Dramatic reduction of the alpha-fetoprotein level after lamivudine treatment of patients with chronic hepatitis B virus infection and cirrhosis

Markedly elevated alpha-fetoprotein levels in the range of >1,000 ng/mL are highly suspicious for the presence of hepatocellular carcinoma. This report describes three patients with cirrhosis and replicating hepatitis B virus infection who presented with initial serum alpha-fetoprotein levels of >1,000 ng/mL without clear evidence of hepatocellular carcinoma based on multiple abdominal imaging studies. Initiation of lamivudine treatment led to rapid and dramatic reductions in the alpha-fetoprotein level to the normal range within 12 weeks in one patient and by >1 log at 7 and 16 weeks in the other two patients. One of the three patients previously developed lamivudine resistance, and discontinuation of lamivudine led to a severe flare of hepatitis B before lamivudine treatment was restarted. During a follow-up period of 14 to 36 months, all three patients maintained stable alpha-fetoprotein levels and had no signs of hepatocellular carcinoma demonstrated by serial abdominal imaging studies. The dramatic decrease in the alpha-fetoprotein levels in these patients is unlikely to be a spontaneous event but is possibly due to suppression of viral replication and associated hepatic inflammatory activities by lamivudine. These observations may be helpful in the diagnostic evaluation and management of patients with markedly elevated alpha-fetoprotein levels and chronic hepatitis B-related cirrhosis.     

Is anti-HBc IgM a useful clinical test in patients with HBsAg-positive chronic hepatitis or primary hepatocellular carcinoma?

Seventy HBsAg-positive patients, including 24 with primary hepatocellular carcinoma, 34 with chronic active hepatitis, 12 with chronic persistent hepatitis and 30 asymptomatic healthy hepatitis B virus carriers were tested for anti-HBc IgM using the Corzyme-M test. Anti-HBc IgM was detected in 50% of the primary hepatocellular carcinoma patients, 26.5% of the chronic active hepatitis patients, 25% of the chronic persistent hepatitis patients, but in none of the healthy hepatitis B virus carriers. There was no correlation between the presence of anti-HBc IgM and HBeAg, hepatitis B virus DNA, ALT or alpha-fetoprotein levels in either the chronic active hepatitis or chronic persistent hepatitis patients. However, a significantly higher positive rate of anti-HBc IgM was noted in the HBeAg-positive or HBV DNA-positive primary hepatocellular carcinoma patients than in those with negative markers of viral replication, but no correlation was noted between the presence of anti-HBc IgM and serum ALT or alpha-fetoprotein levels in these primary hepatocellular carcinoma patients. Also, no differences in positivity for HBeAg, HBV DNA or levels of serum ALT were noted when patients with high titers of anti-HBc IgM were compared to those with low titers. Thus, anti-HBc IgM cannot distinguish between HBsAg-positive patients with chronic active hepatitis, chronic persistent hepatitis or primary hepatocellular carcinoma, does not correlate with serum ALT or alpha-fetoprotein levels and is only associated with markers for viral replication in primary hepatocellular carcinoma patients. Based on this, anti-HBc IgM appears to have a limited usefulness for diagnosis of either chronic hepatitis B or primary hepatocellular carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)     

经皮微波消融术治疗合并肝硬化的原发性小肝癌患者生存分析*

目的 探讨经皮微波消融术（PMCT）治疗合并肝硬化的原发性小肝癌患者的疗效。 方法 2005年1月~2014年7月我院收治的108例合并肝硬化的原发性小肝癌患者,采用PMCT治疗40例,采用开腹肿瘤切除治疗68例。采用Cox回归分析影响患者术后生存的相关因素。 结果 治疗后3年,PMCT治疗患者总生存和无复发生存率分别为60.0%和40.0%,与手术切除治疗组的58.8%和38.2%比,无显著性差异（P>0.05）;单因素分析结果显示死亡患者肝功能分级为B级、血清甲胎蛋白水平高和白蛋白水平低者与生存患者存在显著性差异（P<0.05）;多因素Cox回归模型分析显示肝功能分级（HR=1.81,95%CI:0.97~3.38）、血清AFP（HR=1.83,95%CI:0.99~3.37）和白蛋白水平（HR=1.81,95%CI:0.98~3.36）为影响合并肝硬化的原发性小肝癌患者预后的独立危险因素（P<0.05）。 结论 采用PMCT治疗合并肝硬化的原发性小肝癌患者生存率与手术切除治疗者结果相似,患者预后与肝功能、血清AFP水平和白蛋白水平相关。     

