RESUMEN
The aim of the present work is to assess the level of serum tumor necrosis factor alpha [TNF-alpha] in patients with hepatocellular carcinoma [HCC] and compare the sensitivity of this marker with conventional used marker, alpha-fetoprotein [AFP]. This study was done on sixty five patients attending the Gastroenterology Surgical Center, Mansoura University. 25 patients with HCC, 20 patients with liver cirrhosis, 20 patients with chronic hepatitis in addition to 15 apparently healthy controls [both patients and controls were age and sex matched]. Serum AFP was estimated by an immunoenzymatic assay. Serum TNF-alpha was assayed by a solid phase enzyme amplified sensitivity immunoassay. Results show that serum AFP and TNF-alpha levels were significantly elevated in hepatocelluar carcinoma, cirrhosis and chronic hepatitis groups in comparison to control group. AFP and TNF-alpha showed no significant difference in cirrhosis group in comparison to chronic hepatitis group. No significant correlation was found between HCC stages and both AFP and TNF-alpha. TNF-alpha had a higher sensitivity [100%] than AFP [80%] and lower specificity [40% for TNF-alpha and 64% for AFP] in patients with HCC. In conclusions, serum TNF-alpha is nonspecific marker as it increases in different and stage of liver diseases. TNF-alpha could be used in association with APF in diagnosis of HCC cases. TNF-alpha has higher sensitivity than AFP, but lower specificity as it was elevated in benign inflammatory diseases. TNF-alpha could be used as a marker for early detection of HCC by following up of its level in patients with cirrhosis and chronic hepatitis
RESUMEN
This study investigated the role of parasitic infections as possible etiologic agents in prolonged fever of undetermined origin [FUO]. The value of some diagnostic serological tests was also proved. 43 patients who fulfilled the international criteria for prolonged fever were studied. All cases were exposed to urine examination and culture, stools examinations, hemogram, liver and renal function tests, chest X-ray, tuberculin test, bone marrow, liver biopsy, blood films, serological tests including ELISA, IHA and IFA for detection of schistosomiasis, leishmaniasis, toxoplasmosis and malaria. The majority of cases with positive parasitic etiology were coming from rural areas. The pattern of fever was predominantly intermittent especially with malarial and schistosomal cases. Lymphadenopathy was detected in one third of cases, 60% of which were visceral leishmaniasis. The IHA test for leishmaniasis detected all cases at a titer of 256, 512 and 1024 reciprocally. The dot-ELISA detected 8 out of the 10 cases diagnosed by the IHA test. The detection of seropositive cases of visceral leishmaniasis in the studied area suggests the existence of reservoir or a focus and warrants epidemiological study to establish the actual situation