A nationwide seroprevalence of total antibody to hepatitis A virus from 2005 to 2009: age and area-adjusted prevalence rates / 대한간학회지

BACKGROUND/AIMS: Recent outbreak of hepatitis A in Korea is clearly related to the epidemiological shift of hepatitis A virus (HAV). However, nationwide seroprevalence data have been limited. This study estimated the nationwide, age- and area-adjusted anti-HAV prevalence from 2005 to 2009. METHODS: Retrospective analysis of the results of total anti-HAV test in 25,140 cases which were requested by 1,699 medical institutions throughout the nation to Seoul Clinical Laboratory from Jan. 1 2005 to Dec. 31 2009 was performed. The estimated seroprevalence was adjusted by area and age of the standard population based on the 2005 Census data from Korea National Statistical Office. RESULTS: The area-adjusted anti-HAV prevalence in the children younger than 10 years were 33.4% in 2005 and 69.9% in 2009. The most susceptible age groups to HAV infection during the last 5 years were teenagers and the young adults in their age of twenties. The area-adjusted seroprevalence in 2009 were 11.9% in the age group of 20-29 years, 23.4% in the age group of 10-19 years, 48.4% in the age group of 30-39 years. The population in 40-49 years showed geographically different seroprevalence with the lowest rate in Seoul (80%). CONCLUSIONS: The most susceptible age group to HAV infection is 10-29 years, while the young children less than 10 years showed about 70% seropositivity. The changing seroepidemiology should be monitored continuously for the proper vaccination and patient care.

A Case of Secondary Achalasia due to Recurrence of Stomach Cancer / 대한소화관운동학회지

Achalasia can be provoked by organic causes, and it is called secondary achalasia. Sometimes it is very difficult to distingush secondary achalasia from primary achalasia. We report a case of secondary achalasia due to recurrence of stomach cancer. A 45-year-old man came to our hospital due to three months history of dysphagia and regurgitation. Barium esophagogram showed concentric narrowing at the distal esophagus and dilatation of proximal esophagus. The esophagogastroduodenoscopy showed stenosis of gastroesophageal junction and the endoscope could not pass through it, but there was no evidence of malignancy. Esophageal manometry showed aperistalsis, compatible with achalasia. Abdominal CT showed soft tissue density near the gastroesophageal junction. However it was not possible to differentiate whether it was due to adhesion or malignancy. For correct diagnosis and treatment, explorolaparotomy was performed and it was diagnosed as secondary achalasia due to recurrence of stomach cancer.

Thrombocytopenia between Decompensated Alcoholic and Viral Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: Thrombocytopenia is frequently found among patients with chronic liver disease, and its mechanism, especially among patients with decompensated liver cirrhosis had not been established. Therefore to elucidate the mechanism of thrombocytopenia, the relationship between thrombocytopenia and severity of hepatic dysfunction, splenomegaly was measured. We measured the peripheral blood components with splenic volume obtained from a computerized tomography of decompensated liver cirrhosis patients. METHODS: We studied 103 patients who had been diagnosed with decompensated liver cirrhosis with esophageal varices and ascites from January 1982 to August 1999. We checked their counts of platelets, albumin, bilirubin, splenic volume, degree of esophageal varices, hepatic encephalopathy and ascites by retrograde methods. RESULTS: In viral liver cirrhosis, thrombocytopenia and splenomegaly correlated well with disease severity but they didn't in alcoholic cirrhosis. Of special note, the platelet count was significantly lower and the splenic volume was larger in the Child C of viral cirrhosis patients group than in the alcoholic group(p<0.05). CONCLUSION: When we compared decompensated alcoholic with viral liver cirrhosis patients, the degrees of thrombocytopenia and splenomegaly were much less in the former group. The factors for this phenomena are Splenic Pooling theory, Platelet-associated IgG, Thrombopoietin and Toxic Marrow. We suggest that splenomegaly is an important factor among these, but the mechanisms involved in the pathogenesis of this hematologic phenomena are not completely understood. Especially in alcoholic liver cirrhosis, many other factors may be involved, including the direct effect of alcohol to bone marrow, so further studies will be needed to establish whether a causal relationship exists.