Early hepatocellular carcinoma developed within dysplastic nodule as nodule-within-nodule appearance: Case report with literature review.

Close follow-up of patients with liver cirrhosis has led to increased detection of hepatocellular carcinoma (HCC) at an early stage, especially with magnetic resonance imaging (MRI) innovations. We report the case of a 70-year-old man, with a recent history of liver cirrhosis due to chronic hepatitis C virus (HCV) complicated by hepatocellular carcinoma (HCC), and for whom trans-arterial chemoembolization (TACE) was planned, as the patient was assigned Child B7 at admission. Angiography performed during the first TACE cycle shows not only the "tumor blush" corresponding to previously detected HCC but also an additional small foci of HCC uptake seen within a large dysplastic nodule giving the appearance of "nodule-within-nodule." Early detection of hepatocellular carcinoma improves prognosis. Hence, it is essential to be aware of all early aspects of HCC, including the nodule-within-nodule appearance on cross-sectional imaging, and also in angiography, as in this case.

Evaluation of HCV RNA by PCR and Signal-to-Cutoff Ratios of HCV Antibody Assays for Diagnosis of HCV Infection.

OBJECTIVE: In this study, we assessed whether a hepatitis C virus (HCV) RNA test could replace recombinant immunoblot assay (RIBA) and reduce unnecessary supplemental tests as the signal-to-cutoff (S/Co) ratio from anti-HCV antibody (Ab) tests. METHODS: Anti-HCV Ab tests were performed to screen for HCV infections, and RIBA and real-time polymerase chain reaction were performed for HCV RNA to confirm HCV infection. Receiver operating characteristic curves were evaluated to determine the optimal S/Co ratios for predicting HCV infection. RESULTS: The cutoff value for the S/Co ratio was 3.63 for predicting RIBA results and 10.6 for predicting HCV RNA results. Our data suggested that an S/Co ratio ≥10.6 indicated a high risk of active HCV infection. An S/Co ratio of 3.63 to 10.6 needed further evaluation and repeat HCV RNA testing. No further testing was required for S/Co ratios <3.63 or ≥10.6. CONCLUSION: We determined that the S/Co ratio of the anti-HCV Ab test provides useful information to confirm HCV infections, including the need for further laboratory testing or clinical follow-up.

Prevalence, risk factors and impact of occult HCV infection on liver morbidity among haemodialysis patients: hospital-based cross-sectional study.

OBJECTIVES: Haemodialysis (HD) patients are at risk for blood-borne infections as occult HCV infection, which justifies comprehensive studies. We aimed to determine the prevalence and risk factors of occult HCV infection (OCI) among HD patients. MATERIAL AND METHODS: One hundred eligible HD patients, with no evidence of overt HCV or HBV and HBV vaccinated were recruited, and tested for HCV, HBV markers and HCV RNA. Two HCV-positive patients were excluded and peripheral mononuclear cells of 98 patients were verified for viraemia. RESULTS: OCI was detected in eight (8.16%); with a median viral load of 7010copies/ml. Their mean age was 30.63 (±18.87 years) compared to others (41.73 ± 15.93) (p = .069). History of surgery, dental procedure, and blood transfusion was comparably high in both groups (p > .05). All OCI patients underwent dialysis twice weekly compared to 48.9% of non-OCI patients (p = .006). OCI patients had a significantly higher mean duration of dialysis (12.63 ± 6.74 years), and a significantly higher frequency (50%) of HCV Ab compared to 6.48 ± 4.76, and 10%, respectively, in non-OCI patients. None of OCI patients was reactive to HBcAb compared to 34 (37.8%) patients without (p = .048). Evidence of liver morbidity was detected in 5 (62.5%) OCI patients compared to 43 (47.7%) of non-OCI patients (p > .05). CONCLUSION: Among our HD patients, OCI is considered a comorbid finding associated with mild liver morbidity that warrants strict infection control and periodic testing for blood borne infections.

Correlation Analysis of HCV-RNA,HCV-Ab and HCV-cAg / 现代检验医学杂志

Objective To investigate the correlation of HCV-RNA with detection indexes HCV-Ab and HCV-cAg in its clini-cal application effect among patients with hepatitis C.Methods HCV-cAg and HCV-Ab in 140 cases of HCV-RNA were detected by enzyme linked immunosorbent assay in cases of PCR,which were detected by real-time fluorescence quantitative PCR.Results 127 cases in 140 cases of HCV-RNA positive serum were HCV-cAg positive,in line with the rate of 90.71%,and the cases of 110 HCV-Ab positive,in line with the rate of 78.57%.The positive detection rate of HCV-cAg with different HCV-RNA concentration was increased with the increase of HCV virus content,and the serum of different HCV-RNA concentration had no significant changes in HCV-Ab detection results.Conclusion The detection results of HCV-cAg had a high coincidence rate with HCV-RNA.Therefore detection of HCV-cAg can be as a complementary detec-tion of HCV-Ab,as the window period of HCV infection and infection in immunocompromised persons screening provides a simple,inexpensive method.At the same time it provides rapid screening for HCV infection provide diagnostic basis for those basic medical units who do not have the conditions for detection of HCV-RNA.

