Validity of parentral nutrition after major neck surgeries

Assessment of parentral nutrition as a substitute therapy to enteral nutrition after major neck surgeries with primary pharyngeal repair. Forty patients were included in this study underwent various neck surgeries were prospectively randomized to receive either enteral nutrition [20] patients or parentral nutrition [20] patients. The patients were monitored for postoperative complications, wound healing, hospital stay, time to natural feeding and weight loss. The compared items were similar in both groups [mean duration of nutrition was 9.65, 9.9 days for TPN and NGT group respectively, mean hospital stay was 11.65, 11.9 days for TPN and NGT groups respectively, wound dehiscence and infection was in 15%, 20% in TPN and NGT respectively and also same result for pharyngocutaneous fistula, weight loss was 2.6 Kgm for TPN group and 2.39 Kgm for NGT group; p value was insignificant in all items. There were no major postoperative complications in both groups. The present study reveals that there was no significant statistical difference between parentral and enteral nutrition when used for postoperative nutrition after major neck surgeries

Acute spinal epidural abscess: clinical presentations and surgical management

Spinal epidural abscess is a serious condition affecting males more than females causing spinal cord compression. Risk factors include imunocomprimise, septic lumbar puncture, or haematogenous spread of remote infections. The aim of this study was to highlight the common risk factors for epidural abscess and its management based on eliminating these factors. All patients in the present study underwent plain x-ray, CT scan of affected spine, MRI of the affected area of the spine, and bone scanning when needed. Once neurological symptoms appeared urgent decompression and evacuation of the pus with subsequent culture and sensitivity was done. Liver diseases and Diabetes Mellitus. Were the most risk factors among our patients. The lumbar spine was commonly affected than other areas of the vertebral column. Posterior laminectomy and decompression were done for 24 cases. Fluid puss collection was found in 21 patients whereas 3 patients had a fibrous granulation tissue. Discectomy and partial corpectomy were done when affection of the anterior column was found. Staph. Aurues was found in about 60% of the culture obtained from the abscess. Epidural abscess is best treated by urgent decompression and giving the appropriate antibiotic

Immediate posterior canal wall reconstruction by alloplastic bone cement

To evaluate the author's experience in immediate reconstruction of the posterior canal wall [PCW] using Polymethyl Methacrylate [PMMA] bone cement. Between January 2004 and March 2006, PMMA bone cement was used for immediate reconstruction of the posterior canal wall in 28 patients undergoing mastoidectomy procedure for removal of cholesteatoma. The age of the patients ranged from 18 to 48 years. The patients were followed up with a mean of 16 months. In 28 patients the PCW defect was reconstructed successfully by PMMA bone cement with normal appearance of the external canal skin in 27 patients. Postoperative complications included: middle ear infection in 3 cases, granulation tissue in 4 cases and dehiscence of the external canal skin in one case. From this study, the use of PMMA bone cement is a reliable and easy alternative method for repair of bony defects in the posterior canal wall

Endoscopic trans-septal choanoplasty for congenital choanal atresia

To describe endoscopic trans-septal approach for treatment of choanal atresia. Prospective case series in a tertiary care center. Seventeen patients [7 with bilateral and 10 with unilateral choanal atresia] underwent trans-septal endoscopic choanoplasty. Removal of the vomer and shaving of the medial pterygoid plate were achieved by a small chisel with the use of a 4-mm 0 degree telescope. Nasal stents were not used following creation of the neochoanae. All cases were examined with the endoscopes 4 weeks postoperatively and any granulations or polyps at the site of the neochoanae were removed at that time. One year postoperatively, 16 [out of 17] patients had patent neochoanae. Granulation tissues were encountered in three cases and successfully managed on routine endoscopic examination. Endoscopic trans-septal approach is a direct, wide and safe one day surgery for repair of choanal atresia

Reconstruction of subtotal and total tympanic membrane perforations using cartilage palisade technique

