Disparities in Time to Treatment of Hepatocellular Carcinoma in Patients with Hepatitis B Virus versus Hepatitis C Virus
Jennifer M. WuTsivia HochmanJudith D. GoldbergJafar Al MondhiryBennal PerkinsIulia GiouriuLawrence Leichman
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Background:The most common risk factors for hepatocellular carcinoma (HCC) are hepatitis B (HBV) and C (HCV).Patients with HCV related HCC have biology and outcomes distinct from HBV related HCC.We evaluated whether there is a difference in time from diagnosis to treatment between HCC patients with HBV and HCV. Methods:We conducted a retrospective chart review to identify patients with confirmed HCC, and a known diagnosis of either HBV or HCV at Bellevue Hospital Center between January 2005 and December 2009.Medical records were reviewed for disease and treatment characteristics.Results: Seventy HBV patients and 76 HCV patients were identified.HBV patients were mostly Asian (87%), while the majority of HCV patients were Black and Hispanic (28% and 47%, p<0.0001).At diagnosis, the HBV group presented with larger tumors compared to the HCV group (median 5.3 cm vs. 3.1 cm, p=0.025), and HCV patients were older than HBV patients (median age 61.3 years vs. 50.7 years, p<0.0001).Patients with HBV related HCC received treatment quicker than their HCV counterparts (median 2.1 vs. 3.2 months, p=0.019). Conclusion:Patients with HCV related HCC wait longer for treatment when compared to patients with HBV related HCC in an urban inner-city hospital Efforts to reduce time between outside referral to oncology services may help decrease such disparity.Keywords:
Hepatitis virus
This paper reviewes some climical cultures about thcctiology, particularities and complications of infant hepatitis syndrome in 12 years in our country. In which, there are variant percentage and variant clinical manifes tations of virus hepatitis, CMV hepatitis and bacteria infection or toxic hepatitis etc.
Hepatitis virus
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Objective To investigate the mechanism and clinic value of TNF-α in SH, based on the observation of serum level of TNF-α in patients with various stages of SH and the change of serum level of TNF-α in SH after the therapy of ALSS.Methods Patients were divided into groups with severe hepatitis、acute hepatitis、chronic hepatitis、hepatic cirrhosis after hepatitis and control group. The serum level of TNF-α、 endotoxin and TGF-β 1 were detected in every group as well as severe hepatitis group before and after the therapy of ALSS.Result The level of serum TNF-α、endotoxin、and TGF-β 1 was notably higher than that in acute hepatitis group、chronic hepatitis group、control group, and decreased obviously after the therapy of ALSS(p0.05). Clinical condition of patients whose serum level of TNF-α decreased gradually improved step by step in severe hepatitis group.Conclusion High level of TNF-α in serum plays an important role in hepatocyte damage of severe hepatitis. ALSS can remove TNF-α. The changes of serum TNF-α level in patients with severe hepatitis can be used to judge the severity and the prognosis of severe hepatitis.
Viral Hepatitis
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Objective To study the effect and safety of the plasma exchange in treatment of fatal hepatitis. Methods 36 patients with fatal hepatitis were treated totally 93 times by using the plasma exchange ( KM 8800 or KM 8900 blood purification machine, made in Japan). Results After treatment the symptoms were effectively improved with the general survival rate of 58.33%, the blood levels of TBIL, TBA, NH\-3, ET, PT showed significant decrease, the side effect was avoided after appropriate treatment. Conclusion Plasma exchange is an effective and safe means for fatal hepatitis.
Therapeutic plasma exchange
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Objective To evaluate the curative effect of plasma-exchange therapy for severe hepatitis in artificial liver system. Method 48 severe hepatitis which including 12 acute severe hepatitis,14 subacute severe hepatitis and 22 chronic severe hepatitis,were selected and analysed the changes of the clinic conditiones and bio-chemistry indexes before and after plasma-exchange therapy. Then their curative effects were evaluated. Results The total efficient rate of plasma-exchange therapy in artificial liver system was 63%. And the curative effect in acute and subacute severe hepatitis is better than that in chronic severe hepatitis. Conclusion The plasma-exchange therapy for severe hepatitis is safe and efficient.
