A Case of Single Mass Forming Hepatic Tuberculoma / 계명의대학술지

Tuberculosis mainly develops in the lung, but may also rarely invade other parts of the abdominal region. Abdominal tuberculosis is associated with pulmonary tuberculosis in approximately 15% of cases, and abdominal tuberculosis primarily develops in the terminal ileum and lymphatic gland. Moreover, hepatic tuberculosis is uncommon and is usually accompanied with active pulmonary or miliary tuberculosis. Hence, the development of primary hepatic tuberculoma as a single liver mass is very unusual. In the present report, we describe the case of a 63-year-old man with a solitary hepatic tuberculoma; the 6.4 cm mass was incidentally detected during abdominal computed tomography in the asymptomatic patient, and the diagnosis was confirmed by liver biopsy through ultrasonography-guided fine-needle aspiration.

Erectile dysfunction in patients with liver disease related to chronic hepatitis B

BACKGROUND/AIMS: Despite sexual function making an important contribution to the quality of life, data on erectile function are relatively scant in patients with chronic liver disease. We evaluated the prevalence of and risk factors for erectile dysfunction (ED) in patients with liver disease related to hepatitis B, especially among those with chronic hepatitis B (CHB) or early-stage cirrhosis. METHODS: In total, 69 patients (35 with CHB and 34 with hepatitis-B-related liver cirrhosis [HBV-LC]) aged 40-59 years were analyzed. Child-Pugh classes of A and B were present in 30 (88.2%) and 4 (11.8%) of the patients with HBV-LC, respectively. The erectile function of the patients was evaluated using the Korean version of IIEF-5. RESULTS: The prevalence of any ED was 24.6% for all patients, and 8.6% and 41.2% for those with CHB and HBV-LC, respectively (P=0.002). While there was only one (2.9%) CHB patient for each stage of ED, mild, moderate, and severe ED stages were seen in three (8.8%), one (2.9%), and ten (29.4%) of the HBV-LC patients, respectively. Multiple regression analysis identified the type of liver disease (P=0.010), hypertension (P=0.022), score on the Beck Depression Inventory (P =0.044), and the serum albumin level (P=0.014) as significant independent factors for the presence of ED. CONCLUSIONS: The prevalence of ED was significantly higher in patients with early-stage HBV-LC than in those with CHB. Therefore, screening male patients with early viral cirrhosis for ED and providing appropriate support are needed, especially when the cirrhosis is accompanied by hypertension, depression, or a depressed level of serum albumin.

Spontaneous Regression of Recurred Hepatocellular Carcinoma with Multiple Lung Metastases

Hepatocellular carcinoma (HCC) is the most common form of liver malignancy. Spontaneous regression of HCC is extremely rare phenomenon and mechanism of regression remains ob-scure. 75-year-old woman previously diagnosed with hepatitis C virus-related liver cirrhosis was found to have single mass in liver with elevation of alpha-fetoprotein level to 10,320 ng/mL. Transarterial chemoembolization (TACE) was performed. 27 months after TACE recurred HCC with multiple lung nodules were confirmed. The patient refused any therapeutic modality. The patient underwent follow-up without any anti-cancer treatment. 8 months after recur-rence follow up computed tomography scan revealed spontaneous regression of HCC and completely disappeared lung nodules. The patient is currently doing well and without any evidence of recurrence. The causes of spontaneous regression of HCC are not well understood. Proposed mechanisms are ischemic injury, biological factors, herbal medicine, immunological variations. Further studies are necessary to improve our understanding of this rare phenom-enon.

Clinical Factors for Consideration in Patients with Gastric Hyperplastic Polyps Treated by Endoscopic Polypectomy

BACKGROUND/AIMS: Hyperplastic polyps are the most common type of gastric polyps that constitute 30~93% of all benign epithelial gastric polyps. The overall prevalence of dysplasia in patients with hyperplastic polyps is believed to be 2 cm). We aimed to identify the clinical features of hyperplastic polyps that undergo neoplastic transformation. MATERIALS AND METHODS: Between March 2011 and June 2013, 315 hyperplastic polyps that were removed by endoscopic polypectomy from 217 patients were analyzed retrospectively. RESULTS: Neoplastic transformations were found in 5 cases (1.6%), including 3 cases of adenoma (1.0%) and 2 cases of adenocarcinoma (0.6%). Polypectomy-associated complications were noted in only 2 cases (0.6%), which were bleeding in both cases. Neoplastic transformation was significantly associated with the absence of hyperemia on endoscopy (non-neoplastic transformation group, n=26 [8.4%] vs. neoplastic transformation group, n=3 [60%]; P=0.006). However, no other significant differences was found between these groups in terms of age, sex, presence of Helicobacter pylori, size, location, number of detected polyps in each patient, and endoscopic appearances such as nodular changes or erosions and shape. CONCLUSIONS: No clinical factors were associated with the neoplastic transformation of hyperplastic polyps. In addition, neoplastic transformations were almost impossible to identify using endoscopy. Therefore, endoscopic polypectomy could be considered for the accurate diagnosis and definitive treatment of gastric hyperplastic polyps <1 cm in size.

