Won Choong Choi

The clinical factors for predicting severe diverticulitis in Korea: a comparison with Western countries.

Background/Aims It is unclear whether the risk factors associated with complicated diverticulitis in Asian and Western countries are the same. We evaluated the risk factors associated with severe diverticulitis (SD) in Korea and compared the clinical characteristics of diverticulitis according to location. Methods A retrospective review of 190 patients hospitalized with acute diverticulitis from January 2005 to June 2010 was conducted. SD was defined as one of the following: perforation, abscess, obstruction, sepsis, or peritonitis that required an urgent operation. Results Twenty-four patients (12.6%) were diagnosed with SD. SD was significantly associated with older age, a fever over 38℃, changes in bowel habits and a high visceral adipose tissue (VAT)/total adipose tissue (TAT) ratio. Multivariate analysis showed that the risk factors for developing SD were an age of 40 years or more (odds ratio [OR], 3.2; p=0.032), male gender (OR, 4.0; p=0.021) and left-sided diverticulitis (OR, 6.2; p=0.017). Right-sided diverticulitis (n=175, 92.1%) was significantly associated with younger ages, fewer changes in bowel habits, fewer comorbidities and non-SD. Conclusions This study suggests that the risk factors for developing SD in Korea, where right-sided diverticulitis is predominant, are the male gender, an age of more than 40 years old, and left-sided diverticulitis. Given that there are different risk factors for developing SD in Western countries, different strategies for the treatment of diverticulitis in the Korean population seem to be needed.

Acute Transverse Myelitis After Acute Hepatitis A: Findings on Magnetic Resonance Imaging

3 33-year-old man was admitted to our department because of fever, myalgia, nausea, and vomiting. His liver function test revealed elevation f the hepatic enzyme and hyperbilirubinemia, ie, AST 213 IU, ALT 1105 IU, nd total bilirubin 7.5 mg/dL. Hepatitis A serologic test, ie, HAV IgM, was ositive, and serologic tests for hepatitis B and C were negative. While his liver unction test results were improving, he was discharged with the diagnosis of ecovery state of acute hepatitis A. Five days later, he was readmitted with constipation, urinary retention, and eakness in the low extremities. He also complained of hypersthenia of trunk nd legs. A physical examination revealed grade I of motor weakness in both ow extremities, with bilateral positive Babinski’s sign, deep tendon reflex grade II), and ankle clonus. Lab testing on admission included AST 49 IU, LT 185 IU, total bilirubin 12.3 mg/dL, alkaline phosphatase 142 IU, gammalutanyl transpeptidase 116 U, lactate dehydrogenase 460 U/L, and prothromin time international normalized ratio 1.0. Foley catheter was inserted because of urinary retention on day 2. In view of he ongoing weakness of low extremities, brain computed tomography scan nd a lumbar puncture were performed. Brain computed tomography scan as normal. Cerebrospinal fluid analysis showed red blood cell count 23/mm3, hite blood cell count 20/mm3, 61 mg/dL of glucose, and 65 mg/dL of rotein. The Levin tube was inserted for gaseous distention of abdomen caused by ngoing ileus on day 4. Spine magnetic resonance imaging was performed and howed diffuse increased signal intensity near whole thoracolumbar spinal ord except mid-thoracic level and suggestive of myelitis (Figure A). The atient was diagnosed with acute transverse myelitis after acute hepatitis A. he treatment was started with Ig (400 mg/kg) infusion. Follow-up hepatitis antibody test revealed positive HAV IgM and IgG, but neurologic disorder of he patient was not improved. Steroid therapy (methylprednisolone, 1 mg/kg) was started on day 8 after 5 ays of Ig infusion when HAV IgM titer was slightly decreased. Bedside hysical therapy was also offered. The patient showed decreased abdominal iscomfort, and the abdominal x-ray showed improvement of ileus. Therefore, A

Pure red-cell aplasia and autoimmune hemolytic anemia in a patient with acute hepatitis A.

Pure red cell aplasia (PRCA) and autoimmune hemolytic anemia (AIHA) have rarely been reported as an extrahepatic manifestation of acute hepatitis A (AHA). We report herein a case of AHA complicated by both PRCA and AIHA. A 49-year-old female with a diagnosis of AHA presented with severe anemia (hemoglobin level, 6.9 g/dL) during her clinical course. A diagnostic workup revealed AIHA and PRCA as the cause of the anemia. The patient was treated with an initial transfusion and corticosteroid therapy. Her anemia and liver function test were completely recovered by 9 months after the initial presentation. We review the clinical features and therapeutic strategies for this rare case of extrahepatic manifestation of AHA.

Efficacy of Pegylated Interferon Monotherapy versus Sequential Therapy of Entecavir and Pegylated Interferon in Hepatitis B e Antigen-Positive Hepatitis B Patients: A Randomized, Multicenter, Phase IIIb Open-Label Study (POTENT Study)

Background: Until now, various types of combined therapy with nucleotide analogs and pegylated interferon (Peg-INF) in patients with hepatitis B patients have been tried. However, studies regarding the benefits of de novo combination, late-add on, and sequential treatment are very limited. The objective of the current study was to identify the efficacy of sequential treatment of Peg-INF after short-term antiviral treatment. Methods: Between June 2010 and June 2015, hepatitis B e antigen (HBeAg)-positive patients (n = 162) received Peg-IFN for 48 weeks (mono-treatment group, n = 81) and entecavir (ETV) for 12 weeks with a 48-week course of Peg-IFN starting at week 5 of ETV therapy (sequential treatment group, n = 81). The primary endpoint was HBeAg seroconversion at the end of follow-up period after the 24-week treatment. The primary endpoint was analyzed using Chi-square test, Fishers exact test, and regression analysis. Results: HBeAg seroconversion rate (18.2% vs. 18.2%, t = 0.03, P = 1.000) and seroclearance rate (19.7% vs. 19.7%, t = 0.03, P = 1.000) were same in both mono-treatment and sequential treatment groups. The rate of alanine aminotransferase (ALT) normalization (45.5% vs. 54.5%, t = 1.12, P = 0.296) and serum hepatitis B virus (HBV)-DNA <2000 U/L (28.8% vs. 28.8%, t = 0.10, P = 1.000) was not different in sequential and mono-treatment groups at 24 weeks of Peg-INF. Viral response rate (HBeAg seroconversion and serum HBV-DNA <2000 U/L) was not different in the two groups (12.1% vs. 16.7%, t = 1.83, P = 0.457). Baseline HBV-DNA level (7 log10U/ml vs. 7.5 log10U/ml, t = 1.70, P = 0.019) and hepatitis B surface antigen titer (3.6 log10U/ml vs. 4.0 log10U/ml, t = 2.19, P = 0.020) were lower and predictors of responder in mono-treatment and sequential treatment groups, respectively. Conclusions: The current study shows no differences in HBeAg seroconversion rate, ALT normalization, and HBV-DNA levels between mono-therapy and sequential therapy regimens. Trial Registration: ClinicalTrials.gov, NCT01220596; https://clinicaltrials.gov/ct2/show/NCT01220596?term=NCT01220596&rank=1.