Management of Clevudine-Resistant Chronic Hepatitis B: A Multicenter Cohort Study

BACKGROUND/AIMS: Data are lacking regarding the management of chronic hepatitis B (CHB) with resistance to clevudine (CLV). This study evaluated the efficacy of different rescue therapies for CLV-resistant CHB. METHODS: Patients with CLV-resistant CHB were enrolled in the cohort, and all patients developed virologic breakthrough during CLV therapy and had confirmed-genotypic resistance to CLV (rtM204I mutation) before enrollment. RESULTS: Of the 107 patients, 12 received adefovir (ADV), 21 received a CLV plus ADV combination (CLV+ADV), 34 received a lamivudine plus ADV combination (LAM+ADV), and 40 received entecavir (ETV) therapy for 48 weeks. The CLV+ADV group had the lowest hepatitis B virus (HBV) DNA level (p<0.0001) and showed the greatest reduction of HBV DNA levels from baseline compared to all other groups (p=0.004) at week 48. HBV DNA was undetectable (<70 IU/mL) in 0%, 57.1%, 21.2%, and 27.5% (p=0.003) of the patients in each group, respectively, at week 48. At the end of the study, the mean alanine transaminase (ALT) level, rate of ALT normalization, and rate of hepatitis B envelope antigen loss or seroconversion did not differ between groups. CONCLUSIONS: CLV+ADV combination therapy in patients with CLV-resistant CHB more effectively suppresses HBV replication than ETV, ADV, or LAM+ADV therapy.

Effective Medical Training Courses for Medical Helicopter Crews in South Korea

PURPOSE: The Ministry of Health and Welfare of korea started operating the Helicopter Emergency Medical Service (HEMS) System in 2011 to improve emergency medical services given by physicians aboard helicopters. The purpose of this study was to evaluate the HEMS education program for its effectiveness and satisfaction from trainees. METHODS: A survey of trainees was conducted at the very end of training and education. Trainees for a HEMS crew surveyed included doctors (8), nurses (4), emergency medical technicians (12), pilots (10), flight dispatchers (4) and an administrator (1). The study period was from August 8, 2011 to August 12, 2011. The amount of HEMS education was 16 hours, including 8 hours of theoretical education, 5 hours of simulation and 3 hours of table-top simulation. RESULTS: In an analysis of programs according to trainee satisfaction, the theoretical training program received an average of 4.2+/-0.7 points and; the practical and simulation training program received; 4.4+/-0.8 points. The simulated practical training program thus received a higher score than theoretical education, but the difference was insignificant (p=0.834). CONCLUSION: For the HEMS training programs, the practical and simulation training satisfaction score were higher than the theoretical program. A focus on simulation programs for HEMS could therefore serve as a goal of the HEMS education program.

Acute Comitant Esotropia in a Child With a Cerebellar Tumor

We report a case of acute comitant esotropia in a child with a cerebellar tumor. A 3-year-old boy was referred for management of a 9 month history of acute acquired comitant esotropia. On first presentation, the patient's angle of esodeviation was 50 prism-diopters (PD) at distance and near fixation without any lateral incomitance. The cycloplegic refraction revealed +0.75 diopters in both eyes. Very mild bilateral papilledema was found on the fundus examination, but the neurological examination did not reveal any other pathological findings. Brain MRI showed a 5 cm mass located in the midline of the cerebellum as well as hydrocephalus. The mass was completely excised and histological examination confirmed the diagnosis of pilocytic astrocytoma. Despite neurosurgery, the patient's strabismus remained unresolved. One year after neurosurgery, both medial rectus muscles were surgically recessed by 6 mm, resulting in esotropia of 8PD at distant and near fixation without restoration of bifoveal fusion at follow-up 2 years after the eye muscle surgery. Therefore, acute onset comitant esotropia in a child can be the first sign of a cerebellar tumor, even without any other neurological signs and symptoms.

