Platelet count is associated with sustained virological response rates in treatments for chronic hepatitis C

BACKGROUND/AIMS@#This study was conducted to clarify the sustained virological response (SVR) prediction ability of baseline and treatment-related factors in patients with chronic hepatitis C virus (HCV) infection.@*METHODS@#This retrospective study collected data at four tertiary referral hospitals between June 2004 and July 2012. Out of 476 patients, 330 treatment-naïve patients with chronic HCV infection were recruited. Pegylated interferon α-2a/-2b plus ribavirin was administered for either 24 or 48 weeks depending on the HCV genotype. The baseline and treatment-related predictive factors of SVR were evaluated by analyzing data measured before treatment (i.e., baseline) and during treatment.@*RESULTS@#SVR rates for genotypes 1 and 2 were 63% (97/154) and 79.5% (140/176), respectively (p = 0.001). Multivariate analysis for baseline factors revealed that young age (p = 0.009), genotype 2 (p = 0.001), HCV RNA level of 150 × 10³/µL (p 150 × 10³/µL. In multivariate analysis for treatment-related factors, SVR was associated with achievement of a rapid virological response (RVR; p < 0.001), treatment adherence of ≥ 80/80/80 (p < 0.001).@*CONCLUSIONS@#Young age, genotype 2, low HCV RNA level, RVR, and treatment adherence were significantly associated with SVR. In addition, platelet count was an independent predictive factor for SVR. Therefore, platelet count could be used to develop individualized treatment regimens and to optimize treatment outcomes in patients with chronic HCV infection.

"Cat Scratch Colon" in a Patient with Ischemic Colitis

"Cat scratch colon" is a gross finding characterized by hemorrhagic mucosal scratches on colonoscopy. It is usually associated with a normal colon and is rarely associated with collagenous colitis. In a previous report, cat scratch colon was noted in the cecum and ascending colon, but has also been observed in the distal transverse colon. The patient in this study was also diagnosed with ischemic colitis that may have played a role in the development of cat scratch colon.

Clinical Features of Drug-induced Liver Injury According to Etiology

Drug-induced liver injury (DILI) is an increasingly common cause of acute hepatitis. We examined clinical features and types of liver injury of 65 affected patients who underwent liver biopsy according DILI etiology. The major causes of DILI were the use of herbal medications (43.2%), prescribed medications (21.6%), and traditional therapeutic preparations and dietary supplements (35%). DILI from herbal medications, traditional therapeutic preparations, and dietary supplements was associated with higher elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels than was DILI from prescription medications. The types of liver injury based on the R ratio were hepatocellular (67.7%), mixed (10.8%), and cholestatic (21.5%). Herbal medications and traditional therapeutic preparations were more commonly associated with hepatocellular liver injury than were prescription medications (P = 0.002). Herbal medications and traditional therapeutic preparations induce more hepatocellular DILI and increased elevations in AST and ALT than prescribed medications.

High-resolution Impedance Manometry Criteria in the Sitting Position Indicative of Incomplete Bolus Clearance

BACKGROUND/AIMS: We used high-resolution impedance manometry (HRIM) to determine the length of breaks on the isobaric contour which would predict incomplete bolus clearance in patients in the sitting position. METHODS: In total, 651 swallows in 71 patients with esophageal symptoms were studied using a solid-state HRIM system in the sitting position. Each swallow was classified as complete or incomplete bolus clearance by impedance criteria and peristaltic integrity was evaluated using 20- and 30-mmHg pressure topography isobaric contours. Correlations between the lengths of the breaks for 20- and 30-mmHg were analyzed. RESULTS: Complete bolus clearance was observed in 83.3% (542/651) of swallows. Breaks of 3 and 7 cm or less were associated with a bolus clearance of 96.8% on the 20-mmHg and 94.7% on the 30-mmHg isobaric contour, respectively (P < 0.001). The areas under the ROC curves for the 20 and 30 mmHg isobaric contours were 0.900 and 0.950, respectively. The sensitivity and specificity for complete bolus clearance were 75.6% and 89.3% for breaks 3 cm or less on the 20-mmHg isobaric contour and 87.9% and 78.7% for breaks 7 cm or less on the 30-mmHg contour (P < 0.001). CONCLUSIONS: Breaks of < 3 cm in the 20-mmHg isobaric contour or < 7 cm in the 30-mmHg isobaric contour were associated with com -plete bolus clearance. The threshold for breaks in the sitting position was greater than previous reports using the supine position and longer breaks predicted incomplete bolus clearance.

