RESUMO
Hepatocellular carcinoma [HCC] is considered the fifth most common cancer in the world. Owing to its increased incidence in the last decade and the expected further increase in the next 2 decades, HCC is arousing great interest. HCC commonly develops on cirrhotic livers and therefore, surveillance programs have been suggested to identify early HCC, at a stage suitable for surgical or interventional therapy and has a better clinical outcome. The only serologic marker used in clinical practice is alpha-fetoprotein [alpha-FP], but its sensitivity is poor. Hence, the investigation of new markers is required. To assess the clinical utility of squamous cell carcinoma antigen [SCCA] as a non invasive marker in the early diagnosis of HCC and whether the association of alpha-FP and SCCA could improves the diagnostic power. This study is conducted on 65 newly diagnosed hepatic focal lesion cases from those attending the Tropical Medicine Department, Cairo University Hospitals [Group I] as well as 20 age and sex matched healthy control subjects [Group II]. Group I was further subdivided into la [49 HCC proved untreated patients] and Ib [16 patients with Cirrhosis only] according to their histopathological findings. All patients were subjected to full history taking, clinical examination, laboratory investigations [including liver function test, hepatitis markers, alpha-FP and SCCA serum levels], triphasic abdominal CT and pathological examination. Group I included 42 males [64.7%] and 23 females [35.3%] with ages ranging between 42-70 years [60.7111.28], of them 16 patients had HBV [24.6%], 37 patients had HCV [56.9%] and 12 patients [18.4%] had mixed HBV and HCV infection. Group I was further subdivided into group la which included 49 HCC proved patients and group Ib which included 16 patients with regeneration nodules [cirrhosis only] according to their histopathologic findings. Group II [control] included 20 age and sex matched healthy subjects. Mean levels of serum alpha-FP and SCCA in group Ia was significantly higher when compared with group Ib [p<0.0005 for both of them]. At a cutoff of serum alpha-FP 200 ng/mL, the sensitivity was 35% and the specificity was 100% while at a cutoff >400ng/mL, the sensitivity decreased to 7.6%. On using the receiver operator curve [ROC], to improve the specificity and sensitivity of alpha-FP and SCCA, the cutoff value of 40ng/ml and 0.55ug/L yielded a sensitivity of 67.2% and 61.2% respectively and specificity of 100% [best cutoff]. When combined sensitivity of them was calculated at the best-chosen cutoff values, sensitivity improved to 87.7% with specificity of 100%.Combined use of alpha-FP and SCCA in the screening of patients with hepatic focal lesions may increase the chance of diagnosis of HCC patients
Assuntos
Humanos , Masculino , Feminino , Biomarcadores Tumorais , Antígenos de Neoplasias , alfa-Fetoproteínas , Diagnóstico Precoce , PrognósticoRESUMO
The current study investigates the effect of ketamine bolus injection 3 mg/kg every 6 hours for 48 hours in patients with severe head injury [GCS = 8] sedated either by midazolam 0.1 mg/kg/hr [n=15] or propofol infusion 3 mg kg hr for 48 hours [n=15] and compared their effects on cerebral hemodynamics, HR and MAP to patients in control group [n=10] which received dehydrating measures according to protocol applied in neuro-intensive care unit. In control group, there is non significant changes in all parameters except fluctuation in MV in first 24 hour with significant decrease in ICP in 2nd 24 hours. In [Midazolam-Ketamine] group in first 24 hour, and [propofol-Ketamine] groups, non significant changes in HR. or MAP. MV increases in [propofol-Ketamine] at [20-25 mm] significantly compared to control group. CPP and PI increase significantly in [Midazolam-Ketamine] and [propofol-Ketamine] groups compared to control group [P<0.01]. ICP showed non-significant difference between groups compared to control group. In second 24 hours, non significant changes in all groups compared to FIR or MAP except in [propofol-Ketamine] at 5 mm. MV and CPP showed significant elevation and P1 decrease at [2 min]-compared to control group in [propofol-Ketamine] group. In [Midazolam-Ketamine] and [propofol-Ketamine] group ICP decreases significantly compared to control group. There was significant improvement at 8 days GCS and C.T score and C.T score index with improvement outcome. These results suggests that ketamin, with midazolam and propofol have protective effect on head trauma patients through decreasing P1 and increasing MV in first phase and maintaing CPP with decreasing ICP in second phase