Clinical role of serum squamous cell carcinoma antigen in egyptian patients with hepatocellular carcinoma

Since major advances in our ability to treat hepatocellular carcinoma [HCC] are less likely to come from treating late stage disease it is therefore important to find early stage disease. Serum Alpha-fetoprotein [alpha - FP] is currently the most widely performed screening test, but this sensitivity poor. It has been reported, recently, that squamous cell carcinoma antigen [SCCA] could represent a useful screening marker in patients at risk. The aim of this study to investigate the diagnostic utility of serum SCCA as a non invasive marker in HCC patients compared to alpha-FP. We recruited for the study forty patients with HCC, 25 patients with liver cirrhosis and 15 healthy subjects. Serum levels of SCCA and alpha-FP together with clinical, laboratory, and imaging evaluation were done for all cases. Hepatic focal lesions with atypical CT pattern for HCC were confirmed histopathologically with ultrasound-guided biopsy. Mean values of serum SCCA in HCC group was significantly higher when compared with both the control and cirrhotic groups [p<0.001]. It was significantly elevated in HCC patients showing atypical enhancement pattern versus those with typical one [p<0.05]. At the value of the kit cutoff value [2 ug/l], the specificity and sensitivity of SCCA were 62% and 84% respectively. While when using the receiver operator curve [ROC] curve, to improve the specificity and sensitivity of SCCA, the cutoff value of 2.55 ug/l yielded a sensitivity and specificity of 52.5% and 96% respectively [best cutoff]. The diagnostic sensitivity of alpha-FP at a cutoff 200 ng/dl was 26% and the specificity 100%. The cutoff level of alpha-FP for diagnosis of HCC according to ROC was 91.5 ng/dl yielded a sensitivity and specificity of 62.5% and 92%, respectively [best cutoff]. Simultaneous measurement of alpha-FP and SCCA led to improve the sensitivity of serologic diagnosis of HCC up to 87.5%. SCCA represents a useful diagnostic biomarker for HCC detection, when combined with alpha-FP, it significantly increases the reliability of serologic diagnosis for this cancer. SCCA could specially diagnose those with atypical enhancement pattern in CT scan

Percutanous ablative therapy for HCC: a comparison of three modalities

This study was performed on 78 patients having liver cirrhosis with 91 focal hepatic lesions detected by ultrasound and proved histopathologically to be HCC [biopsy and/or fine needle aspiration cytology; FNAC]. They were 70 males and 8 females their ages ranged between 37 and 75 years old. Patients were classified into three groups, Group A was formed of 32 patients with 37 focal lesions where they received RFA. Group B encountered 25 patients with 26 focal lesions and they received PAI Group C included 21 patients with 28 focal lesions were treated by PEI. Complete ablation was assessed by re-biopsy and/or FNAC, triphasic CT and AFP serum level. As regards the outcome of therapy in group A, complete ablation was achieved in 14/18 [78%] for lesions

community-based study of viral hepatitis infection in Giza Governorate, Egypt: Seroprevalence, risk factors and associated morbidity

