Tenofovir disoproxil fumarate monotherapy for nucleos(t)ide analogue-naive and nucleos(t)ide analogue-experienced chronic hepatitis B patients

BACKGROUND/AIMS: This study investigated the antiviral effects of tenofovir disoproxil fumarate (TDF) monotherapy in nucleos(t)ide analogue (NA)-naive and NA-experienced chronic hepatitis B (CHB) patients. METHODS: CHB patients treated with TDF monotherapy (300 mg/day) for > or =12 weeks between December 2012 and July 2014 at a single center were retrospectively enrolled. Clinical, biochemical, and virological parameters were assessed every 12 weeks. RESULTS: In total, 136 patients (median age 49 years, 96 males, 94 HBeAg positive, and 51 with liver cirrhosis) were included. Sixty-two patients were nucleos(t)ide (NA)-naive, and 74 patients had prior NA therapy (NA-exp group), and 31 patients in the NA-exp group had lamivudine (LAM)-resistance (LAM-R group). The baseline serum hepatitis B virus (HBV) DNA level was 4.9+/-2.3 log IU/mL (mean+/-SD), and was higher in the NA-naive group than in the NA-exp and LAM-R groups (5.9+/-2.0 log IU/mL vs 3.9+/-2.0 log IU/mL vs 4.2+/-1.7 log IU/mL, P<0.01). The complete virological response (CVR) rate at week 48 in the NA-naive group (71.4%) did not differ significantly from those in the NA-exp (71.3%) and LAM-R (66.1%) groups. In multivariate analysis, baseline serum HBV DNA was the only predictive factor for a CVR at week 48 (hazard ratio, 0.809; 95% confidence interval, 0.729-0.898), while the CVR rate did not differ with the NA experience. CONCLUSIONS: TDF monotherapy was effective for CHB treatment irrespective of prior NA treatment or LAM resistance. Baseline serum HBV DNA was the independent predictive factor for a CVR.

Difference in Adenoma Detection Rates according to Colonoscopic Withdrawal Times and the Level of Expertise / 대한소화기학회지

BACKGROUND/AIMS: Adequate screening colonoscopy in the general population decreases the mortality associated with colorectal cancer through detection and removal of adenomatous polyps. Prolonged colonoscopic withdrawal times (>6 min) are reportedly beneficial for adenoma detection rates (ADRs). However, the quality of the endoscopist compared with colonoscopic withdrawal times is not known. The aims of this study were to investigate the difference in ADRs between trainees and experienced examiners. METHODS: A total of 967 consecutive patients who underwent screening colonoscopy in a single University hospital from June 2010 to November 2011 were enrolled in this prospective observational study. Colonoscopy was performed by four experienced staff and seven gastroenterology fellows. RESULTS: Seven gastroenterology fellows performed 633 colonoscopies and four experienced staff performed 334 colonoscopies. The overall detection rates of colorectal adenoma were 31.5% with ADRs of fellows and staff of 29.4% and 35.6%, respectively (p=0.047). Fellows also showed lower advanced ADRs (5.7% vs. 9.9%, p=0.016), and fellows had longer mean withdrawal times than staff (12.4+/-4.9 min vs. 8.2+/-4.1 min, p<0.001). Multivariate analysis showed significantly increased ADRs and advanced ADRs for staff compared with fellows (adjusted OR 2.41, 95% CI 1.70-3.43; adjusted OR 2.55, 95% CI 1.47-4.45, respectively). CONCLUSIONS: ADRs were significantly lower when colonoscopy was performed by trainees, although withdrawal times were longer than those of staff. Our results demonstrated that the quality of colonoscopy, as measured by ADRs, may be improved by experienced examiners.

A Case of Autoimmune Hepatitis Following Acute Hepatitis A / 대한소화기학회지

The pathogenesis of autoimmune hepatitis (AIH) is unclear, but viral infections have been proposed as a potential trigger in patients with genetic predisposition. We report a case of AIH following acute hepatitis A (AHA). A 57-year-old woman presented with fatigue and pitting edema for last 3 months. She had been diagnosed as an AHA 15 months ago based on clinical features, biochemical tests and positive HAV IgM antibody at a local clinic. Her biochemical tests was normalized one month after AHA diagnosis, but the serum levels of aminotransferase started to rise four months after AHA diagnosis. Antinuclear antibody was positive at a titer of 1:40, and anti-smooth muscle antibody was also positive. Hypergammaglobulinemia and liver pathology were typical for AIH. The patients had a score of 17 according to the International Autoimmune Hepatitis Group's system. She was given prednisolone and azathioprine and showed complete response to immunosuppressive therapy. The present case is the first report on AIH triggered by AHA in Korea.

