Inflammation and Hepatic Fibrosis, Then Hepatocellular Carcinoma / 대한소화기학회지

Inflammation is one of the most prominent characteristic features of chronic liver disease, liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Most of HCC cases develop in patients with cirrhosis and cirrhosis develops in patients with chronic liver inflammation. Therefore, there is no doubt that there exist some strong connection among inflammation, fibrosis, and cancer. In fact, chronic unresolved inflammation is associated with persistent hepatic injury and concurrent regeneration, leading to sequential development of fibrosis, cirrhosis, and eventually HCC. This review will discuss the common mechanism of inflammation and fibrosis in chronic liver diseases, and then demonstrate why HCC develops in inflammatory and fibrotic conditions.

Occult hepatitis B virus infection in liver transplant patients in a Brazilian referral center

Estimates of occult hepatitis B virus (HBV) infection prevalence varies among different studies depending on the prevalence of HBV infection in the study population and on the sensitivity of the assay used to detect HBV DNA. We investigated the prevalence of occult HBV infection in cirrhotic patients undergoing liver transplantation in a Brazilian referral center. Frozen liver samples from 68 adults were analyzed using a nested polymerase chain reaction assay for HBV DNA. The specificity of the amplified HBV sequences was confirmed by direct sequencing of the amplicons. The patient population comprised 49 (72.1%) males and 19 (27.9%) females with a median age of 53 years (range=18-67 years). Occult HBV infection was diagnosed in three (4.4%) patients. The etiologies of the underlying chronic liver disease in these cases were alcohol abuse, HBV infection, and cryptogenic cirrhosis. Two of the patients with cryptic HBV infection also presented hepatocellular carcinoma. Markers of previous HBV infection were available in two patients with occult HBV infection and were negative in both. In conclusion, using a sensitive nested polymerase chain reaction assay to detect HBV DNA in frozen liver tissue, we found a low prevalence of occult HBV infection in cirrhotic patients undergoing liver transplant, probably due to the low prevalence of HBV infection in our population.

Incidence of liver cirrhosis in infancy and childhood

Cirrohsis is the end result of chronic liver disease caused by the different pathological factors including congenital malformation, inflammation [hepatitis] and metabolic /storage disorders, leading to liver cell damage. To determine the incidence of liver cirrhosis and childhood with chronic hepatitis, we studied 41 biopsies of children for the presence of cirrhosis. To provide an overview of current childhood statistics of hepatitis and liver cirrhosis to facilitate analysis of the impact of past research discoveries on outcome and provide essential information for prioritizing future research directions. Retrospective study. This study was conducted at the Department of Basic Medical Sciences Institute, JPMC, Karachi from Jan.2000 to Dec. 2007. Slides/ paraffin blocks of liver biopsies from patients under 15 years of age. The cases were of two categories i.e. retrospective and prospective. The distribution of 41 cases of hepatitis was according to Age and Sex. Total 22 [53.7%] cases were encountered in the youngest of 0-5 years age group, 13 [13.7%] cases in 6-10 years and only 6 [14.6%] cases in 11-15 years age group. The distribution of 41 cases of cirrhosis of liver, according to age and sex. The maximum 22 [53.7%] youngest case in 0-5 years, 13 [31.7%] cases in 6-10 years and 6 [14.6%] cases were found in 11-15 year age group. It is observed that the tendency of liver inflammation was decreased with increasing age and sexual differentiation shows male predominance with male to female ratio of 2.4:1. Liver cirrhosis discovered with increasing age in children. It is found to be a common cause for enlargement of liver with associated hepatitis and chronic liver diseases in infants and children. It can lead to higher risks of acute or chronic responses in adulthood and will require new treatment paradigms building on an increased understanding of the molecular processes for infancy and childhood liver cirrhosis

Prediction of compensated liver cirrhosis by ultrasonography and routine blood tests in patients with chronic viral hepatitis / 대한간학회지

BACKGROUND/AIMS: Liver biopsy is a standard method for diagnosis of liver cirrhosis in patients with chronic hepatitis. Because liver biopsy is an invasive method, non-invasive methods have been used for diagnosis of compensated liver cirrhosis in patients with chronic hepatitis. The current study was designed to evaluate the usefulness of ultrasonography and routine blood tests for diagnosis of compensated liver cirrhosis in patients with chronic viral hepatitis. METHODS: Two hundred three patients with chronic viral hepatitis who underwent liver biopsy were included in this study and ultrasonography and routine blood tests were analyzed retrospectively. Ultrasonographic findings, including surface nodularity, parenchyma echogenecity, and spleen size, were evaluated. The diagnostic accuracy of ultrasonography and routine blood tests were examined. RESULTS: Discriminant analysis with forward stepwise selection of variables showed that liver surface nodularity, platelet count, and albumin level were independently associated with compensated liver cirrhosis (p95% specificity: platelet count 1.3; and surface nodularity. If at least one of the four variables exists in a patient with chronic viral hepatitis, we can predict liver cirrhosis with 90% specificity and 61% sensitivity. CONCLUSIONS: These results suggest that four variables (platelet count 1.3, and surface nodularity) can be used for identification of liver cirrhosis in patients with chronic viral hepatitis with high specificity.

