Clinical and Molecular Hepatology

"Complication"

Editorial

GLP-1RA may open a new era for MASLD treatment: Ye Feng, Chengfu Xu; Received June 12, 2025 Accepted June 19, 2025 Published online June 24, 2025; DOI: https://doi.org/10.3350/cmh.2025.0628 [Accepted]

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Original Article

Microbiome

Gut microbiome and metabolome signatures in liver cirrhosis-related complications: Satya Priya Sharma, Haripriya Gupta, Goo-Hyun Kwon, Sang Yoon Lee, Seol Hee Song, Jeoung Su Kim, Jeong Ha Park, Min Ju Kim, Dong-Hoon Yang, Hyunjoon Park, Sung-Min Won, Jin-Ju Jeong, Ki-Kwang Oh, Jung A Eom, Kyeong Jin Lee, Sang Jun Yoon, Young Lim Ham, Gwang Ho Baik, Dong Joon Kim, Ki Tae Suk; Clin Mol Hepatol 2024;30(4):845-862.
Published online July 25, 2024; DOI: https://doi.org/10.3350/cmh.2024.0349

Background/Aims
Shifts in the gut microbiota and metabolites are interrelated with liver cirrhosis progression and complications. However, causal relationships have not been evaluated comprehensively. Here, we identified complication-dependent gut microbiota and metabolic signatures in patients with liver cirrhosis.
Methods
Microbiome taxonomic profiling was performed on 194 stool samples (52 controls and 142 cirrhosis patients) via V3-V4 16S rRNA sequencing. Next, 51 samples (17 controls and 34 cirrhosis patients) were selected for fecal metabolite profiling via gas chromatography mass spectrometry and liquid chromatography coupled to time-of-flight mass spectrometry. Correlation analyses were performed targeting the gut-microbiota, metabolites, clinical parameters, and presence of complications (varices, ascites, peritonitis, encephalopathy, hepatorenal syndrome, hepatocellular carcinoma, and deceased).
Results
Veillonella bacteria, Ruminococcus gnavus, and Streptococcus pneumoniae are cirrhosis-related microbiotas compared with control group. Bacteroides ovatus, Clostridium symbiosum, Emergencia timonensis, Fusobacterium varium, and Hungatella_uc were associated with complications in the cirrhosis group. The areas under the receiver operating characteristic curve (AUROCs) for the diagnosis of cirrhosis, encephalopathy, hepatorenal syndrome, and deceased were 0.863, 0.733, 0.71, and 0.69, respectively. The AUROCs of mixed microbial species for the diagnosis of cirrhosis and complication were 0.808 and 0.847, respectively. According to the metabolic profile, 5 increased fecal metabolites in patients with cirrhosis were biomarkers (AUROC >0.880) for the diagnosis of cirrhosis and complications. Clinical markers were significantly correlated with the gut microbiota and metabolites.
Conclusions
Cirrhosis-dependent gut microbiota and metabolites present unique signatures that can be used as noninvasive biomarkers for the diagnosis of cirrhosis and its complications.

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Editorial

Steatotic liver disease

Nonalcoholic fatty liver disease-based risk prediction of adverse pregnancy outcomes: Ready for prime time?: Seung Mi Lee, Won Kim; Clin Mol Hepatol 2022;28(1):47-49.
Published online November 30, 2021; DOI: https://doi.org/10.3350/cmh.2021.0338

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Original Article

Steatotic liver disease

Systematic review with meta-analysis: Non-alcoholic fatty liver disease and the association with pregnancy outcomes: Hydar El Jamaly, Guy D Eslick, Martin Weltman; Clin Mol Hepatol 2022;28(1):52-66.
Published online September 17, 2021; DOI: https://doi.org/10.3350/cmh.2021.0205

