Efficacy of prolonged entecavir monotherapy in treatment-naive chronic hepatitis B patients exhibiting a partial virologic response to entecavir

BACKGROUND/AIMS: The optimal management of patients exhibiting a partial virologic response (PVR) to entecavir (ETV) has not been determined . The aim of this study was to determine the long-term efficacy of prolonged ETV monotherapy in treatment-naive chronic hepatitis B (CHB) patients exhibiting a PVR to ETV therapy. METHODS: This study included 364 treatment-naive CHB patients treated with ETV for > or =48 weeks and who received continuous ETV monotherapy for > or =96 weeks. PVR was defined as a decrease in serum hepatitis B virus (HBV) DNA of more than 2 log10 IU/mL from baseline but with detectable HBV DNA by real-time PCR assay at week 48. RESULTS: Fifty-two of the 364 patients (14.3%) showed a PVR. Among them, 41 patients received continuous ETV monotherapy for > or =96 weeks (median duration 144 weeks, range 96-312 weeks), and 40 of these patients (95%) achieved a virologic response (VR, HBV DNA <20 IU/mL) during prolonged ETV monotherapy (median duration 78 weeks, range 60-288 weeks). The cumulative probabilities of a VR at weeks 96, 144, and 192 from treatment initiation were 78.0%, 92.7%, and 95.1%, respectively. The VR rate was 97.2% (35/36) in HBeAg-positive patients and 100% (5/5) in HBeAg-negative patients. In multivariate analysis, HBeAg positivity (odds ratio [OR], 9.231; 95% confidence interval [CI], 1.03-82.91; P=0.047) and a high baseline HBV DNA level (OR, 0.170; 95% CI, 0.08-0.37; P=0.000) were independently associated with a delayed virologic response. No patient developed genotypic resistance to ETV during follow-up. CONCLUSIONS: Long-term ETV monotherapy is effective for achieving a VR in treatment-naive CHB patients exhibiting a PVR to ETV. HBeAg positivity and high baseline HBV DNA level were independently associated with a delayed virologic response.

A Case of IgG4-Related Sclerosing Mesenteritis Associated with Crohn's Disease / 대한소화기학회지

Sclerosing mesenteritis (SM) is a rare disease characterized by chronic nonspecific mesenteric inflammation and fibrosis of unknown etiology. Some tumefactive SM shows diffuse accumulation of IgG4-positive plasma cells and is considered as a part of the spectrum of IgG4-related disease. An association between inflammatory bowel disease and IgG4-related disease has been indicated. A 45-year-old woman visited our hospital due to weight loss with intermittent lower abdominal discomfort. Pelvic ultrasound revealed a mass-like lesion in the abdominal wall and pelvis MRI demonstrated a 5.9 cm sized wall-enhancing mass with heterogeneous signal intensity from right adnexa to the abdominal wall. Tumor resection and adhesiolysis was done because of severe adhesion with the small bowel, colon, bladder, uterus, and abdominal wall. Appendectomy was also performed due to adhesion and edematous change. Histological examination of the resected mass showed findings that were compatible with IgG4-related SM. The resected appendix showed chronic granulomatous inflammation without evidence of tuberculosis. She was diagnosed with Crohn's disease after undergoing colonoscopy and CT enterography. Herein, we report a rare case of IgG4-related SM that occurred in conjunction with Crohn's disease.

The Changes of Myosin Heavy Chain Isoforms after Tenotomy on Extraocular Muscle Layers of Rabbits

PURPOSE: Extraocular muscle (EOM) consists of two layers, the global and the orbital layer, which are readily distinguished by their histopathology. This study was conducted to investigate the changes of myosin heavy chain (MHC) and MHC isoforms of the global and the orbital layers of EOM after tenotomy. METHODS: Twenty four New Zealand white rabbits were used. The rectus muscles were harvested on day 3, week 1, week 2, week 3, week 4, and week 8 after EOM tenotomy. The change of MHC amount was measured using an electrophoresis. The changes of MHC isoforms were also measured quantitatively using western blot immunostaining. RESULTS: The amount of total MHC, fast MHC isoform, and slow MHC isoform decreased maximally at 1-week after EOM tenotomy and recovered at 4-week and 8-week after tenotomy. There was no significant change in the amount of the neonatal and developmental MHC isoform. CONCLUSIONS: Fast and slow MHC isoform changed mainly due to the changes in the global layer rather than in the orbital layer after EOM tenotomy.

Intramuscular Hemangioma of the Upper Lid

PURPOSE: Intramuscular hemangioma (IMH) is a rare benign tumor occurring frequently on the trunk and extremities. It is uncommon in the head and neck area, especially in the lid, and is difficult to diagnose preoperatively due to its deep location. A case of IMH of the upper lid area is presented. METHODS: A 14-year-old female presented with a mass in the upper lid and brow area of the left side since 1 month of her age. The patient underwent debulking of the mass. The mass was easy to bleed, yellowish and fatty in appearance. The mass infiltrated surrounding orbicularis and frontalis muscle. RESULTS: Microscopically, the mass was composed of vessels of various size and adipose tissues that extended between individual muscle fibers. CONCLUSIONS: IMH is a rare tumor of the periorbital region, hence preoperative diagnosis is difficult. IMH must be kept in mind as the differential diagnosis in patients of young age presenting with a periorbital soft tissue mass.