Effect of Severe Limb Purpura Following the Administration of COVID-19Vaccination on a Diabetic Foot Requiring Amputation: A Case Report / 대한족부족관절학회지

The current SARS-CoV‑2 coronavirus disease 2019 (COVID-19) pandemic has been a particular challenge for diabetes patients. Since these patients are at a higher risk of COVID-19, they have been prioritized for vaccination. In this report, we describe the case of a patient scheduled for diabetic foot amputation who received the first dose of ChAdOx1 nCov-19 vaccine and subsequently developed severe purpura in his genitalia and both of his hands and feet, accompanied by acute renal failure. The operation had to be postponed as severe limb purpura appeared just before the operation. With adequate management for acute renal failure and topical steroid application for the severe purpura lesions, a successful outcome could be obtained after the delayed first ray amputation. We recommend that COVID-19 vaccination should be carefully administered in patients with a diabetic foot requiring amputation.

Long-term Survival of a Patient with a Large Hepatocellular Carcinoma with Main Portal Vein Tumor Thrombosis and Spontaneous Tumor Rupture

Optimal treatments for patients with advanced hepatocellular carcinoma (HCC) are still limited and their prognosis remains dismal. Yet, there have been rare cases that have shed light on longer survival in these patients assisted by various treatments. This paper aims to present an extraordinary case of far advanced HCC that had been properly managed in spite of continuous recurrence. A patient visited the hospital with a ruptured large HCC with main portal vein tumor thrombosis but survived longer than 14 years owing to active and prompt interventions.

Effect of Statin Use on Liver Cancer Mortality Considering Hypercholesterolemia and Obesity in Patients with Non-Cirrhotic Chronic Hepatitis B

Little is known about the benefits of statin use on liver cancer mortality among patients with chronic hepatitis B (CHB) considering hypercholesterolemia and obesity. A nationwide retrospective cohort study was conducted using data from a Health Examination Cohort of the National Health Insurance Service of Korea. Data on CHB patients with no other concurrent liver disease were acquired, and statin use was defined as a cumulative daily dose ≥28. A 3-year landmark analysis was performed to avoid immortal time bias. Patients who started statin therapy within the landmark date were considered statin users. A Cox regression analysis was applied to assess associations between statin use and liver cancer mortality considering hypercholesterolemia and obesity. Among 13063 patients, 193 (1.5%) died of liver cancer during the mean follow-up period of 10.6 years. After adjusting for demographic and metabolic factors, statin use [hazard ratio (HR), 0.17; 95% confidence interval (CI), 0.04–0.70] and hypercholesterolemia (HR, 0.46; 95% CI, 0.24–0.88 for total cholesterol ≥240 mg/dL) were associated with a decreased risk of liver cancer mortality, whereas body mass index (BMI) ≥30 kg/m² was associated with an increased risk of liver cancer mortality (HR, 2.46; 95% CI, 1.20–5.06). This study showed that statin use was associated with decreased liver cancer mortality when adjusting for cholesterol levels and BMI. This study found that hypercholesterolemia was independently associated with decreased liver cancer mortality regardless of statin use.

The Natural Course of Hepatocellular Carcinoma in a Super-Elderly Patient

As the mean life expectancy increases, the incidence of hepatocellular carcinoma (HCC) in superelderly patients (>85 years old) is expected to increase in Korea. However, their clinical features, treatments, and treatment outcomes are unclear. Herein, we present a case of a large single HCC and its natural course in an 86-year-old man who refused any treatment following histologic diagnosis.

Efficacy of Pegylated Interferon Monotherapy versus Sequential Therapy of Entecavir and Pegylated Interferon in Hepatitis B e Antigen-Positive Hepatitis B Patients: A Randomized, Multicenter, Phase IIIb Open-Label Study (POTENT Study) / 中华医学杂志(英文版)

