Clinical evaluation of the automated COBAS AMPLICOR HCV MONITOR test version 2.0 for quantifying serum hepatitis C virus RNA and comparison to the quantiplex HCV version 2.0 test

A second-generation hepatitis C virus (HCV) quantitative assay (COBAS AMPLICOR HCV MONITOR Test, version 2.0; COBAS HCM-2) has been developed, with the intention of achieving equivalent quantification of all HCV genotypes and improving assay performance. To evaluate the clinical performance of COBAS HCM-2 and its utility in predicting the response to alpha interferon treatment, sera from 215 chronic hepatitis C patients were analyzed and the results were compared with those obtained by the Quantiplex bDNA HCV RNA, version 2.0, assay (bDNA-2). The COBAS HCM-2 had significantly greater sensitivity than bDNA-2 (94.9 versus 88.4%; P < 0.001) when performed with sera from chronic hepatitis C patients who were viremic by a qualitative PCR test. The standard deviations for the within-run and between-run reproducibilities of COBAS HCM-2 were <0. 1 and <0.2, respectively, and it showed an improved linear range between genotypes with the threefold serial dilutions tested (r(2) = 0.986 to 0.995). The COBAS HCM-2 results were positively correlated with the bDNA-2 results, but the values for COBAS HCM-2 were on average 0.96 log lower than the values for bDNA-2. The mean difference in quantification values between these two assays did not differ among samples with different genotypes (0.70 to 1.00 log). No genotype-dependent difference in viral load was observed. The pretreatment viral load was significantly lower in complete responders. By using multivariate analysis, the viral load 2 weeks after the initiation of alpha interferon treatment was the strongest predictor of a complete response. In conclusion, COBAS HCM-2 demonstrated good sensitivity, linearity, and reproducibility and efficiency equal to that of bDNA-2 for the quantification of HCV genotypes 1 and 2. Hence, this assay provides a rapid and reliable method for the quantification of HCV RNA in serum and is useful for the planning of interferon treatment.

Percutaneous ethanol injection of the supplying artery to hepatocellular carcinoma that is not amenable to conventional treatment

The purpose of this study was to evaluate the clinical usefulness of ultrasound-guided percutaneous ethanol injection of the supplying artery (PEISA) to the tumour in the palliative management of hepatocellular carcinoma (HCC) that is not amenable to conventional treatments. A total of 23 cases of HCC, measuring from 3.1 cm to larger than 15 cm (median 5.4 cm) in 17 cirrhotic patients, were treated by PEISA. PEISA was used to control rapid growth of the tumour in seven patients and to reduce abdominal discomfort caused by rapid expansion of the tumour in 10 patients. Tumours with arterial Doppler signals persisting after PEISA underwent repeated treatment. The follow-up period ranged from 2-48 months. PEISA was achieved in 69 out of 76 attempts (90.8%). The amount of ethanol injected on each occasion ranged from 2.5-33 ml. Follow-up colour Doppler scanning showed complete elimination of tumour Doppler signals in 22 out of 23 lesions (95.7%). Following treatment, one tumour disappeared, 13 tumours shrank and nine tumours were unchanged in size. All patients with abdominal discomfort had relief after treatment. The common complications of PEISA were local pain and fever. In conclusion, PEISA is effective at treating painful HCC unsuitable for conventional treatment.

Serotyping and genotyping of hepatitis C virus in Taiwanese patients with type C chronic liver disease and uraemic patients on maintenance haemodialysis

BACKGROUND

To evaluate a recombinant immunoblot hepatitis C virus (HCV) serotyping assay, which determines HCV serotypes 1, 2, and 3 by detecting type-specific antibodies to core-and NS-4-derived peptides.

METHODS

Immunoreactivity of type-specific antibodies among 173 chronic hepatitis C patients and 43 haemodialysis patients in Taiwan was examined and the serotyping results were compared with genotyping by Okamoto's method. Serial specimens from 29 patients undergoing interferon-alpha therapy were also evaluated.

