A case of esophageal variceal bleeding due to a hepatic arterioportal shunt through a hemangioma in cirrhosis / 대한내과학회지

The hepatic hemangioma is the most common benign tumor in the liver. Most hemangiomas are asymptomatic and treatment is not required. Rarely, complications occur due to a hepatic arterioportal shunt through a large high-flow hemangioma. We report a case of recurrent esophageal variceal bleeding despite repeated esophageal variceal ligation (EVL) due to a hepatic arterioportal shunt through a large high-flow hemangioma that was successfully treated with hepatic arterial embolization, in a patient with cirrhosis and end stage renal disease.

Comparison of Model for End-stage Liver Disease Score with Discriminant Function and Child-Turcotte-Pugh Scores for Predicting Short-term Mortality in Korean Patients with Alcoholic Hepatitis / 대한소화기학회지

BACKGROUND/AIMS: Alcoholic hepatitis is an acute or acute-on-chronic inflammatory syndrome associated with significant morbidity and mortality. Traditionally, Maddrey discriminant function (DF) score and Child-Turcott- Pugh (CTP) score have been used for stratifying the prognosis of alcoholic hepatitis. Recently, the model for end-stage liver disease (MELD) score has been applied to alcoholic hepatitis and some investigators consider MELD score as a better prognostic indicator for severe alcoholic hepatitis. Therefore, this analysis was aimed to compare MELD score with DF and CTP scores for predicting the short-term mortality in Korean patients with alcoholic hepatitis. METHODS: The medical records of patients hospitalized with alcoholic hepatitis between January 1, 1999 and December 31, 2004 at Hanyang University Guri-Hospital were analyzed retrospectively. RESULTS: Of the 138 medical records reviewed, 74 cases fulfilled the inclusion criteria (61 males and 13 females; mean age 47.1 years). Twelve patients (16.2%) died within 90 days after admission. Univariate analysis demonstrated that variables such as ascites, hepatic encephalopathy, splenomegaly, international normalized ratio, CTP, and DF scores were significantly correlated with increased 90-day mortality while MELD score was not. According to the multivariate analysis, only CTP score was statistically significant (p=0.012) while DF and MELD scores were not significant for predicting 90-day mortality. The survival analysis with Cox regression test showed higher DF and CTP scores, but not MELD score, significantly increased the risk of in-hospital mortality. CONCLUSIONS: This study demonstrates that DF and CTP scores are independent predictors of short-term mortality in patients with alcoholic hepatitis.

The Study of Plasma D-lactate Level and Acid-base Imbalance in Cirrhotic Patients / 대한신장학회잡지

PURPOSE: D-lactate, optical isomer of L-lactate is not a human metabolite. Once the D-lactate enters the human body, it is mainly metabolized in liver. The metabolism of D-lactate can be changed in patients with decompensated liver cirrhosis with the exposure of antibiotics and the frequent trial of lactulose, if neccessory. The aim of this study is to analyze blood D-lactate level in cirrhotic patients and it's relationship with the degree of hepatic insufficiency and acid-base imbalance. METHODS: Plasma L-lactate and D-lactate levels were measured in 40 cirrhotic patients classified by Child-Pugh system with L-LDH and D-LDH with comparison of their changes before and after the use of antibiotics and lactulose(n=14). Also, acid-base disorders were analyzed in 35 cirrhotic patients, and plasma L, D-lactate levels were determined in each acid-base disorder. RESULTS: Plasma D-lactate level was not significantly elevated in cirrhotic patients compared to the control group(2.34+/-.48 mmol/L vs. 1.63+/-.26 mmol/ L, p=NS), but some patients(n=4, 10%) revealed abnormally elevated D-lactate level. The plasma L, D- lactate levels were not different in subgroups classified by Child-Pugh system as well as by underlying causes of liver cirrhosis, and plasma D-lactate level was not sugnificnatly different before and after the exposure of antibiotics and lactulose. Plasma D-lactate level was significantly increased in 3 patients with respiratory alkalosis and metabolic acidosis(12+/-.98 mmol/L) compared to others(p<0.05). CONCLUSION: These results suggest that, regardless of its decompensated degree and exposure to drugs, a subset of patients with liver cirrhosis can develop elevation of D-lactate in blood, particularly when metabolic acidosis is accompanied.

A case of acute renal failure complicated during interferon treatment of chronic hepatitis B / 대한내과학회지

Hepatitis B virus infection is known to be associated with various types of glomerulonephritis (GN), including membranous GN, membranoproliferative GN, and mesangial proliferative GN. Although there has been considerable experiences with interferon in clinical trials during the past decade, acute renal failure as a complication of interferon treatment has rarely been reported. We report a case in which acute renal failure with proteinuria was associated with interferon-alpha treatment. A 33-year-old man with chronic hepatitis B presented with diarrhea and RUQ pain. Two weeks after INF-alpha treatment, Oliguria and proteinuria suddenly occurred, although the hepatic function was improved. With discontinuation of interferon treatment and ultrafiltration, his renal function was improved.

A Case of Endoscopic Band Ligation Therapy in Gastric Arteriovenous Malformation / 대한소화기내시경학회지

Although various endoscopic treatments, such as laser photocoagulation, electrocoagulation, heater probe, injection have been used for treatment of arteriovenous malformation (AVM), associated complications also have been reported. In order to avoid the complications, elastic band ligation has recently been used as an alternative method for endoscopic treatment of gastric AVM. A 58-year-old man was admitted due to hematemesis and melena. A gastroscopy revealed AVM with vessel exposure and active bleeding at the greater curvature of fundus, and we performed arteriography for emergency embolization, but, we do not find the bleeding vessel. Endoscopic band ligation therapy was performed as an alternative method for control of bleeding. 2 months later, follow-up endoscopy showed disappearance of AVM and no evidence of hemorrhage.

A Case of Tuberculous Peritonitis Confirmed by Peritoneoscopy

Tuberculous peritonitis is mainly transmitted via hematogenous spreading of tuberculous bacilli. But sometimes this disease is occured, as the abdominal lymph node infected by the localized tuberculous enteritis was ruptured We pressent the report and the brief review of related literatures, who experienced a case of tuberculous peritonitis confirmed by paracentiesis and peritoneoscopic examination in a 9 years old male patient who was suspected toa malignant tumor because of the recent unexplained abdominal distension.