Cirrosis Hepática Alcohólica: Actualización Epidemiológica De La Tasa De Mortalidad Entre Los Años 2017-2021 En Chile / Alcoholic Liver Cirrhosis: Epidemiological Update Of Mortality Rates Between 2017-2021 In Chile

Introducción: La cirrosis hepática alcohólica (CHA) es una etapa final de la enfermedad hepática por alcohol. Dada la falta de análisis epidemiológicos recientes en Chile, el objetivo de este estudio es comparar descriptivamente la tasa de mortalidad (TM) por CHA entre los años 2017-2021 en Chile. Metodología: Estudio observacional y transversal, sobre defunciones por CHA en Chile durante 2017-2021 según sexo y edad (n=2.551). Datos obtenidos del Departamento de Estadística e Información en Salud. Se utilizó estadística descriptiva y cálculo de TM. No requirió aprobación del comité de ética. Resultados: Se obtuvo una TM para el período estudiado de 3,98/100.000 habitantes. El sexo masculino presenta la mayor TM con 7,05. El grupo etario de 65-79 años presenta la mayor TM con 9,08/100.000 habitantes. Para TM por región, lidera Los Lagos con 39,84/100.000 habitantes, la menor es Coquimbo con 10,03/100.000 habitantes. Discusión: La mayor TM por CHA se encuentra en hombres, lo cual puede deberse a un mayor consumo social. El grupo etario de 65-79 años presentó la mayor TM, coincidiendo con estadísticas internacionales. El porcentaje de ruralidad pudiera afectar el consumo de alcohol, aumentando la TM por CHA en aquellas más rurales. La prevención es vital para evitar el desarrollo de CHA, siendo crucial establecer programas de salud pública para evitar el consumo de alcohol en Chile. Se identificó una falta de datos epidemiológicos en Chile, por lo que se invita a la actualización de estos.

Introduction: Alcoholic liver cirrhosis (ALC) is one of the final stages of alcoholic-related liver disease (ARLD). Due to the lack of recent epidemiological research in Chile, the main objective of this study is to descriptively compare the mortality rate (MR) due to ALC between the years 2017-2021 in Chile. Methodology: Observational and cross-sectional study, on the number of deaths owing to ALC in Chile during 20172021 according to sex and age (n=2,551). Data obtained from the department of statistics and health information. Descriptive statistics and MR calculation were used. Ethics committee approval was not required. Results: A MR was obtained for the studied period of 3.98/100,000 inhabitants. The male sex submitted the highest MR with 7.05. The age group of 65-79 years presents the highest MR with 9,08/100,000 inhabitants. The region with the highest MR is Los Lagos with 39,84/100.000 inhabitants and the one with the lowest is Coquimbo with 10,03/100.000 inhabitants. Discussion: The highest MR is found in men, which may be due the fact that, socially, men consume more alcohol than women. The age group of 65-79 years presented the highest MR, which coincides with the international statistics. The percentage of rurality impacts the alcohol consumption increasing the MR due to ALD in the most rural areas. Prevention is vital to avoid its development, so it's crucial to establish public health programs to avoid alcohol consumption in Chile. A lack of updated epidemiological information has been identified in our country, therefore it is invited to update the epidemiological data.

A study on the correlation between serum branched-chain amino acid levels and disease severity in alcoholic liver cirrhosis patients / 中华临床营养杂志