Background/Aims
Maternal and fetal outcomes in pregnant patients with Non-alcoholic fatty liver disease (NAFLD) have been largely unexplored. To determine the level of evidence associated with maternal and fetal outcomes in pregnant women with NAFLD.
Methods
We conducted a comprehensive literature search. The studies included pregnant patients with a previous, current or subsequent diagnosis of NAFLD. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI).
Results
Twenty-two studies, with 13,641 female NAFLD patients were reviewed. The results highlight that NAFLD patients had a statistically significant increased likelihood of baseline diabetes mellitus (OR, 6.00; 95% CI, 2.21–16.31; P<0.001; n=7), baseline Hypertension (OR, 3.75; 95% CI, 2.13–6.59; P<0.001; n=4), gestational hypertension (OR, 1.83; 95% CI, 1.03–3.26; P=0.041; n=2), and pre-eclampsia (OR, 2.43; 95% CI, 1.46–4.04; P=0.001; n=3). The odds for a past and current history of gestational diabetes mellitus were OR, 3.78; 95% CI, 2.21–6.44; P<0.001; n=5 and OR, 3.23; 95% CI, 1.97– 5.31; P<0.001; n=6, respectively. As for fetal outcomes, pregnant NAFLD patients were significantly more likely to have a premature birth (OR, 2.02; 95% CI, 1.44–2.85; P<0.001; n=4), large for gestational age birth (OR, 2.01; 95% CI, 1.72–2.37; P<0.001; n=2) or a history of prior miscarriage or abortion (OR, 1.15; 95% CI, 1.02–1.30; P=0.02; n=2). Egger’s regression revealed no evidence of publication bias (P>0.05).
Conclusions
This meta-analysis provides pooled evidence that NAFLD is associated with a substantial increase in maternal diabetic and hypertensive complications and multiple adverse fetal outcomes. This data is important for clinicians managing these patients before, during and after pregnancy.

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Editorial

Artificial intelligence, epidemiology, methodology, or others

Is liver biopsy still useful in the era of non-invasive tests?: Tae Seop Lim, Ja Kyung Kim; Clin Mol Hepatol 2020;26(3):302-304.
Published online July 1, 2020; DOI: https://doi.org/10.3350/cmh.2020.0081

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Original Article

Cholestatic liver disease

Clinical application of ultrasonography-guided percutaneous liver biopsy and its safety over 18 years: Young Chang, Jun Il Kim, Bora Lee, Sang Gyune Kim, Min Jung Jung, Young Seok Kim, Soung Won Jeong, Jae Young Jang, Jeong-Ju Yoo; Clin Mol Hepatol 2020;26(3):318-327.
Published online May 25, 2020; DOI: https://doi.org/10.3350/cmh.2019.0019n

Abstract
PDF

Background/Aims
Liver biopsy (LB) remains the gold standard for the evaluation of liver disease. However, over the past two decades, many noninvasive tests have been developed and utilized in clinical practice as alternatives to LB. The aim of this study was to evaluate the clinical use and safety of LB in the era of noninvasive assessment of liver fibrosis.
Methods
This retrospective study included 1,944 consecutive cases of LB performed between 2001 and 2018 in a tertiary hospital. All of the LBs were conducted under ultrasonography guidance with 18-gauge cutting needles.
Results
LBs were performed an average of approximately 108 times per year during the study period. Chronic hepatitis B (25.3%) and suspected malignancy (20.5%) were the two most common indications for LB. The use of LB for nonalcoholic fatty liver disease increased from 8.1% to 17.2% in the past 5 years compared to the last 10 years, while that for viral hepatitis decreased from 40.3% to 18.9%. Discordance rate between the suspected diagnosis and the final diagnosis was 2.6% (51 cases). The overall rate of major adverse events was 0.05% (one case), which involved delayed bleeding at the biopsy site. Liver cirrhosis was observed in 563 cases (28.9%), and the presence of cirrhosis did not affect the frequency of complications (P=0.289).
Conclusions
LB is widely used in clinical practice as an irreplaceable diagnostic tool, even in the era of noninvasiveness. Ultrasonography-guided LB can be performed safely in patients with liver cirrhosis.