Liver resection in advanced hepatocellular carcinoma

BACKGROUND/AIMS: The aim of this study was to assess the results of major liver resection in patients with advanced hepatocellular carcinoma in terms of safety and survival. METHODOLOGY: The subjects of this study are 19 patients that underwent 24 resections for advanced (stage IV) hepatocellular carcinoma. Eighteen of these resections were performed for primary tumor and 6 were repeat resections. Nine patients presented without cirrhosis, 5 with cirrhosis, and 5 patients had the fibrolamellar variant of hepatocellular carcinoma. RESULTS: Hospital mortality was recorded in 1 case (5%). Morbidity was noted in 7(37%) cases. All patients with fibrolamellar variant of hepatocellular carcinoma are alive at 78, 41, 24, 12 and 9 months (P = 0.008), compared with a median survival of 18 and 9 months for the noncirrhotic hepatocellular carcinoma and cirrhotic hepatocellular carcinoma groups, respectively (P = 0.24). CONCLUSIONS: We conclude that an aggressive policy of major liver resection with vascular reconstruction was justifiable in patients with advanced fibrolamellar variant of hepatocellular carcinoma and in selected patients with noncirrhotic hepatocellular carcinoma, and of doubtful value in patients with cirrhosis.     

Clinical and etiologic features of hepatocarcinoma in Sicily

Hepatocellular carcinoma is a neoplasia with a high degree of malignancy and a quite unfavorable prognosis, and its frequency has tripled over the last 30 years. The aim of this study was to shed further light on some epidemiological and clinical aspects of hepatocellular carcinoma, on the basis of experience with a wide ranging patient population. We included 179 patients (127 males, 52 females, age range 31-86 years), diagnosed with hepatocellular carcinoma between January 1993 and December 1998. For each patient we recorded age, sex, coexistence and cause of cirrhosis, severity of cirrhosis, stage of hepatocellular carcinoma, serum markers of viral hepatitis (hepatitis B surface antigen and hepatitis C virus antibodies) and serum levels of alpha-fetoprotein. Hepatocellular carcinoma was associated with hepatitis C virus in 72% of patients, with hepatitis B virus in 10%, with combined infection in 3% and with negative viral markers in 15%. Mean age at diagnosis was significantly higher in the hepatitis C virus infection patients than in the combined infection patients (p < 0.04); the male/female ratio was 2.1:1 in the hepatitis C virus and 8:1 in the hepatitis B virus subjects. At hepatocellular carcinoma diagnosis, 175 out of 179 patients had liver cirrhosis with a significantly higher severity in patients with negative viral markers than in those with positive viral markers (p < 0.02). The stage of hepatocellular carcinoma at diagnosis was very advanced: in 103 out of 179 cases (58%) neoplasia was stage IV, with a stage I diagnosis in only 14 out of 179 (8%) cases. All the combined (hepatitis B and C virus) cases were diagnosed at stage IV, while hepatocellular carcinoma cases in patients with negative viral markers were diagnosed at earlier stages (66% stages I-II). Serum alpha-fetoprotein levels were above the normal limit (20 ng/mL) in 72% of patients; however, only 30% (54/179) had alpha-fetoprotein values > 400 ng/mL. These data confirm some previous epidemiological and clinical evidence concerning hepatocellular carcinoma (mean age at diagnosis, male/female ratio, severity of pre-existing liver disease, frequency of an associated hepatitis C and/or hepatitis B virus infection). Data based on such a large population, moreover, aid clarification of some still unresolved points such as the utilization of alpha-fetoprotein values in diagnosing hepatocellular carcinoma.     

