The prognosis for patients with hepatocellular carcinoma (HCC) is poor because of the low chance of curative treatment. To increase the chance of intervention and to improve survival, early detection of subclinical HCC (SCHCC) by ␣-fetoprotein (AFP) and/or ultrasonography (USG) screening is implemented in many countries. Three hundred six Chinese patients with HCC diagnosed between January 1995 and December 1997 were recruited. They were categorized into two groups: 142 patients (group 1) had SCHCC diagnosed by screening (AFP and/or USG), and 164 patients (group 2) presented with symptomatic HCC. The tumor size was significantly smaller in group 1 compared with that of group 2 (3.5 cm vs. 8.1 cm; P F .0001). A significantly higher proportion of patients had bilobar involvement, multifocal HCC, diffuse-type HCC, portal vein infiltration, and distant metastasis in group 2 when compared with group 1. Operability and feasibility of treatment by transcatheter intra-arterial chemoembolization (TACE) in group 1 patients (26.8% and 45.1%, respectively) were significantly better than in group 2 patients (7.9% and 32.3%, P F .0001 and P ؍ .03, respectively). The cumulative survival rate was significantly higher in group 1 than in group 2 (P F .0001). For those who had surgical resection and those who had TACE, group 1 patients had a higher cumulative survival rate compared with that of group 2 patients (P ؍ .04 and P ؍ .0003, respectively). Screening for HCC by AFP and/or USG can identify tumors at an early stage, resulting in a higher chance of receiving treatment. Whether it can improve survival requires a further prospective, randomized study. (HEPATOLOGY 2000; 31:330-335.) Hepatocellular carcinoma (HCC) is one of the major health problems throughout the world. The annual incidence is estimated as 530,000 cases globally. 1 A recent study shows that the incidence of HCC is rising in the United States over the past 2 decades, with age-specific incidence shifting toward younger persons. 2 The problem is even more overwhelming in regions where the incidence of chronic viral hepatitis B and/or C is of high prevalence. The prognosis for patients with HCC is still dismal. At present, surgical resection and liver transplantation are the only forms of curative treatment available. However, the chance of curative treatment is often limited by several features of the HCC. HCCs are usually large in size before they give rise to symptoms. Bilobar or multifocal tumors are common. The incidence of associated cirrhosis is also high, being over 80% in most series. [3][4][5] The efficacy for other modalities of treatment, e.g., transcatheter intra-arterial chemoembolization (TACE), also depends on the above factors. 6 To increase the chance of intervention and, more importantly, to improve survival, early detection of subclinical HCC (SCHCC) by ␣-fetoprotein (AFP) and/or ultrasonography (USG) screening is implemented in many countries. Though studies of Asian populations show encouraging results, 7-9 these are not substantiated in...
Chinese patients in Hong Kong with the nondeletional type of hemoglobin H disease have more severe disease than those with the deletional type of the disease. Iron overload is a major cause of disability in both forms of the disease.
Although corticosteroid therapy might be clinically beneficial for bronchiectasis, very little is known of its effects on the inflammatory and infective markers in bronchiectasis. We have therefore performed a double-blind, placebo-controlled study to evaluate the effects of a 4-wk administration of inhaled fluticasone in bronchiectasis. Twenty-four patients (12 female; mean age 51 yr) were randomized into receiving either inhaled fluticasone (500 microgram twice daily) via the Accuhaler device (n = 12) or placebo. At each visit, spirometry, 24-h sputum volume, sputum leukocyte density, bacterial densities, and concentrations of interleukin (IL)-1beta, IL-8, tumor necrosis factor-alpha (TNF-alpha), and leukotriene B4 (LTB4) were determined. There was a significant (p < 0.05) decrease in sputum leukocyte density and IL-1beta, IL-8, and LTB4 after fluticasone treatment. The fluticasone group had one and the placebo group three episodes of exacerbation. There were no significant changes in spirometry (p > 0.05) or any reported adverse reactions in either group. The results of this study show that high-dose fluticasone is effective in reducing the sputum inflammatory indices in bronchiectasis. Large-scale and long-term studies are indicated to evaluate the effects of inhaled steroid therapy on the inflammatory components in bronchiectasis.
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