Treatment Outcome and Renal Safety of 3-Year Tenofovir Disoproxil Fumarate Therapy in Chronic Hepatitis B Patients with Preserved Glomerular Filtration Rate

BACKGROUND/AIMS: To investigate the treatment efficacy and renal safety of long-term tenofovir disoproxil fumarate (TDF) therapy in chronic hepatitis B (CHB) patients with preserved renal function. METHODS: The medical records of 919 CHB patients who were treated with TDF therapy were reviewed. All patients had preserved renal function with an estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m2. RESULTS: A total of 426 patients (184 treatment-naïve and 242 treatment-experienced) were included for analysis. A virologic response (VR) was defined as achieving an undetectable serum hepatitis B virus (HBV) DNA level, and the overall VR was 74.9%, 86.7%, and 89.4% at the 1, 2, and 3-year follow-ups, respectively. Achieving a VR was not influenced by previous treatment experience, TDF combination therapy, or antiviral resistance. In a multivariate analysis, being hepatitis B e antigen positive at baseline and having a serum HBV DNA level ≥2,000 IU/mL at 12 months were associated with lower VR rates during the long-term TDF therapy. The overall renal impairment was 2.9%, 1.8%, and 1.7% at the 1, 2, and 3-year follow-ups, respectively. With regard to renal safety, underlying diabetes mellitus (DM) and an initial eGFR of 60 to 89 mL/min/1.73 m2 were significant independent predictors of renal impairment. CONCLUSIONS: TDF therapy appears to be an effective treatment option for CHB patients with a preserved GFR. However, patients with underlying DM and initial mild renal dysfunction (eGFR, 60 to 89 mL/min/1.73 m2) have an increased risk of renal impairment.

A Case of Nonfunctioning Parathyroid Cyst in the Mediastinum / 대한이비인후과학회지

Parathyroid cysts, which are classified as either functioning or nonfunctioning, are rarely observed as neck masses, especially in the mediastinum. Herein, we present a 38-year-old woman with a nonfunctioning parathyroid cyst in the mediastinum. Physical and radiologic examinations of parathyroid cysts are not specific and preoperative diagnosis is usually difficult. Therefore, clinicians should consider the possibility that parathyroid cysts occuring in the mediastinum mimick other more frequently observed lesions.

Titanium Mesh Cage for Anterior Stabilization in Tuberculous Spondylitis : Is It Safe?

OBJECTIVE: The safety of titanium metal cages in tuberculous spondylitis has not been investigated. We evaluated the outcome and complications of titanium mesh cages for reconstruction after thoracolumbar vertebrectomy in the tuberculous spondylitis. METHODS: There were 17 patients with 18 operations on the tuberculous spondylitis in this study. Sixteen patients were operated with anterior corpectomy and reconstruction with titanium mesh cage followed by posterior transpedicular screw fixations on same day, two pateints were operated by either anterior or posterior approach only. After the affected vertebral body resection and pus drainage from the psoas muscle, titanium mesh cage, filled with morselized autogenous bone, was inserted. All the patients had antituberculosis medication for 18 months. The degree of kyphosis correction and the subsidence of cage were measured in the 15 patients available at a minimum of 2 years. Outcome was assessed with various cross-sectional outcome measures. Recurrent infection was identified by serial ESR(Erythrocyte Sedimentation Rate) and CRP(Cross Reactive Protein) . RESULTS: There was no complication from the use of a titanium mesh cage. Recurrent infection was not detected in any case. Average preoperative of 9.2degrees was reduced to -2degrees at immediate postoperative period, and on final follow up period kyphotic angle was measured to be 4.5degrees. Postoperatively, subsidence was detected in most patients especially at ambulation period, however further subsidence was prevented by the titanium mesh cage. Osseous union was identified in all cases at the final follow-up. CONCLUSION: The cylindrical mesh cage is a successful instrument in restoring and maintaining sagittal plane alignment without infection recurrence after vertebrectomy for tuberculous spondylitis.

A Case Report of Castleman's Disease(Giant Lymph Node Hyperplasia) Presenting as a Isolated Neck Mass / 대한이비인후과학회지

Castleman's disease, a benign lymphoproliferative disease of unknown etiology, rarely occures as a neck mass. Only 6% of the cases reported in the literature was detected primarily in the neck. This disease consists of unicentric or multicentric (or systemic) forms by clinical manifestation and hyaline vascular type or plasma cell type, histologically. The more common hyaline vascular type usually presents as an asymptomatic lymphoid mass. On the other hand, in plasma cell type, systemic manifestations are frequently observed. Definite diagnosis and treatment is possible with complete surgical resection following histologic evaluation. Recently, we experienced a 22 year old woman patient with 5 year history of right neck mass. She underwent surgical mass resection. Pathologic analysis confirmed hyaline vascular variant of Castleman's disease. Now, we report this case with a review of previously reported literature.

A Case of Globozoospermia Conceived by Intracytoplasmic Sperm Injection / 대한산부인과학회잡지

Human sperm are not only pleomorphic but also tend to show large numbers of obvious abnormalities that may be associated with infertility. It is known that the greater the numbers of abnormalities present in each sperm (teratozoospermic index) relates closely to abnormalities in sperm function and the presence of infertility. The variation in morphology that may be seen among human sperm involve the head, midpiece and tail. An oval head is deemed to be normal but many shape and size variations can be seen in an ejaculate, and these include large, small or tapering heads. Amorphous heads are now known to be associated with chromosomal anomalies and a sperm may even show the presence of a double head. Another anomaly of sperm morphology that is occasionally seen is the abnormality known as globozoospermia. In this condition, the sperm head lacks an acrosome and, as a consequence, the head of each spermatozoon becomes rounded. We have experienced a case of globozoospermia which was conceived by intracytoplasmic sperm injection. So we report this case with a brief review of literatures.

Periosteal Osteosarcoma Of The Mandible: Report Of A Case