RESULTS

Of the 205 specimens for which genotyping data were available, 51.2% were of serotype 1, 31.7% of serotype 2, 1.0% of serotype 3, 2.4% of either serotype 1 or 3, and the remaining 13.7% were untypable. The serotypable rate was significantly lower in haemodialysis patients than in chronic hepatitis C patients (70.0% vs 94.9%; P < 0.001). Serotyping of genotype 2b specimens was significantly more dependent on core peptide bands than other genotypes. Using genotyping as the reference, the overall sensitivity, specificity and concordance of the recombinant immunoblot HCV serotyping assay were 86.3%, 97.2% and 83.9%, respectively. However, the serotyping assay had significantly lower sensitivity (69.2%), specificity (77.8%) and concordance (53.8%) for genotype 2b specimens. Of nine HCV complete responders, one lost type-specific antibodies 6 months after the cessation of interferon-alpha treatment.

CONCLUSIONS

These results suggest that, except for less than optimal performance with immunocompromised or genotype 2b patients, the HCV serotyping assay is a practical and useful method for HCV typing in the clinical setting in Taiwan.

Virologic factors related to interferon-alpha-induced thyroid dysfunction in patients with chronic hepatitis C

OBJECTIVE

Hepatitis C virus (HCV), being reported to be associated with a high prevalence of serological markers of autoimmunity in HCV-infected patients, and possibly sharing partial sequences in amino acid segments with thyroid tissue antigens, may be associated with interferon-alpha (IFN-alpha)-induced thyroid dysfunction in chronic hepatitis C patients. We conducted this study to clarify the issue.

DESIGN AND METHODS

One hundred and fifty chronic hepatitis C patients with normal baseline thyroid function were treated with IFN-alpha 2a, 2b and n1 (3-6 million Units three times weekly for 24 weeks). Pretreatment sera were tested for HCV genotype and HCV RNA levels. Serum thyrotropin, total thyroxine and free thyroxine index were performed every 4 weeks for 24 weeks followed by every 8 weeks for another 24 weeks.

RESULTS

Twenty-one (14.0%) patients developed early thyroid dysfunction (abnormal thyroid function during the first 3 months of therapy). Female gender, lower HCV RNA levels, IFN-alpha n1 and a lower IFN-alpha dose were significantly associated with early thyroid dysfunction. On multivariate analysis, gender, IFN-alpha preparation and HCV RNA levels were the significant factors associated with early thyroid dysfunction. Seven (4.7%) patients developed thyroid dysfunction during the second 3 months of IFN-alpha therapy. Taken together, 18.7% patients developed thyroid dysfunction. Female, mixed HCV genotype infection and lower HCV RNA levels were significantly associated with thyroid dysfunction. However, only gender remained significantly associated with IFN-alpha-induced thyroid dysfunction in multivariate analysis.

CONCLUSIONS

The virologic features of HCV may be associated with thyroid dysfunction in chronic hepatitis C patients treated with IFN-alpha. Nevertheless, gender still plays the most important role in IFN-alpha-induced thyroid dysfunction.

An NMR and molecular modeling study of the site-specific binding of histamine by heparin, chemically modified heparin, and heparin-derived oligosaccharides

The diprotonated form of histamine binds site-specifically to heparin, a highly sulfated 1-->4 linked repeating copolymer comprised predominantly of 2-O-sulfo-alpha-L-iduronic acid (the I ring) and 2-deoxy-2-sulfamido-6-O-sulfo-alpha-D-glucopyranosyl (the A ring). The binding is mediated by electrostatic interactions. The structural features of histamine and heparin, which are required for the site-specific binding, have been identified from the results of (1)H NMR studies of the binding of histamine by six heparin-derived oligosaccharides and four chemically modified heparins and molecular modeling studies. The results indicate that the imidazolium ring of diprotonated histamine is critical for directing site-specific binding, while the ammonium group increases the binding affinity. The imidazolium ring binds within a cleft, with the A ring of an IAI triad at the top of the cleft, and the I rings forming the two sides. The H3 proton of the A ring is in the shielding cone of the imidazolium ring. The carboxylate group of the I-ring at the reducing end of the IAI triad and possibly the sulfamido group of the A-ring are essential for site-specific binding, whereas the 2-O-sulfate group of the I ring and the 6-O-sulfate group of the A ring are not. The results indicate that histamine binds to the IAI triad with the I rings in the (1)C(4) conformation. Also, the configuration of the carboxylate group is critical, as indicated by the absence of site-specific binding of histamine by the related IAG sequence, where G is alpha-D-glucuronic acid. The molecular modeling results indicate that the N1H and N3H protons of the imidazolium ring of site-specifically bound histamine are hydrogen bonded to the carboxylates of the I rings at the nonreducing and reducing ends of the IAI trisaccharide sequence.

