Radiofrequency ablation combined with percutaneous ethanol injection in patients with hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is a major burden on health-care systems worldwide. Although radiofrequency ablation [RFA] is currently considered the best technique for coagulative necrosis, the superiority of concomitant use of RFA and percutaneous ethanol injection [PEI] needs to be determined. The study was designed to compare efficacy, safety and rate of survival of patients with HCC assigned to receive combined PEI-RFA versus RFA alone and versus PEI alone. This 3-year study enrolled 90 cirrhotic patients with HCC [Child's class A or B, but not class C]. They were randomly assigned for either PEI-RFA [group I], RFA alone [group II] or PEI alone [group III]. The primary end point was ablation of the tumour. The secondary end point was rate of survival and recurrence. After the first session, complete ablation was significantly higher in the combination group [87.9%] compared with the RFA group [54.54%]. After the second session, complete ablation was achieved in 97.0% of the combination group and in 84.8% of the RFA group. Regarding the PEI group, 75% had complete ablation, whereas 25% had partial ablation after multiple sessions. The survival rate, 1.5 years later, was significantly higher in group I [86.7%] compared with group III [63.3%]. The overall incidence of serious adverse events was nil. Combined treatment is superior to RFA alone and to PEI alone, in safety and efficacy in patients with HCC

Evaluation of the immune response to Hepatitis B vaccine in different age groups of the population of Sana'a - Yemen

The study was made to evaluate the immune response to HBV among individuals with different ages and sexes by measuring the level of circulating anti-HBs antibodies over an interval of 1 to 5 years after immunization with the three doses of hepatitis B vaccine. A total of 300 individuals vaccinated against HBV prior to the study were included, of whom males represent 47.7% and females 52.3% with a mean age of 26.67 years. Sera were tested for HBsAg and anti-HBc by qualitative ELISA and anti-HBs by ELISA quantitative technique.The individual's data were collected in a pie-designed questionnaire including: vaccination date, number of doses of vaccine, sex, occupation and age at the time of the present study. Two hundred and sixteen [81.2%] of 266 individuals [lacking both HBsAg and anti-HBc] responded to the vaccine with anti-HBs antibody level >/= mlu/ml. Thirty-four [11.3] of 300 individuals wre reactive to anti-HBc, indicating an immune response due to previous infection rather than vaccination. Seven [2.3%] of all vaccinated individuals were reactive to HBsAg, indicating infection, Individuals having ages < 15 years had the highest immune response [89.8%] with antibody level >/= 10mlu/ml. There was no difference in response at ages from 16-35 [82.8%], while the lowest response was obtained at ages >36 years [66.7%]. The present study included two vaccination schedules, the first one at 0,1,2 months, showing an immune response of 62.2%, while the second schedule at 0,1,6 months showed a greater immune response of 83.1%. Individuals immunized with a yeast-derived vaccine had higher anti-HB5 levels [81.9%], than those immunized with a plasma-derived vaccine [79.8%].The year intervals [1-5 years] after primary immunization showed no difference in the immune response. This study revealed a high response rate to the vaccine. However, a considerable proportion of vaccinated individuals remain to be reconsidered for either revaccination or booster doses due to nonexistent, inadequate, or low response. The schedule of 0, 1, and 6 months was more efficient in inducing antibodies towards the vaccine than the 0, 1, 2 months schedule

Assessment of fatigue in chronic hepatitis C Egyptian patients: relation to TNF-alpha, Leptin, IL-i and IL-6

Fatigue is a common symptom in chronic hepatitis C [CHC]; but it is not well understood and remains poorly investigated. One of the major obstacles to research is the highly non specific nature of fatigue. In 1994; the fatigue impact scale [FIS] was developed to improve our understanding of the effect of fatigue on quality of life. Recent attention has focused on the role of leptin and energy expenditure in chronic hepatitis C [CHC]. The importance of leptin in the regulation of energy balance, body composition and food intake has been demonstrated in both animal and human studies. 4herations in immune activation and cytokine release have been implicated in the occurrence of fatigue in CHC patients. The purpose of this study is to analyze fatigue in chronic hepatitis C Egyptian patients and to determine its relationship with the degree of underlying hepatitis, resting energy expenditure [PEE], circulating leptin and tumor necrosis factor-a [TNF-alpha], IL-1, and IL-6. Ninety patients were included in the study [61 males, 29 females], who were referred to the department of Tropical Medicine Al Hussein and Bab-Al-Sharyia University Hospitals during the period from March 2004 to March 2006. They were divided into two groups. Group I: 65 patients with chronic hepatitis C. Group II: 25 healthy persons, tested negative for hepatitis C [Control group]. All were submitted to history and clinical examination, liver function tests, HCV [Ab and PCR], the modified fatigue impact scale, resting energy expenditure, tumour necrosis factor [TNF-alpha], serum leptin. IL-alpha, and IL-6. FIS and REE, serum leptin, TNF-, IL-alpha and IL-6 were significantly elevated among HCV patients in comparison to controls. Fatigue didn't correlate with the degree of underlying hepatitis. Fatigue impact scale is a beneficial tool for subjective valuation of fatigue. Fatigue is present in CHC patients but it is not related to the degree of hepatitis. TNF-alpha, IL-1 and IL-6 may contribute partially to the occurrence of fatigue in these patients

