A rare case of cavernous sinus thrombosis following oral squamous cell carcinoma - The etiology and management dilemma.

Intracranial cavernous sinus metastases of oral squamous cell carcinoma (OSCC) are rare, with a reported incidence of 0.4 %. Due to their extremely infrequent presentation the etiology and management modalities of such complications are not clearly represented in the literature. Here we present a case of a 58-year-old male diagnosed with OSCC of Right Lower Alveolus with underlying bone invasion, cT4aN1M0, Stage IV. He underwent Right Hemi-mandibulectomy with Modified Neck Dissection, Pectoralis Major Myocutaneous Flap, and 60 Gy/30# adjuvant radiotherapy. Six months later, the patient was diagnosed with recurrence involving the right infratemporal fossa with associated right cavernous sinus thrombosis. Immunohistochemistry block review showed PDL1 - Positive. The patient was subjected to Cisplatin and Pembrolizumab immunotherapy. After receiving 35 cycles of Pembrolizumab over a period of 2 years the patient is doing well with no recurrence.

Dosimetric comparison of analytical anisotropic algorithm and the two dose reporting modes of Acuros XB dose calculation algorithm in volumetric modulated arc therapy of carcinoma lung and carcinoma prostate.

Volumetric Modulated Arc Therapy (VMAT) is an important modality for radical radiotherapy of all major treatment sites. This study aims to compare Analytical Anisotropic Algorithm (AAA) and the two dose-reporting modes of Acuros XB (AXB) algorithm -the dose to medium option (Dm) and the dose to water option (Dw) in Volumetric Modulated Arc Therapy (VMAT) of carcinoma lung and carcinoma prostate. We also compared the measured dose with Treatment Planning System calculated dose for AAA and the two dose reporting options of Acuros XB using Electronic Portal Imaging Device (EPID) and ArcCHECK phantom. Treatment plans of twenty patients each who have already undergone radiotherapy for cancer of lung and cancer of prostate were selected for the study. Three sets of VMAT plans were generated in Eclipse Treatment Planning System (TPS), one with AAA and two plans with Acuros-Dm and Acuros-Dw options. The Dose Volume Histograms (DVHs) were compared and analyzed for Planning Target Volume (PTV) and critical structures for all the plans. Verification plans were created for each plan and measured doses were compared with TPS calculated doses using EPID and ArcCHECK phantom for all the three algorithms. For lung plans, the mean dose to PTV in the AXB-Dw plans was higher by 1.7% and in the AXB-Dm plans by 0.66% when compared to AAA plans. For prostate plans, the mean dose to PTV in the AXB-Dw plans was higher by 3.0% and in the AXB-Dm plans by 1.6% when compared to AAA plans. There was no difference in the Conformity Index (CI) between AAA and AXB-Dm and between AAA and AXB-Dw plans for both sites. But the homogeneity worsened in AXB-Dw and AXB-Dm plans when compared to AAA plans for both sites. AXB-Dw calculated higher dose values for PTV and all the critical structures with significant differences with one or two exceptions. Point dose measurements in ArcCHECK phantom showed that AXB-Dm and AXB-Dw options showed very small deviations with measured dose distributions than AAA for both sites. Results of EPID QA also showed better pass rates for AXB-Dw and AXB-Dm than AAA for both sites when gamma analysis was done for 3%/3 mm and 2%/2 mm criteria. With reference to the results, it is always better to choose Acuros algorithm for dose calculations if it is available in the TPS. AXB-Dw plans showed very high dose values in the PTV when compared to AAA and AXB-Dm in both sites studied. Also, the volume of PTV receiving 107% dose was significantly high in AXB-Dw plans compared to AXB-Dm plans in sites involving high density bones. Considering the results of dosimetric comparison and QA measurements, it is always better to choose AXB-Dm algorithm for dose calculations for all treatment sites especially when high density bony structures and complex treatment techniques are involved. For patient specific QA purposes, choosing AXB-Dm or AXB-Dw does not make any significant difference between calculated and measured dose distributions.

Dosimetric comparison and validation of Eclipse Anisotropic Analytical Algorithm (AAA) and AcurosXB (AXB) algorithms in RapidArc-based radiosurgery plans of patients with solitary brain metastasis.

