Poster Session:PS 0229 ; Gastroenterology : Acute Viral Hepatitis after Recovering from Neutropenic Fever

( Sang Jun Suh ),( Young Kul Jung ),( Sun Young Yim ),( Ji Hye Je ),( Yang Jae Yoo ),( Hae Rim Kim ),( Sung Hee Kang ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Hyung Joon Yim ),( Jong Eun Yeon ),( Soon Ho 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: Among the patients with hematologic malignancy, hepatitis occurs after recovering from neutropenic fever. Clinical course is decided according to appropriate treatment to causative pathogen. Various organisms can cause acute hepatitis in immunecompromised host, early inspection to the causative pathogen is essential. We investigated which pathogen cause acute hepatitis after recovering from neutropenic fever in patients with hematologic malignancy. Methods: From January 2011 to april 2014, we included the patients with acute hepatitis (elevated Aspartate transaminase and/or total bilirubin above 2 times upper limit of normal range) within two weeks after recoverinig from neutropenic fever. We excluded the patients with acute hepatitis within two weeks after infused by chemoagent or hepatotoxic drugs. Results: Neutropenic fever was occurred in 173 patients, and 43 patients were appropriate to acute hepatitis of above criteria. Male gender was 28 patients, mean age was 51 years. Causative pathogen was identifi ed in 22 patients. The pathogen was aspergillus 5, infl uenza 4, O.tsutsugamushi 2, varicella zoster virus 1, hepatitis E virus 1 pateint, and other 9 patients were bacterial infection. Among 43 patients, 13 patients occurred septic shock and 11 patients were died. Among survived 2 patients, 1 patient was diagnosed as pulmonary aspergillosis and recovered after therapy with voriconazole, other 1 patients was recovered after therapy with broad-spectrum antibiotics under diagnosis of unknown origin pathegen. Conclusions: Acute hepatitis occur in about 25% after recovering from neutropenic fever, and mortality rate was 25% in the patients with acute hepatitis. Early investigation is essential to such patients, and test for aspergillus and infl uenza would be essential.

Change of Nursing Learning Objective in Korea

Yeon Ok Suh,In Sook Park,Hae Sook Park,Soo Yeon Ahn,So Young Kang,Kwang Sung Kim 한국간호과학회 2015 한국간호과학회 학술대회 Vol.2015 No.10

Factors Related to Substantial Pain in Terminally Ill Cancer Patients

Suh, Sang-Yeon,Song, Kyung-Po,Choi, Sung-Eun,Ahn, Hong-Yup,Choi, Youn-Seon,Shim, Jae-Yong Korean Society for Hospice and Palliative Care 2011 한국호스피스.완화의료학회지 Vol.14 No.4

Purpose: Pain is the most common and influential symptom in cancer patients. Few studies concerning pain intensity in the terminally ill cancer patients have been done. This study aimed to identify factors related with more than moderate pain. Methods: This study used secondary data of 162 terminal cancer inpatients at the palliative ward of six training hospitals in Korea. Physician-assessed pain assessment was by 10 point numeric rating scale. Substantial pain was defined more than moderate intensity by the Korean National Guideline for cancer pain. The Korean version of the MD Anderson Symptom Inventory was self-administered to assess symptoms. Survival prediction was estimated by the attending physicians at the time of admission. Results: Less than six weeks of predicted survival and more than numeric rating of six for worst drowsiness in the previous 24 h were significantly related to substantial pain (P=0.012 and P=0.046, respectively). The dose of opioid analgesics was positively related to substantial pain (P=0.004). Conclusion: Factors positively related to substantial pain were less than six weeks of predicted survival and considerable drowsiness. Careful monitoring and active preparation for pain are required in terminal cancer patients having those factors. 목적: 암환자에게 통증은 가장 흔하고 영향이 큰 증상이다. 그러나 말기암환자에서 통증 강도에 대한 연구는 부족하였다. 본 연구는 중등도 이상의 통증과 연관된 요인을 밝히고자 한다. 방법: 우리나라 완화의료 기관 6곳의 입원 병동을 대상으로 말기 암 환자 162명 자료를 사용하였다. 통증은 담당의가 10점 만점 숫자통증등급으로 측정하였다. 중등도 이상의 통증은 보건복지부 지침의 정의에 따랐다. 증상 평가에는 MD Anderson 증상 평가조사지 한국어본을 활용하였다. 생존기간 예측은 입원 당시 담당 전문의가 하였다. 결과: 예측 생존 기간이 6주 미만인 경우와 지난 24시간 졸린 정도가 6점 이상인 경우가 중등도 이상의 통증과 유의하게 연관되었다(각각 P=0.012, P=0.046). 마약성 진통제 투여량도 중등도 이상의 통증에 비례하였다(P=0.004). 결론: 중등도 이상의 통증과 유의하게 연관된 요인은 예측 생존 기간이 6주 미만인 것과 상당한 졸림이었다. 이러한 요인을 나타내는 말기 암 환자에서 주의 깊은 통증의 감시와 적극적인 대비가 필요하다.