<p><b>Background</b>Until now, various types of combined therapy with nucleotide analogs and pegylated interferon (Peg-INF) in patients with hepatitis B patients have been tried. However, studies regarding the benefits of de novo combination, late-add on, and sequential treatment are very limited. The objective of the current study was to identify the efficacy of sequential treatment of Peg-INF after short-term antiviral treatment.</p><p><b>Methods</b>Between June 2010 and June 2015, hepatitis B e antigen (HBeAg)-positive patients (n = 162) received Peg-IFN for 48 weeks (mono-treatment group, n = 81) and entecavir (ETV) for 12 weeks with a 48-week course of Peg-IFN starting at week 5 of ETV therapy (sequential treatment group, n = 81). The primary endpoint was HBeAg seroconversion at the end of follow-up period after the 24-week treatment. The primary endpoint was analyzed using Chi-square test, Fisher's exact test, and regression analysis.</p><p><b>Results</b>HBeAg seroconversion rate (18.2% vs. 18.2%, t = 0.03, P = 1.000) and seroclearance rate (19.7% vs. 19.7%, t = 0.03, P = 1.000) were same in both mono-treatment and sequential treatment groups. The rate of alanine aminotransferase (ALT) normalization (45.5% vs. 54.5%, t = 1.12, P = 0.296) and serum hepatitis B virus (HBV)-DNA <2000 U/L (28.8% vs. 28.8%, t = 0.10, P = 1.000) was not different in sequential and mono-treatment groups at 24 weeks of Peg-INF. Viral response rate (HBeAg seroconversion and serum HBV-DNA <2000 U/L) was not different in the two groups (12.1% vs. 16.7%, t = 1.83, P = 0.457). Baseline HBV-DNA level (7 logU/ml vs. 7.5 logU/ml, t = 1.70, P = 0.019) and hepatitis B surface antigen titer (3.6 logU/ml vs. 4.0 logU/ml, t = 2.19, P = 0.020) were lower and predictors of responder in mono-treatment and sequential treatment groups, respectively.</p><p><b>Conclusions</b>The current study shows no differences in HBeAg seroconversion rate, ALT normalization, and HBV-DNA levels between mono-therapy and sequential therapy regimens.</p><p><b>Trial Registration</b>ClinicalTrials.gov, NCT01220596; https://clinicaltrials.gov/ct2/show/NCT01220596?term=NCT01220596&rank=1.</p>

Incidence of Primary Liver Cancer in Subjects with Chronic Hepatitis B in Korean National Liver Cancer Screening Program

BACKGROUND/AIMS: To optimize efficacy of National Liver Cancer Screening Program (NLCSP) for subjects with chronic hepatitis B (CHB), it is needed to know the incidence of liver cancer and its predisposing factors in the program. METHODS: From January 2010 to December 2014, all the hepatitis B surface antigen (HBsAg) positive participants who received at least two or more abdominal ultrasonography under NLCSP were retrospectively enrolled in a single tertiary hospital. Annual incidence of primary liver cancer was calculated and related clinical factors were investigated. RESULTS: During 5 years, 541 subjects were enrolled. Mean age was 53 years old and 292 subjects (54%) were receiving antiviral agents. Liver cirrhosis (LC) was diagnosed in 212 (39.2%). Mean follow-up time was 2.36 years and 15 hepatocellular carcinoma and 1 intrahepatic cholangiocarcinoma were diagnosed. Annual incidence of primary liver cancer was 9.8 per 1,000 patient year. Cumulative incidence at 1, 3, and 5 year was 0.6%, 2.6%, and 6.4%, respectively. In multivariate analyses, LC (hazard ratio [HR] 8.74, 95% confidence interval [CI] 1.97–38.71, P=0.024), age (HR 1.08, 95% CI 1.01–1.15, P=0.024) were significantly associated with cancer development. CONCLUSIONS: Despite of high rate of oral antiviral therapy, incidence of primary liver cancer is not low in CHB patients in Korea. Old age and presence of LC are independently associated with higher risk of cancer development during surveillance. This study could be used as baseline data for quality control of NLCSP.

Efficacy and safety of entecavir versus lamivudine over 5 years of treatment: A randomized controlled trial in Korean patients with hepatitis B e antigen-negative chronic hepatitis B

BACKGROUND/AIMS: Long-term data on antiviral therapy in Korean patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) are limited. This study evaluated the efficacy and safety of entecavir (ETV) and lamivudine (LAM) over 240 weeks. METHODS: Treatment-naive patients with HBeAg-negative CHB were randomized to receive ETV 0.5 mg/day or LAM 100 mg/day during the 96 week double-blind phase, followed by open-label treatment through week 240. The primary endpoint was the proportion of patients with virologic response (VR; hepatitis B virus [HBV] DNA16 years old) were included (ETV, n=56; LAM, n=64). Baseline characteristics were comparable between the two groups. A significantly higher proportion of ETV-treated patients achieved VR compared to LAM at week 24 (92.9% vs. 67.2%, P=0.0006), week 96 (94.6% vs. 48.4%, P < 0.0001), and week 240 (95.0% vs. 47.6%, P < 0.0001). At week 96, ALT normalization was observed in 87.5% and 51.6% of ETV and LAM patients, respectively (P < 0.0001). Virologic breakthrough occurred in one patient (1.8%) receiving ETV and 26 patients (42.6%) receiving LAM (P < 0.0001) up to week 96. Emergence of resistance to ETV was not detected. The incidence of serious adverse events was low and unrelated to the study medications. CONCLUSIONS: Long-term ETV treatment was superior to LAM, with a significantly higher proportion of patients achieving VR. Both treatments were well tolerated.

