Efficacy and safety of entecavir plus carnitine complex (GODEX(R)) compared to entecavir monotherapy in patient with ALT elevated chronic hepatitis B: randomized, multicenter open-label trials. The GOAL study

BACKGROUND/AIMS: Carnitine and vitamin complex (Godex(R)) is widely used in patients with chronic liver disease who show elevated liver enzyme in South Korea. The purpose of this study is to identify the efficacy and safety of carnitine from entecavir combination therapy in Alanine aminotransferase (ALT) elevated Chronic Hepatitis B (CHB) patients. METHODS: 130 treatment-naive patients with CHB were enrolled from 13 sites. The patients were randomly selected to the entecavir and the complex of entecavir and carnitine. The primary endpoint of the study is ALT normalization level after 12 months. RESULTS: Among the 130 patients, 119 patients completed the study treatment. The ALT normalization at 3 months was 58.9% for the monotherapy and 95.2% for the combination therapy (P<0.0001). ALT normalization rate at 12 months was 85.7% for the monotherapy and 100% for the combination group (P=0.0019). The rate of less than HBV DNA 300 copies/mL at 12 months was not statistically significant (P=0.5318) 75.9% for the monotherapy, 70.7% for the combination and it was. Quantification of HBsAg level was not different from the monotherapy to combination at 12 months. Changes of ELISPOT value to evaluate the INF-gamma secretion by HBsAg showed the increasing trend of combination therapy compare to mono-treatment. CONCLUSIONS: ALT normalization rate was higher in carnitine complex combination group than entecavir group in CHB. Combination group was faster than entecavir mono-treatment group on ALT normalization rate. HBV DNA normalization rate and the serum HBV-DNA level were not changed by carnitine complex treatment.

Comparison of Hemostatic Efficacy between Epinephrine Injection Alone and a Combined Therapy with Hemoclip for Bleeding Peptic Ulcers / 대한소화기내시경학회지

BACKGROUND/AIMS: Many studies have been performed to find the differences between using epinephrine injection alone and a combination therapy with hemoclip for bleeding peptic ulcer, but the results have been controversial. We retrospectively evaluated the hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip for bleeding peptic ulcers. METHODS: Four hundred patients were enrolled. They were assigned to one of the two groups: endoscopic hemostasis with injection of epinephrine (group I, n=156) and combined epinephrine injection with hemoclip (group II, n=244). RESULTS: The continuous bleeding rate was significantly higher in group I than in group II. The recurrent bleeding rate was also significantly higher in group I than in group II. There were no statistical differences in the rates of death, emergency surgery and arterial embolization. The rates of continuous bleeding and the initial failure of hemostasis were higher for the patients with active bleeding on the initial endoscopy irrespective of the applied hemostatic methods. CONCLUSIONS: A combination of epinephrine injection and hemoclip is more effective than epinephrine injection alone for treating bleeding peptic ulcers.

An Analysis Based on Hospital Stay in Ischemic Colitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Ischemic colitis is the most prevalent form of gastrointestinal ischemia, accounting for approximately 50 to 60% of all gastrointestinal ischemic episodes. There are many conditions that predispose an individual to ischemic colitis as well as a wide variety of clinical and endoscopic presentations. This study reviewed the risk factors associated with ischemic colitis, the site of colonic involvement and the effect of antibiotics on the hospital stay. METHODS: 34 inpatients with ischemic colitis during October 2001 and November 2004 were analyzed retrospectively. All patients had intestinal bleeding. RESULTS: The mean age of the patients was 56+/-14. Among the 34 cases, 15 cases had the risk factors associated with ischemic colitis. The presenting symptoms were mainly abdominal pain and diarrhea. The endoscopic findings revealed four cases with pancolitis. One case with chronic liver disease died from septic shock. The mean hospital stay was 12+/-5 days, which was reduced by early admission and colonoscopic diagnosis, bowel rest and fluid therapy. However, patient's age, clinical presentations, location of the involved colon, the presence of risk factors and the use of antibiotics did not influence the hospital stay. CONCLUSIONS: If ischemic colitis with intestinal bleeding is suspected, an early colonoscopic diagnosis and medical treatment such as bowel rest and fluid therapy can reduce the hospital stay.