Graves'-related ophthalmopathy: [A] study of proinflammatory serum cytokines profile and peripheral blood T-cell subsets in relation to clinical status and orbital ultrasonography

Aim: Graves'-related ophthamopathy [GRO] is an organ -specific autoimmune disease passing into two stages, the stage of active inflammatory disease, which is treated conservatively by anti-inflammatory drugs or radiotherapy, and the inactive fibrotic stage, which is treated surgically. It is rather difficult to distinguish inflammatory from noninflammatory stages. The aim of the present work was to study some proinflammatory cytokines as sICAM, IL-2, and IFN-gamma serum levels, and peripheral blood T-cell subsets, together with orbital Ultrasonography in patients with GRO and their relation to clinical activity score [CAS] and relevant clinical parameters. Subjects and Fourty patients with GRO were enrolled, 30 of whom had inactive GRO and 10 cases had active GRO according to the clinical activity score, in addition to 10 healthy volunteers as a control group. Thorough clinical evaluation and orbital ulttrasonography were done for all patients. Laboratory work included measurement of sICAM, IL-2, IFN-gamma in serum and T-cell subsets in peripheral blood for patients and control. It was found that age, sex, smoking habit, or thyroid hormone status are not different in patients having active compared to inactive GRO, while the duration of the disease was significantly different, being shorter in those having active GRO. Extraocular muscle hyporeflectivity, as shown by orbital ultra-sonography, was significantly correlated with clinical activity score [P <0.01]. Serum sICAM-1, IL-2, and IFN-gamma levels were high in patients compared to controls [40.4=/=5 pg/ml versus 10.4 +/- 3.08 pg/ml, 440 +/- 187.6 pg/ml versus 65.8'24.3 pg/ml, and 479=/=160.3 pg/ml versus 116.4 +/- 24.0 pg/ml, respectively], and those having active GRO showed higher levels compared to those with inactive GRO [46.2 +/- 4.6 pg/ml versus 38.4 +/- 3.4 pg/ml, 707 +/- 149 pg/ml versus 351 +/- 87.6 pg/ml and 705.3 +/- 108.2 pg/ml versus 404.2 +/- 86.5 pg/ml, respectively]. T-cell subsets studied [CD3, CD4, and CD8] in peripheral blood were not different in patients with active GRO compared to those with inactive GRO [75.5 +/- 6.19% versus 71.8 +/- 5.53%, 58.4 +/- 4.62% versus 53.7+7.26%, and 14.8'6.05% versus 14.8 +/- 3.18%, respectively]. Conclusions: It is concluded that the duration of the eye disease and orbital utrasonography added to the clinical activity score could help distinguish patients with active Graves'-related ophthalmopathy, while serum levels of slCAM-1, IL-2, and IFN-gamma as single measurements, or peripheral blood T-cell subset pattern are of little help in this respect

Hemostatic disorders in chronic hepatitis C virus infection

This study was conducted on 20 patients [12 males and 8 females], suffering from HCV infection and 10 healthy persons [males] as a control group and ages ranged between 20-55 years. The aim of this study was to assess the hemostatic disorders in HCV infection. All cases were subjected to full history, clinical examination, abdominal ultrasonography and laboratory investigations [CBC, HCV-RNA, PT, APTT and coagulation factors I, II, V, VII, VIII, IX, XI and XII]. The results of this study revealed the highest level of factors II, VIII and XII, the lowest level of factors V, VII and IX that are reflected to prolongation of PT and APTT in HCV patients in comparison to control group. From this study it was concluded that the reduction in the vitamin K dependent factors VII, IX and non-vitamin K dependent factor V in HCV infection patients pointed to cirrhosis and severity of hepatitis. The PT though is a good noninvasive technique to evaluate the liver state and function more than the transaminases and even albumin estimation

Total serum leptin and its relation to sex hormones in Egyptian cirrhotic patients

This study was designed to determine the relation between leptin and sex hormones in 80 persons, 40 of them were cirrhotic and the other 40 were healthy control group [each group included 20 males and 20 females]. Serum leptin and estradiol showed higher levels in cirrhotic patients in comparison with control ones. Free testosterone levels were lower in cirrhotic patients and showed an inverse relation with leptin and estradiol. Leptin showed a positive correlation with estradiol and creatinine. These results are concomitant with the expected relation between leptin and sex hormones. The positive correlation between leptin and creatinine indicates the important role of the kidney in leptin disposal. This relation may point to leptin as a possible marker for early detection of renal impairment and follow up of nephropathic changes. The anorexia and malnutrition affecting cirrhotic patients may be explained by the associated hyperleptinemia, leptin is called the anorectic hormone