Use of 18F-FDG PET to predict tumor progression and survival in patients with intermediate hepatocellular carcinoma treated by transarterial chemoembolization

BACKGROUND/AIMS: 18F-Fluorodeoxyglucose positron-emission tomography (18F-FDG PET) has been used to assess the biological behavior of hepatocellular carcinoma (HCC). In this study, we investigated the usefulness of 18F-FDG PET for predicting tumor progression and survival in patients with intermediate Barcelona Clinic Liver Cancer (BCLC) intermediate-stage HCC treated by transarterial chemoembolization (TACE). METHODS: From February 2006 to March 2013, 210 patients treated with TACE, including 77 patients with BCLC intermediate-stage HCC, underwent examination by 18F-FDG PET. 18F-FDG uptake was calculated based on the tumor maximum (Tmax) standardized uptake value (SUV), the liver mean (Lmean) SUV, and the ratio of the Tmax SUV to the Lmean SUV (Tmax/Lmean). RESULTS: The mean follow-up period for the 77 patients (52 males, 25 females; average age, 63.3 years) was 22.2 months. The median time to progression of HCC in patients with a low Tmax/Lmean ( or = 1.83) was 17 and 6 months, respectively (p < 0.001). The median overall survival time of patients with a low and high Tmax/Lmean was 44 and 14 months, respectively (p = 0.003). Multivariate analysis revealed that the Tmax/Lmean was an independent predictor of overall survival (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.210 to 3.156; p = 0.006) and tumor progression (HR, 2.05; 95% CI, 1.264 to 3.308; p = 0.004). CONCLUSIONS: 18F-FDG uptake calculated by the Tmax/Lmean using PET predicted tumor progression and survival in patients with BCLC intermediate-stage HCC treated by TACE.

Efficacy of Initial Treatment with Clevudine in Naive Patients with Chronic Hepatitis B

BACKGROUND/AIMS: Clevudine, a pyrimidine nucleoside analogue, has potent antiviral effects in patients with chronic viral hepatitis B (CHB). We report the efficacy of initial treatment with clevudine in naive patients with CHB living in Daejeon and Chungcheong Province, South Korea. METHODS: One hundred five adults with CHB were administered 30 mg of clevudine per day for an average of 51 weeks. We evaluated viral markers and liver biochemistry retrospectively every 3 months. RESULTS: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and hepatitis B virus (HBV) DNA before the treatment were 184 +/- 188 IU/L, 150 +/- 138 IU/L, and 7.1 +/- 1.2 log copies/mL, respectively. Undetectable rates (< 60 IU/mL) of DNA were 36.2%, 68.9%, 83.6%, 76.2%, and 75.8% at 12, 24, 36, 48, and 60 weeks, respectively. Seroconversion rates were 9.1%, 13.6%, 24.6%, 26.5%, and 26.1% and ALT normalization rates were 64.5%, 78.1%, 87.9%, 90.0% at 12, 24, 36, and 48 weeks, respectively. Six patients (5.7%) had a viral breakthrough. CONCLUSIONS: Clevudine is a useful drug in the initial treatment of patients with CHB, with a potent antiviral effect and low incidence of viral breakthrough.

Efficacy of initial treatment with peginterferon alpha-2a versus peginterferon alpha-2b in combination with ribavirin in naive chronic hepatitis C patients living in Daejeon and Chungcheong Province in Korea: A comparative study / 대한간학회지

BACKGROUNDS/AIMS: Peginterferon alpha-2a or -2b is the standard treatment regimen in chronic hepatitis C. However, there have been few comparative studies of the efficacies of these two types of peginterferon. We evaluated their efficacies in combination with ribavirin as a initial treatment for chronic hepatitis C. METHODS: Ninety-seven patients were treated with peginterferon alpha-2a (180 microgram/week, n=48) or peginterferon alpha-2b (1.5 microgram/kg/week, n=49) plus ribavirin (800 mg/day for 24 weeks in genotype non-1 or 1,000-1,200 mg/day for 48 weeks in genotype 1). Virologic responses including the early virologic response (EVR), end-of-treatment response (ETR), sustained virologic response (SVR), and adverse effects were analyzed retrospectively. RESULTS: The virologic response rates did not differ significantly between peginterferon alpha-2a and -2b: 89.6% and 89.7% for EVR, 79.2% and 79.5% for ETR, 72.9% and 73.5% for SVR, respectively. Analysis of the virologic responses according to genotype also revealed no significant differences in SVR between peginterferon alpha-2a and -2b (59.3% vs. 59.7% for genotype 1 and 90.5% vs. 83.3% for genotype non-1, respectively), or in adverse effects including flu-like symptom, rash, itching, neutropenia, and thrombocytopenia. CONCLUSIONS: We found no significant differences in therapeutic efficacies and adverse effects between the alpha-2a and -2b types of peginterferon as the initial treatment regimen in naive chronic hepatitis C patients.