Successful Treatment of a Gastric Plasmacytoma Using a Combination of Endoscopic Submucosal Dissection and Oral Thalidomide

We report a rare case of a gastric plasmacytoma treated with endoscopic resection and oral thalidomide therapy. A 70-year-old man was admitted to our hospital with indigestion. He had no specific medical history and unremarkable laboratory results. Gastroendoscopic findings revealed a focal, erythematous, flat elevated lesion in the anterior wall of the stomach antrum. A biopsy revealed atypical lymphocytes. Endoscopic submucosal dissection (ESD) with an insulation-tipped knife was performed 45 days after diagnosis. Radiological and hematological evaluations, including a bone marrow biopsy, were performed and showed no involvement of other organs. The patient was diagnosed with extramedullary gastric plasmacytoma. Follow-up gastroendoscopy was performed three times during a 2-year period and showed nonspecific ESD scarring. The patient's condition was found to be stable.

Clinical features of 28 acutely toxic hepatitis patients who ingested Dictamnus dasycarpus: A single center clinical experience / 대한내과학회지

BACKGROUND/AIMS: The aim of this study was to investigate the clinical features of acutely toxic hepatitis associated with ingesting Dictamnus dasycarpus (D. dasycarpus). METHODS: Between January 2004 and July 2009, 28 patients were enrolled in this study. We reviewed the medical records retrospectively. Acutely toxic hepatitis associated with D. dasycarpus was diagnosed by a Roussel Uclaf Causality Assessment Method Values (RUCAM) score of 6 or above. All patients were tested for viral hepatitis A, B, C, cytomegalovirus, and Epstein-Barr virus. Other tests included anti-nuclear antibody, anti-mitochondrial antibody, and anti-smooth muscle antibody. Abdominal pelvic computed tomography was performed. RESULTS: The incidence was female predominant (64% vs. 36%). The mean patient age was 53.0+/-11 years. The symptoms were jaundice (68%), fatigue (57%), nausea (43%), anorexia (43%), and abdominal pain (24%). The mean RUCAM score was 7.0+/-0.8. The biochemical patterns of hepatotoxicity were hepatocellular (n=23, 82%) and mixed types (n=5, 18%). Radiologic findings were as follows: normal findings (29%), lymphadenopathy (50%), edema of the gall bladder wall (46%), periportal edema (43%), splenomegaly (11%), fatty liver (11%), and ascites (7%). The mean hospitalization period was 21.6+/-11.6 days. The mean duration of recovery from hepatitis was 56.6+/-30.4 days, and all patients recovered completely from the toxic hepatitis. One patient who had severe jaundice developed a complication of pure red cell aplasia during the hospitalization period. CONCLUSIONS: The biochemical pattern of liver injury was hepatocellular predominant. Although the initial manifestations and clinical course were variable, all patients completely recovered with supportive care or steroid treatment. Toxic hepatitis was accompanied by pure red cell aplasia in one patient.

Clinical characteristics of 159 cases of acute toxic hepatitis / 대한간학회지

BACKGROUNDS/AIMS: Toxic hepatitis has recently been discovered to be a major cause of acute hepatitis. We studied the clinical features and prognosis of patients diagnosed with toxic hepatitis at a single institution. METHODS: A retrospective analysis was performed using medical records of 159 cases of toxic hepatitis that were diagnosed from March 2003 to March 2008. Patients were selected based on a RUCAM score of 4 or above. RESULTS: The incidence was higher in women (n=97) than in men (n=62). The age (mean+/-SD) of the patients was 51+/-15 years . The major causes of the disease included the use of Korean traditional therapeutic preparations (34.0%), herbal medicines (41.5%), and drugs prescribed by a physician (23.9%). At the time of admission, jaundice was the most common symptom (41.5%), and the results of a liver serum battery were as follows: aspartate aminotransferase, 729.4+/-877.0 IU/L; alanine aminotransferase, 857.1+/-683.0 IU/L; total bilirubin, 6.4+/-6.5 mg/dL; and alkaline phosphatase, 209.8+/-130.0 IU/L. The hospitalization period was 10.0+/-9.5 days, and the duration of recovery from liver injury was 31.0+/-29.5 days. The factors associated with the hospitalization period included the presence of anorexia and the serum levels of albumin and bilirubin at the time of admission (P<0.05). A high serum bilirubin level and a history of alcohol ingestion were associated with a delayed recovery (Plt;0.05). The sex, age, BMI, and duration of medication were not significantly related to the hospitalization and recovery periods. CONCLUSIONS: The main cause of acute toxic hepatitis in the current study was the use of herbal medicines. The severity of liver injury at the time of admission was a major factor significantly associated with the hospitalization and recovery periods.