Stereotactic radiosurgery (SRS) is increasingly being used to manage solitary or multiple brain metastasis. This study aims to compare and validate Anisotropic Analytical Algorithm (AAA) and AcurosXB (AXB) algorithms of Eclipse Treatment Planning System (TPS) in RapidArc-based SRS plans of patients with solitary brain metastasis. Twenty patients with solitary brain metastasis who have been already treated with RapidArc SRS plans calculated using AAA plans were selected for this study. These plans were recalculated using AXB algorithm keeping the same arc orientations, multi-leaf collimator apertures, and monitor units. The two algorithms were compared for target coverage parameters, isodose volumes, plan quality metrics, dose to organs at risk and integral dose. The dose calculated by the TPS using AAA and AXB algorithms was validated against measured dose for all patient plans using an in-house developed cylindrical phantom. An Exradin A14SL ionization chamber was positioned at the center of this phantom to measure the in-field dose. NanoDot Optically Stimulated Luminescent Dosimeters (OSLDs) (Landauer Inc.) were placed at distances 3.0 cm, 4.0 cm, 5.0 cm, and 6.0 cm respectively from the center of the phantom to measure the non-target dose. In addition, the planar dose distribution was measured using amorphous silicon aS1000 Electronic Portal Imaging Device. The measured 2D dose distribution was compared against AAA and AXB estimated 2D distribution using gamma analysis. All results were tested for significance using the paired t-test at 5% level of significance. Significant differences between the AAA and AXB plans were found only for a few parameters analyzed in this study. In the experimental verification using cylindrical phantom, the difference between the AAA calculated dose and the measured dose was found to be highly significant (p < 0.001). However, the difference between the AXB calculated dose and the measured dose was not significant (p = 0.197). The difference between AAA/AXB calculated and measured at non-target locations was statistically insignificant at all four non-target locations and the dose calculated by both AAA and AXB algorithms shows a strong positive correlation with the measured dose. The results of the gamma analysis show that the AXB calculated planar dose is in better agreement with measurements compared to the AAA. Even though the results of the dosimetric comparison show that the differences are mostly not significant, the measurements show that there are differences between the two algorithms within the target volume. The AXB algorithm may be therefore more accurate in the dose calculation of VMAT plans for the treatment of small intracranial targets. For non-target locations either algorithm can be used for the estimation of dose accounting for their limitations in non-target dose estimations.

Design, Fabrication, and Validation of a Polymethyl Methacrylate Head Phantom for Dosimetric Verification of Cranial Radiotherapy Treatment Plans.

PURPOSE: The present study aims to design and fabricate a novel, versatile, and cost-effective Polymethyl Methacrylate (PMMA) head phantom for the dosimetric pretreatment verification of radiotherapy (RT) treatment plans. MATERIALS AND METHODS: The head phantom designing involves slice-wise modeling of an adult head using PMMA. The phantom has provisions to hold detectors such as ionization chambers of different sizes, Gafchromic films, gel dosimeter, and optically stimulated luminescence dosimeter. For the point dose verification purpose, 15 volumetric modulated arc therapy patient plans were selected, and doses were measured using a CC13 ionization chamber. The percentage gamma passing rate was calculated for acceptance criteria 3%/3 mm and 2%/2 mm using OmniPro I'mRT film QA software, and Gafchromic EBT3 films were used for 2D planar dose verification. RESULTS: Treatment planning system calculated, and the measured point doses showed a percentage deviation ranged from 0.26 to 1.92. The planar dose fluence measurements, for set acceptance criteria of 3%/3 mm and 2%/2 mm, percentages of points having gamma value <1 were in the range of 99.17 ± 0.25 to 99.88 ± 0.15 and 93.16 ± 0.38 to 98.89 ± 0.23, respectively. Measured dose verification indices were within the acceptable limit. CONCLUSIONS: The dosimetric study reveals that head phantom can be used for routine pretreatment verification for the cranial RT, especially for stereotactic radiosurgery/RT as a part of patient-specific quality assurance. The presently fabricated and validated phantom is novel, versatile, and cost-effective, and many institutes can afford it.

Estimation of dosimetric discrepancy due to use of Onyx™ embolic system in Stereotactic Radiosurgery/Radiotherapy (SRS/SRT) planning.

