Relationship between fatty liver, alanine aminotransferase, HBsAg and hepatitis C virus

A community health survey of 923 residents aged 30 years or more was performed in Putai Township of Taiwan. To elucidate the relationships between hepatitis C virus (HCV) and surrogate tests for non-A, non-B hepatitis in hyperendemic areas of hepatitis B virus (HBV) serum levels of alanine aminotransferase (ALT), triglycerides, cholesterol, hepatitis B surface antigen (HBsAg) and antibody to HCV (anti-HCV) were examined. Glucose tolerance tests and the history of diabetes treatment were used to define the diabetes status. Fatty liver was diagnosed by sonography. The prevalence of anti-HCV was 2.6% (95% confidence interval, 1.6-3.6%). Elevated ALT and fatty liver were significantly associated with anti-HCV in univariate analysis. Anti-HCV was not an associated factor for fatty liver after adjusting for serum triglycerides and cholesterol, sex, body mass index and diabetes status through multiple logistic regression. However elevated ALT was still associated with anti-HCV after adjusting for serum triglycerides, sex, body mass index, HBsAg and age through multiple linear regression. The anti-HCV prevalence was similar between HBsAg-positive and negative subjects. Aggregation of HCV infection was found among spouses. It was concluded that elevated ALT and intimate contact with HCV carriers might be associated factors for HCV infection, and that HBV infection and fatty liver were not related to HCV infection in Taiwan.

Clinical utility of pulsed Doppler in the detection of arterioportal shunting in patients with hepatocellular carcinoma

Ninety-seven patients with hepatocellular carcinoma had duplex scanning from the patent or residual portal lumen and comparative angiography. Duplex ultrasonography identified five of nine patients with angiographic evidence of arterioportal shunting. Furthermore, Doppler results indicated the presence of the shunt in one patient without angiographic evidence. Duplex scanning from the portal lumen may be useful in the detection of arterioportal shunting. This procedure can be used to evaluate the hemodynamic change of the recipient portal vein under natural physiologic conditions. However, small shunts without hepatofugal portal blood cannot be detected by this procedure.

The role of hepatitis B and C viruses in hepatocellular carcinoma in a hepatitis B endemic area. A case-control study

To investigate the role of hepatitis B (HBV) and C viruses (HCV) in hepatocellular carcinoma (HCC) in an HBV endemic area and elucidate the interaction of these two viruses, a case-control study of 128 patients with HCC and 384 age-matched and sex-matched control subjects was done. The positive rates of hepatitis B surface antigen (HBsAg, 77.3%, 99 of 128) and anti-HCV (19.5%, 25 of 128) in patients with HCC were significantly higher than in control subjects (P less than 0.001). Both HBsAg and anti-HCV were important risk factors for HCC (relative risks, 13.96 and 27.12, respectively), and the risk for HCC was elevated significantly to 40.05 (95% confidence interval, 12.57 to 127.6) when HBsAg and anti-HCV were considered simultaneously. These results suggested that HBV and HCV were associated highly with HCC in an HBV endemic area and that these two viruses might contribute independent but synergistic effects to the pathogenesis of HCC.

The role of hepatitis B and C viruses in hepatocellular carcinoma in a hepatitis B endemic area. A case-control study

To investigate the role of hepatitis B (HBV) and C viruses (HCV) in hepatocellular carcinoma (HCC) in an HBV endemic area and elucidate the interaction of these two viruses, a case-control study of 128 patients with HCC and 384 age-matched and sex-matched control subjects was done. The positive rates of hepatitis B surface antigen (HBsAg, 77.3%, 99 of 128) and anti-HCV (19.5%, 25 of 128) in patients with HCC were significantly higher than in control subjects (P less than 0.001). Both HBsAg and anti-HCV were important risk factors for HCC (relative risks, 13.96 and 27.12, respectively), and the risk for HCC was elevated significantly to 40.05 (95% confidence interval, 12.57 to 127.6) when HBsAg and anti-HCV were considered simultaneously. These results suggested that HBV and HCV were associated highly with HCC in an HBV endemic area and that these two viruses might contribute independent but synergistic effects to the pathogenesis of HCC.

