Persistent transaminase elevations in chronic hepatitis C patients with virological response during peginterferon and ribavirin therapy.

BACKGROUND/AIMS: The aim of this study was to determine the incidence of persistently abnormal transaminase levels despite clearance of serum hepatitis C virus (HCV) RNA during antiviral therapy for chronic hepatitis C. METHODOLOGY: One hundred and fifty-one patients with chronic hepatitis C undergoing peginterferon alpha and ribavirin therapy and post-treatment follow-up for 24 weeks were included. The blood cell counts, liver biochemistry and serum HCV RNA levels were determined before, during and at 24 weeks after treatment. RESULTS: Overall, 104 patients (68.9%) achieved sustained virological response. Fifty-four of them (52%) had persistently abnormal transaminase levels during treatment despite clearance of serum HCV RNA. Among them, 27 patients (26%) had persistently abnormal serum AST and ALT levels and another 17 patients (16.3%) displayed isolated elevated AST levels. These 44 patients had normalized transaminase levels by two to three months after the end of treatment. The delayed biochemical response correlated with a higher baseline hepatic fibrosis stage (p=0.017) and liver cirrhosis (p=0.001). CONCLUSIONS: Approximately 42% of the patients eventually achieving sustained virological response following peginterferon alpha and ribavirin therapy showed delayed biochemical normalization. Delayed biochemical response was associated with the baseline hepatic fibrosis stage and liver cirrhosis.

Comparison and efficacy of LigaSure and rubber band ligature in closing the inflamed cecal stump in a rat model of acute appendicitis.

Safety of either LigaSure or rubber band in closing inflamed appendiceal stump in acute appendicitis has been less investigated. In this study, cecal ligation followed by resecting inflamed cecum was performed to mimic appendectomy in a rat model of acute appendicitis. Rats were sacrificed immediately (Group A) and 7 days (Group B) after cecal resection, respectively. The cecal stumps were closed by silk ligature (S), 5 mm LigaSure (L), or rubber band (R). Seven days after cecal resection, the LigaSure (BL) and silk subgroups (BS) had significantly less intra-abdominal adhesion and better laparotomy wound healing than rubber band subgroup (BR). The initial bursting pressure at cecal stump was comparable among the three methods; along with tissue healing process, both BL and BS provided a higher bursting pressure than BR 7 days after appendectomy. BL subgroup had more abundant hydroxyproline deposition than BS and BR subgroup. Furthermore, serum TNF-α in BR group kept persistently increasing along with time after cecal resection. Thus, the finding that LigaSure but not rubber band is safe in sealing off the inflamed cecal stump in rat model of acute appendicitis suggests the possibility of applying LigaSure for appendectomy via single port procedure or natural orifice transluminal endoscopic surgery (NOTES).