Interaction of heparin with a synthetic pentadecapeptide from the C-terminal heparin-binding domain of fibronectin

The synthetic pentadecapeptide FN-C/H II (KNNQKSEPLIGRKKT-NH(2)) has the sequence of the carboxy-terminal heparin-binding domain of module III(14) of fibronectin. Interaction of FN-C/H II with bovine lung heparin has been studied by (1)H and (23)Na NMR spectroscopy and by heparin affinity chromatography. FN-C/H II binds to heparin from pD <2 up to pD approximately 10; at higher pD, the binding decreases as the lysine side-chain ammonium groups are titrated. Na(+) counterions are displaced from the counterion condensation volume that surrounds sodium heparinate by FN-C/H II, which provides direct evidence that the binding involves electrostatic interactions. The pK(A) values for each of the five ammonium groups of FN-C/H II increase upon binding to heparin which, together with chemical shift data, indicates that the binding involves both delocalized and direct electrostatic interactions between ammonium groups of FN-C/H II and carboxylate and/or sulfate groups of heparin. NMR data also provide evidence for the direct interaction of the guanidinium group of the arginine side chain with anionic sites on heparin. The affinity of heparin for FN-C/H II and for 13 analogue peptides in which lysine and arginine residues were systematically substituted with alanine increases as the number of basic residues increases. The relative contribution of each lysine and arginine to the affinity of heparin for FN-C/H II is R(12) > K(13) > K(14) > K(1) > K(5). Nuclear Overhauser enhancement (NOE) data indicate that, while FN-C/H II is largely unstructured in aqueous solution, the bound peptide interconverts among overlapping, turn-like conformations over the L(9) - T(15) segment of the peptide. NOE data for the interaction of FN-C/H II with a heparin-derived hexasaccharide, together with the number of Na(+) ions displaced from heparin by FN-C/H II as determined by (23)Na NMR, indicates that the peptide binds to a hexasaccharide segment of heparin. Identical NMR and heparin affinity chromatography results were obtained for the interaction of FN-C/H II and its D-amino acid analogue peptide with heparin, which is of interest for the potential use of peptides as therapeutic agents for diseases in which cell adhesion plays a critical role.

Role of serum C-reactive protein as a marker of hepatocellular carcinoma in patients with cirrhosis

BACKGROUND

The usefulness of C-reactive protein (CRP) as a tumour marker in patients with hepatocellular carcinoma (HCC) is controversial. The purpose of this study was to determine whether CRP estimation could be used to identify patients with HCC among those with cirrhosis.

METHODS

Serum levels of CRP and alpha-fetoprotein (AFP) were investigated in 122 previously untreated patients with cirrhosis and HCC. Another 76 patients with cirrhosis alone were also investigated as controls.

RESULTS

Of the subjects tested, 47.5% of patients with HCC and 39.5% of controls had elevated CRP values (> 6 microg/mL). Although using elevated CRP and/or AFP (> 20 ng/mL) as a criterion showed a significant difference between controls and patients with multiple nodular, massive, or diffuse type HCC (all P < 0.005), the clinical application of this criterion was limited because of low specificity (58%) and accuracy (all < 73%). By using receiver-operating characteristic curves no valuable threshold value of CRP was found to discriminate various types of HCC, except for distinguishing the diffuse type from controls. The CRP value of 12 microg/mL could be used as the cut-off value to differentiate diffuse-type HCC from controls (sensitivity 82.4%, specificity 82%, accuracy 82.1%, P<0.005).

CONCLUSIONS

Serum CRP is not a good marker for HCC. However, very high values of CRP in patients with cirrhosis may suggest the presence of a diffuse-type HCC.

Potential role of Armigeres subalbatus (Diptera: Culicidae) in the transmission of Japanese encephalitis virus in the absence of rice culture on Liu-chiu islet, Taiwan

Mosquitoes known to be involved in the transmission of Japanese encephalitis virus (JE) on Taiwan typically develop in rice fields. However, recent serological evidence indicated that JE virus was being transmitted on Liu-Chiu, a rice-free islet. To identify the mosquito vector in this unusual epidemiological situation, 4 mosquito species commonly found in Liu-Chiu were evaluated for their vector competence for a strain of JE (CH1392) virus isolated from central Taiwan. Armigeres subalbatus (Coquillett) was the most susceptible species, indicating its status as a potential vector. In addition, an isolate of JE (T1P1) virus from Ar. subalbatus collected on Liu-Chiu readily infected the salivary glands of orally infected Ar. subalbatus originating from Liu-Chiu. The infection rate reached 79% (11/14) after a 20-d period of extrinsic incubation at 28 degrees C. We conclude that JE likely was transmitted between vertebrate hosts by Ar. subalbatus in this rice-free islet and that this species should be considered as a potential vector in similar ecological conditions.