A case of fibrolamellar hepatocellular carcinoma in an old-age woman / 대한내과학회지

Fibrolamellar hepatocellular carcinoma (FLHCC) is an entiry distinct from ordinary hepatocellular carcinoma (HCC) and is very rare in oriental countries. In contrast to the ordinary type of HCC, FLHCC is predominantly a disease of young adults and shows no sex predilection. In addition, it is rarely associated with positive hepatitis-B surface antigen, chronic liver disease, and a high level of serum alpha-fetoprotein (AFP). FLHCC has a high resectability rate than that of ordinary HCC, because of its occurrence in adolescents and the lack of underlying disease. Here, we report a case of FLHCC observed in a 78 year old woman. She had a dyspepsia for one month and was older than average-age patient with FLHCC, but had many characteristics of FLHCC. The tumor was removed by right anterior and left medial segmentectomy, and diagnosed as FLHCC.

SB203580, a P38 MAPK Inhibitor, Blocks in vitro Invasion by Human Gastric SNU-638 Cells / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The role of P38 mitogen-activated protein kinase (MAPK) in gastric cancer invasion has not yet been determined. In this study, we examined the effects of SB203580, a specific P38 MAPK inhibitor, on the in vitro invasion of gastric cancer and upon the molecules involved in this process. MATERIALS AND METHODS: Human gastric cancer SNU-638 cells were maintained in RPMI 1640 supplemented with 10% FBS. BIOCOAT matrigel invasion chambers were used to examine in vitro invasiveness, zymography for gelatinase activity, CAT assay for uPA promoter activity and Western and Northern blotting to determine protein and mRNA levels, respectively. RESULTS: Treatment of SNU-638 cells with SB203580, a specific P38 MAPK inhibitor, reduced in vitro invasiveness, dose-dependently. SB203580 treatment was found to decrease both mRNA expression and uPA promoter activity in gastric SNU-638 cells. In vitro invasion of SNU-638 cells was partially abrogated by uPA-neutralizing antibodies. The activities of MMPs were not significantly altered by SB203580. CONCLUSION: Our results suggest that P38 MAPK is a potential therapeutic target for inhibiting uPA-dependent gastric tumor invasiveness and metastasis.

A Case of Endoscopic Therapy of a Bleeding Duodenal Diverticulum / 대한소화기내시경학회지

Duodenal divertula are relatively frequent findings in the adult gastrointestinal tract. The majority of them are asymptomatic, but vague gastrointestinal complaints have often been attributed to these lesions. These diverticula occasionally result in the obstruction of the biliary and pancreatic ducts, which leads to jaundice and pancreatitis. Other complications such as hemorrhage, perforation, sepsis, and death can occur. With the advent of therapeutic endoscopy, the diagnosis and primary treatment of duodenal diverticula associated with bleeding has changed dramatically since its first reported occurrence. Effectiveness of therapeutic endoscopy is very high in patients with diverticular bleeding in the medial aspect of sencond portion of the duodenum because of its high operative mortality. A cases of a patient suffering from gastrointestinal bleeding in the duodenal diverticulum who was diagnosed and managed by endoscopy alone is herein reported with review of relevant literature.

Efficacy of Needle-knife Infundibulotomy in Failed Cannulation on Endoscopic Retrograde Cholangiopancreatography / 대한소화기내시경학회지

BACKGROUND/AIMS: Cannulation failure to biliary tract has been reported in 10% of patients who are performed diagnostic and therapeutic ERCP. Infundibulotomy by use of needle knife is cutting a bulbar part of protruding papilla, which has merit to avoid complete destruction of sphincter of Oddi and serious side effects than general precutting method. We want to know effectiveness and safety of infundibulotomy. METHODS: From January 1997 to December 1998, 36 patients who failed cannulation over three times trial by conventional method are included to this study. We compared the success rate of cannulation and procedure related complication according to bile duct dilatation, periampullary diverticulum and shape of ampulla of Vater. RESULTS: 1) Success rate of cannulation to bile duct is 81% (29/36). 2) All patients in group of bile duct dilatation (14) are succeed to cannulation, which is significantly high compare to other group (p=0.0288). 3) There was no statistical difference in success rate according to presence of periampullary diverticulum. 4) In groups of bulging prominent papilla are succeed in 23 among 26 patients, which is tendency of high in patients than other group (p=0.0760). 5) Total occurrence of procedure related complication was 33% (12/36). 6) The complication rate was not different in two groups according to cannulation success 7) The complication rate was tendency of high in patients without bile duct dilatation (p=0.0756). CONCLUSIONS: Infundibulotomy by use of needle knife is effeetive and safe cannulation method to patient who failed cannulation to bile duct. Success of cannulation is low and occurrence of complication is tendency of high in patient without bile duct dilation, which propose endoscopists attention in selection of indications.

