The Effect of Naïve Tenofovir Dipivoxil Fumarate Monotherapy in Patients with Chronic Hepatitis B: 2-Year Results of a Real-world Single-center Study / 대한내과학회지

BACKGROUND/AIMS: An incomplete virological response has been observed to tenofovir dipivoxil fumarate (TDF) in nucleos(t)ide analogue (NA)-experienced chronic hepatitis B (CHB) patients. This study investigated the efficacy of TDF in NA-naïve CHB patients 96 weeks after treatment. METHODS: CHB patients treated with TDF were enrolled retrospectively between November 2012 and January 2016. We assessed virological and biochemical parameters. RESULTS: The study enrolled 179 NA-naïve patients with a median follow-up duration of 59.6 weeks. The serum hepatitis B virus (HBV) DNA level decreased significantly during treatment. The complete virological response (CVR) rate was 83.21% at week 96. In univariate analyses, the predictors of a CVR at 96 weeks were the baseline HBV DNA level (CVR vs. no-CVR, HBV DNA log10 mean value 7.34 vs. 7.86, 95% confidential interval [CI]: -7.89 to -7.37; p < 0.001) and male sex (CVR vs. no-CVR, 49.1% vs. 81.3%, odds ratio [OR] 0.22, 95% CI: 0.06 to 0.87; p = 0.025). In the multivariate analysis, male sex predicted a CVR at week 96. The CVR was significantly lower in males than in females (OR 0.12, 95% CI: 0.02 to 0.96; p = 0.046). CONCLUSIONS: TDF was effective for treating CHB for more than 2 years in NA-naïve patients.

Septic Shock in Pyogenic Liver Abscess: Clinical Considerations / 대한소화기학회지

BACKGROUND/AIMS: Pyogenic liver abscess (PLA) is a life-threatening condition, despite advances in diagnostic technology and strategies for treatment. A strong predictor of mortality in this condition is septic shock. This study describes clinical, biochemical, and radiologic features in patients with PLA with or without septic shock, with the intent of describing risk factors for septic shock. METHODS: Of 358 patients with PLA enrolled, 30 suffered septic shock and the remaining 328 did not. We reviewed the medical records including etiologies, underlying diseases, laboratory, radiologic and microbiologic findings, methods of treatment and treatment outcomes. RESULTS: The case fatality rate was 6.1%. In univariate analysis, the presence of general weakness, mental change, low platelet level, prolonged PT, high BUN level, high creatinine level, low albumin level, high AST level, high CRP level, abscess size >6 cm, the presence of gas-forming abscess, APACHE II score ≥20, and the presence of Klebsiella pneumoniae infection were significantly associated with septic shock. Multivariate analysis showed the presence of mental change (p=0.004), gas-forming abscess (p=0.012), and K. pneumoniae infection (p=0.027) were independent predictors for septic shock. CONCLUSIONS: The presence of mental change, gas-forming abscess, and K. pneumoniae infection were independent predictors for septic shock in patients with PLA.

Adrenocortical Insufficiency due to Spontaneous Bilateral Adrenal Hemorrhage Presented as Acute Abdominal Pain / 이화의대지

Adrenocortical insufficiency is the clinical manifestation of deficient production or action of glucocorticoids. It is a life-threatening disorder that can result from primary adrenal failure or secondary adrenal failure due to impairment of the hypothalamic-pituitary axis. Primary adrenocortical insufficiency can be caused by autoimmune adrenalitis, infection (especially, tuberculosis), metastatic cancer, lymphoma, adrenal hemorrhage, infarction or drugs. Among these, adrenal hemorrhage may be caused by anticoagulant drug or heparin therapy, thromboembolic disease, hypercoagulable states such as antiphospholipid syndrome, physical trauma, postoperative state, sepsis and severe stress from any cause. However, even fewer reports exist of adrenocortical insufficiency due to spontaneous bilateral adrenal hemorrhage. We report a rare case of acute adrenocortical insufficiency due to spontaneous bilateral adrenal hemorrhage presenting as acute abdominal pain.

Improvement of Hypoxemia by Inhaled Nitric Oxide Gas Therapy in Potential Deceased Donor / 대한이식학회지

Potential diseased donors manifest altered physiological changes associated with pulmonary edema, profound hemodynamic and metabolic abnormalities. These derangements may be more significant after apnea tests which result in severe hypoxemia and cardiovascular complications. Nitric oxide (NO) inhalation therapy can be applied following apnea tests in the brain-dead donor whose ventilator support has been maintained with high positive end-expiratory pressure. Inhalation of NO gas causes selective dilation of blood vessels in only those lung segments that are actively participating in gas exchange (oxygen and carbon dioxide) at the alveolar capillary level. In other words, this increases the blood flow to areas of the lung where oxygen is being provided and thus improves oxygen levels in the body. We report on the case of a 14-year-old organ donor with inhaled NO therapy after apnea testing. The duration of NO inhalation therapy was 14 hours. This deceased donor, who suffered with severe hypoxemia and hemodynamic instability after apnea tests, improved after NO gas therapy and adequate vasoactive drugs. NO gas therapy will be helpful for improving oxygen delivery to pulmonary vessels. Two kidneys and one liver were successfully retrieved from donors. These recipients had well preserved function of allografts. Therefore, NO inhalation can be helpful in improvement of hypoxemia and increasing organ availability in deceased organ donors.

Hypothalamic Hypopituitarism Caused by Pituitary Stalk Dysgenesis / 대한내과학회지

Functional defects of the pituitary gland are a rare cause of pubertal delay. The pituitary stalk is an important structure that connects the hypothalamus and pituitary gland. A defect in fusion of the pituitary stalk and anterior pituitary gland will block the function of the anterior pituitary gland. A 28-year-old man was referred to our clinic with poorly developed secondary sexual characteristics. He had undeveloped facial, axillary, and pubic hair and was Tanner stage I. Laboratory tests gave random serum testosterone < 0.025 ng/mL, luteinizing hormone (LH) < 0.1 mIU/mL, follicle-stimulating hormone (FSH) 0.626 mIU/mL, thyroid-stimulating hormone (TSH) 6.85 microIU/mL, and fT4 6.96 pmol/L. Sella magnetic resonance imaging (MRI) showed no pituitary stalk enhancement. The response in the combined pituitary function test revealed multiple hormonal defects, while the TSH response to thyrotropin-releasing hormone (TRH) was exaggerated and delayed. Therefore, we concluded that pituitary stalk dysgenesis had led to hypothalamic-type panhypopituitarism.

A Case of Chemical Pneumonitis Induced by Glutaraldehyde Aspiration / 대한내과학회지

Glutaraldehyde is a five-carbon dialdehyde with highly reactive chemical properties. It has bactericidal, sporicidal, and fungicidal activities and is used as a disinfectant to combat foot-and-mouth disease in Korea. To our knowledge, there are no reports of chemical pneumonitis caused by glutaraldehyde aspiration. Chemical pneumonitis is defined as lung irritation caused by substances toxic to the lungs. We treated a 71-year-old patient who had a dyspnea and hoarseness that worsened 7 h after ingesting three mouthfuls of 10% glutaraldehyde. Upon arrival at the emergency room, he had severe laryngeal swelling. A chest radiograph showed diffuse haziness of both lower-lung fields. Despite all our efforts at treatment, he died from chemical pneumonitis and its secondary complications.