Plasma proteosome level as a potential marker for hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is a fatal malignancy. Effective curative surgery is achieved when HCC is detected earlier. Proteosomes, the main non-lysosomal proteolytic structures organising the cellular mechanisms of cleaving proteins, can be considered a tumour marker in many kinds of malignancies. The aim of this study was to assess the plasma proteosome level in HCC and cirrhosis and, accordingly, evaluate its potential diagnostic ability in the detection of HCC in cirrhosis. This study included 60 patients, divided into two groups: the HCC group and the liver cirrhosis group. Twenty normal subjects served as a control group. Serum levels of proteosome and alpha-foetoprotein [AFP] were measured using the enzyme-linked immunosorbent assay [ELISA] technique. Plasma proteosome levels were significantly higher in patients with HCC and in patients with cirrhosis without HCC when compared to controls individually [p > 0.002 and p > 0.001, respectively] but did not reach a significant differentiating level between them [area under curve [AUC] = 0.641, p = 0.061]. Moreover, the plasma proteosome level was not correlated with the severity of HCC by the Milan criteria or with AFP level. In addition, it was not significantly related to laboratory or Child-Pugh scoring. Moreover, the combined use of plasma proteosome level and AFP measurements for the diagnosis of HCC was not effective. In this study, the plasma proteosome level was comparably recorded in both patients with cirrhosis and patients with HCC [mean value +/- standard deviation were 5.796 +/- 1.46 and 7.176 +/- 2.48 microgml[-1], respectively], not reaching a significant differentiating level between them, although predictability of HCC using the plasma proteosome level was significant [p = 0.017]

Evaluation of the diagnostic value of serum and tissue apoptotoic cytokeratin- 18 in patients with chronic hepatitis C

Hepatitis C virus [HCV] is considered the most common aetiology of chronic liver disease [CLD] in Egypt. The disease severity ranges from mild illness to cirrhosis and hepatocellular carcinoma. A role for apoptosis in liver damage caused by HCV chronic infection has been suggested. Cytokeratin 18 [CK-18] is the major intermediate filament protein in the liver and is a known caspase substrate in hepatocyte apoptosis. Therefore, we analysed the serum and tissue levels of CK-18 in patients with chronic HCV infection to evaluate its role in hepatocyte apoptosis. We also correlated CK-18 expression with the severity of hepatic pathology. This study examined 80 Egyptian patients with liver disease. There were 69 patients with chronic hepatitis C and 11 patients with hepatitis C-induced cirrhotic changes. Fifteen healthy controls were also included in the study. The levels of CK-18 fragment were quantified in paired serum and liver biopsy samples. The serum and tissue CK-18 levels were reduced in chronic HCV patients compared to early cirrhosis patients. This result indicates that serum levels of CK-18 and the hepatic expression of CK-18 might play an important role in disease progression. The serum and tissue levels of CK-18 were significantly increased and directly correlated with inflammation severity, stage of fibrosis, and ALT levels in the chronic HCV group and the cirrhotic liver group. There was no significant difference in viral load between patient cohorts. The serum level and the hepatic expression of CK-18 are related to disease activity and are directly correlated with METAVIR scoring. This result suggests that serum CK-18 levels may be useful for monitoring disease activity in chronic HCV and liver cirrhosis patients

Echoguided pair technique in diagnosis and treatment of abdominal hydatid cystic disease in Egyptian patients: clnical and ultrasonographic follow up

The introduction of the percutaneous puncture, aspiration, injection of scolecidal agent and reaspiration [PAIR] technique is gaining an increasing acceptance in diagnosis and treatment of abdominal cystic hydatid disease [CHD]. Thirty-three patients [12 male and 21 female with age between 15 and 70 years] had 46 cysts in liver, spleen and kidneys [75.7%, 18.2% and 6.1% respectively]. Puncture, aspiration, injection of 95% sterile alcohol for 20 minutes and reaspitation [PAIR] was used for treatment of hydatid cysts of different types and sizes. Follow up both clinically and ultrasonographically was done over a period of 2 years. The commonest ultrasound picture was type la [overall echofree] in 80.4%, commonly in the liver [75.7%] mainly in the right lobe [88%]. Improvement of symptoms had occurred its 85% within 3 weeks. As regards ultrasound follow up of 41 non-complicated cysts within the 1[st] six months, was disappearance of 5 cysts, 34 reduced in size and 36 showed different grades of solidification. After 1.5 year 10 more cysts disappeared while the pseudotumour appearance was shown in remaining 26 cysts. Ultrasound follow up of the 5 infected cysts revealed complete cure within a period of 8-16 weeks in 4 of them. The last patient discontinued drainage therapy and was referred to surgery. This makes ultrasound cure reaching 97%. Minor complications were skin reaction only in 2 patients [6%]. No fatal anaphylaxis cyst recurrence or rupture into the peritoneal cavity or bleeding from renal or splenic puncturing. PAIR technique under ultrasonographic guidance is the first choice method for treatment of abdominal CHD especially in the developing countries and inoperable hydatid cysts

Band ligation versus beta-blockers in the prevention of primary bleeding of oesophageal varices: clinical, biochemical, ultrasongraphic and endoscopic evaluation

Most of the published data comparing endoscopic variceal band ligation [EVL] to propranolol for primary prevention of variceal bleeding have reached a conclusion that EVL is the option for patients with contraindications or intolerance to beta-blockers. Whether it is an alternative to beta-blockers that could be used for all cirrhotic patients with varices in case propranolol fails, or it is the prophylactic treatment of choice has not been answered. This study was designed to compare the effectiveness of prophylactic EVL to propranolol in the primary prevention of variceal bleeding from medium and large sized varices among Egyptian patients. The study included 60 patients with chronic liver disease, grade III or IV varices and negative history of variceal bleeding. Patients were randomized to receive either EVL or propranolol and were followed up every 3 months for one year. In the EVL group, successful initial variceal obliteration was achieved in 22 patients [88%]. In 5 of these patients [22.7%], variceal recurrence to grade II occurred. Failure to reduce the size of varices was reported in one patient [4%]. Patients in the propranolol group showed high incidence of hypotension [52.1%]. The mean dose of propranolol was low [43 +/- 7.3mg]. A resting heart rate of 69 beats/mm was 100% sensitive and 100% specific for the development of hypotension. Both groups were comparable as regards bleeding and overall mortality but compliance to therapy was significantly less in the propranolol group. Adverse effects to therapy were significantly higher in the propranolol group as hypotension occurred in 52.1% of patients. Although EVL is an invasive therapy as compared to propranolol, yet patients are more compliant to this short term therapy. Given this fact in addition to the high incidence of drug intolerability seen with propranolol makes EVL the preferred therapeutic option despite the comparable effectiveness of the two modalities in the primary prevention of variceal bleeding