Effect of L-carnitine on quality of life in covert hepatic encephalopathy: a randomized, double-blind, placebo-controlled study

Background/Aims@#L-carnitine is potentially beneficial in patients with hepatic encephalopathy (HE). We aimed to evaluate the impact of L-carnitine on the quality of life and liver function in patients with liver cirrhosis and covert HE. @*Methods@#We conducted an investigator-initiated, prospective, multi-center, double- blind, randomized phase III trial in patients with covert HE. A total of 150 patients were randomized 1:1 to L-carnitine (2 g/day) or placebo for 24 weeks. Changes in quality of life and liver function were assessed at 6 months. The model for end-stage liver disease (MELD), the 36-Item Short Form Survey (SF-36), the psychometric hepatic encephalopathy score (PHES), and the Stroop Test were evaluated in all patients. @*Results@#The total SF-36 score significantly improved in the L-carnitine group after 24 weeks (difference: median, 2; interquartile range, 0 to 11; p < 0.001); however, these values were comparable between the two groups. Furthermore, there was a significant ordinal improvement in PHES scores among patients with minimal HE who were in the L-carnitine group (p = 0.007). Changes in the total carnitine level also positively correlated with improvements in the Stroop test in the L-carnitine group (color test, r = 0.3; word test, r = 0.4; inhibition test, r = 0.5; inhibition/switching test, r = 0.3; all p < 0.05). Nevertheless, the MELD scores at week 24 did not differ between the groups. @*Conclusions@#Twenty-four weeks of L-carnitine supplementation was safe but ineffective in improving quality of life and liver function.

A Case of Mycobacterium Abscessus Spondylitis / 대한내과학회지

The designation nontuberculous mycobacteria (NTM) applies to mycobacterial species other than organisms of the Mycobacterium tuberculosis complex and Mycobacterium leprae. In recent decades, the prevalence of human disease caused by NTM has increased; thus, the clinical significance of NTM is increasing. Mycobacterium abscessus is a rapidly growing nontuberculous mycobacterial species that is usually associated with chronic pulmonary disease, posttraumatic soft-tissue infections, nosocomial bloodstream infections, wound infections, and abscesses at the site of prior intramuscular injections; however, vertebral osteomyelitis due to this species is rare. Here, we present a case of vertebral osteomyelitis due to M. abscessus that occurred in a patient with iatrogenic Cushing's syndrome and a history of acupuncture who was treated with wide surgical excision and prolonged combined antibiotic treatment.

Effects of bovine colostrum in diclofenac induced gut injured rat model / 대한내과학회지

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed medicine but induce damage throughout the entire gastrointestinal tract including small intestine with protein and blood loss. Impaired epithelial barrier function, overgrowth of luminal bacteria and others have been implicated in the pathogenesis of NSAID induced enteropathy. Colostrum is a first milk produced after birth and is particularly rich in growth factors, immunoglobulins and antimicrobial peptides. The present study aimed to exam whether defatted bovine colostrum reduce small intestinal injury caused by diclofenac in the animals. METHODS: 64 rats were utilized in four groups; control group, diclofenac group, diclofenac with 5% colostrum group and diclofenac with 10% colostrum group. The animals with colostrum were fed with 5% or 10% colostral solution for 5 days before diclofenac administration. Small intestinal injury was induced by administering a single dose of diclofenac (50 mg/kg subcutaneously). Epithelial permeability, enteric aerobic bacterial counts, serum albumin and protein levels, and pathologic findings of distal ileum were measured. RESULTS: Diclofenac caused marked increase in intestinal permeability, enteric bacterial numbers and intestinal villous damage, and declines in serum levels of total protein and albumin. Co-administration of bovine colostrum reduced intestinal permeability and enteric bacterial numbers, declines in serum albumin and protein levels, and mucosal damage of small intestine induced by diclofenac. CONCLUSION: Bovine colostrums may have beneficial effects on preventing NSAID induced small intestinal injury and bacterial translocation.

A case report of suprerior mesenteric vein thrombosis associated with diverticulitis / 대한내과학회지

Mesenteric vein thrombosis is a rare disease that can be fatal, as it can cause ischemia or infarction of bowels. The mortality rate is 13~50%. The predisposing factors of mesenteric vein thrombosis are numerous, and one of them is diverticulitis. Diverticulitis is a rare disease and mesenteric vein thrombosis caused by diverticulitis has not been reported in Korea. We report a patient with superior mesenteric vein thrombosis associated with diverticulitis of ascending colon, and it was diagnosed by computed tomography and barium enema. After antibiotic therapy, the thrombosis was resolved and the patient was completely recovered.