More often the embolic materials in the brain create artefacts in the planning CT images that could lead to a dose variation in planned and delivered dose. The aim of the study was to evaluate the dosimetric effect of artefacts generated by the Onyx™ embolization material during Stereotactic Radiosurgery/Radiotherapy (SRS/SRT) planning. An in-house made novel Polymethyl Methacrylate (PMMA) head phantom (specially designed for SRS/SRT plans) was used for this purpose. For the evaluation process, we have created concentric ring structures around the central Onyx materials on both the CT sets (with and without Onyx material). The verification plans were generated using different algorithms namely Analytical Anisotropic Algorithm (AAA), Acuros XB and Monaco based Monte Carlo on both CT sets. Mean integral dose over the region of interest were calculated in both CT sets. The dosimetric results shows, due to the presence of Onyx material, relative variation in mean integral dose to the proximal structure (Ring 1) were -4.02%, -2.98%, and -2.49% for Monte Carlo, Acuros XB, and AAA respectively. Observed variations are attributed to the presence of artefacts due to Onyx material. Artefacts influence the accuracy of dose calculation during the planning. All the calculation algorithms are not equally capable to account such variations. Special cares are to be taken while choosing the calculation algorithms as it impacts the results of treatment outcome.

Dosimetric Comparison of Treatment Plans Using Physical Wedge and Enhanced Dynamic Wedge for the Planning of Breast Radiotherapy.

The aim of this study is to compare the physical wedge (PW) with enhanced dynamic wedge (EDW) to determine the difference in the dose distribution affecting the treated breast and the contralateral breast, lungs, heart, esophagus, spine, and surrounding skin in the radiotherapy of breast cancer. Computed tomography (CT) data sets of 30 breast cancer patients were selected from the database for the study. The treatment plans which were executed with PW were re-planned with EDW without changing the beam parameters. Keeping the wedge angles same, the analytic anisotropic algorithm (AAA) with heterogeneity correction was used for dose calculation in all plans. The prescription was 50 Gy in 25 fractions. The dose- volume histogram (DVH) of the planning target volume (PTV) and critical structures of both PW and EDW plans were analyzed. The analysis showed that the maximum dose within the target volume is higher in EDW plan compared to PW plan. However the PTV conformity index (CI) remained the same in both plans. For all the critical structures, the EDW technique offered less dose compared to PW technique. The effect of volume of the contralateral breast on the dose to contralateral breast and the effect of volume of PTV breast for patients with carcinoma left breast on the dose to heart were studied and analyzed for the two wedges. No correlation between volumes and dose parameters was found for the two techniques. The number of monitor units to deliver a particular dose with EDW field is less than that of PW field due to change in wedge factor. As EDW produces less scattered dose to structures outside the treatment field, the risk of a second malignancy can be reduced with this technique.

Verification of Treatment Planning Algorithms Using Optically Stimulated Luminescent Dosimeters in a Breast Phantom.

AIM: The aim of this study is to measure and compare the surface dose of treated breast and contralateral breast with the treatment planning system (TPS) calculated dose using calibrated optically stimulated luminescent dosimeter (OSLD) in an indigenous wax breast phantom. MATERIALS AND METHODS: Three-dimensional conformal plans were generated in eclipse TPS v. 13 to treat the left breast of a wax phantom for a prescribed dose of 200 cGy. The plans were calculated using anisotropic analytical algorithm (AAA) and Acuros algorithm with 1-mm grid size. Calibrated OSLDs were used to measure the surface dose of treated and contralateral breasts. RESULTS: Large differences were observed between measured and expected doses when OSLDs were read in "reading mode" compared to the "hardware mode." The consistency in the responses of OSLDs was better (deviation <±5%) in the "hardware mode." Reasonable agreement between TPS dose and measured dose was found in regions inside the treatment field of treated breast using OSLDs for both algorithms. OSLD measured doses and TPS doses, for the points where the angle of incidence was almost normal, were in good agreement compared to all other locations where the angle of incidence varied from 45° to 70°. The maximum deviation between measured doses and calculated doses with AAA and with Acuros were 2.2% and-12.38%, respectively, for planning target volume breast, and 76% and 77.51%, respectively, for the opposite breast. CONCLUSION: An independent calibration factor is required before using the OSLDs for in vivo dose measurements. With reference to measured doses using OSLD, the accuracy of skin dose estimation of TPS with AAA was better than with Acuros for both the breasts. In general, a reasonable agreement between TPS doses calculated using AAA and measured doses exists in regions inside treatment field, but unacceptable differences were observed for the points lateral to the opposite breast for both AAA and Acuros.

