scholarly journals Serum level of cytokeratin 19 as a diagnostic and prognostic marker in patients with HCV-related hepatocellular carcinoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maissa El Raziky ◽  
Hanan Abdel Hafez ◽  
Aisha Elsharkawy ◽  
Tarek Ahmed Moneer ◽  
Suzan M. EL-Sheikh ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Clinical Laboratory ◽  
Imaging Techniques ◽  
Intervention Group ◽  
Focal Lesion ◽  
Cytokeratin 19 ◽  
Predictive Values ◽  
Group I ◽  
Significant Difference ◽  
Cirrhotic Patients

Abstract Background The heterogeneous nature of human hepatocellular carcinoma (HCC) impedes both treatment strategies and prognostic predictions. Several markers have been proposed for the diagnosis of HCC. Cytoskeleton-associated proteins have been known as cellular integrators in neoplasm formation. Hepatic progenitor cells are thought to express alpha-fetoprotein (AFP) and hematopoietic as well as biliary markers such as cytokeratin 19 (CK 19) and cytokeratin 7. The aim of this study was to verify the role of serum CK 19 alone or in combination with AFP as a diagnostic marker of HCC and to assess the changes in its levels after ablation of HCV-related HCC to evaluate its role as a predictor marker for recurrence of HCC after ablation. The study was conducted on 102 HCV-related cirrhotic patients categorized into three different groups according to the clinical, laboratory, and radiological evaluation: group I—62 patients with early or intermediate HCC who underwent locoregional intervention, group II—20 patients with advanced HCC not fit for any intervention apart from best supportive treatment, and group III—20 cirrhotic patients with no evidence of HCC as proved by two imaging techniques. Results The mean serum levels of CK 19 were 6.5 ± 5.7, 10.5 ± 12.5, and 6.8 ± 2.8 ng/ml in groups I, II, and III, respectively, with no significant difference between groups. Sensitivity, specificity, positive, and negative predictive values of combined AFP and human CK 19 at cutoff levels of 25.5 ng/ml and 6.25 ng/ml were 93.9%, 45%, 87.5%, and 64.3%, respectively. In group I patients, CK 19 levels were comparable in patients with ablated focal lesion and those who did not at baseline; then, it was significantly higher in ablated patients than in patients with residual tumor 1 and 6 months after the intervention. Conclusions Combination of both AFP and CK 19 levels could increase the diagnostic accuracy of suspected HCCs. CK 19 levels are good predictors of ablation/recurrence in patients who underwent interventional procedures minimizing the need for follow-up imaging modalities.

Study of Toll-like Receptor 3 Gene Polymorphism as a Novel Risk Factor for HCV-related Hepatocellular Carcinoma in Egypt

2020 ◽  
Vol 20 (5) ◽  
pp. 382-389 ◽  
Author(s):  
Shimaa EL-Sharawy ◽  
Osama El- Sayed Negm ◽  
Sherief Abd-Elsalam ◽  
Hesham Ahmed EL-Sorogy ◽  
Mona Ahmed Helmy Shehata
Keyword(s):  
Hepatocellular Carcinoma ◽  
Risk Factor ◽  
Gene Polymorphism ◽  
Clinical Laboratory ◽  
Treatment Options ◽  
Laboratory Evaluation ◽  
Toll Like Receptor ◽  
Focal Lesions ◽  
Tlr3 Gene ◽  
Cirrhotic Patients

Background & Aims: Hepatocellular carcinoma (HCC) is a highly aggressive cancer with few treatment options. Toll-like receptor 3 (TLR3) plays a key role in innate immunity and may affect the development of cancers. This study aimed to investigate the association between TLR3 gene polymorphism and HCV-related hepatocellular carcinoma in Egypt. Methods: This work was conducted on 70 individuals; fifty HCV cirrhotic patients were included in two groups; with HCC (30 patients) and without HCC (20 patients) compared with a group of 20 apparently healthy controls. All of the studied individuals underwent clinical-laboratory evaluation. TLR3 gene single-nucleotide polymorphism (SNP) (+1234C/T) was tested by polymerase chain reaction- restriction fragment length polymorphism. Results: This study reported that the prevalence of TLR3 +1234TT genotype was significantly increased in cirrhotic patients with HCC than without HCC, while it was not detected at all among the controls. When analyzing the TLR3 SNP +1234C/T with different clinical parameters in HCC patients, there was a significant association between+1234C/T SNP; namely TT genotype and each of the hepatic focal lesions᾽ number, size and the patients᾽ higher Okuda and BCLC stages. No association could be detected between TLR3 SNP and the age, sex, Child-Pugh grades, MELD score or AFP of the studied HCC cases. Conclusion: TLR3 gene SN P +1234C/T could be a novel risk factor for the HCV-related HCC among the Egyptian population.

