The wide use of lamivudine in chronic hepatitis B has produced a monotonic increase in patients with lamivudine resistance. Therefore, treating lamivudine resistance in chronic hepatitis B is a major concern in clinical practice for the treatment of hepatitis B virus (HBV). There is conflicting evidence on the outcome of pegylated interferon alpha (PEG-IFN alpha) therapy against lamivudine-resistant HBV, which is due to mutations in the YMDD motif. We experienced a patient with chronic hepatitis B who was successfully treated with PEG-IFN alpha-2a after the development of virologic and biochemical breakthrough during lamivudine therapy. Virologic breakthrough was associated with the emergence of YMDD mutants 48 months after starting lamivudine therapy. Treatment with PEG-IFN alpha-2a for 12 months resulted in an undetectable serum level of HBV DNA and the resolution of hepatitis, and the virologic response was maintained over 16 months after cessation of PEG-IFN alpha-2a.
Adult ; Alanine Transaminase/blood ; Antiviral Agents/*therapeutic use ; DNA, Viral/analysis ; Drug Resistance, Viral ; Hepatitis B, Chronic/diagnosis/*drug therapy ; Humans ; Interferon Alfa-2a/*therapeutic use ; Lamivudine/*therapeutic use ; Liver/pathology ; Male ; Polyethylene Glycols/*therapeutic use

Pyoderma gangrenosum is a rare chronic cutaneous disease with distinctive clinical characteristics. A painful nodule or pustule breaks down to form a progressively enlarging ulcer. The diagnosis is confirmed by exclusion of other diseases that may cause cutaneous ulcers. Associated conditions are common. The most common associated conditions are inflammatory bowel diseases, arthritis, hematologic disorders. Pyoderma gangrenosum develops in approximately 3~5% of patients with ulcerative colitis and 1% of patients with Crohn's disease. Until now, only one case of pyoderma gangrenosum associated with Crohn's disease has been reported in Korea. Recently, we experienced a case of pyoderma gangrenosum developed in a patient with Crohn's disease.
Arthritis ; Colitis, Ulcerative ; Crohn Disease* ; Diagnosis ; Humans ; Inflammatory Bowel Diseases ; Korea ; Pyoderma Gangrenosum* ; Pyoderma* ; Ulcer

Biliary complications after liver transplantation occur in 13~35% of patients. Biliary cast syndrome, cast formation of biliary sludge along the bile duct, can develop in 4~18% of liver transplant recipients, although the incidence rate is significantly decreasing due to the improvement of graft harvesting and preservation. It is very important that early diagnosis and effective management of biliary cast syndrome be performed when there is a bile duct stricture or dilatation associated with jaundice and cholangitis in the recipient after liver transplantation, due to the possibility of retransplantation and death of the patient from graft loss. We report a case of a biliary cast formed with suppurative cholangitis and extracted incidentally with a plastic biliary stent during an endoscopic procedure after cadaveric liver transplantation, in which the ERCP findings revealed a stricture at the anastomosis site of the common bile duct and cholangitis.
Bile ; Bile Ducts ; Cadaver ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis* ; Common Bile Duct ; Constriction, Pathologic* ; Dilatation ; Early Diagnosis ; Humans ; Incidence ; Jaundice ; Liver Transplantation* ; Liver* ; Plastics ; Stents ; Superior Mesenteric Artery Syndrome* ; Transplantation ; Transplants

Isolated noncompaction of ventricular myocardium, sometimes referred to as spongy myocardium, is a rare congenital cardiomyopathy. Spongy myocardium results from an arrest in normal endomyocardial embryogenesis. The clinical symptoms and electrocardiographic findings of this disorder can be showed variously. The diagnosis is usually made by echocardiography. We report a case of isolated noncompaction of the ventricular myocardium in a 20-year-old male patient initially presented with syncope caused by ventricular tachycardia, who was diagnosed with echocardiography, cardiac MRI and endomyocardial biopsy.
Adult* ; Biopsy ; Cardiomyopathies ; Diagnosis ; Echocardiography ; Electrocardiography ; Embryonic Development ; Female ; Humans ; Isolated Noncompaction of the Ventricular Myocardium ; Magnetic Resonance Imaging ; Male ; Myocardium* ; Pregnancy ; Syncope ; Tachycardia, Ventricular* ; Young Adult

Isolated noncompaction of ventricular myocardium, sometimes referred to as spongy myocardium, is a rare congenital cardiomyopathy. Spongy myocardium results from an arrest in normal endomyocardial embryogenesis. The clinical symptoms and electrocardiographic findings of this disorder can be showed variously. The diagnosis is usually made by echocardiography. We report a case of isolated noncompaction of the ventricular myocardium in a 20-year-old male patient initially presented with syncope caused by ventricular tachycardia, who was diagnosed with echocardiography, cardiac MRI and endomyocardial biopsy.
Adult* ; Biopsy ; Cardiomyopathies ; Diagnosis ; Echocardiography ; Electrocardiography ; Embryonic Development ; Female ; Humans ; Isolated Noncompaction of the Ventricular Myocardium ; Magnetic Resonance Imaging ; Male ; Myocardium* ; Pregnancy ; Syncope ; Tachycardia, Ventricular* ; Young Adult

A malignant fibrous histiocytoma is a malignant soft tissue neoplasm that occurs frequently in the metaphyseal ends of the long bones of adults. The lung is a common site for metastasis but it is a rare site for a primary malignant fibrous histiocytoma. Here we report a case of a primary malignant fibrous histiocytoma of the lung. The patient was a 53-year-old man who presented with a moderate amount of a left pleural effusion and an ill-defined mass in the left lower lobe on a chest radiograph and a local invasion to the left 10th and 11th rib on chest CT. Under the strong suspicion of lung cancer with a pleural invasion, a serial diagnostic thoracentesis was performed. The cytologic examination of the pleural effusion revealed no malignant cells. Consequently, a thoracoscopic pleural biopsy was performed. The histological examination revealed slender spindle cells and scattered epitheloid cells arranged in a vague storiform or a whirling pattern. Immunohistochemically, the tumor cells tested positive for vimentin and negative for cytokeratin, desmin, CD34 and PAS. These features were consistent with a malignant fibrous histiocytoma. This case is an unusual addition to the small number of published reports on a primary malignant fibrous histiocytoma of the lung.
Adult ; Biopsy ; Desmin ; Histiocytoma, Malignant Fibrous* ; Humans ; Keratins ; Lung ; Lung Neoplasms ; Middle Aged ; Neoplasm Metastasis ; Pleural Effusion ; Radiography, Thoracic ; Ribs ; Sarcoma* ; Soft Tissue Neoplasms ; Tomography, X-Ray Computed ; Vimentin