Ciculating P53 antibodies in patients with hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is one of the most common malignant tumours worldwide. The poor survival after diagnosis has led to the introduction of screening programs using alpha-fetoprotein [AFP], real time ultrasound scanning and computed tomography. Unfortunately, the accuracy of these programs is limited especially in small HCCs, hence there is clearly a need for other markers of malignant changes that can be used to screen cirrhotic patients. The aim of the present study was to assess the value of using a specific ELISA for the detection of antibodies directed against p53 protein as a scneening test for early detection and characterization of HCC. The present study included 34 patients with HCC and 20 control patients with non-neoplastic chronic liver diseases admitted to Tanta University Hospital and National Liver Institute Menoufeya University. The diagnosis in all the cases was based on histopathological examination of sonar-guided liver biopsies. Tumour size and number were determined at the time of presentation by ultrasound and CT scanning, HBsAg and HCV-antibody status were determined Serum bilirubin, ALT, AST, serum albumin, prothrombin activity, and serum alpha-fetoprotein [AFP] concentrations were measured. Circulating p53 antibodies were looked for using ELISA technique specific for detection of antibodies to p53 protein in serum samples. Positivity for circulating anti-p53 was detected in 16/34 of the HCC patients but in none of the control group with a sensitivity of 47.1%, and specificity of 100%. Positivity for AFP [>500 ng/ml] was found in 14/34 of HCC cases but in none of the control group [sensitivity 41.2%, specificity 100%]. The anti-p53 positivity was not significantly correlated to AFP-positivity [p = 0.4], Screening of patients and controls by both tests increased the sensitivity of detection of HCC up to 73.5%. The positivity for anti-p53 was significantly associated with the degree of HCC differentiation. It was significantly higher in well [9/12; 75%] than in poorly differentiated tumours [7/22; 32%] [p < 0.05], but it had not any significant relation with tumour size and number, nor was it related to hepatitis B or C status, background liver diseases, age, sex, serum bilirubin, serum albumin, ALT, AST, or prothrombin activity. In conclusion, detection of anti-p53 by ELISA is convenient and may be a valuable addition to the current screening tests for HCC with the potential to detect tumours at an early, and therefore more treatable, stage

Normalization of left ventricular systolic and diastolic asynchrony after valve replacement for aortic stenosis

The aim of the present study was to evaluate left ventricular wall thickness, systolic and diastolic asynchrony in pressure overload hypertrophy due to aortic stenosis. Twenty five patients were included in the present study. 15 patients with severe aortic stenosis were studied preoperatively as well as early [6 +/- 2 months] and late [36 +/- 12 months] after aortic valve replacement [AVR] using left ventricular biplane angiogram, high-fidelity pressure measurements and echocardiography. Ten normal subjects served as controls. LV systolic function was assessed from biplame ejection fraction and M-Mode echocardiography and diastolic function from the time constant of relaxation, the peak filling rate and the constant of myocardial stiffness. Non uniformity was evaluated. from the coefficient of variation of the time to end-systole [systolic asynchrony] and peak filling rate [diastolic asynchrony] of 12 regions in right and left anterior oblique projections. Ejection fraction was comparable in patients with aortic stenosis and in control, whereas preoperatively diastolic dysfunction with prolonged relaxation by cardiac catheterization and reversed E/A ratio as evidenced by echo-Doppler study was present in patients with aortic stenosis and was normalized late after AYR. Left ventricular hypertrophy also normalized late after AYR [36 months]. L Y systolic asynchrony was present [>2 SD of control] in ten patients and diastolic asynchrony in all patients [15] with aortic stenosis. Systolic asynchrony was normalized in most of our patients [14 of 15 patients] early as well as late after AYR. On the other hand, diastolic asynchrony was present early after AYR in all patients, although there was a significant improvement in comparison to the preoperative evaluation Late after AYR, there was a normalization of diastolic asynchrony in 14 out of 15 patients with aortic stenosis. Systolic asynchrony is normalized early after AYR probably due to reduction of file after load, whereas, diastolic asynchrony persists probably due to residual LV hypertrophy with myocardial stiffness and interstitial fibrosis. Late after AYR, diastolic asynchrony is normalized due to structural remodeling with regression of both myocardial hypertrophy and interstitial fibrosis