INACTIVE HBsAg CARRIER STATE: THE EXPERIENCE OF A SINGLE CENTER IN ISTANBUL, TURKEY
S. OZDEMIR (1), M. COSKUN (2), E. CAGLAR (1), G. SISMAN (1), E. SATIR (1),
I. HATEMI (1), A. SONSUZ (1), G. OZBAY (3), H. SENTURK (1).
(5)Istanbul University, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology, Istanbul, TURKEY.
(6)Balikesir University, Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology, Balikesir, TURKEY.
(7)Istanbul University, Cerrahpasa Faculty of Medicine, Department of Pathology, Istanbul, TURKEY.
Background / Aims: Inactive HBsAg carrier state is defined as persistently serum HBsAg positivity for 6 months, serum HBV-DNA <2,000 IU/ml, and normal serum aminotransferases levels. In this study we investigated the serologic, biochemical and histopathological features of inactive HBsAg carriers.
Methodology: Research data were obtained from 592 patients. The orderly observed 468 cases (292 male, 176 female) (mean age: 39.5±10.8 yr, range: 16-59 yr) were followed-up every 6 months for a period of 2 to 16 years (mean: 7.35±3.4 yr).
Results: The majority of the cases (94%) were HBeAg (-) and anti-HBe (+). HBV-DNA was found ≥2,000 IU/ml in 13 cases in the follow-up period. A liver biopsy was performed in 52 cases with elevated alanine aminotransferase (ALT) levels. In 31 of them mild or moderate chronic hepatitis was detected. One of them had inactive cirrhosis. Anti-HDV was determined five of the 322 cases investigated. Anti-HCV was positive only in one of the 118 cases investigated. In 7 cases HBsAg became negative and 2 of them developed anti-HBs. In the follow-up period none of the cases developed hepatocellular carcinoma.
Conclusions: According to the findings of our study, in this country inactive HBsAg carrier state has a benign course and there is no need for routine liver biopsy. However, these patients should be continued follow-up in terms of transaminases elevations.
DİAGNOSTİC AND PROGNOSTİC ROLE OF SERUM GLYPİCAN 3 İN PATİENTS WİTH HEPATOCELLULAR CARCİNOMA
H. OZKAN1,H. ERDAL1, E. KOCAK2, H. TUTKAK3, Z. KARAEREN4,
M. YAKUT1 , S. KOKLU2
1 Ankara University, School of Medicine, Department of Gastroenterology, 2 MD, Ankara Education and Research Hospital, Department of Gastroenterology, 3 Ankara University School of Medicine, Department of Immunology and Allergic Diseases , Ankara, TURKEY.
Aim: AFP is commonly used as a tumor marker in the diagnosis of HCC. The aim of this study was to asses the diagnostic and prognostic validity of serum GPC3 and to compare with AFP in patients with HCC.
Material and Methods: A total of 128 patients (75 patients with HCC, 55 patients wtih cirrhosis and 28 healty controls) were included in this study. GPC3 cut-off value was decided as 3.9 pg/ml. AFP was divided into 4 subgroup according to cut-off values with 13 ng/ml, 20 ng/ml, 100 ng/ml and 200 ng/ml. Sensitivity, specificity, positive predictive value and negative predictive values of GPC3 and AFP13, AFP20, AFP100, AFP200 subgroups and also GPC3+AFP13, GPC3+AFP20, GPC3+AFP100, GPC3+AFP200 combinations were compared.
Results: Serum GPC3 levels were significantly higher in patients with HCC and cirrhosis compared to control subjects (p<0.05). The median serum GPC3 levels were 3.9 pg / ml in controls, 5.51 pg / ml in patients with cirrhosis and 5.13 pg / ml in those with HCC. The median serum AFP levels were 1.37 ng / ml in controls, 2.32 ng / ml in cirrhotics and 50.65 ng / ml in HCC patients. The sensitivity, specificity, positive and negative predictive values of GPC3 were 61.33%, 41.82%, 58.97% and 44.43% respectively.Whereas the levels were 68.57%, 94.55%, 94.12%, 70.27%, respectively for AFP. In addition there was no correlation between GPC3 levels and prognostic parameters.
Conclusion: GPC3 is not a useful diagnostic and prognostic marker of HCC.