Artificial liver
Acute hepatitis
Antiviral Therapy
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Objective:The objective of this study was to explore the relations of quantitatively measures of serum alphaferoprotein(AFP)and prognosis in severe viral hepatitis.Methods:The level of blood serum AFP was determined by radioimmunassay in 368 cases with gravis type viral hepatitis,and its change was observed in a dynamic rate.Results:The abnormity rate of AFP was 71.19%,the abnormity rate of AFP in acute severe hepatitis patients was significantly less than that in sub-acute severe hepatitis and chronic severe hepatitis(p0.01),the death rate of patients with AFP20μg/L,AFP20-400μg/L and AFP400μg/L was 79.24%,45.84% and 34.054% respectively,the survival severe hepatitis patients were 170 cases with AFP(282.31±56.32)μg/L in 368 cases,198 cases with AFP(90.42土38.88)μg/L died(p0.01).Conclusion:The blood serum AFP determination in gravis type viral hepatitis can be used as a sensitive index for prognosis.A high level of AFP indicates that hepatitis cells regeneration is active and the prognosis is relatively better.
Viral Hepatitis
Acute hepatitis
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The case of a young man with hepatitis A and a chronic course is presented. The patient recived a short course of steroid therapy for recurrence of symptoms following acute hepatitis A. Thereafter liver enzymes have remained marginally elevated for 4 years and annual liver biopsies have shown evidence of chronicity. HAV IgM Ab persisted for 1034 days with subsequent development of HAV IgG Ab. The possiblity of other viruses in the aetiology and the role of steroids in the development of chronicity are discussed.
Acute hepatitis
Etiology
Hepatitis virus
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Objective To study the clinical significance,mechanisms and prognosis in severe hepatitis with reduced cholesterin.Methods We tested the levels of serum cholesterin in 82 cases with severe hepatitis and 65 healthy cases as control group.Patients with severe hepatitis were divided into death group and survival group by prognosis.Patients were divided into three groups according to light,medium and serious cholesterin reduction level.We determined the prognosis of patients with severe hepatitis from the level of cholesterin and the reduction level of cholesterin.Results The levels of cholesterin of the severe hepatitis group and the control group were(2.8±0.9) mmol/L and(4.7±0.7) mmol/L respectively and their difference was significant statistically(P0.01).The levels of serum cholesterin of death group and survival group were(1.5±0.6) mmol/L and(2.9±0.8) mmol/L respectively and their difference was significant statistically(P0.01).The death rate of light,medium and serious cholesterin group were 21.86%,56.41% and 90.91% respectively and their difference was significant statistically(P0.01).Conclusion Cholesterin is a sensitive index that reflected liver destruction and prognosis.Cholesterin is closely related to hepatic dysfunction、tendency of illness state and prognosis.Monitoring cholesterin intimately is significant to ameliorate prognosis and improve survival rate of patients with severe hepatitis.
Clinical Significance
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Objective To study the serum ammonia in severe hepatitis and its value.Methods Serum ammonia in 40 patients with severe hepatitis,20 patients with chronic hepatitis and health adults was measured with DRI-CHEM100 analysator.Results The serum ammonia level of severe hepatitis is much higher than the serum ammonia level of chronic hepatitis(P0.01).The serum ammonia level of chronic hepatitis is much higher than that in health adults(P0.01).The serum ammonia level of patients with hepatic encephalopathy is a little higher than that without hepatic encephlopaty in severe hepatitis.There's no significant difference between patients with hepatic encephalopathy and with hepatic encephalopathy in severe hepatitis(P0.05).There's no significant difference between patients with good prognosis and bad prognosis(P0.05).Conclusion Measurement of serum ammonia is helpful in diagnosis of severe hepatitis.
Hepatic Encephalopathy
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Twenty seven children with relapsing hepatitis have been reviewed. The characteristic clinical course and the excellent prognosis of this form of hepatitis is emphasised. After an apparently ordinary initial episode of hepatitis followed by recovery, a relapse occurs within 1--3 months that is usually more severe clinically and biochemically. The histological appearances are similar to those of acute hepatitis. A delayed but spontaneous recovery occurs. No satisfactory explanation has been proposed for this condition.
Acute hepatitis
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