Clinical application of the Quantiplex HCV RNA 2.0 and Amplicor HCV Monitor assays for quantifying serum hepatitis C virus RNA

AIM

To compare the performance characteristics and clinical application of two different technologies for quantifying serum hepatitis C virus (HCV) RNA levels.

METHODS

HCV RNA was quantified by Amplicor HCV Monitor assay (Amplicor) and Quantiplex HCV RNA 2.0 assay (bDNA-2) in 119 sera from 107 HCV infected patients.

RESULTS

Both assays had similar sensitivity (79.4% for Amplicor; 86.0% for bDNA-2), acceptable coefficients of variation (5.3% in Amplicor; 2.6% in bDNA-2), and good linearity (r2 > or = 0.98). There was a positive correlation between quantification values of both methods (r = 0.683, p < 0.001). The Amplicor values were on an average 1.76 log lower than bDNA-2 results. Male subjects and HCV genotype 1b were significantly associated with higher viral load determined by Amplicor, but not with viral load measured by bDNA-2. In 70 chronic HCV infected patients treated with interferon alfa, mean (SD) pretreatment viral load in 27 complete responders (3.47 (0.84) logs for Amplicor, 5.63 (0.58) for bDNA-2) was significantly lower than in non-responders (4.43 (1.01) logs for Amplicor, 6.10 (0.67) logs for bDNA-2; p < 0.001). Cut off points of 3.9 logs for Amplicor and 5.8 logs for bDNA-2 were determined to be the best for predicting response to interferon alfa, giving acceptable sensitivity (70.4%, 74.1%), specificity (72.1%, 65.1%), and accuracy (71.4%, 68.6%), respectively.

CONCLUSIONS

Both the Amplicor and bDNA-2 assays are clinically useful methods for HCV RNA quantification and are reliable for predicting the outcome of treatment, despite differences in absolute quantification values and in the correlation between HCV genotypes and viral load.

Tissue damage and regeneration of ureteric smooth muscle in rats with obstructive uropathy

OBJECTIVE

To investigate regeneration in obstructed ureters and to elucidate the role of hyperplasia in the thickening of the smooth muscle layer in the late stages of complete ureteric obstruction.

MATERIALS AND METHODS

The expression of Ki-67 antigen, c-Fos, c-Jun and c-Myc in the smooth muscle layer of obstructed ureters was determined using immunohistochemistry in 40 Sprague-Dawley rats. After unilateral ligation of the ureter, five rats each were killed for examination at 1, 3, 7, 10, 14, 21, 28 and 42 days after ligation: dive rats that underwent a sham operation were also examined as controls.

RESULTS

The severity of hydroureter and thickening of the smooth muscle layer progressed consistently in the ligated ureters, but no mitosis was detected in myocytes within 14 days of ligation. Fibrosis in the smooth muscle layer appeared 21 days after ligation and progressed. There was no expression of Ki-67 antigen and oncoproteins until 14 days after ligation. The expression of Ki-67 and c-Myc increased gradually to a peak after 28 days, then declined. However, the expression of c-Fos and c-Jun was low and transient.

CONCLUSION

Cell regeneration is impaired in the damaged muscle layer of obstructed ureters. Only hypertrophy and not hyperplasia of the smooth muscle layer developed during the course of complete ureteric obstruction in this rat model of obstructive uropathy.

