April 1998

Child's grade gives a good guide to short term survival however can this initial grading be used in long term prognosis? Sixty eight patients with cirrhotic portal hypertension were evaluated as regards to liver disease between 1984 and 1994 approximately six weeks after their first variceal haemorrhage. Child's Grade was calculated initially at the time when the patient first bled from varices and then repeated approximately six weeks after the episode. Sclerotherapy was used for all patients to eradicate varices. These patients have been closely followed up untill the end of last year. Thirty six patients died during follow-up. The complications of cirrhosis contributed directly to death in thirty patients(84%) and were implicated in all others. Child's grade evaluated at the time of bleeding showed a trend but did not predict long term survival (log rank p value=0.98), however Child's grade at the six weeks when the patient had somewhat recovered was much more predictive of long term survival (log rank p value< .0001). Seventeen patients who had a Child's C score initially improved either to a B(13) or A(4) at six weeks. The difference in Child's grade achieved at six weeks was due to improvement clinically (decreased ascites or encephalopathy) or improved biochemical/haematological parameters. Six patients remained Child's C at six weeks and all died with ten months. We conclude that the time of determining Child's Grade is crucial in predicting survival, for immediate outcome following a bleed Child's grade may be helpful, but for long term survival analysis Child's grade should be evaluated when the patient has sufficiently recovered from the insult. Those who remain in category C following recovery are in iminent danger of death and should be candidates for liver transplant.

L0310

EVALUATION OF LECTIN.HEACTIVE ALPHA-FETOPROTEIN IN PATIENTS WITH HEPATOCELLULAR CARCINOMA AND CHRONIC LIVER DISEASES. Vu Van Khien, Ha Van Mao, Tran Thi Chinh, Pham Thu Ha. Dept. of Hepatogastroenterology, Central Tran Hung Dao Hospital, Hanoi, Vietnam.

INTRODUCTION : Alpha -fetoprotein (AFP) is widely used as a liver tumor marker in clinical diagnosis. But, serum AFP concentrations also increase in patients with chronic liver diseases (CLD). The microheterogeneity of AFP has been known and its diagnostic values for Hepatocellular Carcinoma (HCC) have been evaluated extensively. We studied the Lectin reactivity of serum AFP in Vietnam with HCC and CLD. PATIENTS AND METHODS : Frozen sera were collected from 45 patients consisting of 24 patients (20 males and 4 females) with HCC and 21 patients (17 males and 4 females) with CLD without HCC such as chronic hepatitis or liver cirrhosis. Diagnosis of HCC was made by tumor biopsy. Diagnosis of CLD were made on the basis of laboratory data, results of diagnostic imaging. A fraction of semm AFP reactive with Lens culinaris agglutinine - A was measured by lectin-affinity electrophoresis coupled with antibody-affinity blotting RESULTS : The mean value of LCA - Reactive Alpha-fetoprotein (AFP-L3) in the 24 HCC patients was (59.58 _+ 9.70%), significantly higher (p<0.01) than the value in chronic liver diseases (12.03% + 2.49%). When the cut-off level was set 15% (mean -+ SD), the sensitivity was 95.83%, the specificity was 80.95%, and the accuracy was 85.18% in the 24 HCC patients. LCA - Reactive AFP showed no correlation with serum AFP concentration (r = 0.036), while it was weakly corelated with tumor size ( r = 0.36 p =0.0003) and it was highly corelated in moderately or poorly differentiated tumor than in well differentiated tumor (p < 0.01). In particular, AFP-L3 was positive in 5 of the 24 (20.8%) patients with single small liver cancer (¢P < 2.5cm). CONCLUSION : Measurement of the AFP-L3 fractions serum Alpha- fetoprotein allow the differentiation of HCC from chronic liver diseases. We consider this method to be a useful adjunct in the diagnosis of HCC.

AASLD A1273

L0311

USEFULNESS AND FINDINGS OF TRI-PHASIC SPIRAL CT IN HEPATIC HEMANGIOMA. Honc,-soo Kim. M.D., II-kwun Chung, M.D., Sang-heum Park, M.D., Moon-ho Lee, M.D., Sun-joo Kim, M.D., Kun-soo Han*, M.D., Department of internal medicine, radiology*, Soonchunhyang University, Chonan, Korea.

