Reactivation of Hepatitis B Virus and Its Prevention in Patients with Rheumatic Diseases Receiving Immunosuppressive Therapy

Introduction of biologic agents to treat patients with rheumatic diseases and cancer has improved clinical outcomes. However, this advance increases the risk of hepatitis B virus (HBV) reactivation in hepatitis B surface antigen carrier and even in resolved HBV infection, which can lead to liver failure and even death. In particular, the risk of HBV reactivation is heightened by the use of B-cell depleting agents such as rituximab, high dose corticosteroid, and anti-tumor necrosis factor-α. Therefore, identification of individuals at risk, and understanding the mechanism of HBV reactivation are essential to preventing HBV reactivation before initiating immunosuppressive therapy. Here, we review the mechanism, incidence, and prevention of HBV reactivation in the setting of immunosuppression.

Disability Weights for Cancers in Korea

This study renewed the estimation of disability weights for cancers in Korea, reflecting the nation's economic and medical-technological development during the past 10 yr. Thirty-two medical doctors evaluated disability weights for 24 major cancers based on the visual analogue scale (VAS) method. To check the intra-rater reliability, a correlation was calculated between 2011 and 2012 medians. To assess the inter-rater reliability, a correlation was estimated between oncologist and non-oncologist medians. To assess the inter-method reliability, a correlation was calculated between medians on VAS and Person-Trade-Off approaches. Moreover, findings in this study were compared to those in 2003 research. Spearman correlation was used and the 1% significance level was applied. Disability weights were relatively high for pancreas cancer (0.90), gallbladder cancer (0.81), mouth and oropharynx cancer (0.80), and esophagus cancer (0.80). Conversely, they were relatively low for breast cancer (0.37), prostate cancer (0.33) and thyroid cancer (0.10). All the inter-rater reliabilities were higher than 0.7. Indeed, the intra-rater and inter-method reliabilities were 0.752 and 0.927, respectively. Above all, disability weights for major cancers went down in Korea during 2003-2012, reflecting the progress of medical technology and the growth of cancer survival.

A case of hyperinfection syndrome with Strongyloides stercoralis

A case of Strongyloides stercoralis infection wss experienced in a 73-year old Korean female patient, was hospitalized with relapse of cholecystitis. The patient developed cough and dyspnea 17 days after the admission. On the 27th hospitalized day, diarrhoea, nausea, vomiting and abdominal pain started. A number of parasitic larvae were incubated at 25 C for 2 days. Typical fork tailed filariform larvae of S. stercoralis (Bavay, 1876) Stiles and Hassall, 1902, were identified after cultivation. There was no improvement of diarrhoea after the medication with mebendazole. After the administration of thiabendazole, however, diarrhoea was stopped. On the 6th day of medication, S. stercoralis larvae were no more detected, and thereafter no larva was observed by repeated stool examinations upto 2 months after chemotherapy. The patient had the history of administration of steroid for articular rheumatism. Therefore this case seems to be a hyperinfection of S. stercoralis due to an autoinfection and to be the first report on the hyperinfected strongyloidiasis in Korea. Related literature was briefly reviewed.

A Case of Right Atrial Myxoma

Primary tumors of the heart are uncommon lesions that can mimic almost any type of cardiac disease. Over 90 per cent of myxoma which are the most common cardiac tumor occur in the atria, with 3 to 4 times as many occuring on the left as on the right. The development of nonivasive echocardiographic technique has made it possible to screen large numbers of patients with atrial myxoma with ease and safe. A 28 year old housewife was admitted because of dyspnea for 5 months. Clinical diagnosis of right atrial myxoma was made by echocardiography and right atrial angiocardiogram. Surgical resection was performed successfully. We presented a case of right atrial myxoma with a review of literatures.