24 Weeks Treatment with Pegylated Interferon Alfa Plus Ribavirin May Be Possible in Genotype 1 Chronic Hepatitis C Patients with Rapid Virological Response Who Have Low Pretreatment Viremia / 대한소화기학회지

BACKGROUND/AIMS: The standard treatment for chronic hepatitis C infected with hepatitis C virus (HCV) genotype 1 is a combination of pegylated interferon alfa and ribavirin over a 48 weeks period. It is unclear if 24 weeks treatment is possible for patients showing a rapid virological response (RVR) without compromising the sustained virological response (SVR) in Korea. METHODS: Between June 2005 and September 2008, among patients chronically infected with the HCV genotype 1 who were treated with pegylated interferon alfa subcutaneously once weekly plus ribavirin based on body weight, 55 patients who had low pretreatment viral load (<600,000 IU/mL) and RVR were enrolled. A total of 55 patients were divided into 24 weeks treatment group (n=29) and the standard treatment group (n=26). The HCV RNA was quantitatively assessed before treatment, and after 12 weeks of treatment, and also qualitatively assessed after 4 weeks of treatment, at end of treatment (24 weeks), and 24 weeks after end of treatment. RVR was defined as undetectable HCV RNA at the 4 weeks of treatment. RESULTS: Among the 55 patients, SVR was achieved in 100% (29/29) of the patients in 24 weeks treatment and 96.2% (25/26) of the patients in the standard treatment (p=0.473). CONCLUSIONS: HCV genotype 1 infected patients with a low baseline HCV RNA concentration who become HCV RNA negative at week 4 may be treated for 24 weeks without compromising sustained virlolgical response. However, an additional trial will be needed to optimize the treatment duration.

A Case of Rectal Leiomyosarcoma Presenting as a Semipedunculated Polypoid Mass / 대한소화기내시경학회지

Rectal leiomyosarcoma is an extremely rare disease. Anal bleeding, rectal pain and a sensation of pressure in the anus are the most common symptoms. It tends to form a polypoid intraluminal mass and commonly originates from the muscularis propria, but may arise from the muscularis mucosa, or in the walls of the blood vessels. Characteristically, leiomyosarcoma has very high mitotic activity and is, on immunohistochemical staining, positive for actin and desmin, but negative for c-kit and S-100. We experienced a case of a rectal leiomyosarcoma in a 54 year-old man who presented with anal bleeding. Colonoscopic examination revealed a 4.5 cm-sized semipedunculated polypoid mass at mid-rectum. We confirmed that it was a leiomyosarcoma histologically by endoscopic resection with mechanical snaring. Low anterior resection followed by radiation therapy was performed. We report here on this case with a review of the relevant literature.

Permanent sudden hearing loss associated with peginterferon and ribavirin combination therapy during hepatitis C treatment / 대한내과학회지

Peginterferon and ribavirin combination therapy for chronic hepatitis C is associated with major adverse effects, and systemic side effects are common. However, little is known about the influence of peginterferon on hearing loss, although it has been described as a rare complication of standard interferon. A 65-year-old man with chronic hepatitis C (genotype 2) developed sudden unilateral right-sided hearing loss just after finishing 24 weeks of treatment with peginterferon alpha 2a (180 microg/week) and ribavirin (800 mg/day). The audiological examination revealed a right-sided sensorineural hearing loss. Auditory brain-stem response measures confirmed the diagnosis. The hearing loss did not respond to corticosteroid therapy. The auditory disability remained unchanged 12 months after the end of treatment, although no HCV RNA was detectable 24 weeks after the end of treatment. We report a patient who developed irreversible hearing loss just after completing treatment with peginterferon and ribavirin

A Case of Primary Biliary Malignant Lymphoma Mimicking Klatskin Tumor / 대한소화기학회지

Primary non-Hodgkin's lymphoma of the extrahepatic bile duct presenting as obstructive jaundice is extremely rare. A 60-year-old man was admitted due to suddenly developed jaundice. Computerized tomography and endoscopic retrograde cholangiopancreatography showed a tumor at the proximal common hepatic duct. These clinical and radiologic findings resembled those of Klatskin tumor. The resection of the common hepatic duct tumor, lymph node dissection, and Roux-en-Y hepaticojejunostomy were carried out. There was no regional lymph node metastasis and no residual tumor at the resection margins. Histology and immunohistochemistry of the resected specimen confirmed a diffuse large B-cell malignant lymphoma involving the common hepatic duct. The patient is scheduled to receive adjuvant chemotherapy. In summary, primary non-Hodgkin's lymphoma of the extrahepatic bile duct, despite its rarity, should be considered in the differential diagnosis of causes for obstructive jaundice. An accurate histopathologic diagnosis and surgical resection combined with chemotherapy may be the approach to offer a chance for cure.

