Advanced fibrosis is not a negative pretreatment predictive factor for genotype 2 or 3 chronic hepatitis C patients

BACKGROUND/AIMS: Chronic hepatitis C patients with advanced fibrosis have unsatisfactory sustained virological response (SVR) rates. Few data demonstrating the efficacy of combination therapy in chronic hepatitis C patients with advanced fibrosis in South Korea are available. The purpose of this study was to assess whether the stage of fibrosis impacts the efficacy of combination therapy for chronic hepatitis C. METHODS: We retrospectively reviewed data for a total of 109 patients with chronic hepatitis C, treated with peginterferon alfa and ribavirin. SVR according to the stage of liver fibrosis assessed by pretreatment liver biopsy and genotype results were analyzed. RESULTS: Data from 66 genotype 1 patients (60.6%) and 43 genotype 2 or 3 patients (39.4%) among the 109 patients were analyzed. SVR rates for the genotype 1 patients were significantly lower for the stage 3-4 group (32.1%) than the stage 0-2 group (78.9%; P<0.001). SVR rates (92.0% for stage 0-2, 77.8% for stage 3-4, P=0.184) of genotype 2 or 3 patients were not significantly different according to fibrosis stage. Likewise, the frequency of adverse events was not significantly different according to fibrosis stage. CONCLUSIONS: Compared to patients without advanced fibrosis, we can anticipate good SVR rates for genotype 2 or 3 patients with advanced fibrosis and they did not show an inferior tolerability for peginterferon and ribavirin combination therpy. Our results suggest that active treatment is needed for genotype 2 or 3 patients with advanced fibrosis.

A Case of Primary Colon Amyloidosis Presenting as Hematochezia / 대한소화기학회지

Amyloidosis is characterized by a deposition of insoluble fibrils in various organs and tissues. Amyloid deposition, in the gastrointestinal track, provokes a dysfunction of the organ, due to an accumulation of fibrils, and causes a variety of clinical symptoms and endoscopic findings. Primary amyloidosis in the gastrointestinal tract is rarely reported in Korea. We experienced a case of recurrent intestinal bleeding, in a 59-year-old female patient with primary amyloidosis. A colonoscopy revealed the presence of multiple large circular ulcers. In the entire colon, diffuse nodular lesions with edema and bleeding were found. A colonoscopic biopsy established the diagnosis of amyloidosis, to the exclusion of other disease components. We concluded that the patient had localized amyloidosis. Though a definitive therapeutic strategy has not been established for localized gastrointestinal amyloidosis, the patient has been successfully treated with a high-dose of steroids and azathioprine.

Could Nafamostat or Gabexate Prevent the Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis? / 대한소화기학회지

BACKGROUND/AIMS: ERCP is the most common procedure for the diagnosis and treatment of bile duct and pancreatic disease, but Post-ERCP pancreatitis makes poor outcome in some cases. The protease inhibitors, nafamostat and gabexate, have been used to prevent pancreatitis related to ERCP, but there is some debate. We tried to evaluate the efficacy of gabexate and nafamostat for the prevention of post-ERCP pancreatitis. METHODS: Two hundred forty two patients (73 patients in the gabexate group, 88 patients in the nafamostat group and 81 patients in the placebo group) were included in the study after selective exclusion. The incidence of pancreatitis after ERCP was compared among groups. RESULTS: The incidence of pancreatitis were 6.8% in the gabexate group, 5.7% in the nafamostat group and 6.2% in the placebo group (p=0.954). CONCLUSIONS: There was no meaningful difference among the gabexate, nafamostat and placebo group.

Abscesso-Colonic Fistula Following Radiofrequency Ablation Therapy for Hepatocellular Carcinoma; A Case Successfully Treated with Histoacryl Embolization / 대한소화기학회지

Hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms occuring worldwide. Although surgical resection still remains the treatment of choice for HCC, radiofrequency ablation (RFA) has emerged as reliable alternatives to resection. It is less invasive and can be repeated after short intervals for sequential ablation in case of multiple lesions. The most common complication of RFA is liver abscess, and bile duct injury such as bile duct stricture has been reported. This is a case report of a rare complication of abscesso-colonic fistula after RFA for HCC. The case was treated by percutaneous abscess drainage and antibiotics and occlusion of abscesso-colonic fistula with n-butyl-2-cyanoacrylate embolization.

Morphometric Analysis of Maxillary Sinus Floor and Alveolar Process in Korean / 체질인류학회지

The implant placement and sinus floor elevation on maxillae have required the accurate understanding of maxillary sinus floor and alveolar process. Therefore, the purpose of this study was to investigate the maxillary sinus floor morphology and the correlation between maxillary sinus floor and alveolar process in Korean. Twenty-nine cadaveric maxillae with normal teeth were used, with age at death ranging from 40 to 90 years (mean: 59.9 years). After the maxilla was cut above the nasal cavity floor, it was sectioned at midline of the tooth from 1st premolar to 2nd molar by parallel to long axis of the tooth. The specimens were scanned using the Scanner (HP Scanjet G4050). The scan image was measured using Adobe Photoshop CS3 at the 0.01 mm. Mean, SD, and correlation coefficient (r) were took using SPSS. The width of maxillary sinus floor at nasal cavity floor level was 7.87+/-3.04 mm at 1st premolar (P1), 11.05+/-4.40 mm at 2nd premolar (P2), 13.21+/-4.78 mm at 1st molar (M1), and 12.47+/-4.32 mm at 2nd molar (M2). The depth of maxillary sinus floor at nasal cavity floor level was -3.74+/-4.57 mm, -4.77+/-4.80 mm, -4.84+/-4.69 mm, and -4.19+/-6.24 mm at P1, P2, M1, and M2, respectively. The height of alveolar process bone was 19.02+/-3.36 mm, 15.71+/-4.44 mm, 13.59+/-3.22 mm, and 12.50+/-2.99 mm at P1, P2, M1, and M2, respectively. The correlation coefficient (r) between the width of maxillary sinus floor and the height of alveolar process was 0.342, 0.631, 0.602, and 0.543 at P1, P2, M1, and M2, respectively, which were lack of correlations. The correlation coefficient (r) between the depth of maxillary sinus floor and the height of alveolar process was 0.808, 0.899, 0.789, and 0.805 at P1, P2, M1, and M2, respectively. It represented that the deeper the depth of maxillary sinus floor, the lower the height of alveolar process was. In conclusion, the maxillary sinus floor in Korean was the deepest and the widest at M1, and the height of alveolar process was the lowest at M2. This result provided useful anatomic information about maxillary sinus floor for the implant placement and sinus floor elevation.