scholarly journals Apparent diffusion coefficient for differentiating between benign and malignant hepatic focal lesions

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Sherif Abugamra ◽  
Aya Yassin ◽  
Asmaa Saber Mostafa Abdel-Rehim ◽  
Dina Sayed Sheha
Keyword(s):  
Hepatocellular Carcinoma ◽  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Focal Lesion ◽  
Benign Lesions ◽  
Focal Lesions ◽  
Significant Difference ◽  
Apparent Diffusion ◽  
Malignant Lesions ◽  
The Mean

Abstract Background The aim of this study was to prospectively evaluate the role of diffusion weight MRI (DWI) in the characterization of hepatic focal lesions by using apparent diffusion coefficient (ADC). Thirty patients (18 women, 12 men; mean age 48.5 years) with hepatic focal lesions were included in this study. Patients underwent DW MR imaging with the SPLICE sequence. ADC of each focal lesion carcinoma was calculated from DW MR Images obtained with low and high b values. ADCs were compared among pathological types of focal lesions. Results Among the 30 patients included in the study, 46 focal lesions were detected. Twenty-four lesions were metastatic lesions from primary cancer, 7 lesions were hepatocellular carcinoma (HCC), 9 lesions were hemangiomas, and 6 lesions were simple cysts. There was highly significant difference between the mean ADC of the malignant lesions (metastasis and HCC) and the mean ADC of benign lesions (hemangiomas and cysts). The ADC of malignant lesion was much less than that of benign lesion. The mean ADC of malignant lesions (n = 31) was 0.73 ± 0.19 × 10−3 mm2/s, and the mean ADC of benign lesions (n = 15) was 1.94 ± 0.68 × 10−3 mm2/s (p value < 0.001). There was no significant difference between the cysts and hemangiomas. There was no statistically significant difference between the metastases and hepatocellular carcinoma. Conclusion ADCs values were able to differentiate benign from malignant lesions. ADC should be considered in the work up of patients with hepatic focal lesions.

scholarly journals The expression of microRNA-331-3p and microRNA-23b3 in Egyptian patients with early-stage hepatocellular carcinoma in hepatitis C-related liver cirrhosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Reham A. Aboelwafa ◽  
Walid Ismail Ellakany ◽  
Marwa A. Gamaleldin ◽  
Marwa A. Saad
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Hepatitis C ◽  
Early Stage ◽  
Group Iii ◽  
Real Time Quantitative Pcr ◽  
Early Stages ◽  
Group I ◽  
Egyptian Patients ◽  
Cirrhotic Patients

Abstract Background Hepatocellular carcinoma and hepatitis C are strongly associated. The current work aimed to study the expression levels of microRNA-331-3p and microRNA-23b-3p as propable biomarkers for detecting liver cancer (HCC) at its early stages in patients with HCV-related liver cirrhosis. The current prospective study included two hundred participants, divided into three groups: group I, 100 patients with HCV-related liver cirrhosis; group II, 50 HCC patients at early stages; and group III, 50 apparentlyhealthy controls. All patients had routine laboratory workup and ultrasound hepatic assessment. Values of microRNA-331-3p and microRNA-23b-3p were measured by real-time quantitative PCR. Results Levels of miR-331-3p were significantly higher in HCC patients than in cirrhotic patients and controls (p < 0.001), while levels of miR-23b-3p were significantly lower in HCC patients compared to cirrhotics and controls (p < 0.001). ROC curve revealed that miR-23b-3p had 80% sensitivity and 74% specificity, miR-331-3p had 66% sensitivity and 61% specificity, and AFP had 64% sensitivity and 61% specificity of 61% in discrimination between HCC patients from controls. Conclusion Serum miR-23b-3p is a more effective predictor than miR-331-3p and AFP for the development of hepatocellular carcinoma in hepatitis C (HCV)-related cirrhotic patients.

