Two Cases of Systemic Amyloidosis Presenting with Abnormalities in Liver Function Tests / 대한소화기학회지

Systemic amyloidosis results from the deposition of insoluble, fibrous amyloid proteins. It occurs mainly in the extracellular spaces of multiple organs and tissues including the kidney, heart, and liver. Although amyloid deposition in the liver is common in patients with systemic amyloidosis, clinically apparent liver disease is relatively rare. Indeed, most patients with systemic amyloidosis manifest only minimal to moderate hepatomegaly and trivial abnormalities in liver function tests. Recently, we experienced two cases of patients who presented with abnormalities in liver function tests and hepatomegaly as manifestations of systemic amyloidosis. We report these cases with a review of the relevant literatures.

The diagnostic efficacy of endoscopic mucosal resection (EMR) in gastric flat adenoma / 대한내과학회지

BACKGROUND: EMR is an alternative to surgical removal of superficial neoplastic lesions of the gastrointestinal tracts. The aim of this study is to assess the diagnostic efficacy of EMR in gastric flat adenoma. METHODS: Ninety five lesions of gastric flat adenoma removed by EMR in 89 patients were enrolled in this study at Kyungpook National University Hospital from January 1999 to June 2002. We have analysed diagnostic efficacy of EMR in gastric flat adenoma. RESULTS: Tubular adenoma were 78 cases (82.1%), tubular adenoma with high grade dysplasia were 16 cases (16.8%) and villous adenoma was 1 case (1.1%). Locations were antrum 57 cases (60.0%), body 22 cases (23.1%), angle 14 cases (14.7%), pylorus 1 case (1.1%) and cardia 1 case (1.1%). Among 95 lesions of gastric flat adenoma, 26 cases (27.4%) revealed upgraded histologic diagnosis between endoscopic biopsy and EMR. Twenty two lesions (37.3%) among 59 lesions that were 1cm size or more were upgraded in the histologic staging to carcinoma or high grade dysplasia, compared with 4 lesions (11.1%) among 36 lesions less than 1cm size (p<0.01). Eight lesions (50.0%) among 16 lesions diagnosed in tubular adenoma with high grade dysplasia were upgraded in the histologic staging to carcinoma, compared with 12 lesions (15.4%) among 78 lesions diagnosed in tubular adenoma (p<0.01). Bleeding was the only complication and occurred in 24 lesions (25.3%). CONCLUSION: EMR resulted in upgrading of the histologic staging to carcinoma or high grade dysplasia in 27.4% of gastric flat adenomas.

The Diagnostic Value of Serum Hyaluronic Acid, 7S Domain of Type IV Collagen and AST/ALT Ratio as Markers of Hepatic Fibrosis in Chronic Hepatitis B and Cirrhosis Patients / 대한간학회지

BACKGROUND/AIMS: The prognosis of chronic liver disease is closely related to the development of hepatic fibrosis. Liver biopsy is the gold standard method to assess inflammatory activity and fibrosis stage, but this is associated with morbidity and mortality. This study aimed to evaluate the diagnostic value of serum hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio as markers of hepatic fibrosis in chronic hepatitis B and cirrhosis. METHODS: This study included 100 patients with chronic hepatitis B and cirrhosis. Liver biopsy and histopathologic classification were done. Serum hyaluronic acid and 7S domain of type IV collagen were measured by one step sandwich binding protein assay and radioimmunoassay using polyclonal antibody to 7S domain of type IV collagen, respectively. RESULTS: The serum concentrations of hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio in the cirrhosis group (139 +/- 98.4 ng/mL, 6.9 +/- 3.5 ng/mL, 1.6 +/- 1.5) were significantly higher (p<0.01) than those in the normal and fatty liver group (20.2 +/- 12.5 ng/mL, 3.5 +/- 0.5 ng/mL, 0.7 +/- 0.3), mild hepatitis group (32.3 +/- 52.7 ng/mL, 3.9 +/- 1.4 ng/mL, 0.7 +/- 0.4), and moderate to severe hepatitis group (68.2 +/- 72.3 ng/mL, 5.3 +/- 2.4 ng/mL, 0.8 +/- 0.4). At the cutoff value of 77 ng/mL for hyaluronic acid and 6.3 ng/mL for 7S domain of type IV collagen and 0.62 for AST/ALT ratio, the sensitivities were 81.8%, 63.6%, 90.9% and specificities were 87.3%, 88.6%, 53.1% for discriminating cirrhosis (fibrosis score: 4) from the mild to severe fibrosis (fibrosis score: 0-3). CONCLUSIONS: Serum hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio measurement may be clinically useful as markers of hepatic fibrosis in chronic hepatitis B and cirrhosis.