Clinically Useful Diagnostic Tool of Contrast Enhanced Ultrasonography for Focal Liver Masses: Comparison to Computed Tomography and Magnetic Resonance Imaging

BACKGROUND/AIMS: To evaluate the diagnostic value of contrast (SonoVue(R)) enhancement ultrasonography (CEUS) and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI) in evaluating liver masses. METHODS: CEUS (n=50), CT (n=47), and MRI (n=43) were performed on 50 liver masses in 48 patients for baseline mass characterization. The most likely impression for each modality and the final diagnosis, based on the combined biopsy results (n=14), angiography findings (n=36), and clinical course, were determined. The diagnostic value of CEUS was compared to those of CT and MRI. RESULTS: The final diagnosis of the masses was hepatocellular carcinoma (n=43), hemangioma (n=3), benign adenoma (n=2), eosinophilic abscess (n=1), and liver metastasis (n=1). The overall diagnostic agreement with the final diagnosis was substantial for CEUS, CT, and MRI, with kappa values of 0.621, 0.763, and 0.784, respectively. The sensitivity, specificity, and accuracy were 83.3%, 87.5%, and 84.0%, respectively, for CEUS; 95.0%, 87.5%, and 93.8%, respectively, for CT; and 94.6%, 83.3%, and 93.0%, respectively for MRI. After excluding the lesions with poor acoustic sonographic windows, the sensitivity, specificity, and accuracy for CEUS were 94.6%, 87.5%, and 93.3%, respectively, with a kappa value of 0.765. CONCLUSIONS: If an appropriate acoustic window is available, CEUS is comparable to CT and MRI for the diagnosis of liver masses.

The Risk Factors for Bleeding of Fundal Varices in Patients with Liver Cirrhosis

BACKGROUND/AIMS: The relationship between portal hemodynamics and fundal varices has not been well documented. The purpose of this study was to understand the pathophysiology of fundal varices and to investigate bleeding risk factors related to the presence of spontaneous portosystemic shunts, and to examine the hepatic venous pressure gradient (HVPG) between fundal varices and other varices. METHODS: In total, 85 patients with cirrhosis who underwent HVPG and gastroscopic examination between July 2009 and March 2011 were included in this study. The interrelationship between HVPG and the types of varices or the presence of spontaneous portosystemic shunts was studied. RESULTS: There was no significant difference in the HVPG between fundal varices (n=12) and esophageal varices and gastroesophageal varices type 1 (GOV1) groups (n=73) (17.1+/-7.7 mm Hg vs 19.7+/-5.3 mm Hg). Additionally, there was no significant difference in the HVPG between varices with spontaneous portosystemic shunts (n=28) and varices without these shunts (n=57) (18.3+/-5.8 mm Hg vs 17.0+/-8.1 mm Hg). Spontaneous portosystemic shunts increased in fundal varices compared with esophageal varices and GOV1 (8/12 patients [66.7%] vs 20/73 patients [27.4%]; p=0.016). CONCLUSIONS: Fundal varices had a high prevalence of spontaneous portosystemic shunts compared with other varices. However, the portal pressure in fundal varices was not different from the pressure in esophageal varices and GOV1.

Occult Hepatitis B Virus Infection in Chronic Hepatitis C / 대한소화기학회지

Occult HBV infection is defined as the presence of HBV DNA in the liver (with or without detectable or undetectable HBV DNA in the serum) of individuals testing negative for HBsAg. Studies on occult HBV infection in hepatitis C patients have reported highly variable prevalence, because the prevalence of occult HBV infection varies depending on the hepatitis B risk factors and methodological approaches. The most reliable diagnostic approach for detecting occult HBV detection is through examination of liver DNA extracts. HCV has been suspected to strongly suppress HBV replication up to the point where it may be directly responsible for occult HBV infection development. However, more data are needed to arrive at a definitive conclusion regarding the role of HCV in inducing occult HBV infection. Occult HBV infection in chronic hepatitis C patients is a complex biological entity with possible relevant clinical implications. Influence of occult HBV infection on the clinical outcomes of chronic hepatitis C may be considered negative. However, recent studies have shown that occult HBV infection could be associated with the development of hepatocellular carcinoma and contribute to the worsening of the course of chronic liver disease over time in chronic hepatitis C patients. Nevertheless, the possible role of occult HBV infection in chronic hepatitis C is still unresolved and no firm conclusion has been made up until now. It still remains unclear how occult HBV infection affects the treatment of chronic hepatitis C. Therefore, in order to resolve current controversies and understand the pathogenic role and clinical impacts of occult HBV infection in chronic hepatitis C patients, well-designed clinical studies are needed.