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Review

Liver Transplantation

Immunologic strategies and outcomes in ABO-incompatible living donor liver transplantation: Jongwook Oh, Jong Man Kim; Clin Mol Hepatol 2020;26(1):1-6.
Published online March 26, 2019; DOI: https://doi.org/10.3350/cmh.2019.0023

Abstract
PDF

Antibody mediated rejection (AMR) after adult ABO-incompatible living donor liver transplantation (ABO-I LDLT) induced hepatic necrosis or diffuse intrahepatic biliary complications, which were related with poor graft and patient survival. Various desensitization protocols have been used to overcome these problems. Since using rituximab, the outcomes of ABO-I LDLT show a similar survival rate to those of ABO-compatible living donor liver transplantation. However, diffuse bile duct complications still occur after ABO-I LDLT. We have reviewed the past and current immune strategies for desensitization and to provide outcomes and ABO incompatibility-related complications in ABO-I LDLT.

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Case Reports

Infectious liver disease

Hepatogastric fistula as a rare complication of pyogenic liver abscess: Kyu Won Lee, Hee Yeon Kim, Chang Wook Kim, Young Ki Kim, Ohbeom Kwon, Min Ah Kim, Youngyun Cho, Keungmo Yang; Clin Mol Hepatol 2017;23(1):87-90.
Published online March 9, 2017; DOI: https://doi.org/10.3350/cmh.2016.0029

Abstract
PDF

Hepatogastric fistula following a pyogenic liver abscess is extremely rare, and only a handful of cases have been reported. An 88-year-old female presented with generalized weakness, fever and chills. An abdominal computed tomography scan revealed a 5cm-sized hypodense lesion with internal septa in the left lateral section of the liver. Due to initial suspicion of early liver abscess, she was treated with empirical intravenous antibiotics. Initially, aspiration or drainage of the liver abscess was not performed due to immature lesion characteristics. An ultrasonography-guided percutaneous drainage of the liver abscess was performed 17 days after hospitalization due to a more mature lesion appearance on follow-up imaging. On tubography, contrast media leakage through the fistulous tract was visualized. Surgical management was performed, and she was discharged 2 weeks after surgery.

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Min Kyu Kang, Hee Jung Kwon, Min Cheol Kim
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A case of hemocholecyst associated with hemobilia following radiofrequency ablation therapy for hepatocellular carcinoma: Keun Young Shin, Jun Heo, Ji Yeon Kim, Sang Jik Lee, Se Young Jang, Soo Young Park, Min Kyu Jung, Chang Min Cho, Won Young Tak, Young Oh Kweon; Korean J Hepatol 2011;17(2):148-151.
Published online June 23, 2011; DOI: https://doi.org/10.3350/kjhep.2011.17.2.148

Abstract
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Radiofrequency ablation (RFA) is performed as an alternative to surgical resection for primary or secondary liver malignancies. Although RFA can be performed safely in most patients, early and late complications related to mechanical or thermal damage occur in 8-9.5% cases. Hemocholecyst, which refers to hemorrhage of the gallbladder, has been reported with primary gallbladder disease or as a secondary event associated with hemobilia. Hemobilia, defined as hemorrhage in the biliary tract and most commonly associated with accidental or iatrogenic trauma, is a rare complication of RFA. Here we report a case of hemocholecyst associated with hemobilia after RFA for hepatocellular carcinoma that was successfully managed by laparoscopic cholecystectomy.

