Clinical Characteristics and Treatment Outcome of Peginterferon Plus Ribavirin in Patients Infected with Genotype 6 Hepatitis C Virus in Korea: A Multicenter Study

BACKGROUND/AIMS: Because of the limited geographic distribution, there have been insufficient data regarding hepatitis C virus (HCV) genotype 6 in Korea. This study aimed to investigate the clinical characteristics and available treatment outcomes of patients with genotype 6 HCV in Korea. METHODS: From 2004 to 2014, data were collected from Korean patients infected with genotype 6 HCV in eight hospitals. RESULTS: Thirty-two patients had genotype 6 HCV. The median age was 44 years, and 6c was the most common subtype. The baseline median alanine transaminase level was 88 (21 to 1,019) IU/mL, and the HCV RNA level was 1,405,000 (96,500 to 28,844,529) IU/mL. Twenty-five patients were treated with peginterferon (PEG-IFN) and ribavirin. Three follow-up losses occurred. Additionally, 13 patients attained a sustained virologic response (SVR), seven patients relapsed, and two patients exhibited a null response. The SVR rates were 40% and 75% for the 24- and more than 48-week treatments, respectively, and five of the six patients who achieved a rapid virologic response (RVR) attained a SVR. CONCLUSIONS: Korean patients infected with genotype 6 HCV are relatively young, and 6c is the most common subtype. When treated with PEG-IFN and ribavirin, the SVR rate was 52%. Similar to other genotypes, a longer duration of treatment and attainment of RVR are important for SVR.

The Usefulness of Monitoring of Transtubular Potassium Gradient and Spot Urine Na/K Ratio in the management of Cirrhotic Ascites / 대한간학회지

BACKGROUND/AIMS: Transtubular potassium gradient(TTKG) is known as the most accurate indicator of aldosterone activity. TTKG may be used to monitor the effectiveness of aldosterone antagonist which is prescribed generally for the management of cirrhotic ascites. Spot urine [Na]/[K] ratio may also be used for the same purpose. METHODS: After measuring TTKG, spot urine [Na]/[K] ratio, and plasma aldosterone concentration in each of the 23 patients all who had cirrhotic ascites, 100 mg of spiron-olactone was prescribed to be taken daily for 5 days. When no diuretic response occurred and TTKG was more than 3.5 at the end of 5 days, the dose of spironolactone was increased by 100 mg/day at the interval of 5 days until TTKG decreased to below 3.5. Furosemide was added to the non-responders if their TTKG had dropped to below 3.5. RESULTS: Basal plasma concentration of aldosterone was higher than upper normal limit in 13(57%) patients, and correlated with TTKG significantly(r=0.60, p=0.002). TTKG was calculated to be 3.5+/-0.67 when assuming the aldosterone activity has been completely blocked. Spot urine [Na]/[K] ratio had significant negative correlation with TTKG before and after the administration of spironolactone. In most patients, diuretic response appeared with the fall of TTKG (especially below 3.5) and with the rise of spot urine [Na]/[K] ratio. In patients who did not respond to a low dose spironolactone, further treatment plan (to increase dose of spironolactone or to add furosemide) was guided by TTKG, and all were successful. CONCLUSIONS: TTKG and spot urine [Na]/[K] ratio are good indicators of aldosterone activity, and might be used as useful guidelines in the diuretic management of cirrhotic ascites.

Endoscopic Mucosal Resection (EMR) as a Curative Treatment of Early Gastric Cancer / 대한소화기내시경학회지

The endoscopic mucosal resection(EMR) is proposed by some Japanese investigators as a curative therapy of early gastric cancer(EGC) because of its minimal invasiveness and excellent results. To evaluate the possible role of EMR as a curative treatment modality of EGC, we retrospectively analyzed l9 casea with EGC initially treated by EMR in Seoul National University Hospital from December 1993 and January 1996. 1) The histologic diagnosis prior to EMR was adenocarcinoma in 12 cases(63%) and adenomatous polyp in 7 cases(38%), which were confirmed as adenocarcinoma after EMR. 2) The histologic curative resection was done in 7 cases(37%). Two cases of them showed recurrence of the gastric cancer and were treated by radical surgery. The other five cases have been closely observed by regular endoscopic examination without recurrence for the maximal period of 1~3 months. 3) Histoiogically inadequate resection(positive cancer cell in resection margin, submucosal cancer infiltration, or no cancer tissue in resected specimen) was done in 12 cases(73%). But two surgically resected cimens of them have no residual cancer cells, and there was no cancer cells in the follow-up biopsy of the other two patients. There 4 cases were seemed to he examples of buring effect of EMR 4) After excluding five depressed lesions greater than 1 cm is long diameter, nine lesions were curatively treated by EMR. So successful EMR rate for strictly indicated lesions wsa 64% 5) There was no signifieant complication related to the procedure. We thnnk that endoscopic mucosal resection has a potential role as a curative treatment modality in a highly selected patient with darly gastric cancer