Pattern of histologic progression from acute and chronic hepatitis B to cirrhosis / 대한간학회지

The chronic active or aggressive hepatitis B, in which periportal inflammation(piecemeal necrosis) is conventionally accepted as the pattern of progression to cirrhosis', implies little concern with intralobular necroinflammation as a process responsible for aggravation and progression. Some published observations, however, refer to episodes of acute necrotizing bouts(subacute hepatic necrosis) have been reported". For technical reasons, relatively few sequential biopsy studies of chronic hepatitis B are available and particularly, initial acute hepatitis B is barely documented since biopsies are now rarely perfomed in acute stages of hepatitis4. Moreover, most published sequential studies are complicated by therapeutic intervention. The availability of Korean sequential biopsy specimens and the increasing interest in parenchymal changes in the evolution of hepatitis B encouraged the description of the progression of acute and chronic hepatitis B to cirrhosis. During the long-term follow-up study, acute bouts of intralobular parenchymal necroinflammation are observed whenever the stage of aggravation is caught and the biopsy is possible. Whatever the result of these studies, the observation presented suggests a major role of parenchymal changes in the evolution of chronic hepatitis B and this experience focuses on the important lesions of the lobular parenchyma in classification and evaluation of chronic hepatitis'. Seven patients are selected on the basis of elevated S-ALT level, and submit to repated needle biopsies during a 6-month period". Of these, 2 cases show chronic active hepatitis with early cirhosis constantly, and in 5 cases CAH appear 1 or 2 times in each case during the follow-up period. In clinical follow-up after the sequential biopsies, these 7 patients were all healthy at least for an average of 18.6 years ranging from 14 to 27 years, except for one who developed into HCC without complication of cirrhosis. Thus, while the sample size of this study is small, continuous piecemeal necrosis seems not to be a pattern of progression to cirrhosis. In conclusion, acute and chronic hepatitis B experienced in Korea appear to progress to cirrhosis by means of repeated acute episodic bouts of intralobular necroinflammation, and the conventional concept that continuous progress by piecemeal necrosis seems not to hold true.

Persistence and Anamnestic Response of Antibody to HBsAg Induced by Natural Immunization or Vaccine Treatment / 예방의학회지

For evaluating the boosting (anamnestic) effects of the most recent commercially produced plasma derived heat-inactivated hepatitis B vaccine (A. Co.), 117 adults with naturally acquired antibody to hepatitis B surface antigen (anti-HBs) were selected at random. In addition, out of case immunized at zero and 1 month, and boosted at 6 months (primary booting) by conventional vaccine (B.Co), inactivated by pepsin digestion and formalin treatment, 11 cases who showed elevated titer after primary boosting were also submitted to the study. The results were as follows: 1) Out of the 117 subjects with naturally acquired anti-HBs, 6(5.1%) showed isolated anti-HBs and the titers were below 10 ratio units (RU). Negative seroconversion was seen in 4 (3.4%) of the 117 cases at 12 months after the screening and, of these cases, 3 showed isolated anti-HBs below 10 RU (increased GMT, 28.04) at one month after primary booster injection with 3 microgram dose of A. Co. Vaccine at all, but 90% of the other subjects responded. 3) The anti-HBs titers of all the 11 cases who showed a rise of more than 10 RU (increased GMT, 28.04) at one month after primary booster injection by 20 microgram dose of B. Co. vaccine decreased at 19 months after the primary booster. And 3 subjects (27.3%) of the 11 reached negative seroconversion. All of the 11 cases, who had secondary booster injection with 3 microgram dose of A. Co. vaccine at 19 months after primary boosting, showed increased anti-HBs titer at least 20 RU or more (increased GMT, 57.72) at one month after the boosting. According to the above results in the anti-HBs screening survey for the purpose of immunization with hepatitis B vaccine, subjects with isolated anti-HBs below 10 RU should be regarded as being in an unimmunized state. In cases who are in risk circumstances, immunized primarily with a 20 microgram dose of B. Co. vaccine, a secondary booster injection should be given within 2 years after initiation of primary immunization and a 3 microgram booster dose of A. Co. vaccine can be reliably used.

Drug - Induced Esophageal Ulcers / 대한소화기내시경학회지

Over 26 kinds of tablets and capsules, such as Tetracycline, Quinidine and Potassium preparations were reported to cause esopbageal ulcerations, eharacterized in various size, shape and number, ind sually in mid-esophagus, Recently authors experienced 10 cases of drug-induced esophageal ulcerations due to antibiotics and antiinflammatory agents such as Tetracycline, Aspirin, etc. Four cases were men and six were women. Four cases were in third dades, three in fourth cleeades, two in fifth decades and one in sixth decades. Presenting symptoras were odynophagia(4/10), dysphagia(3/10), substernal pain(7/10) and epigastric pain(3/10). Endoscopic examination of the esophgus showed single or multiple, small and shallow ulcers on the mid-esophgeal mucosa at the level of 30cm from the ineisor in eight cases, one Iarge and deep ulcer at the level of 40cm from incisor in one patient and one amall, shallow and one large, deep ulcers at the same time. in one patient The shape of alcers were various from a round to a large horseshoe shaped one. The clinical course was mild without complications. It was suggested that drug-induced esophsgeal ulcers with antibiotics and antiinflammatory agents could be found frequently and they had benign and mild clinicalc ourse,