Endoscopic Findings in Boerhaave's Syndrome: Report of three cases / 대한소화기내시경학회지

Boerhaave's syndrome, which was first described by Herman Boerhave in 1724, is a spontaneous esophagcal rupture resulting from severe nausea and vomiting. It is a very rare disorder, frequently developed in the 4th to 6th decade of life, and affects males more commonly than females. A typical clinical triad of chest pain, fever, and subcutaneous emphysema was manifested in only 20-30% of cases involving an esophageal rupture and most patients complained of many nonspecific symptoms such as dyspnea and hematemesis. In cases of vomiting resulting from alcohol ingestion, gastrofiberscopy can be performed in hematemetic patients under the assumption of upper gastrointestinal bleeding in most cases of Boerhaave's syndrome. We report 3 patients of Boerhaave's syndrome who visited our hospital because of hematemesis. Their endoscopic findings were, 1) a large, deep oval-shaped laceration with a sharp margin on the distal esophagus 2) a cavitary lesion with internal multiple hematomas and/or necrotic debris, and 3) a formation of air bubbles in the hematoma relating to respiration.

A Case of Colonic Tuberculosis Cured by Secondary Anti - Tuberculosis Medicine / 대한소화기내시경학회지

Tuberculosis is common disease in developing countries manifested by multi-organ involvement. Although the incidence of tuberculosis has been reducing recently due to the advancement of anti-tuberculosis chemotherapy, improvement of public health, and early diagnosis, the rate is still higher in developing countries. The diagnasis of colonic tubcrculosis is difficult due to its frequency, vague manifestation, and difficulty in confirming the disease process. Fortunately, the advent of flexible colonoscopy has provided an opportunity to confirm the diagnosis of colonic tuberculosis, however biopsy can frequently leveal false negative results. A-27-year-old man was admitted with a 2 week history of rectal bleeding. He complained of anorexia, abdominal pain, and weight loss. Routine laboratory tests and chest X-ray findings were within normal limits, with the exception of left pleural thickening. A colonoscopy showed irregular and small, multiple, and shallow polypoid mucosal lesions in the ascending colon and multiple ulcers in the transverse colon. Multiple colonic biopsies suggested tuberculosis. After three months of prirnary anti-tuberculosis medica tion, the patient showed slightly improved coiono- scopic findings. Follow-up colono- scopic findings revealed more aggrevation and chest X-ray findings showed multiple patch consolidation in the left lung field. Primary anti-tuberculosis medication was stopped and substituted for secondary anti-tuberculosis medication. When clinical and colonoscopic methods are found to be compatible with intestinal tuberculosis in countries with a high prevalence of colonic tuberculosis, a therapeutic trial with an antituberculosis agent is usually considered. In a failed therapeutic trial, considerations must be made not only to other inflammatory bowel diseases such as crohn's disease, but also to multi-drug resistance tuberculosis.

A Case of Eosinophilic Gastritis Mimicking Gastric Submucosal Tumor / 대한소화기내시경학회지

Eosinophilic gastroenteritis is an uncommon disorder characterized by eosinophilic infiltration of the bowel wall, usually associated with peripheral blood eosionphilia. It usually involves the stomach and small intestine simultaneously. If the stomach alone is involved, the lesion can sornetimes be misdiagnosed as a primary gastric neoplasm. We experienced a case of eosionphilic gastritis mistaken for gastric submucosal tumor. A 37-year-old man presented to our hospital with acute epigastric pain. Endoscopy showed gastric submucosal tumor in the antrum of the stomach. Endoscopic ultrasonography(EUS) revealed diffuse thickening of the 3rd and 4th layer of the stomach. The patient underwent gastric surgery under the impression that he had a gastic neoplasm.

A Case of Acute Pancreatitis due to Impaction of Ascaris lumbricoides into the Pancreatic Duct / 대한소화기내시경학회지

Acute pancreatitis due to impaction of Ascaris lumbricoides into the pancreatic duct is very rare. Authors hnve experienced one case of pancreatic ascariasis. Patient was a 62-year-old female with epigastric pain. Abdominal USG and endoscopic retrograde cholangiopancreatography showed characteristic finding of pancreatic ascariasis. Ascaris was removed with palypectomy snare and acute pancreatitis was resolved completely.

ProMACE/MOPP combination chemotherapy in advanced, intermediate and high grade non-Hodgkin's lymphoma / 대한혈액학회지

No abstract available.