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Radiofrequency Ablation of Hepatocellular Carcinomas Adjacent to the Gallbladder Without Isolation Under Contrast-Enhanced Ultrasound Monitoring: A Comparative Study with Long Term Follow-Up
Liping Luo, Ronghua Yan, Qingjing Zeng, Yinglin Long, Xuqi He, Kai Li, Erjiao Xu
Journal of Hepatocellular Carcinoma.2023; Volume 10: 631. CrossRef
Hemocholecyst caused by accidental injury associated with radiofrequency ablation for hepatocellular carcinoma: A case report
You-Wen Tan, Xin-Yue Zhang
World Journal of Clinical Cases.2023; 11(23): 5610. CrossRef
The development of a predictive risk model on post-ablation hemobilia: a multicenter matched case–control study
Bozhi Liu, Honglu Li, Jiang Guo, Youjia Duan, Changqing Li, Jinglong Chen, Jiasheng Zheng, Wei Li
The British Journal of Radiology.2021;[Epub] CrossRef
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Giancarlo GISMONDO VELARDI, Angela TETI, Giuseppe E. GRECO, Sandro BALDARI
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Margaux Marclay, Mary Hudson, Rachel A. Jania, Amanda Anderson, L. Abbigail Granger, Rudy Bauer, Andrea N. Johnston
Journal of the American Veterinary Medical Association.2021; 259(9): 980. CrossRef
Haemocholecyst related to gallbladder malignancy
Sukanta Ray, Ranajoy Ghosh, Sujan Khamrui, Amit Kumar Das, Suman Saha, Dilip Kumar
Tropical Doctor.2020; 50(3): 243. CrossRef
Hemorrhagic Cholecystitis in a Patient on Maintenance Dialysis
Masayuki Shishida, Masahiro Ikeda, Nozomi Karakuchi, Kosuke Ono, Naofumi Tsukiyama, Manabu Shimomura, Koichi Oishi, Kazuaki Miyamoto, Kazuhiro Toyota, Seiji Sadamoto, Tadateru Takahashi
Case Reports in Gastroenterology.2017; 11(2): 488. CrossRef
Treatment of a Hemocholecyst
Esther Barbon Remis, Aránzazu Martínez Menéndez, Enrique Alexandre Hurle, Jose Manuel Del Casar Lizcano, M. Cruz Díez Santesteban
Cirugía Española (English Edition).2014; 92(4): 293. CrossRef
Tratamiento laparoscópico de un hemocolecisto
Esther Barbon Remis, Aránzazu Martínez Menéndez, Enrique Alexandre Hurle, Jose Manuel Del Casar Lizcano, M. Cruz Díez Santesteban
Cirugía Española.2014; 92(4): 293. CrossRef
Percutaneous sonography-guided radiofrequency ablation in the management of parathyroid adenoma
SY Xu, Y Wang, Q Xie, HY Wu
Singapore Medical Journal.2013; 54(07): e137. CrossRef
Significance of simultaneous laparoscopic cholecystectomy in thermal ablation for hepatocellular carcinoma located adjacent to gallbladder
Hiroya Iida, Tsukasa Aihara, Shinichi Ikuta, Hidenori Yoshie, Ryo Okamoto, Naohito Beppu, Munefumi Tomomatsu, Akihiro Maeda, Humihiko Kimura, Masahiro Kishimoto, Hidenori Yanaghi, Ayako Kakuno, Naoki Yamanaka
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Original Article

Diagnostic usefulness of the random urine Na/K ratio in cirrhotic patients with ascites: a pilot study: Jae Eun Park, M.D., Chang Hyeong Lee, M.D., Byung Seok Kim, M.D., Im Hee Shin, Ph.D.1; Korean J Hepatol 2010;16(1):66-74.
Published online March 26, 2010; DOI: https://doi.org/10.3350/kjhep.2010.16.1.66

Abstract
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Background/Aims
Twenty-four hour urinary sodium excretion (24-h UNa) of greater than 78 mmol/day is important in the management of cirrhotic ascites. Although the random urine sodium-to-potassium ratio (UNa/K) is strongly correlated with 24-h UNa, and approximately 95% of patients with a random UNa/K greater than 1 have 24-h UNa greater than 78mmol, few data have been published on the correlation between 24-h UNa and random UNa/K. We evaluated diagnostic value of morning and afternoon random UNa/K (AM UNa/K and PM UNa/K, respectively) with 24-h UNa. Methods: A total of 42 male patients were enrolled from October 2007 to March 2008. Each patient collected 5 mL of urine twice at random times during 24-h urine collection (at 10-12 a.m. and 3-5 p.m.). ROC curve analysis was performed to evaluate the feasibility of AM and PM UNa/K for differentiating 24-h UNa greater than 78mmol/day. Results: Forty patients with a 24-h urinary creatinine of greater than 15 mg/kg were analyzed. The 24-h UNa, AM UNa/K, and PM UNa/K were 107.9±91.2mmol (mean±SD), 3.44±3.64, and 3.97±4.60, respectively. When compared with 24-h UNa greater than 78 mmol, AUROC values for AM and PM UNa/K were 0.861 (95% CI, 0.715-0.950) and 0.929 (95% CI, 0.802-0.986), respectively (P=0.0001). No difference was found between the AUROC for AM and PM UNa/K (95% CI, -0.161-0.153, P=0.113). UNa/K greater than 1.25 was sensitive and specific for prediction of 24-h UNa greater than 78 mmol. Conclusions: The results suggest that anytime random UNa/K greater than 1.25 is an accurate, cost-effective, and convenient method for replacing 24-h UNa. Large multicentered cohort studies are needed to confirm our results. (Korean J Hepatol 2010; 16:66-74)

