The factors associated with longitudinal changes in liver stiffness in patients with chronic hepatitis B

BACKGROUND/AIMS: Liver stiffness (LS) as assessed by transient elastography (TE) can change longitudinally in patients with chronic hepatitis B (CHB). The aim of this study was to identify the factors that improve LS. METHODS: Between April 2007 and December 2012, 151 patients with CHB who underwent two TE procedures with an interval of about 2 years were enrolled. Ninety-six of the 151 patients were treated with nucleos(t)ide analogues [the antiviral therapy (+) group], while the remaining 55 patients were not [the antiviral therapy (-) group]. The two groups of patients were stratified according to whether they exhibited an improvement or a deterioration in LS during the study period (defined as an LS change of 0 kPa, respectively, over a 1-year period), and their data were compared. RESULTS: No differences were observed between the antiviral therapy (+) and (-) groups with respect to either their clinical characteristics or their initial LS. The observed LS improvement was significantly greater in the antiviral therapy (+) group than in the antiviral therapy (-) group (-3.0 vs. 0.98 kPa, P=0.011). In the antiviral therapy (+) group, the initial LS was higher in the LS improvement group (n=63) than in the LS deterioration group (n=33; 7.9 vs. 4.8 kPa, P<0.001). However, there were no differences in any other clinical characteristic. In the antiviral therapy (-) group, the initial LS was also higher in the LS improvement group (n=29) than in the LS deterioration group (n=26; 8.3 vs. 6.5 kPa, P=0.021), with no differences in any other clinical characteristic. CONCLUSIONS: A higher initial LS was the only factor associated with LS improvement in patients with CHB in this study.

Risk Factors for Local Recurrence of Early Gastric Cancer after Endoscopic Submucosal Dissection / 대한내과학회지

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is a widely accepted method of treatment for early gastric cancer (EGC) without lymph node metastasis. However, there have been few studies about factors associated with local recurrence. The aim of our study was to evaluate the risk factors for local recurrence in patients with EGC after ESD. METHODS: We retrospectively analyzed medical records of patients who underwent ESD of EGC at Gachon University Gil Medical Center. From February 2008 to July 2011, ESD for EGC was performed in 222 cases involving 214 patients. Patients with additional treatment after ESD, patients with recurred EGC, and patients with endoscopic follow-up of < 12 months were excluded. After exclusions, a total of 150 cases were included. RESULTS: The mean age of the patients was 63.9 +/- 9.8 years, and 74.3% were male. The en bloc resection rate was 139/150 (92.7%), and the complete resection rate was 131/150 (87.3%). Local recurrence at the ESD site was found in 5 cases (5/150, 3.3%) during a mean follow-up period of 24 months. In multivariate analysis, tumor involvement at the lateral resection margin [HR: 13.12 (1.19 - 145.10); p = 0.036], piecemeal resection [HR: 25.31 (1.24 - 517.57); p = 0.036], and lymphovascular invasion [HR: 485.06 (2.30 - 102449.79); p = 0.024] were associated with local recurrence after ESD. CONCLUSIONS: Local recurrence after ESD was significantly associated with involvement of the lateral resection margin, piecemeal resection, and lymphovascular invasion. Therefore, patients who have these risk factors should be followed up more carefully to detect local recurrence.

Genetic polymorphism at codon 10 of the transforming growth factor-beta1 gene in patients with alcoholic liver cirrhosis / 대한간학회지

BACKGROUND/AIMS: Transforming growth factor beta1 (TGF-beta1) is a key cytokine in the production of extracellular matrix. A genetic polymorphism at codon 10 of the TGF-beta1 gene is associated with liver fibrosis. We investigated the effect of genetic polymorphisms at codon 10 on the development of alcoholic liver cirrhosis (ALC). METHODS: In total, 119 controls and 182 patients with ALC, were enrolled in the study. Clinical and laboratory data including total lifetime alcohol intake were collected at enrollment. The genotype at codon 10 was determined for each patient by single-strand conformation polymorphism. RESULTS: There were three types of genetic polymorphism at codon 10: homozygous proline (P/P), heterozygous proline/leucine (P/L), and homozygous leucine (L/L). Among the controls, the proportions of P/P, P/L, and L/L were 26.1%, 44.5%, and 29.4%, respectively in the ALC group, these proportions were 23.1%, 43.4%, and 33.5%, respectively. The genotype distribution did not differ between the controls and the ALC group. In the ALC group, age, total lifetime alcohol intake, and distribution of Child-Pugh class did not differ with the genotype. Of the male patients with ALC (n=164), the proportions of P/P, P/L, and L/L were 20.1%, 44.5%, and 35.4%, respectively the genotype distribution did not differ between the male controls and the male ALC patients. CONCLUSIONS: The genotype at codon 10 in TGF-beta1 does not appear to influence the development of ALC. Further study is needed to investigate other genetic factors that influence the development of ALC in patients with chronic alcohol intake.

