followed by e l iminat ion of c i r cu la t i ng HBsAg. We have tested by monoclonal antibody enzyme immu- noassay for the presence of pre-S 2 and ant i -pre-S 2 16 serum samples co l le - cted from 7 adult pat ients with FH-B; a l l of them were IgM anti-BBc posi- t i ve . Of these 7 pat ients, four died of l i v e r f a i l u r e and the remaining 3 survived. On admission, 4 pat ients were pos i t i ve for both HBsAg and anti-HBs, 2 were pos i t i ve only for anti-HBs and one was pos i t i ve only for HBsAg. Three pat ients were pos i t i ve for pre-S 2, 3 for ant i -pre-S 2 and one was negative for both of them. Pre-S 2 was detectable only in the pre- sence of c i r cu la t i ng HBsAg regardless of the coexistence of anti-HBs. In contrast , ant i -pre-S 2 was demonstrated only in the presence of anti-HBs even in the absence of HBsAg. The outcome of FH-B appeared to be unrela- ted to the pre-S2/anti-pre-S 2 status.

These data indicate that: (a) immune reactions to pre-S 2 epitope seem to be unrelated to the pathogenesis of FH-B and (b) the presence of c i r cu la t i ng pre-S 2 peptide and i t s antibody lacks of prognostic s i g n i f i - cance.

$184