Duplex pulsed Doppler sonography in the differential diagnosis of hepatocellular carcinoma and other common hepatic tumours

180 previously untreated consecutive patients with liver tumours (308 lesions), including 104 hepatocellular carcinomas (148 lesions), 43 metastases (116 lesions) and 33 haemangiomas (44 lesions), were studied to determine the value of duplex sonography in the differentiation of hepatocellular carcinoma from other tumours. For lesions measuring less than or equal to 5 cm in diameter, hepatocellular carcinoma demonstrated the highest rate and haemangioma demonstrated the lowest rate of Doppler signals from within the lesions. To differentiate malignancy from haemangioma, the presence or absence of Doppler signals from these lesions were used as criteria. The specificity and positive predictive value were very high (100%, 100%), but the sensitivity, negative predictive value and accuracy were low (61.5%, 48.3%, 71.7%, respectively). With one exception, all lesions measuring less than 3 cm in diameter with detectable Doppler signals were hepatocellular carcinoma. Using these results it is possible to differentiate hepatocellular carcinoma from metastases and haemangioma with high sensitivity, specificity, positive and negative predictive value, and accuracy (80.8%, 96.4%, 95.5%, 84.4%, 88.9%, respectively, for metastases; 80.8%, 100%. 100%, 81.5%, 89.6%, respectively, for haemangioma). We conclude that Doppler signals from within a lesion in combination with its size can aid differentiation of hepatocellular carcinoma from two other kinds of common hepatic tumour.

Radiotherapy in the treatment of hepatocellular carcinoma and its metastases

A study was conducted to evaluate the effect of external radiation therapy on hepatocellular carcinoma (HCC) and its metastatic lesions. A total of 33 patients with cytopathologically proven HCC were subjected to radiation therapy over a 4-year period, and treatment was discontinued in 8 cases due to jaundice, severe discomfort, or early mortality. Thus, 25 patients with 28 lesions underwent irradiation with a total dose ranging between 3000 and 5600. Of these, seven were irradiated for liver tumors, and the results showed that two lesions decreased in size, the symptoms improved in 1 case, and another patient maintained stable disease for 4 months. Among the 21 metastatic lesions treated, only 2 patients failed respond to the treatment. Nine subjects were irradiated for bone metastases, and the bone pain subsided in all but one case. The survival for bone metastasis was as long as 23 months when the primary tumor was treated effectively. Three of the four cases of irradiated skin nodules disappeared and had not recurred after 5 months, 1 year, and 4 years, respectively. Tumor shrinkage or symptoms of relief were noted for three abdominal lymph nodes, one neck lymph node, one pleural tumor, and one lung tumor. Clinical improvement associated with a stable lesion was observed in two patients with brain metastasis. Follow-up revealed regrowth of the tumor or recurrence of symptoms in most of the patients. However, none of the patients died as a direct result of a metastatic lesion. Although external radiation therapy is palliative in intent, it appears to be useful in the treatment of HCC and its metastatic lesions.

Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization and analysis of prognostic factors

A total of 100 patients with histologically proven hepatocellular carcinoma (HCC) underwent transcatheter arterial chemoembolization (TACE) and were followed for more than 1 year and 10 months. Portal vein branch thrombosis was diagnosed in 14 patients, and extrahepatic metastasis was noted in 11 subjects. The embolization material used was iodized oil (0.1-0.2 ml/cm tumor area at its maximal diameter), which was prepared by pumping with contrast agent and then mixed with anticancer drugs; Gelfoam particles measuring 1-2 mm in size were subsequently injected. The overall cumulative 0.5- 1-, 2-, and 3-year survival rates were 81%, 57%, 31%, and 21%, respectively. Patients with an intact capsule and those with solitary lesions, especially when the tumor diameter was < 5 cm, achieved a higher survival rate. In contrast, incomplete TACE, extrahepatic metastasis, and portal vein thrombosis were associated with the worst outcome. Patients with positive HBsAG and diffuse or multiple tumors also showed a poor outcome. Early diagnosis and early treatment of HCC are the keys for the achievement of better clinical results.

Duplex pulsed Doppler sonography of hepatocellular carcinoma treated with transcatheter arterial embolization

Thirty-one patients with hepatocellular carcinoma underwent duplex scanning of their lesions with comparative angiography and serum alpha-fetoprotein determinations before and after transcatheter arterial embolization. Duplex ultrasound correctly identified 26 patients with patent tumor vessels after embolization. The Doppler signals became undetectable after embolization in the other five patients. Comparative angiography demonstrated good devascularization of their lesions. However, tiny tumor blush or small satellite nodules around the periphery of the devascularized masses were found. Therefore, the presence of signals after therapy indubitably needs further embolization. The timing of the second embolization for the patient with undetectable Doppler signals after the first embolization needs to be justified by further evaluations.