Short-term Clinical Outcomes Based on Risk Factors of Recurrence after Removing Common Bile Duct Stones with Endoscopic Papillary Large Balloon Dilatation

BACKGROUND/AIMS: Recurrence is an important late complication of endotherapy of bile duct stones. Endoscopic papillary large balloon dilation (EPLBD) can be used as an alternative method of removing difficult bile duct stones. The aim of this study was to evaluate short term clinical outcomes after removing common bile duct (CBD) stones using EPLBD. METHODS: A retrospective review was performed based on the medical records of 141 patients who received EPLBD, with or without endoscopic sphincterotomy, between September 2008 and February 2010. Of these, 50 patients, were enrolled in the study. Clinical and endoscopic parameters were analyzed to identify risk factors for CBD stones recurrence. RESULTS: Male:Female ratio was 22:28 (mean age, 67.4+/-14.4 years). Recurrence rate was 24.0% (12/50). Mean follow-up period was 10.8+/-4.5 months. Nineteen (38.0%) had a history of surgery and 20 (40.0%) were comorbid with periampullary diverticula. Mean diameters of the stones and CBD were 13.8+/-4.3 mm and 20.1+/-7.2 mm, respectively. In univariate analysis, large CBD stones (> or =12 mm) and angulated CBD (angle < or =145degrees) were identified as the significant predictors of recurrence. In multivariate analysis, angulated CBD (angle < or =145degrees) was the significant independent risk factor for recurrence. CONCLUSIONS: Close follow-up seems necessary in patients with angulated CBD (angle < or =145degrees).

Clinical characteristics of lung cancer diagnosed from 2006 to 2008: Data from Gachon University Gil Hospital / 대한내과학회지

BACKGROUND/AIMS: This study examined the clinical characteristics of patients with lung cancer who were diagnosed at the Gachon University of Medicine and Science Gil Hospital from January 2006 to December 2008. METHODS: The lung cancer data were downloaded from the hospital medical information system using cancer registration information. The patient clinical characteristics were analyzed retrospectively. RESULTS: A total of 713 patients were diagnosed with lung cancer. Their median age was 69 years, 78.1% were over 60 years old, and 73.1% and 58.2% were men and smokers, respectively. Adenocarcinoma (32.7%) was the most common histologic type, followed by squamous carcinoma (25.9%), unclassifiable non-small-cell lung cancer (NSCLC) (17.3%), and small-cell carcinoma (SCLC) (15.0%). In the NSCLC group, the stage at diagnosis was IA (1.5%), IB (5.6%), IIA (1.3%), IIB (4.3%), IIIA (5.4%), IIIB (23.1%), IV (47.7%), and unknown (11.1%). In the SCLC group, 20.6% of the patients were in the limited stage, 76.6% were in the extensive stage, and 2.8% were unknown. The patients were treated by surgery (9.8%), concurrent chemoradiotherapy (6.7%), radiotherapy only (5.9%), chemotherapy (32.4%), or best supportive care only (29.7%). The median overall survival was 15.3 months (95% CI, 11.5~19.1). The median survival based on histology was adenocarcinoma (35.0 months), squamous (13.5 months), NSCLC (14.2 months), and SCLC (11.8 months) (p=0.0445). CONCLUSIONS: Adenocarcinoma was the most common histologic type at our institute. Most patients were over 60 years of age (78.1%) and had stage III/IV (76.3%) cancer. The survival of patients with adenocarcinoma was longer than that for the other histological types.