The two different states of hepatitis B virus DNA in asymptomatic carriers: HBe-antigen-positive versus anti-HBe-positive asymptomatic carriers

During the course of hepatitis B virus (HBV) infection, there exists a long period of normal liver function tests with different states of HBeAg/Ab. As the state of HBV in asymptomatic carriers was not well characterized, we quantitatively and qualitatively examined HBV in both HBeAg-positive and anti-HBe-positive asymptomatic carriers. Sera from 10 HBeAg-positive and 27 anti-HBe-positive asymptomatic carriers were analyzed. The amount of HBV DNA was determined by dot-blot hybridization and polymerase chain reaction. The mutations in precore and core regions, spanning 636 nucleotides, of hepatitis B virus were examined by directly sequencing the amplified HBV DNA. HBV DNA was detected in all 10 HBeAg-positive cases, whereas it was found in only 7 of 27 (26%) anti-HBe-positive cases by the nested PCR method. The mean amount of HBV DNA in HBeAg-positive cases was 10(9.1 +/- 0.7) copies/ml, while that in anti-HBe-positive cases was 10(1.0 +/- 1.5) copies/ml. There were no missense mutations in the entire precore and core genes of HBV DNA taken from HBeAg-positive asymptomatic carriers. In contrast, many mutations (mean 9.0 +/- 3.3, range 6-14) were detected in the core gene of seven anti-HBe-positive asymptomatic carriers including two cases with increments of the mutations. Analysis of the precore region revealed three wild-type and four mutant-type (including one coexisting with wild-type) cases. These data suggest that HBV exists in quite different ways in "asymptomatic" carriers; in the HBeAg-positive phase HBV probably coexists with the host and remains as the wild type, whereas in the anti-HBe-positive phase a drastically reduced amount of HBV with many mutations remains, probably as a consequence of the long-lasting interaction with the host. Nevertheless, such small amount of virus could cause fulminant hepatic failure. It is important to make further clinical and virological investigations in order to understand the state of asymptomatic carrier.

Prevalence and manifestations of hepatitis C seropositivity in children in an endemic area

BACKGROUND

According to our previous studies, Paisha Township in Penghu Islets is an endemic area for hepatitis B virus and hepatitis C virus (HCV) infection and for hepatocellular carcinoma. We conducted this study to understand the prevalence of anti-HCV seropositivity among children in this area and to observe clinical manifestations of anti-HCV-positive children.

METHODS

In March, 1994, 1164 (93.6%) of 1243 students from all 6 kindergartens, 9 primary schools and 3 middle schools in Paisha Township participated in the screening for anti-HCV by enzyme immunoassay with second generation commercial kits (Abbott EIA 2.0). Anti-HCV tests were duplicated for the positive sera in 2 laboratories. All anti-HCV-positive children were followed annually for 2 years.

RESULTS

The prevalences of children from kindergartens (ages 3 to 6 years), primary schools (ages 7 to 12 years) and middle schools (ages 13 to 15 years) were 0% (0 of 229), 0.8% (5 of 617) and 1.9% (6 of 318), respectively. Initially the optic density (OD) values of anti-HCV were > 2.0 in 4 cases (36%), between 1.0 and 2.0 in 2 cases, and < 1.0 in the other 5 cases. None had sonographic parenchymal changes in the liver. In the 2-year follow-up of the anti-HCV-positive subjects, type 2a HCV-RNA persisted in 3 of 4 children with an OD of anti-HCV more than 2.0; 2 of them had 2 elevations of alanine transaminase values. Four of 7 children with an OD of 2.0 or less had a decrease in OD values in the follow-up examinations, and 2 of them became anti-HCV-negative.

CONCLUSION

Only 36% (4 of 11) of anti-HCV-positive children had an OD of > 2.0. Subjects with sequentially low OD might recover from chronic HCV infection without detectable HCV RNA and with normal alanine aminotransferase values.

Early genetic and cellular responses in the smooth muscle layer of obstructed ureters in a rat model of obstructive uropathy

OBJECTIVE

To investigate the early genetic and cellular responses in the smooth muscle layer of completely obstructed ureters, and to determine whether myocytes proliferate (hyperplasia) in the ureters during the early stage of obstructive uropathy.

MATERIALS AND METHODS

The study comprised 35 female Sprague-Dawley rats which had undergone unilateral ligation of their ureters. After ureteric ligation, five rats each were killed and examined at 0.5, 1, 2, 4, 8, 16 and 24 h after ligation. The proximal portion of the ureters was prepared for light and electron microscopy. The expression of c-Fos, c-Jun, c-Myc and Ki-67 antigen was assessed immunohistochemically.

