The shift in prevalence of hepatitis A immunity in Flanders, Belgium.
Beutels M. Van Damme P. Vranckx R. Meheus A.
WHO Collaborating Centre for Prevention and Control of Viral Hepatitis, Department of Epidemiology and Community Medicine, University of Antwerp, Wilrijk, Belgium.
The purpose of this study was to obtain data on the prevalence of hepatitis A in Flanders, Belgium, in order to analyse any change in the epidemiological pattern of hepatitis A virus (HAV) in the region, and to determine at which age pre-vaccination testing would be useful. To meet these goals, a sero-epidemiological survey was conducted: 4058 serum samples were collected from a random sample of the general population in 1993-94. The overall age-standardised prevalence was 51.3%. Among non-Belgians (N = 245), the age-standardised anti-HAV prevalence was 66.4%, significantly higher than the 49.6% anti-HAV prevalence found in Belgians (N = 3186). Among Belgians, seroprevalence increased with age: from 5.4% in the youngest age group (0-14 years) to over 80% in the two oldest age groups (55-64 years and > or = 65 years). Prevalence rates were as high as 31.7% in the 25-34 year old age category, and 60.8% in the 35-44 year old age category. The age-specific prevalence figures among Belgians and non-Belgians reflect two different epidemiological patterns: the epidemiological pattern of a low endemic region for Belgians and the epidemiological profile of an intermediate endemic region forn non-Belgians. The age-specific prevalence figures in Belgians were compared with the 1979 and 1989 anti-HAV prevalence figures in Belgian first-time blood donors. A clear epidemiological shift showing decreasing HAV prevalence in the youngest age groups was found. If we accept that pre-vaccination screening is useful at a 35% prevalence rate, all persons over 35 years of age should be screened before vaccination.
Follow-up of colon cancer: detection of liver metastases: benefit and periodicity.
de Goede E. Filez L. Janssens J. Van Cutsem E.
Department of Gastroenterology (Internal Medicine), University Hospital Gasthuisberg, Leuven, Belgium.
The aim a follow-up programme in patients with cancer is to detect relapse or metastases in an early asymptomatic stage. This is only useful if the diagnosis of recurrence has implications for treatment and if early treatment of recurrence leads to an improved prognosis. This is certainly the case for liver metastases of colon cancer. Surgical resection of localised liver metastases has a 25-30% 5-year survival. Early chemotherapy for non-resectable metastatic disease improves the survival and prolongs the symptom-free period in comparison with chemotherapy starting at the onset of symptoms. Follow-up for colorectal cancer should be offered to patients with the highest risk of recurrence and should consist of clinical examination, CEA monitoring, ultrasound of the liver, chest X-ray and periodic colonoscopy. Issues for further research are the determination of a follow-up programme with the highest sensitivity, the determination of the periodicity of follow-up, the search for prognostic factors for recurrence, cost issues and the final proof of a survival benefit in a large follow-up programme. CONCLUSIONS: Indirect evidence supports the need for a good follow-up programme for colorectal cancer focussing on the detection of liver metastases.
Mesenterico-left intrahepatic portal vein shunt: original technique to treat symptomatic extrahepatic portal hypertension.
de Ville de Goyet J. Martinet JP. Lacrosse M. Goffette P. Melange M. Lerut J.
Departments of Pediatric Surgery, Cliniques Universitaires St Luc, Catholic University of Louvain, Brussels, Belgium.
MESENTERICO-LEFT INTRAHEPATIC PORTAL VEIN SHUNT: Original technique to treat symptomatic extrahepatic portal hypertension. OBJECTIVE: Revascularization of the intrahepatic portal system as decompressive surgery for chronic extrahepatic portal hypertension. SUMMARY BACKGROUND DATA: In patients with extrahepatic portal hypertension (portal trunk thrombosis in presence of a normal liver), shunt surgery is indicated when patient is bleeding from varices at a site not accessible for the endoscopist. Although surgical portal decompression is an efficient procedure, there is a risk of depriving the liver from the splanchnic venous flow and a risk of developing porto-systemic shunt related side effects. METHOD: A shunt was created between the superior mesenteric vein and the umbilical portion of the left portal vein. This technique allows to bypass the thrombosed portion of the portal vein but avoiding dissection of the cavernoma in the liver hilum and related risk of intraoperative hemorrhage. RESULTS: The procedure was successfully performed in one adult patient considered unshuntable in view of classic surgical procedures and in whom sclerotherapy was unsuccessful. This operation achieved an effective decompression of the splanchnic venous system. CONCLUSION: Rerouting the venous splanchnic flow through the liver was possible. It had the major physiological advantage of restoring the normal hepatic vascularization. It also avoided putting the patient at risk of developing porto-systemic shunt related side effects. This option should be considered when shunt procedures are indicated in patients with extrahepatic portal hypertension.