Biomedical subjects

S D Lee

Publications and source records attributed to S D Lee.

At least 127 records · Page 7Linked to original sources

PubMed2000

Diabetes mellitus as a risk factor of liver cirrhosis in patients with chronic hepatitis B virus infection.

Liver cirrhosis may occur in chronic hepatitis B surface antigen (HBsAg) carriers. Diabetes mellitus (DM)-associated chronic hepatitis may also occasionally lead to cirrhosis; however, its role in the course of chronic HBsAg carriers has not been studied. A cohort of 500 HBsAg carriers (398 men; mean age at entry, 42 +/- 15 years) were followed up longitudinally. After a mean follow-up of 5.8 +/- 3.3 years, 71 (14.2%: 70 men) patients developed cirrhosis. Increased risks of cirrhosis were found among men and the elderly (p < 0.001). Fifteen (21.1%) cirrhotic patients were noted to have had DM for 2-15 years before the development of cirrhosis. By contrast, only eight (1.9%; p < 0.001 ) of the patients without cirrhosis developed DM. When cirrhotic patients were compared to 102 age- and sex-matched non-cirrhotic controls, DM and elevation of serum alanine transaminase levels were found to be independent factors associated with the advent of cirrhosis in multivariate analysis. Other factors, including acute exacerbation, bridging hepatic necrosis, and superinfection by hepatitis C or D viruses, were insignificant. Our results suggest that DM may play a role in the progression to liver cirrhosis in chronic HBsAg carriers. High-risk subjects should be closely monitored for late complications.

Adult↗

PubMed2000

Pseudogastroparesis as a presentation of small-bowel malignancy.

Establishing the diagnosis of small-bowel malignancy is sometimes an extremely difficult challenge owing to its non-specific symptoms. The mainstay of treatment is early recognition, diagnosis and surgical resection. The prognosis depends primarily on the degree of spread and stage at presentation. We present two cases with initially obscure presentations of a small-bowel tumour. One was a jejunal adenocarcinoma, but an initial upper gastrointestinal and small-bowel series did not disclose the lesion; the other was a primary ileal lymphoma, first thought to be diabetes mellitus gastroparesis. Therefore, a negative small-bowel series or presentation of a systemic disease-associated intestinal pseudo-obstruction or gastroparesis does not exclude the possibility of a small-bowel malignancy, if the clinical symptoms are not alleviated after prokinetic medications. The clinicians should further pursue the possibility of an obstructing lesion.

Adenocarcinoma↗

PubMed2000

Factors predictive of liver cirrhosis in patients with chronic hepatitis B: a multivariate analysis in a longitudinal study.

OBJECTIVE AND DESIGN: Chronic hepatitis B virus (HBV) infection may lead to liver cirrhosis; however, factors associated with the development of cirrhosis have been incompletely studied. A total of 516 patients with chronic hepatitis B were followed up longitudinally to determine their outcome. METHODS: The clinical and pathological features were compared between those with and without cirrhosis occurrence. The risk factors were analysed, and the probability of the development of cirrhosis was estimated. RESULTS: During a mean follow-up period of 5.7 +/- 3.4 years (range 1-17 years), cirrhosis occurred in 71 patients, with a calculated annual incidence of 2.4%. Older age (> 45 years) at entry, male gender, persistent hepatitis (> 1.5-fold rise of serum alanine aminotransferase levels for at least one year) and diabetes mellitus were identified as independent risk factors of cirrhosis in a multivariate analysis (odds ratios 8.0, 19.3, 2.0 and 5.2, respectively; P values all < 0.05). A logistic regression equation was used to predict the probability of cirrhosis occurrence, which was as high as 76.6% when all risk factors were present. Acute exacerbation or super-infection by hepatitis C or D viruses were not significant predictors. Patients with subsequent cirrhosis had higher initial hepatic histological necro-inflammatory activities when compared to age- and sex-matched non-cirrhotic controls (Knodell's scores: 8.2 +/- 2.4 versus 6.0 +/- 4.1, P< 0.05). CONCLUSIONS: Patients who were elderly, male, diabetic or had a history of persistent and histologically severe hepatitis were at increased risks of liver cirrhosis. Aggressive anti-viral therapy may be needed for these patients and they should be closely monitored for HBV-related late complications.