Surfactant utilization and short-term outcomes in an era of non-invasive respiratory support in Canadian neonatal intensive care units.

OBJECTIVE: Increased use of non-invasive respiratory support (NRS) in the delivery room management of preterm neonates has resulted in delayed surfactant treatment, yet the short-term effects of this change are unknown. The aim of this study was to comparatively evaluate the use of surfactant and the short-term outcomes prior to and after the implementation of early routine use of NRS. STUDY DESIGN: Eligible infants of <29 weeks gestational age (GA) admitted to a Canadian tertiary neonatal center during two time periods (2005 to 2008 and 2010 to 2013) were included in this retrospective cohort study. Timing of surfactant (prophylactic vs therapeutic) and short-term outcomes were compared between the two groups. Univariate and multivariate regression analysis was performed to determine the adjusted odds ratio (AOR) along with 95% confidence interval (CI) of receiving exogenous surfactant and developing bronchopulmonary dysplasia (BPD) using the later cohort as the reference group. Subgroup analyses were also performed for infants <26 and 26 to 286/7 weeks GA, respectively. RESULTS: A total of 3980 and 5137 infants were included in the first and second time periods, respectively. There was no significant difference in overall surfactant utilization between the two time periods (AOR 1.00, 95% CI 0.89, 1.13). However, between 2005 and 2008, a lower proportion of neonates received therapeutic surfactant compared with the later cohort (47.1% vs 56.9%, P<0.01) but were more likely to receive prophylactic surfactant (52.9% vs 43.1%, P<0.01). BPD overall was significantly higher in the earlier cohort (AOR 1.19, 95% CI 1.07, 1.33), particularly among the <26 weeks gestation subgroup (AOR 1.34, 95% CI 1.08, 1.66). CONCLUSION: Early routine use of NRS did not impact overall surfactant utilization rate, although therapeutic surfactant administration rates were higher with a concomitant decrease in BPD rates.

Impact of field strength and RF excitation on abdominal diffusion-weighted magnetic resonance imaging.

AIM: To retrospectively and prospectively compare diffusion-weighted (DW) images in the abdomen in a 1.5T system and 3.0T systems with and without two-channel functionality for B1 shimming. METHODS: DW images of the abdomen were obtained on 1.5T and 3.0T (with and without two-channel functionality for B1 shimming) scanners on 150 patients (retrospective study population) and 10 volunteers (prospective study population). Eight regions were selected for clinical significance or artifact susceptibility (at higher field strengths). Objective grading quantified signal-to-noise ratio (SNR), and subjective evaluation qualified image quality, ghosting artifacts, and diagnostic value. Statistical significance was calculated using χ(2) tests (categorical variables) and independent two-sided t tests or Mann-Whitney U tests (continuous variables). RESULTS: The 3.0T using dual-source parallel transmit (dpTX 3.0T) provided the significantly highest SNRs in nearly all regions. In regions susceptible to artifacts at higher field strengths (left lobe of liver, head of pancreas), the SNR was better or similar to the 1.5T system. Subjectively, both dpTX 3.0T and 1.5T systems provided higher image quality, diagnostic value, and less ghosting artifact (P < 0.01, most values) compared to the 3.0T system without dual-source parallel transmit (non-dpTX 3.0T). CONCLUSION: The dpTX 3.0T scanner provided the highest SNR. Its image quality, lack of ghosting, and diagnostic value were equal to or outperformed most currently used systems.

Ex vivo expansion of normal and chronic myeloid leukemic stem cells without functional alteration using a NUP98HOXA10homeodomain fusion gene.