The purpose of this study was to evaluate the use of palisade cartilage technique for reconstruction of subtotal and total tympanic membrane [TM] perforations compared with temporalis fascia [TF] graft. Prospective study consists of ninety five patients suffering from chronic inactive suppurative otitis media with subtotal and total TM perforations. The patients underwent full history taking, clinical examination and audiological evaluation. The patients were classified into two groups: group A [75 patients] in whom cartilage palisade technique was used and group B [20 patients] in whom TF graft was used. Closure of TM perforation was achieved in 71 patients [94.6%] of group A and in 7 patients [35%] in group B. As regards hearing results, there was highly significant postoperative improvement in pure tone averages as well as air-bone gap averages in both groups. In group A, the air-bone gap was closed to less than 10 dB in 26.6% and from 10-25 dB in 56% and to more than 25dB in 17.4%. While in group B, the air-bone gap was closed to less than 10 dB in 25% and from 10 - 25 dB in 65% and to more than 25dB in 10%. In this study, the average pre and postoperative air-bone gap were 26.1 dB and 13 dB respectively for cartilage group and 25.3 dB and 13.1 dB for fascia group. This study revealed that, the palisade technique is an effective, straight foreword technique with high success rate and good hearing results without postoperative complications

Nodal level affection in elective neck dissection for squamous cell carcinoma of the larynx

The best prophylactic treatment for the NO neck is a subject of debate. Some authors propose lateral selective lymph node dissection [levels II-IV] for laryngeal squamous cell carcinoma [SCC] on the basis of probability of finding occult metastases in those lymph nodes. The necessity of routine dissection at level IV has been questioned. The purpose of this study was to find the incidence of level IV metastases in patients with transglottic and supraglottic SCC who underwent lateral neck dissection. We retrospectively evaluated 54 patients with N0 supraglottic and transglottic SCC who underwent total laryngectomy and selective [level II-IV] neck dissection. Twelve patients [22.2%] had occult neck metastases, 3 of them had also contralateral occult positive nodes. Level IV involvement occurred only in one patient [1.85%] ipsilaterally who had also other positive ipsilateral nodes at level II-III. Extracapsular spread [ECS] occurred in 23.8% of positive nodes. Elective dissection of level IV in clinically NO supraglottic and transglottic SCC may be unnecessary and reserved for cases with highly suspicious involvement of level II-III nodes to avoid occasional morbidity associated with its dissection

Endoscopic removal of third ventricular colloid cysts in non dilated ventricles

Colloid cysts are benign conditions forming not more than 1% of all intracranial neoplasm. The natural history of colloid cysts is not fully understood and the presenting manifestations are usually non specific. Many treatment options have been established for treating colloid cysts, the most recent of them is the endoscopic removal Although small or non dilated ventricles add difficulty to the procedure, yet it is not an obstacle against safe and complete resection. Between 2004 and 2007 we have operated on 10 cases of colloid cysts with non dilated ventricles [average or small sized]. Eight cases were females and two were males. The age ranged between 18 and 43 years. Headache was the outstanding symptom and occurred in all patients. Two patients suffered short term memory deficit. We used the Gaab endoscopic system with an outer sheath diameter of 6.5mm. We used neither neuronavigation nor stereotactic guidance. Follow up period ranged from 35 to 2 monthes. we were able to achieve total cyst removal in all cases. Mild transient short term memory deficit occurred in I patient. There was no mortality. Taping and working inside dilated ventricles are easier than that in smaller ones, however average or even small ventricles are not a contraindication against endoscopic colloid cyst removal even in the absence of neuronavigation and stereotaxy. Still the endoscope in small ventricles can be used safely, effectively with shorter operative period and shorter hospital stay when compared to the traditional operative techniques