The association of elevated alanine aminotransferase activity with obesity in health screenig subjects / 대한내과학회지

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has recently been recognized to be one of the leading causes of chronic liver disease. Obesity and type 2 diabetes are associated strongly with NAFLD. Although often used to detect liver disease, sometimes the cause of elevated Alanine Transaminase (ALT) activity was unclear. In the absence of other causes, the author examined whether BMI and metabolic markers of NAFLD can explain the cause of abnormal ALT in Korean. METHODS: From April 2002 to November 2003, 9997 persons visited health promotion center of Kyungpook National University Hospital and took health screening. After excluding persons with excessive alcohol consumption, abnormal gamma-GTP, hepatitis B, hepatitis C, 8379 persons were included in this study. All patients underwent anthropometric measures, blood chemistry analysis and abdominal ultrasonographic exam. RESULTS: Elevated ALT levels were found in 10% (835 persons) of the all subjects. In univariate analysis, factors associated with elevated ALT levels (por=23 kg/m2) was 79% in abnormal ALT group. In multivariate logistic regression study, total cholesterol and blood pressure were eleminated but sex, BMI, triglyceride level, ultrasonographic fatty change were strongly associated with elevated ALT level (p<0.01). CONCLUSION: In this study, unexplained ALT elevation was strongly associated with obesity, adiposity and other features of metabolic syndrome, and thus may represent nonalcoholic fatty liver disease. However, more research is needed for the definite clinical determinants of nonalcoholic fatty liver disease in Korean.

Hepatic Cirrhosis Occurring in a Young Woodchuck (Marmota monax) Due to Vertical Transmission of Woodchuck Hepatitis Virus (WHV)

Histologic and clinicopathologic findings of a woodchuck (Marmota monax) vertically infected with woodchuck hepatitis virus (WHV) are presented. The liver exhibits marked cirrhotic changes, which is characteristic of the pre-transformation phase of WHV. At necropsy, the woodchuck exhibited ascites and the liver had a grossly nodular appearance. Microscopically, focal hepatocyte necrosis and inflammatory cells were observed in midzonal and periportal areas in the liver. In Macchiavellos stained sections, cytoplasmic inclusion bodies appeared reddish granular materials. We believe that this may represent a new suitable and cost-effective cirrhotic model for the disease processes associated with hepadnaviruses in a number of other species, most notably Hepatitis B virus infection in man.

Diagnostic Accuracy of Ultrasonography-guided Needle Biopsy of the Liver as determined by Postsurgical Sampling / 대한간학회지

BACKGROUND/AIMS: It is questionable whether the needle biopsy of the liver can represent the whole pathology of the liver. This study evaluates the diagnostic accuracy of ultrasonography-guided needle biopsy of the liver as determined by surgically resected liver. METHOD: The histopathologic findings of preoperative ultrasonography-guided needle biopsy for confirming the background liver disease and surgically resected liver were compared in the 40 patients with primary hepatocellular carcinoma. RESULTS: 1) Of the 40 cases, 30 (75.0%) cases showed the same histopathological diagnosis between the two methods. Their histopathological results were: 20 cases of cirhosis, 6 cases of chronic hepatitis and 4 cases of normal tissue. 2) There was a direct proportion between histologic concordance, the number of portal areas, and the size of the needle biopsy specimen. The histologic concordance rate was 79.2% in the cases with 4 portal areas in their biopsy sample and 100% in the cases with more than 5 areas. 3) Of the 10 cases in which diagnostic discrepancy was found between the two methods, 8 cases of chronic hepatitis and 1 case of normal tissue, all diagnosed by needle biopsy, proved to be cirrhosis by surgically resected liver. One case of normal tissue proved to be chronic hepatitis. The causes of diagnostic error were fragmentations of tissue and inadequate specimens. CONCLUSION: The diagnostic accuracy of the ultrasonography-guided needle biopsy of the liver was 75.0% in our study. To lessen the diagnostic error, at least 4 or more portal areas should be contained in the biopsy sample and the fragmentation of tissue should be minimized.

