Long-term follow up of Egyptian patients with chronic hepatitis c: impact of interferon therapy on their outcome - with special reference to HCC

To our knowledge no previous data worldwide investigated the effects of interferon therapy in the treatment of hepatitis C virus [HCV] for longer than two years. So, this study was conducted to address the longer-term [3.5 years] Group II: 59 patients, chronic HCV with no cirrhosis, [interferon group-I] received interferon 3MIU every other day for 6 months. 57 patients completed the interferon therapy as 2 patients excluded during interferon therapy.outcomes of clinical, virological, biochemical and clinical responses to interferon therapy and the change in incidence of hepatocellular carcinoma [HCC] and other HCV-related complications in-patients with chronic hepatitis C with and without liver cirrhosis. 139 patients in our study were classified into 4 groups: Group I: 20 patients, chronic HCV with no cirrhosis, [control group-1] received silymarin 70 mg thrice daily for 3.5 years. Group III: 20 patients, chronic HCV with cirrhosis, [control group-2] received silymarin 70mg thrice daily for 3.5 years. Group IV: 40 patients, chronic HCV with cirrhosis, [interferon group-2] received interferon 3MIU every other day. for 6 months. Evaluation of our patients during the study period was based on the followings: 1] Response at the end of interferon therapy and 3 years after interferon withdrawal. 2] Incidence of liver decompensation. 3] Incidence of portal hypertension 4] Incidence of gastrointestinal bleeding. 5] Incidence of hepatocellular carcinoma. 1- Interferon alpha is effective in chronic hepatitis C and 49% of patients obtain a sustained benefit [long-term responders]. 2-The sustained response to interferon therapy in patients with chronic hepatitis C with cirrhosis is 0% after 3 years of stop interferon. 3-Interferon therapy significantly reduces the risk of developing portal hypertension, ascites and hepato-cellular carcinoma in patients with HCV cirrhosis irrespective of the virological response to interferon. - Early treatment of patients with chronic hepatitis C before reaching the stage of cirrhosis.- Proper selection of patient who is candidate for interferon therapy to increase the response rate. Cirrhosis should not be considered a reason for excluding patients with HCV- related liver disease from interferon therapy

Detection of metastatic potential capacity in colorectal carcinoma using flow cytometry and imunocytochemistry

Improved staging in all forms of gastro intestinal cancers is a desirable task because many of these cancers are understaged even after curative surgical resection. Indeed, early dissemination of isolated tumour cells is a frequent characteristic of epithelial tumours. The present work at detection of these micrometastatic cells in BM of colorectal cancer [CRC] patients using flow cytometry and immunocytochemistry on mononuclear cells [MNC] and on bone marrow [BM] smears, and comparing the results of the 3 techniques. Presence of micrometastasis was assessed using monoclonal antibody [MoAb] against intracellular cytokeratin 18. the material of the study consisted of 40 cases of CRC constituting the subjects of the study, 28 of them with no overt metastasis while the remaining 12 patients expressed overt metastasis. The results of the cases revealed the following: 1. Using flow cytometry the mean number of micrometastatic cells detected was much higher than those detectd by immunocytochemistry on BM and MNC. 2. The presence of positive micrometastasis was 70% with flow cytometry and 69.2% with immunocytochemistry on BM smear and 50% on MNC. 3. All cases having macrometastasis were positive for micrometastasis using the 3 techniques. In cases showing no overt metastasis, more than half of the patients [57%] were positive for micrometastasis using flow cytometry and a nearly similar% age [55%] with immunocytocemistry on BM smear, while only 37% of these cases had micrometastasis with immunocytochemistry on MNC. As regards the comparison between the 3 techniques, we found that nearly all positive cases by flow cytometry were positive by immunocytochemistry on BM smear except for 2 cases, while only 17 cases were positive by immunocytochemistry on MNC out of 22 cases positive by flow cytometry. Thus flow cytometry can be considered a more sensitive technique, followed by immunocytochemistry on BM smear. Immunocytochemistry on MNC revealed no positive cells at all when applied on negative control cases, while 30% of the cases showd moderately staining cells when using immunocytochemistry on BM smear. Also 20% of negative control cases showed low positivity with flow cytometry. Thus immunocytochemistry on MNC can be considered less sensitive but more specific than the 2 other methods