Antiviral therapy for "difficult-to-treat" hepatitis C virus-infected patients / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To review the updated research on direct antiviral agents (DAAs)-including regimens for hepatitis C virus (HCV), and focus on "difficult-to-treat" HCV-infected patients.</p><p><b>DATA SOURCES</b>The literature concerning DAAs and hepatitis C cited in this review was collected from PubMed and Google Scholar databases published in English up to July 2013.</p><p><b>STUDY SELECTION</b>Data from published articles regarding HCV and DAAs in clinical trials and in clinical use were identified and reviewed.</p><p><b>RESULTS</b>It was recognized that some "difficult-to-treat" patients would still exist, even though stronger treatments using such as DAAs, including telaprevir and boceprevir, which lead to higher sustained virological response rates, are available. Such patients include those with advanced fibrosis/cirrhosis, elderly persons, children, HCV-human immunodeficiency virus co-infected patients, HCV-infected recipients, and so on.</p><p><b>CONCLUSIONS</b>Certain "difficult-to-treat" patients would still exist, even though stronger treatment is available. Although evidence from clinical trials is still lacking, interferon-sparing regimens could have stronger effects for eradicating HCV in such cases.</p>

Submerging Endoscopic Submucosal Dissection Leads to Successful En Bloc Resection of Colonic Laterally Spreading Tumor with Submucosal Fat

A 72-year-old female with a colonic laterally spreading tumor (LST) was referred to our department. A total colonoscopy revealed a large nongranular LST, 30 mm in diameter, in the ascending colon. Detailed examination with chromoendoscopy confirmed that the lesion was an intramucosal tumor, and endoscopic submucosal dissection (ESD) was performed. After a circumferential incision around the lifted lesion with a submucosal fluid cushion, diffuse adipose tissue was observed in the submucosal layer beneath the lesion. The endoscopic view was blurred when dissecting the submucosal layer due to fat adhering to the lens. Since this made it difficult to continue the procedures, we infused water into the lumen and kept the endoscope tip immersed in the collected water. The resulting improved view made it possible to complete all procedures without withdrawing the endoscope to wipe the lens. The lesion was successfully resected en bloc without complications. The pathological examination indicated the curative resection of a tubulovillous adenoma. We propose that a submerged ESD could also be an effective procedure for colonic neoplasms with submucosal fat by avoiding blurring of the endoscopic view.

Submucosal Injection of Normal Saline can Prevent Unexpected Deep Thermal Injury of Argon Plasma Coagulation in the in vivo Porcine Stomach

BACKGROUND/AIMS: There have been several reports of thermal injury induced by argon plasma coagulation (APC) in animal models, but no follow-up studies have revealed the actual thermal injury. METHODS: APC was performed on the stomachs of two living minipigs with and without prior submucosal injection of normal saline. The power and argon gas flow were set to 60 watts and 2 L/min, respectively, and pulse durations of 5, 10, and 20 seconds were used. One of the minipigs was killed immediately thereafter and the other was killed 1 week later. RESULTS: The minipig killed immediately showed only subtle differences between noninjected and injected injuries under all the conditions, and the usefulness of prior submucosal injection was not obvious. However, the minipig killed 1 week later had a deep ulcer extending to the deeper muscle layer at the noninjected site where APC had been applied for 20 seconds, whereas tissue injury of the injected site was limited to the submucosal layer. CONCLUSIONS: Unexpected tissue damage can occur even using a short-duration APC. Prior submucosal injection for APC might be a safer alternative technique, especially in a thinner and narrower gut wall.

Local ablation therapy for hepatocellular carcinoma. from ethanol injection to radiofrequency ablation

This article reviews the current status of local ablation therapy for hepatocellular carcinoma [HCC]. In the treatment of HCC, non-surgical treatments play important roles since only 20-30% of patients are candidates for surgery. Still worse, even after curative surgical resection, 80% of patients develop recurrence within 5 years. Among non-surgical treatments, image-guided local ablation therapies have been widely used for cases of small-number and small-size lesions, because they are potentially curative, minimally invasive, and easily repeatable. Although percutaneous ethanol injection has long been a standard therapy, there has been a drastic shift from ethanol injection to radiofrequency ablation in recent years. Randomized controlled trials proved that radiofrequency ablation is superior to ethanol injection in the treatment of HCC from the viewpoint of not only treatment response but also long-term survival. Radiofrequency ablation will play more important roles in the treatment of HCC