prevalence of neurological complications among adult Sudanese patients with chronic liver disease

We aimed to study the prevalence of neurological complications among adult Sudanese patients with chronic liver disease [CLD] seen in Ibn Sina Hospital [Sudan] [February 2005 - February 2006]. This is a prospective descriptive cross sectional hospital based study. Ninety six adult Sudanese patients with CLD were included in the study. All patients had been subjected to full detailed history, proper clinical examination and necessary investigations including EEG, Brain CT, MRI, NCS and EMG. Male to female ratio was [2.5:1]. Splenomegally was observed in 71 patients [74%], shrunken liver in 83 [86.5%], 74 [77.1%] had ascites. Sixty percent had liver cirrhosis, 24% had cirrhosis with periportal fibrosis [PPF]. Hepatocellular Carcinoma [HCC] was detected in 12 patients. Out of 96 patients with CLD, neurological complications were detected in 44 [45.8%], acute hepatic encephalopathy ranging from grade I to grade IV was found to be the most common neurological complication [29 patients]. Neurological complications were common among adult Sudanese patient with chronic liver disease

Comparative analysis of HBV and HCV infection in hepatocellular carcinoma and chronic liver disease--an autopsy based study.

Hepatocellular carcinoma (HCC) is one of the common malignancies worldwide including Asian countries. Chronic viral hepatitis is implicated as an important etiological factor in carcinogenesis of liver. AIM: To study incidence of hepatitis B (HBV) and C (HCV) viruses in HCC and to compare the incidences with that of chronic liver disease. MATERIALS AND METHOD: 40 cases each of HCC (group I) and chronic liver disease including cirrhotic liver (group II) who died of the liver disease. All cases were stained with HBsAg and HBcAb for HBV and RT-PCR for HCV RNA. Different groups were compared using student's t-paired and chi-square tests. RESULTS: Group I--HCC was seen in 37 cirrhotics and 3 non-cirrhotic cases. HBsAg was positive in 32 cases (80%), HBcAb in 22 cases (55%) and HCV in 23 cases (57.5%) (p<0.05). Dysplastic nodule (DN) was seen in 25 cases, HBsAg and HBcAg positivity were seen in 18 and 15 cases respectively. Group II--32 cases were cirrhotic and 8 were non-cirrhotics. HBsAg was positive in 28 (70%), HBcAb in 12 (30%) and HCV in 18 (45%) cases. DN was seen 24 cases, HBsAg and HBcAg postiviy were seen in 16 and 7 cases respectively. HBV and HCV co-infection was seen in 20 and 15 cases, and HCV with HBcAb positivity was seen in 13 and 9 cases in groups I and II respectively. Number of cells in each case showing positivity for HBcAb was also significantly higher in group I (p<0.01). Age and sex distribution did not show any distinctive differences between the two groups. CONCLUSION: the study highlights a high incidence ofHBVand HCV infection in cases of chronic liver disease and HCC. HBcAb positive state appears to be an independent risk factor for HCC.

Cirrose hepática: aspectos morfológicos relacionados às suas possíveis complicações. Um estudo centrado em necropsias / Hepatic cirrhosis: morphologic aspects related to its possible complications. A study focused on necropsies

INTRODUÇAO: A cirrose hepática é muito prevalente em nosso meio, cursando freqüentemente com complicações como insuficiência e carcinoma hepatocelulares e hipertensão portal. OBJETIVOS: Analisar os aspectos clínicos e morfológicos das cirroses, relacionando-os com os principais padrões histológicos e suas complicações. MATERIAL E MÉTODO: Entre 35 fígados cirróticos provenientes de necropsias realizadas no Serviço de Verificação de Obitos da Capital (SVOC-SP), estudados em cortes seqüenciais a cada centímetro, dois padrões anatomopatológicos predominaram: os associados a hepatites crônicas e os decorrentes de esteato-hepatites. RESULTADOS E DISCUSSAO: A alta incidência de cirrose em necropsias (7,1 por cento), com freqüente detecção de macronódulos (62,8 por cento) e de carcinoma hepatocelular (CHC) (37,1 por cento), aponta para a relevância dessas questões em saúde pública. A análise histológica demonstrou o encontro de neoductos, agressão biliar e siderose com maior freqüência na hepatite crônica que na esteato-hepatite. CONCLUSÕES: Essa abordagem sistemática nos espécimes necroscópicos permitiu-nos a identificação de elevada freqüência de cirrose em necropsias do SVOC e, em especial, daquelas decorrentes de hepatites crônicas, aspecto de interesse sanitário. A freqüente detecção de CHC, além de constituir modelo para futuros estudos sobre o surgimento dessas neoplasias, demonstra ser uma das principais complicações da cirrose avançada, qualquer que seja sua causa.

