Prevalence, Risk Factors and Clinical Characteristics in Patients with Genotype 6 Chronic Hepatitis C: A Single Institute Experience / 대한소화기학회지

BACKGROUND/AIMS: Hepatitis C genotypes 1 and 2 are widely distributed globally. In contrast, genotype 6 is found mainly in Southeast Asia, while genotype 6 is rare in Korea. This study aims to investigate the prevalence, risk factors and clinical characteristics of patients with genotype 6 chronic hepatitis C. METHODS: We retrospectively identified 133 HCV-infected patients who underwent HCV genotype analysis between January 2012 and December 2012, and analyzed the prevalence, risk factors and clinical characteristics of patients diagnosed with genotype 6 chronic hepatitis C. RESULTS: Among 133 patients, 53 patients (39.8%) were infected with genotype 1, 62 patients (46.6%) with genotype 2, 2 patients (1.5%) with genotype 3, 14 patients (10.5%) with genotype 6, and 2 patients (1.5%) with mixed genotypes (genotype 1 and 6). The risk factors associated with genotype 6 were acupuncture (n=4, 28.6%), intravenous drug use (n=3, 21.4%), tattoo (n=2, 14.3%), and transfusion (n=2, 14.3%). Of the 14 patients with genotype 6, 6 patients were treated with pegylated interferon and ribavirin. Five patients had reached the end of treatment. All patients reaching end of treatment for genotype 6 showed early virological response and sustained virological response. CONCLUSIONS: The prevalence of genotype 6 is 10.5% and mixed infections of genotype 1 and 6 are 1.5% in patients with chronic hepatitis C. A major potential risk factor is intravenous drug use and the treatment response rate to pegylated interferon plus ribavirin is high in patients with genotype 6 chronic hepatitis C. Large scale multicenter studies are needed.

A Case of Cameron Ulcer Presenting with Melena / 대한내과학회지

Cameron ulcers are gastric ulcers or erosions located at mucosal folds in patients with large hiatal hernias. Mechanical trauma, gastric acid injury, or ischemia can cause their formation. Cameron ulcers are frequently seen as incidental findings during upper gastrointestinal endoscopy. About half of patients with these lesions are asymptomatic. However, Cameron ulcers are related to iron deficiency anemia and gastrointestinal bleeding in some cases. Here, we report a case of Cameron ulcers presenting with melena, which was successfully treated with proton pump inhibitors and iron supplementation.

A Case of a Successful Band Ligation of a Colonic Perforation during Diagnostic Colonoscopy / 대한소화기내시경학회지

Colonoscopy is a relatively safe tool for diagnosis and treatment of colorectal disease. But colonic perforation during colonoscopy is a severe complication and sometimes becomes a life-threatening condition. It occurs with a frequency of 0.07% among patients having diagnostic colonoscopy and in up to 0.40% of patients having therapeutic colonoscopy. In these cases, surgical treatment is needed but endoscopic repair and conservative management could reduce the need for immediate operations. Endoscopic clipping has been the principal method for non-operative treatment of iatrogenic colonic perforation, but it has important limitations. One of them is that it is technically difficult to clip when the angle of approach is tangential. Here we report a case of an iatrogenic colonic perforation treated with endoscopic band ligation rather than endoscopic clipping, because of approach difficulties.

A Case of Endocarditis due to Granulicatella adiacens / 감염과화학요법

Granulicatella species are nutritionally variant streptococci first described in 1961. Granulicatella species form a part of the normal flora of the oral cavity, genitourinary tract, and intestinal tract. These micro-organisms cause bacteremia or local infections such as endocarditis, central nervous system infections, arthritis, and osteomyelitis. Since isolation of Granulicatella species is difficult, only a few cases of infection caused by this microorganism have been reported. Herein, we report a case of endocarditis caused by Granulicatella adiacens in a 46-year-old patient with ventricular septal defect.

De novo Hyponatremia in Patients Undergoing Peritoneal Dialysis: A 12-month Observational Study / 대한신장학회지

PURPOSE: Hyponatremia occurs infrequently in patients undergoing peritoneal dialysis (PD). Nevertheless, one must understand its pathophysiology, since the therapeutic strategy differs from that of non- PD-related hyponatremia. This study examined the clinical features of hyponatremia in PD and evaluated the factors that may contribute to its development. METHODS: We retrospectively enrolled 51 normonatremic PD patients at Gachon University Gil Hospital, South Korea. Using the plasma sodium levels at month 13, the patients were divided into hyponatremia (Na+ or = 135 mEq/L) groups. Then, the clinical variables of these patients were examined, including peritoneal function and adequacy tests, and biochemical parameters. RESULTS: The de novo hyponatremia (n=8) and normonatremia (n=43) groups had no significant differences in baseline characteristics. At month 1, the serum albumin was lower in the hyponatremia group (p=0.022). In the peritoneal equilibration test analysis, the dialysate-to-plasma ratio for creatinine (D/ P(Cr)) measured after 13 months differed significantly between the two groups (p=0.007), while the maximum dip in sodium did not differ. No significant differences were observed in the normalized protein equivalent of nitrogen appearance, Kt/V, or residual renal function. CONCLUSION: Our data suggest that the development of hyponatremia is associated with a lower initial serum albumin level and increased D/P(Cr) in patients undergoing PD. Therefore, the serum sodium levels should be monitored more carefully in these patients.

Peritonitis due to Leclercia adecarboxylata in a Patient Receiving Automated Peritoneal Dialysis / 대한신장학회지

Peritonitis in patients undergoing peritoneal dialysis is a major complication and the leading cause of peritoneal dialysis failure. Leclercia adecarboxylata is a motile, gram-negative, facultative anaerobic bacillus of the Enterobacteriaceae family. These bacteria are uncommon pathogen, and rarely isolated from environmental and clinical specimens. Some cases have been reported about peritonitis due to Leclercia adecarboxylata in a patient receiving continuous ambulatory peritoneal dialysis (CAPD). However, there has never been any report about peritonitis in a patient receiving automated peritoneal dialysis (APD). We have isolated Leclercia adecarboxylata from peritoneal fluid in a patient receiving APD, and the patient completely recovered with 14-day treatment of intraperitoneal antibiotics without catheter removal.