Asymptomatic chronic HBsAg carriers with normal liver function tests are, in general regarded as having no liver pathology. Most of the histologic findings in asymptomatic chronic carriers have been reported from areas with low incidence of Hepatitis B virus (HBV) infection, such as North America and Western Europe. It is well known that there are many differences in HBV infection between low and high endemic areas, but there have been few reports on the histologic findings of asymptomatic chronic HBsAg carriers from endemic areas. The present study was undertaken in Korea which is one of the endemic areas for HBV infection and was designed to assess the prevalence of chronic liver disease by peritoneoscopic liver biopsy among asymptomatic chronic HBsAg carriers and to make a basis for the follow-up of asymptomatic chronic HBsAg carriers according to the results obtained. One hundred and ten asymptomatic HBsAg-positive carriers with normal liver function tests and no hepatomegaly were included in the study. Final diagnosis by peritoneoscopic liver biopsy revealed that of the 110 asymptomatic carriers only 27 (24.5%) had a histologically normal liver, while 51 (46.4%) had chronic liver diseases, and the remaining 32 (29.1%) had nonspecific histologic abnormalities (nonspecific reactive changes in 18 cases, cholestasis in 6 cases, and fatty change in 8 cases). Of the 51 patients with chronic liver diseases, 3 had liver cirrhosis, 4 chronic active hepatitis with cirrhosis, 11 chronic active hepatitis and 33 chronic persistent hepatitis. The frequency of liver cirrhosis and chronic active hepatitis with cirrhosis was significantly high in the over 30 years of age group (12.1%) than in the under 30 years of age group (0%; p = 0.011 by Fisher's exact test). In conclusion, 46.4% of the Korean asymptomatic chronic HBsAg carriers with normal liver function tests and no hepatomegaly had chronic liver disease. This finding contrasted with reports from low incidence areas of HBV infection. Our results suggest that in endemic areas, a liver biopsy should be considered to assess the status of liver disease in asymptomatic chronic HBsAg carriers even if liver function tests are normal and hepatomegaly is absent, and the result can be used as a basis for the follow-up of each asymptomatic chronic HBsAg carriers.
Adolescent ; Adult ; Biopsy ; Carrier State/*pathology ; Chronic Disease ; Female ; Hepatitis B/*pathology/physiopathology ; Hepatitis B Surface Antigens/*analysis ; Human ; Laparoscopy ; Liver/*pathology/physiopathology ; Male ; Middle Age

BACKGROUND AND PURPOSE: It has been shown that erythropoietin is neuroprotective in animal models of neurodegenerative diseases including amyotrophic lateral sclerosis (ALS). The aim of this study was to determine the safety and feasibility of repetitive high-dose recombinant human erythropoietin (rhEPO) therapy in ALS patients. METHODS: Two consecutive studies were conducted. We first recruited 26 subjects for an initial single-arm safety study. After a lead-in period of 3 months to assess the disease progression, rhEPO was infused intravenously (35,000 IU) once per month for 3 months, and the subjects were followed for an additional 3 months. The ALS Functional Rating Scale-Revised (ALSFRS-R) was used for clinical assessment. After confirming the safety of rhEPO, 60 subjects were recruited for the second controlled study (rhEPO and control groups), which involved a total of 6 infusions at a rate of 1/month. RESULTS: There were no serious adverse events in the first study. The mean rate of decline in the ALSFRS-R score was lower during the treatment period than during the lead-in period (mean+/-SD: 2.6+/-1.8 and 3.7+/-2.6, respectively; p=0.02). However, the rate of decline during the subsequent 3 months returned to that observed in the lead-in period. In the second study, the mean rate of decline in ALSFRS-R score was significantly lower in the rhEPO group than in the control group (during months 0-3, 1.8+/-1.7 vs. 3.1+/-2.3, p=0.03; during months 4-6, 2.1+/-2.2 vs. 3.5+/-2.3, p=0.02). CONCLUSIONS: Intravenous high-dose rhEPO is both safe and feasible for the treatment of ALS. Further investigation using different intervals and doses should be considered.
Amyotrophic Lateral Sclerosis* ; Disease Progression ; Erythropoietin* ; Humans ; Models, Animal ; Neurodegenerative Diseases ; Pilot Projects*