A Case of Pheochromocytoma Crisis with Acute Myocardial Infarction Induced by Glucocorticoids Administration

The most common symptoms of pheochromocytoma are paroxysmal or sustained hypertension, or symptoms of paroxysmal adrenergic stimulation such as palpitation, headache, and diaphoresis. These patients can on rare occasion reveal or be complicated with cardiovascular symptoms such as arrhythmia, cardiomyopathy, acute coronary syndrome and cardiogenic shock. These cardiac manifestations of pheochromocytoma may delay the diagnosis, which can cause a catastrophic outcome. A pheochromocytoma crisis is provoked by surgery, anesthesia, exercise and, several drugs and it is known to be an endocrine emergency with mortality as high as 85%. Many classes of drugs are well known to precipitate adverse reactions, but the presentation of pheochromocytoma after the administration of steroid has rarely been reported. We report here on a case of pheochromocytoma crisis with acute myocardial infarction after the patient took prednisolone. Furthermore, we discuss the mechanism of glucocorticoid induced crisis and myocardial infarction in pheochromocytoma patients.

A Case of Septic Shock Caused by Escherichia coli after Intravenous Injection of Contaminated Propofol

Propofol (2,6-diisopropylphenol) is a rapid and short-acting anesthetic agent that is used for general anesthesia and endoscopic sedation. It is available as an aqueous lipid emulsion and this preparation could serve as a bacterial culture medium. We report a case of a 46-year-old female who developed septic shock caused by Escherichia coli after being sedated by propofol to undergo gastrointestinal endoscopy. The contaminated propofol was identified as the cause of septic shock by pulsed-gel electrophoresis.

Spontaneous Bacterial Peritonitis Caused by Hafnia alvei in a Patient with Liver Cirrhosis

Hafnia alvei is a gram-negative bacillus that is rarely isolated from human clinical specimens and is rarely pathogenic. This organism is an extremely uncommon cause of spontaneous bacterial peritonitis (SBP). We report a case of an 83-year-old male with hepatitis C-associated liver cirrhosis and hepatocellular carcinoma who was diagnosed with SBP caused by H. alvei. He was admitted to an university-affiliated hospital with fever and abdominal pain. There were 2 episodes of SBP during 2 months. Although isolates of H. alvei from ascitic fluid were shown to be susceptible to cefotaxime, responses for cefotaxime treatment were inadequate in both episodes. Therefore, cefotaxime was switched to imipenem in the first episode and to ciprofloxacin in the second, according to the results of antimicrobial susceptibility. After the antibiotics was changed, SBP was resolved.

Unexpected Complication of Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis in a Patient with Acute Ischemic Stroke: Aortic Dissection / 대한뇌혈관외과학회지

We report here on a case of acute aortic dissection after intravenous tissue plasminogen activator (t-PA) administration in a patient with acute ischemic stroke. A 75-year-old woman with a history of hypertension and diabetes mellitus presented with left hemiplegia and a decreased mentality. The admission studies revealed severe stenosis of the right middle cerebral artery and decreased cerebral perfusion. Initial chest radiography showed hypertensive cardiovascular changes and increased interstial markings on both lung fields. Cyanosis and cardiac arrest occurred 80 minutes after intravenous t-PA administration. Emergency cardiopulmonary resuscitation was done and chest CT showed a dissection involving the whole aorta and pericardial effusion due to bleeding. In spite of our earnest efforts, the patient died. It should be kept in mind that aortic dissection can occur after intravenous t-PA administration and an early clinical suspicion and diagnosis is needed to avoid this devastating complication.

Cerebrovascular Complications after Coronary Bypass Surgery / 대한흉부외과학회지

BACKGROUND: Cerebrovascular accidents after coronary bypass surgery(CBS) are serious and responsible about 10% for postoperative mortality. Recently, the rate of cerebrovascular complication after CBS has increased with increasing number of the operations for high risk patients with old age, hypertension, diabetics and etc. This study was intended to identify the risk factors of cerebrovascular accident after CBS by reviewing the medical records of the patients who underwent CBS. MATERIALS AND METHOD: We reviewed the medical records and statistically analyzed the data of 185 patients who underwent CBS between March 1991 and July 1999. RESULT: The rate of cerebrovascular complication was 7.5%(14 patients) of which there were 5 deaths. Total number of postoperative death was 11 during the same period, and 45.5% of postoperative deaths were associated with cerebrovascular complication. Postoperative arrhythmia(p=0.0064), history of previous CVA(p=0.0090), bypass time(p= 0.0181), atherosclerosis of aorta(p=0.03575) and diabetics(p=0.0452) were statistically related with the development of postoperative cerebrovascular complication. Two patients underwent carotid endarterectomy concomitantly with CBS, neither of them developed cerebrovascular complications. The 3 patients over 75 years did not develop cerebrovascular complication after CBS. CONCLUSION: Risk factors associated with the development of postoperative cerebrovascular complication after CBS were postoperative arrhythmia, history of previous stroke, bypass time, atherosclerosis of aorta and diabetics.