Hepatic Asialoglycoprotein Receptor Scintigraphy Using 99mTc - Galactosylated Serum Albumin ( GSA ): Biodistribution Study in Mice with Thioacetamide - induced Hepatic Injury / 대한간학회지

BACKGROUND/AIMS: Tc-DTPA-galactosylated serum albumin (GSA) is a new liver imaging agent that specifically binds to asialoglycoprotein receptor, which resides exclusively on the plasma membrane of mammalian hepatocytes. To evaluate the usefulness of hepatic scintigraphy with Tc-GSA in the assessment of hepatic function, we have investigated serial changes in organ uptakes of Tc-GSA in mice with thioacetamide-induced hepatic injury and compared to changes in histology or levels of hepatic enzymes. MATERIALS AND METHODS: Acute hepatic injuries were induced by intraperitoneal injection of thioacetamide in ICR (Institute of Cancer Research) mice. Hepatic injuries were serially assessed by either light microscopic examination of liver slices or measurement of hepatic enzymes. The biodistribution of Tc-GSA was measured in liver and each excised organs using gamma counter. RESULTS: Hepatic injuries in light microscopic examination were not evident at 12 hours after injection of thioacetamide but resulted in maximal centrilobular necrosis and inflammation at 24 hours. These histologic changes were progressively improved upto 72 hours. Studied hepatic enzymes were elevated at 6 hours and reached to maximal level at 24 hours after administration of thioacetamide and declined progressively after then. Hepatic uptake of Tc-GSA was lowest at 6 hours after administration of thioacetamide and serially recovered until 72 hours. CONCLUSION: The degree in the decrease of hepatic uptake of Tc-GSA was precedent to either histologic changes or elevation of hepatic enzymes and correlated with the degree of hepatic daneges in acute hepatic injury. These findings suggest that hepatic scintigraphy using Tc-GSA can be used to detect early changes and serial assessment of hepatic function in acute hepatic injury.

Hepatic Asialoglycoprotein Receptor Scintigraphy Using 99mTc - Galactosylated Serum Albumin ( GSA ): Biodistribution Study in Mice with Thioacetamide - induced Hepatic Injury / 대한간학회지

BACKGROUND/AIMS: Tc-DTPA-galactosylated serum albumin (GSA) is a new liver imaging agent that specifically binds to asialoglycoprotein receptor, which resides exclusively on the plasma membrane of mammalian hepatocytes. To evaluate the usefulness of hepatic scintigraphy with Tc-GSA in the assessment of hepatic function, we have investigated serial changes in organ uptakes of Tc-GSA in mice with thioacetamide-induced hepatic injury and compared to changes in histology or levels of hepatic enzymes. MATERIALS AND METHODS: Acute hepatic injuries were induced by intraperitoneal injection of thioacetamide in ICR (Institute of Cancer Research) mice. Hepatic injuries were serially assessed by either light microscopic examination of liver slices or measurement of hepatic enzymes. The biodistribution of Tc-GSA was measured in liver and each excised organs using gamma counter. RESULTS: Hepatic injuries in light microscopic examination were not evident at 12 hours after injection of thioacetamide but resulted in maximal centrilobular necrosis and inflammation at 24 hours. These histologic changes were progressively improved upto 72 hours. Studied hepatic enzymes were elevated at 6 hours and reached to maximal level at 24 hours after administration of thioacetamide and declined progressively after then. Hepatic uptake of Tc-GSA was lowest at 6 hours after administration of thioacetamide and serially recovered until 72 hours. CONCLUSION: The degree in the decrease of hepatic uptake of Tc-GSA was precedent to either histologic changes or elevation of hepatic enzymes and correlated with the degree of hepatic daneges in acute hepatic injury. These findings suggest that hepatic scintigraphy using Tc-GSA can be used to detect early changes and serial assessment of hepatic function in acute hepatic injury.