Bone marrow suppression in chronic hepatitis C

Various extrahepatic manifestations of chronic viral infections are known. Here are described four cases of chronic hepatitis C in which marrow suppression was found on initial diagnosis. The diagnosis was made with standard criteria of elevated ALT, with positive anti HCV and presence of HCV RNA. No anti viral treatment with Interferon or Ribavirin was possible in these cases. Only supportive treatment was feasible. All these patients died because of complications of chronic liver disease

Postoperative outcome in patients with chronic viral hepatitis undergoing non-portal hypertension surgery

Forty patients with chronic hepatic failure were subjected to 22 elective non-portal hypertension surgical procedures [cholecystectomy, hernia repair, ulcer procedure and anal surgery] and 18 emergent surgery [strangulated hernia, appendectomy and intestinal obstruction]. Three of the patients died within 30 days of surgery. The clinical and the laboratory findings associated with 30 days mortality were identified in patients with chronic liver failure undergoing non portal hypertension surgery, this surgery carries a high risk of morbidity and mortality to these high-risk patients

Perfiles de glucosa e insulina en pacientes con hepatitis crónica por virus C / Glucose and insulin profiles on patients with chronic C hepatitis

Con objeto de estudiar el comportamiento de los perfiles de glucosa e insulina en pacientes con hepatitis crónica por virus C (HCV), se incluyeron once pacientes con edad promedio de 47.5 años e índice de masa corporal de 23.8 por ciento 1.4. Cinco de ellos eran diabéticos. Su diabetes apareció años después de la hepatitis. El grupo control estuvo compuesto por 12 sujetos sanos con edad promedio de 42.8 años e índice de masa corporal de 24.1 ñ 1.2. Los pacientes tuvieron hepatitis crónica con diferentes grados de daño hepático, pero sin cirrosis. Las cifras de glucosa en ayunas fueron 119.9 ñ 43.4 mg/dL para el grupo de pacientes y 91.9 ñ 3.6 mg/dL para el control. Los niveles de insulina de ayunas fueron 28.1 ñ 17 µU/mL para el grupo de pacientes y 12.9 ñ 3.9 µU/mL para el control. Los valores posprandiales de insulina fueron 38.5 ñ 38 µU/mL para el grupo de pacientes y 51.04 ñ 27 µU/mL para el control. Los valores poprandiales de glucosa fueron 146.9 ñ 118 mg/dL para el grupo de pacientes y 104 ñ 15 mg/mL para el control. En cuanto a la glucosa y a la insulina, el grupo de pacientes no mostró diferencias significativas cuando sus valores de ayuno se compararon versus los posprandiales, contrario a lo que sucedió en el control (p < 0.01 y p< 0.005). Se sugiere que en pacientes con HCV se efectúen periódicamente mediciones de glucemia de ayuno y posprandiales para detectar oportunamente alteraciones de hiperglucemia

Pulmonary function abnormality in patients with portal hypertension with or without chronic liver disease.

Pulmonary function (FVC, FEV1, PEFR, MMEF) and arterial blood gases (ABG) were analysed in 30 patients of portal hypertension. The aetiology of portal hypertension included cirrhosis of liver (n = 10), non cirrhotic portal fibrosis (NCPF, n = 10) and extrahepatic portal vein obstruction (EHPVO). Ten patients with chronic active hepatitis (CAH) without portal hypertension were also studied. Most pulmonary functions were abnormal (low) in portal hypertension and the most affected parameters, were FEV1, PEFR and MMEF (p < 0.05). The same was also observed in CAH, although in less number of patients. Hypoaxemia (26.7%) and wide alveolar--arterial oxygen gradient were observed most frequently in patients of portal hypertension. These patients also had a more alkaline blood pH. EHPVO patients had better lung function and arterial blood gas values. Patients with NCPF had greater impairment in pulmonary function.

