Clinical features of hepatocellular carcinoma with reference to ages in Korean patients / 대한내과학회지

BACKGROUND: Hepatocellular carcinoma(HCC) has characteristic differences in both viral profiles and the most frequently occurring age in each country. It also has clinically distinct features between adult patients of the age under 65 and senile patients over 65 years. Herein we investigate differences in clinical features of the patients with HCC of the three different age groups : young patients (group 1) below 45 years of age; most frequently occurring age (45 - 65 year) (group 2); and elderly patients (group 3) above 65 years of age. METHODS: The 371 HCC patients hospitalized and followed-up from 1986 to February 1997 have been analyzed. At the time of diagnosis there was no significant difference among the three groups in alcohol intake, cigarette smoking, sex, family history of liver disease, mean values of aminotransferases, Child-Pugh class, tumor location, TNM stage, tumor size, varix grade, metastasis, abdominal pain, ascites, encephalopathy, fever, or jaundice. RESULTS: In the younger group HCC showed (1) a high incidence of HBsAg positivity (group 1, 95.3%; group 2, 78.6%; group 3, 25%; p400 ng/mL) showed no differences among the three age groups (p=0.23766). (6) The overall survival rates did not differ statistically among the three groups (mean survival: group 1, 12 months; group 2, 18 months; group 3, 15 months; p=0.4635, log rank test). CONCLUSION: These data support the younger patients with HCC are the most frequently associated with HBV contrarily to the elderly patients the more frequently associated with HCV or NBNC rather than HBV. This suggests, in turn, that the onset of HCC occurs one or two decades later in those with adult-acquired HCV than it does in lifelong HBV patients after neonatal vertical infection.

Comparison of Free Ionized Calcium Levels by Direct Measurement and Those Calculated from Total Calcium, Albumin, and pH in Chronically Ill Patients / 대한신장학회잡지

This study was aimed to assess the free calcium status with or without its direct measurement in patients on hemodialysis(HD: n=27) and malnourished ones from extrarenal diseases(MN: n=14). It was performed by the comparison of measured free calcium (Ca++m) levels by gas analyzer and calculated free calcium(Ca++c) levels based on those of total calcium (TCa), albumin, and pH with the modified algorithm invented by Moore(J Clin Invest. 49:318, 1970). Of 27 HD pts, 14(5296) had low[Ca++m] below 1.05mmol/L despite only 2(796) with low [TCa] below 2.05mmoV L, whereas 14 MN pts had similar numbers between low[Ca++m] and low[TCa]. Compared to MN pts, HD pts showed significantly lower mean levels(SE) of pH(7.37 0.01 vs. 7A4 0.01, p<0.01), higher[TCa](2.33 0.04 vs. 1.83 0.08mmol/L, p<0.01), and higher albumin (4.33 0.06 vs. 2.59 0.17mg/dL, p<0.01).However, [Ca++m] between 2 groups did not reveal any significant difference. Furtherrnore, in total 41 pts of 2 groups, no similarity was observed between the values of [Ca++ml and [Ca++c] but with their significant difference(p<0.05). Only[TCa] was significantly corre- lated with albumin level(r=0.73, p<0.01). Furthermore, multiple regression analysis between [Ca++m] and other factors including pH and albumin didn't show any correlation. In conclusion, this data suggests that relatively high prevalence of low values of physiologically important free ionized calcium in chronically ill pts, especially on maintenance HD, could be missed when predicted on total calcium level, and pH without its direct measurement.

