Clinical Features and Risk Factors for Severe Complications among Patients with Acute Hepatitis A Virus Infection in The Jeonbuk Province of Korea / 대한소화기학회지

BACKGROUND/AIMS: The frequency of symptomatic acute HAV infections in adulthood are increasing in Korea. This study analyzes the clinical severity in patients with acute HAV infection and investigates risk factors associated with three severe complications: prolonged cholestasis, acute kidney injury, and acute liver failure. METHODS: We performed a retrospective analysis of 726 patients diagnosed from January 2006 to December 2010 at three tertiary hospitals in Jeonbuk Province, Republic of Korea with acute HAV infection. RESULTS: In the group of 726 patients, the mean age was 30.3 years, 426 (58.6%) were male, and 34 (4.7%) were HBsAg positive. Severe complications from acute HAV infection occurred as follows: prolonged cholestasis in 33 (4.6%), acute kidney injury in 17 (2.3%), and acute liver failure in 16 (2.2%). Through multivariate analysis, age > or =40 years (OR 2.63, p=0.024) and peak PT (INR) > or =1.5 (OR 5.81, p=0.035) were found to be significant risk factors for prolonged cholestasis. Age > or =40 years (OR 5.24, p=0.002) and female gender (OR 3.11, p=0.036) were significant risk factors for acute kidney injury. Age > or =40 years (OR 6.91, p=0.002), HBsAg positivity (OR 5.02, p=0.049), and peak total bilirubin (OR 1.11, p=0.001) were significant risk factors for acute liver failure. CONCLUSIONS: Age > or =40 years, female gender, HBsAg positivity, peak PT (INR) > or =1.5, and peak total bilirubin were significant risk factors for severe complications in acute HAV infections.

A Case of Colonic Adenocarcinoma in a Patient with Wilson's Disease

Wilson's disease (WD) is an autosomal recessive inherited disorder of copper metabolism that results in the accumulation of copper in the body and primarily in the liver, brain, and cornea. Copper is a toxic metal and might be associated with cancer induction. Most malignancies associated with WD are hepatocellular carcinoma and cholangiocarcinoma. Other intra-abdominal malignancies have been only rarely reported. To our knowledge, this is the first report to suggest that patients with WD may be vulnerable to a malignant change in the colonic mucosa during long-term copper chelating therapy. We report a case of colonic adenocarcinoma in a patient with WD and review the related literature.

Continuous Long-Term Entecavir Therapy in Naive Chronic Hepatitis B Patients Showing Partial Virologic Response

BACKGROUND/AIMS: We investigated the efficacy of continuous long-term entecavir 0.5 mg treatment in naive chronic hepatitis B patients showing a partial virologic response (PVR). METHODS: A total of 227 patients were included. PVR was defined as a more than 1 log10 IU/mL decline in detectable serum hepatitis B virus (HBV) DNA by polymerase chain reaction (PCR; > or =20 IU/mL) at week 48. A complete virologic response (CVR) was defined as undetectable serum HBV DNA by PCR (<20 IU/mL) at week 48. RESULTS: At week 48, the rate of the PVR was 64/227 (28.2%). Among patients with PVR, the cumulative rates of virologic response (serum HBV DNA <20 IU/mL) at weeks 96 and 144 were 45.2% and 73.8%, respectively. The cumulative rates of genotypic resistance were not significantly different between patients with a PVR and patients with a CVR (p=0.057). However, the cumulative rates of virologic breakthrough were higher in patients with PVR than in patients with CVR (4% vs 0% and 11.2% vs 0% at weeks 96 and 144, respectively; p<0.001). CONCLUSIONS: Long-term continuous entecavir 0.5 mg treatment in patients with a PVR resulted in an additional virologic response without a significant increase in genotypic resistance. However, the rate of virologic breakthrough was higher in the partial responders.

Non-Recurrent Inferior Laryngeal Nerve in Thyroid Surgery: The Usefulness of Preoperative Neck CT and Clinical Review / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We investigated the expression of glucose uptake transporter-1 (GLUT-1) and epidermal growth factor receptor (EGFR) in the head and neck squamous cell cancer (HNSCC) and their influence on survival rate. We also aimed to demonstrate the relationships between the expressions of GLUT-1 and EGFR and the maximal standardized uptake values (mSUV) of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET). SUBJECTS AND METHOD: Surgical specimens from 50 patients with HNSCC, who had undergone surgical intervention, were first processed for tissue array and then for immunochemistry for GLUT-1 and EGFR. Expressions of GLUT-1 and EGFR were analyzed according to the differentiation of tumor, T & N stage and invasiveness of the tumor etc. The relationship between PET-mSUV and the expressions of EGFR and GLUT-1 was evaluated as well as its possibility as a prognostic factor of SUV. RESULTS: The expression of EGFR was significantly high in the lymph node of the positive group. Associated with the expression of GLUT-1, a tendency of increased index score (IS) values in the advanced T stages was observed but it was not statistically significant. The mSUV in FDG-PET showed statistically significant association with the maximal tumor size (pearson correlation 0.569, p=0.023); however, no association with GLUT-1 and EGFR was observed. A universal strong expression of GLUT-1 could have made it difficult to figure out statistically significant correlations. Disease free survival was to be influenced by T stage, moderate and poor differentiation and GLUT-1 expression. Only the T stages had independent significance in the multivariate analysis using the Cox regression model. CONCLUSION: We found that the expression of GLUT-1 could not show statistically significant correlation with PET-mSUV. Since the expression of EGFR has significant correlation with lymph node metastasis, EGFR may have the possibility of being a target for anticancer molecular therapy.