Fibrolamellar hepatocellular carcinoma with a recurrence of classic hepatocellular carcinoma: a case report and review of Oriental cases

A 72-year-old Chinese male, hepatitis B carrier, received a right hepatic trisegmentectomy in 1997 for fibrolamellar hepatocellular carcinoma. Serum alpha-fetoprotein was in the normal range until two years after the operation, a rapid increase to 241 ng/mL occurred and computed tomography showed a 2-cm-sized recurrent nodule in the caudate lobe. Because computed tomography arterioportography showed additional multifocal nodules in the residual liver, transarterial embolization was performed. Four months after the first transarterial embolization, the caudate tumor grew to 6 cm and serum alpha-fetoprotein increased to 6090 ng/mL. Prior to the second transarterial embolization, this new hepatic lesion received a biopsy and showed a characteristic feature of classic hepatocellular carcinoma, which was different from the previous one. Four months after the second transarterial embolization, computed tomography showed no recurrent tumor and serum alpha-fetoprotein subsequently normalized. Twenty-two months after the first transarterial embolization, a 2.5-cm-sized tumor recurred again at the lateral segment. At this time, serum alpha-fetoprotein (3.6 ng/mL) was not elevated. He received the third transarterial embolization and is still alive. Recurrence of fibrolamellar hepatocellular carcinoma after hepatic resection has been reported to be high, but a case report with a character of muticentric, multifocal, and metachronous recurrences of fibrolamellar and classic type hepatocellular carcinoma is very rare. This is the second case report in the literature.     

Serum alpha-fetoprotein levels and microheterogeneity in patients with different liver diseases.

Serum alpha-fetoprotein levels were determined in patients (268) with liver disease. Markedly elevated concentrations (greater than 100 micrograms/l) were found in twelve patients with malignant tumours and two with cirrhosis. Molecular variants of alpha-fetoprotein were distinguished by lectin affinity chromatography of these sera. Reversible binding to concanavalin A (86 +/- 5%) and to lentil agglutinin (61 +/- 19%) conformed to expected values for primary hepatocellular carcinoma except in one patient with a metastatic carcinoma whose alpha-fetoprotein binding to concanavalin A was similar to non-liver alpha-fetoprotein (44 +/- 13%), and the two patients with cirrhosis in whom binding to lentil agglutinin was typical for benign liver disorders (less than 20%). Since low levels of serum alpha-fetoprotein and non-characteristic alpha-fetoprotein binding patterns assisted in the regrouping of eleven out of 24 patients initially thought to have primary hepatocellular carcinoma, it was concluded that alpha-fetoprotein determination and lectin affinity chromatography are helpful in distinguishing primary hepatocellular carcinoma from metastatic and benign liver diseases. Slight increases in the alpha-fetoprotein level in the presence of serum hepatitis B surface antigen indicated seven patients at risk for primary hepatocellular carcinoma who should be monitored frequently.     

Survival after jaundice: a prospective study of 1000 consecutive cases

A consecutive series of 1002 jaundiced adult patients covering 23 different causes of jaundice is presented. Patients were followed up for 2 to 7 years. The survival for the 784 patients included during their first episode of jaundice was calculated for each diagnostic category. Examples of decreased survival as compared with the general population were (figures indicate 3 months' and 5 years' survival, respectively): alcoholic cirrhosis 0.81, 0.35; cryptogenic cirrhosis 0.78, 0.32; pancreatic carcinoma 0.54, 0.04; cholangiocarcinoma 0.26, 0.00; and heart failure with liver congestion 0.47, 0.07. Ten of 172 patients with acute viral hepatitis died, 1 of fulminant hepatitis and 9 because of suicide or accidents. Of 105 patients with gallstones 37 died during the study period, but in only 9 of these could death be attributed to the gallstone disease. New diagnostic methods and types of treatment for jaundiced patients have been developed during recent years. To justify fully these diagnostic and therapeutic modalities, knowledge of the prognosis for the various causes of jaundice is essential.     

