Clinical significance of vascular endothelial growth factor and endostatin in patients with hepatocellular carcinoma

Despite the progress in early diagnosis of liver cancer, its prognosis remains poor. Tumor angiogenesis is critical to both growth and metastasis of hepatocellular carcinoma [HCC], and has drawn much attention in recent years. Details regarding serum levels of proangiogenic and antiangiogenic growth factors controlling this process could be obtained by studying serum levels of vascular endothelial growth factor [VEGF] and endostatin respectively. Accordingly, the aim of the present study was to evaluate the clinical significance of serum levels of VEGF and endostatin in patients with HCC and their possible role in metastatic spread. The study was conducted on 25 patients with HCC and 15 age and sex matched healthy controls. The patient group was subdivided into 10 patients with metastatic spread and 15 patients with localized tumors without evidence of any metastasis. Results of the present study revealed that VEGF was significantly higher in HCC patients with and without metastasis when compared to the control group [P<0.01 and P<0.05, respectively]. Furthermore, levels of VEGF were significantly higher in the metastatic group than the non- metastatic one [P<0.05]. In contrast, there was no statistical significant difference in endostatin levels between any of the studied groups [P>0.05]. Moreover, the correlation between serum levels of VEGF and endostatin did not reach statistical significance [P> 0.05]. Our data shows that serum VEGF levels in HCC patients is directly associated with metastasis and recurrence of tumors and increases gradually with the progression of disease. Therefore, the serum VEGF level in HCC patients appears to reflect the disease potential activity of vascular invasion and is a possible marker for metastasis. On the other hand, the unelevated levels of endostatin point to that the angiogenic response is more prominent than the anti-angiogenic response in liver metastasis. These findings support the rationale for anti- angiogenesis therapy in these patients. Thus the role of endostatin as anti -angiogenic factor may be preserved for therapeutic not diagnostic use. However, further investigation is required to elucidate the effectiveness of this promising tool in order to achieve anti-angiogenic properties

Endoscopic control of gastric variceal bleeding with butyl cyanoacrylate in patients with schistosomiasis

100 patients with portal hypertension due to schistosomal hepatic fibrosis and/or post-hepatitic liver cirrhosis were included. All patients presented with bleeding from gastric varices, either fundal [80 patients] or inferior extension of esophageal varices [20 patients], were enrolled. Injection therapy was administered as the first active measure. No tamponade or drugs were used. Cyanoacrylate was mixed with lipid and injection through a hand-made probe. A mean of 3 [range 1 - 9] ampoules of cyanoacrylate were used per injection session. Bleeding stopped at the end of all sessions. Ten patients with fundal varices had rebleeding during the first 24 hours. Reinjection could control bleeding in 6 patients with a total success rate of 95%. Four patients were managed surgically. Fatal pulmonary embolism developed in one patient with fundal varix. Another five patients [6.25%] died from bleeding-related liver failure. In conclusion, injection of cyanoacrylate is highly satisfactory in controlling bleeding from both types of gastric varices