No abstract available.
Adult ; *Fatty Liver/diagnosis/etiology/pathology ; Humans ; Male

HCV-related decompensated liver cirrhosis is a life-threatening illness with an average 5-year survival rate of 50%. Because these patients have higher risk of morbidity and mortality including development of hepatocellular carcinoma, the benefits of eradicating the virus may be greater than in those with less-advanced disease. Recently, direct-acting antiviral agents (DAAs) are replacing interferon-based regimens that have serious adverse events and low tolerability in the treatment of HCV infection. Many clinical trials using combination of several DAAs with or without ribavirin are now actively on-going in HCV-related decompensated cirrhosis, and encouraging data are beginning to appear. In this review, recent advances in the treatment of HCV-related decompensated cirrhosis are introduced with special focus on new DAAs.
Antiviral Agents/*therapeutic use ; Drug Therapy, Combination ; Hepatitis C/complications/*drug therapy/pathology ; Humans ; Interferon-alpha/therapeutic use ; Liver Cirrhosis/*complications/pathology ; Practice Guidelines as Topic ; Republic of Korea ; Ribavirin/therapeutic use

Acquiring a sustained virological response (SVR) in patients with cirrhosis or advanced hepatic fibrosis reduces liver disease-related mortality and the incidence of hepatocellular carcinoma. However, the SVR rate of the current standard of care, which is combination therapy with peg-interferon-alpha and ribavirin, is significantly lower, and treatment-related complications occur more frequently in patients with cirrhosis. Thus, antiviral treatment should be individualized in this population. This review highlights the issues associated with anti-hepatitis C virus treatment in patients with compensated and decompensated cirrhosis.
Carcinoma, Hepatocellular ; Fibrosis ; Hepatitis C* ; Humans ; Incidence ; Liver ; Liver Cirrhosis* ; Mortality ; Ribavirin ; Standard of Care

Hepatitis B virus (HBV) infection during pregnancy brings up unique management challenges. Varying aspects of care must be considered, including the effects of pregnancy on the course of HBV infection, effects of HBV infection on maternal and fetal health, treatment of HBV during and after pregnancy, and prevention of perinatal infection. For those with chronic HBV infection, the course of disease is usually unchanged during pregnancy. However, flares have been reported shortly after delivery. Women with high HBV DNA titer have an increased likelihood of perinatal transmission and may contribute to the failure of current passive-active immunoprophylaxis at birth. The aim of the present review is to provide a tool that may help physicians to manage correctly HBV infection in pregnancy.
Breast Feeding ; Cesarean Section ; DNA ; Female ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Parturition ; Pregnancy

Although the classical gold standard for diagnosing and staging non-alcoholic fatty liver disease (NAFLD) and assessing fibrosis is liver biopsy, the procedure has several drawbacks, such as sample error, subjectivity in interpretation, high cost, and a small but real risk of complications.In an attempt to replace liver biopsy and to subcategorize patients with NAFLD into different prognoses, many non-invasive methods using various biomarkers, scoring systems, and imaging methods, such as elastography, have been attempted in the last decade. This article summarizes non-invasive diagnostic tests for the diagnosis of NAFLD/Nonalcoholic steatohepatitis, as well as the limitations and merits of liver biopsy.
Biomarkers ; Biopsy ; Diagnosis* ; Diagnostic Tests, Routine ; Elasticity Imaging Techniques ; Fatty Liver* ; Fibrosis ; Humans ; Liver ; Prognosis

