Proposal of a Novel Serological Algorithm Combining FIB-4 and Serum M2BPGi for Advanced Fibrosis in Nonalcoholic Fatty Liver Disease

Background/Aims@#Noninvasive methods have become increasingly critical in the diagnosis of fibrosis in chronic liver diseases. Herein, we compared the diagnostic performance of serum Mac2 binding protein glycosylation isomer (M2BPGi) and other serological panels for fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) and proposed an improved two-step diagnostic algorithm for advanced fibrosis. @*Methods@#We enrolled 231 patients diagnosed with NAFLD who underwent a liver biopsy. We subsequently evaluated the diagnostic performance of serological panels, including serum M2BPGi, a fibrosis index based on four factors (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and NAFLD fibrosis score (NFS), in predicting the stage of liver fibrosis. We then constructed a two-step algorithm to better differentiate advanced fibrosis. @*Results@#The areas under the receiver operating characteristic curves of serum M2BPGi, FIB-4, APRI, and NFS for advanced fibrosis (≥F3) were 0.823, 0.858, 0.779, and 0.827, respectively. To reduce the performance of unnecessary liver biopsy, we propose a two-step algorithm using FIB-4 as an initial diagnostic tool and serum M2BPGi (≥0.6) as an additional diagnostic method for patients classified as intermediate (23%). Using the proposed algorithm, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 0.812, 0.814, 0.814, 0.600, and 0.927, respectively. @*Conclusions@#Serum M2BPGi is a simple and effective test for advanced fibrosis in patients with NAFLD. Application of the two-step algorithm based on FIB-4 and M2BPGi proposed here can improve diagnostic performance and reduce unnecessary tests, making diagnosis easily accessible, especially in primary medical centers.

A Case of Transverse Myelitis Following Treatment with Atezolizumab for Advanced Hepatocellular Carcinoma / 대한소화기학회지

The results of the IMbrave150 study have led to widespread use of the combination therapy of atezolizumab and bevacizumab as a first-line treatment for unresectable or metastatic hepatocellular carcinoma (HCC). Compared to traditional cytotoxic chemotherapy agents, immune checkpoint inhibitors show a spectrum of side effects ranging from mild side effects such as skin rash to potentially severe systemic effects such as myocarditis. We present a case of transverse myelitis diagnosed during the treatment of HCC with atezolizumab and bevacizumab combination therapy.

A case report of advanced hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy and sorafenib combination therapy followed by metastasectomy of lung and muscle metastases

Currently, various tyrosine kinase inhibitors and immune checkpoint inhibitors have been suggested in the treatment guidelines for advanced hepatocellular carcinoma (HCC). However, sorafenib was the only systemic drug approved 10 years ago. In 2010, a woman diagnosed with HCC rupture and multiple lung metastases visited our hospital. At the time of visiting our hospital, she had undergone transarterial chemoembolization at another hospital to control bleeding due to HCC rupture. We treated her with hepatic arterial infusion chemotherapy and sorafenib combination therapy to increase the control of intrahepatic tumors in consideration of the modest efficacy of sorafenib. The intrahepatic tumor was almost controlled. Metastasectomy was performed to control lung oligometastasis. Subsequently, additional muscle metastasis was confirmed, and metastasectomy was performed. Although this is a very rare case, it shows that a multidisciplinary approach can improve the prognosis of patients with HCC.

Efficacy of Hepatic Arterial Infusion Chemotherapy and Radiofrequency Ablation against Hepatocellular Carcinoma Refractory to Transarterial Chemoembolization and Vascular Variation: A Case Study / 고신대학교의과대학학술지

Transarterial chemoembolization is often the first-line treatment for multiple hepatocellular carcinomas. However, hepatic arterial infusion chemotherapy is a treatment option for hepatocellular carcinoma refractory to multiple sessions of transarterial chemoembolization. Hepatic arterial infusion chemotherapy requires implantation of an appropriate port into the hepatic artery. However, it may be impossible to implant a port due to hepatic artery variation. We report a case of hepatocellular carcinoma refractory to transarterial chemoembolization and hepatic artery variation treated successfully with hepatic arterial infusion chemotherapy and radiofrequency ablation with complete response after implantation of ports in both liver lobes.

Drug Induced Liver Injury by Prophylactic Administration of Albendazole / 대한소화기학회지

Albendazole is used as a typical antiparasitic agent worldwide. The side effects of albendazole may include nausea, vomiting, abdominal pain, dizziness, headache, alopecia, and increased liver enzymes. Mild elevation of the liver enzyme has been reported in more than 10% of cases, but drug induced liver injury was reported to be very rare. A 30-year-old woman visited the Dong-A University Hospital with anorexia, nausea, jaundice, and elevated liver enzyme. For diagnosis, other acute hepatitis etiologies were excluded, but the prophylactic administration of albendazole was verified. This paper introduces a case of drug-induced liver injury through the prophylactic administration of albendazole. Physicians should be aware of severe liver injury as one of the side effects of albendazole.

