BACKGROUND: It has been suggested that clearance of HBeAg was usually durable in Caucasians with chronic hepatitis B (CHB) after cessation of lamivudine, but little is known whether such effect is durable in Asian patients. The aim of this study was to evaluate the therapeutic efficacy of lamivudine, the predictive factors for response (defined as clearance of both HBV-DNA and HBeAg) and relapse rate in patients with CHB. METHODS: We retrospectively analyzed 67 patients with CHB who were treated with lamivudine from August 1996 to September 1997. Among them, 41 were non-responders to interferon alpha. Lamivudine was given at a dose of 150 mg a day over 6 months. In responders, lamivudine was continued between 2 and 4 months more after clearance of HBeAg and they were followed for 12 months without further treatment. Mean duration of therapy in responders and non-responders was 8.9 months (range; 6-13 months) and 11.6 months (range; 7-22 months) respectively. RESULTS: 51 (79.1%) cleared serum HBV-DNA, 31 (46.3%) cleared both serum HBV-DNA and HBeAg, and 25 patients (37.3%) were seroconverted to anti-HBe. Predictive factors for response were female, high levels of serum ALT and low levels of serum HBV-DNA. However, during follow-up in responders, the cumulative relapse rate was 64% at 12 months. CONCLUSION: Although lamivudine effectively suppressed HBV replication, relapse rate was high even in responders. It is suggested that the response to lamivudine is not durable in Korean patients with CHB.
Asian Continental Ancestry Group ; Female ; Follow-Up Studies ; Hepatitis B e Antigens ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Interferon-alpha ; Lamivudine* ; Recurrence* ; Retrospective Studies

Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis characterized by an autoimmune inflammatory process. This is the first case report of AIP, not otherwise specified, accompanied by pericardial effusion. A 52-year-old female visited our hospital due to dyspnea. Echocardiography showed a large amount of pericardial thickening. Abdominal computed tomography revealed diffuse enlargement of the pancreas body and tail with a sausage-shaped appearance, surrounded by a thick hypodense rim. Endoscopic retrograde cholangiopancreatography could not identify the tail portion of the pancreas, despite forceful contrast injection. Serology was positive for antinuclear antibody and IgG4 was normal. Endoscopic ultrasound-guided core biopsy of the pancreas was performed. Histologic examination revealed a fibrous connective tissue with inflammatory infiltration. The patient was treated with steroids. In the follow-up images, abnormal findings of pericardial effusion were improved, although an irregular long stricture of the pancreas tail portion remained.
Antibodies, Antinuclear ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Connective Tissue ; Constriction, Pathologic ; Dyspnea ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Immunoglobulin G ; Middle Aged ; Pancreas ; Pancreatitis* ; Pancreatitis, Chronic ; Pericardial Effusion* ; Steroids

Anti-glomerular basement membrane (Anti-GBM) nephritis is an autoimmune disorder characterized by rapidly progressive crescentic glomerulonephritis (RPGN). The treatment of anti-GBM nephritis with plasmapheresis, steroids and immunosuppressant has improved outcomes. An early diagnosis is essential for the survival of patients and a recovery of renal function. The diagnosis of anti-GBM disease has been traditionally based on the demonstration of linear deposits of immunoglobulins along the glomerular basement membrane by immunofluorescence (IF) microscopy. However, a kidney biopsy cannot always be easily performed in such ill patients. Recent development of specific enzyme immunoassays for anti-GBM antibody in the serum has made possible a provisional diagnosis without a kidney biopsy. A 46-year-old male patient with hypertension and hepatitis B presented with generalized edema and general weakness. Laboratory findings were compatible with acute renal failure and nephrotic syndrome with positive serum anti-GBM antibodies. After plasmapheresis with steroid pulse therapy, renal biopsy was performed and diagnosed as membranoproliferative glomerulonephritis (MPGN) with granular deposit of Ig G and C3. Follow-up antibody titers were negative. This case demonstrates the possibility of false-positive anti-GBM antibody in the serum. Therefore, enzyme immunoassay for anti-GBM antibody should be used only as a screening or follow-up test in patients that have been confirmed positive by IF microscopy.
Acute Kidney Injury ; Anti-Glomerular Basement Membrane Disease ; Antibodies ; Autoantibodies ; Basement Membrane ; Biopsy ; Early Diagnosis ; Edema ; False Positive Reactions ; Fluorescent Antibody Technique ; Follow-Up Studies ; Glomerular Basement Membrane ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative ; Hepatitis B ; Humans ; Hypertension ; Immunoenzyme Techniques ; Immunoglobulins ; Kidney ; Male ; Mass Screening ; Microscopy ; Middle Aged ; Nephritis ; Nephrotic Syndrome ; Plasmapheresis ; Steroids