Duplex pulsed Doppler sonography of portal vein thrombosis in hepatocellular carcinoma

Sixteen patients with hepatocellular carcinoma had duplex pulsed Doppler scanning of the portal thrombus and comparative angiography. Fifteen patients demonstrated detectable Doppler signals from the thrombus. The Doppler signals were corroborated by the "thread-and-streaks" sign on angiography in eight patients. This suggests that signals come from tumor vessels within the thrombus. Therefore, the presence of Doppler signals in the thrombotic portal venous system is not only due to partial obstruction of the lumen. Tumor thrombus from hepatocellular carcinoma must be considered, especially when the detectable signals are pulsatile waves.

Abdominal sonographic screening in a single community

A health survey, on adults aged 30 years or more, was carried out at 3 villages on the southwest coast of Taiwan. A total of 923 cases (42.6%) of the 2,166 population participated in the survey. The estimated total population prevalence rates were as follows: no gross lesion (60.5%), fatty liver (25.2%), biliary stone (5.2%), gall bladder polyp (1.9%), hepatic hemangioma (1.4%), liver cyst (0.9%) and renal cyst (2.9%). The prevalence rates of gall bladder polyp and renal cyst were higher in men, while that of fatty liver was higher in women. There was an increase in the prevalence with age for fatty liver in females. The results might be a reference about the above findings among Chinese in Taiwan.

The effect of pitressin and glypressin in variceal bleeding--a preliminary clinical trial

Effects of hemostatic and various side effects were compared between glypressin and pitressin. Fifty-five episodes of esophageal variceal bleeding in 29 patients were studied. Although the glypressin group included more patients in Pugh's classification C than the pitressin group, the result of hemostasis was not influenced. The effect of hemostasis was evaluated in 24 episodes receiving either glypressin or pitressin. The hemostatic effects of glypressin and pitressin were 6/11, 54.5% and 7/13, 53.8% respectively. Eighteen episodes in six patients, with multiple episodes, were used to observe the effect of these two drugs in the same person. No difference was observed. The number of side effects in the glypressin group and the pitressin group were 5 and 10 respectively. Although the side effects of glypressin might be fewer than those of pitressin, chest pain was observed in patients receiving glypressin treatment. The use of glypressin in the patients with cardiac diseases should be studied further. Glypressin is more convenient in clinical use. However, pitressin doses is easily modified. Both drugs might be selected in the control of variceal bleeding.

Risk factors for gallstones among Chinese in Taiwan. A community sonographic survey

A health survey of adults aged 30 years or more was carried out in southwest Taiwan to determine the prevalence of gallstones and to study risk factors associated with gallstones. Blood samples were collected and abdominal sonographic examination and anthropometric measurements were performed on a total of 923 people. The 40 gallstone cases detected resulted in a prevalence of 4.3%. The risk factors explored included age, sex, hepatitis, obesity, hyperlipidemia, and diabetes mellitus (DM). Age and DM were the only significant factors associated with gallstones in our study. With a reference group of 30-39-year-olds as a comparison, multiple logistic regression analysis showed a trend effect with odds ratios of 1.73, 3.74, and 6.32 for age groups of 40-49, 50-59, and 60 or above, respectively. The odds ratio for DM was as high as 2.59. However, sex, body weight index, chronic hepatitis B, and hyperlipidemia were not significantly associated with gallstones.

Prediction of fatty liver from serum triglyceride levels and body weight indexes

Fatty liver is a common disease in Taiwan. In this study, we tried to evaluate the validity of predicting the presence of fatty liver from clinical data instead of liver biopsy or sonography. From a community survey in Putai, a total of 873 adults older than 30 years and quantified as to triglyceride level, body height, body weight, and the results of the oral glucose tolerance test and upper abdominal sonography were recruited for analysis. Using a receiver operating characteristic (ROC) curve, the best 'cutoff values' for determination of fatty liver were predicted from body weight index and serum triglyceride level in 8 clusters grouped by sex, age and presence or absence of diabetes mellitus. The best cutoff values of triglyceride in the 8 clusters varied from 100 to 170 mg/dl with worse validity. Most of the values were 130 and 140 mg/dl. The cutoff values of body weight index were constant in all clusters and showed greater validity than those for triglyceride. They were 115% or 120%. Their accuracy for the prediction of fatty liver was positively correlated with its prevalence. However, their accuracy was lower than 70% in non-diabetic females. We conclude that body weight index is a good parameter for prediction of fatty liver especially in the high risk groups and we recommend that health-determining cutoff values of serum triglyceride and body weight index should be set at 130 mg/dl and 115%, respectively.