Drug Induced Liver Injury by Prophylactic Administration of Albendazole / 대한소화기학회지

Albendazole is used as a typical antiparasitic agent worldwide. The side effects of albendazole may include nausea, vomiting, abdominal pain, dizziness, headache, alopecia, and increased liver enzymes. Mild elevation of the liver enzyme has been reported in more than 10% of cases, but drug induced liver injury was reported to be very rare. A 30-year-old woman visited the Dong-A University Hospital with anorexia, nausea, jaundice, and elevated liver enzyme. For diagnosis, other acute hepatitis etiologies were excluded, but the prophylactic administration of albendazole was verified. This paper introduces a case of drug-induced liver injury through the prophylactic administration of albendazole. Physicians should be aware of severe liver injury as one of the side effects of albendazole.

Bortezomib-Based Salvage Chemotherapy in Refractory/Relapsed Multiple Myeloma Patients: A Single Center Experience in Real Clinical Practice / 대한내과학회지

BACKGROUND/AIMS: Bortezomib-based chemotherapy has proven to be an effective salvage regimen for refractory/relapsed multiple myeloma patients in many clinical trials. However, few reports have shown the outcomes and adverse events of bortezomib-based salvage chemotherapy in clinical practice. METHODS: From April 2006 to September 2011, 37 patients were retrospectively analyzed. A total of 19 patients received bortezomib therapy and 18 patients received bortezomib plus dexamethasone therapy. RESULTS: The median follow-up duration was 18.13 months (range, 0.97-87.20 months). The median number of cycles administered was four (range, 1-13). The overall response rate by International Myeloma Working Group (IMWG) 2006 criteria was 64.9%, including six complete responses (16.2%). The median number of cycles to best response was three (95% confidence interval [CI], 1.36-4.64). Six patients achieved their best responses after four cycles of bortezomib therapy. The median time to progression and overall survival were 5.10 (95% CI 4.03-6.17), and 23.10 (95% CI, 9.24-36.96) months, respectively. The incidence of grade 3/4 neutropenia and thrombocytopenia was 29.7% and 64.9%, respectively. A total of 27.0% patients experienced grade 3 peripheral neuropathy. Herpes zoster developed in 11 patients (29.7%). Treatment was stopped in 22 patients (59.5%) due to adverse events after bortezomib-based therapy, and treatment-related mortality occurred in 4 of 25 deaths in total. CONCLUSIONS: Bortezomib-based therapy is a very effective salvage regimen in real clinical practice, although patients relapse after multiple chemotherapies. Despite intolerable in some patients, management of toxicities and extended cycles of therapy could benefit more patients, resulting in higher response rates.

Case of Successful Radiofrequency Ablation of Multiple Bilateral Renal Cell Carcinomas in von Hippel-Lindau Disease / 대한내과학회지

Von Hippel-Lindau (VHL) disease is an inherited, autosomal dominant syndrome that manifests as a variety of benign and malignant tumors in various organs. Notably, renal cell carcinoma (RCC) in patients with VHL disease tends to be multifocal and bilateral, and tends to recur or new tumors develop after removal. Radiofrequency ablation (RFA) has recently been introduced as a minimally invasive treatment for small hereditary RCCs with a low complication rate and a minimal decrease in renal function. We present a case of successful RFA of multiple bilateral RCCs in a 24-year-old female with VHL. Computed tomography (CT) of the abdomen revealed multiple bilateral RCCs. The patient received sequential RFA for the bilateral RCCs, resulting in a complete response. At the time of writing, there was no sign of recurrence or renal failure. In conclusion, percutaneous RFA is a promising treatment for VHL patients who cannot undergo surgery, with excellent treatment outcomes and minimal change in renal function.

Case of Successful Radiofrequency Ablation of Multiple Bilateral Renal Cell Carcinomas in von Hippel-Lindau Disease / 대한내과학회지

Von Hippel-Lindau (VHL) disease is an inherited, autosomal dominant syndrome that manifests as a variety of benign and malignant tumors in various organs. Notably, renal cell carcinoma (RCC) in patients with VHL disease tends to be multifocal and bilateral, and tends to recur or new tumors develop after removal. Radiofrequency ablation (RFA) has recently been introduced as a minimally invasive treatment for small hereditary RCCs with a low complication rate and a minimal decrease in renal function. We present a case of successful RFA of multiple bilateral RCCs in a 24-year-old female with VHL. Computed tomography (CT) of the abdomen revealed multiple bilateral RCCs. The patient received sequential RFA for the bilateral RCCs, resulting in a complete response. At the time of writing, there was no sign of recurrence or renal failure. In conclusion, percutaneous RFA is a promising treatment for VHL patients who cannot undergo surgery, with excellent treatment outcomes and minimal change in renal function.

Native Aortic Valve Thrombosis Resembling Papillary Fibroelastoma

The differential diagnosis of cardiac mass is important in determining the therapeutic plan and avoiding unnecessary surgical intervention. Non-invasive imaging methods would be useful in the diagnosis of suspected cardiac mass, because they may provide earlier diagnosis and more accurate assessment of cardiac mass. Native aortic valve thrombosis is a rare disorder and difficult to differentiate from a tumor, and in particular, a papillary fibroelastoma. Thus, the clinical decision making with imaging modalities should be performed cautiously. We recently met a female patient who had a aortic valve mass resembling papillary fibroelastoma in normal native valve. The patient underwent a surgical resection and the pathologic finding showed an organized thrombus with no evidence of papillary fibroelastoma.