الفهرس 
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Abstract
Hepatocellular carcinoma (HCC) is a major health problem. The incidence of HCC is increasing and it is becoming more and more significant both clinically and epidemiologically. Now HCC represents the fifth most common cancer in the world and the third most frequent cause of mortality amongst oncological patients, accounting for an estimated 600,000 deaths annually.
According to the World Health Organization (WHO), the burden of HCC is expected to continue to increase until 2030, and the incidence and mortality rates for HCC are virtually identical, reflecting the overall poor survival of patients with this tumor.
HCC generally develops in cirrhotic livers. The various underlying chronic liver diseases that result in cirrhosis have a variable incidence of HCC development. Viral hepatitis B and C (HBV, HCV) are among the most frequent causes of HCC worldwide.
HCC very rarely develops in patients with normal liver histology (without liver cirrhosis).
Since HCC is a disease with a very poor prognosis due to resistance to conventional chemotherapy, and mostly diagnosed at an advanced stage when most potentially curative therapies are of limited efficacy, close follow-up of patients with cirrhosis is important in order to detect HCC at an early stage. Early detection enables us to provide the patient with the most optimal therapy.
Serotonin is formed in the body from exogenous L- tryptophan. The process of serotonin synthesis occurs in the gastrointestinal (GI) tract, central and peripheral nervous system, and immune system cells.
Summary
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The GI tract is the largest source of serotonin. Approximately 90% of total serotonin is found there and is synthesized mainly in the enterochromaffin cells.
The liver plays an important part in serotonin metabolism. Hepatocytes contain enzymes maintaining the specific metabolism of some amino acids and serotonin precursors t promotes the increase in portal pressure aggravating edema and inflammation of the liver which complicate the course of chronic hepatitis and cirrhosis of the liver, in addition to its function as a neurotransmitter and vascular active molecule, serotonin is also a mitogen for hepatocytes and promotes liver regeneration. A possible role in hepatocellular carcinoma has not yet been investigated.Aim of this study is is to assess the serotonin blood level in patients with hepatocellular carcinoma .
The present study was conducted on 68 cases of hepatocellular carcinoma patients. In addition 20 apparently healthy subjects matching age and gender were selected as a control group.
Patients were selected from out patient clinic of Menoufia University Hospital. All members of the study were subjected to: thorough history taking, complete physical examination and investigations including complete blood count, ALT, AST, serum albumin, serum bilirubin, prothrombin time, serum urea, blood creatinine, abdominal ultrasound , alphafetoprotein , triphasic CT of the liver and serotonin blood level .
Statistical analysis of the results of the present study revealed the following points:
no significant difference between HCC group and controls with regard age and gender.
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WBCs was significantly higher in HCC group than controls and plateletes are significantly lower in HCC group than controls but there was no significant difference between HCC group and controls are regard hemoglobin level
Total bilirubin is significantly higher in HCC patients than controls ,albumin is significantly lower in HCC patients than controls, prothrmbin time , AST, ALT are significantly higher in HCC group than controls
Level of Alphafeto protein was significant higher in HCC group than in control
Level of serotonin was significant higher in HCC patients than controls
Patients with HCC and metastasis has serotonin level higher than HCC alone.
Sertonin level was significantly higher in cirrhotic patient child score C than in child A , B, There was no significant difference between child A and B with regard level of serotonin .
There was a significant positive correlation between serotonin level and AFP, total bilirubin, prothrombin time, spleen size, portal vein diameter, Child-Pugh score and MELD score. There was a significant negative correlation between serotonin level and blood urea . There was no correlation between serotonin level and age, albumin, AST, ALT, creatinine, haemoglobin, WBCs, platletes, number of focal lesions , size of tumor.