Boronate Affinity Chromatography of γ-Glutamyltransferase in Patients with Hepatocellular Carcinoma

We analyzed the serum gamma-glutamyltransferase (gamma-GT) by boronate affinity chromatography to ascertain the presence or absence of any changes in the binding properties of gamma-GT toward boronate gels in patients with hepatocellular carcinoma and liver cirrhosis, and in normal controls. The mean gamma-GT activity ratio of the bound (peak 2) and nonbound (peak 1) fraction in patients with hepatocellular carcinoma was significantly higher than that in patients with liver cirrhosis or in normal controls. Thus, the gamma-GT, which has adjacent cis-hydroxyl groups in its carbohydrate moieties, was found to increase in the serum of patients with hepatocellular carcinoma. The positivity rate was examined in patients with hepatocellular carcinoma and liver cirrhosis, using a cut-off level for the peak 2:peak 1 ratio of 1.05 (mean + 2 SD of liver cirrhosis). Nineteen (42.2%) patients with hepatocellular carcinoma had a ratio of peak 2:peak 1 higher than 1.05. Nine of the 19 patients who had serum alpha-fetoprotein levels below 100 ng/ml had an elevated peak 2:peak 1 ratio. In total, 77.8% of the occurrence of hepatocellular carcinoma could be detected by a combination of these two markers. Three patients who had developed hepatocellular carcinoma during the course of cirrhosis but remained negative for alpha-fetoprotein throughout the course developed higher levels of peak 2:peak 1 ratio when hepatocellular carcinoma occurred. These results indicate that the two markers, the peak 2:peak 1 ratio of serum gamma-GT activity and serum alpha-fetoprotein level, may be considered to serve as complementary markers for the diagnosis of hepatocellular carcinoma.     

Impact of interferon therapy on the natural history of hepatitis C virus related cirrhosis

BACKGROUND: The role of interferon treatment on the natural history of hepatitis C virus related cirrhosis is under debate. AIM: To evaluate the effect of interferon on the clinical course of compensated hepatitis C virus related cirrhosis. PATIENTS AND METHODS: Seventy two cirrhotic patients treated with interferon and 72 untreated controls matched treated patients with for quinquennia of age, sex, and Child-Pugh's score were enrolled in a prospective non-randomised controlled trial. Treated patients received leucocytic interferon alfa, with an escalating schedule for 12 months. The incidence and risk (Cox regression analysis) of clinical complications (hepatocellular carcinoma, ascites, jaundice, variceal bleeding, and encephalopathy) and death were calculated. RESULTS: Over median follow up periods of 55 months for treated and 58 for untreated subjects, seven and nine patients, respectively, died, and 20 and 32, respectively, developed at least one clinical complication (ns). Hepatocellular carcinoma developed in six treated and 19 untreated patients (p=0.018). Seven treated patients showed sustained aminotranferase normalisation and none died or developed complications. Clinical complications were significantly associated with low albumin, bilirubin, and prothrombin activity while hepatocellular carcinoma was significantly related to no treatment with interferon, oesophageal varices, and high alpha fetoprotein levels. By stratified analysis, the beneficial effect of interferon was statistically evident only in patients with baseline alpha fetoprotein levels > or =20 ng/ml. CONCLUSIONS: Interferon does not seem to affect overall or event free survival of patients with hepatitis C virus related cirrhosis while it seems to prevent the development of hepatocellular carcinoma. Patients who achieved sustained aminotransferase normalisation survived and did not develop any complications during follow up.     