Hepatitis crónica activa en un caso de hipertiroidismo severo / Active chronic hepatitis in a severe hyperthiroidism case

Se describe una adolescente que sufría de hipertiroidismo severo de larga evolución, con pobre respuesta a medicamentos antitiroideos y dos episodios de ictericia previos, que ingresó con un hipertiroidismo clínicamente activo a pesar de estar recibiendo propiltiouracilo, ictericia intensa y hepatomegalia. El estudio y manejo de su hepatitis fue complejo, dado que las posibilidades de disfunción hepática en el contexto de un hipertiroidismo, podrían obedecer a toxicidad por drogas, insuficiencia cardíaca, hipertiroidismo por sí mismo o hepatitis autoinmune. Se manejó con suspensión del propiltiouracilo, régimen hipercalórico, propanolol y dos dosis de I131, con lo cual se logró controlar el hipertiroidismo. El estudio de laboratorio e histopatológico fue compatible con hepatitis crónica activa que se manejó con corticoides orales, coincidiendo con lo cual la paciente está asintomática, si bien la biopsia hepática muestra aún signos de actividad

Seguimiento prolongado de pacientes con enfermedad hepática crónica por VHC / Long term follow up of patients with chronic hepatitis by CHV

Thirty two patients (18 males whose ages ranged from 32 to 68 years old) with hepatitis C virus chronic hepatitis (positive anti-HCV by ELISA, conformed by RIBA II) that were followed by the authors during 2 to 25 years, were retrospectively analyzed. 13 subjects had a history of blood transfusions, one had an accidental pinprick and other sexual contact with a HCV positive individual; the transmission source was not identified in the resting 19 subjects. Only 5 individuals had an acute onset. The rest of the patients had a few symptoms with moderate and fluctuating transaminase elevations. Liver biopsy at the onset showed a chronic hepatitis with moderate activity, even in 15 individuals with cirrhosis (47 percent). During follow up, six subjects deteriorated clinically, appearing liver failure and 3 of these died 4, 5 and 14 years after the disease appearance. No subject developed a hepatocarcinoma

Efectos colaterales de la terapia esteroidea en un caso de hepatitis crónica activa autoinmune / Side effects of steroid therapy in autoinmune active chronic hepatitis. Report of a case

Se presenta una paciente con diagnóstico de HCAA tratada con corticoides que sufrió osteoporosis marcada de su columna vertebral. Se le administró calcio y vitamina D, con buena evolución clínico humoral raidológica densitométrica. Se plantea como otra alternativa terapéutica para contrarrestar la osteoporosis inducida por corticoides, la utilización de calcitonina intranasal y vitamina D.

Lipoidoproteinose-hialinose mucocutânea: doença de Urbach-Wiethe; apresentaçäo de um caso e revisäo da literatura / Lipoidproteinosis-hyalinosis mucocutaneous: disease of Urbach-Wiethe: report of a case and review of literature

Os autores fazem a revisäo bibliográfica e apresentam um caso de Lipoidoproteinose, ou hialinose cutâneo-mucosa ou Doença de Urbach-Wiethe. Trata-se de uma doença rara, que ocorre por acumulo de material hialino de natureza bioquímica desconhecida, nas mucosas, pele, trato aéreo digestivo alto, sistema nervoso central, e em outros tecidos. Säo descritos as manifestaçöes e os achados clínicos gerais e otorrinolaringológicos, os exames complementares, bem como a evoluçäo clínica. Pela raridade e gravidade da doença que näo tende a regredir seja espontaneamente ou com tratamento, levando ao êxito letal, o otorrinolaringologista deve ter conhecimento prévio desta doença

Pioderma gangrenoso: a propósito de 4 casos uno asociado embarazo / Pyoderma gangrenosum: report of 4 cases, one associated with pregnancy

El pioderma gangrenoso (PG) es una dermatosis ulcerativa, de causa desconocida, poco frecuente, que presenta características clínico-evolutivas distintivas, que en un alto porcentaje de casos se halla asociada a enfermedades sistémicas. Las más frecuentemente relatadas son las enfermedades inflamatorias intestinales, artritis (seronegativas) y variados procesos hematológicos. Presentamos 4 casos de PG, uno sin enfermedad sistémica asociada, el segundo con colitis ulcerosa crónica, el tercero con múltiples asociaciones hepatitis crónica activa, colitis ulcerosa crónica , TBC) y el cuarto caso asociado a embarazo, hecho no registrado hasta el momento. Hemos utilizado con buena respuesta el peróxido de benzoilo tópico en una paciente y clofazimina en tres casos