Objective:To characterize the serum branched-chain amino acid (BCAA) and aromatic amino acid profiles in patients with alcoholic liver cirrhosis (ALC).Methods:Forty patients with ALC were recruited into the study group, twenty patients with hepatitis B-induced liver cirrhosis (HBV-LC) and ten healthy subjects (HC) were recruited as controls from August 2017 to August 2019 in Beijing YouAn Hospital, Capital Medical University. The serum concentrations of isoleucine, leucine, valine, phenylalanine and tyrosine were determined by ultra-fast liquid chromatography tandem quadrupole mass spectrometry (LC-MS/MS) and Fischer ratio was also calculated for the three groups.Results:The serum isoleucine concentration in the study group [(23.74±8.81) μmol/L] was significantly lower than that in the HBV-LC group [(30.85±8.70) μmol/L, P = 0.031] and the HC group [(61.51±23.06) μmol/L, P < 0.01]. The serum leucine concentration in the study group [(127.99±38.54) μmol/L] was significantly lower than that in the HC group [(153.70±11.88) μmol/L, P = 0.036] and was not significantly different compared with the HBV-LC group [(126.70±31.00) μmol/L, P = 0.890]. The concentration of valine in the study group was (39.56±10.51) μmol/L, which was significantly lower than that in the HBV-LC group [(124.71±45.00) μmol/L, P < 0.01] and the HC group [(164.23±37.16) μmol/L, P < 0.01]. The concentration of phenylalanine in the study group was (141.19±29.35) μmol/L, which was significantly higher than that in the HBV-LC group [(116.07±21.52) μmol/L, P = 0.001] and the HC group [(80.94±7.16) μmol/L, P < 0.001]. Fischer ratio in the study group was significantly lower (1.17±0.34) than that in the HBV-LC group (2.07±0.66, P < 0.01) and the HC group (3.36±0.50, P < 0.01). Along with liver function deteriorating from Child-Pugh grade A to C, the isoleucine, leucine and valine levels in the study group decreased gradually. Fischer ratios in subgroups with Child-Pugh grade C and B liver function were 1.01±0.22 and 1.15±0.32, respectively, significantly lower than that in Child-Pugh grade A subgroup (1.52±0.38, P = 0.001 and P = 0.008). Conclusions:Serum BCAA levels and Fischer ratio decreased significantly in ALC patients, which were more prominent in patients with Child-Pugh grade B and C liver function. In Child-Pugh grade A patients, the decline of Fischer ratio developed earlier than the decrease of serum albumin. Monitoring of BCAA level changes should be an important component in nutritional intervention in ALC patients.

Study of Cardiac Function in Alcoholic Cirrhotic Patients

Introduction: Cardiac dysfunction in patients with cirrhosisoccurs in the setting of a circulatory dysfunction characterizedby a marked splanchnic arterial vasodilation. Circulatory changescan lead to the cardiac dilatation of the left chambers and thedevelopment of functional changes in the heart. The present studyis intended to assess cardiac functions in patients of liver cirrhosis.Material and methods: It was a cross sectional study conductedamong 74 diagnosed cases of liver cirrhosis, admitted todepartment of general medicine, KIMS Hospital during the 6months study duration.Results: Overall LVDD was diagnosed in 59 cases (79.73%).Out of which, 47.29% cases presented with Stage 1 (impairedrelaxation) LVDD, Stage 2 LVDD (pseudo normal) among31.08% and only one patient had severe restrictive type of(Stage 3) LVDD.Conclusion: Left ventricular diastolic dysfunction iscommonly associated with advancement of hepaticdysfunction while systolic function is maintained till advancedhepatic failure

Implications of alcoholic cirrhosis in atherosclerosis of autopsied patients / Implicações da doença hepática alcoólica na aterosclerose de pacientes autopsiados

