No abstract available.
Demyelinating Diseases ; Hyponatremia

BACKGROUND/AIMS: The aim of this study was to elucidate the antiviral efficacy of lamivudine (LMV)-adefovir (ADV) combination therapy in chronic hepatitis B patients who showed resistance to LMV and ADV consecutively. METHODS: A retrospective review was performed in eighteen patients with chronic hepatitis B who developed virologic breakthroughs during LMV-ADV sequential mono-therapy and treated with LMV-ADV combination therapy. RESULTS: The median duration of follow up was 17 months (range, 6-27) after the start of LMV-ADV combination therapy. Mean HBV DNA level in log10 IU/mL was 6.08+/-0.95, 4.05+/-1.66, 3.17+/-1.58, 3.18+/-2.16, and 2.35+/-1.52 at 0, 3, 6, 12, and 24 months, respectively. Sixteen patients (88.9%) showed HBV DNA reduction below detection limit (<20,000 IU/mL). HBeAg seroconversion was observed in one patient (7.1%) after 8 months of combination therapy. Virologic breakthrough occurred in only one patient after 21 months of combination therapy. Viral rebound occurred in two patients at 12 months and 14 months of combination therapy. Normalization of serum ALT was achieved in twelve patients (66.7%). Primary non-response was observed in two cases (11.1%). CONCLUSIONS: LMV-ADV combination treatment was effective in 88.9% of patients with resistance to LMV and ADV in a short-term follow up. It may be applied as a bridge therapy until another effective antiviral regimen becomes available.
Adenine/*analogs & derivatives/therapeutic use ; Adult ; Antiviral Agents/*therapeutic use ; DNA, Viral/analysis ; Drug Resistance, Viral ; Drug Therapy, Combination ; Female ; Genotype ; Hepatitis B, Chronic/*drug therapy ; Humans ; Lamivudine/*therapeutic use ; Male ; Middle Aged ; Phosphonic Acids/*therapeutic use ; Time Factors

BACKGROUND/AIMS: Visceral larva migrans, caused by Toxocara canis and Toxocara cati, has emerged as a significant cause of eosinophilic liver abscess (ELA). Differentiation of ELA associated with toxocariasis (ELA-T) from metastasis or primary liver malignancy is sometimes difficult. However, the role of albendazole treatment remains uncertain in this condition. The aim of this study was to evaluate whether albendazole can enhance the radiologic resolution of ELA-T. METHODS: We retrospectively reviewed the medical records of the patients diagnosed with ELA-T at our institution between January 2008 and December 2011. ELA-T was diagnosed based on the imaging findings on computed tomography or magnetic resonance imaging and the presence of positive serum IgG antibody for Toxocara canis. Among a total of 163 patients, 32 patients received albendazole (albendazole group) and 131 did not (control group). Baseline characteristics and fate of liver nodules were compared between the two groups. RESULTS: Baseline characteristics (age, sex, number and maximal size of lesions, eosinophil count) were similar between the two groups. Median duration for achieving radiologic resolution in the albendazole group was significantly shorter than in the control group (207 days [range 186-228] vs. 302 days [range 224-380], p=0.023). In Cox regression analysis of the cumulative rates of radiologic resolution, the hazard ratio for albendazole treatment was 1.99 (95% confidence interval, 1.22-3.23). CONCLUSIONS: Radiologic resolution of ELA-T can be accelerated with albendazole treatment. Hence, inconvenience associated with long-term follow-up and unnecessary worries among patients can be eliminated with albendazole treatment.
Adult ; Aged ; Aged, 80 and over ; Albendazole/*therapeutic use ; Animals ; Antiprotozoal Agents/*therapeutic use ; Eosinophils/*immunology ; Female ; Humans ; Immunoglobulin G/blood ; Larva Migrans, Visceral/*drug therapy/parasitology ; Liver/enzymology/metabolism ; Liver Abscess/*etiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Tomography, X-Ray Computed ; Toxocara canis/immunology/isolation & purification

