A seroepidemiological study of hepatitis C virus (HCV) in an area with a high prevalence of chronic liver disease in the Kyushu district of Japan

Portal Vein Embolization Followed by Right-Side Hemihepatectomy for Hepatocellular Carcinoma Patients: A Japanese Multi-Institutional Study

BACKGROUND

Portal vein embolization (PVE) is useful to expand the indications of major hepatectomy; however, its oncologic effects are not fully understood. This study aimed to confirm the efficacy of preoperative PVE for hepatocellular carcinoma patients.

STUDY DESIGN

Between 2000 and 2012, five hundred and ten patients with hepatocellular carcinoma undergoing right-side hemihepatectomy were enrolled (PVE group, n = 162 and non-PVE group, n = 348). To equalize background factors, one-to-one propensity case-matched analysis and multivariate analysis were performed. Short- and long-term outcomes were evaluated.

RESULTS

Propensity score-matched patients, 148 in each group, were selected. The percentage of resected liver volume on admission was significantly greater in the PVE group (60.5% vs 48.3%; p < 0.001), but decreased considerably after PVE, from 60.5% to 50.3% (p < 0.001). The 5-year cumulative recurrence-free survival (36.4% vs 35.3%) and overall survival (58.6% vs 52.8%) rates were comparable. Extrahepatic recurrences were less common in the PVE group (18.1% vs 38.8%; p = 0.004). Independent prognostic factors for recurrence-free survival were morbidity (hazard ratio [HR] = 1.56), multiple tumors (HR = 1.97), red cell concentrate administration (HR = 1.57), older age (HR = 2.09), and massive portal invasion (HR = 2.33); and those for overall survival were morbidity (HR = 2.37), multiple tumors (HR = 1.71), and massive hepatic venous invasion (HR = 3.49).

CONCLUSIONS

Even though hepatocellular carcinoma patients who underwent preoperative PVE and right-side hemihepatectomy had a significantly larger resected liver volume on admission, they have a comparable long-term prognosis as patients with up front hepatectomy. In addition, PVE might decrease extrahepatic recurrences.

A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt

BACKGROUND

The hepatitis C pandemic has been systematically studied and characterized in North America and Europe, but this important public health problem has not received equivalent attention in other regions.

AIM

The objective of this systematic review was to characterize hepatitis C virus (HCV) epidemiology in selected countries of Asia, Australia and Egypt, i.e. in a geographical area inhabited by over 40% of the global population.

METHODOLOGY

Data references were identified through indexed journals and non-indexed sources. In this work, 7770 articles were reviewed and 690 were selected based on their relevance.

RESULTS

We estimated that 49.3-64.0 million adults in Asia, Australia and Egypt are anti-HCV positive. China alone has more HCV infections than all of Europe or the Americas. While most countries had prevalence rates from 1 to 2% we documented several with relatively high prevalence rates, including Egypt (15%), Pakistan (4.7%) and Taiwan (4.4%). Nosocomial infection, blood transfusion (before screening) and injection drug use were identified as common risk factors in the region. Genotype 1 was common in Australia, China, Taiwan and other countries in North Asia, while genotype 6 was found in Vietnam and other Southeast Asian countries. In India and Pakistan genotype 3 was predominant, while genotype 4 was found in Middle Eastern countries such as Egypt, Saudi Arabia and Syria.

CONCLUSION

We recommend implementation of surveillance systems to guide effective public health policy that may lead to the eventual curtailment of the spread of this pandemic infection.

Cerebrospinal fluid atypical lymphocytes in Japanese encephalitis

Among atypical lymphocytes (AL) examined morphologically and immunohistochemically in the cerebrospinal fluid (CSF) of adult patients with encephalitis, we distinguished a CD4+ 'type I' AL, with a multilobulated nucleus resembling those of the abnormal cells in adult T-cell leukemia (ATL), from a CD8+ 'type II' AL, a large lymphocyte with basophilic cytoplasm and a nucleus containing coarse chromatin. Type I AL were detected in 7 of 8 patients with Japanese encephalitis (JE), but in none of 11 patients with herpes simplex encephalitis (HSE) and none of 19 patients with unspecified acute viral encephalitis. Type II AL were seen frequently in all three groups. The observation of type I AL in CSF strongly suggests JE, which warrants careful follow-up without antiherpetic drugs. In identifying type I AL, which presumably are virally transformed lymphocytes, care must be taken to distinguish them from leukemic involvement by ATL cells, which frequently includes the meninges. Both type I and type II AL also must be differentiated from lymphoma cells.