Virtual colonoscopy as a new diagnostic tool in cancer colon

Virtual reality imaging is a new technology that combines helical computed tomography and magnetic resonance [MR] data and advanced three-dimensional graphics software to generate endoluminal perspective images of hollow organs. Computed tomography colonography [Virtual colonoscopy] is an imaging procedure in which a series of helical CT scans of the patient's colon are rendered by computer into slices that can be visualized as serially combined images to provide a three-dimentional tour of the colon. So, this technique has been evaluated, mostly conducted in diagnostic [rather than screening] setting in higher-risk patients. In this work, we try to evaluate the sensitivity and accuracy of virtual colonoscopy as a new modality for colorectal evaluation in patients subjected to traditional colonoscopy and double-contrast barium enema study who are diagnosed as having cancer colon and to correlate the findings of virtual colonoscopy with those of conventional colonoscopy and barium study. This work was conducted on twenty [20] patients, selected among 91 patients of different colonic illness admitted in Mansoura and Banha Gastroenterology Centers. They were thirteen [13] males and seven [7] females with age ranging form 49-75 years; mean age [59.5 +/- 8.6] years. All patients were subjected to complete medical history, thorough clinical examination, routine laboratory tests and special laboratory investigations as carcino-embryonic antigen [CEA] and occult blood in stool. Abdominal ultrasonography, barium double-contrast enema, traditional colonoscopy and virtual colonoscopy were done for all patients. Colonoscopic biopsies were obtained as routine in every case in addition to biopsy from any suspected areas or detected masses. Histopathological examination was done also for every sample. From this study, we concluded that CT colonography [Virtual Colonoscopy] is feasible for the detection of colorectal cancer with high success in sizes more than 10mm and further technical advances will improve the performance of CT colonoscopy and will allow patients available imaging modality for full structural examination of the colon

Study of serum thrombopoietin in patients with chronic hepatitis C virus infection

The aim of this study is to measure serum thrombopoietin [TPO] levels in patients with chronic active hepatitis C and post-hepatitis C liver cirrhosis, and examine the relationship between serum thrombopoietin concentration and the clinical stage of the disease, spleen index, circulating platelet counts, and liver functions in liver cirrhosis. One hundred and seventeen patients with chronic liver disease related to hepatitis C virus [44 with chronic active hepatitis C and 73 with liver cirrhosis] were selected, as a study group, from those admitted at the Internal Medicine Department of Benha University Hospitals. Their ages ranged from 37 to 62 years. Diagnosis of chronic active hepatitis C virus was based on the presence of positive HCV antibodies by 3[rd] generation ELISA [enzyme linked immunosorbant assay], abnormal elevation of serum transaminases for longer than 6 months, confirmed by positive HCV RNA by polymerase chain reaction [PCR] and liver biopsy which shows the stigmata of chronic hepatitis. Thirty healthy subjects were selected as a control group and matched with the study group regarding age, sex and residence. The mean levels of serum thrombopoietin in patients with chronic active hepatitis [CAH] were significantly higher than the control group [117.5 +/- 14.59 pg/ml, vs 99.8 +/- 11.03 pg/ml; P<0.001 respectively] while the mean levels of serum thrombopoietin were lower in cirrhotics than in CAH and the controls [82.82 +/- 20.7 pg/ml vs 117.5 +/- 14.59 pg/ml and 99.8 +/- 11.03 pg/ml; P<0.001 respectively]. In patients with liver cirrhosis, the mean levels of thrombopoietin decreased as the disease progressed [94.4 +/- 4.8 pg/ml in patients at Child-Pugh stage A, 73.4 +/- 10.5 pg/ml in patients at stage B and 45.1 +/- 5.6 pg/ml in patients at stage C] with statistical significant difference in-between them [P<0.001]. Thrombocytopenia [TCP] was found in 47 out of 73 [64.4%] of patients with liver cirrhosis. The mean levels of TPO in cirrhotics with TCP were significantly lower than cirrhotics without TCP [74.1 +/- 20.9 pg/ml vs 98.6 +/- 5.43 pg/ml; P<0.001]. Interestingly, in patients with liver cirrhosis, there was a correlation between serum TPO and the platelet counts [r = 0.826, P<0.001], but the spleen index did not exhibit correlation with the platelet counts and serum TPO [r = 0.036, r = - 0.103; P>0.05 respectively]. Serum TPO levels showed a negative correlation with total bilirubin, and a positive correlation with serum albumin and prothrombin concentration [r = - 0.915, r = 0.903, r = 0.856; P< 0.001 respectively]. The stepwise regression analysis showed that the prothrombin concentration, the serum albumin and the platelet count are the more significant variables with TPO [P<0.05]. It is concluded from this study that serum thrombopoietin levels increase in patients with chronic active hepatitis C, but in patients with liver cirrhosis, serum thrombopoietin levels decrease. As the liver disease progresses serum TPO decrease more. The impaired production of thrombopoietin may contribute to the development of thrombocytopenia in advanced stage of liver disease although increased splenic sequestration of platelets in the enlarged spleen may have an additional role. Since serum TPO is associated with liver function tests it is suggested that concentration of serum TPO is, to some degree, dependent on the capacity of the liver to produce this protein. It is prudent to speculate that the substitution of recombinant TPO in patients with cirrhosis will alleviate, if not cure, the thrombocytopenia observed in cirrhosis of the liver. Even more important, substitution of recombinant TPO could prevent bleeding complications by reducing the duration and extent of the platelet nadir after orthotopic liver transplantation