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Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease that predominantly occurs in middle-aged women. It is characterised by inflammatory destruction of interlobular and septal bile ducts, subsequent fibrosis, and finally liver cirrhosis. The disease slowly progresses over decades and may lead to liver failure. It is more frequently diagnosed now than it was in the past probably because of a greater awareness of the disease. Liver function tests reveal an elevation of serum alkaline phosphatase and µ-glutamyltransferase levels with or without elevated aminotransferase levels. Antimitochondrial antibodies (AMAs) are found in 95% of patients with PBC. AMAs have been shown to be directed against the 2-oxo-acid dehydrogenase complexes located on the inner membrane of the mitochondria. However, AMA titres do not correlate with disease severity or progression, and the role of AMAs in the pathogenesis of primary biliary cirrhosis is not yet known. The disease is frequently associated with other autoimmune disease, including Sjogren's syndrome, thyroid disorders and scleroderma. Most therapeutic efforts have been directed at altering the immune response. Ursodeoxycholic acid (UDCA) appears to be effective therapy in preventing or delaying the need for liver transplantation and improving survival. However, a number of patients receiving UDCA still develop progressive disease and go on to transplantation, which is an effective therapy at the end stage of the disease. Various prognostic models have been proposed to assist in the determination of the optimum timing of liver transplantation. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) represents one of the most common neoplasms worldwide. To date, curative treatment options include liver transplantation or resection. Unfortunately, most patients are detected with nonresectable or -transplantable HCC due to disease extension or comorbid factors, and are therefore candidates only for palliative treatments. Palliative medical treatments, including systemic chemotherapy, immunotherapy or hormonal manipulation, have a borderline activity on HCC and cannot be recommended outside clinical trials. A high response rate has been reported with local therapies such as transcatheter arterial embolisation, intra-arterial chemotherapy or percutaneous alcohol (ethanol) injection, but as there is no clear evidence of a survival advantage for these treatment modalities, further investigations are required. Multidisciplinary treatment, including preoperative cytoreduction or postoperative adjuvant therapy, is currently under investigation, with encouraging survival results. HCC patients should be evaluated within clinical trials, possibly randomised and with homogeneous prognostic factors, in order that we may find the answer to all these important questions. [ABSTRACT FROM AUTHOR]