RESULTS

c-Fos and c-Jun were detected 2 h after ligation and the expression of these two proteins reached a maximum after 4 h, becoming undetectable 16 h after ligation. The expressions of c-Fos and c-Jun were strongly correlated (r = 0.9854, P < 0.001). The expressions were of c-Myc and Ki-67 antigen was not detected within 24 h after ureteric ligation. The amount of rough endoplasmic reticulum (rER) in the ligated ureters increased soon after complete ligation and the increase continued throughout the period of ureteric obstruction (r = 0.9699, P < 0.001). The change in rER was also significantly correlated with the expression of c-Fos and c-Jun within 8 h after ligation.

CONCLUSION

The expression of c-Fos and c-Jun, but not c-Myc, might contribute to the hypertrophy of the ureteric smooth muscle layer during the course of complete ureteric obstruction. There is no hyperplasia in ureteric smooth muscle in the early stages of obstructive uropathy.

Changes of hepatitis B markers among young adults in a hepatitis B virus endemic area: a follow up study on medical students

To elucidate the hepatitis B virus (HBV) infection status of teenagers, to observe changes of the status of these young adults after long-term follow up, to clarify the HBV replication activity of young HBsAg carriers, and to understand the anti-HBs titer of those immune to HBV-infection, a comparison between two health examinations at a 5-or 6-year interval was conducted among 132 medical students. Their ages were 19.1 +/- 0.9 (mean +/- SD). There were 19 (14.4%) HBsAg carriers, 57 (43.2%) immune to HBV infection, and 56 (42.4%) susceptible to HBV. All 19 HBsAg positive carriers were still in carrier status in the second examination. Twelve (63.1%) of the HBV carriers had already HBeAg negative seroconversion before the age of 25. And two carriers might be in the late e seroconversion phase. One susceptible student had a subclinical HBV infection during his university life, with an incidence of HBV infection of 0.47% (1/213) per person-year. Nine (11%) of 82 HBV-immune students had lower anti-HBs concentrations. Six of the 9 students were immunized by natural infection. Anamnestic response developed after booster vaccination. This study shows that these young adults have an HBsAg-carrier rate similar to the general adult population in Taiwan. However, HBeAg seroconversion occurs more often and earlier in this particular population than previous reports have indicated. Moreover, only 24 (40%) susceptible subjects received HBV vaccination after the first recommendation and it is necessary to be more forceful in recommending prompt vaccination.

Hepatic focal nodular hyperplasia: findings on color Doppler ultrasound

BACKGROUND

We assessed the color Doppler ultrasound (US) findings in focal nodular hyperplasia (FNH).

METHODS

Seven FNH lesions were imaged with color Doppler US and hepatic angiography.

RESULTS

In four lesions, color Doppler demonstrated a central stellate vascular appearance which correlated with central feeding artery with spoke-wheel sign angiographically. Except for one lesion, color Doppler US imaging correlated with angiographic findings.

CONCLUSIONS

Color Doppler US is capable of demonstrating the typical findings of a central feeding artery and stellate vascular pattern in many cases of FNH.

Influence of furosemide on the ureteric damage in a rat model of obstructive uropathy

Furosemide has been used in the diuretic renography and diuretic radionuclide scan to evaluate the severity of hydroureter and hydronephrosis. To elucidate the influence of furosemide on obstructed ureters, unilateral ligation of ureter was performed in 45 rats. Twenty-four of the rats received intramuscular injections of furosemide (6 mg/kg/day) after the third day postligation. Eight rats were sacrificed for examination on days 7, 10 and 14 after ligation, respectively. The remaining 21 untreated rats were also sacrificed for comparison. The severity of hydroureter and hydronephrosis in the ligated side of the furosemide-treated rats was significantly higher than that of the untreated rats. However, the histological changes in the treated and untreated rats showed no significant difference. The ultrastructural alterations aggravated along the course of ureteric obstruction. Intriguingly, the ultrastructural changes were significantly milder in the treated rats. We conclude that the administration of furosemide might increase the severity of hydroureter, but it does not accelerate the ureteric damage of the obstructed ureters.

Clinical utility of color Doppler sonography in the differentiation of hepatocellular carcinoma from metastases and hemangioma

The clinical utility of color Doppler sonography in the differentiation of hepatocellular carcinoma from metastases and hemangioma was investigated in 72 hepatocellular carcinomas (80 lesions), 30 metastases (82 lesions), and 39 hemangiomas (54 lesions). Overlaps of color patterns were found among hepatocellular carcinoma, metastases and hemangioma. Pulsatile waves from lesions with the basket, vessels within tumor, or spot patterns, or lesions measuring less than 3 cm with detectable signals, did not favor the diagnosis of hemangioma. In conclusion, color Doppler sonography can aid in the differentiation of hepatocellular carcinoma from hemangioma but may be unreliable in the differentiation of hepatocellular carcinoma from hypervascular metastases.