Adult↗

PubMed2000

The impact of chronic hepatitis B viral infection on gastrointestinal motility.

OBJECTIVES: Disturbed gastrointestinal (GI) motility probably exists in alcoholic cirrhotic patients; however, the influence of chronic hepatitis B virus (HBV) infection on GI motility remains unknown. The purpose of this prospective study was to determine the impact of chronic HBV infection on human GI transit, and to explore the possible patient factors modulating GI motility. METHODS: We used a non-invasive hydrogen breath test measuring the oro-caecal transit time (OCTT) to assess the GI motility in 45 asymptomatic HBV carriers, 26 patients with chronic hepatitis B, 23 patients with HBV-related liver cirrhosis, and 45 age- and sex-matched healthy volunteers. Their clinical symptoms and various blood parameters, such as platelet count, prothrombin time, etc. were recorded. Plasma substance P, nitrate/nitrite and endothelin-1 levels were also measured. RESULTS: The OCTTs in controls, HBV carriers, chronic hepatitis B and liver cirrhosis patients were (mean +/- SEM) 78.4 +/- 5.8, 80.9 +/- 4.2, 93.9 +/- 8.8 and 106.5 +/- 12.4 min, respectively. The OCTT was delayed in patients with HBV-related liver cirrhosis compared to that of controls (P=0.039). Among the cirrhotic patients, presentation with ascites delayed OCTT (145.7 +/- 27.2 versus 91.3 +/- 11.9 min, P=0.039). Neither Child- Pugh grade, portal hypertension, various blood parameters, plasma substance P, nitrate/nitrite or endothelin-1 levels had any influence on OCTT. CONCLUSIONS: HBV infection alone does not alter GI motility, whereas the patients with liver cirrhosis may have delayed GI motility. Ascites is most likely a factor responsible for the delayed GI transit among chronic HBV-infected subjects.

Aged↗

PubMed2000

Hongia gen. nov., a new genus of the order Actinomycetales.

An aerobic, nocardioform actinomycete, named LM 161T, was isolated from a soil sample obtained from a gold mine in Kongiu, Republic of Korea. This organism formed well-differentiated aerial and substrate mycelia and produced branched hyphae that fragmented into short or elongated rods. The cell wall contains major amounts of LL-diaminopimelic acid, alanine, glycine, glutamic acid, mannose, glucose, galactose, ribose and acetyl muramic acid. The major phospholipids of this isolate are phosphatidylcholine, diphosphatidylglycerol, phosphatidylglycerol and phosphatidylinositol, and the major isoprenologue is a tetrahydrogenated menaquinone with nine isoprene units. The whole-cell hydrolysate of strain LM 161T contains 12-methyltetradecanoic and 14-methylpentadecanoic acids as the predominant fatty acids, but does not contain mycolic acids. The G+C content of the DNA is 71.3 mol%. The phylogenetic position of the test strain was investigated using an almost complete 16S rDNA sequence. The isolate formed the deepest branch in the clade encompassing the members of the suborder Propionibacterineae Rainey et al. 1997. On the basis of chemical, phenotypic and genealogical data, it is proposed that this isolate be classified within a new genus as Hongia koreensis gen. nov., sp. nov. in the order Actinomycetales. The type strain is LM 161T (= IMSNU 50530T).

Actinomycetales↗

PubMed2000

Catellatospora koreensis sp. nov., a novel actinomycete isolated from a gold-mine cave.