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Evaluations of Surface PM10 Concentration and Chemical Compositions in MERRA-2 Aerosol Reanalysis over Central and Eastern China
Xiaodan Ma, Peng Yan, Tianliang Zhao, Xiaofang Jia, Jian Jiao, Qianli Ma, Dongqiao Wu, Zhuozhi Shu, Xiaoyun Sun, Birhanu Asmerom Habtemicheal
Remote Sensing.2021; 13(7): 1317. CrossRef
Diagnostic usefulness of the spot urine sodium/potassium ratio in cirrhotic patients with ascites
Jin Wook Lee, Jae Seok Hwang, Woo Jin Chung, Heon Ju Lee, Jung Gil Park, Chang Hyeong Lee, Byung Seok Kim, Jeong Eun Song, Young Oh Kweon, Won Young Tak, Soo Young Park, Se Young Jang, Jeong Ill Suh, Byoung Kuk Jang, Bhagwan Dass
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Low sodium to potassium ratio in spot urine sample is associated with progression to acute kidney injury and mortality in hospitalized patients with cirrhosis
Elayne Cristina Morais Rateke, Camila Matiollo, Emerita Quintina de Andrade Moura, Michelle Andrigueti, Claudia Maccali, Janaína Sant'Ana Fonseca, Sabine Machado Fiorenza Canova, Janaína Luz Narciso-Schiavon, Leonardo Lucca Schiavon
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Comparative study of spot urine Na/K ratio and 24-hour urine sodium in natriuresis evaluation of cirrhotic patients with ascites
Otávio Marcos da Silva, Gabriela Bicca Thiele, Leonardo Fayad, César Lazzarotto, Esther Buzaglo Dantas-Corrêa, Leonardo de Lucca Schiavon, Janaína Luz Narciso-Schiavon
GE Jornal Português de Gastrenterologia.2014; 21(1): 15. CrossRef
Avaliação da natriurese no doente cirrótico: determinação pontual Na+/K+na urina ou doseamento de sódio na urina de 24 horas?
Susana Lopes
GE Jornal Português de Gastrenterologia.2014; 21(1): 7. CrossRef
Can 24‐h urine sodium excretion be replaced by spot urine sodium/potassium in patients with decompensated cirrhosis?
Evangelos Cholongitas, Stylianos Karatapanis, Theodora Nakouti, Charis Birtsou, Labrini Skorda, Ioannis Kouvelis, Vasilios Papastergiou, Nikolaos Papachrysos, John Goulis, Evangelos Akriviadis
Liver International.2012; 32(1): 172. CrossRef

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Case Report

Development of ocular myasthenia during pegylated interferon and ribavirin treatment for chronic hepatitis C: Hyung Min Kang, M.D., Myung Jin Park, M.D.1, Jeong-Min Hwang, M.D.1, Jin Wook Kim, M.D., Sook-Hyang Jeong, M.D.; Korean J Hepatol 2009;15(2):209-215.
Published online June 30, 2009; DOI: https://doi.org/10.3350/kjhep.2009.15.2.209

Abstract
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A 63-year-old male experienced sudden diplopia after 9 weeks of administration of pegylated interferon (IFN) α-2b and ribavirin for chronic hepatitis C (CHC). Ophthalmologic examinations showed ptosis on the right upper lid and restricted right eye movement without any other neurological signs. A brain imaging study and repetitive nerve stimulation test indicated no abnormality. The acetylcholine receptor antibody titer and response to acetylcholinesterase inhibitors were negative, and the results of thyroid function tests were normal. The patient’s ophthalmological symptoms improved rapidly 3 weeks after discontinuation of pegylated IFN α -2b and ribavirin. The ocular myasthenia associated with combination therapy of pegylated IFN α-2b and ribavirin for CHC is very rarely reported; therefore, we present this case with a review of the various eye complications of IFN therapy. (Korean J Hepatol 2009;15:209-215)

