Jai Keun Kim

Prediction of compensated liver cirrhosis by ultrasonography and routine blood tests in patients with chronic viral hepatitis

Background/Aims Liver biopsy is a standard method for diagnosis of liver cirrhosis in patients with chronic hepatitis. Because liver biopsy is an invasive method, non-invasive methods have been used for diagnosis of compensated liver cirrhosis in patients with chronic hepatitis. The current study was designed to evaluate the usefulness of ultrasonography and routine blood tests for diagnosis of compensated liver cirrhosis in patients with chronic viral hepatitis. Methods Two hundred three patients with chronic viral hepatitis who underwent liver biopsy were included in this study and ultrasonography and routine blood tests were analyzed retrospectively. Ultrasonographic findings, including surface nodularity, parenchyma echogenecity, and spleen size, were evaluated. The diagnostic accuracy of ultrasonography and routine blood tests were examined. Results Discriminant analysis with forward stepwise selection of variables showed that liver surface nodularity, platelet count, and albumin level were independently associated with compensated liver cirrhosis (p<0.05). Cross-tabulation revealed that the following 4 variables had >95% specificity: platelet count <100,000 /uL; albumin level <3.5 g/dL; INR >1.3; and surface nodularity. If at least one of the four variables exists in a patient with chronic viral hepatitis, we can predict liver cirrhosis with 90% specificity and 61% sensitivity. Conclusions These results suggest that four variables (platelet count <100,000 /uL, albumin level <3.5 g/dL, INR >1.3, and surface nodularity) can be used for identification of liver cirrhosis in patients with chronic viral hepatitis with high specificity.

High circulating microRNA-122 expression is a poor prognostic marker in patients with hepatitis B virus-related hepatocellular carcinoma who undergo radiofrequency ablation

OBJECTIVESnAim of this study was to investigate the prognostic potential of plasma microRNA-122 levels in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma after hepatic resection or radiofrequency ablation (RFA).nnnDESIGN AND METHODSnA total of 120 patients with HBV-related hepatocellular carcinoma who underwent hepatic resection (n=63) or RFA (n=57) were included. The pretreatment plasma microRNA-122 level was assessed using quantitative real time polymerase chain reaction, and the correlation between microRNA-122 expression and various clinical parameters was investigated.nnnRESULTSnMultivariate Cox regression analysis demonstrated that, in all patients, a low platelet count (<100×10(9)/L), low albumin level (≤3.5g/dL.), and advanced tumor stage (modified Union for International Cancer Control stage III/IV) were independent prognostic factors for disease-free survival, while a low albumin level and advanced tumor stage were independent prognostic factors for overall survival (OS). In a subgroup analysis of patients who underwent RFA, the patients with high miR-122 expression (>100) had significantly lower OS on Kaplan-Meier analysis (P=0.042). Furthermore, high microRNA-122 expression (hazard ratio [HR]=2.67; 95% confidence interval [CI]=1.12-6.35; P=0.026) and advanced tumor stage (HR=2.27; 95% CI=1.23-4.18; P=0.009) were independent risk factors for poor OS in patients treated with RFA. The combination of microRNA-122 and tumor stage resulted in an area under the curve of 0.818 for predicting 1-year OS in patients who underwent RFA.nnnCONCLUSIONSnHigh plasma microRNA-122 expression was associated with poor OS in patients with HBV-related hepatocellular carcinoma who underwent RFA.

Comparison of Ultrasound-Guided Core Needle Biopsy and Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Solid Pancreatic Lesions.

The objective of our study was to compare the diagnostic yield of endoscopic ultrasound (EUS)‐guided fine‐needle aspiration (FNA) using a 25‐gauge needle and ultrasound (US)‐guided core needle biopsy (CNB) using an 18‐gauge core needle for diagnosis of solid pancreatic lesions.

Dieulafoy's Lesion of Jejunum: Presenting Small Bowel Mass and Stricture

Dieulafoys lesion is an uncommon cause of gastrointestinal bleeding. Hemorrhage occurs through mucosal erosion from an abnormally dilated submucosal artery. Although Dieulafoys lesion is usually located in the stomach, it may occur anywhere in the gastrointestinal tract. We report here on a case of jejunal Dieulafoys lesion presenting as a mass and short segment stricture on CT and enteroclysis.

Comparison of radiofrequency ablation and transarterial chemoembolization for the treatment of a single hepatocellular carcinoma smaller than 4 cm

BACKGROUND/AIMSnRadiofrequency ablation (RFA) is an established curative therapeutic modality for unresectable hepatocellular carcinoma (HCC), and transarterial chemoembolization (TACE) has been used as a palliative treatment for inoperable HCC. It is still unknown whether RFA and TACE are equally effective for improving the survival of patients with unresectable HCC that is amenable to either treatment. The aim of this retrospective study was to compare the clinical impacts of two treatments, and analyze the prognostic factors for recurrence and survival.nnnMETHODSnNinety-three patients with a single HCC smaller than 4 cm who showed complete responses (complete ablation or complete lipiodol tagging) after treatment with RFA (n=43) or TACE (n=50) between January 2002 and February 2009 were investigated. Univariate and multivariate analyses were performed for 13 potential prognostic factors using the Cox proportional-hazards model.nnnRESULTSnThe time-to-recurrence rates at 1, 2, and 3 years after treatment were 32.9%, 44.3%, and 55.4%, respectively, for the RFA group, and 42%, 68.3%, 71.7% for the TACE group. The probability of survival at 1, 2, and 3 years was 97.7%, 77.4%, and 63.1%, respectively, for the RFA group, and 95.9%, 76.1%, and 60.2% for the TACE group. The time-to-recurrence and overall survival rates did not differ significantly between the two treatment groups. A multivariate Cox proportional-hazards model revealed that a tumor size larger than 3 cm and lower serum albumin levels were independent risk factors for recurrence, and that being male, being seropositive for hepatitis B surface antigen, and having a higher serum albumin level were independent favorable prognostic factors for survival.nnnCONCLUSIONSnTACE and RFA exhibited similar therapeutic effects in terms of recurrence and survival for patients with a single HCC smaller than 4 cm, if they could exhibited complete responses.

Gastrointestinal Gas and Abdominal Fat Quantity Measured by Three-Dimensional Abdominal Computed Tomography in Patients with Functional Bloating

Background/AimsnThe aim of this study was to assess whether increased intestinal gas or fat content in the abdominal cavity is related to abdominal bloating, using three-dimensional abdominal computed tomography scan.nnnMethodsnTwenty-nine healthy individuals without abdominal bloating and organic disease (15 women; mean age, 49 years; range of age, 23-73 years) and 30 patients with chronic recurrent abdominal bloating-diagnosed with functional bloating (10 women; mean age, 53 years; range of age, 35-75 years) - participated in this study. The mean values of measured parameters were compared using independent sample t-test.nnnResultsnThe mean volume of total colon gas in bloated patients was similar to that in control subjects. The distribution of intra-abdominal gas was also similar between the two groups. However, the amount of gas in the transverse colon tended to be significantly higher in patients with bloating than in controls (p=0.06). Body mass index was similar between the two groups (23.4±3.2 kg/m2 and 22.3±3.1 kg/m2, respectively). Moreover, no significant differences with respect to circumferential area, subcutaneous fat, visceral fat area, and total fat area were found between the two groups.nnnConclusionsnBloating might not just be the result of gastrointestinal gas or intra-abdominal fat. Other contributing factors, such as localized abnormality in gas distribution and visceral hypersensitivity, may be involved.