Effect of Nitric Oxide on the Survival of R28 Cells

PURPOSE: To evaluate the effect of nitric oxide (NO) on the survival of R28 cells. METHODS: After immunostaining for GFAP, vimentin, S-100, and neurofilament, R28 cells were exposed to S-nitroso-N-acetyl-D, L-penicillamine (SNAP) at various concentrations, with and without the NO inhibitor, Nomega-Nitro-L-arginine methyl ester (L-NAME) for 1 and 3 days. Cellular survival of R28 cells and the production of NO were quantified by rapid colorimetric assays using the MTT and Griess assay, respectively. To evaluate the effect of serum, 10% serum or serum-free media were used separately. RESULTS: R28 cells showed strong immunoreactivity to GFAP and vimentin compared to S-100 or neurofilament. SNAP inhibited the survival of R28 cells in a dose-dependent manner, and this effect of NO on the cellular survival was abolished by L-NAME. These results were similar after exposure for 1 and 3 days, regardless of the presence of serum in the media. CONCLUSIONS: The current results suggest that NO decreased the survival of R28 cells. Further studies are necessary to evaluate the mechanism of cytotoxicity of the R28 cells.

Effect of Nitric Oxide on the Migration and Fibroblast-mediated Contraction of Collagen Gels

PURPOSE: To investigate the role of nitric oxide (NO) on the migration of cultured human Tenon's capsule fibroblasts (HTCF) and contraction of collagen gel. METHODS: After artificial wounding, the primarily cultured HTCF were exposed to an NO donor such as sodium nitroprusside (SNP), S-Nitroso-N-acetylpenicillamine (SNAP), or dexamethasone at various concentrations. The cellular migration was measured up to five days. After embedding the cells in the collagen gels, the amount of contraction by the gels was also measured. Cellular survival and NO production were measured with MTT assay and Griess assay, respectively. RESULTS: Cellular survival was decreased by both NO donors but not by dexamethasone. SNP inhibited migration of HTCF in a dose-dependent manner and enhanced contraction of collagen gels. However, SNAP had no effect on the cellular migration or gel contraction. Dexamethasone inhibited cellular migration but did not affect the contraction of collagen gels. CONCLUSIONS: Among the NO donors, only SNP inhibited migration of HTCF and enhanced contraction of collagen gels in vitro. Thus, the effects between the two NO donors on fibroblast induced wound healing differ.

A case of enteropathy-type intestinal T-cell lymphoma, confused with celiac disease / 대한내과학회지

Primary gastrointestinal lymphomas are commonly B-cell type, in contrast to the rare T-cell type, which has been noted as a complication of celiac disease that has not been reported in Korea so far. Primary T-cell lymphoma is commonly associated with enteropathy, and we report a case of small bowel T-cell lymphoma associated with enteropathy, with minimal mucosal lesion such as flattening of folds, which was difficult to differentiate with celiac disease clinically and pathologically.

Histopathological Features and the Clinical Significance of White Spots around Colon Cancer / 대한소화기내시경학회지

BACKGROUND AND AIMS: To investigate the difference between colorectal adenocarcinomas with white spots (foamy cells) and those without white spots, clinically and histopathologically, were examined 37 cases of colorectal adenocarcinomas were classified in this study. METHODS: Two groups: those with white spots and those without. In each case, evidence of lymph node and liver metastasis was sought. Immunoreactive staining for macrophage was performed. RESULTS: Increased incidence of exophytic tumors was found (73%, p=0.028) in the group with white spots. The incidences of lymph node metastasis were 33% vs. 45% between the group with white spots and the group of without, but the difference was not statistically significant. CONCLUSIONS: These results suggested that foamy cells might have a beneficial role in colorectal cancer, although they were not statistically significant. Therefore, further prospective study be warranted.

Significance of Lymph Node Metastasis in Early Gastric Cancer

One hundred thirty four early gastric cancer cases were analyzed to determine the clinicopathologic features influencing lymph node metastasis. Subtotal gastrectomy for 122 patients and total gastrectomy for 12 patients were carried on including lymph node dissection of node groups 1 and 2. The mean duration of the follow-up was 44.2 months. In this review, the only pathologic feature influencing lymph node metastasis was depth of invasion. The rate of lymph node metastasis was significantly higher in submucosal cancer(30.3%) than mucosal cancer(8.6%)(Chi-Square test, P=0.0009). The lymph node metastasis was the only independent prognostic factor of early gastric cancer(P=0.0006), and raise the question whether the present definition of early gastric cancer is still of value. Most important result of our study is that 20.9% of the early gastric cancer had pathologically proven lymph node metastasis, and have worse prognosis than the cases without metastasis. In stead of the currently used early gastric cancer, we propose superficial cancer for carcinoma confined to mucosa or submucosa on endoscopic finding, and to save the term of early gastric cancer for the cases in which the invasion limited to the mucosa or submucosa without lymph node metastasis.