Serum HCV-RNA levels in patients with chronic hepatitis C: Correlation with histological features

Liver disease in chronic hepatitis C virus [HCV] infection ranges from minimal lesion to liver cirrhosis and sometimes eventually evolving hepatocellular carcinoma. Whether and how HCV determines the different clinical and histological manifestation of the disease is not fully understood. It has not been clearly elucidated whether the extent of liver injury induced by HCV is influenced mainly by direct cytopathic damage or by an immune-mediated response against HCV-infected hepatocytes. The aim of this study is to verify whether the amount of virus in individual patient's serum could be related to the severity of liver injury. This study was carried out in the Gastroenterology and Hepatology Teaching Hospital, Medical City, Baghdad. Serum levels of HCV-RNA were measured in 27 patients with chronic HCV using b-DNA assay. Core liver biopsies of the patients were evaluated according to Ishak histological activity index system. The serum HCV RNA concentrations in the patients ranged from 3.2 x 10[3] to 1.2 x 10[7] copies/ml. In all patients no correlation was observed between the variable levels of viraemia and the age of the patients. Furthermore no correlations were observed between the serum HCV RNA concentrations and the biochemical liver function test levels: Total serum bilirubin, AST, ALT, and alkaline phosphatase. Histologically; patients were categorized into four subgroups: four patients [14.8%] had minimal activity, 17 patients [63%] had mild activity, and six patients [22.2%] had moderate activity. No significant correlation was found between viraemic levels and these histological findings or their individual components: Interface hepatitis, confluent necrosis, intralobular liver cell necrosis and portal inflammation. According to the stage of the fibrosis, the patients were categorized into seven subgroups: one patient [3.7%] with stage zero, seven patients with stage one [25.9%], four patients with stage two [14.9%], eight patients with stage three [29.6%], three patients with stage four [11.1%], two patients with stage five [7.4%], and two patients in cirrhotic stage six [7.4%]. There was no correlation between the serum HCV RNA concentration and the stage of fibrosis. Hepatic steatosis was observed in 16/27 patients. It was mild in nine patients, moderate in five patients, and severe in two patients. Correlation has not been observed between the serum HCV RNA viraemic level and the severity of steatosis. Serum HCV-RNA level does not determine the degree of hepatic injury precisely and liver biopsy is necessary to accurately evaluate the extent of liver damage

role of endoscopic ultrasound-guided Fine-needle aspiration cytology in diagnosis of pancreatic masses: review of 40 cases in Iraq

Pancreatic masses are often initially identified by magnetic resonance imaging or computed tomography, during evaluation of varied symptoms. Endoscopic ultrasound [EUS]-guided fine-needle aspiration [FNA] has been proved to be safe and useful method for tissue sampling including the pancreas. In this study we aim to find out some of the factors which may influence successful EUS-FNA of pancreatic masses, like: location of the mass, size, consistency and other significant factors. A retrospective study of 40 patients underwent EUS-FNA of pancreatic masses, referred to Gastroenterology and Hepatology Teaching Hospital in Baghdad, from March 2005 to December 2007 [this is the first study done in Iraq]; all patients were clinically suspected to have pancreatic malignancy. Cytology samples were evaluated and many other clinical variables were examined for association with EUS-FNA diagnosis. Twenty six [65%] patients were males, and 14[35%] patients were females. Age ranged between 13-65 years with a mean of 46.6 years, the size of pancreatic masses range between 1.7-13cm, the masses were divided into 3 groups according to their sizes: <5cm 26[65%] cases, between 5-10cm 13[32.5%] cases, and>10 cm 1[2.5%] case. Consistency wise the masses were characterized as solid 34[85%] cases, mixed solid and cystic 6[14%] cases. In 13[32.5%] cases the mass was located in the body of pancreas, 25[62.5%] cases in the head, and 2[5%] cases in the tail. Regarding the cytological diagnosis: 19[47.5%] cases were benign [inflammatory conditions], and 21[52.5%] cases were malignant; including 17[80.9%] cases adenocarcinoma, 2[9.5%] cases malignant mucinous tumor, and small cell carcinoma 1[4.8%]case, and papillary and solid epithelial neoplasm [solid pseudopapillary tumor SPPT] 1 [4.8%]case. Lymph node enlargement was found in 10[25%] cases. EUS-FNA can be used to sample pancreatic tumors in most patients. Communication clinical background information and imaging findings to the cytopathologist can facilitate the interpretation of the FNA specimens