Summary Introduction: Alcoholism is a major public health problem, which has a high social cost and affects many aspects of human activity. Liver disease is one of the first consequences of alcohol abuse, and steatosis, liver cirrhosis and hepatitis may occur. Other organs are also affected with pathological changes, such as pancreatitis, cardiomyopathies, dyslipidemias and atherosclerosis. Objective: To identify the occurrence and degree of atherosclerosis in alcohol-dependent individuals with liver cirrhosis, observing macroscopic and microscopic changes in lipid and collagen deposits and in the liver. We also aimed to verify the association of lipid and collagen fiber deposits with gender, age and body mass index, and to relate alcoholism, liver cirrhosis and atherosclerosis. Method: We performed a study based on autopsy reports of patients with alcoholic liver cirrhosis, with analysis of aorta and liver fragments to verify the occurrence and degree of atherosclerosis, as well as collagen contents. Results: Microscopic atherosclerosis was higher in young subjects (early injury) and in patients with alcoholic liver cirrhosis. The macroscopic analysis of atherosclerosis in aortas showed that patients in more advanced age groups presented more severe classifications. Atherosclerosis, both micro and macroscopically, and the percentage of fibrosis in the liver and aorta were more expressive in females. Conclusion: Cirrhotic patients presented a higher percentage of fibrosis and lipidosis, and may represent a group susceptible to the accelerated progression of cardiovascular diseases. Investigative studies contribute to targeting health-promoting interventions, reducing the mortality and costs of treating cardiovascular disease.

Resumo Introdução: O alcoolismo é um grande problema de saúde pública, de elevado custo social e que afeta vários aspectos da atividade humana. Hepatopatia é uma das primeiras consequências do abuso de álcool, podendo ocorrer esteatose, cirrose hepática e hepatite. Outros órgãos, porém, também são afetados, ocorrendo alterações patológicas, como pancreatite, cardiomiopatias, dislipidemias e aterosclerose. Objetivo: Identificar a ocorrência e a intensidade de aterosclerose em alcoolistas com cirrose hepática, observando alterações macro e microscópicas do depósito lipídico e de fibras colágenas e fígado. Verificar a associação de depósito lipídico e de fibras colágenas com gênero, idade e índice de massa corporal (IMC). Relacionar alcoolismo, cirrose hepática e aterosclerose. Método: Foi realizado estudo com base em laudos de autópsias de pacientes com cirrose hepática alcoólica, sendo estudados aortas e fígados para verificar a ocorrência e a intensidade de aterosclerose, bem como a quantidade de colágeno encontrada. Resultados: A aterosclerose microscópica foi maior em jovens (lesão inicial) e em pacientes com cirrose hepática alcoólica. A análise macroscópica da aterosclerose nas aortas mostrou que pacientes com faixas etárias mais avançadas apresentaram classificações mais intensas. A aterosclerose, tanto micro quanto macroscopicamente, e a porcentagem de fibrose no fígado e na aorta foram mais expressivas no gênero feminino. Conclusão: Os pacientes cirróticos apresentaram maior porcentagem de fibrose e lipidose, e podem representar um grupo susceptível à acelerada progressão de doenças cardiovasculares. Estudos investigativos contribuem para o direcionamento das intervenções promotoras da saúde, reduzindo a mortalidade e os custos no tratamento das doenças cardiovasculares.

Aldehyde Dehydrogenase 2 (ALDH2) Polymorphism and the Risk of Alcoholic Liver Cirrhosis among East Asians: A Meta-Analysis

PURPOSE: The aldehyde dehydrogenase 2 (ALDH2) gene has been implicated in the development of alcoholic liver cirrhosis (ALC) in East Asians. However, the results are inconsistent. In this study, a meta-analysis was performed to assess the associations between the ALDH2 polymorphism and the risk of ALC. MATERIALS AND METHODS: Relevant studies were retrieved by searching PubMed, Web of Science, CNKI, Wanfang and Veipu databases up to January 10, 2015. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using either the fixed- or random effects model. RESULTS: A total of twelve case-control studies included 1003 cases and 2011 controls were included. Overall, the ALDH2 polymorphism was associated with a decreased risk of ALC (*1/*2 vs. *1/*1: OR=0.78, 95% CI: 0.61-0.99). However, in stratification analysis by country, we failed to detect any association among Chinese, Korean or Japanese populations. CONCLUSION: The pooled evidence suggests that ALDH2 polymorphism may be an important protective factor for ALC in East Asians.