HOX genes have been implicated as regulators of normal and leukemic stem cell functionality, but the extent to which these activities are linked is poorly understood. Previous studies revealed that transduction of primitive mouse hematopoietic cells with a NUP98HOXA10homeodomain (NA10HD) fusion gene enables a subsequent rapid and marked expansion in vitro of hematopoietic stem cell numbers without causing their transformation or deregulated expansion in vivo. To determine whether forced expression of NA10HD in primitive human cells would have a similar effect, we compared the number of long-term culture-initiating cells (LTC-ICs) present in cultures of lenti-NA10HD versus control virus-transduced CD34(+) cells originally isolated from human cord blood and chronic phase (CP) chronic myeloid leukemia (CML) patients. We found that NA10HD greatly increases outputs of both normal and Ph(+)/BCR-ABL(+) LTC-ICs, and this effect is particularly pronounced in cultures containing growth factor-producing feeders. Interestingly, NA10HD did not affect the initial cell cycle kinetics of the transduced cells nor their subsequent differentiation. Moreover, immunodeficient mice repopulated with NA10HD-transduced CP-CML cells for more than 8 months showed no evidence of altered behavior. Thus, NA10HD provides a novel tool to enhance both normal and CP-CML stem cell expansion in vitro, without apparently altering other properties.

High voltage electrical burn injuries in teenage children: case studies with similarities (an Indian perspective).

From 1992 to 2012, a total of 911 paediatric burns were admitted and treated at Kanchi Kamakoti Childs Trust Hospital Intensive Burn Care Unit, of these 28 children had suffered electrical injuries and burns. 7 teenagers suffered high voltage electrical burn injuries: 2 were involved in train accidents which caused fatal electrical injuries, and 5 had electrical burn injuries caused by similar types of accidents, requiring Paediatric Intensive Care Unit (PICU) care, repeated surgeries and extensive rehabilitation. A common factor among these latter 5 patients was that they were injured by overhead high electrical voltage cables. Their management was labour intensive and highly costly. In this report, the type of accident, the electrical voltage that produced burns and the treatment details are elaborated. Findings included similarities in age and type of accident, and failure to implement safety procedures and apply standard norms of high voltage transmission feeder lines.

De 1992 à 2012, un total de 911 enfants brûlés ont été admis et traités à l'unité de soins intensifs chez l'Hôpital Kanchi Kamakoti Childs Trust. 28 de ces enfants avaient subi des blessures et des brûlures électriques. 7 adolescents ont subi des brûlures électriques à haute tension: 2 ont été impliqués dans un accident de train qui a causé des blessures électriques mortelles, et 5 avaient des blessures causées par les accidents similaires, nécessitant des soins intensifs pédiatriques, chirurgies répétées et une longue reeducation. Un facteur commun entre ces 5 jeunes, c'est qu'ils ont été blessés par des câbles électriques aériens à haute tension. Leur gestion était laborieuse et très coûteuse. Dans ce rapport, le type d'accident, la tension électrique qui a produit des brûlures et des détails de traitement sont élaborés. Les résultats comprenaient des similitudes dans l'âge et le type d'accident et aussi dans l'absence de mise en oeuvre des procédures de sécurité et de l'application des normes sur les lignes d'alimentation de transmission à haute tension.

Implementation of dual-source RF excitation in 3 T MR-scanners allows for nearly identical ADC values compared to 1.5 T MR scanners in the abdomen.

BACKGROUND: To retrospectively and prospectively compare abdominal apparent diffusion coefficient (ADC) values obtained within in a 1.5 T system and 3 T systems with and without dual-source parallel RF excitation techniques. METHODOLOGY/PRINCIPAL FINDINGS: After IRB approval, diffusion-weighted (DW) images of the abdomen were obtained on three different MR systems (1.5 T, a first generation 3 T, and a second generation 3 T which incorporates dual-source parallel RF excitation) on 150 patients retrospectively and 19 volunteers (57 examinations total) prospectively. Seven regions of interest (ROI) were throughout the abdomen were selected to measure the ADC. Statistical analysis included independent two-sided t-tests, Mann-Whitney U tests and correlation analysis. In the DW images of the abdomen, mean ADC values were nearly identical with nonsignificant differences when comparing the 1.5 T and second generation 3 T systems in all seven anatomical regions in the patient population and six of the seven in the volunteer population (p>0.05 in all distributions). The strength of correlation measured in the volunteer population between the two scanners in the kidneys ranged from r = 0.64-0.88 and in the remaining regions (besides the spleen), r>0.85. In the patient population the first generation 3 T scanner had different mean ADC values with significant differences (p<0.05) compared to the other two scanners in each of the seven distributions. In the volunteer population, the kidneys shared similar ADC mean values in comparison to the other two scanners with nonsignificant differences. CONCLUSIONS/SIGNIFICANCE: A second generation 3 T scanner with dual-source parallel RF excitation provides nearly identical ADC values compared with the 1.5 T imaging system in abdominal imaging.