scholarly journals Hepatocellular carcinoma in patients undergoing orthotopic liver transplantation: radiological findings with anatomopathological correlation in Brazil

2006 ◽  
Vol 43 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Antônio Carlos Maciel ◽  
Carlos Thadeu Cerski ◽  
Roger Klein Moreira ◽  
Vinicius Labrea Resende ◽  
Maria Lúcia Zanotelli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Orthotopic Liver Transplantation ◽  
Imaging Techniques ◽  
Arterial Phase ◽  
Hepatitis C Virus Infection ◽  
Cirrhotic Patients

BACKGROUND: Hepatocellular carcinoma is one of the most common malignant tumors worldwide. Imaging techniques, specially computed tomography and ultrasound, are among the most useful diagnostic tools, although the accuracy of these methods may have a significant variability. AIMS: To determine the prevalence of hepatocellular carcinoma in cirrhotic patients undergoing orthotopic liver transplantation at "Santa Casa de Misericórdia" of Porto Alegre, RS, Brazil; to estimate the sensitivity of computed tomography and ultrasound in pretransplantation detection of hepatocellular carcinoma in this population; to correlate the radiological characteristics with anatomopathological findings. MATERIALS AND METHODS: Retrospective prevalence study. Population: adult, cirrhotic patients undergoing orthotopic liver transplantation from January 1990 to July 2003. Among the 292 transplanted patients, 31 cases of hepatocellular carcinoma were diagnosed, of which 29 were included in the study. Tumor characteristics in both ultrasound and computed tomography were compared to those observed in anatomopathological examination. RESULTS: Prevalence of hepatitis C virus infection among patients with diagnosis of hepatocellular carcinoma was 93.5%, and the prevalence of hepatocellular carcinoma among transplanted patients was 10.6%. The overall sensitivity of the imaging techniques was 70.3% for computed tomography and 72% for ultrasound. CONCLUSION: The prevalence of hepatocellular carcinoma at our institution, as well as the sensitivity of both ultrasound and computed tomography to detect such tumors at pretransplantation screening were similar to those found by other authors, while the prevalence of hepatitis C virus infection, the most common etiological agent for liver disease in our patients, is one of the highest ever reported in literature. Factors influencing hepatocellular carcinoma detection rates were: time from examination to liver transplantation; acquisition of computed tomography images during arterial phase; lesion size. Arterial phase proved to be the most useful part of computed tomography examination in this study.

Assessment of Safety and Applicability of Laparoscopic vs Open Non Anatomical Resection of Hepatocellular Carcinoma in Cirrhotic Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Mahfouz Mohammed ◽  
Hany Saeed Abdel Basset ◽  
Mohammed Abd Almegeed Elsayed ◽  
Ahmed Abdel Basset Hegazi
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Laparoscopic Liver Resection ◽  
Operative Time ◽  
Short Term ◽  
Open Liver Resection ◽  
Resection Group ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
The Mean

Abstract Background Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Liver surgery was one of the last frontiers reached by minimally invasive surgery. Surgical technique and equipment evolved to overcome technical limitations, making laparoscopic liver resections (LLR) safe and feasible. Surgeons developed skills in a stepwise approach, beginning with low complexity operations for benign diseases and reaching high-complexity surgeries for malignant cases and living donor organ harvesting. Objective s: The aim of the study is to compare short term results of laparoscopic versus open hepatectomy regarding to intra operative details and post-operative management and complications for achieving a safe hepatic resection for treatment of HCC in cirrhotic patients. Patients and Methods In this prospective study, a comparison between laparoscopic resection and open resection was done to compare short-term results between laparoscopic and open liver resection. This study was conducted on 30 patients with hepatocellular carcinoma. 15 patients (50%) were treated by laparoscopic liver resection (Group A) while the other 15 patients (50%) were treated by open liver resection (Group B). Results Regarding the demographic data, the presence of past history of medical condition and the preoperative laboratory results, no statistical significance was found. The mean operative time has statistically significant difference between the 2 groups, with decreased operative time in the laparoscopic group (P &lt; 0.001). The mean blood loss has no statistically significant difference relations between the 2 groups, (P = 0.866) with conversion rate of (13.3%) happened in two cases. Conclusion Laparoscopic liver resection is a safe and feasible treatment option for HCC in cirrhotic patient needing minor resection at laparoscopic segments (II, III, IVa,V,VI). Laparoscopic liver resection for HCC has superior short- term and comparable oncological outcomes to open liver resection. LLR should be performed for carefully selected patients and by an expert surgical team.