Endoscopic anatomy of the sphenoidal air sinus

Advances in optics and endoscopic instrumentation have revolutionized endoscopic surgery for sellar and juxtasellar pathologies. Sphenoid sinus is more complicated than the other paranasal sinuses. Anatomical details of the sphenoid sinus relevant to utilizing the endoscope are very important. We aimed to study the anatomical variations of the sphenoid sinus in cadavers building up an experience that can aid application in clinical cases. An endoscopic study for the sphenoid sinus was carried out on 15 cadavers and 10 patients with pituitary adenomas during the microscopic removal of these adenomas. The results were discussed with particular reference to the important endoscopic, anatomical and surgical features of the sphenoid sinus. Anatomical variants can be identified endoscopically. Knowing about and expecting these variations have a great role in improving the surgical performance and the operative outcome

effectiveness of injection snoreplasty in treatment of simple snoring

Injection snoreplasty is introduced as an innovative, and effective palatal rigidity procedure with minimal cost and discomfort for controlling simple snoring. A well-described sclerosing agent, ethanolamine oleate 5%, is injected into the soft palate for reduction and/ or elimination palatal flutter snoring. Thirty four patients with a diagnosis of simple palatal flutter snoring [apnea / hyponea index less than 5] were enrolled in this study. Office treatment sessions were performed 6 weeks apart. Success was judged by subjective improvement in snoring and evidence of palatal scarring. Thirty two patients reported significant decrease in snoring. There were no significant postinjection complications. Visual analog pain scale confirmed minimal discomfort. Most patients received more than one injection [average 1.8] in order to induce optimal palatal stiffening. Injection snorepiasty is a simple, safe, and effective office treatment for simple snoring, Advantages over current snoring procedures include simplicity, low cost, decreased posttreatment pain levels, and minimal or no convalescence

Molecular studies on cytochrome P-450 lanosterol 14 alpha-demethylase gene of fluconazole resistant candida albicans clinical isolates

Resistance to azole antifungals continues to be a significant problem in Candida albicans. One of the major mechanisms of azole resistance in C. albicans has been reported to be mutations in the ERGII gene encoding the azole target enzyme cytochrome P-450-dependent lanosterol 14 alpha- demethylase. This study was carried out to explore the presence of any point mutation in ERGII gene sequence of some C.albicans clinical isolates resistant to fluconazole. Three hundred C. albicans isolates, from various specimens were examined. These isolates were tested for antifungal susceptibility to fluconazole. The minimum inhibitory concentrations [MICs] of resistant C. albicans isolates were done by NCCLs macrobroth dilution method and E test. C. albicans ATCC 90028 was used as a control susceptible strain in all tests. The resistant C. albicans isolates were tested by PCR to amplify the entire ERGII gene. The isolates were further tested for point mutation concerning the ERGII gene by singlestranded conformation polymorphism [SSCP] analysis and DNA sequencing. Sixteen [5.4%] out of 300 of the isolates were resistant to fluconazole by disc diffusion and macrobroth dilution [MICs ranged from 64 - 128 micro g/ml]. E test showed 4 [25%] sensitive isolates [MIC 4-8 micro g/ml] and 12 [75%] resistant [MIC 64 - 256 micro g/ml]. Point mutation [fragment variations] in ERGII gene was detected in 7[43.75%] isolates by SSCP technique. DNA sequencing of the PCR amplified ERGII fragments of four isolates that showed band mutation by SSCP revealed; 25 nucleotide changes, resulting in 4 amino acid substitutions in regions covered by fragments that did and did not show variation by SSCP. Accordingly, the sensitivity of the SSCP technique was [55.5%]. Ten of these changes were also present in strain ATCC90028, other mutations exist in resistant isolates only and these mutations could play a role in drug resistance alone or in association with other mechanisms particularly when they resulted in an amino acid substitution. Although, PCR-SSCP analysis can give false positive results, since not all mutations detected can cause amino acid changes [silent mutations], our results concerning DNA sequencing were confirmative for strains showing positive PCR-SSCP results

Qualitative measurement of HCV-RNA by home-made PCR in chronic liver diseases compared with commercial kits

