Comparison of Somatostatin and Vasopressin in the Control of Acute Esophageal Variceal Hemorrhage: A Prospective Randomized Trial / 대한간학회지

BACKGROUND/AIMS: Although endoscopic band ligation or injection sclerotherapy are the current standard therapies for bleeding esophageal varices, the best method for initial control is unclear. The aim of this prospective study was to compare the efficacy and toxicity of somatostatin and vasopressin in the management of esophageal variceal hemorrhage. METHODS: From March, 1997 to September, 1998, 28 consecutive cirrhotic patients admitted to the Yonsei Medical Center because of active variceal bleeding were included in this trial. The patients were randomized to receive either somatostatin (15 patients) or vasopressin (13 patients) for 48 hours. RESULTS: There were no significant differences between the two treatment groups in relation to Child's classification, amount of bleeding before randomization and units of blood transfused during therapy. Initial control of bleeding was achieved in 13 (86.7%) patients receiving somatostatin and in 10 (76.9%) of those treated with vasopressin. However, two patients in the somatostatin group and two in the vasopressin group bled again during treatment. Therefore complete control of bleeding during the 48 hours of therapy was achieved in 11 (73.4%) patients treated with somatostatin and in eight (61.5%) of those receiving vasopressin. Differences were observed in complications associated with each therapy. Vasopressin produced complications in four patients (chest pain in two, hypertension in one and hyponatremia-induced seizure in one) while somatostatin produced minor complication in one patient. CONCLUSIONS: This study suggests that somatostatin is efficacious in controlling acute hemorrhage from esophageal varices and has a lower risk of adverse effects than vasopressin.

Sequence Analysis of 'a' Determinant in Two Patients with De Novo HBV Infection after Renal Transplantation / 대한간학회지

BACKGROUND/AIMS: HBV infection can be seen after organ transplantation. The presence of anti-Bs in serum means protection from HBV infection. If amino acids were mutated in 'a' determinant which was a common antigenic epitope of HBsAg, escape from humoral immunity can occur. Recently, in chronic HBV infected patients who received liver transplantation but reinfected by HBV, many authors reported mutations in 'a' determinant sequence. However, in renal transplantation, there were few reports about HBV infection and 'a' determinant mutation after transplantation. Therefore, we studied the incidence of HBV reinfection after renal transplantation and also tried to analyze 'a' determinant sequence in those patients. METHODS: We reviewed HBsAg-egative patients who received renal transplantation in our hospital, but turned HBsAg positive after transplantation. We selected two patients who were anti-Bs positive before transplantation but turned HBsAg positive after transplantation, and analyzed 'a' determinant of amino acid sequence of these patients. RESULTS: Among 1682 patients who were HBsAg negative before transplantation, 21 patients were turned HBsAg positive after transplantation. Among them, 6 patients were anti-Bs positive before transplantation. Sequence analysis of the 'a' determinant amino acid in two patients whose HBsAg turned positive after transplantation revealed no evidence of mutation in comparison with previously reported subtype 'a' determinant sequences. CONCLUSION: In renal transplantation, HBV could be reinfected in patients who had been anti-Bs positive before transplantation even without mutation in 'a' determinant region.

Effectiveness of Early Detection among the High Risk Group of Hepatocellular Carcinoma by Ultrasound Screening Test / 대한간학회지

BACKGROUND/AIMS: The prognosis of primary hepatocellular carcinoma is extremely poor because of its large size, portal vein thrpombosis, extrahepatic metastasis and underlying liver cirrhosis. The aim, of this study is to evaluate the usefulness of ultrasound screening test for early detection of hepatocellular carcinoma in high-ridk populations. METHODS: We analysed 119 patients who were diagnosed with hepatocellular carcinoma by ultrasonography screening test in Yonsei University Severance Hospital from the period of January 1990 to December 1996. RESULT: The mean follow-up duration to the diagnosis of hepatocellular carcinoma was 30 months (range 3-75). The number of patients with single lesion was 89(75%). The mean diameter of the tumor was 3.0 cm (range 1-10) , 82 patients (70%) had masses measured less than 3cm in diameter. The Number of patients with elevated serum alphafetoprotein level above 400ng/ml was 29(25%). The median survival was 28 months in screening group, significant compared with 7 months in control group (p<0.001). CONCLUSIONS: Ultrasound follow-up in high-ridk group of hepatocellular carcinoma mede it possible to detect small tumors in a high percentage of cases. This may lead to an increase in the number of potentially curable tumors and hence an increase in the overall survival rate. So ultrasound screening test is important in the high-ridk group of hepatocellular carcinoma.

A Case of Behcet's Disease Involving Stomach and Entire Small Intestine Tereminal Ileum Perforation / 대한소화기내시경학회지

Behcet's syndrome is a multisystemic, chronic inflammatory disease with triad of oral ulcer, genital ulcer and inflammatory ocular lesion. Intestinal Behcet's disease accounts for 1-2% of Behc'ets disease and most commonly affects the ileocecal region as ulcerations. A 70-year-old male patient was admitted to this hospital because of melena for 5 days. There was a history of recurrent aphthous stomatitis and genital ulcer. Colonoscopy showed multiple, irregularly, rnarginated, ellipsoid ulcers surrounded by hyperemic mucosa with vessel exposure on terminal ileum. Esophagogastroduodenoscopy showed multiple, round punched out ulcers on antrum and duodenal bulb. He was taken the near total small bowel resection, right hemicolectomy and ileotransverse colostomy because of hemorrhage and terminal ileal perforation. Three days after operation, melena reappeared and esopbagogastoduodenascopy revealed bleeding from duodenal ulcers and impending perforation of antral ulcer. He was reoperated with antrectomy, truncal vagotomy and gastroduodenostomy. Resected small bowel was 510 cm in length and there were multiple small round transverse ulcers surrounded by hyperemic edematous elevated rnucosa. Three 'punch-out ulcers' were also found on resected gastric antrum. So, we report a case of gastrointestinal Behcet's disease involving stomach, duodenum, jejunum and ileum with terminal ileum perforation.