BACKGROUND/AIMS: Despite great progress, antiviral treatment for chronic hepatitis C in patients with prior hepatocellular carcinoma (HCC) has been rarely investigated. We evaluated the efficacy and safety of antiviral therapy following treatment for hepatitis C-related HCC. METHODS: Thirteen patients (age 34 to 60 years) who were treated with peginterferon plus ribavirin after treatment for HCC were reviewed. RESULTS: There were 6 patients with genotype 1 and 7 patients with genotype 2. All patients showed advanced fibrosis (> or =F3) but belonged to the Child-Pugh class A. Treatment was stopped in 2 patients because of recurrent HCC and in 1 patient due to a lack of early virologic response. Seven patients achieved sustained virologic response and three patients relapsed. The sustained virologic response rate was 54% overall, 17% in genotype 1, and 86% in genotype 2. No significant adverse events were reported. CONCLUSIONS: Antiviral therapy should not be excluded in patients who were previously treated with HCC with genotype 2 chronic hepatitis C, in which an efficacious antiviral treatment for chronic hepatitis C was feasible. Additional study is needed to prove the validity of antiviral therapy in patients with genotype 1 hepatitis C-related HCC.
Carcinoma, Hepatocellular ; Fibrosis ; Genotype ; Hepatitis ; Hepatitis C, Chronic ; Humans ; Ribavirin

PURPOSE: To investigate the measured values of the talus in Koreans. MATERIALS AND METHODS: We measured 88 tali from 44 cadavers that have been donated between December 2012 and December 2015. Of the cadavers, 27 were male and 17 were female. Their mean age was 73 years. The length and width of the talus were measured using a digital goniometer and vernier caliper. RESULTS: The values of cadaveric measurement, mean maximal width and length, width and length of the dome anterior, width and length of the posterior facet, height and length of the trochlear medial facet, and height and length of the trochlear lateral facet were 43.6±2.6 mm, 56.5±3.3 mm, 32.5±2.0 mm, 42.2±2.7 mm, 22.2±2.2 mm, 34.7±2.0 mm, 15.3±1.3 mm, 33.3±2.9 mm, 25.3±3.3 mm, and 30.8±2.4 mm for men and 38.9±1.6 mm, 53.6±2.4 mm, 27.9±2.1 mm, 37.4±3.2 mm, 20.6±0.8 mm, 31.9±1.2 mm, 13.6±2.6 mm, 28.4±2.5mm, 24.9±2.1 mm, and 28.9µ1.4 mm for women, respectively. The size of the talus showed an accuracy of 86% when anteroposterior diameter was greater than 59 mm. A difference in the size of the right and left talus was not observed. The mean inclination and declination angles were 24.4°±4.2° and 28.2°±5.4° for men, and 24.6°±3.6° and 24.7°±6.7° for women (p=0.980, p=0.018), respectively, at least 15°, which showed a big difference for every object up to 37°. CONCLUSION: This paper, to the best of our knowledge, is the first study to measure the talus in Koreans. There were differences by gender and ethnicity in the in measured talus values. The measurements were smaller than European-Americans and greater than Japanese.
Asian Continental Ancestry Group ; Cadaver* ; Female ; Humans ; Male ; Talus*

BACKGROUND/AIMS: We assessed the clinical features and prognosis of acute viral hepatitis A (AHA) complicated with acute kidney injury (AKI) and elucidated predictive factors for AKI in patients with AHA. METHODS: We reviewed medical record of 391 patients with AHA admitted at our institution since 2000. RESULTS: AKI was present in 45 patients (11.5%). The proportion of the AKI group increased since 2008 (5.4% before 2008 vs. 15.9% since 2008, p=0.001). The AKI group was older than the non-AKI group (35.7+/-8.7 years vs. 31.3+/-7.8 years, p=0.002). Other baseline clinical characteristics were similar between two groups. Initial hemoglobin, platelet, and serum albumin were significantly low and prothrombin time, serum bilirubin, creatinine, AST, and ALT were significantly high in the AKI group. Hepatic encephalopathy, ascites, gastrointestinal bleeding, and sepsis were more frequently observed in the AKI group. While six patients (13%) in the AKI group received liver transplantation (LT) but three patients died within one month, one patient in the non-AKI group receiving LT is alive. Multivariate analysis showed that older age (OR 1.07, 95% CI 1.02-1.12), initial thrombocytopenia <150,000/mm2 (OR 2.85, 95% CI 1.24-6.57), prothrombin time (PT) prolongation (OR 5.34, 95% CI 2.55-11.19), and hypoalbuminemia (OR 8.24, 95% CI 2.53-26.86) were independently associated with the occurrence of AKI. CONCLUSIONS: AHA with AKI is an increasing problem showing significant morbidity and mortality in Korea. AKI is highly associated with older age, initial thrombocytopenia, PT prolongation, or low serum albumin, and has bad prognostic effect.
Acute Disease ; Acute Kidney Injury/complications/*diagnosis/therapy ; Adult ; Age Factors ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Bilirubin/blood ; Creatine/blood ; Female ; Hemoglobins/analysis ; Hepatitis A/complications/*diagnosis ; Humans ; Hypoalbuminemia/complications ; Liver Transplantation ; Male ; Middle Aged ; Odds Ratio ; Platelet Count ; Predictive Value of Tests ; Prognosis ; Prothrombin Time ; Serum Albumin/analysis ; Thrombocytopenia/complications

