Comparison of clinical features and survival of patients with hepatitis B- and hepatitis C-associated hepatocellular carcinoma in Thailand.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are leading causes hepatocellular carcinoma (HCC) worldwide. The aim of this study was to determine whether differences do exist between HBV- and HCV-associated HCC in terms of clinical, pathologic features and prognosis among Thai patients. The authors retrospectively reviewed the clinical data of 188 patients with pathologically proven HCC, who were admitted to Chulalongkorn Hospital between January 1997 and December 1999. Of these cases, there were 105 patients (55.9%) with hepatitis B surface antigen (HbsAg) positive, 19 patients (10.1%) with anti-HCV positive, and 2 patients (1.0%) with both markers positive. The authors found that the mean age of patients with HBsAg positive was significantly lower than that of anti-HCV positive (49.2 +/- 12.7 and 58.3 +/- 8.9 years, respectively, p = 0.003). In contrast, the mean serum alpha-fetoprotein level of HBsAg positive group was significantly higher than that of anti-HCV positive group (48,583.6 +/- 109,494.1 and 2,022.7 +/- 4,869.1 IU/ml, respectively, p = 0.001). However, there was no difference between the two groups in terms of the severity of underlying liver disease, tumor histology and morphology, clinical staging, and the overall survival rate of the patients. The authors concluded that, among Thai populations, the majority of clinical features and survival of HBV-associated HCC did not differ from those with HCV-associated HCC.

Serum hyaluronan: a marker of liver fibrosis in patients with chronic liver disease.

The aim of this study was to evaluate the clinical significance of serum hyaluronan (HA) as a marker of liver fibrosis in patients with chronic liver disease. Serum HA was measured by an ELISA-based method in 28 patients with chronic hepatitis (CH), 43 patients with liver cirrhosis (LC), 57 patients with hepatocellular carcinoma (HCC) and 60 healthy controls. Mean serum HA concentration in patients with LC was 1,376.80 +/- 2,568.85 ng/ml which was significantly higher than those in patients with CH, HCC and the controls (575.93 +/- 732.58, and 426.36 +/- 687.33, and 117.86 +/- 311.11 ng/ml, respectively). Based on a ROC curve analysis, a cut-off point of 354 ng/ml discriminated between LC and other groups with a sensitivity, specificity and accuracy of 82.4%, 78.2%, and 80.2%, respectively. Mean HA concentrations were correlated with the degree of liver fibrosis, but not the grade of necroinflammatory activity. In patients with LC, the mean serum HA level was significantly increased in the Child C group (3,977.96 +/- 4,906.21 ng/ml) in comparison with the Child B and A groups (1,002.63 +/- 448.55, and 537.90 +/- 424.16 ng/ml, respectively). We conclude that serum HA concentrations reflect the extent of liver fibrosis and severity of cirrhosis. Thus, serum HA can be a diagnostic marker of liver fibrosis and cirrhosis in patients with chronic liver disease.

Clinical, pathological, and electron microscopic findings in two Thai children with Pompe disease.

The authors report on a Thai boy who first presented at age 7 months and an unrelated Thai girl in her neonatal period with hypotonia, cardiomegaly and hepatomegaly. Their chest roentgenograms showed markedly enlarged hearts, EKGs showed abnormally shortened PR intervals with gigantic QRS complexes, and electron microscopic studies of their skin samples showed glycogen accumulations surrounded by membranes. The boy died at age 22 months and the girl at age 9 months due mainly to cardiorespiratory failure. Autopsy of the girl showed marked accumulation of glycogen in the liver, heart and numerous additional tissues including her brain. The clinical, pathological, and electron microscopic findings of these two children are consistent with the diagnosis of Pompe disease. Pompe disease is an autosomal recessive disorder of glycogen metabolism resulting from deficiencies in activity of the lysosomal acid alpha-glucosidase. Definite diagnosis of the disease can be made from a biochemical test or a mutation analysis. To the authors' knowledge, no service laboratories in Thailand offer the tests. Because Thai children have occasionally been reported to be affected by Pompe disease, an attempt to establish a definite diagnostic test for Pompe disease in Thailand should be encouraged. With a definite diagnosis, the proper genetic counseling and prenatal diagnosis could be offered to the families.