ABSTRACT
This study was performed on 78 patients having liver cirrhosis with 91 focal hepatic lesions detected by ultrasound and proved histopathologically to be HCC [biopsy and/or fine needle aspiration cytology; FNAC]. They were 70 males and 8 females their ages ranged between 37 and 75 years old. Patients were classified into three groups, Group A was formed of 32 patients with 37 focal lesions where they received RFA. Group B encountered 25 patients with 26 focal lesions and they received PAI Group C included 21 patients with 28 focal lesions were treated by PEI. Complete ablation was assessed by re-biopsy and/or FNAC, triphasic CT and AFP serum level. As regards the outcome of therapy in group A, complete ablation was achieved in 14/18 [78%] for lesions = 3cm and in 11/17 [65%] for lesions ranging between 3-5cm. In group B, complete ablation for lesions = 3cm occurred in 100% of cases while in lesions ranging from 3-5cm it was achieved in 13/16 [81%]. In group C, complete ablation was 100% [13/13] for lesions = 3cm and 93.3% [14/15] for lesions 3-5cm. Comparing the outcome of all techniques the overall success in group A was 71.4% while in group B it was 88.5% and 96.4% in group C. As regards the number of sessions in each group, the mean number of sessions was 2.2 +/- 0.75, 2.19 +/- 0.72 and 5.2 +/- 2.6 in group A, B and C, respectively. Major complications occurred in 4 patients of group A [second degree burn at the site of grounding pads, pneumothorax, malignant pleural effusion and hematemesis] and in one patient of group C [seedling]. Minor complications as pain, fever and ascites occurred in all groups, but it was more evident in group B. After the follow up of all patients the survival rate was 93 and 83% for group A, 85% and 78% for group B and 45.4%, 30% for group C patients at 1 year and 1.5 years, respectively. In conclusion, PEI, PAI and RFA are effective modalities for treatment of HCC; however PEI and PAI are cheaper, more effective and safer than RFA, however the survival was better in the RFA group
Subject(s)
Humans , Male , Female , Catheter Ablation , Ethanol , Acetates , Tomography, X-Ray Computed , Liver Function Tests , Kidney Function Tests , Survival Rate , Treatment Outcome , BiopsyABSTRACT
HCV is one of the major health problem in Egypt, where it is highly prevalent. Genotype 4 is the most common genotype of HCV and its response to treatment is still a controversy. HCV genotype 4 quasispecies diversity within the 5' untranslated region [5'UTR] was studied in a series of 22 native Egyptian patients with chronic hepatitis C virus with no previous treatment who satisfied all NIH criteria for combined treatment of pegylated IFN and ribavirine and was correlated with the outcome of treatment. The study also included 7 control patients with no antiviral treatment. HCV sequencing was done using the TRUGENE HCV 5-NC genotyping kit. At the 48[th] week of treatment, 15 patients [68%] showed virological response. Whereas HCV-RNA was still detected in 7 patients [32%] in this period; of those, 6 experienced a partial virological response followed by viral breakthrough during treatment. Only one patient did not show any virological or chemical response. The four females included in this study were all responders. There was a significant correlation between the response rate and lower fibrosis [p=0.026] as well as the total number of mutation spots [including all the insertions, deletions, transitions and transversions] [p=0.007, p= 0.035]. Patients who responded to interferon treatment had statistically significant less number in both transitions [p=0.007] and the genetic distances between the quasispecies [p= 0.035]. So, viral genetic complexity and variability may play a role in the response to IFN treatment. The consensus alignment of all three groups revealed no characteristic pattern among the three groups. However, the G to A transitions at 160 was observed among non responders who need further study to confirm this observation