New Scoring Systems for Severity Outcome of Liver Cirrhosis and Hepatocellular Carcinoma: Current Issues Concerning The Child-Turcotte-Pugh Score and The Model of End-Stage Liver Disease (MELD) Score / 대한간학회지

It has been approximately 30 years since Child-Turcotte-Pugh score has been used as a predictor of mortality in patients with liver cirrhosis and hepatocellular carcinoma (HCC). Recently, new prognostic models such as Model for End-Stage Liver disease (MELD), Short- and Long-term Prognostic Indices (STPI and LTPI), Rockall score, and Emory score were proposed for predicting survival in patients with liver cirrhosis treated by transjugular intrahepatic portosystemic shunt (TIPS). In MELD scoring, three independent variables which showed a wide range of results including serum creatinine, serum bilirubin and international normalization ratio (INR) of prothrombin time were evaluated in log(e) scale in comparison with simply categorized-into-three scoring system of Child-Turcotte-Pugh. The etiology of liver cirrhosis was applied to the score of MELD: alcoholic or cholestatic, 0; viral or others, 1. Concurrent statistic (C-statistic) of MELD (0.73-0.84) was slightly superior or insignificantly different to that (0.67-0.809) of Child-Turcotte-Pugh score. In February 2002, UNOS status 2a and 2b were replaced with MELD score for priority allocation of liver transplantation. MELD score does not reflect the severity of patients with HCC or metabolic disorders. For assessing prognosis in patients with liver cirrhosis or HCC, there seems little reason to replace the well established Child-Turcotte-Pugh score. Herein the literatures was briefly reviewed.

Outbreak of Hepatitis by Orientia tsutsugamushi in the Early Years of the New Millenium / 대한간학회지

BACKGROUND/AIMS: Orientia -tsutsugamushi infection is an acute febrile disease due to the accidental transmission through human skin of forest dwelling vector Leptotrombidium larva. The authors observed liver dysfunctions in patients diagnosed with tsutsugamushi disease (Scrub typhus) in the past 3 years and report the data in the hope of bringing attention to this disease in the differential diagnosis of autumn-season hepatitis, especially of non-A, non-B and non-C hepatitis. METHODS: Medical records of 22 patients diagnosed with tsutsugamushi disease by the hemagglutinin method between October 2000 and November 2002 were reviewed. RESULTS: Female gender was dominant in the ratio of 3.4:1. Mean age was 56.4 +/- 2.6. Admission was between 23rd September and 15th November with the peak between mid October and early November. Fever, being the most common symptom, was observed in 21 cases, myalgia in 13, arthralgia in 12, chills in 6, and skin rash in 6. An incubation period of 7-9 days was most common (10 cases), 13-15 days (4), 10-12 days (3), within 3 days (3), and 4-6 days (2). Average ALT, AST and GGTP were increased to 93.2 +/- 17.3 IU/L (18 +/- 345 IU/L), 92.5 +/- 11.7 IU/L (34-255 IU/L) and 132.2 +/- 14.5 IU/L (19-251 IU/L), respectively, but total bilirubin was normal. All the patients improved with doxycycline therapy. CONCLUSIONS: Since it usually shows liver dysfunction, it is important to take Orientia tsutsugamushi into consideration in differential diagnosis of autumn-season, febrile hepatic disease.

A Case of AILD-like T Cell Lymphoma with Monoclonal Gammopathy / 대한혈액학회지

We report a case of 74 year old man presented with generalized lymphadenopathy with hepatosplenomegaly. Lymph node biopsy revealed angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) and most areas of lymph node were replaced with large atypical lymphocytes which were revealed to be T cells by immunohistochemistry. All together, the patient was diagnosed as AILD-like T cell lymphoma with bone marrow involvement. The patient presented monoclonal gammopathy (IgG lambda) without any evidence of plasma cell dyscrasia or secondary amyloidosis. After three cycles of combination chemotherapy including cyclophosphamide, prednisone, vincristine and doxorubicin, the patient achieved partial remission with decreased level of serum and urine monoclonal protein.

A Clinical Study on Intestinal Tuberculosis / 대한소화기내시경학회지

Intestinal tuberculosis is an infectious disease which is still prevalent in the developing countries including Korea. It may occur insidously, have a vague clinical marofestation, and take a chronic course. We have analyzed 101 cases of intestinal tuberculosis. proven by clinical and histopathologic diagnosis for 10yrs since 1977. The results are as follows: 1) Intestinal tbc was prevalent in the age of 20-30 and the male to female ratio was 1:1.7. 2) Among clinical manifestations, abdominal pain, and tenderness, general malaise and abdominal mass were observed in order of frequency. 3) Active pulmonary lesion was associated in 73 cases (73.3%). 4) Ileocecal region was the most frequent site of involvement in barium study and in colonoscopy. 5) The most frequent colonoscopic finding was multiple ulceration and pseudopolyposis and chronic granulomatous inflammation was noted in 58% on hitopathology. 6) Ulcerative type was the most common type 45.4% by intestinal x-ray and colonofiberscopic examination

A Clinical Study on the Antihypertensive Effect of Enalapril

Enalapril, a new angiotensin converting enzyme inhibitor,was administered in 30 hypertensive patients for 12 weeks or longer in order to evaluate the antihypertensive effects and side effects (in some cases combination with hydrochlorthiazide). The doses were from 10mg to 40mg once a day. The results were as follows : 1) Before medication and 2, 4, 6, 8, 10 and 12weeks of medication, the average systolic and diastolic pressure were 176.7+/-16.0/108.6+/-7.6, 146.0+/-12.5/91.7+/-6.9, 138.3+/-16.1/87.3+/-10.6, 140.7+/-13.9/87.3+/-9.6, 137.3+/-13.5/87.7+/-9.1, 137.3+/-14.8/87.0+/-8.5, 138.7+/-15.4/87.3+/-9.1mmHg respectively. After 12 weeks of medication, marked or moderate degree of anti-hypertensive effect was observed in 90% of all cases (p<0.005), and the further significant decease of systolic blood pressure after 4 weeks compared with 2 weeks (p<0.025) was observed. 2) There was no significant change in pulse rate before and after medication. 3) There was no significant change in the laboratory findings such as fasting blood sugar, serum BUN, creatinine, cholesterol, GOT, GPT, blood WBC, hemoglobin, hematocrit, and urine protein before and after treatment. 4) The side effects of enalapril were observed in 2 cases of 30 cases (6.6%), mild dizziness and mild fatigue, which were not required discontinuing the medication or decreasing the dose.

Clinical Trial on the Antianginal Effect of Trapidil

Antianginal effect of Trapidil was evaluated in 30 patients (18 male and 12 females) with angina rectoris. The results were follows : 1) Antianginal effect of the drug were good in 18 cases (60%) and fair in 8 cases (37%), and there was no effect in 4 cases(13%). 2) Improvement in ECG changes was observed in 29%. 3) There were no significant change in CBC, RUA, LFT, serum electrolyte and lipid study before and after medication. 4) The adverse effects of trapidil were constipation, gastric cramp and dizziness, respectively one case. But they were not required discontinuing the medicetion. On the basis of these results, Trapidol was evaluated to be promising antianginal drug.