Trends of liver cancer and its major risk factors in Korea / 한국역학회지

The Republic of Korea (hereafter Korea) is one of the countries with high incidence of liver cancer and there is great difference in incidence of liver cancer between male and female. We investigated the sex-specific trends of three major risk factors of liver cancer, which are hepatitis B virus(HBV) infection, hepatitis C virus(HCV) infection, and alcoholic liver cirrhosis. The incidence of liver cancer was obtained from the Cancer Registration Statistics of the National Cancer Center of Korea. Hepatitis B surface antigen (HBsAg) seropositivity was based on data from the 2011 Korea National Health and Nutrition Examination Survey. Disease statistics from the Health Insurance Review and Assessment Service of Korea were used to evaluate trends in HCV infection and alcoholic liver cirrhosis. The prevalence of these risk factors were compared with the incidence of liver cancer. Males had a three to four times higher incidence of liver cancer than females did from 1999 to 2011. This gap between the incidence for males and females increased with age and males aged 50 to 59 showed a five times higher incidence than females of the same age did. In general, HBsAg seropositivity decreased from 1998 to 2011. The prevalence of HCV infections was 96.2 and 90.3 per 100,000 females and males, respectively in 2013. The prevalences of HCV infections from 2009 to 2013 did not substantially differ. The annual average prevalence of alcoholic liver cirrhosis from 2009 to 2013 was 77.22 and 8.90 per 100,000 males and females, respectively; the prevalence among males was 8.7 times higher than that among females. The prevalence rapidly increased with age in males, and males aged 60 to 69 peaked with a 19.2 times higher prevalence than that among females of the same age group. We found that the incidence of alcoholic liver cirrhosis, a major risk factor of liver cancer, exhibited a trend similar to that of liver cancer incidence in males, and this trend also differed remarkably by sex.

Kallistatin, a new and reliable biomarker for the diagnosis of liver cirrhosis

Kallistatin, which protects organs and cells against inflammation, fibrosis and oxidative stress, is mainly synthesized and secreted in liver. However, its relationship to human liver disease remains unclear. The purpose of this study was to explore the relationship between serum kallistatin and clinical evidence of both cirrhosis and hepatocellular carcinoma (HCC), and to determine if serum kallistatin levels could be used as a diagnostic indicator of hepatic health status, especially human liver cirrhosis (LC). Our cohort consisted of 115 patients with clinically proven liver fibrosis (LF), LC, or HCC by liver biopsies, and 31 healthy controls (CON). Serum kallistatin levels were quantified by ELISA. Results of the present study demonstrated that irrespective of the underlying etiology, serum kallistatin levels were significantly lower in the LF/LC group when compared with the CON group. A decrease in serum kallistatin levels appeared to reflect the extent of cirrhosis, with the lowest levels associated with higher grades of cirrhosis. Patients with LC had a noticeable correlation between serum kallistatin levels and other serum biochemical indicators. The area under the curve (AUC) for LC, viral liver cirrhosis (VLC) and alcoholic liver cirrhosis (ALC) was 0.845, 0.757 and 0.931, respectively. In conclusion, our findings demonstrated that kallistatin, a plasma protein produced by the liver, can be a useful and reliable diagnostic indicator of hepatic health status, especially for LC.

Bone mineral density assessed by dual energy X-ray radiography in patients with alcoholic or HBV-related liver cirrhosis / 第二军医大学学报

Objective: To investigate the differences of bone mineral density (BMD) among the patients with alcoholic or HBV-related liver cirrhosis, and healthy controls. Methods: Dual-energy X-ray radiography was employed to determine the BMD of he lumbar vertebra and bilateral hip joints in 57 patients with alcoholic cirrhosis, 67 with hepatitis B cirrhosis, and 175 healthy controls. The demographic data and clinical characteristics(hepatic fibrosis and hepatic function) of all the participants were collected. Independent sample -test was used to compare the differences among 3 groups and multiple classified logistical regression analysiswas used to evaluate factors influencing BMD. Results: The BMD of alcoholic cirrhosis and HBV-related cirrhosis patients were significantly lower than that of healthy controls(P<0. 01), and theBMD in alcohol cirrhosis patients was significantly lower than that in HBV-related cirrhosis patients(P<0. 05). Univariate logistic regression analysis identified that female gender, elder age, liver cirrhosis degree, and liver function were significantly correlated with the levels of BMD (P<0. 01). Multivariate analysis showed that alcoholic cirrhosis (0R = 2. 053, 95%CI= 1. 931-3. 852) and HBV-related cirrhosis (0R=1. 521, 95%CI=1. 342-2. 354) were the independent risks of reduced BMD in patients. Conclusion: BMD levels of patients with alcoholic cirrhosis and HBV-related cirrhosis are significantly lower than that of the healthy controls, and hepatic cirrhosis is independent factor of osteoporosis.