The genotypes of hepatitis C virus in patients with chronic hepatitis C virus infection in southern Taiwan

To investigate the genotype distribution of hepatitis C virus (HCV) in southern Taiwan, the sera from 56 patients with chronic HCV infection were studied. Twenty-nine patients were men and 27 were women. Age ranged from 22 to 65 years (mean, 47.3 +/- 11.4). Eighteen of them had chronic persistent hepatitis, 27 had chronic active hepatitis, and 11 had liver cirrhosis. HCV RNA was detected by reverse transcription-nested polymerase chain reaction using primers derived from the 5'-noncoding region. The genotypes of HCV were determined by amplification of the core region with the type-specific primers as described by Okamoto et al.. All sera were positive for HCV RNA. The prevalence rates of genotypes were as follows: 1b/II, 44.6%(25/56); 2a/III, 41.1%(23/56); 2b/IV, 3.6%(2/56); mixed 1b/I + 2a/III, 5.4%(3/56): mixed 1b/II + 2b/IV, 1.8%(1/56) and type unclassified 3.6%(2/56). The distribution of genotypes was not related to the patients' age, sex, and histological changes. Nevertheless, patients having past history of blood transfusion had a significantly higher rate of HCV type 2a/III infection (72.2% versus 34.2%, p < .05, chi-square test). We concluded that both of the HCV genotypes 1 b/II and 2a/III are predominant types in southern Taiwan and regional HCV genotype distribution may differ even within this island. Selective transmission of specific genotypes may pass along different infectious routes.

Treatment of chronic hepatitis C with interferon-alpha: a preliminary report

Interferon alpha (IFN-alpha) has been indicated to be dramatically effective in some but not all patients with chronic hepatitis C virus (HCV) infection. We investigated prospectively 27 patients of chronic hepatitis C, 12 females and 15 males, treated with IFN-alpha for a better regimen of the therapy and for any effective predictor of response to the treatment. All patients were treated with 3 to 6 million units (MU) of recombinant IFN-alpha 2b (n = 15) or lymphoblastoid IFN-alpha (n = 12) given 3 times weekly for 12 to 36 weeks. Patients with normal alanine aminotransferase (ALT) value during therapy, who sustained this response throughout 6 months follow-up after treatment was completed, were grouped into the complete responders. Patients with normal ALT value during therapy but who relapsed after treatment completed, were grouped as partial responders. Non-responders were defined as patients without normal ALT value during therapy. The rates of complete response, partial response, and non-response were 29.6%, 40.8%, and 29.6%, respectively. The degree of response to IFN-alpha therapy was not related to age, sex, type of IFN-alpha, history of blood transfusion, the state of liver pathology, or pretreatment level of ALT value. The complete responsive rate to IFN-alpha was higher in patients treated with total dose above 215 MU [38.1% (8/21) vs. 0% (0/6), p = 0.06], in patients treated for at least 24 weeks [40% (8/20) vs. 0% (0/7), p < 0.05], and in patients with non-genotype 1b/II HCV infection [40% (8/20) vs. 0% (0/7), p < 0.05]. We concluded that IFN-alpha was effective in the treatment of chronic HCV infection, particularly in those other than HCV genotype 1b/II. A high-dose, and long-duration regimen may be recommended for better response of chronic hepatitis C to IFN-alpha therapy.

Changes in intrahepatic portal hemodynamic in early stage hepatic abscesses

Color Doppler sonography was used to investigate the changes in intrahepatic portal hemodynamics in early stage hepatic abscesses (21 lesions). At time of patients' admission, 10 lesions measuring over 6 cm showed reverse flow from at least one of their corresponding segmental portal branches, but 11 lesions measuring 6 cm or less did not show this phenomenon. All portal branches with reverse flow eventually returned to a normal direction of flow after successful medication. In conclusion, a large early stage hepatic abscess may show temporary reverse portal flow on color imaging. Thus, a differential diagnosis of hepatic tumors with reverse portal flow should include early stage hepatic abscesses.