Risk of hepatitis B virus-related hepatocellular carcinoma development is much higher in Koreans than in Taiwanese

No abstract available.

Predictive Value of Antiviral Effects in the Development of Hepatocellular Carcinoma in the General Korean Population with Chronic Hepatitis B

BACKGROUND/AIMS: The benefit of oral antiviral therapy in preventing hepatocellular carcinoma (HCC) in the general population is not well understood. We used a novel prediction method to estimate the risk of HCC in the Korean population based on various treatment guidelines. METHODS: The 5-year risk of HCC following antiviral therapy was calculated using an HCC risk prediction model. A virtual cohort that represented Koreans (>40 years old) with chronic hepatitis B virus (HBV) infection was established using the fifth National Health and Nutrition Examination Survey. The antiviral indications tested were the Korean National Health Insurance (NHI) and European Association for the Study of the Liver (EASL) guidelines as well as a new extended indication (serum HBV DNA >2,000 IU/mL regardless of serum aminotransferase level). RESULTS: A total of 993,872 subjects were infected with HBV in the general Korean population. Over a 5-year period, 2,725 HCC cases were predicted per 100,000 persons (0.55%/yr). When the cohort was treated based on the Korean NHI, the EASL, and the newly extended indications, HCC risks decreased to 2,531 (−7.1%), 2,089 (−23.3%), and 1,122 (−58.8%) cases per 100,000 persons, respectively (p<0.0001). CONCLUSIONS: Simulated risk prediction suggests that extending of oral antiviral indication may reduce the HCC risk in the general population.

Application of a Grey Zone for HCV and HIV Immunoassays for Blood Donor Screening: Is It still Necessary? / 대한수혈학회지

BACKGROUND: When enzyme immunoassays (EIA) were implemented, considering the limited sensitivity of 1st generation EIAs, the Korean Red Cross (KRC) applied grey zones for detection of weak reactive samples that could lead to false negative results. Despite improved performance of assays, grey zone application is still in practice. We examined whether application of a grey zone to HCV and HIV EIAs is still necessary. METHODS: HCV and HIV EIA results, number of grey zone results, results of further testing done on grey zone samples, and NAT results from 2005 to 2012 were analyzed retrospectively using the Blood Information Management System of the KRC. RESULTS: Among 18,736,094 cases tested, 4,817 HCV (0.03%) and 5,108 HIV (0.05%) cases repeatedly had grey zone results. Twenty-eight (0.58%) HCV grey zone cases were positive on the recombinant immunoblot assay, but negative on NAT. For HIV, 3 cases were diagnosed as indeterminate by the Korea Centers for Disease Control and Prevention (KCDC). However these cases did not seroconvert after several years and were also negative on NAT. CONCLUSION: For HCV, since the grey zone led to detection of true anti-HCV positive cases, not detected by NAT, application of the grey zone should be continued. For HIV, since none of the grey zone cases has been diagnosed as HIV positive by the KCDC, further application of the grey zone is thought not to be necessary. Re-evaluation of the grey zone will save costs for testing, and prevent discard of blood components and loss of donors.

Polymorphisms in PRKCDBP, a Transcriptional Target of TNF-alpha, Are Associated With Inflammatory Bowel Disease in Korean

