INTRODUCTIONWorldwide, hepatocellular carcinoma (HCC) is graded sixth in incidence and third in mortality among all cancers.1 Chronic viral hepatitis B and C account for 80-90% of all HCC cases being major risk factors.2 In Egypt, HCV infection causes up to 40-50% of HCC cases. The overall 5-year survival rate of HCC is 5-9% from the time of diagnosis and 69% for patients undergoing hepatectomy, especially for early detected tumor which is a single nodule below 2 cm. The dismal prognosis is largely due to late detection. 3 Early detection of HCC by ABSTRACT Background: Hepatocellular carcinoma (HCC) is the third cause of cancer-related death worldwide. Heat Shock protein 60 (HSP60), a mitochondrial chaperone, is overexpressed in diverse malignant cells. Chromatin Assembly Factor-1 (CAF-1), a histone chaperone, is down-regulated in quiescent non-proliferating human cells. We aimed to clarify the role of HSP60 and CAF-1 mRNA expression in diagnosis of HCC post-HCV infection. Methods: HSP60 and CAF-1 mRNA levels in urine and blood were quantified by Taqman real-time PCR in 49 subjects; 25 cirrhotic with HCV-related HCC, 12 cirrhotic without HCC and 12 healthy controls. Results: HSP60 and CAF-1 mRNA levels in urine and blood were significantly higher in HCC versus cirrhosis and controls, and in cirrhosis versus controls. Their levels in HCC were significantly increased by advancement of HCC BCLC staging system. HSP60 in urine had 85% sensitivity and 66% specificity at cut off 258354 RU and 85% sensitivity and 60 % specificity at cut off 37576 RU in blood for HCC diagnosis. CAF-1 in urine had 81% sensitivity and 66% specificity at cut off 137756 RU and 77% sensitivity and 64% specificity at cut off 49726 RU in blood for HCC diagnosis. HSP60/CAF-1 sensitivity and specificity in urine and blood were better than either marker alone, with better results in urine (91% and 73%, respectively) than blood (88% and 66%, respectively). Conclusions: HSP60 and CAF-1 in urine and blood may be useful HCC diagnostic markers that were correlated with advancement of HCC with better combined marker sensitivity and specificity than either marker alone especially for urine.

Portal hypertensive gastropathy(PHG) is a complication of portal hypertension and considered one of the causes of upper gasterointestinal bleeding. Helicobacter pylori as one of the most common pathogenic organism worldwide because it infects 50% of the population all over the world. The role of H. Pylori infection in the development of PHG and its severity is controversal. The aim of this study is to determine the frequency of H. pylori infection in cirrhotic patients with PHG and to find out the possible association of H. pylori infection with PHG severity. This study was carried out on 90 patient with cirrhotic liver, divided into two groups according to prescence or absence of PHG diagnosed by upper endoscopy. H.Pylori infection was significantly more frequent in patients with PHG than patients without PHG. H.Pylori infection was significantly more frequent in patients with sever PHG than patients with mild PHG .Splenomegaly, presence of esophageal varices, gastric varices and H.Pylori infection are independent predictors for PHG presence.

Background and study aim : Portal hypertension is one of the most important complications of liver cirrhosis. Endoscopic screening of all patients with liver cirrhosis would result in a large number of unnecessary additional burden to endoscopic units. This study is designed to assess insulin resistance in cirrhotic patients due to hepatitis C infection as non invasive parameter for esophageal varices. Patients and Methods :This study was conducted on 50 cirrhotic patients (Child A) post hepatitis C who attended the Hepatology Department and outpatient clinic at Shebein El Kom Teaching Hospital. All the patients were evaluated by thorough history ,clinical examination, biochemical parameters ,metabolic features, including insulin resistance by the homeostasis model assessment (HOMA), ultrasonongraphy , liver biopsy and upper gastrointestinal endoscopy to search for esophageal varices. Results : EVs (esophageal varices) were detected in 18 of 50 patients. By multivariate analysis ,the presence of EVs was independently associated with a low platelet count/spleen diameter ratio (562.75 + 99.16) , a high HOMA-IR score (5.49 + 0.754), high body mass index , low hemoglobin, low albumin, high alanine aminotransferase and high aspartate aminotransferase. Conclusion: Insulin resistance in patients with Hepatitis C virus cirrhosis (Child A) measured by HOMA-IR score significantly predicts the presence esophageal varices in this patients and can be used as non-invasive parameter for predicting esophageal varices.