Long-term outcomes of two rescue therapies in lamivudine-refractory patients with chronic hepatitis B: combined lamivudine and adefovir, and 1-mg entecavir

BACKGROUND/AIMS: Adefovir (ADV) and lamivudine (LAM) combination therapy (ADV+LAM) has been a useful option for patients with LAM-resistant (LAM-r) chronic hepatitis B (CHB). However, the long-term outcomes of LAM+ADV and 1-mg entecavir (ETV) rescue therapies have still been limited. The aim of this study was to determine the long-term outcomes of these two rescue therapies. METHODS: Sixty patients with LAM-r CHB underwent rescue therapy with LAM+ADV (n=36) or 1-mg ETV (n=24). We determined the duration of rescue therapy, timing and type of mutation, undetectable serum hepatitis B virus (HBV) DNA by PCR (lower limitation of detection, < 140 copies/mL), biochemical response (alanine aminotransferase < 40 IU/mL), and the incidence of hepatitis B virus e antigen (HBeAg) seroconversion and virologic breakthrough. RESULTS: Baseline characteristics did not differ between the two therapy groups. The duration of rescue therapy was 56 months (range, 14-100 months) in the ADV+LAM group and 42 months (range, 12-73 months) in the ETV group (P=0.036). The cumulative rates of HBV DNA undetectability and HBeAg seroconversion up to 6 years were 88.6% and 43.0%, respectively, in the ADV+LAM group, and 45.8% and 31.8% in the ETV group. The rate of virologic breakthrough and resistance was 14.4% in the ADV+LAM group and 71.9% in the ETV group (P=0.001). CONCLUSIONS: Combination of LAM and ADV therapy for up to 6 years achieved modest rates of virological suppression and resistance. ETV is not an optimal therapy because the risk of viral breakthrough to ETV increases over time.

The Frequency and Risk Factors of Colorectal Adenoma in Health-Check-up Subjects in South Korea: Relationship to Abdominal Obesity and Age

BACKGROUND/AIMS: Obesity is associated with the risk of colorectal cancer. However, there is a lack of information about the relationship between obesity and colorectal adenoma. We investigated whether general and abdominal obesity are risk factors for colorectal adenoma. METHODS: Subjects who received health check-ups, including colonoscopy, from April 2006 to September 2007 in Chung-Ang University Hospital were included (n=1,316). The frequency and characteristics of colorectal adenomas were analyzed according to demographic features, past history, blood tests, body mass index, and components of metabolic syndrome. Abdominal obesity was defined as a waist circumference of > or =80 cm in women and > or =90 cm in men. RESULTS: The sex ratio of the subjects was 1.9:1 (male:female) and their age was 47.7+/-10.0 years (mean+/-SD). In univariate analysis, abdominal obesity was significantly associated with the frequency of colorectal adenoma (26.5% "yes" vs 16.9% "no"; p or =100 mg/dL) or fatty liver (p or =60 years; OR, 6.7; 95% CI, 3.5-12.5), and abdominal obesity (OR, 1.5; 95% CI, 1.0-2.2) were independent risk factors for colorectal adenoma (p<0.05). The frequency of multiple adenomas (more than two sites) was also significantly higher in subjects with abdominal obesity. However, the effect of abdominal obesity on the development of colorectal adenoma decreased in elderly people. CONCLUSIONS: Abdominal obesity is an independent risk factor for colorectal adenoma and its multiplicity, especially in younger people in South Korea.

A case of cytomegalovirus colitis in a patient with liver cirrhosis / 대한내과학회지

Most cases of cytomegalovirus (CMV) colitis are associated with an immunocompromised status, especially with human immunodeficiency virus (HIV) infections and transplantation. It rarely occurs in immunocompetent adults. We report a rare case of CMV colitis in a patient with HBV related liver cirrhosis. A 49 year-old patient presented with lower abdominal pain and bloody diarrhea. Sigmoidoscopic examination showed multiple shallow ulcerations and severe mucosal edema. Conservative treatment for the patient including antibiotics was not effective. Repeated sigmoidoscopic examination with re-biopsy showed intranuclear inclusion bodies suggestive of CMV infection. After administration of Ganciclovir, abdominal pain and bloody diarrhea improved.

Acute pulmonary edema during endovascular stenting of a patient with non-malignant superior vena cava syndrome: A case report / 대한내과학회지

The superior vena cava (SVC) syndrome results from the disturbance of blood flow in superior vena cava caused by the obstruction. The most common etiology of this condition is the external compression by a malignant tumor. Other causes include thrombus from a pacemaker, defibrillator or central venous catheters. The conventional treatment is radiation and chemotherapy. Recently stenting has been used as a first-line therapeutic strategy for non-malignant cases with balloon and self-expanding stents. In our report, a 77 year-old woman had the SVC syndrome without identification of an underlying disease. A percutaneous endovascular intervention was performed. The stent was placed successfully but just after the procedure, the venous return immediately increased and acute pulmonary edema developed. The patient improved after intravenous diuretics and oxygen. Here we report our experience and review the medical literatures for the management of the non-malignant SVC syndrome, with percutaneous endovascular intervention and the rare complication of pulmonary edema.

A Case of In-Stent Plaque Rupture Presenting as an Acute Myocardial Infarction

In-stent atheromatous plaque rupture is a very rare event. A 51-year-old man presented with an acute inferior myocardial infarction 9 years after bare-metal stent implantation in the mid-portion of right coronary artery. After thrombolytic therapy, coronary angiography and intravascular ultrasound (IVUS) revealed a ruptured plaque at the mid portion of the stented segment.