Hepatitis C Virus Infection in Pregnancy / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to estimate the prevalence of hepatitis C virus seropositivity and define the risk factors for HCV infection in a group of pregnant women and the effect of HCV infection to mother and baby at the time of delivery. METHODS: From March 1997 to February 1998, 5655 women who delivered over 20 gestational weeks at our hospital were screened for HCV-Antibody(RIA), and the samples of most of HCV-Ab positive cases were analyzed for HCV-RNA by polymerase chain reaction(PCR). We also studied the risk factors for HCV infection, the effect of HCV infection to mothers and neonates at delivery. RESULTS: Of 5655 mothers 25 (0.44%) were HCV-Ab positive, and 20 of HCV-Ab positive mothers were analyzed for HCV-RNA by PCR. Of 20 HCV-Ab positive mothers 12 cases (60%) were HCV-RNA positive. Risk factors significantly more prevalent among HCV-seropositive patients were : a history of habitual intraveneous drug use, a history of smoking, alcohol drinking during pregnancy, having liver cirrhorsis. The proportions who had received a blood transfusion, had a history or ongoing syphilis or were positive for hepatitis B virus surface antigen were not significantly different between seropositive and seronegative women. Liver function test at delivery was abnormal in 4 cases(16%) of HCV-Ab positive group. And the number of abnomal liver function test cases in HCV-Ab negative group were 47(0.83%). This had statistical difference. In neonates at delivery, all 20 neonates of 20 ones having HCV-Ab positive mother were HCV-Ab positive. But only 2 cases of 20 babies were HCV-RNA positive. CONCLUSION: Mothers who have risk factors such as injecting drug use, smoking, alchohol drinking and liver cirrhorsis, should undergo HCV-Ab testing and quantitative HCV-RNA testing by PCR. More advanced studies about vertical transmission of HCV infection are needed.

An Evaluation of Commercial Reagent Kits for Detecting HCV Antibodies: GenediaTM HCV ELISA 3.0, GenediaTM HCV Rapid and GenediaTM HCV Confirm 4.0 / 대한임상병리학회지

BACKGROUND: This study was conducted to evaluate accuracy of newly developed HCV Ab test kits by Korea Green Cross Co.(Yongin, Kyunggi), namely GenediaTM HCV ELISA 3.0 (ELISA) for routine test, GenediaTM HCV Rapid (RAPID) for quick screening. and GenediaTM HCV Confirm 4.0 (CONFIRM) for confirmation. METHODS: Performance of ELISA was compared with that of Ortho HCV 3.0 ELISA (Neckargemund, Germany; ORTHO ELISA) using 990 patients' sera. Accuracy of RAPID was evaluated by testing on 114 HCV Ab negative and 86 positive specimens by ELISA. Discrepant results obtained by RAPID were confirmed by Chiron RIBA HCV 3.0 Strip Immunoblot Assay (Ca, USA; RIBA) and HCV Blot 3.0 (Genelabs Diagnostics, Singapore; BLOT). Accuracy of CONFIRM test was compared between RIBA and BLOT using 78 ELISA positive sera. To elucidate prevalence of viremia, RT-PCR was performed on 165 serum samples and results were compared with that of ELISA and RAPID. RESULTS: Agreement of test results between ELISA and ORTHO ELISA was 99.6% (986/990). On HCV Ab negative specimens 99.1% (113/114) agreed among RAPID, ELISA and ORTHO ELISA. However, on seropositive specimens 91.7% (79/86) agreed between RAPID and ELISA. Agreement between CONFIRM and RIBA was 83.3% (65/78). Core antigen showed the highest reactivity and NS5 antigen showed the lowest reactivity with CONFIRM. HCV RNA was detected in 58.3% (28/48) of ELISA positive specimens, however, it was not detected in ELISA negative specimens. There was no correlation between prevalence of HCV RNA and 5 antigens used in ELISA test. CONCLUSIONS: Newly developed Korea Green Cross GenediaTM HCV ELISA 3.0, Rapid and HCV Confirm were considered to be clinically accurate routine, quick screening and confirmatory test for detecting HCV Ab in serum samples.

Prevalence and Risk Factors of Hepatitis C Virus Infection in Chronic Hamodialysis Patients(multi-center study) / 대한내과학회지

OBJECTIVES: The aim of this study was to evaluate the prevalence and risk factors of hepatitis C virus(HCV) infection in patients on chronic hemodialysis. METHODS: We measured antibody to HCV using second generation enzyme immunoassay(ELISA) test or radioimmunoassay(RIA) and hepatitis B surface antigen, serum values of AST, ALT in 224 patients of six urban hemodialysis units. We also investigated some clinicai parameters such as age, sex, duration and frequency of hemodialysis, the amount of blood transfusion, and hemodialysis of infected patients on separate machines. RESULTS: 1) 33 of 224 patients(14.7%) were positive for HCV antibody. 2) The prevalence of HCV antibody were most significantly correlated with duration of hemodialysis and less significantly with frequency of hemodialysis, amount of blood transfusion but not correlated with age, sex and level of liver enzyme. 3) The prevalence of HCV antibody was significantly higher in a center which did not separate dialysis machine for HCV antibody positive patients than centers which did. CONCLUSION: Th prevalence of HCV antibody was most signficantly correlated with duration of hemodialysis. We suggest that environmental factor of hemodialysis unit may play major role in HCV infection of hemodialysis patients. So the importance of separate dialysis machine from HCV antibody positive patients should be emphasized.