Guided liver biopsy of hepatic focal lesions in chronic liver disease patients: when and why?

Hepatocelluar carcinoma [HCC] is one of the most common malignant neoplasms in the world. To assess the value of the ultrasound or CT guided biopsy of hepatic focal lesion [s] with normal or mild elevation of serum alpha fetoprotein [below 200ng/mL] in the diagnosis of hepatocellular carcinoma. One-hundred twenty one chronic liver disease patients with hepatic focal lesion[s] and serum alpha fetoprotein below 200ng/ml were included in the present study. All patients were subjected to careful history taking and full clinical examinations, laboratory investigations [CBC, liver profile, hepatitis markers and serum AFP level], abdominal ultrasound, abdominal triphasic spiral computed tomography [CT] and biopsy of the hepatic focal lesion[s] guided by ultrasound for histopathological examination. According to the histopathological diagnosis of the lesion, patients were divided into non-HCC group [Group I] and HCC group [Group II] which included dysplastic nodules as well. Group I included a total of 29 patients -20 males [68.9%] and 9 females [31.1%] - aged between 30 and 68 [mean 51.7 +/- 9.3] years. Pathological examination of their liver biopsies revealed 14 cases as chronic hepatitis, 5 cases as liver cirrhosis, 5 cases as adenocarcinoma, 1 case as squamous cell carcinoma 2 cases as hemangioma and 1 case as cholangiocarcinoma and one case of lymphoma. Group II included a total of 92 patients -75 males [81.5%] and 17 females [18.5%] - aged between 36 and 74 [mean 55.0 +/- 8.8] years. Pathological examination of their liver biopsies revealed 88 cases as HCC and 4 cases as hepatic dysplastic nodules. The sensitivity and specificity of triphasic abdominal spiral CT in the diagnosis of HCC were 91.3% and 69.0% respectively, while, the positive and negative predictive values were 90.3% and 72.5% respectively. Guided liver biopsy of hepatic focal lesions in chronic liver disease patients has a valuable diagnostic role in cases with low alpha fetoprotein below 200ng/ml in whom the non-HCC nature is suspected and cases with negative or atypical HCC criteria in spiral abdominal CT

Dengue fever as a cause of acute febrile illness in Sharkiya

The prersent work aimed at detection of dengue as a cause of acute febrile illness in Sharkiya. One hundred patients complaining of fever, headache, myalgia and arthralgia were included in the present study. Acute and convalescent serum samples were collected from each patient and tested by indirect ELISA for the presence of dengue virus immunoglobulin G. Four-fold rise in antibody titre was found in sera eight patients"from acute to convalescent". The eight patients had leucopenia and none of them showed haemorrhagic manifestations. The present study showed that dengue fever can not be ignored as a possible cause of acute febrile illness in Sharkyia. So infection control measures must be taken to prevent its spread, especially in new countries, through people comming from endemic areas. Also, it is recommended to facilitate methods for laboratory diagnosis of dengue fever for early detection and treatment

Helicobacter pylori stool antigen test: evaluation of diagnostic accuracy in Egyptian patients with dyspepsia

Thirty-six H. pylori infected patients [proved by positive Grams stained film, rapid urease test, culture and histopathology] as well as ten non-infected patients selected among 120 Egyptian patients presenting with dyspepsia were included in the present study. There was no statistically significant difference between H. pylori positive and negative patients concerning their presenting symptoms. The endoscopic examination revealed that gastritis was more prevalent in H. pylori infected patients. A significant relation was found between the complaint of regurgitation and the endoscopic finding of hiatus hernia as well as between the complaints of heart burn and epigastric pain on one hand and the endoscopic detection of gastritis on the other hand. The histopathological examination of gastric biopsies revealed that gastritis in its moderate degree was more prevalent in H. pylori infected patients than in the controls. Stool specimens collected from 36 H. pylori positive patients and 10 ten non-infected controls were examined by an enzyme immunoassay for the detection of H. pylori antigens [Premier Platinum HpSA]. The HpSA test was positive in 35 out of the 36 H. pylori infected patients and in 2 out of the 10 non-infected cases. The sensitivity and specificity of the test were 97.2% and 80%, respectively. The overall accuracy rate was 93.5%. The positive and negative predictive values for HpSA test were 94.6% and 89%, respectively