Hepatitis C is a major health problem in Egypt. As global population estimates reach 170 million infected with the hepatitis C virus [HCV], there has never been a more pressing need for sensitive, precise tests for active infection. This study aimed to develop a sensitive, precise, cost saving protocol for measuring qualitative HCV RNA by PCR. To accomplish this aim, we optimized an-already published-direct RT-PCR protocol without extracting viral nucleic acid. Neat serum [3UL] was used, denatured with phosphate-buffered saline, then nested RT-PCR was performed. Two pairs of primers [inner and outer] were used, which had been selected from the most conservative 5'- untranslated region of the HCV genome. Designing of the inner primers based on nucleotide sequence of the genotype IV which is the more prevalent among Egyptian HCV patients. Positive result showed an 237 bp-sizing band by gel electrophoresis. Sensitivity of the optimized method was estimated also, and revealed a detection limit of 460 copies/ml. This emphasizes that the optimized protocol is a good screening test in comparison with other commercially used ones. Negative cases should be confirmed by extraction method to avoid any loss of false negatives

incidence of HCV infection among type-II diabetic patients, is there an association?

To study the relationship between diabetes mellitus [DM] and hepatitis C virus [HCV] infection, this study included: 200 diabetic patients of type 2 and 185 apparently healthy blood donors as their controls. It included also 50 diabetic patients of type 1 and 42 blood donors as their controls. All patients and their controls were age and sex matched. Patients were attendants of Diabetic Out-Patients Clinic, Faculty of Medicine Menoufiya University. Fasting and postprandial blood glucose levels, glycosylated haemoglobin [Hb Al[c]], kidney function tests, liver function tests, viral hepatitis markers [hepatitis B surface antigen, HBs Ag and anti-HCV antibodies] were performed for all studied subjects. All anti-HCV positive cases were evaluated for HCV viraemia by RT-PCR for HCV-RNA. On comparing results of type 2 diabetic patients with their controls, results revealed a significant high prevalence of anti-HCV seropositivity in patients group as 67 out of 200 patients [33.5%] were anti-HCV seropositive vs. 32/185 [17.3%] in their controls [p<0.01]. It was found that 55/67 [82.1%] of anti-HCV positive cases were also HCV-RNA positive. HBs Ag seropositivity was significantly higher among type 2 DM [15.5% of 200 patients vs. 4.3% of 185 controls, p<0.01]. Statistically significant differences [p<0.01] in the levels of ALT and AST were observed between HCV-seropositive and HCV-seronegative patients with type 2 DM. Blood urea and serum creatinine showed significant elevated values [p<0.01] among type 2 diabetic patients. No significant correlation was observed between HCV-seropositivity and glycaemic control [Hb Alc]. In type 1 DM there was a significant high prevalence of anti-HCV seropositivity [42% of 50 patients vs. 19.04% of 42 controls, p<0.01]. It could be concluded that both HBV and HCV infections are equally frequent in diabetes; therefore, diabetes mellitus is considered as an important risk factor for acquiring chronic liver disease. These findings, although suggestive, don't establish a cause and effect relationship and are not consistent with the conjecture that diabetes leads to HCV infection, but instead favor hypothesis suggesting that persistent HCV infection is associated with the subsequent development of diabetes

Circulating mage-1 andmage-3 transcripts as tumour-specific markers for hepatocellular carcinoma

