الفهرس 
HEPATOCELLULAR CARCINOMAOnly 14 pages are availabe for public view
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Abstract
Transarterial embolization (TAE) remains a common treatment option in unresectable patients with hepatocellular cancer (HCC); for the purpose of palliation however no standard protocols for pre- and post-procedure care have been devised. Specifically, the role of antibiotic prophylaxis against infection has not been evaluated. Generally, the use of antibiotics has been left to the discretion of the proceduralist, with the use hypothesized to reduce TAE associated liver abscess, but no supporting data exists for this practice.
The aim of this work was to compare 3 different groups of prophylactic antibiotics commonly used in patients undergoing TACE to find the group that gives better results in preventing occurrence of infections post-TACE and to compare the efficacy of intravenous versus oral route of administration of these prophylactic antibiotics.
This study was conducted on, 180 patients with proved HCC eligible for treatment with TACE selected from all patients presented to Tropical Medicine Department and Outpatient Hepatoma Clinic for early detection of hepatic tumor, Ain Shams University Hospitals, from May 2010 till March 2011. The study protocol was approved by the Investigation and Ethics Committee of our hospital.
Included patients were classified into 3 groups:
Group 1: included 60 HCC patients; 30 patients received intravenous third generation cephalosporin; ceftriaxone 1 gm vial I.V. every 24 hours, one day before intervention and for 4 days afterwards and the other 30 patients received oral third generation cephalosporin; cefixime 400 mg cap PO every 24 hours one day before intervention and for 4 days afterwards.
Group 2: included 60 HCC patients; 30 patients received intravenous levofloxacin 500 mg/100 mL vial I.V. every 24 hours one day before intervention and for 4 days afterwards and the other 30 patients received oral levofloxacin 500 mg tab PO every 24 hours one day before intervention and for 4 days afterwards.
Group 3: included 60 HCC patients; 30 patients received intravenous ciprofloxacin 200 mg/100 mL vial I.V. every 12 hours one day before intervention and for 4 days afterwards and the other 30 patients received oral ciprofloxacin 500 mg tab PO every 12 hours one day before intervention and for 4 days afterwards.
Patients in all groups were subjected to full history taking, thorough clinical examination and laboratory investigations including (complete blood picture, liver function tests, kidney function, hepatitis viral markers and alfa fetoprotein) together with abdominal ultrasonography (US) and triphasic spiral computed tomography (CT).
The day after intervention and on day 5 post-procedure, the following laboratory parameters were repeated: Complete blood picture with differential count, C-reactive protein titre, ESR, Liver function tests and Renal function tests.
After one month of the treatment, a final assessment was also done: Complete blood picture with differential count, C-reactive protein titre, ESR, Liver function tests, Renal function tests and alfa fetoprotein.
This study revealed that the percentage of males (85%) was higher than that of females (15%) in all studied groups, the age of patients ranged from 36 to 72 years (56.57), 94.4% of patients were seropositive for HCV-Ab and 3.3% of patients were seropositive for HbsAg and 2.2% were positive for both HBV and HCV infections.
In our study, the group of ciprofloxacin gave better results than those of third generation cephalosporin and those of levofloxacin when comparing the 3 groups regarding total WBC count, differential count and CRP level. And also, no significant difference was found between the oral and intravenous routes among the 3 groups. None of the studied patients developed liver abscess or any other infection after TACE.
This mean that use of either ciprofloxacin , third generation cephalosporin or levofloxacin is effective in preventing infection after TACE .
In this study, there were 14 patients (7.7%) who suffered from manifestations of liver cell failure in the form of rising billirubin level, elevated liver enzymes, low albumin values and prolonged prothrombin time. The laboratory parameters in most of these patients returned back to near pre-procedure levels after 2 to 3 weeks and no mortality was recorded. None of those patients developed symptoms or signs of hepatic encephalopathy.