MINIMALLY INVASIVE TREATMENT OF COMPLICATIONS OF STERILE PANCREATONECROSIS
MHCA City Clinical Hospital No 3 named after M.A. Podgorbunskiy, Kemerovo, RUSSIA
Introduction. Analysis of publications of contemporary scientific literature showed that there is no developed generally accepted concept of minimally invasive treatment of complications of sterile pancreatonecrosis, which would reduce total mortality and duration of stay in hospital
Materials and methods of study. A retrospective analysis of results of treatment of 315 patients with sterile pancreatonecrosis, complicated by acute postnecrotic cysts, treated in the surgical department of Clinical Hospital No 2 of SCH No 3 from January 2001 to January 2008. Among the examined patients there were 250 (79.4%) men and 65 (20.6%) women, average age 47.9 ± 2.6 years. All patients were urgently hospitalized, patients admitted to the hospital for complications of pancreatonecrosis have been exposed to minimally invasive treatment methods under ultrasound scanning control. Patients were divided into groups: 1-patients exposed to puncture method of treatment (n = 105) (PM group), 2 patients exposed to puncture-drainage method of treatment (n = 105) (PDM group), 3 patients exposed to draining method of treatment (n = 105) (DM group).
Results and their discussion. In the course of application of minimally invasive treatment methods, groups of patients were compared in terms of overall mortality, the average stay in hospital. PM group (n = 105), average stay 40.5 ± 1.7 days, mortality 12 (11.4%), PDM group (n = 105), average stay 42.3 ± 1.8 days, mortality 18 (17, 1%), DM group (n = 105), average stay 14.6 ± 0.6 days, mortality 4 (3.8%). In the DM group - minimum average stay and mortality.
Conclusion. The optimal variant of treatment of patients with sterile pancreatonecroses, complicated by acute postnecrotic cysts with sizes ranging between 100 mm or more is drainage method under ultrasound scan control.
INDICATORS OF REGULATORY SYSTEMS OF THE VEGETATIVE NERVOUS SYSTEM IN PATIENTS WITH HEPATIC CIRRHOSIS OF NONALCOHOLIC ETHIOLOGY
PLOTNIKOVA E.Y., BARANOVA E.N., KRASNOV M.V.
SHAMRAY M.A., TALITSKAYA E.A.
Kemerovo State Medical Academy, Kemerovo, RUSSIA
The aim of the study: Comprehensive study of vegetative disorders in patients with nonalcoholic hepatic cirrhosis.
Materials and methods: We studied 86 patients with nonalcoholic hepatic cirrhosis (viral, fatty, drug, cryptogenic). All patients were divided into three groups according to severity of the disease - into the classes A, B, C by Child-Pugh. In the group A there are 32 patients, in group B - 28 patients, and in the group C - 26 patients. The control group consisted of 33 patients of same age and gender. To study the function of the vegetative nervous system, there was used the method of mathematical analysis of heart rate according to Bayevsky R.M. by means of “Korveg” computer program developed by us. Differences between compared parameters were considered statistically different at p ≤ 0,05.
Discussion of the results: In our study, we calculated the integral indices, characterizing the activity of various parts of the vegetative nervous system, characterizing the ratio of primary indicators: TI - tension index (reflects the degree of centralization of heart rate control), IVB - the index of vegetative balance (the ratio of activity of sympathetic and parasympathetic parts), COT - orthostatic test index (directivity and degree of change in the functioning of the vegetative nervous system, mainly of its sympathetic segment). All indicators in patients with HC (p <0.05) significantly differed among themselves and in comparison with the control group. Indexes of regulatory systems of vegetative nervous systems showed the prevalence of expressed sympathicotonia at rest and in active orthostasis, which significantly increased with worsening of the grade of cirrhosis.
Conclusions: In patients with hepatic cirrhosis, express deviation at all levels of autonomic regulation - increased sympathetic and decreased parasympathetic regulation, suppression of vasoreflectory and baroreflectory mechanisms, as well as humoral regulation, which leads to disruption of adaptive features of the vegetative nervous system are observed. Severe autonomic dysfunction determines a number of symptoms deteriorating course of cirrhosis and its prognosis. The severity of cirrhosis (classes by Chily-Pugh), is accompanied by a statistically significant worsening of adaptive abilities of the vegetative nervous system.