The members of human Melanoma Associated Antigen [MAGE] gene family are highly expressed in human hepatocellular carcinoma [HCC]. The present study aimed to detect tumour cells in the peripheral blood of HCC patients by using mRNA of the MAGE-1 and MAGE-3 genes as specific tumour markers. This study was carried out on 100 subjects included in three groups; group I: HCC patients [n=50], group II: cirrhotic patients [n=25] and group III: apparently healthy subjects as controls [n=25]. Patients of groups I and II were attendants of the Out Patient Clinics of National Liver Institute, Menoufiya University. The mRNA of the MAGE-1 and MAGE-3 genes in peripheral blood mononuclear cells [PBMC] was detected by using nested RT-PCR. Results revealed that of the 50 HCC patients, MAGE-1 and MAGE-3 mRNA were positive in 56% [28/50] and 46% [23/50] of PBMC respectively and 64% [32/50] of HCC samples were detected to express at least one type of MAGE mRNA. The detection of MAGE transcripts in PBMC was correlated with the advanced stages and the tumour size of HCC as 92.9% [26/28] and 100% [23/23] of positive MAGE-1 and MAGE-3 transcripts respectively were detected in HCC cases in stages III and VI. Also, 100% of positive MAGE-1 and MAGE-3 mRNA detected were related to HCC cases having sizes > 4cm. In addition, expression of MAGE-3 was correlated to the evidences of metastasis. On the other hand, detection of MAGE-1 and/or MAGE-3 transcripts was not detected in the PBMC of cirrhotic patients or in the PBMC of healthy controls. No statistical significant correlation was observed between the expression of MAGE genes and the increased levels of alphafoeto protein [AFP], the presence of liver cirrhosis or viral hepatitis. Therefore, these tumour specific antigens can be used as molecular markers for early diagnosis and possible targets for immunotherapy for patients with HCC

Clinical, oro dental and cytogenetic studies in some cases of papillon-lefevre syndromes and prepubertal periodontitis

Prepubertal peripdontitis is a rapidly prognessive form of early onset periodontitis leading to destruction of the periodontal support of the primary and secondary dentition. The aim of this study is to determine the basics for genetic mapping of six Egyptian cases suffering from prepubertal periodontitis and its variants. After completion of clinical assessment, cytogenetic study was performed for all cases including chromosomal analysis and plain X-ray for their hands. The gentic study revealed arachnodactyly of their hands, However no radiographic deformity of their fingers was detected. The cytogenetic study for all patients did not show any abnormality. This study might have important implications on oral public health, and in diagnosis and treatment of periodontitis

prostingen gene is up-regulated by androgens through androgen receptors in breast cancer cell lines

In order to explore the possible involvement of prostinogen in the pathogenesis of cancer, the expression of prostinogen, at the mRNA level, was studied by real time quantitative RT-PCR in three different breast cancer cell lines with different receptor contents and activity. Prostinogen is up-regulated by androgens in breast cancer cell lines. Time course experiments were done as early as two hours. In addition, blocking experiments showed a significant decrease in the expression levels after adding receptor blockers. This evidence suggested that this regulation is directly mediated through the androgen receptor

Detection and quantification of hepatitis B virus DNA by three different methods in HBsAg positive patients