A Case of Hepatic Peribiliary Cysts in a Patient with Alcoholic Liver Cirrhosis / 대한소화기학회지

Hepatic peribiliary cysts (HPCs) are characterized by cystic dilatations of the peribiliary glands located throughout the branches of the biliary systems. Specifically, they are mainly located along the hepatic hilum and major portal tracts. The natural history and prognosis of HPCs are uncertain. In fact, almost all HPCs have been discovered incidentally during radiological examination or autopsy, and they are considered to be clinically harmless. Recently, several cases of HPCs associated with obstructive jaundice or liver failure were reported in patients with pre-existing liver disease in several studies. However, until now there have been no reports of such a case in Korea. Herein, we report a case of HPCs that show a disease course with a poor prognosis. These HPCs developed in a 47-year-old man with progressive alcoholic liver cirrhosis.

Genetic polymorphism at codon 10 of the transforming growth factor-beta1 gene in patients with alcoholic liver cirrhosis / 대한간학회지

BACKGROUND/AIMS: Transforming growth factor beta1 (TGF-beta1) is a key cytokine in the production of extracellular matrix. A genetic polymorphism at codon 10 of the TGF-beta1 gene is associated with liver fibrosis. We investigated the effect of genetic polymorphisms at codon 10 on the development of alcoholic liver cirrhosis (ALC). METHODS: In total, 119 controls and 182 patients with ALC, were enrolled in the study. Clinical and laboratory data including total lifetime alcohol intake were collected at enrollment. The genotype at codon 10 was determined for each patient by single-strand conformation polymorphism. RESULTS: There were three types of genetic polymorphism at codon 10: homozygous proline (P/P), heterozygous proline/leucine (P/L), and homozygous leucine (L/L). Among the controls, the proportions of P/P, P/L, and L/L were 26.1%, 44.5%, and 29.4%, respectively in the ALC group, these proportions were 23.1%, 43.4%, and 33.5%, respectively. The genotype distribution did not differ between the controls and the ALC group. In the ALC group, age, total lifetime alcohol intake, and distribution of Child-Pugh class did not differ with the genotype. Of the male patients with ALC (n=164), the proportions of P/P, P/L, and L/L were 20.1%, 44.5%, and 35.4%, respectively the genotype distribution did not differ between the male controls and the male ALC patients. CONCLUSIONS: The genotype at codon 10 in TGF-beta1 does not appear to influence the development of ALC. Further study is needed to investigate other genetic factors that influence the development of ALC in patients with chronic alcohol intake.

A Case of Crescentic IgA Nephropathy Associated with Alcoholic Liver Cirrhosis / 대한신장학회지

It has been reported that IgA nephropathy is associated with alcoholic liver cirrhosis. However, crescentic glomerulonephritis or nephrotic syndrome are relatively rare. We experienced a patient with IgA nephropathy complicated with alcoholic liver cirrhosis who showed favorable clinical outcomes through steroid treatment. A 54-year-old man with alcoholic liver cirrhosis was hospitalized for generalized edema, nephrotic-range proteinuria and azotemia. We performed a renal biopsy and crescentic formations were found in half of the glomeruli. After use of steroid, azotemia and proteinuria improved gradually.