A new actinomycete strain, LM 042T, which was isolated from a gold-mine cave in Kongju, Republic of Korea, is described by phenotypic and genotypic characters. The organism formed short chains of non-motile spores and globose bodies from substrate mycelium. An aerial mycelium was absent. This organism was chemotaxonomically characterized by the presence of meso-diaminopimelic acid, rhamnose, xylose, glucose, mannose and ribose in whole-cell hydrolysates (a type II cell wall and a variant of sugar pattern D), a glycolyl type of muramic acid, DNA G+C content of 70.4 mol%, a type PII phospholipid pattern (phosphatidylethanolamine as a diagnostic nitrogenous phospholipid), a tetrahydrogenated menaquinone with 10 isoprene units as a major menaquinone, and fatty acid profiles predominated by iso-branched hexadecanoic acid, iso-branched pentadecanoic acid and heptadcenoic acid. A comparative analysis of 16S rDNA sequences indicated that this organism formed a distinct clade within the evolutionary radiation of the family Micromonosporaceae and clustered with members of the genus Catellatospora. The 16S rDNA similarity values between the isolate and its phylogenetic neighbours, the two subspecies of Catellatospora citrea and Catellatospora tsunoense, were 95.0-95.2% and 94.9%, respectively. An equidistant relationship was observed among the isolate, Catellatospora ferruginea and all other members of the Micromonosporaceae genera (levels of similarity 93.0-94.0%). The combination of physiological, chemotaxonomic and DNA-DNA hybridization data supported that this organism is a novel species of the genus Catellatospora, for which the name Catellatospora koreensis sp. nov. is proposed. The type strain is LM 042T (= IMSNU 50729T).

Actinomycetales↗

PubMed2000

Saccharothrix violacea sp. nov., isolated from a gold mine cave, and Saccharothrix albidocapillata comb. nov.

The generic position of two isolates from soils inside a gold mine cave in Kongju, Korea, was determined by 16S rDNA sequencing and chemotaxonomic characteristics. Phylogenetic analysis indicated that both of the isolates formed a clade with Lentzea albidocapillata and members of the genus Saccharothrix of the family Pseudonocardiaceae. The chemical composition of the isolates and of Lentzea albidocapillata was consistent with that of the genus Saccharothrix, which is characterized by a type III cell wall (the meso-isomer of diaminopimelic acid, and galactose and rhamnose as characteristic whole-cell sugars), MK-9(H4) as the major menaquinone, and a phospholipid type PII pattern (phosphatidylethanolamine as a diagnostic phospholipid). The combination of morphological features, chemotaxonomic characters and phylogenetic data supported the proposal that Lentzea albidocapillata, the only and type strain of the genus Lentzea, should be transferred to the genus Saccharothrix. On the basis of physiological properties, cellular fatty acid composition and DNA-DNA hybridization data, two new species within the genus Saccharothrix are proposed: Saccharothrix violacea sp. nov., type strain LM 036T (= IMSNU 50388T), and Saccharothrix albidocapillata comb. nov., type strain DSM 44073T (=IMSNU 21253T).

Actinomycetales↗

PubMed2000

An endoscopic injection with N-butyl-2-cyanoacrylate used for colonic variceal bleeding: a case report and review of the literature.

We report a 64-yr-old patient with liver cirrhosis and bleeding esophageal varices that were obliterated by repeated endoscopic sclerotherapy. Eleven years later, he developed a massive, life-threatening rectosigmoid variceal hemorrhage. An endoscopic injection with N-butyl-2-cyanoacrylate (Histoacryl), performed over the rectosigmoid varices, achieved temporary hemostasis. The etiology, prevalence, relationship with portal hypertension, diagnosis, and treatment of colorectal varices are discussed.

Colon, Sigmoid↗

PubMed2000

Treatment of mastalgia with tamoxifen in male patients with liver cirrhosis: a randomized crossover study.