Stereological Analysis of gamma-Glutamyl Transpeptidase Positive Foci in Diethylnitrosamine-Induced Hepatocarcinogenesis of Sprague-Dawley Rats / 대한간학회지

BACKGROUND/AIMS: Hepatocarcinogenesis of microscopically altered foci could be shown to be progressed into a trabecular pattern of hepatocellular carcinoma. And it is reported that down-regulation of TGF beta II receptor and up-regulation of TGF alpha and c-myc reveal the progression of diethylnitrosamine-induced foci into liver cell cancer. Up-regulation of TGF beta II receptor, however, causes apoptosis of foci. To determine characteristic morphology and growth kinetics of putatively precancerous y glutamyl transpeptidase (GGT) positive foci and hyperplastic nodules, a stereological quantification was attempted in the Peraino's neonatal rat model initiated by diethylnitrosamine and promoted by phenobarbital. MATERIALS/METHODS: Fifteen Sprague-Dawley rats were I.p. injected with 0.15 pmole/g of body weight of diethylnitrosamine mixed in corn oil at one day after birth. From weaning at 4 weeks of life, the rats were continuously fed 0.035% phenobarbital in drinking water and sacrified 5 rats at each time point of 8 weeks, 16 weeks, and 32 weeks. Teklad standard diet was fed after weaning. The livers obtained were fixed in freshly prepared, cold ethanol-acetic acid (99:1 vo1%). For the GGT histochemical staining, Rutenberg's method was modified, and counterstained with H & E or toluidine blue. For the stereological analysis GGT positive foci and nodules were traced in 200 consecutive tissue sections and quantified the 3 dimensional volumes by computer assisted planimetry. Either spheroidal or non-spheroidal morphology was determined by parabola 2nd degree equation ' y=ax+bx+c (sphere a=-P,). RESULTS: Thirty nine (55.71%) out of 70 representative lesions were nonspheroidal. Especially at 8 weeks, the 28 out of 40 GGT positive foci were irregular, nonspheroidal shape. Later times, however, GGT positive foci and reprogrammed nodular lesions were become spheroidal. Lilliefors probabilities test for spheroidal frequency was statistically significant (p<0.05). CONCLUSION: Stereologically non-spheroidal characteristics of the early GGT positive foci limit growth kinetic estimation by 3 dimensional volume quantitation but permit in later times in spheroidal, GGT positive foci and reprogrammed nodules showing fade-out of GGT activity. In other words, GGT positive foci may be clonally selected for growing into hyperplastic nodules and hepatocellular carcinoma or regressed by apoptosis.

Reflectance Spectrophotometry for the Evaluation of Therapeutic Effect of Falshlamp - pumped Pulsed Dye Laser for Nevus Flammeus / 대한피부과학회지

BACKGROUND: At present, flashlamp-pumped pulsed dye lasers are treatment of choice for the treatment of congenital capillary malformations like nevus flammeus. Clinical methods have been generally used to evaluate their effectiveness in many papers. OBJECTIVE: To evaluate the effectiveness of the laser therapy in nevus flammeus patients, we used reflectance spectrophotometry as a supportive objective method in addition to the clinical evaluation. METHODS: Thirty-two patients with definite nevus flammeus skin lesion, mainly on head and neck, were treated with flashlamp-pumped pulsed dye laser(SPTL-1b) at 8 week interval. Patients without previous treatment and the others with previous treatments were grouped separately to compare the influence of previous treatment to laser therapy. Erythema/Melanin indices were measured before and after laser therapy in both normal and lesional skin. Based on these indices, relative blanching effect were calculated. RESULTS: Clinically, they showed 58.6% improvement in their skin color in average and Erythema/Melanin indices measured on normal skins were 13.09+/-3.91 a.u. and 34.65+/-2.82 a.u.. Erythema indices measured on lesional skins were 26.07+/-10.26 a.u. and 20.73+/-8.81 a.u. in non-treated group and 2453+/-6.14 a.u. and 21.18+/-5.47 a.u. in pre-treated group, alternatively. Relative blanching effect in both groups were calculated as 35.9% and 31.6%, meaning no significant difference(p>0.3). Clinical evaluation and relative blanching effect showed good correlation(r=0. 691). CONCLUSION: Reflectance spectrophotometry can be useful in evaluating successful laser treatments in nevus flammeus patients. Reflectance measurements, an objective estimate of blanching, correlate well with the clinical results, and are helpful in monitoring and predicting the therapeutic outcome in dye laser treated patients.