BACKGROUND/AIMS: We investigated the effect of low dose corticosteroid therapy on HBV reactivation in patients with chronic HBV infection. METHODS: From August 1998 to March 2007, the HBsAg-positive patients who received oral or intravenous corticosteroid therapy for more than 1 week at Samsung Medical Center were included in this retrospective study. We included those patients who received anticancer chemotherapy or organ transplantation, or concurrent antiviral therapy or other immunosuppressive agents. HBV reactivation was defined as a 10-fold increase in the HBV DNA levels compared with baseline. RESULTS: A total of 16 patients were included. They were 45.4+/-16.7 years of age, and the male:female ratio was 14:2. Their combined diseases included bronchial asthma, allergic urticaria, allergic rhinitis, etc. The corticosteroid doses were converted to prednisolone equivalent doses and these varied from 2.5 mg to 50 mg per day. Eleven patients used less than 20 mg of prednisolone per day. The mean medication duration was 60.1 days (range: 7-364 days). Among the patients, only one patient showed HBV reactivation. This ankylosing spondylitis patient was a 31-year old man who took prednisolone 5 mg/day for 364 days. He displayed HBeAg-positivity before corticosteroid treatment. There was no aggravation of the levels of ALT, albumin, bilirubin, and PT between the pre-and post-medication in this patient. CONCLUSIONS: The short term use of low dose corticosteroid is not likely to be related with HBV reactivation in those patients with chronic HBV infection, yet long term use may lead to viral reactivation. Further large scaled, prospective studies on this subject are needed.
Asthma ; Bilirubin ; DNA ; Hepatitis B e Antigens ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Immunosuppressive Agents ; Organ Transplantation ; Prednisolone ; Retrospective Studies ; Rhinitis ; Rhinitis, Allergic, Perennial ; Spondylitis, Ankylosing ; Transplants ; Urticaria

BACKGROUND/AIMS: Adefovir (ADV) is the preferred drug for treating lamivudine (LAM)-resistant hepatitis B. However, not all patients who face virologic breakthrough during LAM treatment respond to ADV. The aim of this study was to determine the factors associated with efficacy of ADV in LAM-resistant hepatitis B patients. METHODS: The medical records of 231 patients who received ADV due to LAM-resistance were reviewed. Efficacy was assessed by the initial virologic response (IVR), defined as hepatitis B virus (HBV) DNA not being undetectable by real-time PCR at 6 months of ADV treatment. RESULTS: Seventy patients (30%) achieved IVR. While 'add-on' modality, hepatitis B e antigen (HBeAg) negativity, and low baseline HBV DNA levels were associated with IVR in univariate analysis, multivariate analysis revealed HBeAg status and the DNA level to be the significant factors. The probability of IVR achievement increased sharply per each log10 copies/mL decrement in the baseline viral load, which was 133 times in patients who had HBV DNA <10(5) copies/mL compared with those who had > or =10(8) copies/mL. CONCLUSIONS: Factors associated with the IVR were HBeAg negativity and a low baseline viral load. Therefore, when virologic breakthrough with genotypic resistance emerges during LAM therapy, ADV treatment should be considered immediately before further increases in viral load. Additional long-term follow-up data are warranted.
Achievement ; Adenine ; DNA ; Drug Resistance, Viral ; Follow-Up Studies ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Lamivudine ; Lipopolysaccharides ; Medical Records ; Multivariate Analysis ; Organophosphonates ; Real-Time Polymerase Chain Reaction ; Viral Load

