Introduction: Malignant ascites results from imbalance between protein in the peritoneal cavity and absorption of fluids via the lymphatic system. More than twenty interleukins are known to play an important role in the protection against tumors. Materials and methods: Ascitic fluid IL1B, IL2, IL4, IL6, IL10, TNFα, and IFNγ levels were assessed in forty-five patients with liver cirrhosis and ascites as judged by histopathological and ultra-sonographic findings. They were divided into two groups according to presence of hepatic focal lesions. Ten patients with focal hepatic lesions were randomly selected and subjected to analysis of serum levels of IL2 and IL10. Results: Ascitic fluid IL-4, IL-6 and IL-10 levels were found to be significantly higher in patients with hepatocellular carcinoma than patients with cirrhosis. TNFα, and IFNγ were also found to be higher in hepatocellular carcinoma than patients with cirrhosis but with no significance. On the other hand, there was no significant difference in levels of IL1B and IL2 between the two groups. Ascitic fluid IL2 and IL10 levels were found to be higher in ascitic fluid than in serum of the same patients. Conclusion: Ascitic fluid levels of IL-4, IL-6 and IL-10 are higher in hepatocellular carcinoma patients than patients with cirrhosis alone. Levels of ascitic fluid IL2 and IL10 were proved to be a better prognostic tool than their levels in sera of the same patients. To conclude; patients with cirrhosis may be subjected to schedualed examination of ascitic fluid cytokine to predect transformation into hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is a highly lethal malignancy and clinically validated medications have not yet been developed since there are no reliable diagnostic and prognostic biomarkers. Based on bioinformatics tools, TGF-b1 gene was the first target gene of miRNA-122, therefore this study was intended to assess the potential interconnection between TGF-b1 and miRNA-122 as a diagnostic and prognostic biomarker in the progression of HCC in patients with chronic hepatitis C (CHC) genotype (4). In this study, 100 people were included and split into two groups; group I: CHC patients without HCC that were classified into patients CHC without cirrhosis and CHC cirrhotic patients, group II: CHC patients with HCC, and healthy volunteers as control. The expression of miRNA-122 and TGF-b1 genes were analyzed using Real-Time PCR. An upregulation of miRNA-122 gene in cirrhotic and HCC patients compared to both chronic HCV non-cirrhotic, and cirrhotic patients, while, a decrease in expression of TGF-b1 was found in cirrhotic patients compared to HCV non-cirrhotic patients. Although significantly downregulated in HCC patients. Regression analysis indicated that the expression levels of miRNA-122 and TGF-b1 could be regarded as important indicators of the alterations in cirrhotic and HCC patients versus HCV non-cirrhotic patients, also with the chances of HCC versus cirrhosis patients. Our data indicated an interaction between miRNA-122 and TGF-b1, regulated gene expression and recommended the use of these parameters as noninvasive predictive biomarkers and therapeutic targets for HCV induced liver cirrhosis and HCC.

Background: Post-ERCP pancreatitis (PEP) has been the most frequent complication of Endoscopic Retrograde Cholangiopancreatography (ERCP). It has been documented to happen after 5–30% of ERCP procedures. PEP is new or exacerbated abdominal pain associated with a serum lipase or amylase concentration which is more than three times the upper limit of normal at 24 hours post-ERCP, requiring at least two days of prolongation of the planned admission. Following pancreatic sphincterotomy, pancreatic stenting is commonly used with the objective of decreasing both early restenosis and post-ERCP pancreatitis. Aim of the work: Evaluation of the pancreatic stenting technique as a preventive measure against post ERCP pancreatitis in calcular obstructive jaundice patients with difficult cannulation. Patients and methods: Forty Egyptian patients with calcular biliary obstruction with a difficult biliary cannulation who are at risk of developing PEP enrolled in a prospective randomized controlled comparative study. Group A: 20 patients with manipulation of pancreatic duct by guidewire without pancreatic stent insertion; Group B: 20 patients with manipulation of pancreatic duct by guidewire with pancreatic stent insertion.Results: The pancreatic duct stenting technique had reduced the risk of PEP significantly in calcular biliary obstruction patients with difficult CBD cannulation to 20?% (in group B) compared with 60?% in (group A).Conclusion: Prophylactic pancreatic stenting technique is a simple and easy procedure that showed to be efficient in decreasing cases of post ERCP pancreatitis in difficult cannulation patients. The endoscopists should be trained to practice the procedure safely.

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