OBJECTIVE: Mastalgia is occasionally found in patients with liver cirrhosis, especially in those receiving spironolactone for treatment of ascites. The pathogenesis is still unclear. Estrogen excess in cirrhotic patients and estrogenic effects of the spironolactone are possible leading causes. Treatment directed against the preponderance of estrogenic stimulation in these patients has never been investigated. This study was designed to investigate the efficacy and safety of tamoxifen, an estrogen antagonist, on mastalgia in patients with liver cirrhosis. METHODS: A total of 16 male cirrhotic patients with mastalgia were randomly assigned to two groups. One group was treated with tamoxifen (20 mg p.o., b.i.d.) for 1 month, followed by placebo for the next month. The other group was treated in the reverse order. All patients received spironolactone for ascites and/or peripheral edema, and the drug was continued during the study period. The size of the breasts and the degree of breast pain and tenderness were recorded in all subjects before and after the treatment periods. Serum levels of estradiol and testosterone were measured using the radioimmunoassay method. RESULTS: Of the 16 patients, 14 experienced a decrease or disappearance of the breast pain and/or tenderness during the tamoxifen treatment period, whereas only two of the 16 patients felt an improvement during the placebo period (p < 0.05). There were significant improvements in the breast pain and tenderness scores and decreases in the breast sizes during the tamoxifen treatment period (before vs after: 1.4+/-0.3 vs 0.4+/-0.2, p = 0.002; 1.9+/-0.2 vs 0.5+/-0.2, p < 0.001; and 6.8+/-0.6 vs 5.5+/-0.6 cm, p = 0.02, respectively), whereas no obvious change was seen during the placebo period. Serum levels of estradiol and testosterone did not change significantly after the tamoxifen or placebo treatments (p > 0.05). No major side effects were noted during the therapeutic periods. CONCLUSIONS: Tamoxifen is effective and safe in the management of mastalgia in male cirrhotic patients taking spironolactone.

Aged↗

PubMed2000

Delayed liquid gastric emptying in patients with hepatocellular carcinoma.

OBJECTIVE: Liver cirrhotic patients sometimes have disturbed gastric emptying (GE). Apparently there is no study addressing the issue of whether patients with hepatocellular carcinoma (HCC) have similarly impaired GE. Using impedance tomography to measure liquid GE, we attempted to assess the characteristics of GE in HCC patients. METHODS: We enrolled 34 healthy controls and 45 HCC patients in the current study, and compared their GE according to certain defined criteria. After each subject drank 500 ml of water, 12 electrodes were placed in a circular array around the subject's upper abdomen. One pair of electrodes was applied with electrical current, and the remaining 10 electrodes recorded signals consecutively in a rotating order. Based on tomographic calculation, serial changes in the averaged signals of altered resistivities were constructed to display liquid GE. Meanwhile, the demographic and clinical data, various blood parameters, and gut peptide levels of the patients were recorded. RESULTS: The half-emptying times in controls and HCC patients were 15.14 +/- 1.56 and 21.38 +/- 1.84 min, respectively (p < 0.05), whereas the areas under the emptying curve were 1732.2 +/- 106.4 and 2246.6 +/- 109.8 arbitrary units, respectively (p < 0.05). Delayed GE was observed in the HCC patients, as demonstrated by vomiting and anorexia. The cirrhotic component in HCC patients only resulted in a shorter period needed for full distention of the stomach after drinking (4.33 +/- 1.02 vs 8.78 +/- 2.1 min; p < 0.05). Other characteristics, including demographics, clinical state, tumor size, ascites, blood parameters, and gut peptides, had no influence on GE. CONCLUSIONS: Liquid GE is inhibited in HCC patients, particularly in those mainly showing symptoms of vomiting and anorexia. Other demographic and tumor characteristics are not responsible for delayed liquid GE; however, the cirrhotic component may promote stomach distention.

Carcinoma, Hepatocellular↗

PubMed2000

Diagnostic value of immunoglobulin G (IgG) and IgM anti-hepatitis E virus (HEV) tests based on HEV RNA in an area where hepatitis E is not endemic.