The detection and quantification of hepatitis B virus genomes appear to be the most reliable methods for monitoring HBV infection and assessing response to antiviral treatment. The aim of this study assess the performance of three HBV DNA detection and quantification assays currently used for the management of HBV infected patients. In our study. 44 HBsAg +ve samples were assayed to HBV DNA detection and quantification by three different methods [In House HBV PCR. Amplicor HBV Monitor and HBV branched DNA DNA "bDNA"]. Twenty three samples [52.27%] were HBV DNA positive by one or more of the three methods and 21 samples [47.73 3/4] were HBV DNA negative by the three methods. Twenty one samples [47.73 3/4] were HBV DNA positive by Amplicor HBV Monitor and their cops number ranged from 440 - 40x106 copies/ml. Ten samples [22.73%] were HBV DNA positive by in House HBV PCR with copy number ranged from 6400 - 40 x 106 copies/ml. Eight samples [18.18%] were HBV DNA positive by NBV branched DNA [bDNA] and their copy number ranged from I.2x106 40x106 copies/ml. Branched DNA [bDNA] versus Amplicor HBV Monitor showed that: [i] bDNA and Arnplicor HBV Monitor gave concordant results for 27 [61.63%] of 44 the samples. The assays were both positive in six samples [13.64%]. The assays were both negative in 21 samples [47.73%]. [ii] bDNA and Amplicor HBV Monitor gave discordant results in 17 cases [38.64%]: bDNA was positive and Amplicor HBV Monitor negative in two cases [4.55%]. While bDNA was negative and Amplicor HBV Monitor positive in 15 cases [34.1%], HBV-DNA load in the Monitor assay was higher in 14] NA positive samples [mean = 9.7 x 106 copies/ml] than bDNA negative samples [mean 4.1 x 104 copies ml]. In House positive [mean = 9.7 x 106 copies/ml] than bDNA negative samples [mean 4.1 x 104 copies/ml]. In House PCR and Amplicor HBV Monitor showed that [i] In House PCR and Amplicor HBV Monitor gave concordant results with 33 of the 44 samples [75.0%]. The assays were both positive with to samples [22.73%]. The assays were both negative in 23 cases [52.27%] [ii] In House PCR and Amplicor HBV Monitor gave discordant results in 11 cases [25.0%] In House PCR was negative and Amplicor HBV Monitor gave discordant results in 11 casses [26.0%] in House PCR was negative and Amplicor HBV Monitor gave discordant resutlds in 11 cases [25.0%]. In House PCR was negative and Amplicor HBV Montor positive in these ii cases. HBV-DNA load in the Monitor assay was higher in In House PCR positive samples [mean 5.88 x 106 copies/ml] than In House PCR negative samples [mean 21 x 102 copies mb. In House PCR versus bDNA showed that: [i] in House PCR and bDNA gave concordant results with 38 of the 44 samples [86.36%]. The assays were both positive in six cases [13.64%]. The assays were both negative in 32 caes [72.73%]. [ii] In House PCR and bDNA gave discordant results in six cases [13.64%] In House PCR was positive and bDNA negative with four samples [0.09%]. In House PCR was negative and bDNA positive with two samples [4.55%]. HBV-DNA load in the Monitor assay was higher in bDNA positive samples [mean x 10 copies mb than In House PCR positive samples [mean 5.88 x 102 copies mb. The monitor assasy was more sensitive than both the In House PCR and bDNA. This better sensitivity appeared to be clinically relevant [even their respective performance, these three assays should be used in complementary fashion in the management of HBV infected patients

Development of home-made PCR technique for HCV-RNA detection

Hepatitis C virus is a single stranded RNA virus; it is closely related to flavi and pesti-viruses. It is 50-60 nm in size and contains 3011 amino acids and 9033 nucleotides. Virus particles have not been visualized by immune-electron microscopy. HCV-antibody by EIA technique is considered as a good screening test for HCV infection, but PCR is mandatory for therapy. Amplification of HCV-RNA is a difficult procedure due to low copy number of the virus, so nested PCR is recommended to have good sensitivity and specificity. Commercial kit as Roche Amplicor and others are available in the market. Their results are satisfactory especially Roche but they are expensive for performing a research on large number of patients or even for routine work. The aim of this study was the comparison between Amplicor Roche PCR as a gold standard and Homemade [PCR] to evaluate accuracy and cost efficiency of Home made RT-PCR. Several trials were made to optimize the different conditions of the homemade PCR until we reached the best conditions to perform it. Home made PCR showed 97.5% sensitivity and 93.5% specificity compared to Roche as a gold standard. Finally we conclude that Homemade [POR] is accurate, sensitive, specific and cost efficient compared to Amplicor Roche PCR as a gold standard. However, Homemade PCR need very good technical experience and excellent reagents to keep its sensitivity and specificity

value of branched DNA hybridization assay [chiron] in patients with chronic HBV infection in comparison with HBeAg and HBV DNA-PCR

