Stylianos Karatapanis

Clinical Course of Lamivudine Monotherapy in Patients with Decompensated Cirrhosis due to HBeAg negative chronic HBV infection

OBJECTIVES:We have evaluated the efficacy of long-term lamivudine monotherapy in patients with decompensated HBeAg-negative/HBV-DNA positive cirrhosis.METHODS:We analyzed the clinical course and outcome of lamivudine treatment in 30 consecutive cirrhotics and compared with 30 HBV untreated historical HBeAg-negative controls matched for age and gender.RESULTS:Significant clinical improvement, defined as a reduction of at least two points in Child-Pugh score was observed in 23 of the 30 treated patients (76.6%) versus none of the 30 patients in the control group (p < 0.0001) after a mean follow-up of 20.6 ± 12.1(±SD) months. There were 10 deaths in the treated group versus 24 in the control group (p= 0.07). Liver-related deaths occurred in five of the eight patients soon after the development of biochemical breakthrough. Patients with clinical improvement had better survival than patients with no improvement (p= 0.04) or those who developed biochemical breakthrough due to YMDD mutants (p= 0.001).CONCLUSIONS:Lamivudine significantly improves liver function in HBeAg-negative decompensated cirrhosis. However, the development of the biochemical breakthrough due to YMDD mutants is associated with fatal outcome.

On‐treatment prediction of sustained response to peginterferon alfa‐2a for HBeAg‐negative chronic hepatitis B patients

We assessed predictors of response in HBeAg‐negative chronic hepatitis B patients treated with peginterferon alfa‐2a in routine clinical practice.

Can 24-h urine sodium excretion be replaced by spot urine sodium/potassium in patients with decompensated cirrhosis?

1. Locarnini S, Omata M. Molecular virology of hepatitis B virus and the development of antiviral drug resistance. Liver Int 2006; 26: 11–22. 2. Van Bommel F, Wunsche T, Mauss S, et al. Comparison of adefovir and tenofovir in the treatment of lamivudine resistant hepatitis B virus infection. Hepatology 2004; 40: 1421–5. 3. Chang TT, Gish RG, Hadziyannis SJ, et al. A dose-ranging study of the efficacy and tolerability of entecavir in lamivudine refractory chronic hepatitis B patients. Gastroenterology 2005; 129: 1198–209. 4. Yim HJ, Hussain M, Liu Y, et al. Evolution of multidrug resistant hepatitis B virus during sequential therapy. Hepatology 2006; 44: 703–12. 5. Sherman M, Yurdaydin C, Simsek H, et al. Entecavir therapy for lamivudine-refractory chronic hepatitis B: improved virologic, biochemical, and serology outcomes through 96 weeks. Hepatology 2008; 48: 99–108. 6. Sherman M, Yurdaydin C, Sollano J, et al. Entecavir for treatment of lamivudine-refractory, HBeAg-positive chronic hepatitis B. Gastroenterology 2006; 130: 2039–49. 7. Tenney DJ, Rose RE, Baldick CJ, et al. Longterm monitoring shows hepatitis B virus resistance to entecavir in nucleoside-naive patients is rare through 5 years of therapy. Hepatology 2009; 49: 1503–14. 8. Qi X, Xiong S, Yang H, et al. In vitro susceptibility of adefovir associated hepatitis B virus polymerase mutations to other antiviral agents. Antivir Ther 2007; 12: 355–62.

Pegylated interferon alfa-2b pen device and ribavirin treatment for patients with chronic hepatitis C: an evaluation of patient satisfaction.

Objective The aim of this study was to evaluate the satisfaction of patients with chronic hepatitis C who used the pegylated interferon α-2b pen device. Methods Patients from multiple centers in Greece were recruited to participate in this noninterventional, observational study. Patients received pen device training for at least 6 weeks before treatment and used questionnaires to provide feedback (rating scale: 1–4, negative; 5–7, positive) on training, medication preparation and injection, and appreciation of the device. Results were analyzed with standard statistical analysis and multivariate logistic regression. Results In total, 507 patients (mean age, 43.5 years), 77.4% of whom were treatment naive, participated in the study. Overall, 84.2% of patients rated training positively, 67.4% of patients rated medication preparation positively, and 88.3% of patients rated medication injection positively. Appreciation of the pen device treatment method was rated positively by 82.2% of patients. Intravenous drug users were more likely to rate medication injection positively (P=0.0284) and to appreciate this method of drug delivery (P=0.0328) than other patients. Patients with lower levels of education were less likely to rate training positively (P=0.0202) and showed less appreciation for this route of drug delivery (P=0.0341) than other patients. Treatment-naive patients were more likely to provide positive responses about the overall procedure than were treatment-experienced patients (odds ratio: 1.932; P=0.032). Adverse events were reported by 6.4% (29 of 453) of patients. Conclusion Patients were satisfied with the pegylated interferon α-2b pen device; therefore, good treatment adherence is expected with its use.

A Huge Abdominal Mass

Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens Medical School, Athens, Liver Clinic, First Department of Internal Medicine, General Hospital of Rhodes, Rhodes, Greece 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 Question: A 25-year-old male patient was admitted for weight loss and increasing abdominal discomfort. On physical examination, a large mass was palpated in the upper abdomen. Laboratory tests were all within normal range. Abdominal ultrasound and cross-sectional imaging (computed tomography, magnetic resonance imaging) revealed an enormous cystic tumor in right abdomen, 25 20 cm in size, occupying almost the half of the abdominal cavity (Figure A, B). Concomitant kidney or liver cysts were absent. At operation, a giant polycystic tumor producing considerable compression of neighbor organs was evident (Figure C). The tumor was completely removed. What is your diagnosis? Look on page 000 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. 94 95 96 97 98 99 100 Conflicts of interest The authors disclose no conflicts.