Acute hepatitis E (AHE) has rarely been reported in industrialized countries, but the rate of seroprevalence of hepatitis E virus (HEV) antibodies (anti-HEV) is inappropriately high. The sensitivity and specificity of the assay used to test for immunoglobulin G (IgG) and IgM anti-HEV have not been well established in areas where hepatitis E is not endemic (hereafter referred to as "nonendemic areas"). We collected serum samples from 13 AHE patients, 271 healthy subjects, and 160 other liver disease patients in Taiwan to test for HEV RNA by reverse transcription (RT)-PCR and for IgG and IgM anti-HEV by enzyme-linked immunosorbent assays. The sensitivities of IgG and IgM anti-HEV (relative to RT-PCR) were 86.7 and 53.3%, respectively. The specificities of IgG and IgM anti-HEV assays for diagnosing AHE were 92.1 and 98.6%, respectively. The rate of seroprevalence of IgG anti-HEV was 11% among healthy subjects in this nonendemic area, and it increased with age. In summary, IgG anti-HEV is a good diagnostic test for screening for AHE in nonendemic areas. The high rate of prevalence of anti-HEV in healthy subjects indicates that subclinical infection may exist.

Acute Disease↗

PubMed2000

Closing volume influences the postural effect on oxygenation in unilateral lung disease.

In normal adults, both blood flow and ventilation are distributed preferentially to the dependent lung zones. In adults with unilateral lung disease, arterial oxygenation improves when they are positioned with their good lung down because of improved matching of ventilation and perfusion. When the closing volume is increased, dependent airways are closed during tidal breathing, so that reduced ventilation-perfusion ratio and hypoxia develops and ventilation is preferentially distributed to the upper lung zones. We undertook an observational study on the effects of lateral recumbency on arterial oxygenation in adult patients with unilateral lung disease and tested the hypothesis that oxygenation in lateral recumbency might be influenced by an increase in closing volume. Arterial blood gases were analyzed in the supine, right and left lateral decubitus positions and the AaPO(2) was calculated in 44 randomly selected patients 49.9 +/- 18.7 yr of age with unilateral pneumonia (23 cases) or pulmonary tuberculosis (21 cases). In 26 patients, individual Pa(O(2)) with the normal lung in the dependent position was higher than that with the diseased lung; the opposite was true for 18 patients. The difference in Pa(O(2)) and AaPO(2) between the two positions was statistically significant in both groups. In 16 patients (10 men and six women 49.2 +/- 18.2 yr of age), we measured closing volume and determined the fractional ventilation to each lung by (133)Xe lung scan in the three positions. In these 16 patients, the difference in Pa(O(2)) between the normal and the diseased lung in the dependent position was related significantly to the difference in the fractional ventilation going to the normal lung between the dependent and the supine position (r = 0.642, p = 0. 007). The latter was related significantly to the % predicted closing volume (CV/VC) (r = -0.597, p = 0.015). This study has shown that closing volume, as well as posture, might be involved in determining oxygenation in lateral recumbency in patients with unilateral lung disease.

Adolescent↗

PubMed2000

Endogenous opioids modulate ventilation and peak oxygen consumption in obese Zucker rats.

Levels of endogenous opioids are increased in morbidly obese humans and obese rats. Endogenous opioids are important neuromodulators, and are involved in a wide range of functions including ventilatory control. We studied eight lean and eight obese Zucker (Z) rats at 6 and 16 wk of age. We assessed minute ventilation (V E) at rest and during hypercapnic challenges, as well as peak oxygen consumption (V O(2peak)) after the administration of saline (control), naloxone hydrochloride (N(HCl)), and naloxone methiodide (N(M)). Administration of N(HCl) and N(M) to lean animals had no effect on V E and V O(2peak). Similarly, N(M) failed to alter V E and V O(2peak) in obese rats studied at 6 or 16 wk of age. In young obese rats, N(HCl) significantly (p < 0.05) increased resting V E (721 +/- 154 [mean +/- SD] ml/kg/min versus 937 +/- 207 ml/kg/min, saline versus N(HCl), respectively); VE in response to 4% CO(2) (924 +/- 110 ml/kg/min versus 1,212 +/- 172 ml/ kg/min); V E in response to 8% CO(2) (1,233 +/- 172 ml/kg/min versus 1,565 +/- 327 ml/kg/min); and V O(2peak) (90.8 +/- 9.6 ml/kg(0.75)/min versus 98.3 +/- 5.9 ml/kg(0.75)/min). However, N(HCl) administration had no effect on V E or V O(2peak) in obese rats retested at 16 wk of age. Thus, endogenous opioids modulate resting ventilation, ventilatory responsiveness to CO(2), and V O(2peak) in young obese rats by acting specifically on receptors located within the central nervous system. This modulation disappears once the animals reach 16 wk of age.

