Triphasic spiral CT imaging of hepato-cellular carcinoma in the cirrhotic liver

Hepatocellular carcinoma [HCC] is responsible for a large proportion of cancer deaths worldwide and derives its blood supply predominantly from the hepatic artery. The imaging modalities used in diagnosis of HCC include ultrasound [US], multiphase spiral CT [MsCT], magnetic resonance imaging [MRI], angiography, positron emission tomography [PET], and imaging-guided biopsy. The aim of this study was to clarify the role of triphasic spiral CT in evaluation of patients with hepatocellular carcinoma developed on top of cirrhosis. This study included 30 male patients with evident cirrhosis and suspected clinically and/ or by real time ultrasonography [US] to have hepatocellular carcinoma [HCC]. All of them were subjected to the followings: 1]-Full history taking and clinical examination.2]-Laboratory investigations including: hepatic function tests and serum alfa-feto-protein level. 3]-Real time ultrasonography of the liver [US]. 4]-Triphasic spiral CT of the liver [TsCT]. 5]-Finally, the results were confirmed by CT-guided biopsy in 15 cases, US-guided biopsy in 10 cases, and follow up in the remaining 5 cases. The mean age of the studied patients was 57 years. Their commonest clinical presentation was right upper quadrant abdominal pain. All of them showed elevated liver function tests and the alfa-feto-protein level was elevated in 73.3% of these cases. All of the detected lesions were solid and/or predominantly solid on real time US study and 20/30[66.7%] lesions showed non-homogenous echo texture pattern. Their outlines were ill-defined in 20/30[66.7%] lesions and halo sign was noted in 15/30[50%] lesions. The lesions commonly affected the medial segment of left hepatic lobe in 12/30[40%] cases. On triphasic spiral CT [TsCT], the mean size of the examined lesions was 7.1cm. 15/30[50%] lesions showed faint, non-homogenous enhancement, 10/30[33.3%] lesions showed intense, and homogenous enhancement and 5/30[16.7%] showed peripheral enhancement on the arterial phase. 66.7% and 83.3% of the studied lesions appeared isodense compared with the adjacent cirrhotic hepatic parenchymal tissue on both portal venous and delayed phases. Associated findings included splenomegaly in 66.7% of the cases, ascites was noted in 20% of the patients and portal vein thrombosis was seen in 13.3% of the cases. Real time US is the preliminary imaging modality for evaluation of patients with suspected HCC on top of cirrhosis, as it gives a good idea about the morphological characteristics of these lesions. In addition, US-guided needle biopsy is frequently required for their diagnosis. Triphasic spiral CT is valuable for further characterization of these lesions, determination of their vascular supply and guides their percutaneous biopsy

Histopathological and immune-pathological changes in the prostates of golden hamsters experimentally infected with schistosoma mansoni

This work has been planned to study the histopathological and immune-pathological changes in the prostates of experimentally infected golden hamsters with Schistosoma mansoni. Fifty male golden hamsters, 10 weeks old, 200-250 gm in weight each and free from parasitic infections were used. They were classified into two groups. Group [1] 40 male golden hamsters infected with 350 S. mansoni cercariae S.C. each. Group [2] 10 male golden hamsters [control]. Viable S. mansoni eggs were collected, washed and egg hatching was performed. Biomphalaria alexandrina snails were infected by 6 - 8 miracidia each. The released cercariae were collected, counted and concentrated so as to contain 350 cercariae / 0.5 ml. [the infective dose / hamster S. C.]. Five infected hamsters were killed 6, 8, 10, 12, 14, 16, 18 and 20 weeks p. i. Control animals were sacrificed at once. The prostate- glands of the infected and control male hamsters were dissected; fixed in 10% phosphate buffered formalin. Microscopic examination was conducted on 4 microm thick H. and E. stained sections from paraffin embedded specimens. Immunohistochemical detection of hamster's schistosomal antigen in prostatic sections was performed by DAKO Avidin-biotin peroxidase technique. Other portions of the prostates were digested in 5% KOH for detection of S. mansoni eggs. The results of this work showed that there were diffuse, non granulomatous inflammatory reaction starting at 12[th] week p.i. and reaching maximum intensity at 16[th] week p.i. The epithelial linings of the prostatic acini showed hyperplasia, enfolding and lymphocytic cell infiltration. Stromal fibrosis started at 18[th] week p.i. in 10 [25%] infected hamsters. Immunohistochemical examination showed mild deposits at 12[th] week p.i., moderate deposits at 14[th] week p.i. and intense deposits at 16[th] week p.i. KOH digestion of prostatic pieces showed no S. mansoni ova at any period p. i. S. mansoni infection could involve the prostate gland by variable degrees of inflammation and fibrosis. These inflammatory reactions may be due to antigen deposition in such organ. The inflammation and fibrosis may interfere with the normal function of the prostatic gland leading to alteration of the chemical composition of the seminal fluid which may decrease the fertility capacity of the sperms. Also, prostatic hypertrophy may lead to problems in the erection and urinary tract obstruction

