Establishing ultrasound based transient elastography cutoffs for different stages of hepatic fibrosis and cirrhosis in Egyptian chronic hepatitis C patients

Background and study aim: transient elastography is widely used to assess fibrosis stage in chronic hepatitis C [CHC]. We aimed to establish and validate different transient elastography cut-off values for significant fibrosis and cirrhosis in CHC genotype 4 patients

Patients and Methods: the data of 100 treatment-naive CHC patients [training set] and 652 patients [validation set] were analysed. The patients were subjected to routine pretreatment laboratory investigations, liver biopsy and histopathological staging of hepatic fibrosis according to the METAVIR scoring system. Transient elastography was performed before and in the same week as liver biopsy using FibroScan [Echosens, Paris, France]. Transient elastography results were correlated to different stages of hepatic fibrosis in both the training and validation sets

Results: ROC curves were constructed. In the training set, the best transient elastography cut-off values for significant hepatic fibrosis [>/=F2 METAVIR], advanced hepatic fibrosis [>/=F3 METAVIR] and cirrhosis [F4 METAVIR] were 7.1, 9 and 12.2 kPa, with sensitivities of 87%, 87.5% and 90.9% and specificities of 100%, 99.9% and 99.9%, respectively. The application of these cut-offs in the validation set showed sensitivities of 85.5%, 82.8% and 92% and specificities of 86%, 89.4% and 99.01% for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis, respectively

Conclusion: transient elastography performs well for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis, with validated cut-offs of 7.1, 9 and 12.2 kPa, respectively, in genotype 4 CHC patients

Relation of ALT and AST levels to the histopathological changes in liver biopsies of patients with chronic hepatitis C genotype 4

Worldwide, Egypt has a high prevalence of adult hepatitis C virus [HCV] infection. Serum alanine aminotransferase [ALT] activity is most commonly measured to assess hepatic disease. The revision of the definition of the normal limits for the ALT level is advisable. The aim of this work was to compare the histopathological changes in the liver tissue biopsies of HCV-infected patients, clinically presenting with ALT levels below normal, based on the conventional, previously used upper limit of normal [ULN] of ALT [40 U/L for men and 30 U/L for women] with the proposed new ULN [30 U/L for men, and 19 U/L for women]. This is a retrospective cross-sectional study. A total of 668 cases of chronic hepatitis C genotype 4 were included. Patients were classified according to grades of histological activity and fibrosis stages [by the Metavir scoring system]. They were also classified into normal and high groups according to the old and new cutoffs of both aspartate transaminase [AST] and ALT levels.The results of our study showed that the serum AST level in our study showed a better correlation with the histopathological changes in liver biopsy rather than ALT, especially when using the old cutoff of the ULN for AST. The serum ALT level in our study [both the old and the new cutoffs] did not show a significant correlation with the histopathological status in the liver biopsies of our patients. This study concluded that the old cutoff of the ULN AST is a better predictor of fibrosis

Study of the enhancing effect of sodium chloride injection on radiofrequency ablation of hepatocellular carcinoma

One of the potential strategies to increase the efficacy of RFA is to modulate the biologic environment of the treated tissues. Several investigators have studied increasing RFA heating by combining intra-tumoral injections of different concentrations of sodium chloride with RFA. The aim of this study is to assess the enhancing effect of normal saline [NS] on radiofrequency ablation [RFA] of hepatocellular carcinoma [HCC] using a cool-tip needle. This study included 40 patients with HCC [proved by histopathology or combined spiral CT and elevated alpha-fetoprotein]. They were randomly divided into two groups [20 patients in each group]. The first group was treated with RFA preceded by intra-tumoral normal saline injection [RFA + S]; the second group was treated with RFA only [RFA]. The procedure was successful in all patients [100%] of the RFA + S group and in 11 [55%] of the RFA group [as proved by spiral CT or pathology]. This difference between the two procedures was statistically highly significant [P = <0.01]. No major complications occurred in either group. Combined RFA and normal saline is more effective than RFA alone. Considering the reduced cost and wide availability of isotonic saline together with the easy performance of the intra-tumoral injection, the dramatic improvement in therapeutic effect of RFA to 100% could be a breakthrough in future strategies to modernize the RFA technique

Sensitivity of ductal lavage to detect breast cancer

The use of ductal lavage for cancer detection is based on the premise that fluid-yielding ducts are the ducts most likely to contain disease, and when these ducts are lavaged, cytologic findings will reflect the disease present. Ductal lavage sensitivity can be improved by the use of ductoscopy which allow direct visualization of the intraductal lesions and more distal exploration of the ductal tree. Ductoscopy and ductal lavage were performed in the operating room before mastectomy on 25 women with known breast cancer. When ductal lavage show sufficient cellularity for cytologic diagnosis, the lavaged duct was injected with patent blue dye. Histologic findings in ducts with and without dye were recorded. Associations between cytologic and histologic results were examined. Both cytologic and histologic materials were obtained from 17 [85%] of 20 ducts with sufficient cellularity and in 12 [48%] of 25 breasts. Sensitivity of ductal lavage cytology was 42.8% [3 cytologically positive ducts of 7 dye-containing ducts with histologically confirmed cancer]. Ductal lavage can detect breast cancer in 12% of the total study population [3 breast of the total study 25 breast]. In 22 cases with fluid yielded ducts; ductal lavage can detect breast cancer in 13.6%. The sensitivity of ductal lavage to detect breast cancer increase at the level of ductal analysis and can detect cancer in 21.9% of the total duct yielded fluids. In breasts with cancer, ductal lavage appears to have low sensitivity for cancer detection. The findings of our study do not support the premise that ductal lavage is an effective tool for the detection of breast cancer

Pravastatin and its effects on renal reperfusion injury in an experimental model in dogs

The aim of this study was to determine if pretreatment with pravastatin would attenuate acute renal dysfunction that occurs following ischemic reperfusion injury in an experimental model in dogs. Twenty mongrel dogs were randomized into two groups [n = 10 per group]. In addition, a control group was also included in which bilateral renal ischemic arterial clamping was applied for one hour before which blood samples were taken for baseline biochemical evaluation and tumor necrosis factor alpha [TNF alpha] estimation. Declamping was done for 15 min and another blood sample for TNF alpha estimation was taken. Then, the animal's abdomen was closed and the animal awakened from anesthesia. At 48 hours later, the animal was re-operated upon and the left kidney was harvested for histopathologic examination and blood samples were taken for the previously mentioned tests. Another group of ten dogs underwent the same procedure after five days preoperative treatment with pravastatin [0.5 mg/kg/day for 5 days]. The results showed that pravastatin may play a role in modulating renal impairment following aortic, renovascular or transplantation surgery allowing early reduction form an ischemic reperfusion injury