ABSTRACT
Hepatocellular carcinoma [HCC] is a major burden on health-care systems worldwide. Although radiofrequency ablation [RFA] is currently considered the best technique for coagulative necrosis, the superiority of concomitant use of RFA and percutaneous ethanol injection [PEI] needs to be determined. The study was designed to compare efficacy, safety and rate of survival of patients with HCC assigned to receive combined PEI-RFA versus RFA alone and versus PEI alone. This 3-year study enrolled 90 cirrhotic patients with HCC [Child's class A or B, but not class C]. They were randomly assigned for either PEI-RFA [group I], RFA alone [group II] or PEI alone [group III]. The primary end point was ablation of the tumour. The secondary end point was rate of survival and recurrence. After the first session, complete ablation was significantly higher in the combination group [87.9%] compared with the RFA group [54.54%]. After the second session, complete ablation was achieved in 97.0% of the combination group and in 84.8% of the RFA group. Regarding the PEI group, 75% had complete ablation, whereas 25% had partial ablation after multiple sessions. The survival rate, 1.5 years later, was significantly higher in group I [86.7%] compared with group III [63.3%]. The overall incidence of serious adverse events was nil. Combined treatment is superior to RFA alone and to PEI alone, in safety and efficacy in patients with HCC
ABSTRACT
Fatigue is a common symptom in chronic hepatitis C [CHC]; but it is not well understood and remains poorly investigated. One of the major obstacles to research is the highly non specific nature of fatigue. In 1994; the fatigue impact scale [FIS] was developed to improve our understanding of the effect of fatigue on quality of life. Recent attention has focused on the role of leptin and energy expenditure in chronic hepatitis C [CHC]. The importance of leptin in the regulation of energy balance, body composition and food intake has been demonstrated in both animal and human studies. 4herations in immune activation and cytokine release have been implicated in the occurrence of fatigue in CHC patients. The purpose of this study is to analyze fatigue in chronic hepatitis C Egyptian patients and to determine its relationship with the degree of underlying hepatitis, resting energy expenditure [PEE], circulating leptin and tumor necrosis factor-a [TNF-alpha], IL-1, and IL-6. Ninety patients were included in the study [61 males, 29 females], who were referred to the department of Tropical Medicine Al Hussein and Bab-Al-Sharyia University Hospitals during the period from March 2004 to March 2006. They were divided into two groups. Group I: 65 patients with chronic hepatitis C. Group II: 25 healthy persons, tested negative for hepatitis C [Control group]. All were submitted to history and clinical examination, liver function tests, HCV [Ab and PCR], the modified fatigue impact scale, resting energy expenditure, tumour necrosis factor [TNF-alpha], serum leptin. IL-alpha, and IL-6. FIS and REE, serum leptin, TNF-, IL-alpha and IL-6 were significantly elevated among HCV patients in comparison to controls. Fatigue didn't correlate with the degree of underlying hepatitis. Fatigue impact scale is a beneficial tool for subjective valuation of fatigue. Fatigue is present in CHC patients but it is not related to the degree of hepatitis. TNF-alpha, IL-1 and IL-6 may contribute partially to the occurrence of fatigue in these patients