Effect of sustained virologic response on the incidence of hepatocellular carcinoma in patients with HCV cirrhosis

Background and objectivesEvidence suggests that sustained virologic response to interferon treatment decreases incidence of hepatocellular carcinoma in patients with hepatitis C virus cirrhosis. This study was designed to compare the incidence of hepatocellular carcinoma among cirrhotic patients exposed to interferon based treatment with or without achieving a sustained virological response, in order to evaluate the role of interferon itself in the prevention hepatocellular carcinoma.MethodsA cohort of 85 patients with compensated hepatitis C cirrhosis was followed after treatment with interferon and ribavirin. Sustained virological response was defined as negative polymerase chain reaction assay 24 weeks after the end of treatment. Patients were followed every 6 months with ultrasound and alpha-fetoprotein. Hepatocellular carcinoma was diagnosed by the finding of a focal liver lesion greater than 2 cm with arterial hypervascularization on two imaging techniques and/or by liver biopsy.ResultsThe mean follow-up time was 32.1 ± 20 months for patients who achieved a sustained virological response and 28.2 ± 18 months among 47 patients (55%) without SVR. Hepatocellular carcinoma was diagnosed in 1 (3%) vs. 8 (17%) responders and non responders respectively (p = 0.02).ConclusionPatients with cirrhosis due to hepatitis C virus who achieved sustained virological response had significantly lower incidence of hepatocellular carcinoma when compared to those without treatment response. Interferon treatment without achieving sustained virological response does not seem to protect against hepatocellular carcinoma.     

alpha-Fetoprotein monitoring in Chinese patients with chronic hepatitis B virus infection: role in the early detection of hepatocellular carcinoma

Two hundred ninety patients (203 men, 87 women), age 7 to 74 years (mean: 39.1 years), with chronic hepatitis B virus infection, were prospectively followed for a period of 1 to 4 years to determine the value of alpha-fetoprotein monitoring in the early detection of hepatocellular carcinoma. At presentation, 66% of the patients were asymptomatic, 19% had chronic hepatitis and 15% had established cirrhosis. Forty-four (15%) patients had elevated alpha-fetoprotein levels on one or more occasions during the study period. Twenty patients with normal alpha-fetoprotein levels at presentation developed elevated alpha-fetoprotein levels during the course of follow-up, whereas 24 patients had elevated alpha-fetoprotein levels at presentation. Six (14%) of these 44 patients (five men and one woman), age 23 to 66 years, had persistent or progressive increase in alpha-fetoprotein levels and were confirmed to have hepatocellular carcinoma. In four patients, the alpha-fetoprotein levels were below 500 ng per ml at the time of tumor localization. Only three patients had resectable tumors. All six patients would have been missed if alpha-fetoprotein screening was restricted to men above the age of 40 with cirrhosis and anti-HBe. Of the remaining 38 patients, elevation in alpha-fetoprotein levels in 18 patients was associated with exacerbations of the underlying liver disease and/or significant changes in level of hepatitis B virus replication, but in 20 patients, no apparent cause could be identified. The elevation in AFP levels exceeded 200 ng per ml in 26% and persisted beyond 6 months in 15% of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fatal liver failure in haemophiliacs with HIV-induced immunodeficiency: observation of six patients

We observed six cases of haemophiliacs with HIV-induced immunodeficiency who died from fatal liver failure despite the absence of evident cirrhosis. They all had the infection with hepatitis viruses (two patients with hepatitis B and D viruses and four patients with hepatitis C virus) and their CD4 counts were severely decreased. They were much younger than cirrhotic haemophiliacs without HIV. Their serum levels of hyaluronic acid and type IV collagen were lower than those in haemophiliacs with cirrhosis, and were normal. No patients had experienced symptoms or concomitant diseases characteristic of cirrhosis, such as ascites, jaundice, oesophageal/gastric varices or hepatocellular carcinoma, except for one case who had a history of mild ascites. The characteristics of this liver failure were different from liver failure resulting from cirrhosis caused by chronic hepatitis, which suggests liver failure that is specific to patients with immunodeficiency. This kind of liver failure can be a factor threatening survival in patients with HIV infection and with hepatitis virus co-infection in an immunodeficient state.     