The optimal hepatitis B virus [DNA] quantitative assay for clinical use remains to be determined. Information on the virus load and the replicative activity of I-IBV is of importance in the management of patients with chronic HBV infection. We evaluate the branched-DNA [bDNA] assay [Quantiplex: Chiron Corp.] in-patients with chronic HBV infection in comparison with HBeAg and in-house HBV DNA-PCR. Serum samples from 53 hepatitis B surface antigen [HBsAg]-positive patients and 20 HBsAg-negative controls were assayed. According to presence or absence of HBeAg, the patients were divided into two groups: [1] First group consists of 9 HBsAg-positive and HBeAg-positive patients, [2] Second group consists of 44 HBsAg-positive and HBeAg-negative patients. Our results showed that the in-house HBV DNA-PCR was positive 77.78% [7 patients] and 15.91% [13 patients] in the first and second groups respectively. The branched DNA was positive [above the detection level] 55.56% [5 patients] and 9.1% [4 patients] in the first and second groups respectively. All the positive patients for HBV DNA by bDNA assay were positive also by in-house HBV DNA-PCR [9 patients]. Only 5 patients were positive for HBV DNA by in-house HBV DNA-PCR and at the same were negative by bDNA [below the detection level]. The rest of patients [39 Patients] were negative for HBV DNA by in-house DNA-PCP and bDNA assays. These results showed that PCR is a more sensitive method for detecting HBV DNA in serum than bDNA assay

Matrix metalloproteinase-9 [Mmp-9] circulating intercellular adhesion molecule-1 [Cicam-1], and procollagen III peptide [PIIIP] in hepatocellular carcinoma and various chronic liver diseases

A sound predictive test is lacking for the identification of cirrhotic patients at high risk of developing hepatocellular carcinoma. In the present study, plasma MMP-9, plasma clCAM-1, serum alpha-feto protein [AFP] and serum PIIIP levels were measured and evaluated in 30 patients suffered from chronic hepatitis [CH], 30 patients suffered from liver cirrhosis [LC] and 30 patients suffered from hepatocellular carcinoma [HCC], in addition to 30 normal healthy individuals as a control group using RIA method for estimation of PIIIP and ELISA methods for estimations of the AFP and clCAM-1 and MMP-9. The study showed that the mean values of plasma MMP-9, plasma clCAM-1, serum PIIIP and serum AFP levels were 44.8 ng/ml, 232.1 ng/ml, 3.4 ug/l, 3.2 ng/Ml respectively among control group, 88.61 ng/ml, 489.5 ng/ml, 11.5 ug/l, 8.7 ng/ml respectively among Chronic hepatitis patients, 96.6 ng/ml, 781.3 ng/ml, 13.9 ug/l, 26.5 ng/ml respectively among Liver cirrhosis patients and 212.1 ng/ml, 999.4 ng/ml, 26.6 ug/l, 784.6 ng/ml respectively among HCC patients. Plasma MMP-9, plasma clCAM-1, serum PIIIP and serum AFP showed statistically highly significantly increase in all patients groups [P <0.001] when compared with the healthy control group. Plasma MMP-9 showed statistically highly significant increase in HCC group when compared with CH and LC groups, while did not show any statistically significant change [P> 0.05] in CH and LC groups when compared with the control group or with each other. clCAM-1 showed statistically highly significant increase in LC and HCC groups when compared with CH group with no significant change between LC and HCC groups and lastly serum AFP and PIIIP levels showed statistically highly significantly increase in HCC group when compared with CH and LC groups. As regard HCC histopathological grading all measured parameters showed statistically nonsignificant changes in different HCC grades except MMP-9 which showed a statistically significant increase in grade III when either compared with grade I or grade II. Receiver operating characterstic curve [ROC curve] was constructed using multiple cut off points for every studied parameter and calculating the sensitivity and the specificity at each cut off point and also calculating the area under each curve. The optimum cut off point for diagnosis of HCC from CH and LC for plasma MMP-9, plasma clCAM-1, serum PIIIP, and serum AFP were 89.8 ng/ml, 905 ng/ml, 25.8 ug/L and 68 ng/ml respectively, also, the study showed that AFP was the best of the studied HCC markers as it had the biggest area under ROC curve [0.86] followed by MMP-9 [0.76], cICAM [0.715] and lastly PIIIP [0.71]