Infection Due to Mycobacterium Avium

Where the term embraces minor disturbances in the liver the incidence of malignant change is low, while if the diagnostic criteria are stringent the incidence appears higher (Parker, 1957). For this reason the results in Table II cannot strictly be compared, and serve only to give a general impression. Adopting the same criteriaas the present series, Sherlock (1958) found an incidence of carcinoma in cirrhosis of 14%. Table III shows that malignant change has been recognized more frequently in successive five-year periods, although undue emphasis should not be placed on this increase owing to the small number of patients studied. The incidence of primary liver carcinoma in cases of cirrhosis at necropsy for the last five years was 28.3%. Thus a tumour which is rare in the whole population is common in relation to a small group of patients with cirrhosis. Appreciation of the frequency of the condition will be more likely to suggest the diagnosis than a search for or reliance upon diagnostic signs and tests. The apparently high incidence of malignant change may be due either to a real increase or to improved methods of recognition. We are not in a position to decide this point. A feature of interest is the association of peptic ulcer with cirrhosis and hepatoma. Active chronic peptic ulcer occurs in 4 to 8% of all hospital necropsies (Watkinson, 1960). A greater incidence in cirrhosis is well recognized, figures as high as 19.5% being quoted (Lipp and Lipsitz, 1952). In the present series 14.2% of patients dying with cirrhosis were found to have chronic peptic ulcers. Macdonald and Mallory (1958) showed the incidence in hepatoma to be higher (16%) and in the present series the incidence of chronic peptic ulcer in those dying of hepatoma was 23.3%. No explanation for this is offered, but from the clinical standpoint the association may be of some importance, since further investigation of upper abdominal pain in cirrhosis may be abandoned when an ulcer is demonstrated unless it is appreciated that cirrhosis, hepatoma, and ulcer may often coexist.