Clinical Efficacy of Compound Glycyrrhizin Combined with Reduced Glutathione on Patients with Alcoholic Liver Cirrhosis / 中国药房

OBJECTIVE:To observe the curative effects of compound glycyrrhizin used in combination with reduced glutahione for the treatment of alcoholic liver cirrhosis(ALC).METHODS:40 patients with ALC were randomized into the treatment group and control group.The treatment group was treated with compound glycyrrhizin 80mL and reduced glutathione 1.20g to observe the changes in hepatic function,hepatic fibrosis,clinical symptoms and therapeutic effects;whereas the control group was treated only with reduced glutathione 1.20g.The course of treatment lasted 2 weeks for both groups.RESULTS:After treatment for 2 weeks,the serum glutamic pyruvic transaminase(ALT),aspartate aminotransferase (AST),?-glutamyl transpeptidase(?-GT),total biliribin(TB),hyaluronic acid(HA),type Ⅲ procollagen(PC Ⅲ) and type Ⅳ collagen(Ⅳ-C) levels in the treatment group decreased markedly, the clinical symptoms were improved obviously,the total effective rates in the treatment group were 90% and there were significant differences in ALT, AST,?-GT,TB,HA,PC Ⅲ,Ⅳ-C levels.Cli-nical symptoms and total effective rates between treatment group and control group showed significant difference(P

Clinical stuay on 68 cases of alcoholic cirrhosis / 中国基层医药

Objective To study clinical features and its diagnosis and treatment of alcoholic cirrhosis.Methods 68 cases with alcoholic cirrhosis were retrospectively analyzed,with cirrhosis from hepatitis B as control.Results Alcoholic cirrhosis accounted for 8.5% of in-patient cirrhosis in the correspomding period,mean age being(53.5?14.6),and with more than 135g alcohol intake per day which persisted over 10 years.Such signs significantly increased as dark complexion,liver palms,spider naevi,hepatomegaly,ynecomastia,hypertrophy of parotid gland,?-glutamyltansferase(GGT),ratio of aspartate aminotransferase(AST) to alanine aminotransferase(ALT),mean corpuscular volume(MCV),uric acid(UA),serum ferritin(SF) rose apparently,usually combined with hepatogenic diabetes,peptic ulcer,hyperuricemia,hyperlipemia.Peculiar complication were alcohol withdrawal syndrome,gort,gouty arthritis,aseptic necrosis of femur.Among them,53 cases(77.9%) improved clinically,9 cases(13.2%) showed no effect,6 cases(8.8%) died.Conclusions Occurrence of dark complexion,liver palms,spider naevi,hepatomegaly,ynecomastia,hypertrophy of parotid gland and test of GGT,AST/ALT,MCV,UA,SF are helpful to clinic and differentiation diagnosis of alcoholic cirrhosis,abstinence are not able to prevent its development.Long-term therapy aiming at endotoxin toxemia might improve prognosis of alcoholic cirrhosis.

Comparison of bacterial infection rate between patients with alcoholic liver cirrhosis and viral liver cirrhosis / 대한내과학회지

BACKGROUND: Some studies have reported that bacterial infection is more common in alcoholic compared to non-alcoholic liver cirrhosis such as viral liver cirrhosis. However, other studies reported no significant differences in the bacterial infection rate between alcoholic and non-alcoholic liver cirrhosis. This study was performed to compare the frequency of bacterial infection between alcoholic and viral liver cirrhosis. METHODS: We analyzed 190 cirrhotic patients (alcoholic 83, viral 107) with 539 hospitalized cases (alcoholic 242, viral 297) who were followed for more than 12 months. RESULTS: During the follow up period, 82 patients (43.2%) presented with bacterial infectionsthat developed in 34 (41.0%) patients with alcoholic liver cirrhosis and 48 (44.9%) patients with viral liver cirrhosis. There was no significant difference in the frequency of bacterial infection including community acquired and nosocomial infection between alcoholic and viral cirrhotic patients regarding the Child-Pugh class, various laboratory parameters and site of infection. Gram-negative and enteric bacterial strains were the most frequently isolated pathogens in both groups. CONCLUSIONS: There was no significant difference in the frequency of infection between patients with alcoholic and viral liver cirrhosis. Further efforts are needed to reduce bacterial infection by gram negative and enteric bacteria in patients with both alcoholic and viral cirrhosis.