Purpose: To evaluate the characteristic finding of hepatic hemangioma on tri- phasic spiral CT and usefulness of portal phase finding on atypical enhancement pattern. Material and Methods: Fifty-four hepatic hemangioma in thirty-five patients were analyzed by tri-phasic spiral CT, and were confirmed by RBC spect, MRI, liver biopsy, and follow up images. Tri-phasic Spiral CT examination used injected non-ionic contrast material at the rate of 2.7ml/sec and arterial, portal venous and delayed phase CT images were obtained 30, 60, 120 seconds after the start of contrast injection, respectively. The tri-phasic enhancement pattem as divided six categories which were total hgh attenuation, total iso attenuation, total low attenuaion, peripheral high attenuation, central high attenuation, mixed attenuation. Results: Most common enhancement pattem on arterial, portal venous and delayed phase was peripheral high attenuation, and no one case showed total low attenuation on delayed phase. Typical hemangioma enhancement pattern is 45(83%) cases and atypical form is 9(17%) cases on tri-phasic CT and the portal venous phase may be helpful for detection of hepatic hemangioma in the 5 cases. 10 cases were diagnosed by tri-phasic spiral CT among 11 cases below 1 cm in size.

Table. atypical enhancement pattern of hemangioma on spiral CT

arterial phase portal phase delayed phase total

Tld Tid Tid 3 Thd Thd Tid 3 Tld Phd Tid 2 Chd Chd Tid 1

(Total low dense;Tld, total iso dense;Tid, total high dense;Thd, central high dense;Chd, peripheral high dense;Phd)

Conclusion: Tri-phasic spiral CT is very useful method for diagnosis of hepatic hemngioma, especially small sized lesion and enhancement pattern of portal venous phase may be helpful for...(abstract ends).

L0312

OUTCOME OF ENDOSCOPIC INJECTION THERAPY OF HISTOACRYL IN BLEEDING GASTRIC VARICES. H.G. Kim. K.H. Han. Y.C. Lee, C.Y. Chon, Y.M. Moon, J.K. Kang, I.S. Park. Dept. of Gastroenterology, Yonsei University Medical College, Seoul, Korea.

Massive bleeding from gastric varices is often a serious medical emergency. The role of endoscopic therapy in gastric variceal bleeding is still controversial. Aim. The present study was carried out to investigate the efficacy and outcome of endoscopic injection treatment of bleeding gastric varices with tissue adhesive N-butyl-2-cyanoacrylate(histoacryl). Subjects and methods. During the last two and half years, 276 patients were admitted due to esophagogastric variceal bleeding. Of these 47(17%) patients had gastric variceal bleeding, and 36 patients( 32 M; 4 F; age 35-77 years) among them were treated with emergent endoscopic injection therapy with histoacryl. The location of gastric varices was cardia in 16 patients, cardia and fundus in 14 patients, and fundus in 6 patients. Among them, 33 patients(92%) had esophageal varices. Histoacryl mixed with lipiodol were injected until effective bleeding control was achieved ( total amount 1.0 - 10ml, average 1.3ml/session ). Retrospective review of various clinical parameters including types of bleeding gastric varices, amount of transfusion, vital signs, result of hemostasis, clinical outcome, rebleeding rate was analyzed. Results. Histoacryl injection therapy of bleeding gastric varices showed initial hemostasis rate of 83.3%(30/36). The hemostasis rate was 74%(14/19) in spurting and oozing cases, and 93%(14/15) in only stigmata cases. During follow up period of 4 to 30 months(average 10 months), rebleeding rate was 33.3%(10/30) in cases of initial successful hemostasis. Among them, 7 patients died during admission period. In 5 of 10 rebleeding cases, the rebleeding site was injection site or ulcer developed by previous histoacryl injection. There was no significant differences in initial hemostasis rate and rebleeding rate according to the location and the shape of gastric varices, the amount of injected histoacryl, and concomitant treatment of esophageal varices. Conclusion. Endoscopic injection therapy of gastric varices with histoacryl can be performed rapidly and easily in active gastric variceal bleeding. But rebleeding from injection site ulcers was relatively frequent and fatal. Therefore prompt surgical or radiological modality should be considered according to gastric variceal location, size, patient's age and the status of liver function after the initial hemostasis.