Mohammed Mahmoud Nabeel

Background and study aims: The well-known complications of variceal bleeding together with the high
mortality rate mandate effective prophylaxis. Because of the intolerance, failure of response and lack
of compliance related to B blockers and because of the high incidence of variceal recurrence after endoscopic
variceal ligation (EVL), other alternatives should be investigated. As APC provides coagulation at a
shallow depth, it has been considered an ideal procedure to promote mucosal fibrosis for oesophageal
varices. This study aims to investigate the safety and effectiveness of APC application to the oesophagus
post-variceal obliteration in an attempt to decrease variceal recurrence and bleeding, as compared to EVL.
Patients and methods: This study included 60 patients with chronic liver disease and portal hypertension
referred to the Gastrointestinal Endoscopy Unit, Kasr Al-Aini Hospital, Cairo University, during the period
from August 2008 till January 2010. Patients had to have large-sized varices (F3), without history of
bleeding, portal hypotensive drugs or intervention.
Patients were allocated into either group I that included 30 patients for whom EVL was performed and
sequentially followed by one session of APC or group II that included 30 patients for whom EVL alone was
done. Patients underwent surveillance endoscopy at 3 and 6 months to evaluate variceal recurrence (F1
or more).
Results: Both groups were comparable in terms of the demographic features, hepatic functional reserve
and endoscopic findings. Post-APC, fever was reported in 6.7%, dysphagia in 3.3%, procedure-related
bleeding in 0% and stricture in 3.3%. At 3 and 6 months follow-up, both groups were comparable in terms
of variceal recurrence and none of the patients in both groups developed variceal bleeding.
Conclusion: Although, APC application to the oesophageal mucosa is a safe technique, its additive benefit
in terms of variceal recurrence and re-bleeding is comparable to EVL alone. This is encountered when
only a single session of APC is applied. A more beneficial effect of multiple sessions of APC awaits further
studies.

Human mesenchymal stem cells (hMSCs) are mostly studied for their potential clinical use. Little is known about the underlying molecular mechanisms that link hMSCs to the targeted inhibition of tumor cells. The present study was conducted to evaluate the tumor suppressive effects of human mesenchymal stem cells (hMSCs) on human hepatoma cell line (HepG2) and their signaling mechanisms. To fulfill this objective, the influence of hMSCs on genes concerned with apoptosis, mitogenesis as well as on the proliferation of HepG2 cell line was investigated using either hMSCs-conditioned or using hMSCs and HepG2 co-culture conditioned media. Cell survival was evaluated using cell proliferation (MTT) assay kit. Gene expression of survivin, proliferating cell nuclear antigen (PCNA), β-Catenin, telomerase and VEGF was assessed by real time reverse transcription-polymerase chain reaction (RT-PCR). HpG2 cells cultured with either hMSCs-conditioned media or with hMSCs&HepG2 co-culture conditioned media showed decreased proliferation and decreased expression of survivin, PCNA, β-Catenin and telomerase. However, both media had increased expression of VEGF. Treatment of HepG2 cells by either hMSCs conditioned media or by hMSCs and HepG2 co-culture condition media led to a significant decrease in cell proliferation and down regulation of genes concerned with antiapoptosis, mitogenesis, and cell proliferation. This indicates that hMSCs can suppress tumorigenesis through factors produced in their conditioned media.

Background and study aims: Gastrointestinal endoscopy is an invasive technique and it may be associated with a risk of bacteraemia, especially if endoscopy is associated with an intervention such as injection sclerotherapy or band ligation. The aim of the work is to investigate the incidence of bacteraemia following elective elastic band ligation and elective injection sclerotherapy in cirrhotic patients. Patients and methods: Our study included 80 cirrhotic patients with grade III–IV oesophageal varices divided into three groups: 30 patients treated with elective injection sclerotherapy, 30 patients treated with elective band ligation and 20 patients underwent diagnostic upper endoscopy and served as control. All patients were subjected to full clinical evaluation, abdominal ultrasonography and lab investigations, including blood culture before and after the endoscopic procedure. Results: No positive blood cultures were detected before the technique. Seven patients (8.75%) had positive blood culture after endoscopy; six of them (20%) were in the injection sclerotherapy group, one patient (3.33%) in the band ligation group and none in the upper endoscopy group. Positive blood culture was more frequent in Child C patients (four patients) compared to Child B (two patients) and Child A patients (one patient) with statistically significant difference. Three types of micro-organisms were isolated: Acinetobacter, alpha haemolytic streptococci and coagulase negative staphylococci. Conclusion: The rate of bacteraemia is higher in the injection sclerotherapy group compared with the band ligation group, especially in Child C patients.

Background and study aims: One of the potential strategies to increase the efficacy of RFA is to modulate
the biologic environment of the treated tissues. Several investigators have studied increasing RFA heating
by combining intra-tumoral injections of different concentrations of sodium chloride with RFA. The aim
of this study is to assess the enhancing effect of normal saline (NS) on radiofrequency ablation (RFA) of
hepatocellular carcinoma (HCC) using a cool-tip needle.
Patients and methods: This study included 40 patients with HCC (proved by histopathology or combined
spiral CT and elevated alpha-fetoprotein). They were randomly divided into two groups (20 patients in
each group). The first group was treated with RFA preceded by intra-tumoral normal saline injection
(RFA + S); the second group was treated with RFA only (RFA).
Results: The procedure was successful in all patients (100%) of the RFA + S group and in 11 (55%) of the
RFA group (as proved by spiral CT or pathology). This difference between the two procedures was statistically
highly significant (P = <0.01). No major complications occurred in either group.
Conclusions: Combined RFA and normal saline is more effective than RFA alone. Considering the reduced
cost and wide availability of isotonic saline together with the easy performance of the intra-tumoral
injection, the dramatic improvement in therapeutic effect of RFA to 100% could be a breakthrough in
future strategies to modernize the RFA technique.