Metallothionein [MTI and MT II] gene expression in hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is one of the most frequent human tumors worldwide, and commonly evolves from chronic hepatitis and liver cirrhosis. It is therefore very important to detect and evaluate the progressing state of chronic hepatic disorders. Recently, serum metal levels such as copper [Cu] and zinc [Zn] have been reported to be highly sensitive in the diagnosis of some diseases. Hypozincemia and marked hypercupremia have been reported in patients with digestive, hepatic, breast, and lung cancers. Also much attention was paid to the association between metallothioneins [MTs] and chronic liver diseases including HCC. Available informations suggested that MTs might play important roles in carcinogenic and apoptotic process of some tumors. The aim of the present study was to throw the light on the role of zinc, copper and metallothioneine in the diagnosis of chronic liver diseases and to clarify the role of metallothioneins [MTs] I and II mRNA expression in hepatocellular carcinoma. This study was carried out on 45 patients with liver diseases [15 patients with chronic hepatitis, 15 patients with liver cirrhosis and 15 patients with HCC] as well as 15 healthy individuals as a control group. All patients and controls were subjected to estimation of serum copper, zinc and metallothioneine levels also their tissue levels were estimated in all patient groups. Metallothioneins [MT I and MT II] mRNA expression by RT-PCR were done for all cases. The results of the present study documented a significant decrease in serum and tissue levels of zinc and metallothioneine with concomitant increase in copper levels in all patient groups. More changes were documented in HCC patients. Concerning the PCR results of MT genes expression, there was a significant decrease in MT I and MT II mRNA expression in HCC patients when compared to the other groups. They also decreased in patients with liver cirrhosis when compared to the control group and patients with chronic hepatitis. In contrast their expressions do not show significant decrease in chronic hepatitis when compared to the control group. On the basis of these results, it could be concluded that serum zinc, copper, and metallothioneines levels may be used as a non-invasive biochemical markers for early detection of the progression of chronic liver diseases. Moreover, the progressive decrease in MT I and MT II gene expression may play an important role in carcinogenesis of HCC

Evaluation of endoscopic band ligation plus argon plasma photocoagulation versus scleroligation for eradication of esophageal varices: a prospective randomized controlled study

Bleeding from esophageal varices is the most severe and lethal complication of portal hypertension. The aim of this work was evaluation of the technique of endoscopic band ligation plus argon plasma photocoagulation versus scleroligation as a new method used for eradication of esophageal varices. This study was conducted on 200 patients out of 294 studied patients. Patients who fulfilled the inclusion criteria were randomized to four groups, Group I: comprised of 50 patients who were subjected to endoscopic injection sclerotherapy, Group II. comprised of 50 patients who were subjected to variceal band ligation, Group III comprised of 50 patients who were subjected to combined endoscopic sclerotherapy and band ligation, Group IV comprised of 50 patients who were subjected to endoscopic band ligation plus argon plasma photocoagulation. Comparison of the endoscopic number of therapeutic session between different studied groups showed that group III was significantly lower in number of sessions. As regard post treatment complications during the follow up period, Group I showed the high incidence of transient pyrexia, transient dysphagia and/or retrosternal pain and ulceration, while group II showed the higher incidence of re-bleeding was demonstrated. The higher incidence of recurrence rate of esophageal varices after eradication during the follow up was detected in group II, while the higher mortality incidence was detected in group I and II, In this study the follow up incidence did not significantly differ between the different studied groups. Scleroligation allows very rapid eradication of varices, low recurrence rate, avoided the disadvantage of high recurrence of band ligation alone, and did not require special skill over sclerotherapy or band ligation but the total cost is higher than that required for sclerotherapy. Also, Band ligation plus argon plasma photocoagulation allows very rapid eradication of varices, and low recurrence rate, with no obvious recorded complications, but it has the disadvantage of being the most expensive technique and requires special machine which is not available except in few endoscopic centers

Role of mast cells and cytokine profile [TNF-alpha, IFN-gmma, IL4 and IL-4 mRNA] in different types of leprosy

The aim of this study was to compare the number and the distribution of mast cells in biopsies taken in non reactional and reactional periods of the leprosy lesions. In addition, the expression of cytokines profile was analysed. 60 patients with leprosy were classified into three groups. Group I [non reactional leprosy included 38 patients, Group II [type I reaction] TIR included 13 patients, and Group III [type II reaction] TIJR included 9 patients. Cytokine profile was detected by determination of TNF-alpha, INF-gamma, IL-4 in the serum. In addition, IL-4 mRNA was determined in whole blood of all studied groups. Multiple punch biopsy specimens were taken from individual patients; for the examination of intra-lesional variation in mast cell numbers, specimens were taken from the centre of the lesion, the edge of tile lesion, and from the apparently unaffected skin outside the lesion at a point 2 cm from the nearest identifiable margin of the lesion. Comparison of INF-gamma and TNF-alpha in the sera of the different studied groups showed a significant difference between the groups, with a tendency to decrease in levels more in group III. Positive correlation between IFN-gamma and TNF-alpha, was detected. In addition, comparison of IL-4 and mRNA for IL-4 in the sera of the different studied groups showed a significant difference between the groups, with a tendency to increase in levels more in group III. Positive correlation between serum IL-4 and mRNA for IL-4, was observed. Density of mast cells in skin lesions of the different studied groups showed an insignificant difference between all groups as regards the centre of the lesion, while a significant difference was detected between group III and both groups I and II as regards mast cell density in the periphery and interstitium. The number of mast cells tends to increase from TT up to LL. A positive correlation was detected between mast cell density and IL-4 mRNA [r=0.57], while other studied cytokines did not show such a correlation. The cytokine profile is Th1 predominant in non reactional and TIR leprotic patients, while it shows Th2 predominance in TIIR leprotic patients. According to the pattern of cytokine production, mast cells are closely related to CD8+ T cells and IL-4mRNA leading to increased density of mast cells in skin lesions from TT up to LL, which in turn controls the out come of the disease