Effectiveness of combined therapy radiofrequency ablation/transarterial chemoembolization versus transarterial chemoembolization/radiofrequency ablation on management of hepatocellular carcinoma.

BACKGROUND: One of the most widespread cancer-associated death worldwide is Hepatocellular carcinoma. Concerning hepatic malignant tumor staging system known as Barcelona clinic of liver cancer, a superior curative response could be carried out by combined techniques [radiofrequency ablation (RFA) and transarterial chemoembolization (TACE)] for stage B comparing with TACE alone as palliative monotherapy. OBJECTIVES: To discuss the merging effect of RFA followed by TACE and vice versa on objective response, overall survival, local recurrence and tumor-free survival. PATIENTS AND METHODS: Sixty-eight cases included with hepatic tumor on top of chronic liver disease post-viral infection and divided into two groups according to different combined treatment modality; first cohort included 34 patients treated with TACE followed by RFA, while the second one included 34 patients treated with RFA followed by TACE for two lesions or single medium-sized lesion stage. RESULTS: Complete response and objective response rates were 91% and 82% after TACE/RFA and 100% and 91% after RFA/TACE, respectively. Regarding Milan criteria, there was significant downstaging after RFA/TACE (P < 0.05). First and second overall survival rates were 85% and 65% after TACE/RFA versus 100% and 74%, respectively, after RFA/TACE (P > 0.05). Kaplan-Meier curve as regards disease-free survival rate, median time were 17.1 months [95% confidence interval (CI) 12.2-22.0] in TACE/RFA and 23.2 (95% CI 18.1-28.2) months in RFA/TACE (P > 0.05). CONCLUSION: RFA/TACE showed effective complete response, downstaging, disease-free survival and overall survival for the treatment of hepatic malignant tumors.

Assessment of the co-incidence between non alcoholic fatty liver disease and carotid atherosclerosis.

Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of abnormal liver biochemistry and cryptogenic cirrhosis. Those with NAFLD have a higher prevalence of atherosclerosis, as shown by increased carotid artery intimal media thickness (CIMT). The aim of this study is to assess the co-incidence and prevalence between NAFLD and carotid atherosclerosis. In this study seventy-two subjects were categorized into 2 groups. GI: 52 patients diagnosed as NAFLD with diabetes mellitus type 2 or obesity or hyperlipedemia. GII: 20 diseased controls diagnosed as NAFLD without other predisposing factor. CIMT and plaque prevalence were estimated by carotid ultrasonography as a single trained operator who was blind to clinical characteristics of participants. The results showed that CIMT by carotid duplex ultrasonography was significantly higher in group A than group B but CIMT did not reveal any significant difference as regards to the etiology of NAFLD. CIMT was significantly higher in cases with bright liver than those with homogenous liver (by abdominal US) in group I and II. CIMT was significantly higher in those with moderate steatosis than those with mild steatosis (in GI & GII).

Impact of hepatocellular carcinoma on health related quality of life in Egyptian patients: a single centre study.

Among patients with chronic liver disease, impairment in HRQOL has been reported. Hepatocellular carcinoma (HCC) is one of the major squeal of chronic liver diseases. So, relationship between subjective HRQOL and HCC must be analysed. This study assessed the effect of HCC on HRQOL, and its loco-regional treatment on HRQOL. Forty patients with HCV related chronic liver disease as a control group was enrolled in the study. Eighty HCC patients on top of chronic HCV liver disease categorized according to the modality of loco-regional treatment (BCLC staging system) into GI; 40 HCC patients treated with radiofrequency ablation (RFA) and GII; 40 HCC patients treated with trans-arterial chemoembolization (TACE). The SF-36 questionnaire was performed before and one month after the intervention. Comparing the parameters of HRQOL in GI before and after RFA, and in GII before and after TACE; there was a statistically significant improvement in group I. However, the improvement in group II (TACE) was non-significant (P>0.05).

Clinical features of avian influenza in Egyptian patients.

The clinical manifestations associated with H5N1 infection in humans range from asymptomatic infection to mild upper respiratory illness, severe pneumonia, and multiple organ failure. The ratio of symptomatic cases to asymptomatic cases is not known, because it is not possible to precisely define the number of asymptomatic cases. A total of 97 cases suffering from avian flu were suspected based on history taking, demographic data, clinical manifestations, laboratory and radiological investigations. The followings were done for all cases; complete blood picture (differential leucocytic count), coagulation profile, renal and liver function tests. H5N1 influenza virus was diagnosed thorough PCR technique. Changes in arterial blood gases and repeated chest X-rays were reported frequently. All patients were given specific antiviral therapy (oseltamivir). The study described the clinical picture and laboratory results of 81 confirmed avian influenza human cases in an Egyptian hospital (Abassia chest hospital), and reviewed the avian influenza current situation covering from March 2006 to June 2009 with very high pick in the first half of 2009. The significant apparent symptoms were fever as initial and main symptom (93.75%), followed by shortness of breathing (73%), cough (66.6%), muscle & joint pain (60%) and sore throat (40%).

Assessment of Rose Bengal test in diagnosing Egyptian human brucellosis.

A total of 30 patients suffering from brucellosis were suspected based on history taking, clinical manifestations and positive serum tube agglutination test (at titer > or = 1/160). The followings were done for all cases; complete blood picture (differential leucocytic count) and liver function tests, serodiagnosis of Brucella (serum tube agglutination test (STAT) as well as Rose Bengal test (RBT) and PCR. The study aimed to analyze the diagnostic value of RBT as compared to STAT and PCR for human brucellosis, and to evaluate the sensitivity, specificity, accuracy, the cost and the time consuming of RBT as compared to STAT and PCR. There was a significant difference between diagnosis by RBT and both STAT > or = 1/640, & STAT > or = 1/1280. Also, there was a significant difference between PCR and both STAT > or = 1/640, and STAT > or = 1/1280. No significant difference was detected between RBT in diagnosing acute and chronic infection. STAT > or = 1/320 proved to be better than STAT at other titers and RBT in diagnosis of brucellosis. RBT proved to be suitable as screening test regarding time (faster) and cost. But, STAT > or = 1/320 from a practical and economic point of views proved to be the best one in diagnosing human brucellosis.

Assessment of the role of interleukin-6 in diagnosis of hepatocellular carcinoma.

Interleukin-6 (IL-6) is a promising tumor marker for hepatocellular carcinoma; HCC. IL-6 may help to identify a subset of HCC patients with low alpha-fetoprotein (AFP) level, and may serve as complementary tumor marker, however, this has to be clarified. This study assesses the value of measuring serum level of interleukin-6 in patients with chronic liver disease and HCC, and evaluates its sensitivity and specificity in comparison to AFP in early diagnosis of HCC. Seventy five patients with chronic liver disease (CLD) with or without HCC and 25 healthy controls were included. Patients were divided into Group I: 25 patients with CLD but no evidence of HCC. Group II: 25 patients with HCC on top of post-viral hepatitic with elevation in AFP (> 200 ng); and Group III: 25 patients with HCC on top of post-viral hepatitic but without elevation in AFP (< 200 ng). Analysis of the mean serum IL-6 levels revealed a statistically significant difference between all groups (P < 0.01). A significant positive correlation was found between mean levels of IL- 6 & AFP in HCC (P < 0.05), the mean IL-6 levels in patients with Child classification C was higher than in those with Child A and B.After adjustment using multiple logistic regressions, only loss of weight and AFP were found to be significantly associated with HCC (P < 0.05). It is concluded that the diagnostic value of IL-6 increased when it is associated with AFP measurement. Combining the two markers can provide a new perspective in the diagnosis of HCC.