BACKGROUND/AIMS: Chronic hepatitis has been divided into chronic persistent hepatitis, chronic lobular hepatitis and chronic active hepatitis. These terms should be discontinued in favor of etiologic terminology. The activity of necro-inflammation and the degree of fibrosis should be evaluated for grading the severity and the stage of the disease. In this study, we sought to evaluate the long-term outcome and prognostic factors of chronic hepatitis B according to the new histological classification of chronic hepatitis proposed by the Korean Study Group for the Pathology of Digestive Diseases. METHOD: One hundred and eighty-eight patients (mean age, 35.0 years; male/female 3.9:1) with biopsy-proven chronic hepatitis B were retrospectively assessed with a mean follow-up of 80.6 months. The patients were divided into a biochemically-active group and a biochemically-inactive group according to serum alanine aminotransferase (ALT) changes during follow-up periods. The development of compensated cirrhosis and hepatocellular carcinoma were investigated during follow-up periods. As well, the liver biopsy specimens of the patients were reviewed according to the new histological classification of chronic hepatitis (grade of lobular activity and porto-periportal activity, stage of fibrosis). RESULTS: Lobular activity and porto-periportal activity correlated with the serum ALT level at the time of biopsy (p<0.05). The development of compensated cirrhosis correlated with porto-periportal activity and stage of fibrosis (p<0.05). The probability of the development of compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma increased significantly in the older age group (>= or 40 years) and the biochemically-active hepatitis group (p<0.01). The risk factors for the development of compensated cirrhosis and decompensated cirrhosis were old age (>= or 40 years) and biochemically-active hepatitis during follow-up periods. For hepatocellular carcinoma they were old age (>= or 40 years), male gender and biochemically-active hepatitis during follow up periods by multivariate analysis. CONCLUSIONS: The present study suggests that the new histological classification of chronic hepatitis indicates hepatitis activity and the prospect for progression to cirrhosis in chronic hepatitis B. The biochemical hepatitis activity during follow-up periods is the independent prognostic factor for the development of cirrhosis and hepatocellular carcinoma in chronic hepatitis B. Therefore, effective treatment to decrease hepatitis activity may reduce the develoment of cirrhosis and hepatocellular carcinoma.
Alanine Transaminase ; Biopsy ; Carcinoma, Hepatocellular ; Classification* ; Fibrosis ; Follow-Up Studies ; Hepatitis ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Liver ; Male ; Multivariate Analysis ; Pathology ; Retrospective Studies ; Risk Factors

A case of antiphospholipid antibody syndrome, accompanied by valvular heart disease and Moya moya syndrome, has never been reported. Here, we report on a case that had mitral regurgitation and Moya moya syndrome, associated with antiphospholipid antibody syndrome secondary to systemic lupus erythematosus. This patient underwent a mitral valve replacement for mitral valve regurgitation. The postoperative course was uneventful, and the pathological findings of the mitral valve showed a degenerative change, due to chronic inflammation, a proliferative fibrous change and calcification, but without thrombus formation. However, the patient returned to the hospital with a cerebral hemorrhage, which was caused by Moya moya syndrome. Surgical drainage was performed, and the patient was discharged without any complications. The patient is on anticoagulation and immunosuppression drugs, with no problems to date.
Antibodies, Antiphospholipid* ; Antiphospholipid Syndrome* ; Cerebral Hemorrhage ; Drainage ; Heart Valve Diseases* ; Humans ; Immunosuppression ; Inflammation ; Lupus Erythematosus, Systemic ; Mitral Valve ; Mitral Valve Insufficiency ; Thrombosis