Three cases of extensive liver metastasis in neuroendocrine tumors / 대한내과학회지

Malignant neuroendocrine tumors have the histological features of malignant tumors, and localized invasion and distant metastasis can occur. After clinical presentation, patients with neuroendocrine tumors usually show rapid deterioration. The first case involved a patient who underwent treatment for poorly differentiated adenocarcinoma of the lung. A percutaneous liver biopsy was performed to look for diffuse infiltration of the tumor in the liver. As a result, the patient was diagnosed with large-cell neuroendocrine carcinoma of the lung with diffuse liver metastasis. The other two patients presented with liver masses. Liver biopsies revealed metastatic neuroendocrine tumors of the liver. In patients presenting with diffuse hepatic infiltration of a tumor, a neuroendocrine tumor should be considered in the diagnosis, and immunohistochemical staining and further studies should be performed to locate the origin of the tumor. We report three cases of neuroendocrine tumors with diffuse liver metastasis.

Experience of Osteomyelitis of the Pubic Symphysis Following Surgical Treatment of Perianal Necrotizing Fasciitis / 감염과화학요법

Osteomyelitis of the pubic symphysis is not common and has often been reported to occur after urological or gynecological procedures. It can be spontaneous in origin but it also is associated with trauma, athletic exertion, pregnancy, and parturition. The early symptoms of osteomyelitis of the pubic symphysis mimic those of osteitis pubis, and therefore, the differential diagnosis between these two entities is of clinical importance. A fifty nine-year-old man who had previously received debridement and wide excision of perianal necrotizing fasciitis visited our hospital with pain on both inguinal areas. The core biopsy of the pubic symphysis and aspiration culture were performed, from which Pseudomonas aeruginosa was recovered. He was treated with parenteral ceftazidime for 5 days followed by cefepime for 7 weeks and showed favorable clinical response. To our knowledge, this is the first report on osteomyelitis of pubic symphysis resulting from debridement and wide excision of perianal necrotizing fasciitis in Korea.

Experience of Osteomyelitis of the Pubic Symphysis Following Surgical Treatment of Perianal Necrotizing Fasciitis / 감염과화학요법

Osteomyelitis of the pubic symphysis is not common and has often been reported to occur after urological or gynecological procedures. It can be spontaneous in origin but it also is associated with trauma, athletic exertion, pregnancy, and parturition. The early symptoms of osteomyelitis of the pubic symphysis mimic those of osteitis pubis, and therefore, the differential diagnosis between these two entities is of clinical importance. A fifty nine-year-old man who had previously received debridement and wide excision of perianal necrotizing fasciitis visited our hospital with pain on both inguinal areas. The core biopsy of the pubic symphysis and aspiration culture were performed, from which Pseudomonas aeruginosa was recovered. He was treated with parenteral ceftazidime for 5 days followed by cefepime for 7 weeks and showed favorable clinical response. To our knowledge, this is the first report on osteomyelitis of pubic symphysis resulting from debridement and wide excision of perianal necrotizing fasciitis in Korea.

A Case of Tracheomegaly and Recurrent Pneumomediastinum Combined with Pulmonary Fibrosis / 결핵및호흡기질환

Tracheomegaly is a distinctive condition that presents with marked dilation of the trachea. Spontaneous pneumomediastinum is the result of alveolar rupture with dissection of the airway along the bronchus and into the mediastinum. Tracheomegaly and recurrent spontaneous pneumomediastinum are rare complications of pulmonary fibrosis when combined with rheumatoid arthritis. We present a case of tracheomegaly and recurrent spontaneous pneumomediastinum that was precipitated by repeated respiratory infection and chronic cough in a patient with pulmonary fibrosis that was associated with rheumatoid arthritis.

Four Cases of Dengue Fever-Dengue Hemorrhagic Fever and Domestic Literature Review / 감염과화학요법

Dengue virus infection is an emerging imported disease in Korea. A total of 4 cases of dengue fever or dengue hemorrhagic fever diagnosed at Soonchunhyang University Hospital in Bucheon between January 2001 and December 2007 were retrospectively reviewed. In addition, relevant domestic literatures from Korean bibliographic databases, which matched 'dengue fever', 'dengue hemorrhagic fever' or 'dengue shock syndrome' as key words, have been reviewed. Ten articles (13 patients) met the inclusion criteria and were included in this review. All the patients except for one, who was infected in Africa, were infected in Asian countries: Philippines (4), Indonesia (3), India (2), Cambodia (2), Sri Lanka (1), Thailand (1), Bangladesh (1), Myanmar (1), and Malaysia (1). Clinical manifestations after returning from abroad were as follows: fever (100%), chills (82%), headache (65%), myalgia (53%), nausea (41%), neutropenia (82%), thrombocytopenia (82%), and elevation of AST (82%) and ALT (53%). Most of the patients improved with conservative care except for one who died of dengue shock syndrome.