Aneurysm of the inferobasal wall and ventricular septal rupture complicated with inferior myocardial infarction / 대한내과학회지

The incidence of left ventricular aneurysm following acute myocardial infarction is 5 to 10 percent. Eighty % of aneurysms involve the anteroapical wall of the left ventricle: They are four times more frequent in this wall than in the inferior or posterior wall. Anterior myocardial infarction causes aneurysm in the anteroapical wall of the left ventricle, while inferior myocardial infarction causes aneurysm in the posterobasal wall of the left ventricle. Yet the aneurysmal complications in the interventricular septum after myocardial infarction are very rare. A 74-year-old woman with inferior myocardial infarction presented with both an aneurysm of the inferobasal wall and a ventricular septal rupture, and these were detected by two-dimensional and Doppler echocardiography. The aneurysm originated from the inferobasal portion of the left ventricular wall. The short-axis view of the two-dimensional echocardiography revealed an abrupt discontinuity of the junctional area of the inferoseptum and the inferior segment, and a large aneurysm at the inferior portion of the left ventricular cavity. The communication orifice was 4 cm wide. Color Doppler echocardiography showed a left-to-right shunt flow from the aneurysm to the right ventricle. We report here on a case of an aneurysm of the inferobasal wall and a ventricular septal rupture, and these lesions were detected by two-dimensional and Doppler echocardiography.

The influencing Factors of Quality of Life in Hemodialysis Patients / 대한신장학회잡지

This study was performed to evaluate the factors influencing the Quality of Life(QOL) in hemodialysis patients. Authors surveyed and analyzed the questionnaires about social characteristics, symptom, social support, satisfaction with life and quality of life. With these questionnaires, authors compared the hemodialysis patients(N=240, >6 month with hemodialysis) with the control group(N=240). Additionally authors eva- luated the anemia state, nutritional state and dialysis effect, and then analyzed the correlation between these laboratory findings and quality of life in hemodialysis patients. The results were as follows ; 1) The mean age of control group was 33.4 +/- 8.2 yrs, and the patients group was 48.812yrs. 2) Of 294 patients, 73 had the religion(75.2%), 173 had studied above high school(58.8%), 211 were married(71.8%), and 94 were homemaker(3296). Economically, 130 of 294 patients(44.2M) were the middle classes. The patients without occupation were 121 of 294 patients(41.2M), while those with occupation were 77(26.1%) and remainder were housemaker. The patients with medical insurance were 59.9%, those with 1st Medicaid were 22.4%, and those with 2nd Medicaid were 17%. 3) The causes of ESRD were CGN(29.5%), DM (22.3%), etc. Total duration of hemodialysis was 51.4 43.8 months in average, and weekly hemodialysis time was 11.541.98 hours in average. Average BMI was 20.6 +/- 2.79, and in 236 of 294 patients(80.1%), EPO was injected. Of all the complication, 96(32.9%) was cardiovascular problem. Iron storage state was relatively good in all the patients, and the mean level of PTH-i was 174.3 +/- 307.9pg/dl, hemoglobin 8.5 +/- 1.3g/dl, cholesterol 161.536.6mg/dl, total protein 6.60.5g/dl, albumin 3.960.4g/dl. The URR was 65.36.9%, and KtV was 1.3 +/- 0.3. The comparison about laboratory finding between male and female was as followed; Hb. and albumin level was signifi- cantly higher in male compared with female patients, and cholesterol, URR and Kt/V was significantly higher in female than in male. 4) The result of statistic analysis about several variables and Questionnaires. (1) The subjective and objective instrument about QOL showed positive correlation, and the QOL was correlated positively to symptom, physical health state and social support. (2) Of social characteristics, the direct influencing factors for QOL were occupation, economic state, marriage state, and educational state, whereas in- direct factors were a fee for medical treatment and social support. In clinical and laboratory characteristics, the significant factors were age, DM, symptoms, albumin, pre-dialytic creatinine, sodium and calcium. The effect of dialysis did not correlate with QOL. In conclusion, to increase QOL in dialysis pa- tients, all of the community, family, and medical team should make an effort. Firsty, the concern and the support of the community about the dialysis patients should be promoted in social welfare and the opportunity of employment. Secondly, the patients should promote the self-reliance and self- efficacy to take a share of their role in the community and a family by their own efforts. Lastly, the medical team should make an effort to decrease the symptom, to correct the anemia and malnutrition, to treat the complication, and to promote the physical activity. Through these efforts, the health of patients will be elevated. Elevation of the patient's health will increase the possibility of employment and self-reliance, and subsequently will increase the economics. If so, the burden of a fee for the medical treatment will be reduced. Additionally, if social and familial support increase, the QOL of the dialysis patients will be better.

The Study of Transplacental Transfer of Immunoglobulin G in Premature Infants

PURPOSE: Premature infants have low serum immunoglobulin G (IgG) levels because IgG is transplacentally acquired, primarily after 32-34 weeks of gestational age. We studied the transplacental transfer of serum IgG in preterm infants. METHODS: The IgG levels in the sera were measured by radial immunodiffusion method (Behring nephelometer, Germany). RESULTS: There was a significant difference between IgG concentration and gestational age; the IgG concentration increased from 462.2 +/- 105.5mg/dL at less than 26 weeks of gestation to 1009.0 +/- 242.6mg/dL at 35 and 36 weeks of gestation with increasing gestational age (P<0.01). The linear relation between IgG concentration and birthweight; the IgG concentration in the sera of premature infants were increased from 588.3 +/- 136.4mg/dL at birthweight less than 1250g to 1149.3 +/- 287.8mg/dL at birthweight more than 2251g with increasing birth weight (P<0.05). CONCLUSION: The effects of gestational age and birthweight on the concentration of IgG at birth were highly interdependent and significant. These results suggest that IVIG administration is needed for nearly all premature infants with birthweight less than 1200g and gestational age less than 32 weeks.

Severe hypophosphatemia in hospitalized patients / 대한신장학회잡지

No abstract available.