Animals↗

PubMed2000

An optimal dose of perfluorocarbon for respiratory mechanics in partial liquid ventilation for dependent lung-dominant acute lung injury.

BACKGROUND: Despite increasing knowledge about partial liquid ventilation (PLV), the optimal dose of perfluorocarbon (PFC) is not yet established. Because there exist normal regions in the lung with ARDS and because PLV in the normal lung results in worsened gas exchange, we postulated that the optimal dose of PFC for PLV may be less than the functional residual capacity (FRC) dose in the lung with limited disease. DESIGN AND SETTING: Animal study at the Asan Institute for Life Sciences, Seoul, Korea. SUBJECTS: Twelve rabbits in which dependent lung-dominant lung injury was created by a modified saline solution lavage. INTERVENTIONS: PLV performed at six different doses of perfluorodecalin in sequence (3, 6, 9, 12, 15, and 18 mL/kg every 15 min). MEASUREMENTS AND RESULTS: Our modified saline solution lavage induced atelectasis and hemorrhage confined to the dependent lung with severe hypoxia (PaO(2)/fraction of inspired oxygen = 37 +/- 6 mm Hg). Peak airway pressure (Ppeak) and inspiratory pause pressure (Ppause) with PLV were lower at doses of 3 to 15 mL/kg (all p < 0.05), but not different at a dose of 18 mL/kg, when compared with gas ventilation. Ppeak increased at doses of 12, 15, and 18 mL/kg, when each was compared with the preceding PFC dose. At increasing PFC doses, the change in the elastic component of airway pressure (Ppause after minus Ppause before) was negative until the dose of 9 mL/kg, but was positive at doses of 12 mL/kg and above. The change in the resistive component ([Ppeak minus Ppause] after minus [Ppeak minus Ppause] before) was negative until the dose of 6 mL/kg, but was positive at the dose > or = 9 mL/kg. CONCLUSION: Respiratory mechanics during PLV for dependent lung-dominant lung injury were optimal at a PFC dose less than the FRC.

Animals↗

PubMed2000

Bioequivalence assessment of closerin capsule to dura seromycin capsule of cycloserine after a single oral dose administration to healthy male volunteers.

AIM: A bioequivalence study of the closerin capsules to the dura seromycin capsules was conducted. PATIENTS AND METHODS: Twenty-four healthy male Korean volunteers received each medicine at the cycloserine dose of 250 mg in a 2 x 2 crossover study. There was a one-week washout period between the doses. Plasma concentrations of cycloserine were monitored by a high-performance liquid chromatography for over a period of 72 hours after the administration. AUCinf (the area under the plasma concentration-time curve from time zero to time infinity) was calculated by the linear-log trapezoidal method. Cmax (maximum plasma drug concentration) and Tmax (time to reach Cmax) were compiled from the plasma concentration-time data. Analysis of variance was carried out using logarithmically transformed AUCinf and Cmax, and untransformed Tmax. RESULTS: There were no significant differences between the medications in AUCinf and Cmax. The point estimates and 90% confidence intervals for AUCinf (parametric) and Cmax (parametric) were, in point estimate (90% confidence interval), 0.992 (0.950 approximately 1.037) and 1.051 (0.965 approximatly 1.144), respectively, satisfying the bioequivalence criteria of the European Committee for Proprietary Medicinal Products and the US Food and Drug Administration Guidelines. The corresponding value of Tmax was 0.000 (-0.250 approximatly 0.125). Moreover, the modified Pitman-Morgan's adjusted F test and equal variance test (one-sided) indicated that the 2 medications were comparable in intra- and inter-individual variability in cycloserine bioavailability. CONCLUSION: Therefore, these results indicate that the 2 medications of cycloserine are bioequivalent and, thus, may be prescribed interchangeably.