A Case of 'True' Fungus-Infected Aneurysm of Abdominal Aorta in an Immunocompetent Patient / 감염과화학요법

Infected aneurysms are uncommon, frequently fatal lesions. "True" fungus-infected aneurysms are even rarer. Fungal infections have high morbidity and mortality. However, diagnosis is frequently difficult, since the symptoms are non-specific and standard diagnostic procedures are often insensitive. We experienced a patient with persistent fever and negative blood cultures. The patient was immunocompetent and had no risk factors, and was diagnosed with a fungus-infected aneurysm based on computed tomography and vascular surgery. The vascular tissue revealed some narrow-based budding yeast within the thrombus, suggesting Candida infection. Seventeen cases of infected aneurysm of the abdomen were reported in Korea from 1988 to 2007, although none were "true" fungus-infected aneurysms, making this the first fungus-infected aneurysm of the abdomen in Korea. Prompt diagnostic procedures and aggressive treatment modalities are necessary for patients with occult infection and negative blood cultures, regardless of their immunocompetence, because of the high morbidity and mortality of this condition.

Four Cases of Dengue Fever-Dengue Hemorrhagic Fever and Domestic Literature Review / 감염과화학요법

Dengue virus infection is an emerging imported disease in Korea. A total of 4 cases of dengue fever or dengue hemorrhagic fever diagnosed at Soonchunhyang University Hospital in Bucheon between January 2001 and December 2007 were retrospectively reviewed. In addition, relevant domestic literatures from Korean bibliographic databases, which matched 'dengue fever', 'dengue hemorrhagic fever' or 'dengue shock syndrome' as key words, have been reviewed. Ten articles (13 patients) met the inclusion criteria and were included in this review. All the patients except for one, who was infected in Africa, were infected in Asian countries: Philippines (4), Indonesia (3), India (2), Cambodia (2), Sri Lanka (1), Thailand (1), Bangladesh (1), Myanmar (1), and Malaysia (1). Clinical manifestations after returning from abroad were as follows: fever (100%), chills (82%), headache (65%), myalgia (53%), nausea (41%), neutropenia (82%), thrombocytopenia (82%), and elevation of AST (82%) and ALT (53%). Most of the patients improved with conservative care except for one who died of dengue shock syndrome.

A Case of 'True' Fungus-Infected Aneurysm of Abdominal Aorta in an Immunocompetent Patient / 감염과화학요법

Infected aneurysms are uncommon, frequently fatal lesions. "True" fungus-infected aneurysms are even rarer. Fungal infections have high morbidity and mortality. However, diagnosis is frequently difficult, since the symptoms are non-specific and standard diagnostic procedures are often insensitive. We experienced a patient with persistent fever and negative blood cultures. The patient was immunocompetent and had no risk factors, and was diagnosed with a fungus-infected aneurysm based on computed tomography and vascular surgery. The vascular tissue revealed some narrow-based budding yeast within the thrombus, suggesting Candida infection. Seventeen cases of infected aneurysm of the abdomen were reported in Korea from 1988 to 2007, although none were "true" fungus-infected aneurysms, making this the first fungus-infected aneurysm of the abdomen in Korea. Prompt diagnostic procedures and aggressive treatment modalities are necessary for patients with occult infection and negative blood cultures, regardless of their immunocompetence, because of the high morbidity and mortality of this condition.

A Case of Double Primary Neurilemmoma on Both Chest Wall, One of Them is Bulging to Skin from Intercostal Nerve / 결핵및호흡기질환

Neurilemmomas are benign nerve sheath tumors derived from Schwann cells that rarely occur in the chest wall. Neurilemmomas of the chest wall are usually solitary lesions that bulge toward the pleural cavity. Neurilemmomas are confirmed histologically based on the presence of Verocay bodies, Antoni A and Antoni B tissue patterns and S-100 protein. Bilateral neurilemmomas in the chest wall are extremely rare, as are those that grow in the subcutaneous tissue but not the pleural area. We report here a case of bilateral chest wall neurilemmomas in which the tumors bulged out to the skin and were palpable.

Use of Molecular Identification Analysis in a Case of Intra-familial Transmission of Tuberculosis / 결핵및호흡기질환

No abstract available.