BACKGROUND/AIMS: Emerging data indicate that polymorphic sequence variations in the tumor necrosis factor alpha (TNF-alpha) gene may affect its production, and be associated with the risk of inflammatory bowel disease (IBD). PRKCDBP is a putative tumor suppressor gene and a transcriptional target of TNF-alpha. The aim of this case-control study is to explore the possible association of single nucleotide polymorphisms (SNPs) in PRKCDBP with the development of IBD in Koreans. METHODS: Genotyping analysis of four SNPs of PRKCDBP [rs35301211 (G210A), rs11544766 (G237C), rs12294600 (C797T), and rs1051992 (T507C)] was performed on 170 ulcerative colitis (UC),131 Crohn's disease (CD) patients, and 100 unrelated healthy controls using polymerase chain reaction and restriction fragment length polymorphism. RESULTS: Heterozygous configuration of three SNPs (G210A, G237C, and C797T) was very rare in both patients and healthy controls. However, allele frequencies of the T507C SNP showed a significant difference between UC patients and controls (P=0.037). The CC genotype of the T507C SNP was identified in 46.6% (61 of 131) of CD and 49.4% (84 of 170) of UC patients, but only in 33.0% (33 of 100) of healthy controls. Furthermore, CC homozygosity was more prevalent than TC heterozygosity in both CD and UC patients versus controls (P=0.016; gender-adjusted odds ratio [aOR], 2.16; 95% confidence interval [CI], 1.16-4.04 and P=0.009; aOR, 2.09; 95% CI, 1.193.64; respectively) CONCLUSIONS: Our results suggest that the T507C SNP in PRKCDBP, a TNF-alpha-inducible gene, might be associated with susceptibility to IBD (particularly UC) development in Koreans.

Successful Eradication of Helicobacter pylori Using Modified Quadruple Therapy in Patient with Long-lasting H. pylori-induced Active Gastritis

Helicobacter pylori is a well known major causative agent of chronic gastritis. In general, the inflammation induced by this organism is a chronic active gastritis, which develops into atrophic gastritis. It is well established that atrophic gastritis is one of the major risk factors of intestinal gastric cancer. Thus, severe long-lasting gastritis induced by H. pylori infection is considered for treatment to prevent gastric cancer. We experienced a case of dramatic eradication of H. pylori using a fifth-line salvage therapy in a patient with H. pylori-induced active gastritis during four years of follow-up.

A Case of Adrenal Tuberculosis with Atypical Clinical Manifestation / 고신대학교의과대학학술지

Addison's disease is a rare disorder that causes fatigue, genral weakness, weight loss, pigmentation due to adrenal hypofunction and it's underlying causes are various. We report a case of 42-year-old man with fatigue, generalized cutaneous pigmentation. Computed tomography showed bilateral adrenal enlargement, but no calcification. Adrenal tuberculosis was established by ultrasound-guided fine needle aspiration biopsy.

The Korean National Liver Cancer Surveillance Program: Experience of a Single Healthcare Center in 2011 / 대한내과학회지

BACKGROUND/AIMS: The aim of this study was to investigate outcomes and current status of the National Liver Cancer Screening Program in a single healthcare center. METHODS: Subjects received abdominal ultrasonography (US) and/or serum alpha-fetoprotein (AFP) testing from January 2011 to December 2012. The clinical characteristics of the subjects, detection rate of liver cancer, and direct medical costs were investigated. RESULTS: Among 621 subjects, five (0.8%) were newly detected with hepatocellular carcinoma. Four underwent curative treatment, and all were detected by US (two surgical resections and two radiofrequency ablations). The remaining patient, whose disease was detected by an elevated AFP level, was infiltrative type with a poor prognosis. Of 492 subjects whose medical history was revealed, 45% had hepatitis B, 5% had hepatitis C, 1% had both, and 3% had other liver cirrhosis including alcoholic cirrhosis. The remaining 46% of subjects had no risk factors for liver cancer. Direct medical costs were estimated at 8,420,000 Won for detecting a single case of liver cancer, which was much lower than that of stomach cancer at 45,060,000 Won. If the non-high risk subjects were excluded, the cost for a single case of liver cancer decreased to 5,560,000 Won. CONCLUSIONS: The high-risk group should be more accurately defined by appropriate screening tests to optimize liver cancer surveillance. The detection rate by the liver cancer surveillance program was about 1%, and most tumors could be detected at the early stage by US. The role of AFP seemed to be small for early defection of liver cancer.

A Case of Early Gastric Cancer with Solitary Metastasis to the Pleura

The incidence of early gastric cancer (EGC) has increased to >50% in Korea owing to a higher detection rate caused by rapid advances in diagnostic instrumentation. EGC with distant metastasis has been rarely reported. Here, we report the case of a 76-year-old woman in whom general EGC was initially diagnosed by endoscopy and endoscopic ultrasonography. She subsequently underwent endoscopic submucosal dissection (ESD). Histological examination of the ESD specimen revealed that neoplastic cells were located predominantly in the submucosal layer and submucosal lymphatic channels. Metastatic cancer cells were also found in the pleural effusion. After conducting all analyses, including immunohistochemical staining, we concluded that the patient had primary EGC with pleural metastasis.