Microbiology of infected acellular dermal matrix (AlloDerm) in patients requiring complex abdominal closure after emergency surgery.

BACKGROUND: Acellular dermal matrix (AlloDerm) has recently been introduced as an option for complex abdominal closure for patients with loss of abdominal wall domain secondary to intra-abdominal sepsis or necrotizing fasciitis. AlloDerm has been touted as a promoter of neovascularization and collagen deposition. Currently, the rate of AlloDerm infection in contaminated cases is unknown. Our objective was to determine if the organisms cultured during source control would infect AlloDerm. METHODS: The medical records of patients who required complex abdominal closure with AlloDerm in a tertiary-care hospital were reviewed from January to December, 2005. For each patient demographic, the reason for urgent surgery, American Society of Anesthesiologists (ASA) class, Acute Physiology and Chronic Health Evaluation (APACHE) II score, serum albumin concentration, culture results of purulent fluid obtained during surgery, and culture results of biopsies of infected-appearing AlloDerm (change of color, delayed granulation, odor) were collected. Data are presented as mean +/- standard error of the mean. RESULTS: Seventeen patients required the use of AlloDerm for tension-free closure of the abdominal wall after surgery for source control in necrotizing fasciitis (13%) or intra-abdominal sepsis (87%). The mean age was 61 +/- 2 years; 73% of the patients were Caucasian, the remainder being African American. The mean APACHE II score was 23.7 +/- 2.0, and the median ASA class was 3. The mean preoperative albumin concentration was 2.27 +/- 0.26 g/dL. Most (76%) of the patients had a wound vacuum-assisted closure system placed over the AlloDerm. Four patients (24%) were noted to have an infection of the AlloDerm graft at 24 +/- 10 days postoperatively. The cultures obtained at operation and from infected AlloDerm show similar organisms (Pseudomonas in two, Escherichia coli and methicillin-resistant Staphylococcus aureus in one each). Infected AlloDerm was coated with silver sulfadiazene and moistened dressings, and all four patients had complete resolution of the AlloDerm infection with an adequate bed of granulation tissue, allowing skin grafting. CONCLUSION: Patients with contaminated abdomens who require complex closure with AlloDerm are at risk of developing infection of their graft material with organisms similar to those present at the time of surgery. Once culture results are obtained, topical antimicrobials with activity against the cultured organisms may be employed as part of the AlloDerm dressings to prevent infection and promote healing.

Alpha-fetoprotein as a tumor marker in hepatocellular carcinoma: investigations in south Indian subjects with hepatotropic virus and aflatoxin etiologies.

OBJECTIVES: The prevalence of hepatitis B virus (HBV) is reportedly the main cause of hepatocellular carcinoma (HCC) in India, where hepatitis C virus (HCV)-associated HCC is believed to be relatively less prevalent. We verified the usefulness of alpha-fetoprotein (AFP) as a tumor marker and analyzed the influence of viral etiology on AFP levels in HCC. METHODS: Of a total of 1012 cases with liver disease, 202 were investigated for the presence of AFP (142 HCC cases, 30 cirrhosis cases, and 30 chronic liver disease (CLD) cases). In addition, serum samples from 30 healthy patients, 30 hepatitis B surface antigen (HBsAg) carriers, and 30 acute viral hepatitis cases were included as controls. AFP was quantitatively determined using a commercial ELISA (Quorum Diagnostics, Canada). Out of the 142 HCC cases screened for AFP, aflatoxin B1 (AFB1) detection was carried out in 38 HCC cases using an in-house immunoperoxidase test. RESULTS: In HBV and HCV co-infected HCC cases, the AFP positivity was 85.7%. In HBV alone-associated HCC, the positivity was 62.9%, and 54.5% of AFB1 positive HCC cases showed AFP positivity. In HBV and HCV negative HCC cases, the positivity was 20.5%, and in HCV-associated HCC it was 17.6%. The HBV/HCV co-infected group and HBV alone positive HCC cases had significantly elevated levels of AFP. When AFP positivity was analyzed based on the marker profile of HBV, 89.7% of AFP positive cases were HBV-DNA positive. CONCLUSIONS: The overall positivity pattern of AFP in HCC does indicate that higher levels of AFP are observed with hepatitis virus positivity, especially with HBV. Further studies must be carried out to correlate the serum levels of AFP with the size, number, and degree of differentiation of HCC nodules.