A long-term survival case underwent repeated hepatic arterial infusion chemotherapy with portal branch ligation and wrapping of the liver using sheets for hepatocellular carcinoma

Despite progress in therapeutic modalities for hepatocellular carcinoma, chemotherapy is the only remaining option for a considerable number of patients because of severe advanced disease and/or cirrhosis. Repeated hepatic arterial infusion chemotherapy with portal branch ligation and decollateralization using a silicone rubber sheet was performed for hepatocellular carcinoma. Tumor size and serum concentration of alpha-fetoprotein markedly decreased after hepatic arterial infusion chemotherapy. Although the patient had no recurrent tumor, he died of hepatorenal failure 7 years after treatment. Hepatic arterial infusion chemotherapy combined with portal branch occlusion and decollateralization is a new therapeutic method for unresectable hepatocellular carcinoma.     

Three cases of small hepatocellular carcinoma presenting as obstructive jaundice

Background

Despite improved diagnostic tools, it is often difficult to make a correct diagnosis of small hepatocellular carcinoma (HCC) in patients with obstructive jaundice.

Case outlines

Three cases of small HCC (<2 cm diameter) presenting as obstructive jaundice are reported. All tumours were initially diagnosed as hilar cholangiocarcinoma based on ultrasono-graphy, computed tomography, cholangiography and angiogra-phy. Because of insufficient hepatic function, none of the patients underwent hepatic resection. One patient died 8 months after first admission to our hospital, another died of disseminated intravascular coagulation I month after admission, and the third was treated with hepatic arterial infusion chemotherapy and survived >36 months.

Conclusion

It is important to consider HCC in the diagnosis of obstructive jaundice in patients who are predisposed to HCC because of liver cirrhosis and/or chronic viral hepatitis, and have elevated serum alpha-fetoprotein.     

Characteristics of hepatocellular carcinoma in hemodialysis patients in hepatitis B endemic area

BACKGROUND/AIMS: Hepatocellular carcinoma is one of the most common malignancies in Taiwan, a hepatitis B endemic area. In this study, we aimed to evaluate the characteristics of hepatocellular carcinoma in patients receiving hemodialysis, as this patient group is at high risk for malignancy. METHODOLOGY: From October 1991 to September 1997, thirteen patients receiving hemodialysis and diagnosed with hepatocellular carcinoma were enrolled in this retrospective study. Patients' clinical course, laboratory data, image study and treatment were evaluated. RESULTS: Among these 13 patients, hepatitis B virus related in 6 and hepatitis C virus related in 7. There was no statistical significance in serum levels of asparate aminotransferase, alanine aminotransferase, bilirubin and alpha-fetoprotein between hepatitis B virus and hepatitis C virus related hepatocellular carcinoma. Hepatitis B virus related hepatocellular carcinoma had a shorter mean dialysis period (29.67 +/- 22.18 vs. 87.86 +/- 79.90 months, P = 0.25) and mean duration from beginning hemodialysis to diagnosis of hepatocellular carcinoma (17.16 +/- 26.94 vs. 76.08 +/- 65.69 months, P = 0.05), but there was no statistical significance. In the area of treatment, the survival curves of the treatment (hepatic resection and/or transcatheter arterial chemoembolization) group and supportive group were compared by log-rank test and there was no statistical significance for these two groups (P = 0.69). CONCLUSIONS: Both hepatitis B virus and hepatitis C virus are equally important for hepatocellular carcinoma in hemodialysis patients in hepatitis B endemic Taiwan. The acquisition of hepatitis B virus or hepatitis C virus might be not related to hemodialysis. Periodic screening with ultrasonography and serum alpha-fetoprotein is necessary among hemodialysis patients with evidence of hepatitis B virus or hepatitis C virus infection.     

Effect of drinking on the outcome of cirrhosis in patients with hepatitis B or C

Survival rates were calculated for 251 patients with cirrhosis of the liver but without hepatocellular carcinoma, primary biliary cirrhosis, or autoimmune cirrhosis who underwent laparoscopy during the past 21 years at the authors' hospital. The survival rates were calculated by the Kaplan-Meier method. Stored serum was assayed for hepatitis B surface antigen (HBsAg) and antibodies to the hepatitis C virus (HCV). Patients with alcoholic cirrhosis had significantly better survival rates than patients with HBsAg, HCV, or both. Differences in survival rates between patients with hepatitis B and C were insignificant. In both groups, habitual drinkers had a significantly lower survival rate. The results suggested that alcohol accelerates liver damage in subjects with viral hepatitis.     

