The Prognosis of Liver Cirrhosis in Recent Years in Korea

The survival of a recent series of 823 cirrhosis patients who were followed up for a mean of 48 months was analyzed. Cirrhosis was ascribed to alcohol (26%), hepatitis virus B (58%), hepatitis virus C (11%) or both (2%), or was cryptogenic (3%). Features of decompensation were observed in 51% of the patients at entry, and newly developed in 44% of compensated patients within 5 yr. The 5-yr survival after decompensation was 25%. The leading causes of death were liver failure (53%), hepatocellular carcinoma (HCC, 23%), and variceal bleeding (10%). Early detection of HCC significantly improved the survival of cirrhosis patients. Biannual ultrasonography increased the detection rate of small HCC. Mortality of variceal hemorrhage was much lower in patients with Child-Pugh scores from 5 to 8 than in those with scores above 8 (5% vs. 52%). Endoscopic prophylaxis significantly decreased the incidence of first variceal hemorrhage, but the effect was insufficient to improve the rate of survival. Mortality of first spontaneous bacterial peritonitis was 18%. These data suggest that the mortality of major complications of liver cirrhosis has considerably decreased during the last two decades, while there was no remarkable improvement in long-term survival. More efficient management of etiologic factors would be required.

An Immunohistochemical study of the origin and differentiation of gastric stromal tumor / 대한내과학회지

BACKGROUND: Gastrointestinal stromal tumors (GISTs) have the subject of debate and controversy regarding their histogenesis, criteria on malignancy, prognostic features, site-specificity and their nomenclature. These tumors have various phenotypical features and are generally divided into (1) tumors showing differentiation toward smooth muscle cells (2) tumors showing apparent differentiation toward neural elements (3) tumors showing dual differentiation toward smooth muscle and neural elements (4) tumors lacking differentiation toward either cell type (uncommitted type). This study was performed to identify the possible origin and differentiation of gastric stromal tumor. METHODS: This study was performed on 38 patients who had gastric stromal tumors on endoscopy or endoscopic ultrasonography and confirmed by endoscopic or surgical resection between January 1994 and June 1999 at Department of Internal Medicine, Korea University College of Medicine. Formalin-fixed, paraffin-embedded tissues were studied by immunohistochemical method for detecting the presence of CD 34, CD 117, Vimentin, SMA, Desmin, S-100, PGP 9.5 and NSE. RESULTS: The patients' age ranged from 26 to 81 years old, with an average age of 53.8 years. The male to female ratio was 1:1.2. Endoscopic resections were performed on 22 patients and surgical operations on 16 patients. The average tumor size was 25.3 mm in diameter. On immunohistochemical staining method, the uncommitted type was found in 18 patients (47.4%), of which 17 patients (94.4%) were CD117 (+), CD34 (+), Vimentin (+), 12 patients (31.6%) had muscular differentiation, 7 patients (18.4%) showed neural differentiation and 1 patient (2.6%) showed differentiation toward both neural and muscular immunohistochemical pattern. CONCLUSION : Gastric stromal tumors showed phenotypical diversity in immunohistochemical staining suggesting different histogenesis. Most uncommitted type had a phenotype of intersititial cells of Cajal (ICC) and this evidence supports the hypothesis that uncommitted type has the origin of ICC.

The Effect of Lamivudine in Chronic Liver Disease associated with Hepatitis B Virus / 대한간학회지

BACKGROUND/AIMS: Lamivudine has demonstrated a potent suppression of viral replication and a substantial histologic improvement in many patients with chronic hepatitis B. This study is intended to evaluate the effects of lamivudine and the breakthrough rate in patients with HBV associated chronic liver diseases including decompensated liver cirrhosis, and to investigate the clinical factors closely related with these events. METHODS: A total of 58 patients(chronic hepatitis 21, cirrhosis 37) showing abnormal serum levels of aminotransferase and detectable serum HBV DNA for at least 6 month received 150 mg of lamivudine once a day for 3-27 months (median 13). The Kaplan-Meier methods and the Cox regression model were used for statistic analysis. RESULTS: The one-year cumulative incidences of the negative conversion of serum HBV DNA, normalization of aminotransferase, and seroconversion of HBeAg were 98.3%, 86.2% and 20.6%, respectively. Eighteen-month and 2-year cumulative breakthrough rates were 24% and 47%, respectively. The Child-Pugh scores were improved (p<0.001) in patients with decompensated liver cirrhoses(n=21). The negative conversion of HBV DNA, breakthrough rates and seroconversion were not significantly associated with the progression of disease, mutation in pre-core region and previous treatment with interferon. The pre-treatment aspartate aminotransferase (AST) level was associated with a higher rate of seroconversion(p<0.03). CONCLUSION: Despite a higher breakthrough rate, 2-year lamivudine treatment has induced the seroconversion of HBeAg in 26% of patients, and improved the clinical manifestations in decompensated cirrhotic patients.

A Clinical Study on Small Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: Cases of small hepatocellular carcinoma (HCC) have been increasing with the progress of diagnostic methods . In this study the screening methods for early diagnosis of HCC were re-evaluated, and comparative therapeutic analyses were perfomed. METHODS: A total of 110 patients with small HCC (< 5 cm and < 4 nodules ) were retrospectively analyzed. The patients were divided into four treatment groups ; unt reated group (No T x, n=12), transarterial-oily-chemoembolization group (TOCE, n=43), combined treatment group of percutaneous ethanol injection and TOCE (CEI, n=22), OP group ( OP, n=33). RESULTS: Small HCC occupied 22.6% of total HCC cases. Only one third of small HCC cases were detected during the regular screening. In this group, Alpha-fet oprotein as say provided a diagnostic clue in 50% of cases, ultras onography in 71%, and the combination of both in 88%. Five year survival rate and 5-year non-recurrence rate in small HCC was 29% and 37% respectively. Comparative therapeutic analys es showed t hat CEI and OP gave a better survival than TOCE in Child grade A. CEI prolonged survival in Child grade B wher eas TOCE did not. Only TOCE was tried and did not improve the survival in Child grade C. CONCLUSION: 1) A more strict screening is needed in high risk group of HCC. 2) As a first line of treatment in small HCC, OP or CEI can be selected in Child grade A, and CEI in Child grade B. In Child grade C, a less invasive treatment (PEIT , microwave coagulat ion therapy) should be investigated.