scholarly journals Physical methods for the treatment of fever in critically ill patients: a randomized controlled trial

2016 ◽  
Vol 50 (5) ◽  
pp. 823-830 ◽  
Author(s):  
Patrícia de Oliveira Salgado ◽  
Ludmila Christiane Rosa da Silva ◽  
Priscila Marinho Aleixo Silva ◽  
Tânia Couto Machado Chianca
Keyword(s):  
Body Temperature ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Intervention Group ◽  
Tympanic Temperature ◽  
Control Group ◽  
Physical Methods ◽  
Group I ◽  
Significant Difference ◽  
Ice Pack

Abstract OBJECTIVE To evaluate the effects of physical methods of reducing body temperature (ice pack and warm compression) in critically ill patients with fever. METHOD A randomized clinical trial involving 102 adult patients with tympanic temperature ≥ 38.3°C of an infectious focus, and randomized into three groups: Intervention I - ice pack associated with antipyretic; Intervention II - warm compress associated with antipyretic; and Control - antipyretic. Tympanic temperature was measured at 15 minute intervals for 3 hours. The effect of the interventions was evaluated through the Mann-Whitney test and Survival Analysis. "Effect size" calculation was carried out. RESULTS Patients in the intervention groups I and II presented greater reduction in body temperature. The group of patients receiving intervention I presented tympanic temperature below 38.3°C at 45 minutes of monitoring, while the value for control group was lower than 38.3°C starting at 60 minutes, and those who received intervention II had values lower than 38.3°C at 75 minutes of monitoring. CONCLUSION No statistically significant difference was found between the interventions, but with the intervention group I patients showed greater reduction in tympanic temperature compared to the other groups. Brazilian Registry of Clinical Trials: RBR-2k3kbq

scholarly journals Correlation between extraintestinal manifestations and clinical parameters with the histologic activity index in patients with inflammatory bowel diseases

2013 ◽  
Vol 70 (10) ◽  
pp. 947-952
Author(s):  
Milos Stulic ◽  
Djordje Culafic ◽  
Dragana Mijac ◽  
Goran Jankovic ◽  
Ivana Jovicic ◽  
...  
Keyword(s):  
Disease Activity ◽  
Clinical Laboratory ◽  
Inflammatory Diseases ◽  
Activity Index ◽  
Clinical Parameters ◽  
Extraintestinal Manifestations ◽  
Cross Sectional ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Bacground/Aim. Crohn's disease (CD) and ulcerative colitis (UC) are chronic, idiopathic, inflammatory diseases of the digestive tract. The aim of this study was to determine a possible correlation between the clinical parameters of the disease activity degree and the presence of extraintestinal manifestations with disease activity histopathological degree, in patients presented with CD and UC. Methods. This cross-sectional study included 134 patients (67 with CD and UC, respectively) treated at the Clinic of Gastroenterology, Clinical Center of Serbia, Belgrade. After clinical, laboratory, endoscopic, histopathologic and radiologic diagnostics, the patients were divided into two groups according to their histopathological activity. The group I comprised 79 patients whose values of five-grade histopathological activity were less than 5 (45 with CD and 34 with UC), while the group II consisted of 55 patients with the values higher than 5 (22 with CD and 33 with UC). The CD activity index (CDAI) and Truelove and Witts' scale of UC were used for clinical evaluation of the disease activity. Results. CD extraintestinal manifestations were present in 28.9% and 63.6% of the patients in the groups I and II, respectively (p < 0.05). Comparison of the mean CDAI values found a significant difference between these two patients groups (the group I: 190.0 ? 83.0, the group II: 263.4 ? 97.6; p < 0.05). No correlation of extraintestinal manifestations of the disease, Truelove and Witts' scale and histological activity was found in UC patients (p > 0.05). Conclusion. In the patients presented with CD, the extraintestinal manifestations with higher CDAI suggested a higher degree of histopathological activity. On the contrary, in the UC patients, Truelove and Witts' scale and extraintestinal manifestations were not valid predictors of the disease histopathological activity.