Treatment with intramedullary nails in tibial shaft fractures / 대한정형외과학회잡지

Recently, there is seen frequently the tibial shaft fracture due to the increased traffic accident & the high industry, and this fracture has many problems in a treatment because of nonunion, malunion, and infection. And so the methods of treatment is variable according to physicion. Intramedullary nailings are prefered for treatment of tibial shaft fracture. Between June, 1990 and December, 1993, we treated fifty four fractures of the tibial shaft with Ender nails(33 cases) and Delta nails(21 cases). The authors analyzed the effects of these two methods, and we obtained the following resutls. 1) Average operating time was 107 minutes in Ender nail and 109 minutes in Delta nail. In the average full weight-bearing time, postoperatively, was 8.7 weeks in ender nail and 8.5 weeks in Delta nails. The mean bone union time was 16.5 weeks in Ender nail and 16.8 weeks in Delta nail, and so there was no significant difference in bone union time between two devices. 2) The complications are four cases of delayed union(12.1%), three cases of superficial infection(9.1%), two cases of angular deformity(6.1%), and one case of checkrein deformity(3.0%) in the 33 cases of Ender nail, and two cases of delayed union(9.5%), one case of angular deformity(4.8%), and one case of superficial infection(4.8%) in the 21 cases of Delta nail. 3) In the 30 cases of Ender nails(90.9%), the functional results were exellent or good, and 19 cases of Delta nails(90.5%) were excellent or good.

Benign osteoblastoma arising in the paranasal sinuses (report of 2 cases).Son Jae-Il / 대한이비인후과학회지

No abstract available.

A case of lymphomatoid granulomatosis / 대한피부과학회지

No abstract available.

Treatment of Palmoplantar Hyperhidrosis with Iontophoresis / 대한피부과학회지

In the present study, tap water iontophoresis as a method of treatment of palmoplantar hyperhidrosis was evaluated. Eighteen patients, twelve males and six females, with singnificant palmoplantar hyperhidrosis were treated on every weekday for 2 weeks. The hand and foot of the same side were randomly selected for the treatment by tap water iontophoresis according to the the method described by Levit. The selected hand and foot were immersed in a pair of pans containing tap water and exposed to 30V and 3 to 14mA of direct current for 20 minutes. The results obtained were as follows . Among 18 patients treated, 14(77.8%) accomplishei3 sufficient control of hyperhidrosis after 6 12(average 9.1) treatments. Two patients showed a moderate response and one weak response. One patient showed no response. Several patients experienced untoward effects such as mild itching, erythema, tingling sensation, exfoliation, compensatory hyperhidrosis, but the discomfort was not so severe as to stop the treatment

Clinical Observation of Cotreal / 대한정형외과학회잡지

Various kinds of spinal instrumentation have been developed for treatment of spinal disorders which are associated with instability. Recently, newly designed devices using pedicle screw were developed with advantages of short segment fixation and firm internal fixation. This is a retrospective clinical and roentgenographic study to evaluate the effectiveness of Cotrel 1. Of the 27 cases, spinal stenosis were 11, spondylolisthesis were 8, spondylolysis were 4, burst fracture were 2, metastatic bone tumor was 1, and failed back syndrome was 1 case. 2. Result of clinical evaluation by Hanley's criteria at last follow up were excellent in 7(27%), Good in 15(58% ), fair in 4(15%). (1 case of metastatic bone tumor was excluded). 3. In the cases of spondylolisthesis, we tried to reduce the displacement in 2 cases of Meyerding Grade II, and 1 case was reduced and 1 case was not reduced. In the cases of of Meyerding Grade I, no further displacement was developed. 4. The complications were observed in 10(37%)cases. A) Generalized complications were 2 cases of hematoma, 3 cases of superficial infection of wound, and 1 case of nerve root irritation. B) Failure in instrmentation were 1 case of screw breakage, 1 case of complete loss of fixation between screw and rod, and 2 cases of partial loss of fixation. 5. To prevent above mentioned complications in fixation of the instrument, the following factors are recommended: 1) Selection of the adequate length of rod. 2) Fixation of the additional implant such as security bolt when instability between screw and rod is predictable. 3) Selection of the closed head screw in the fixation of proximally sided screw if possible. 6. Cotrel-Dubousset instrument has many advantages such as rigid internal fixation, anatomical reduction, and good maintenance and also effective in reduction and maintenance of spondylolisthesis and in wide posterior decompression of spinal stenosis, but for prevention of some complications, precise use of instrument and good application of surgical technique will be needed.

A Case of Desmoplastic Trichoepithelioma / 대한피부과학회지

We report herein a case of desmoplastic trichoepithelioma in a 73-year-old female, who is the oldest among the patients of the disease reported in Korea. She had an asymptomatic, hard, annular lesion, measuring 0.6 x 0.7 cm with an elevated border and a depressed center on the left nasolsbial fold. Histopathological findings showed narrow strands of basaloid tumor cells, horn cysts and a desmoplastic stroma.

A Report of congenital Radio / 대한정형외과학회잡지

Congenital synostosis of the proximal ends of the radius and ulna is a rare malformation which often completely prevents pronation and supination of the forearm. The evidence for a genetic etiology is provided by noting its presence in a Klinefelter's syndrome and its positive familial history. Two cases of congenital radioulnar synostosis occurred in brothers have been experienced and are to be reported with review of references.