A Case of Hypervascular Hyperplastic Nodules in a Patient with Alcoholic Liver Cirrhosis

Most hypervascular nodules in a cirrhotic liver are hepatocellular carcinomas (HCCs); however, some are benign hypervascular hyperplastic nodules. We report a case of benign hypervascular hyperplastic nodules in a 41-year-old male patient without hepatitis B or C virus infection, with a history of alcohol abuse, and diagnosed with an aortic aneurysm. The dynamic computerized tomography of the liver demonstrated multiple nodular lesions on both liver lobes with arterial enhancement and delayed washout. The hepatic angiography showed multiple faint nodular staining of both lobes in the early arterial phase. Magnetic resonance imaging revealed numerous nodules showing high signals on T1 weighted images, with some nodules showing a low central signal portion. The clinical impression was HCC. The ultrasonography-guided liver biopsy, which was performed on the largest nodule (2.5 cm in size), revealed hepatocellular nodules with slightly increased cellularity, unpaired arteries, increased sinusoidal capillarization, and focal iron deposition. However, both cellular and cytological atypia were unremarkable. Although the clinical impression was HCC, the pathological diagnosis was hypervascular hyperplastic nodules in alcoholic cirrhosis. Differential diagnosis of hypervascular nodules in cirrhosis and HCC is difficult with imaging studies; thus, histological confirmation is mandatory.

A Case of Hypervascular Hyperplastic Nodules in a Patient with Alcoholic Liver Cirrhosis

Most hypervascular nodules in a cirrhotic liver are hepatocellular carcinomas (HCCs); however, some are benign hypervascular hyperplastic nodules. We report a case of benign hypervascular hyperplastic nodules in a 41-year-old male patient without hepatitis B or C virus infection, with a history of alcohol abuse, and diagnosed with an aortic aneurysm. The dynamic computerized tomography of the liver demonstrated multiple nodular lesions on both liver lobes with arterial enhancement and delayed washout. The hepatic angiography showed multiple faint nodular staining of both lobes in the early arterial phase. Magnetic resonance imaging revealed numerous nodules showing high signals on T1 weighted images, with some nodules showing a low central signal portion. The clinical impression was HCC. The ultrasonography-guided liver biopsy, which was performed on the largest nodule (2.5 cm in size), revealed hepatocellular nodules with slightly increased cellularity, unpaired arteries, increased sinusoidal capillarization, and focal iron deposition. However, both cellular and cytological atypia were unremarkable. Although the clinical impression was HCC, the pathological diagnosis was hypervascular hyperplastic nodules in alcoholic cirrhosis. Differential diagnosis of hypervascular nodules in cirrhosis and HCC is difficult with imaging studies; thus, histological confirmation is mandatory.

Genetic Polymorphisms of Alcohol-metabolizing Enzymes and Cytokines in Patients with Alcohol Induced Pancreatitis and Alcoholic Liver Cirrhosis / 대한소화기학회지