Safety of balanced propofol and midazolam in upper gastrointestinal endoscopy for sedation in cirrhotic patients

2020 ◽  
pp. 1-13
Author(s):  
Laima Alam ◽  
Mohammad Asif Khattak ◽  
Mafaza Alam
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Recovery Period ◽  
Hepatic Clearance ◽  
Upper Gastrointestinal Endoscopy ◽  
Patient’S Satisfaction ◽  
Dose Time ◽  
Group I ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
Upper Gastrointestinal

Abstract Objective: Sedation for upper gastrointestinal endoscopy (UGIE) in patients with cirrhosis is theoretically associated with high incidence of adverse events due to low levels of binding proteins and decreased hepatic clearance of drugs. The objective of the study was to assess the safety of combined propofol and midazolam sedation in cirrhotic patients undergoing UGIE. Methods: A total of 500 patients undergoing UGIE were divided in to two groups in a prospective observational study from Jan 1st 2018 to June 30th 2018. Group (I) consisted of cirrhotic patients who underwent the procedure with sedation and Group (II) consisted of non-cirrhotic patients who opted for sedation. The main outcome measurements included vitals monitoring before, during and after procedure, total sedation dose, time to initial and deep sedation, recovery time and complications. Results: There was no significant difference between sedation safety and rate of complications for the cirrhotic and non-cirrhotic patients except for the recovery period during initial 10 minutes. The Modified Aldrete score for the cirrhotic patients was 9.5±0.5 min as compared to 9.8±0.4 min for non-cirrhotic patients (p<0.001) at 10 minutes. Grade 2 hepatic encephalopathy was seen in 0.8% of the cirrhotic patients who required hospitalization for 24 hours. Also balanced sedation was acceptable by the patients and the endoscopists equally with statistically significant scores on endoscopist’s assessment of co-operation and assessment of patient’s satisfaction scores. Continuous...

Accuracy of AASLD guidelines for pre-operative diagnosis of hepatocellular carcinoma in a surgical population.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 198-198
Author(s):  
Edwin Yang ◽  
Hennedige Priyanti Tiffany ◽  
Miaoshan Lim ◽  
Choon Hua Thng ◽  
Pierce K. H. Chow
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatitis B ◽  
Disease Risk ◽  
Imaging Techniques ◽  
High Sensitivity ◽  
Dynamic Imaging ◽  
Endemic Region ◽  
Predictive Values ◽  
Tumor Seeding ◽  
Patient Morbidity

198 Background: The diagnosis of Hepatocellular Carcinoma (HCC) is mainly by dynamic imaging techniques based on guidelines such as that of the American Association for Study of Liver Disease (AASLD). No biopsy is required if criteria in the guidelines are met due to high pre-test probability of disease, risk of tumor seeding and patient morbidity that occurs with invasive liver biopsy. The 2005 AASLD guidelines mandates that there be liver cirrhosis before an imaging diagnosis of HCC can be made. However, updates to the guidelines in 2010 have been expanded to patients with either cirrhosis and/or chronic Hepatitis B carriers. AIM: To compare the sensitivity and positive predictive values of the 2005 and 2010 guidelines in a Hepatitis-B endemic region. Secondary aim: To evaluate proportion of patients who avoided unnecessary biopsies. Methods: A retrospective study of 176 patients from 2006-2010 from a joint cancer service in our centre who had undergone surgical resection for presumptive diagnoses of HCC, were analysed. Their hepatitis status and imaging findings were also examined. Multiphasic CT Liver images were re-examined by 2 oncologic radiologists and the diagnosis of HCC and cirrhosis was only made when there was concordance in opinion. Results: Of all cases, 89.6% of patients were histologically proven HCCs. Sensitivity of detecting cirrhosis on CT was 83.2% with an accuracy of 81.5%. Sensitivity of diagnosis based on the 2010 and 2005 guidelines were 58.1% and 57.4% respectively. When the sensitivities of the previous vs revised guidelines were compared using Mcnemar’s Test, the 2010 guidelines showed a 24.6% increase in sensitivity (p < 0.05). 4.65% more cases avoided unneeded biopsies when applying the 2010 criteria. Conclusions: Diagnosis of HCC under the 2005 AASLD guidelines were based on the pre-operative diagnosis of cirrhosis which in this centre, was of high sensitivity and accuracy. The increase in the sensitivity of diagnosing HCC in the 2010 criteria may reduce the need for invasive biopsy and likelihood for tumor seeding.

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