Interstitial pulmonary changes in patients with hepatitis C-related chronic liver disease

Several extrahepatic manifestations [EHMs] have been reported in the natural history of hepatitis C virus [HCV] infection. Some studies had demonstrated a higher frequency of HCV in patients with idiopathic interstitial pulmonary fibrosis [IPF]. The aim of this study is to investigate interstitial pulmonary changes via high-resolution computed tomography [HRCT] and pulmonary function tests [PFTs] in patients with HCV infection. Forty patients with HCV infection without diagnosis of any pulmonary diseases [group I] and 10 healthy persons [group II] were enrolled in the study. PFT and HRCT were performed in all cases. Findings of interstitial pulmonary involvement were detected in the HRCT of 19 out of 40 patients [47.5%]. A decrease lower than 80% of the predicted value was detected in forced vital capacity [FVC] with restrictive pattern together with post-exercise hypoxia, in 21 [52.5%] patients. There was a significant difference between both groups in the findings of HRCT [x[2] = 7.66, df = 1, p = 0.004] and PFTs [x[2] = 9.05, df = 3,p = 0.002]. According to the Child-Pugh classification, in group I, 15 patients were of class A, 16 were of class B and nine of class C, with no significant difference between classes as regards HRCT findings and PFT values. Six patients were positive for serum cryoglobulins. In these patients, all the parameters were not related to age. Pulmonary interstitial changes are prevalent in HCV-infected patients, irrespective of the severity of their liver condition. It may also occur without respiratory symptoms

Treatment of hepatocellular carcinoma in cirrhotic patients: a prospective randomized study comparing radiofrequency and ethanol injection

Although surgery remains as a gold standard line for management of hepatocellular carcinoma [HCC], many cases are not candidates for surgery due to underlying chronic liver disease and limited functional reserve even with recent advances in the field of surgery. At the same time several local ablative techniques have emerged and proved to be minimally invasive and effective measures for in situ control of HCC, of these techniques, radiofrequency ablation [RFA], and percutaneous ethanol injection [PEI]. The aim of the current study was to evaluate the safety and efficacy of RFA and ethanol injection for the treatment of HCC, to reach a protocol for proper management of unresectable HCC and, also to assess the quality of life before and after each technique. In the current study we had two groups of patients with HCC on top of cirrhosis due to hepatitis C virus [HCV] infection, one of them was subjected to RFA [G 1] and the other [G2] was subjected to PEI as therapeutic modalities for their HCC. As regards GI, it included 30 patients with 36 HCC lesions with a mean size of 3.02 cm which were treated by percutaneous US guided RFA using cooled-tip electrodes with a mean of 1-2 sessions of RFA. Studied patients were followed over variable periods that ranged between 6-18 months with a mean of 11.6 months. The responses to therapy were as follows: Complete ablation in 32 out of 36 lesions [88.8%], partial response in 3 out of 36 lesions [8.3%], recurrence in 3 [8.3%] lesions, and newly developed lesions in 7 cases. G2 included 20 patients with 26 HCC lesions with a mean size of 3cm for which we used PEI modality, we found that 21 out of 26 lesions [80.7%] had complete response, 4 out of 26[15.3%] had partial response and one [3.8%] showed local recurrence, and newly developed lesions were seen in 5 cases. The period of follow up ranged from 4-12 months with a mean of 10 months. As regards survival, one year survival rate was 75% in GI and 80% in G2. We concluded that, both RFA and PEI are safe and effective procedures and result in significant improvement in quality of life in patients with unresectable HCC. RFA showed higher rate of complete necrosis and requires fewer sessions than PET in the management of HCC

Intercellular adhesion molecule-1 in sera of patients with chronic viral hepatitis

Chronic liver disease is a major public health problem in Egypt. Circulating soluble intercellular adhesion molecule-1 [sICAM-l] may serve as an indirect consequence of inflammation and tissue damage. The present study was done on 76 patients with chronic viral hepatitis disease selected from Tropical Medicine Department, Ain Shams University Hospital. Patients comprised 51 males and 25 females with mean age 49 +/- 11.6 years. Fourteen apparently healthy adults with matched age and sex were also tested as a control group. Hepatitis B surface antigen, antibodies to hepatitis C and sICAM-1 were measured using ELISA technique. Estimation of liver profile parameters was also done. SICAM-l was found to he highly significantly increased in patients with chronic liver disease when compared with controls [1122.1 +/- 330.0 versus 647.3 +/- 191.2, p < 0.001]. SICAM-l was significantly correlated with AST, alkaline phosphatase, direct and total bilirubin, albumin and prothrombin time. On comparing compensated and decompensated chronic hepatitis patients, there was a significant increase in sICAM-l in decompensated patients [1198 +/- 316.8 versus 1053.7 +/- 330.6, p < 0.05]. This result indicates a positive correlation between sICAM-l and the degree of severity of liver inflammation. In addition, sICAM-l was significantly increased in chronic hepatitis patients with concomitant bilharziasis than those having only chronic hepatitis. [1223.5 +/- 354.3 and 1056.0 +/- 298.8 in bilharzial and non bilharzial patients respectively, p< 0.05]. From the present study we conclude that slCAM-1 exhibits more significant correlation with the degree of severity of liver pathology than transaminases. The measurement of sICAM-l may complement the information regarding histological grading and staging of chronic hepatitis, providing a more reliable and non-invasive method to follow up chronic liver disease