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Comments

Edgerton Y. Davis MD

A minor quibble. Strictly speaking, infection with Schistosoma mansoni causes hepatic fibrosis, not cirrhosis. In schistosomiasis, the hepatic architecture is disturbed at a pre-sinusoidal level, protecting the hepatocytes, which retain normal hepatocellular function. The fibrosis does lead to portal hypertension, variceal bleeding, and portal-systemic encephalopathy.

Moreover, it is infection with Schistosoma haematobium that is endemic in Egypt. S. haematobium causes vesicular inflammation, fibrosis, and eventually, cancer of the urinary bladder. But neither hepatic fibrosis nor cirrhosis.

Thus it would be very unlikely for Yasser Arafat to have had cirrhosis on the basis of schistosomiasis.

There is a particular virus associated with irreversible hepatopathy which would explain why the French and the family are so reticent.

CodeBlueBlogMD

No, not a minor quibble. Thank you for the excellent latter.

In a previous post I addressed the other manifestations of cirrhosis, including pre-sinusoidal disease, especially portal hypertension which is also a clear-cut diagnosis on CT (many serpentine vessels in the retroperitoneum, bowel mesentery, splenic hilum; and splenomegaly)and the point being that, again, this would never be reported as a "negative" CT -- the report announced regarding Arafat's CT of the abdomen and pelvis.

My essential point about the diagnosis of cirrhosis is that it is a common final pathway morphologic and mechanical manifestation of several pathophysiologic pathways and they would not have had to admit either alcohol or hepatitis as an etiology.

I DID check the distribution of the different schistosomes before posting (http://www.path.cam.ac.uk/~schisto/Background/Distribution.html) and it looked as if Arafat was in an endemic area, but I defer to your expertise and thank you for your input.

Edgerton Y. Davis MD

You are very gracious. Your main points were certainly correct and very well taken, namely that cirrhosis is a common final end stage for a number of underlying conditions, and that advanced cirrhosis should not be difficult to diagnose.

I agree completely that at end-stage, the CT would never be "normal."

I concede that Arafat may very well have spent more or less time in areas in which S. mansoni occurs, and a look at the map you link to does show S.mansoni in Egypt. However, I think that S.haematobium is much more common there.

I surmise that thrombocytopenia and an intracranial haemmorhage were also implicated. It will be interesting to see if the nephew reveals anything more.

CodeBlueBlogMD

Expert input, I believe, is a valuable -- no, THE most valuable -- part of the internet/blogging experience.

I hope you come back to this site and add ideas, and if you would like to be a guest poster, or work on a case together, email me any time at: tboyle@davinci-imaging.com

Thanks Again,

CBBMD

Thomas Lentil

You are all ignoring the obvious. First, look at who gains from Arafat getting a "mysterious" illness and dying suddenly? Notice how right afterwards all the talk everywhere was of "a new day" in the path to peace in the Middle East with an apparantly puppet Abbas at the helm instead of Arafat? It is a matter of public record that the Israeli Mossad tried unsuccessfully to assassinate Arafat at least thirteen (13) times previously. They obviously have more of a motive than anyone else. If it was a regular criminal case and for example someone had died and the same individuals were known to have attempted to murder them thirteen times before, wouldn't you think they would be the prime suspests? Any time a person falls dead in strange "mysterious" circumstances an autopsy gets performed to (at least try to) determine the cause of death. Why did Arafat get buried so hastily and with NO AUTOPSY? Pretty self-evident, even without an autopsy: Arafat was poisoned.

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