The Effect of Cimetidine in Treatment of Erosive Gastritis / 대한소화기내시경학회지

In an attempt to evaluate the efficacy ef cimetidine in treatment of erosive gastritis, a praspective study wras done in 9 cases of heworrhagie gastritia, 4 cases yunctiform gastritis, 9 caees verrueous gastritia, and 9 caseis mixed type, Four hundred mg of cimetidine was given in the morning and at bedtime for 3 weeks. Evaluation ef the efficacy was assessed by clinical syinptoms acoring and by endoscopic findings of erosion before treatment, on the 8th day, on the 15th day, and on the 22th day of treatment in all patients. The results were as follows; 1) Clinical sytnptoms in patients with erosive gastritis were epigastric discamfortness(83. 9%), heart burn(80. 0%), indigestion(77, 6%), hunger pain(74.2%), belching(71.0%), anotexla (48.4%) and nausea(45.5%). There was no differenees of symptoms among the type of erosion. 2) Percent decrease in clinical eyxeptoms were; 45% on the 8th day, 68% on the 15th day, 81% on the 22th day of treatment. Ciinical symptoms in patients with punetiform gastritis lasted longer than other typea. 3) Disappearance of the gastric mucossl erosion was seen in 8 cases of hemorrhagic gastritis, 6 case of mixed type, 5 cases of verruceous gastritis, 2 cases of punctiform gastritis, and overall 21 Cases(67.7%) on the 22th day of treatment, endoscopieally. Faur eases af punctiform gastritis were transformed into verrueous gastritis during the treatment. 4) Disappearance of the erosion was observed more frequently in the mueosa of oxyntic area than that of antrum. This study suggests that cimetidine appears to be effective for relief of elinical symptoms in patients with erosive gastritis, and for treatment of hemorrhagic gastritis and erosions in the mucosa of oxyntic area,

The Successful Dissolution of 2 Cases of Fat Bezoars by Pancreatic Lipase / 대한소화기내시경학회지

Gastric bezoars are large masses or concretions, composed with plant fiber, hair and miscellaneous foreign bodies, found in the stomach and occur usually as sequele of gastric surgery. We experienced 2 cases of fat bezoars which developed after drinking of melted beef fst. They had postprandial epigastric fullness and pain, those were relieved on supine and left recumbent position. Upper gastrointestinal series showed a large movable mass in the stomach in hoth cases. On gastrofibercopic examination, a large egg sized white bezoar was cordirmed in both cases and a gastrie ulcer at antrum associated in one case. In attempt to removal of the bezoars, we tried to break them, but failed because of its character. The patients were treated with pancreatic lipase containg digestives, Pancreon-F and Azintal. From one day after this treatment, symptoms were completely relieved. Five days later, we confirmed disappearance of bezoars by gastrofiberscopy. and upper gastrointestinal barium

Pseudomembranous Colitis Caused by Clostridium Difficile / 대한소화기내시경학회지

Pseudomembranous colitis (PMC) was first described by Finney as postoperative diphtheritic enteritis in 1893 and was known to be associated with antibiotics by Reiner et al in 1952. Most cases of antibiotic-associated PMC are now associated with cytotoxigenic C. difficile. The association of PMC several antibiotics is well docamented; however, its association with clindamycin appeared to be most striking. We experienced a male patient who developed tarry stool, abdominal pain and diarrhea after having recieved clindamycin for two weeks. The PMC diagnosed by colonofiberscopy with biopsy and C. difficile was identified by tissue-culture study. The patient was treated by oral vancomycin and healed. Described here a case of PMC with some review of literature.

Endoscopic Examination in Patients following Gastrectomy / 대한소화기내시경학회지

It had heen emphasized the necessity for upper gastrointestinal endoscopic examinations in patients. Who has had gastrectomy and presents persisting gastrointestinal symptoms. This study was conducted to evaluate endoscopic findings and clinical symptoms in patients following gastrectomy. (continue...)

Mirizzi Syndrome: A case report / 대한소화기내시경학회지

Mirizzi syndrome is an uncommon cause of obstructive jaundice. It consists of the following elements: (1) an anatomic arrangement of the cystic duct such that it lies almost parallel to the common hepatic duct, (2) impaction of a gallstone in the cystic duct or neck of the gall bladder, (3) partial mechanical obstruction of the common hepatic duct by the stone itself or the resulting inflammatory reaction, and (4) recurrent cholangitis or ultimately cholangitic cirrhosis due to the partial obstruction. (continue...)

Vectical Transmission of Hepatitis B

No abstract available.