A solitary necrotic nodule of the liver

No abstract available.

Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data

BACKGROUND/AIMS: While gastric variceal bleeding (GVB) is not as prevalent as esophageal variceal bleeding, it is reportedly more serious, with high failure rates of the initial hemostasis (>30%), and has a worse prognosis than esophageal variceal bleeding. However, there is limited information regarding hemostasis and the prognosis for GVB. The aim of this study was to determine retrospectively the clinical outcomes of GVB in a multicenter study in Korea. METHODS: The data of 1,308 episodes of GVB (males:females=1062:246, age=55.0+/-11.0 years, mean+/-SD) were collected from 24 referral hospital centers in South Korea between March 2003 and December 2008. The rates of initial hemostasis failure, rebleeding, and mortality within 5 days and 6 weeks of the index bleed were evaluated. RESULTS: The initial hemostasis failed in 6.1% of the patients, and this was associated with the Child-Pugh score [odds ratio (OR)=1.619; P<0.001] and the treatment modality: endoscopic variceal ligation, endoscopic variceal obturation, and balloon-occluded retrograde transvenous obliteration vs. endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and balloon tamponade (OR=0.221, P<0.001). Rebleeding developed in 11.5% of the patients, and was significantly associated with Child-Pugh score (OR=1.159, P<0.001) and treatment modality (OR=0.619, P=0.026). The GVB-associated mortality was 10.3%; mortality in these cases was associated with Child-Pugh score (OR=1.795, P<0.001) and the treatment modality for the initial hemostasis (OR=0.467, P=0.001). CONCLUSIONS: The clinical outcome for GVB was better for the present cohort than in previous reports. Initial hemostasis failure, rebleeding, and mortality due to GVB were universally associated with the severity of liver cirrhosis.

Septic Pylephlebitis as a Rare Complication of Crohn's Disease / 대한소화기학회지

Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections.

Clinical Outcome of Treatment with Infliximab in Crohn's Disease: A Single-Center Experience / 대한소화기학회지

BACKGROUND/AIMS: Our aim was to assess the long-term data regarding efficacy and safety of infliximab (IFX) treatment for refractory Crohn's disease (CD) patients in our tertiary teaching hospital. METHODS: We have retrospectively analyzed the medical records of 89 CD patients who underwent IFX treatment between March 2003 and February 2011 at Kyung Hee University Hospital (Seoul, Korea). The primary outcome measurements were the rates of initial clinical response (CR) at 10 weeks after the 1st IFX infusion and sustained CR at the end of the follow-up. Overall adverse events related to IFX treatment were also evaluated. RESULTS: The mean (SD) follow-up period of eligible 80 patients was 33.7 (21.9) months. A total of 77 patients (96%) showed initial clinical response, but 8 patients showed loss of response to IFX during the follow-up. Finally, 59 patients (59/77, 76.6%) showed sustained CR at the end of the study. Logistic regression analyses showed that an initial CR at 10 weeks was the independent predictor associated with sustained CR (OR 22.286, 95% CI 2.742-132.717, p=0.001). Overall adverse events reported in 18 patients (18/80, 23.3%), including 3 serious infection (pulmonary tuberculosis and herpes zoster). CONCLUSIONS: Treatment with IFX was efficacious and relatively safe for refractory CD patients in Korea. An initial CR at 10 weeks was significantly associated with sustained CR.

Recent trends in hepatitis B virus infection in the general Korean population

BACKGROUND/AIMS: Hepatitis B virus (HBV) is the major cause of chronic liver disease in Korea, but viral prevalence has decreased because of hepatitis B vaccination programs. In this study, we investigated longitudinal changes in HBV in fection in the general Korean population. METHODS: HBV surface antigen (hepatitis B surface antigen, HBsAg) seropositivity was assessed from the Korea National Health and Nutrition Examination Survey (I to V). In total, 50,140 subjects were tested for serum HBsAg positivity over a period of 12 years (1998 to 2010). RESULTS: The prevalence of HBsAg seropositivity decreased over the study period. The rates of HBsAg carriers were 4.61% in 1998, 4.60% in 2001, 3.69% in 2005, 3.01% in 2008, and 2.98% in 2010 (p 0.05). Neither gender nor socioeconomic status were associated with the decreased prevalence of HBsAg carriers. CONCLUSIONS: HBV infection has decreased in the Korean population since the advent of vaccination programs. However, the decrease is limited to the younger population, and viral persistence remains in the middle-aged and older population.