Alpha-fetoprotien as a diagnostic tool in differntiating hepatocellular carcinoma from benign hepatic disorders

Objective: Differential diagnosis of hepatocellular carcinoma [HCC] from benign lesions of the liver is often difficult yet of great clinical importance. In the present study, we analysed diagnostic value of alpha-fetoproteins in hepato- cellular carcinoma. Design: A descriptive study Setting: Department of Internal Medicine, Liaquat University Hospital, Jamshoro, Sindh from February 2000 to December 2002

Subjects and Methods: Total 200 persons were studied. 100 presented with liver mass and other symptoms directing toward liver pathology, later confirmed histopathologically, as suffering from HCC while the other 100 subjects came to the department with jaundice and were HbsAg and anti-HCV positive on blood screening. All these subjects underwent blood test for alpha-fetoprotien. This tumor marker was analyzed by using enzyme immunoassay-based kit

Results: The alpha-fetoprotien positivity was statistically evaluated. In HCC, this test was statistically significant with p value of <0.001. In this study sensitivity of alpha-fetoprotien was 72%, specificity 89%, positive predictive value 86.7% and negative predictive value of 76.1%

Conclusion: These findings suggest that alpha-fetoprotien has the potential to differentiate between benign and malignant liver diseases and it is a useful tool in the diagnosis of HCC

Management of decompensated cirrhosis due to HbeAg-negative chronic HBV infection with lamivudine monotherapy

Objective: To evaluate the efficacy of long-term lamivudine monotherapy in patients with decompensated cirrhosis due to HbeAg-negative1HBV-DNA positive. Design: Case - control study. Setting: Departments of Medicine and Surgery, Liaquat University Hospital, Jamshoro, and Isra University Hospital Hyderabad, from March 2000 to June 2003

Patients and Methods: We analyzed the clinical course and outcome of lamivudine treatment in 30 consecutive cirrhotics and compared with 30 HBV untreated HbeAg-negative controls

Results: Significant clinical improvement, defined as a reduction of at least two points in Child-Pugh score was observed in 23 of the 30 treated patients [76.6%] versus none of the 30 patients in the control group [p< 0.0001] after a mean follow-up of 10.6 + 2.1 [+SD] months. There were 10 deaths in the treated group versus 24 in the control group [p= 0.07]. Patients with clinical improvement had better survival than patients with no improvement [p=0.04]

Conclusion: Lamivudine monotherapy significantly improves liver function in HbeAg-negative decompensated cirrhosis