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Autoimmune Neuromuscular Diseases Induced by Immunomodulating Drugs
Songkit Supakornnumporn, Bashar Katirji
Journal of Clinical Neuromuscular Disease.2018; 20(1): 28. CrossRef
Myasthenia Crisis Induced by Pegylated-Interferon in Patient With Chronic Hepatitis C
Su Jung Baik, Tae Hun Kim, Hye In Kim, Jeong Yeon Rhie
Medicine.2016; 95(21): e3782. CrossRef
Pegylated Interferon Induced Myasthenia Crisis—A Case Report
Jonathan P. Congeni, Robert B. Kirkpatrick
Journal of Clinical Neuromuscular Disease.2013; 14(3): 123. CrossRef

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Original Article

The Cause and Complication of Liver Cirrhosis during the Reccent 5 Years: Kwang Sik Seo , Byung Seok Lee , Jae Kyu Sung , Sang Oo Lee , Seok Hyun Kim , Kyung Tae Kim , Seung Min Lee , Jin Hee Kim , Nam Jae Kim , Heon Young Lee; Korean J Hepatol 1997;3(3):202-209.

Abstract
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Background/Aims
The causes and complications of liver cirrhosis are varied and increasing prevalence of alcoholic liver disease has been suspected. We tried to categarize the causes and complications of liver cirrhosis. Methods: We investigated the 159 patients who are diagnosed as liver cirrhosis at Chungnam National University Hospital during the recent 5 years. Results: 1) HBV infection was the most common cause of liver cirrhosis (48.1%), alcohol was next (42.9%). 2) Alcoholic liver cirrhosis was the most common cause in male (54.2%), postnecrotic cirrhosis (HBV) was the most common cause in female (66.7%). The difference was considered to come from the fact that male drinks more, constantly or habitually. 3) Alcohol was the most common cause of liver cirrhosis above the fifth decade of age and HBV is under 40 yeats of age. 4) The complications of liver cirrhosis are variceal bleeding, most common, splenomegaly and ascites in order. Hepatocellular carcinoma occumd also especially in HBV induced liver cirrhosis. Conclusion: Alcoholic liver disease is a common cause of liver cirrhosis. (Korean J Hepatol 1997;6:202 209)

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Case Report

A Case of Intraluminal Gallbladder Hematoma after Percutaneous Liver Biopsy: Taek Kun Kwon, M.D., Sang Hoon Jeon, M.D., Hae Won Park, M.D., Woo Jin Jung, M.D., Jun Young Hwang, M.D., Kyung Sik Park, M.D., Kwang Bum Cho, M.D., Jae Seok Hwang, M.D., Sung Hoon Ahn, M.D., and Soong Kook Park, M.D.; Korean J Hepatol 2002;8(4):486-489.

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Percutaneous liver biopsy is valued in the diagnosis of diffuse or localized liver disease. Serious complications after ultrasonography-guided liver biopsy are rare. We report a case of a 69-year-old man who underwent a percutaneous liver biopsy for the evaluation of his underlying liver disease with subsequent late complication of intraluminal gallbladder hematoma.(Korean J Hepatol 2002;8:486-489)

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Original Article

Clinical Features of Liver Abscess Developed after Radiofrequency Ablation and Transarterial Chemoembolization for Hepatocellular Carcinoma: Min Hyung Kim, M.D., Moon Seok Choi, M.D., Yong Sung Choi, M.D., Do Young Kim, M.D., Ji Min Lee, M.D.2, Seung Woon Paik, M.D., Joon Hyuek Lee, Kwang Cheol Koh, M.D., Byung Cheol Yoo, M.D., Dongil Choi, M.D.1 and Jong Chul Rhee; Korean J Hepatol 2006;12(1):55-64.

