Risk factors for hepatocellular carcinoma in patients with liver cirrhosis.

OBJECTIVE: Although cirrhosis is known to predispose toward hepatocellular carcinoma (HCC), there is no agreement on the factors that can influence the risk for HCC in patients with cirrhosis. This study was designed to identify differences in cirrhosis-related risk factors for developing HCC in relation to epidemiological characteristics, stage of the disease and etiology. METHODS: 512 patients from southwestern Spain with Child-Pugh stage A or B cirrhosis were examined periodically by ultrasonography, and alpha-fetoprotein (AFP) concentration was measured. RESULTS: The average length of follow-up was 37 months. A total of 52 cases of HCC were detected, which represented a risk of 17% after 5 years of follow-up. The Cox model showed that the risk of HCC increased by 8% per year of increasing age. Male sex (relative risk: 3.4), hepatitis C virus infection (relative risk: 4.6), hepatitis B virus infection (relative risk: 2.9) and AFP levels higher than 15 ng/ml (relative risk: 2.5) were also shown to be risk factors. Among alcoholic patients, only age (risk increased by 15% per year), and hepatitis C virus infection (relative risk: 5.4) were risk factors for HCC. However, in patients infected by hepatitis C virus, the main risk factors were age (relative risk increased by 8% per year), male sex (relative risk: 3.9), co-infection with hepatitis B virus (relative risk: 4.9), and increased AFP (relative risk: 2.8). Of the patients with HCC, 71% were infected with hepatitis C virus. Alcoholism, Child-Pugh stage and duration of cirrhosis did not increase the risk of the appearance of HCC. CONCLUSIONS: The risk of HCC increased to 17% after 5 years of follow-up in patients with Child-Pugh stage A or B cirrhosis. Hepatitis C virus infection was the main risk factor in patients with cirrhosis. Other risk factors were age, male sex, hepatitis B virus infection and altered AFP level.

[Hepatic abscesses: is simple aspiration puncture with echography control an alternative to catheter drainage?]. / Abscesos hepáticos: es la punción-aspiración simple con control ecográfico una alternativa al drenaje con catéter?

UNLABELLED: Percutaneous drainage is currently the treatment of choice in liver abscess. The most commonly used technique is catheter placement but this procedure is not free of complications. OBJECTIVE: To analyze the safety and efficacy of needle aspiration in the treatment of liver abscesses. PATIENTS AND METHODS: Non-random, prospective study of nine patients with pyogenic liver abscess who underwent simple needle aspiration with sonographic guidance. RESULTS: In all patients, aspiration identified the etiologic agent. In eight patients (88.9%) the procedure was effective and in the remaining patients, the abscess was finally drained by sonographically guided catheter placement. In five patients, aspiration was successful at the first attempt and only one abscess required more than two attempts. No complications were observed. CONCLUSIONS: In our experience, needle aspiration with sonographic guidance is safe and effective in the treatment of pyogenic liver abscesses. Use of catheters is reserved for cases of rapid reaccumulation of exudate without general improvement in the patient.