Hepatitis viruses are major causes of acute and chronic liver diseases in Egypt. The aim of this study was to investigate the seroprevalence, risk factors and associated morbidity of viral hepatitis in Giza Governorate, Egypt. The study was conducted in 4 rural and 4 semiurban communities and included 2305 subjects selected by a cluster r and om method. They underwent complete clinical and abdominal ultrasonographic [US] assessment and laboratory tests including stool and urine examination, hemoglobin, ALT estimation and viral hepatitis markers by enzyme immunoassay. The latter included anti-HAV IgG, HBsAg, anti-HBc, anti-HBs, anti-HCV and anti-HEV IgG. Subsets of sera were tested for HBV DNA and HGV RNA by specific PCR. The overall prevalence of anti-HCV was 20.9% [age-adjusted prevalence = 24.5%; CI: 22.7-26.3%] and was significantly rising with age from 10% below age of 20 years to 40% among those above 50 years. The infection rate of hepatitis B virus [HBV] was 57.1% with HBsAg carrier rate of 3.6%. Seropositivity of anti-HBs and anti-HBc was very high [45.8% and 44.7%, respectively] and correlated positively with age with no sex-related difference. Combined HCV and HBV infection was evident in 13% of subjects. HBV DNA was detected in 86% of HBsAg-positive cases and in 20% of HBsAg-negative anti-HBc- and anti-HCV-positive cases. Seromarkers for hepatitis B and C were significantly commoner in semiurban than in rural communities. Dental manipulation and previous parenteral antischistosomal therapy were significant risk factors for hepatitis B and C infection. Anti-HAV was positive in 99.7% whereas anti-HEV was positive in HBV= Hepatitis B virus. CLD = Chronic liver disease. HCC = Hepatocellular carcinoma. US = Ultrasonography. ALT = Alanine transaminase. OR = Odds ratio. CI = Confidence interval. 9.2%. HGV RNA was detected in 16.5% of the studied samples. It was always associated with HBV and /or HCV infection. History of hematemesis was recorded in 1.2% of individuals. US examination revealed hepatomegaly in 19.2% of subjects, splenomegaly in 8.2%, bright liver in 31%, coarse liver texture in 10%, periportal fibrosis in 20% and ascites in 2%. These findings were significantly more common in anti-HCV- and HBsAg-positive subjects. ALT elevation was commonest and highest in individuals with positive HBsAg or with HBV-HCV coinfection. Hepatitis B and C infection and associated morbidity still constitute a great health problem in Egypt. Hepatitis A is holoendemic and hepatitis E is endemic. Hepatitis G is always associated with HBV or HCV infection. Occult hepatitis B should be considered in future studies

pattern of liver function tests in enteric fever

This study was performed on 50 patients clinically diagnosed as enterica. Only 35 of them proved to have enterica. 20 out of the 35 showed disturbed liver function tests [LFT] and 5 out of 15 of those with negative blood culture and low agglutinin titre also had disturbed LFT. HBsAg was detected only in 6 patients with disturbed LFT, denoting a carrier state or incubated virus hepatitis while the remaining patients with disturbed LFT were negative for HBsAg indicating that enterica may change the pattern of LFT and be misdiagnosed as virus hepatitis

Gall bladder status in patients with schistosomal and non-schistosomal chronic liver diseases using ultrasonography

From this study, there was a positive correlation between gall bladder wall thickening and hypoalbuminemia, ascites and portal vein diameter. However, gal bladder wall thickening may be met with in cases of hepatosplenic schistosomiasis who did not yet develop neither ascites nor hypoalbuminemia, probably due to portal hypertension with its congestive sequalae. On the other hand, thickening of the gall bladder wall in these cases may also be due to actual deposition of Schistosoma ova in its wall or due to a genuine intrinsic gall bladder disease

Correlation between toxoplasma IgG seropositivity and history of spontaneous abortion or stillbirth

This study was conducted on 90 women aged 16- 41 years who attended the obstetric and gynaecologic unit at Kasr-El-Aini Hospital, Cairo University. Fifty of them were pregnant in their third trimester and 40 were non pregnant controls. Their sera were tested for the presence of IgG toxoplasma antibodies using IFA test. Cord blood from pregnant women at delivery was also tested. IgG positive cord blood was tested for IgM toxo-antibodies. Of 90 women 19 [21+ACU-] were seropositive for IgG toxo antibodies. There was no significant difference in seropositivity by age group. Of 33 women with history of spontaneous abortion 11 [33+ACU-] were seropositive as compared to 8 [14+ACU-] of 57 who had not [P less than 0.05] with no correlation between positive toxoplasma serologic status and status and stillbirth. Eleven of 50 pregnant women were IgG toxo antibodies positive. All gave birth to babies with IgG toxo antibodies and the titers for mothers and offsprings were comparable. All cord blood samples were negative for IgM toxo antibodies