BACKGROUND/AIMS: The notion that acute hepatitis A superimposed on chronic hepatitis B infection leads to a worse outcome than acute hepatitis A alone remains controversial. The aim of this study was to determine the influence of the presence of hepatitis B surface antigen (HBsAg) on the severity of acute hepatitis A. METHODS: We retrospectively analyzed 449 patients hospitalized for acute hepatitis A from January 2000 to February 2010 and compared clinical outcomes based on the presence of HBsAg. RESULTS: Of the 449 patients, 30 patients were in the HBsAg-positive group and 419 in the HBsAg-negative group. The HBsAg-positive group was older than the HBsAg-negative group (36.1+/-8.3 vs 31.8+/-8.5 years, p=0.004); however, other baseline characteristics were similar between the 2 groups. Mean peak values of prothrombin time, serum total bilirubin, and serum creatinine at admission were significantly higher in the HBsAg-positive group. When comparing clinical outcomes between the 2 groups, gastrointestinal bleeding, acute renal failure, and acute liver failure were more frequently observed in the HBsAg-positive group. In particular, the incidence of acute liver failure was approximately 9-fold higher in the HBsAg-positive group than in the HBsAg-negative group (23.3% vs 3.3%; odds ratio [OR], 8.80; p<0.001). Multivariate analysis showed that HBsAg (OR, 7.43; 95% confidence interval [CI], 2.56 to 21.57) and age (OR, 1.07; 95% CI, 1.02 to 1.13) were independent risk factors for the occurrence of acute liver failure. CONCLUSIONS: In patients with chronic hepatitis B infection, acute hepatitis A is associated with more severe clinical outcomes, including acute liver failure, compared with patients with acute hepatitis A alone.
Acute Kidney Injury ; Bilirubin ; Creatinine ; Hemorrhage ; Hepatitis ; Hepatitis A ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic ; Humans ; Incidence ; Liver ; Liver Failure, Acute ; Multivariate Analysis ; Odds Ratio ; Prothrombin Time ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: We investigated the effect of low dose corticosteroid therapy on HBV reactivation in patients with chronic HBV infection. METHODS: From August 1998 to March 2007, the HBsAg-positive patients who received oral or intravenous corticosteroid therapy for more than 1 week at Samsung Medical Center were included in this retrospective study. We included those patients who received anticancer chemotherapy or organ transplantation, or concurrent antiviral therapy or other immunosuppressive agents. HBV reactivation was defined as a 10-fold increase in the HBV DNA levels compared with baseline. RESULTS: A total of 16 patients were included. They were 45.4+/-16.7 years of age, and the male:female ratio was 14:2. Their combined diseases included bronchial asthma, allergic urticaria, allergic rhinitis, etc. The corticosteroid doses were converted to prednisolone equivalent doses and these varied from 2.5 mg to 50 mg per day. Eleven patients used less than 20 mg of prednisolone per day. The mean medication duration was 60.1 days (range: 7-364 days). Among the patients, only one patient showed HBV reactivation. This ankylosing spondylitis patient was a 31-year old man who took prednisolone 5 mg/day for 364 days. He displayed HBeAg-positivity before corticosteroid treatment. There was no aggravation of the levels of ALT, albumin, bilirubin, and PT between the pre-and post-medication in this patient. CONCLUSIONS: The short term use of low dose corticosteroid is not likely to be related with HBV reactivation in those patients with chronic HBV infection, yet long term use may lead to viral reactivation. Further large scaled, prospective studies on this subject are needed.
Asthma ; Bilirubin ; DNA ; Hepatitis B e Antigens ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Immunosuppressive Agents ; Organ Transplantation ; Prednisolone ; Retrospective Studies ; Rhinitis ; Rhinitis, Allergic, Perennial ; Spondylitis, Ankylosing ; Transplants ; Urticaria

A 46-year-old woman was found to have a huge liver mass that was detected by abdominal ultrasonography. Abdominal CT and MRI showed a 10 cm-sized, encapsulated mass occupying the anterior segment of the right hepatic lobe. Extended right hemihepatectomy was performed and pathological examination revealed fibroblast-like spindle cells within dense deposits of collagen. On immunohistochemical staining, these spindle tumor cells showed an intense CD34 immunoreactivity. The patient is alive without evidence of tumor recurrence 7 months after the resection. Solitary fibrous tumor is a very rare neoplasm found in the liver parenchyma, and it has been reported in less than 30 patients in the English literature. We present here the first such case in Korea.
Antigens, CD34/analysis/immunology ; Female ; Humans ; Liver Neoplasms/*diagnosis/pathology/surgery ; Magnetic Resonance Imaging ; Middle Aged ; Solitary Fibrous Tumors/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed ; Tumor Markers, Biological/analysis/immunology

BACKGROUND/AIMS: The role of radiofrequency ablation (RFA) remains uncertain in patients with viable hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE). METHODS: A total of 101 patients (April 2007 to August 2010) underwent RFA for residual or recurrent HCC after TACE. We analyzed their long-term outcomes and predictive factors. RESULTS: The overall survival rates after RFA were 93.1%, 65.4%, and 61.0% at 1, 3, and 5 years, respectively. Predictive factors for favorable overall survival were Child-Pugh class A (hazard ratio [HR], 3.45; p=0.001), serum alpha-fetoprotein (AFP) level <20 ng/mL (HR, 2.90; p=0.02), and recurrent tumors after the last TACE (HR, 3.14; p=0.007). The cumulative recurrence-free survival rate after RFA at 6 months was 50.1%. Predictive factors for early recurrence (within 6 months) were serum AFP level > or =20 ng/mL (HR, 3.02; p<0.001), tumor size > or =30 mm at RFA (HR, 2.90; p=0.005), and nonresponse to the last TACE (HR, 2.13; p=0.013). CONCLUSIONS: Patients with recurrent or residual HCC who undergo prior TACE show a favorable overall survival, although their tumors seem to recur early and frequently. While good liver function, a low serum AFP level, and recurrent tumors were independent predictive factors for a favorable overall survival, poor response to TACE, a high serum AFP level, and large tumors are associated with early recurrence.
Aged ; Carcinoma, Hepatocellular/*mortality/*therapy ; *Catheter Ablation ; Chemoembolization, Therapeutic/mortality ; Combined Modality Therapy/mortality ; Female ; Humans ; Liver Neoplasms/*mortality/*therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local/mortality ; Survival Rate ; Treatment Outcome ; alpha-Fetoproteins/analysis

Intestinal bypass surgery, particularly jejuno-ileal bypass surgery, performed for the purpose of weight reduction may cause an unexpected exacerbation of nonalcoholic steatohepatitis (NASH). Here, we report a case of NASH caused by small intestinal bacterial overgrowth, which developed after jejuno-colic bypass surgery and resolved dramatically after surgical correction.
Edema ; Fatty Liver ; Jejunoileal Bypass ; Weight Loss