Natural History of Chronic Hepatitis B in Children / 소아과

PURPOSE: We investigated the spontaneous seroconversion rate of hepatitis B viral markers and predictive factors affecting seroconversion in children with chronic hepatitis B. METHODS: The study population included 214 children diagnosed as chronic hepatitis B, with positive HBsAg, HBeAg and HBVDNA over six months, and all patients had a family history of chronic Hepatitis B. They were followed between May 1982 and Febrary 2003 in the Department of Pediatrics, Yonsei University College of Medicine. Serum HBsAg, HBeAg, anti-HBs, HBVDNA, and AST/ALT were measured every six months. RESULTS: The mean age of patients was 7.4+/-4.5 years. The loss of HBeAg, HBVDNA and HBsAg were observed in 44(19.2%), 34(15.9%) and 3(1.4%) children respectively. The patients with serum ALT levels over three times normal and with HBVDNA less than 1,000 pg/dL showed significantly higher seroconversion rates of HBeAg and HBVDNA(P<0.001). By analyzing with the life table method, the cumulative seroconversion rate of HBeAg was 11% at 10 and 35% at 19 years of age, while HBVDNA was 9% at 10 and 32% at 19 years of age. In cases of HBsAg, the cumulative seroconversion rate was only 1.5% at 19 years of age. The age of patients, serum ALT and HBVDNA levels were proven as signifincant factors influencing the seroconversion of HBeAg and HBVDNA(P<0.001). CONCLUSION: In children with chronic hepatitis B, the seroconversion rate of HBeAg and HBVDNA are expected to be 35% and 32%, respectively, by the age of 19 years. The age of patients, serum ALT and HBVDNA levels seem to have significant influence on HBeAg and HBVDNA seroconversion.

Fast Fluid-Attenuated Inversion-Recovery MR Image in the Intracranial Tumors : Comparison with Fast Spin-echoImage

PURPOSE: To evaluate the significance of fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) images for the diagnosis of intracranial tumors. MATERIALS AND METHODS: MR imaging was used to study15 patients with various intracranial tumors and were compared the findings according to fast spin echo and fast FLAIR images. RESULTS: In 12 of 15 patients, tumor signal intensities on FLAIR images were consistent with those shown on T2-weighted (T2W) images. In seven of eight patients who had cystic or necrotic components within the mass, FLAIR images showed isosignal intensity and in the other patient, high signal intensity was seen. There was variation in the signal intensity from cerebrospinal fluid (CSF). In 12 of 13 patients in whom edema was associated with tumor, FLAIR images were clearer than T2W images as their signal intensity was brighter. In eight patients, however, FLAIR and T2W images provided a similar definition of the margin between edema and tumor. In six patients with intratumoral hemorrhage, FLAIR and T2W images showed the same signal intensities at all stages of the hemorrhage except the chronic cystic stage. CONCLUSION: We concluded that in the diagnosis of intracranial tumors, FLAIR images can supplement conventional spin-echo images.