Gastrointestinal tract involvement in hepatocellular carcinoma: clinical, radiological and endoscopic studies

Gastrointestinal tract involvement with hepatocellular carcinoma was observed in 8 out of 396 patients (2%) during the course of the disease. Histological involvement was confirmed in 6 cases. All 8 patients were men. The most common clinical presentation was frank gastrointestinal bleeding, which became evident in all cases. Esophageal varices were not seen in any patient. The sites of involvement were the stomach (3), duodenum (4), and jejunum (1). The median time between the diagnosis of primary tumors and gastrointestinal tract involvement was 4.5 months (range: 0 to 12 months). Hematogenous spread was presumed to have occurred in two patients with diffuse-type hepatocellular carcinoma, one of whom had main portal vein thrombosis. Direct invasion by contiguous neoplasm was the major mode of gastrointestinal tract involvement. This complication is more likely to develop in patients with large, subcapsular, massive type hepatocellular carcinoma treated by transcatheter arterial embolization and/or intra-arterial chemotherapy. The median survival after the diagnosis of gastrointestinal involvement was 1 month (2 weeks-4 months).

Factor analysis for the presence of serum HBV DNA in chronic hepatitis B virus infection

To elucidate the role of HBeAg and other influential factors for the presence of serum HBV DNA and their interactions, serum HBV DNA was examined in 68 patients with chronic HBV infections and 23 HBsAg negative persons by molecular hybridization. Based on the univariate analysis, the positive rate of HBV DNA was higher in patients with HBeAg (31/43, 72.1%) than in patients with anti-HBe (5/22, 22.7%) with an odd ratio of 8.78. The positive rates of HBV DNA between men and women were not significantly different, and the positive rates of HBV DNA were not related to the SGPT levels. The mean age of patients without HBV DNA was higher than that of patients with HBV DNA (p value less than 0.025), and the positive rate and concentration of HBV DNA were decreased with increasing age (p value less than 0.005). The positive rates of serum HBV DNA among different histological changes were not statistically different. However, the discordance of HBV DNA and HBeAg/anti-HBe was increased when the liver parenchymal damage became severe (p less than 0.05). Only 5 patients were anti-D positive and 3 of them had serum HBV DNA. To exclude interactions of the influential factors, multivariate analysis was also performed. HBeAg was the only significant factor for the presence of serum HBV DNA when logistic regression was used (p less than 0.001). The age was an important factor when the concentration of serum HBV DNA was considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Lymphocyte transformation in patients with HBsAg-positive chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma

To evaluate cellular immunity, mitogen-induced lymphocyte transformation was assessed in 146 patients with chronic hepatitis B virus (HBV) infection, including 63 patients with chronic hepatitis (CH), 34 with liver cirrhosis (LC), and 49 patients combined with liver cirrhosis and hepatocellular carcinoma (HCC). The PHA-induced transformation indices (TI) were lower in patients with chronic HBV infection, especially in the LC and the HCC groups. The Con A-induced TI were also diminished in patients with chronic HBV infection. The mitogen-induced TI in patients with CH showed no significant difference in regards to different histological patterns, HBeAg/anti-HBe statuses, sex groups, age distributions, and SGPT levels. However, the mitogen-induced TI were substantially higher in CH patients with elevated serum AFP levels, especially in the group with AFP levels over 100 ng/ml. From these data, we conclude that: (1) impaired PHA-induced TI in patients with LC may partly explain the high risk factor of LC in the occurrence of HCC; (2) the reduction in TI induced by optimal concentration of Con A reflects the defective suppressor cell activity in patients with chronic HBV infection, even in patients with HCC; (3) no significant difference among the control group and patients with chronic HBV infection in PWM-induced TI implies that the response of B cells may be normal in patients with chronic HBV infection; (4) elevated mitogen-induced TI in CH patients with high AFP levels indicate that the activation of lymphocyte may contribute to the severity of inflammation and tissue damage.