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Background/Aims: Radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) have been applied for treating hepatocellular carcinoma (HCC), but procedure-related complications can be a serious problem. This study was conducted to evaluate the clinical features of HCC patients who developed liver abscess after RFA and TACE, as compared to those patients without malignancy. Methods: In our center, from December 1999 to March 2004, 31 cases of liver abscess developed after local treatment of HCC (13/751 after RFA and 18/8417 after TAE), which correspond to 5.1% of the total cases (602) of liver abscess. We evaluated the patients’ clinical features, the abscess characteristics, the bacteriology, treatment modality, hospital days and mortality, as compared to those characteristics of 263 abscess patients without malignancy. Results: The time required to diagnose liver abscess was longer in the TACE group (24.8±16.5 days) compared to that of the other two groups (12.2±9.0 days in the RFA group, 9.6±7.5 days in the controls, P=0.001). Gas-forming liver abscess is most frequently found in the RFA groups (76.9%). There were more hospitalized days for the TACE groups than for the RFA group and the controls (34.7±19.8 vs. 15.2±9.2 vs. 18.6±10.9 days, respectively, P<0.001). Two patients (11%) in the TACE group died of sepsis and liver failure. Conclusions: For the patients with prolonged fever after RFA and especially after TACE for HCC, a diagnosis of liver abscess should be suspected earlier to reduce the morbidity and mortality due to liver abscess per se and also the sepsis-related decompensation of the liver. (Korean J Hepatol 2006;12:55-64)

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Case Report

A Case of Bell`s Palsy Associated with Peginterferon Alfa-2a and Ribavirin Therapy for Chronic Hepatitis C Virus Infection: Moo Yeol Lee, M.D., Hoon Cho, M.D., Yeong Muk Kim, M.D., and Joon Sang Lee, M.D.; Korean J Hepatol 2006;12(3):444-448.

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Pegylated interferon alfa-2a (PEG-IFN) and ribavirin combination therapy is the first line treatment for chronic HCV infection. There are four reports of Bell’s palsy associated with interferon-α (IFN-α) and ribavirin therapy. We report here a case of Bell’s palsy that occurred in a patient with chronic HCV infection during combination PEG-IFN and ribavirin therapy. The patient was 49-year-old man with chronic hepatitis C for 2 years. The liver biopsy showed grade 1 and stage 1. Therapy with PEG-IFN (Pegasys) 180 μg/week and ribavirin 1200 mg/day was initiated. After 3 weeks of treatment, the patient showed a loss of muscular tone on the left side of his face. A diagnosis of Bell’s palsy was made, and the PEG-IFN and ribavirin therapy was stopped. Prednisolone 45 mg/d was given and then tapered for 8 weeks. His palsy improved over 6 weeks. (Korean J Hepatol 2006;12:444-448)

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Editorial

Preoperative Evaluation and Postoperative Complications with Prognostic Impact of Surgical Resection for the Hepatocellular Carcinoma in Cirrhotics: Koo Jeong Kang; Korean J Hepatol 2006;12(4):479-483.

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Original Articles

The Adverse Effect of Indirectly Diagnosed Portal Hypertension on the Complications and Prognosis after Hepatic Resection of Hepatocellular Carcinoma: Min An , Joong Won Park , Jeong A Shin , Joon Il Choi , Tae Hyun Kim , Seong Hoon Kim , Woo Jin Lee , Sang Jae Park , Eun Kyoung Hong , Chang Min Kim; Korean J Hepatol 2006;12(4):553-561.