The effect of curative surgical resection and adjuvant radiotherapy in patients with extrahepatic bile duct cancer / 대한내과학회지

BACKGROUND/AIMS: To evaluate the effect and prognostic factors related to curative surgical resection and adjuvant radiotherapy in patients with extrahepatic bile duct cancer. METHODS: The authors performed a retrospective analysis of 53 patients with extrahepatic bile duct cancer who were treated at Chungnam National University Hospital between 1998 and 2005. 18 patients (Group 1) were managed with percutaneous bile drainage (n=13) or endoscopic bile drainage (n=5), 17 patients (Group 2) underwent only curative resection, and 18 patients (Group 3) received radiotherapy after curative resection. The radio-sensitizer used in these patients was 5-FU. RESULTS: Three-year overall survival was 5.6% in group 1, 64.7% in group 2, and 61.1% in group 3, with no significant difference noted between group 2 and group 3. The disease-free survival rate was 64.7% in group 2 and 66.7% in group 3, with no significant difference noted between the two groups. We evaluated age, sex, differentiation, tumor location, perineural invasion, operative method, lymphovascular tumor emboli, T stage, and N stage as possible prognostic factors. T stage, N stage, and operative method were significant factors in group 2, but age was the only significant factor in group 3. Group 2 patients had longer overall survival than did group 3 patients with well-differentiated cancer, but group 3 patients had longer survival than did group 2 patients with lymph node metastasis. The recurrence rate was 34.3% (mean value) and was no different between group 2 and group 3. Recurrence sites included local tissue, such as liver, and regional lymph nodes. There were no serious complications during radiotherapy. CONCLUSIONS: Patients who underwent curative surgical resection and adjuvant radiotherapy after surgery had no statistically significant difference in survival or recurrent rates. However, curative surgery is considered to be the only method to improve survival. Our results suggest that radiotherapy after curative resection may improve survival in patients with lymph node metastasis.

The Use of Uncovered Self-Expandable Metallic Stents for Palliation ofGastric Outlet Obstruction Caused by Stomach Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: The purpose of this study is to investigate the effectiveness and safety of the use of uncovered self-expandable metallic stents as a palliative therapy for gastric outlet obstruction caused by stomach cancer. METHODS: A total of 36 patients who underwent uncovered stent insertion were investigated. Hanarostents (uncovered pyloric/duodenal stents, M.I. Tech Co., Ltd.) were used in the procedures. The technical success rate, clinical success rate, presence of clinical symptoms and complications were estimated during the study period. RESULTS: The technical success rate for stent replacement was 97.2% (35 out of 36 patients) and the clinical success rate was 91.7% (33 out of 36 patients). The mean dysphagia scores before and after the procedures were 2.44 and 0.92, respectively. The median hospital stay after stenting was 10 days and the mean follow-up period was 91 days. Thirteen patients died during the follow-up period (mean survival, 70 days). The complication rate was 22.2% (8 out of 36 patients). Restenosis occurred in four cases, bleeding in two cases, pain in one case and stent migration in one case. There were no deaths related to the procedures. CONCLUSIONS: These findings suggest that placement of uncovered self-expandable metallic stents for gastric outlet obstruction caused by stomach cancer results in good symptomatic improvement with a low rate of complications.

Docetaxel-Cisplatin-5-FU Combination Chemotherapy as a First-line Treatment in Patients with Metastatic or Recurred Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to investigate the efficacy and safety of 'docetaxel-5-FU-cisplatin' combination chemotherapy as a first-line treatment in patients with metastatic or recurrent gastric cancer. METHODS: We investigated a total of 51 patients who were diagnosed as pathologically proven gastric cancer and received 'docetaxel-5-FU-cisplatin' combination chemotherapy between March 2001 and March 2006. All the cases were surgically unresectable because they were either metastatic or recurred gastric cancer. We studied these cases retrospectively on the basis of medical records. The administered doses of decetaxel was 75 mg/m2 and cisplatin 60 mg/m2 on day 1, 5-FU 750 mg/m2 over 24 hrs on day 1 to day 5, every 4 weeks. RESULTS: Among the 51 patients, 21 patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 27 patients had PS 1, 3 patients had PS 2. For response rates, 7 (13.7%) achieved complete response, 17 (33.3%) partial response, 12 (23.5%) stable disease, and 15 (29.4%) progressive disease, respectively. The overall response rate was 47.1%. The median time to progression was 6.7 months (2-34 months). Median overall survival was 14.6 months (2.7-62.5 months). Median disease free survival was 9.5 months (4.2-21.9 months). National Cancer Institute-common toxicity criteria (NCI-CTC) grade 4 leukopenia occurred in 10 cases (per 229 cycles). Grade 4 neutropenia occurred in 51 cases, grade 4 thrombocytopenia in 2 cases. Grade 1 mucositis occurred in 32 cases, grade 1 myalgia in 6 cases. CONCLUSIONS: 'docetaxel-5-FU-cisplatin' combination chemotherapy is an active and tolerable regimen as a first-line treatment in patients with metastatic or recurred gastric cancer.