Administration, Oral↗

PubMed2000

Clinical and epidemiological implications of swine hepatitis E virus infection.

In nonendemic areas, most patients with acute hepatitis E were infected through traveling to endemic areas. However, some patients did not have a history of foreign travel before infection. Furthermore, high seroprevalence rates of antibody to hepatitis E virus (anti-HEV) were found in the general adult population in some countries without any recorded outbreak of hepatitis E. The significance of anti-HEV assay in these subjects remains obscure. To study if swine might be a source of HEV infection, HEV was tested in sera of 235 pigs in Taiwan, and from 5 patients with acute HEV infection who either denied or did not provide any foreign travel history. Three (1.3%) pigs had detectable swine HEV RNA. The swine and human HEV strains from Taiwan formed a monophyletic group, distinct from three previously reported groups: the United States human and swine HEV strains, the Mexico strain, and the largest group composed of the Asian and the African strains. The identity of nucleotide sequences was 84-95% between swine and human HEV strains in Taiwan, and 72-79% between Taiwan strains and those from different areas. The predicted amino acid sequence of a Taiwan swine HEV strain within the peptide 3-2 used in commercial anti-HEV assay showed a high identity (91-94%) with those of other human and swine HEV strains. Swine may be a reservoir of HEV and subclinical swine HEV infection may occur. Cross-reactivity of current anti-HEV assay may account for the high prevalence rate of anti-HEV in the general population in nonendemic areas.

Adult↗

PubMed2000

Clinical significance of changes in serum hepatitis B virus DNA titer in patients with chronic hepatitis B treated with interferon.

BACKGROUND: Interferon (IFN) has been used in the treatment of patients with chronic hepatitis B virus (HBV) infection. Nonetheless, the changes in serum HBV DNA titer during IFN treatment and the effect of these changes on the therapeutic results have not been well studied. METHODS: Twenty patients with chronic hepatitis B who were positive for serum hepatitis B e antigen (HBeAg) and HBV DNA received IFN-alpha 2a 4.5 million units by subcutaneous injection three times a week for 24 weeks. Twenty age- and sex-matched patients with chronic hepatitis B were selected as a control group. Treatment response was defined as the normalization of serum alanine aminotransferase (ALT) and the seroconversion of serum HBeAg 24 weeks after discontinuation of the IFN treatment. Serum HBV DNA was measured using the branched DNA (bDNA) signal amplification assay. RESULTS: There was no significant difference in pretreatment mean serum ALT and HBV DNA titer in either the IFN-treated or the control group. Treatment response was found in six (30%) of 20 IFN-treated patients and in four (20%) of 20 control patients (p > 0.05). Serum HBV DNA titer fell after IFN treatment and remained undetectable only in patients with final treatment response. Serum HBV DNA was negative at week 12 of the IFN treatment in four (67%) of six patients with treatment responses, significantly higher than in none (0%) of 14 patients without a treatment response (p = 0.001). Multivariate logistic regression revealed that the negativity of serum HBV DNA at week 12 of the IFN treatment successfully predicted treatment response. CONCLUSIONS: Thirty percent of the patients with chronic hepatitis B responded to IFN-alpha 2a 4.5 million units subcutaneously injected three times a week for 24 weeks. Negativity of serum HBV DNA measured by bDNA assay at week 12 of the IFN treatment may suggest a beneficial treatment outcome.

Adult↗

PubMed2000

Hepatocellular carcinoma presenting as a pyogenic liver abscess in a patient with hemochromatosis.

Primary hemochromatosis is rare in Taiwan. Hepatocellular carcinoma (HCC) is endemic in Taiwan, but HCC with initial presentation as pyogenic liver abscess is unusual. We report a case of HCC presenting as pyogenic liver abscess in a hemochromatotic patient with cirrhosis. The patient underwent hepatectomy and had a smooth postoperative course. Unfortunately, he died of pneumonia eight months after surgery. HCC should be considered in the differential diagnosis in hemochromatotic patients with a pyogenic liver abscess.

Aged↗