Prevalence of aflatoxin B1 in liver biopsies of proven hepatocellular carcinoma in India determined by an in-house immunoperoxidase test.

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death in the world. The incidence of HCC in India is reportedly low and varies from 0.2 to 1.9 %. Aflatoxins, secondary metabolites produced by Aspergillus flavus and Aspergillus parasiticus, are potent human carcinogens implicated in HCC. The prevalence of aflatoxin B1 (AFB1) as co-carcinogen was analysed using an in-house immunoperoxidase test in 31 liver biopsies and 7 liver-resection specimens from histopathologically proven HCC, and in 15 liver biopsies from cirrhosis patients (control group). Serum was tested for hepatitis B and C serological markers using commercial assays, and for AFB1 using an in-house ELISA with a sensitivity of approximately 1 ng ml(-1) for AFB1. In spite of positive AFB1 immunostaining in HCC cases, all serum specimens, from both HCC and the control groups, were AFB1-negative. There were 18 (58.1 %) HCC cases that revealed AFB1 in liver biopsies; 68.8 % (n=11) of non-B non-C hepatitis cases with HCC and 46.1 % (n=6) of the hepatitis B surface-antigen-positive subjects were positive for AFB1. Out of the two hepatitis B/hepatitis C virus co-infected cases, one was positive for AFB1. Of seven tumour-resection samples, six were positive for AFB1. Only one case revealed AFB1 in the non-tumour area of the resected material. Thus AFB1 staining was significantly associated with tumour tissue (P=0.03). Aflatoxins proved to have a significant association with HCC in this peninsular part of the subcontinent. The impact seems to be a cumulative process, as revealed by the AFB1 deposits in HCC liver tissue, even though the serum levels were undetectable.

Diagnosis of hepatitis C virus infection by ELISA, RIBA and RT-PCR: a comparative evaluation.

OBJECTIVES: To evaluate the efficacy of second-generation ELISA (ELISA-2), third-generation ELISA (ELISA-3) and third-generation recombinant immunoblot assay (RIBA 3.0) for detection of antibodies to hepatitis C virus (anti-HCV) in comparison with reverse transcriptase-polymerase chain reaction (RT-PCR) to detect HCV RNA for the diagnosis of hepatitis C. METHODS: Sera of 108 patients with chronic liver disease (CLD) were analyzed by ELISA-2, ELISA-3, RIBA 3.0 and RT-PCR in the first part of the study; in the second part, sera of 105 patients with non-chronic liver disease were evaluated with ELISA-3, RIBA 3.0 and RT-PCR. RESULTS: In the CLD group, anti-HCV was positive in 4.6%, 14.8% and 16.6% by ELISA-2, ELISA-3 and RIBA 3.0, respectively. Among these anti-HCV positive cases, HCV RNA was positive in 100%, 58.9% and 64%, respectively. ELISA-2 did not give false-positive results, but missed substantial number of anti-HCV positive cases (p < 0.001). In the second group, anti-HCV was positive in 76.3% by ELISA-3 and 68.6% by RIBA 3.0 (p:ns). HCV-RNA was positive in 88.7% of ELISA- and RIBA-positive cases; in 60% of ELISA-positive, RIBA-indeterminate cases; and in 46.4% of ELISA-negative, RIBA-negative cases. CONCLUSIONS: ELISA-2 is not a suitable assay for routine screening. ELISA-3 was at par with RIBA 3.0 and it can be recommended for routine screening for anti-HCV. RT-PCR for HCV is of value in detecting early viremic, anti-HCV negative cases; this may be of importance in the treatment of hepatitis C.