T cell subsets in chronic hepatitis B and the effect of prednisolone withdrawal and interferon alpha-2b

OBJECTIVES: The evaluations of the pathogenetic roles of cell mediated immunity and of the preventive effect for disease progression with interferon(IFN) treatment in patients with chronic active hepatitis-B(CAH-B) are the objectives of this study. METHODS: Thirty-two patients with CAH-B were treated with interferon alpha-2b(IFN alpha-2b) with prednisolone withdrawal and 30 control patients were treated with conventional hepatotonics for 6 months. Peripheral total T cell fractions and T cell subsets of the patients with CAH-B, treated with IFN alpha-2b with prednisolone withdrawal, were examined 1 month before administration of prednisolone, and compared with 12 normal controls for assessing the potential role of cellular immunity in the development of CAH-B. To estimate the effectiveness of IFN therapy for the patients with CAH-B, levels of various liver function tests, HBsAg, anti-HBs, HBeAg, anti-HBe, HBV DNA, anti-HCV and others were assessed for the treatment group and compared with control patients at pre- and post-treatment period each. RESULTS: The value of CD4 was significantly lower in patients with CAH-B than normal controls (36.3 +/- 7.7% vs 42.1 +/- 5.7%, p < 0.05) and the value of CD8 was significantly higher in patients with CAH-B than normal controls (30.6 +/- 10.3% vs 24.3 +/- 5.2%, p < 0.05) before prednisolone administration. The patients in responder group (n = 26) had significantly lower CD4 cells compared with normal controls, but non-responders (n = 6) did not have. The levels of liver function test(LFT) in the patients with IFN alpha-2b treatment with prednisolone withdrawal were not different from the control patient group at pretreatment, but significantly lower than control patient group's after treatment, regardless of response to IFN alpha-2b treatment with prednisolone withdrawal. CONCLUSIONS: The cellular immunity of the host may have a potential role in the pathogenesis of chronicity of hepatitis B infection. IFN alpha-2b treatment with prednisolone withdrawal may be regarded as one of the effective treatment modalities for the inhibition of disease progression in patients with CAH-B.

Clinical Observation on Patients with Hematochezia / 대한소화기내시경학회지

BACKGROUND/AIMS: The purpose of this study was to examine the clinical observations of patients with hematochezia in attempt to determine the appropriate evaluation and treatment of this group of patients. METHODS: Seventy patients with hematochezia were admitted to Intemal medicine (IM) Department of Chungnam National University Hospital from January 1990 to August 1997. The clinical observations of patients with hematochezia were reviewed and the results are as follows. RESULTS: 1) The causes of the hematochezia were ischemic colitis (18.6%), hemorrhoids (15.7%), ulcerative colitis (14.3%), unknown (12.8%), rectal cancer (7.1%), nonspecific ulcers (rectum; 4.3%, colon; 1.4%), diverticulosis (5.7% ), colon cancer (4.3%.), mdiation colitis (2.9%), angiodysplasia (2.9%), polyps (2.9%), Samonella colitis (2.9%), rectal varix (1.4%), ileitis(1.4%) and ileal ulceration (1.4%). 2) The average hemoglobin of the patients with hematochezia was 9.6 g/dl. Forty percent of the patients with hematochezia required a transfusion and the average transfusion amount was 4.4 packs (Pack Red Cell). Patients with nonspecific ulcers (recutum, colon), angiodysplasia, colon cancer, ilieal lesion and rectal varix required more transfusions (average transfusion amount, 5.7 packs). 3) Patients who improved with eonservative treatment only were 85.7%, and 11.4% required surgical intervention. Also 2.9% required endoscopic intervention. 4) Confirmative modalities of hematochezia included colonoscopy (80%), and others (angiography, barium enema, and operation etc.). CONCLUSIONS: In patients with hematochezia admitted to the IM Department, the cause of hematochezia was confirmed by colonoscopy and patients with hematochezia were mainly managed using conservative treatment.

The Comparison of Adverse Effect and Short-term Effect of Different Dosage of Recombinant Interferon Alpha-2b Treatment in Patients with Chronic Active Hepatitis Type B / 대한간학회지

BACKGROUND/AIMS: The efficacy and adverse effects of two different dosages of recombinant a2b interferon were studied in 45 patients with chronic active hepatitis B from March 1991 to December 1996. METHODS: The 19 patients received in a dose of 3MU thrice weekly for 16 weeks, the 14 patients received in a dose of 5MU thrice weeldy for 16 weeks and the 12 patients received conservative management. We evaluated serologic examination and adverse effects. Results 1) The rate of improvement in aminotransferase was significantly higher in interferon treated group (75.0%) compared to control group (16.7%) and it tended to be higher in 5MU group (85.6%) than 3MU group (68.4%) but, the latter had no statistical signifcance (P=0.27). 2) The disappearance rate of HBV-DNA was significantly higher in interferon treated group (72.7%) compared to control group (0%) and it tend to be higher in 3MU group (78.5%) than 5MU group (62.5%) but, the latter had no stastical significance (P=037). 3) The loss rate of HBeAg was significantly higher in interferon treated group (50.0%) compared to control group (O%) and it tend to be higher in 5MU group (66.7%) than 3MU group (37.5%) but, the latter had no stastical significance(P=0.13). 4) Fever (75.8%), leukopenia (41.2%), headache (30.3%), myalgia (18.2%), thrombocytopenia (17.6%), anorexia (11.8%) were noted and fever was significantly higher in 5MU group compared to 3MU group (P=0.02). Conclusion The effective improvement of liver function test and disappearance rate of HBeAg tended to be higher in 5MU group than 3MU group, but it was not stastistically significant. Fever was significantly higher in 5MU group compared to 3MU group.

The Relationship between Biliary Calculi and Juxtapapillary Duodenal Diverticuli / 대한소화기내시경학회지

BACKGROUND/AIMS: Juxtapapillary duodenal diverticuli are often associated with biliary stones. The aim of this study was to investigate the prevalence of juxtapapillary duodenal diverticuli in biliary stones. METHODS: Three hundred and thirteen patients underwent endoscopic retrograde cholangiopancreatography were studied prospectively. RESULTS: Seventy-five patients had juxtapapillary duodennl diverticuli(24%). The occurrence of diverticuli increased with age and more commomly in female patients. The prevalence of diverticulii was higher in patients with commom bile duct stones(35.6% vs 17.6%; P 0.002) and gallbladder stones(33.3% vs 17.6%; P=0,001) than in patients without biliary stones (17.6%). CONCLUSIONS: We conclude that biliary stones are associated with juxtapapillary diverticuli.