The status of serum hepatitis B virus DNA in HBSAG-positive hepatocellular carcinoma

To elucidate the status of serum hepatitis B virus (HBV) DNA in HBsAg-positive hepatocellular carcinoma (HCC), 100 type B chronic liver disease (CLD) patients and 19 HCC patients were studied. The positive rate of serum HBV DNA in HBeAg-positive CLD patients was significantly higher than that in HBeAg-negative CLD patients, and the correlation between the presence of serum HBV DNA and patients' age showed a negative trend. In contrast, the positive rates of serum HBV DNA in HCC patients were not related to the status of HBeAg and age, and the positive rate of serum HBV DNA in HBeAg-negative HCC patients was significantly higher than that in HBeAg-negative CLD patients. Nevertheless, the serum concentrations of HBV DNA in HCC patients were significantly lower than those in CLD patients. These results suggest that replication of HBV in HCC patients might differ from that in CLD patients, and that persistent low-level HBV replication might be related to the presence of HCC.

Longitudinal study of intrahepatic portal flow: a novel approach using Doppler technique

The present study investigates whether the application of the summation of portal blood flow (SPBF), measured from the left umbilical portion and the right anterior branch by Doppler, could be of use in the longitudinal study of intrahepatic portal flow or not. Forty-five subjects were divided into two groups. Group I subjects included males and post-menopausal females. Thirty-seven subjects (19 normal volunteers, 12 subjects with chronic hepatitis, six cirrhotics) were investigated by the more experienced doctor A at 9 day intervals for an intra-observer study. Among them, seven subjects (four normal volunteers, three with chronic hepatitis) were also investigated consecutively at 10 min apart by doctor B on days 1 and 10 for an interobserver study. Group II subjects included eight normal subjects with a regular menstrual cycle. They were investigated by doctor A during menstruation, mid-follicular, ovulatory and mid-luteal phases of the menstrual cycle to evaluate the possible impact of the menstrual cycle on SPBF measurement. The reproducibility of measurements was assessed by the coefficient of variation (CV) and the reproducibility coefficient. Data are expressed as mean +/- s.d. The CV of the SPBF for intra-observer and interobserver study were 4.88 +/- 3.36 and 4.19 +/- 2.53, respectively. All differences of SPBF were within their corresponding reproducibility limits. The results of SPBF measurements obtained from different phases of the menstrual cycle were variable. Only the comparison between the data obtained from mid-follicular and mid-luteal phases could demonstrate acceptable CV values (3.98 +/- 3.12%) and all the differences in SPBF measurements were within the repeatability limit. In conclusion, Doppler SPBF measurement may be useful in the longitudinal evaluation of intrahepatic portal flow changes.

Treatment of hepatocellular carcinoma smaller than 5 cm by transcatheter arterial chemoembolization

To assess the effectiveness of transcatheter arterial chemoembolization (TACE) in the treatment of small hepatocellular carcinoma (HCC) and to analyze the prognostic factors, a total of 77 patients with histologically proven HCC, < or = 5 cm in diameter, were enrolled for the study and followed for more than 2 years, The overall cumulative 1-, 2-, and 3-year survival rates were 79.2%, 50.6% and 36.7%, respectively. The median survival time of Child-Pugh's A patients was 990 +/- 146 days, which was significantly better than the median survival time of Child-Pugh's B patients (450 +/- 82 days) Furthermore, positive HBeAg and alpha-Fetoprotein (AFP) were factors close to statistically significant. In contrast, sex, age, HBsAg, Anti-HCV, tumor type, tumor size and tumor number were not related to the prognosis in small HCC who received TACE.

Percutaneous intravascular ethanol injection of the supplying tumor vessel in the treatment of hepatocellular carcinoma larger than 3 cm

Percutaneous intravascular ethanol injection of the supplying vessel of the tumor using color Doppler imaging was performed in three patients (three lesions) with hepatocellular carcinoma measuring more than 3 cm. Intravascular injection was achieved in six out ot seven attempts. The total amount of ethanol injected intravascularly was small (10, 15,0 and 26 ml for each patient). One attempt failed and the ethanol was injected perivascularly. No serious complication was noted. After treatment, two patients showed remarkable decrease in tumor size and one showed massive tumor necrosis. In conclusion, ethanol injection using the intravascular approach may be of value in the palliative management of large hepatocellular carcinomas.