HB virus infection and delta surinfection in Sahelian Africa

78 hospitalized patients were selected when presenting with at least one of these signs: hepatomegaly, jaundice, ascites, oesophageal varices, abdominal venous pattern, splenomegaly. All had radioimmunoassays for hepatitis B surface antigen (HBsAg) and antidelta antibody (78/78). Acute or chronic hepatic disease was diagnosed in 56 patients: 7 acute viral hepatitis, 13 chronic hepatitis, 23 non alcoholic hepatic cirrhosis, and 13 hepatocellular carcinoma. Twenty-two patients with other diagnoses served as controls. Serum antidelta was present in each group: acute viral hepatitis (2/7), chronic hepatitis (2/13), non alcoholic hepatic cirrhosis (9/23), hepatocellular carcinoma (3/13), controls (2/22). Every patient with acute or chronic hepatic disease and positive serum anti-delta was positive for serum HBsAg. Amony controls, 2 patients with positive serum antidelta were negative for serum HBsAg but positive for antiHBs. Delta superinfection is present in the sahelian region; Patients with acute viral hepatitis, chronic hepatitis, non alcoholic hepatic cirrhosis, and hepatocellular carcinoma are electively infected. Patients with acute or chronic hepatitis and positive serum antidelta have hepatitis B virus evolutive infection (positive serum HBsAg).     

Infection à virus HB et surinfection delta en Afrique Sahélienne

78 hospitalized patients were selected when presenting with at least one of these signs: hepatomegaly, jaundice, ascites, oesophageal varices, abdominal venous pattern, splenomegaly. All had radioimmunoassays for hepatitis B surface antigen (HBsAg) and antidelta antibody (78/78). Acute or chronic hepatic disease was diagnosed in 56 patients: 7 acute viral hepatitis, 13 chronic hepatitis, 23 non alcoholic hepatic cirrhosis, and 13 hepatocellular carcinoma. Twenty-two patients with other diagnoses served as controls. Serum antidelta was present in each group: acute viral hepatitis (2/7), chronic hepatitis (2/13), non alcoholic hepatic cirrhosis (9/23), hepatocellular carcinoma (3/13), controls (2/22). Every patient with acute or chronic hepatic disease and positive serum anti-delta was positive for serum HBsAg. Amony controls, 2 patients with positive serum antidelta were negative for serum HBsAg but positive for antiHBs.Delta superinfection is present in the sahelian region; Patients with acute viral hepatitis, chronic hepatitis, non alcoholic hepatic cirrhosis, and hepatocellular carcinoma are electively infected. Patients with acute or chronic hepatitis and positive serum antidelta have hepatitis B virus evolutive infection (positive serum HBsAg).     

Detection of hepatocellular carcinoma during a clinical follow-up of chronic liver disease: observations in 31 patients.

In 31 patients with an initial diagnosis of cirrhosis or chronic hepatitis hepatocellular carcinoma (HCC) was detected after a clinical follow-up of 8 months to 14 years with an average of 59 months. They had had no scintigraphic and biochemical abnormalities suggestive of HCC at the beginning. The follow-up period before the detection of carcinoma was shorter in patients positive for hepatitis B surface antigen compared with those negative for hepatitis B surface antigen. Analyses of clinical data during the follow-up and liver scans made shortly before tumor detection suggested that in most of these patients HCC became discernible relatively early in the course of cirrhosis or long before cirrhosis reached an advanced stage. A sharp rise in serum alpha-fetoprotein level proved highly diagnostic in 11, it remained low throughout in 7, and tumor was already unresectable in the majority. Although continuous and regular check for alpha-fetoprotein is imperative in patients with chronic liver disease, particularly in those with hepatitis B surface antigenemia, additional diagnostic tools are necessary for the detection of small HCC in its resectable stage.