BACKGROUND/AIMS: The notion that acute hepatitis A superimposed on chronic hepatitis B infection leads to a worse outcome than acute hepatitis A alone remains controversial. The aim of this study was to determine the influence of the presence of hepatitis B surface antigen (HBsAg) on the severity of acute hepatitis A. METHODS: We retrospectively analyzed 449 patients hospitalized for acute hepatitis A from January 2000 to February 2010 and compared clinical outcomes based on the presence of HBsAg. RESULTS: Of the 449 patients, 30 patients were in the HBsAg-positive group and 419 in the HBsAg-negative group. The HBsAg-positive group was older than the HBsAg-negative group (36.1+/-8.3 vs 31.8+/-8.5 years, p=0.004); however, other baseline characteristics were similar between the 2 groups. Mean peak values of prothrombin time, serum total bilirubin, and serum creatinine at admission were significantly higher in the HBsAg-positive group. When comparing clinical outcomes between the 2 groups, gastrointestinal bleeding, acute renal failure, and acute liver failure were more frequently observed in the HBsAg-positive group. In particular, the incidence of acute liver failure was approximately 9-fold higher in the HBsAg-positive group than in the HBsAg-negative group (23.3% vs 3.3%; odds ratio [OR], 8.80; p<0.001). Multivariate analysis showed that HBsAg (OR, 7.43; 95% confidence interval [CI], 2.56 to 21.57) and age (OR, 1.07; 95% CI, 1.02 to 1.13) were independent risk factors for the occurrence of acute liver failure. CONCLUSIONS: In patients with chronic hepatitis B infection, acute hepatitis A is associated with more severe clinical outcomes, including acute liver failure, compared with patients with acute hepatitis A alone.
Acute Kidney Injury ; Bilirubin ; Creatinine ; Hemorrhage ; Hepatitis ; Hepatitis A ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic ; Humans ; Incidence ; Liver ; Liver Failure, Acute ; Multivariate Analysis ; Odds Ratio ; Prothrombin Time ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: The role of radiofrequency ablation (RFA) remains uncertain in patients with viable hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE). METHODS: A total of 101 patients (April 2007 to August 2010) underwent RFA for residual or recurrent HCC after TACE. We analyzed their long-term outcomes and predictive factors. RESULTS: The overall survival rates after RFA were 93.1%, 65.4%, and 61.0% at 1, 3, and 5 years, respectively. Predictive factors for favorable overall survival were Child-Pugh class A (hazard ratio [HR], 3.45; p=0.001), serum alpha-fetoprotein (AFP) level <20 ng/mL (HR, 2.90; p=0.02), and recurrent tumors after the last TACE (HR, 3.14; p=0.007). The cumulative recurrence-free survival rate after RFA at 6 months was 50.1%. Predictive factors for early recurrence (within 6 months) were serum AFP level > or =20 ng/mL (HR, 3.02; p<0.001), tumor size > or =30 mm at RFA (HR, 2.90; p=0.005), and nonresponse to the last TACE (HR, 2.13; p=0.013). CONCLUSIONS: Patients with recurrent or residual HCC who undergo prior TACE show a favorable overall survival, although their tumors seem to recur early and frequently. While good liver function, a low serum AFP level, and recurrent tumors were independent predictive factors for a favorable overall survival, poor response to TACE, a high serum AFP level, and large tumors are associated with early recurrence.
Aged ; Carcinoma, Hepatocellular/*mortality/*therapy ; *Catheter Ablation ; Chemoembolization, Therapeutic/mortality ; Combined Modality Therapy/mortality ; Female ; Humans ; Liver Neoplasms/*mortality/*therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local/mortality ; Survival Rate ; Treatment Outcome ; alpha-Fetoproteins/analysis