A Case of Periureteral Varices with Nutcracker Syndrome Diagnosed by Intravenous Pyelography / 대한신장학회지

Renal pelvic and periureteral varices are rare cause of hematuria. On the intravenous pyelography, periureteral varices show a scalloped corkscrew-like appearance to the ureter without evidence of proximal obstruction. The cause of these varices includes renal vein thrombosis, obstruction of the inferior vena cava, congenital anomalies of the inferior vena cava or renal veins, infection, malignancy and nutcracker syndrome. We report a case of Periureteral Varices Diagnosed by Intravenous Pyelography caused by nutcracker syndrome.

Prolonged Extreme Thrombocytosis in a Postsplenectomy Patient with Hereditary Spherocytosis

We report a case of prolonged extreme reactive thrombocytosis in a post-splenectomy patient with hereditary spherocytosis. A 29-year-old female patient presented with gall stones detected incidentally by abdominal ultrasonography. Her laboratory findings showed hemolytic anemia with spherocytosis on the peripheral blood smear and increased osmotic fragility. She was diagnosed with hereditary spherocytosis and underwent a laparoscopic cholecystectomy and splenectomy. After undergoing surgery, the hemolytic anemia was resolved but thrombocytosis was newly detected. Nineteen months after the splenectomy, the thrombocytosis was still persistent and extremely high. To our knowledge, this is the first report of a prolonged extreme reactive thrombocytosis after a splenectomy in Korea.

A Case of Central Nervous System Actinomycosis Presenting as Brain Abscess / 감염과화학요법

Actinomyces normally colonizes the mouth, colon, and vagina. Although disruption of mucosa may lead to infection at virtually any site, central nervous system actinomycosis is rare. A 45-year-old man presented with seizure and magnetic resonance imaging showed brain abscess. He was diagnosed with actinomycotic and streptococcal infection of brain by histologic and microbiologic examination. After stereotactic aspiration and biopsy, he was treated successfully by prolonged antibiotic therapy using intravenous penicillin-G and oral amoxicillin.

A Case of Syphilitic Uveitis in an Immunocompetent Patient / 감염과화학요법

Syphilis is re-emerging worldwide due to the HIV epidemic. Prior to the introduction of penicillin, syphilis was the second most common primary cause of all cases of uveitis. Today, ocular syphilis is a rare disease, especially in an immunocompetent patient. Variable manifestation without pathognomonic signs of ocular syphilis often lead to delayed diagnosis, resulted in irreversibile loss of vision. In Korea, syphilitic uveitis has not been reported in an immunocompetent patient since 1984. We experienced a case of syphilitic uveitis in an immunocompetent man with visual deterioration. As the incidence of syphilis is increasing in these days, a high degree of clinical suspicion should be considered in patients with unexplained ocular inflammation and visual disturbances.

A Case of Central Nervous System Actinomycosis Presenting as Brain Abscess / 감염과화학요법

Actinomyces normally colonizes the mouth, colon, and vagina. Although disruption of mucosa may lead to infection at virtually any site, central nervous system actinomycosis is rare. A 45-year-old man presented with seizure and magnetic resonance imaging showed brain abscess. He was diagnosed with actinomycotic and streptococcal infection of brain by histologic and microbiologic examination. After stereotactic aspiration and biopsy, he was treated successfully by prolonged antibiotic therapy using intravenous penicillin-G and oral amoxicillin.

A Case of Syphilitic Uveitis in an Immunocompetent Patient / 감염과화학요법

Syphilis is re-emerging worldwide due to the HIV epidemic. Prior to the introduction of penicillin, syphilis was the second most common primary cause of all cases of uveitis. Today, ocular syphilis is a rare disease, especially in an immunocompetent patient. Variable manifestation without pathognomonic signs of ocular syphilis often lead to delayed diagnosis, resulted in irreversibile loss of vision. In Korea, syphilitic uveitis has not been reported in an immunocompetent patient since 1984. We experienced a case of syphilitic uveitis in an immunocompetent man with visual deterioration. As the incidence of syphilis is increasing in these days, a high degree of clinical suspicion should be considered in patients with unexplained ocular inflammation and visual disturbances.