F. Ramalho

Treatment and prognostic factors in patients with hepatocellular carcinoma

Abstract: Introduction: Hepatocellular carcinoma is a leading cause of death from cancer worldwide. Survival of patients depends on tumor extension and liver function, but yet there is no consensual prognostic model.

Chronic liver disease staging classification based on ultrasound, clinical and laboratorial data

In this work the identification and diagnosis of various stages of chronic liver disease is addressed. The classification results of a support vector machine, a decision tree and a k-nearest neighbor classifier are compared. Ultrasound image intensity and textural features are jointly used with clinical and laboratorial data in the staging process.

Oropharyngeal pemphigus in a patient with chronic hepatitis C during interferon alpha-2a therapy.

There are a few reports in the literature concerning pemphigus induced by interferon given for hepatitis C. We present the case of a 28-year-old woman with post-transfusional chronic hepatitis C who developed ulcers and vesicles on her tongue, cheeks, posterior oropharynx and vocal cords 5 months after beginning treatment with recombinant interferon alpha-2a. The direct and indirect immunofluorescence was diagnostic of pemphigus vulgaris. The drug was promptly withdrawn; the patient was medicated with prednisolone and azathioprine and recovered only 3 months later. Although there are several publications describing the occurrence of other autoimmune diseases in patients receiving interferon alpha therapy, this is the first report of a pemphigus induced by interferon in hepatitis C patients involving oropharyngeal and laryngeal mucosae without cutaneous involvement.

Hepatitis B vaccination in hospital personnel and medical students.

We determined the prevalence of hepatitis B markers and the compliance to hepatitis B vaccination in a University Hospital of Santa Maria, Lisbon. The program was begun in 1989 for all hospital personnel and students of the medical school. The screening included 2,360 health care workers and 1,153 students; 57% (2,360/4,103) of hospital personnel and 41% (1,153/2,779) of medical students appeared for vaccination. The prevalence of hepatitis B markers was 16.8% (397/2,360) for hospital personnel and 5.5% (64/1,153) for students, the chronic carrier appearing in 0.95% (22/2,360) of hospital personnel and 0.3% (4/1.153) of students. The departments with the highest prevalence were the Biochemical Laboratory (64%, 7/11), Surgery (42%, 13/31), Pulmonary (39%, 9/23), Emergency (29%, 7/24), Hematology Laboratory (29%, 7/24), and Orthopedics (29%, 10/35). The prevalence was higher in students in the last 3 years of medical school than those in the first 3 years (12.2% [22/181] vs. 7.2% [8/110], p = NS). Adverse effects to vaccination occurred in 14.5%, with local pain the most frequent in 8.6%. The serologic efficacy was 95% (1,044/ 1,097). A nonresponse was observed in male workers, 13% (26/200) compared with 5% (45/897) for females (p < 0.05). Older employees also showed higher nonresponse: The average age of workers with anti-HBs of 0 IU/l was 52.3 years and those with anti-HBs of more than 100 IU/l was 38.4 years (p < 0.02). Hepatitis B vaccination is safe and effective. Our study shows the need for a more aggressive approach to the vaccination of health care workers because a significant percentage of them are not protected.

The usefulness of ultrasound in the classification of chronic liver disease

Chronic Liver Disease is a progressive, most of the time asymptomatic, and potentially fatal disease. In this paper, a semi-automatic procedure to stage this disease is proposed based on ultrasound liver images, clinical and laboratorial data. In the core of the algorithm two classifiers are used: a k nearest neighbor and a Support Vector Machine, with different kernels. The classifiers were trained with the proposed multi-modal feature set and the results obtained were compared with the laboratorial and clinical feature set. The results showed that using ultrasound based features, in association with laboratorial and clinical features, improve the classification accuracy. The support vector machine, polynomial kernel, outperformed the others classifiers in every class studied. For the Normal class we achieved 100% accuracy, for the chronic hepatitis with cirrhosis 73.08%, for compensated cirrhosis 59.26% and for decompensated cirrhosis 91.67%.

Idiopathic hypereosinophilic syndrome presenting as cholestatic liver disease

We report the case of a 34-year-old white man with recurrent episodes of abdominal pain, cholestasis and eosinophilia. The diagnosis of idiopathic hypereosinophilic syndrome (IHS) was made after exclusion of all known causes of eosinophilia. Liver biopsy revealed an eosinophilic infiltrate with biliary damage. The patient recovered after prednisolone treatment. We review the literature on the association between IHS and liver disease.

Active E Rosette-Forming Cells in the Peripheral Blood of Patients with Chronic Active Hepatitis

E rosette-forming cells (E-RFC) and active E-RFC were studied in the peripheral blood in patients with chronic active hepatitis (CAH), chronic persistent hepatitis (CPH), and in control subjects. A significant reduction in active E-RFC (a subpopulation of T lymphocytes considered actively involved in cell-mediated immune reactions) was found in patients with untreated CAH, both HBsAg positive or negative. In contrast, patients with immunosuppressive-treated CAH showed an increased relative number of active E-RFC. A significant increase in active E-RFC was demonstrable in other immunosuppressivetreated chronic inflammatory disorders. In CPH active E-RFC were not different from normal controls. The number of E-RFC showed a relative and absolute decrease in both CPH and untreated CAH. These studies demonstrate an increase in active E-RFC in immunosuppressive-treated CAH and suggest that prednisone and azathioprine may have a differential effect on T lymphocyte subpopulations.