We detected des-gamma-carboxy prothrombin, an abnormal prothrombin, in the serum of 69 of 76 patients (91 per cent) with biopsy-confirmed hepatocellular carcinoma (the mean level of the abnormal prothrombin was 900 ng per milliliter). In contrast, levels of the abnormal prothrombin were low in patients with chronic active hepatitis (mean, 10 ng per milliliter) or metastatic carcinoma involving the liver (mean, 42 ng per milliliter), and undetectable in normal subjects. In five patients treated with vitamin K there was no reduction in abnormal prothrombin, indicating that its presence was not due to vitamin K deficiency. Surgical resection of tumors in two patients and chemotherapy in one patient markedly reduced abnormal-prothrombin concentrations, which later increased with recurrence of disease. Serum alpha-fetoprotein levels correlated poorly with abnormal-prothrombin levels. Together, the assay for abnormal prothrombin and the alpha-fetoprotein assay identified 64 of 76 patients with hepatoma (84 per cent). Abnormal prothrombin may be useful in the laboratory diagnosis of primary hepatocellular carcinoma.

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To combat hepatitis B virus (HBV) infection in Taiwan, a mass immunoprophylaxis program was launched on July 1, 1984, aiming first at prevention of chronic HBV carriage from perinatal mother-to-infant infection. In the first 15-month period, 352,721 (78%) of 450,585 pregnant women were screened for hepatitis B surface antigen (HBsAg); HBsAg was present in 62,359 (18%), with 50% of them categorized as highly infectious. Infants born to HBsAg-positive women were given 5 micrograms of a plasma-derived hepatitis B vaccine at ages 1, 5, and 9 weeks, with a booster at age 12 months. Infants of highly infectious carrier mothers received an additional 0.5 mL of hepatitis B immune globulin within 24 hours after birth. The coverage rate of the hepatitis B immune globulin was 77% in 27,375 infants born to highly infectious mothers, and that of the first, second, third, and the fourth doses of vaccine was 88%, 86%, 84%, and 71%, respectively, in infants of 55,620 carrier mothers. The reported untoward reactions to immunization were negligible. We conclude that a mass hepatitis B vaccination program is feasible in hyperendemic areas such as Taiwan; this should be a significant step toward the effective control of HBV infection in these areas.

phylactic endoscopic variceal ligation (EVL) might be an ideal To determine the efficacy of endoscopic variceal ligatherapy. [13][14][15][16][17] tion (EVL) in prophylaxis on the rate of first esophageal The present study was thus designed to determine, in a variceal bleeding, we conducted a prospective, randomcontrolled and prospective manner, whether EVL therapy of ized trial in 126 cirrhotic patients with no history of high-risk varices will affect the risk of first variceal bleeding previous upper gastrointestinal bleeding and with and improve chances of survival of cirrhotic patients with no esophageal varices endoscopically judged to be at high previous bleeding from the upper gastrointestinal tract. risk of hemorrhage. The end-points of the study were bleeding and death. Life- 62) in the EVL group and 58% (37/64) in the controlfrom the study. Patients were randomly allocated to either a treat- group. Comparison of Kaplan-Meier estimates of thement group or to a control group (using a sealed-envelope method). time to death of both groups showed significantly lowerAll patients were informed of endoscopic findings and possible risks. mortality in the ligation group (P Å .001). Patients under-Patients in the treatment group were informed about study protocol going EVL had few treatment failures and died mainly and possible complications. Informed consent was obtained from each of hepatic failure. The lower risk in the EVL group was patient, and study protocol conformed to the ethical guidelines of the attributed to a rapid reduction of variceal size. Prophy-1975 Declaration of Helsinki, as reflected in a priori approval by the lactic EVL was more efficient in preventing first bleed-institution's human research review committee. Three patients who ing in patients with good condition (Child A) than in did not provide the consent were excluded from the study. Functional hepatic reserve was classified according to the Pugh-modified Childs those with decompensated disease (Child B and C). We classification. 18 The patients in Child class A were defined as having conclude that prophylactic EVL can decrease the inci-''compensated'' cirrhosis; the patients in Child classes B and C were dence of first variceal bleeding and death over a period defined as having ''decompensated'' disease. The successful control of corresponded to a rate of bleeding ú90.2% in the retrospective classimassive bleeding is the major goal of the emergency manage-fication of the study by Beppu et al. 20 This means that all patients ment of such patients. 4 However, the high mortality rate as-had blue varices of F2 or F3 size with at least one of the following: sociated with bleeding esophageal varices has not been signif-red wale markings (//, ///), cherry-red spots (//, ///), or heicantly reduced over the past decades, despite the enormous matocystic spots (/). Active variceal bleeding was diagnosed when blood was seen directly by endoscopy to issue from a varix, or when progress in pharmacological therapy and surgery. (Olympus XQ 20, To...

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