BACKGROUND/AIMS: Susceptibility to organ damage induced by alcohol may be related to inherited variations (polymorphisms) in alcohol-metabolizing enzymes, or polymorphisms affecting cytokines. The aim of this study was to compare the genotype and allelic frequencies of ADH2, ADH3, ALDH2, cytochrome P450-2E1, IL-1, IL-6, IL-8 and tumor necrosis factor-alpha in patients with alcoholic pancreatitis and alcoholic liver cirrhosis with those of controls. METHODS: We determined the polymorphism of genes of the above-mentioned alcohol-metabolizing enzymes and cytokines in 29 alcoholic pancreatitis patients (AP), 22 alcoholic liver cirrhosis patients (LC) and 100 healthy blood donors (control). The genotypes were characterized by restriction fragment length polymorphism after amplification of genomic DNA by polymerase chain reaction. RESULTS: The allelic frequency of CYP2E1*c2 was significantly different in three groups (AP: LC: Control=0.224: 0.136: 0.320, p<0.05). There was no significant difference in the other genotypes or allelic frequencies of the three groups. The allelic frequencies of CYP2E1*c2 and ALDH2*2 were more frequent in the control than patients with alcoholic liver cirrhosis (LC: Control=0.136: 0.320, p<0.05, LC: Control= 0.114: 0.265, p<0.05). Allelic frequencies of ADH2 was statisitcally different between LC and control (ADH2*1; LC: Control=0.727: 0.495, ADH2*2; 0.227: 0.360, ADH2*3; 0.046: 0.145, p<0.05). CONCLUSIONS: There was no difference in the frequencies of genotype and allele of enzymes and cytokines among the three groups. However, frequency of ADH2*1 was significantly higher and those of CYP2E1*c2 and ALDH2*2 were significantly lower than LC group than control.

The comparison of bacterial infection rate in the patients with alcoholic and viral cirrhosis / 대한내과학회지

BACKGROUND: Liver cirrhosis may be considered one of the most common cause of acquired immunodeficiency. Alcohol abuse may be predisposing factor to infections in patients with liver cirrhosis, so we compared the rate of spontaneous bacterial peritonitis (SBP) and other bacterial infections in alcoholic and viral liver cirrhosis. METHODS: We studied 188 patients who had been diagnosed with liver cirrhosis from January 1995 to June 2000 and evaluated the frequency of bacterial infections (SBP, pneumonia, urinary track infection, bacteremia, infectious colitis) retrospectively according to cause and degree of cirrhosis. RESULTS: Among 188 patients (alcoholic 76, viral 112), 64 patients (34%) presented with bacterial infection at hospitalization, 33 (43%;33/76) of 64 subjects were alcoholic and 31 (28%;31/112) of 64 subjects were viral liver cirrhosis. The rate of bacterial infections was higher in alcoholic liver cirrhosis than viral cirrhosis (p0.05). CONCLUSION: This results suggest that the rate of bacterial infections are more common in alcoholic than viral liver cirrhosis in relatively early stage and it may be influence the prognosis of liver cirrhosis.

A Case of Boerhaave Syndrome with Empyema in both Lungs in Alcoholic Liver Cirrhosis / 대한소화기내시경학회지

Spontaneous esophageal perforation (Boerhaave Syndrome) is an unusual condition that frequently leads to fatal complications. It typically occurs with rigorous emesis after an unduly large meal or heavy drinking. Its diagnosis is often delayed in almost all cases due to nonspecific symptoms and signs, resulting in increased morbidity and mortality. Therefore early diagnosis and appropriate treatment are very important. Recently we experienced a case of esophagogastric junctional perforation accompanied by bilateral empyema and mediastinitis after heavy alcohol drinking in a 56-year-old male patient. He was presented with hematemesis and abdominal pain. We diagnosed him using esophagography and chest CT. Thus, we report a case with a brief review of related literatures.

Cutaneous Infection Caused by Fusarium verticillioides in a Patient with Diabetes Mellitus and Liver Cirrhosis / 대한의진균학회지

Fusarium species, which are common soil saprophytes, have been implicated as a pathogen causing a variety of opportunistic infections such as keratitis, onychomycosis, burn wound infection or disseminated systemic infections in immunocompromised hosts. We report a case of cutaneous infection caused by F. verticillioides in a 59-year-old man, with a long history of diabetes mellitus and alcoholic liver cirrhosis. He presented with a few papules and fluctuant cutaneous nodules on both forearms traumatized by woodstick 4 months ago. The diagnosis of F. verticillioides infection was established by histopathologic examination and finding of tissue cultures.