Abstract
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Backgrounds/Aims
Surgical resection is considered as a curative treatment modality for patient with hepatocellular carcinoma (HCC). Since HCC often occurs in chronic liver disease, selecting optimal candidates based on the hepatic function reserve and the risk of hepatic decompensation after resection is important. In recent studies, clinically relevant portal hypertension including hepatic venous pressure gradient (HVPG) is considered as the best predictor of postoperative hepatic decompensation. However, since measuring HVPG requires an invasive procedure it is not widely used in practice. We aimed to evaluate whether the portal hypertension diagnosed indirectly could be a useful parameter for predicting postoperative prognosis. Methods: A total of 142 patients with HCC who had endoscopic examination, computed tomography and surgical resection from January 2001 to June 2004 were included in the study. We diagnosed portal hypertension indirectly by the presence of varices or splenomegaly with thrmobocytopenia. Postoperative complications and survival rate according to the presence of portal hypertension was studied. Results: The postoperative morbidity rate was 42.2%. The incidence of ascites and prolonged hyperbilirubinemia were significantly higher in portal hypertension group (ascites 43.8 vs. 10.3%, hyperbilirubinemia 20.3 vs. 1.3%, respectively, P<0.01). The cumulative 3-year recurrence-free survival rate showed no statistical difference between the two groups. However, the cumulative 3-year survival rate was significantly higher in the non-portal hypertension group (82.8% vs. 53%, respectively, P=0.014). Conclusion: Indirectly diagnosed portal hypertension is correlated with the development of complications and poor prognosis after the surgical resection of HCC. (Korean J Hepatol 2006;12:553-561)

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Clinical Features of Acute Viral Hepatitis A Complicated with Acute Renal Failure: Kee Sup Song, M.D., Min Ju Kim, M.D., Chang Soo Jang, M.D., Hyuk Sang Jung, M.D., Hyun Hee Lee, M.D., Oh Sang Kwon, M.D., Yun Soo Kim, M.D., Duck Joo Choi, M.D., Ju Hyun Kim, M.D., Seung Yeon Ha, M.D.1; Korean J Hepatol 2007;13(2):166-173.

Abstract
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Background
Most patients with acute viral hepatitis A (AVHA) spontaneously recover, but a few patients experience complications. This study was carried out to examine clinical features of AVHA complicated with acute renal failure (ARF). Method: Medical records of 404 patients with AVHA were reviewed. Clinical features of AVHA patients with ARF (group A) were compared with those of AVHA patients without ARF (group B). Result: ARF complication was present in 11 patients (3%). There were no differences between group A and B in sex ratio and age. Microscopic hematuria (7 cases), proteinuria (7 cases), metabolic acidosis (4 cases), oliguria (4 cases), pulmonary edema (3 cases) and hyperkalemia (2 cases) were found in group A. The prevalence of heavy alcohol drinking (64% vs 3%, p<0.001) and diabetes mellitus (18% vs 1%, p=0.01) was higher in group A than B. The peak value of ALT (median: 4,290 IU/L vs 1,266 IU/L, p=0.006) and total bilirubin (median: 10.8 mg/dL vs 6.0 mg/dL, p=0.001) was higher in group A than B. Duration of admission was longer in group A than B (median: 14 days vs 5 days, p<0.001). Four patients of group A recovered with renal replacement therapy, while 7 patients recovered with conservative treatment. Conclusions: The AVHA patients with ARF experienced more severe hepatitis than those without ARF, but they had a good prognosis with the proper treatment. (Korean J Hepatol 2007;13:166-173)

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Case Report

A Case of Acute Hepatitis A Complicated by Guillain-Barre Syndrome: Yun-Jeong Bae, M.D., Kang Mo Kim, M.D., Kwang Kuk Kim, M.D.1, Jae Hyung Rho, M.D., Hyun Ki Lee, M.D., Yung Sang Lee, M.D., Dong Jin Suh, M.D.; Korean J Hepatol 2007;13(2):228-233.

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We report here a case of acute hepatitis A, which was complicated by Guillain-Barré syndrome (GBS). A 32-year old male admitted to our hospital with the symptoms of acute hepatitis and was diagnosed to have acute hepatitis A with positive IgM anti hepatitis A virus antibody. On 9th day after the onset of jaundice, acute progressive, ascending, symmetric motor paralysis were developed and eventually respiratory failure ensued. Cerebrospinal fluid analysis showed albumino-cytologic dissociation and nerve conduction velocity test suggested a polyradiculopathy. He was diagnosed to have GBS and treated with intravenous immunoglobulin and required a ventilatory support. After 90 hospital days, he recovered in ambulatory condition with the aid of crutches. The clinical course, prognosis and the outcome of neuropathic symptoms of GBS following acute hepatitis A were relatively poor in our case. (Korean J Hepatol 2007;13:228-233)