Generation and genotyping of a mouse model of the diabetic atherosclerosis model

Sung Mok Hong,Harry Jung,Yoon Soo Choi,Yoo Yeon Kim,Bo Young Kim,Ha Jin Nam,Jun Gyo Suh 한국실험동물학회 2015 한국실험동물학회 학술발표대회 논문집 Vol.2015 No.8

Cyanoacrylate injection versus band ligation for bleeding from cardiac varices along the lesser curvature of the stomach

( Sang Jung Park ),( Yong Kwon Kim ),( Yeon Seok Seo ),( Seung Woon Park ),( Han Ah Lee ),( Tae Hyung Kim ),( Sang Jun Suh ),( Young Kul Jung ),( Ji Hoon Kim ),( Hyunggin An ),( Hyung Joon Yim ),( Jae 대한간학회 2016 Clinical and Molecular Hepatology(대한간학회지) Vol.22 No.4

Background/Aims: Practice guidelines recommend endoscopic band ligation (EBL) and endoscopic variceal obturation (EVO) for bleeding from esophageal varices and fundal varices, respectively. However, the optimal treatment for bleeding from cardiac varices along the lesser curvature of the stomach (GOV1) remains undefined. This retrospective study compared the efficacy between EBL and EVO for bleeding from GOV1. Methods: Patients treated by EBL or EVO via cyanoacrylate injection for bleeding from GOV1 were enrolled. Patients diagnosed with hepatocellular carcinoma or treated with endoscopic injection sclerotherapy were excluded. Results: The study included 91 patients treated for bleeding from GOV1. The mean age was 56.3±10.9 years (mean±SD), and 78 of them (85.7%) were men. Overall, 51 and 40 patients were treated with EBL and EVO, respectively. A trend for a higher hemostasis rate was noted in the EVO group (100%) than in the EBL group (82.6%, P=0.078). Varices rebled in 15 patients during follow-up. The rebleeding rate was significantly higher in the EBL group than in the EVO group (P=0.004). During follow-up, 13 patients died (11 in the EBL group and 2 in the EVO group); the survival rate was marginally significant between two groups (P=0.050). The rebleeding-free survival rate was significantly higher in the EVO group than in the EBL group (P=0.001). Conclusions: Compared to EBL, EVO offered significantly lower rebleeding rates, significantly higher rebleeding-free survival rates, and a trend for higher hemostasis and survival rates. EVO appears to be the better therapeutic option for bleeding from GOV1. (Clin Mol Hepatol 2016;22:487-494)

Cyanoacrylate Injection versus Band Ligation for the Treatment of Bleeding from Cardiac Varices on Lesser Curvature Side of the Stomach

( Sang Jung Park ),( Yeon Seok Seo ),( Seung Woon Park ),( Han Ah Lee ),( Tae Hyung Kim ),( Sang Jun Suh ),( Young Kul Jung ),( Ji Hoon Kim ),( Hyung Joon Yim ),( Jong Eun Yeon ),( Kwan Soo Byun ),( S 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Practice guidelines recommend endoscopic band ligation (EBL) for the treatment of bleeding from cardiac varices on lesser curvature side of the stomach (CVs). However, endoscopic variceal obturation (EVO) using cyanoacrylate has been reported more effective than EBL for fundal variceal bleeding and considering that the mucosa covering cardiac varices is more thickened than esophageal varices and being exposed to gastric acids or food materials continuously, EVO could be more effective than EBL for the treatment of bleeding from CVs. This study was performed to compare the efficacy between EVO and EBL for the treatment of bleeding from CVs. Methods: All patients who were treated EBL or EVO for bleeding from CVs were enrolled. The patients diagnosed with hepatocellular carcinoma or treated with endoscopic injection therapy were excluded. Results: A total of 77 patients treated with bleeding from CVs were enrolled. Age was 56.4±10.6 years and 67 patients (87.0%) were men. Fifty-one and 26 patients were treated with EBL and EVO, respectively. Hemostasis were achieved in 73 patients (94.8%). Hemostasis rates did not differ between EBL (47 patients, 92.2%) and EVO (26 patients, 100%) groups. Varices rebled in 13 patients during follow-up. Rebleeding rate was significantly higher in EBL group compared to EVO group (P=0.044). During follow-up, 12 patients died (10 in EBL group, 2 in EVO group). Mean survival time was 310.4±13.5 days, which did not differ between two groups (P=0.142). Conclusions: Hemostasis success rate and survival did not differ between the EBL and EVO groups. However, rebleeding rate was significantly lower in EVO group compared to EBL group. EVO could be better option for the treatment of bleeding from CVs on lesser curvature side of the stomach.

Is propofol safe when administered to cirrhotic patients during sedative endoscopy?

( Sang Jun Suh ),( Hyung Joon Yim ),( Eileen L Yoon ),( Beom Jae Lee ),( Jong Jin Hyun ),( Sung Woo Jung ),( Ja Seol Koo ),( Ji Hoon Kim ),( Kyung Jin Kim ),( Rok Son Choung ),( Yeon Seok Seo ),( Jong 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.1

Background/Aims: In patients with liver cirrhosis, drugs acting on the central nervous system can lead to hepatic encephalopathy and the effects may be pro-longed. Recently, misuse of propofol has been reported and the associated risk of death have become an issue. Propofol is commonly used during sedative endoscopy; therefore, its safety in high-risk groups must be further investigated. We performed a pilot study of the safety and effi cacy of propofol during endos-copy in Korean patients with cirrhosis. Methods: Upper gastrointestinal endoscopy was performed under sedation with propofol along with careful monitoring in 20 patients with liver cirrhosis and 20 control subjects. The presence or development of hepatic encephalopathy was as-sessed using the number connection test and neurologic examination. Results: Neither respiratory depression nor clinically significant hypotension were observed. Immediate postanesthetic recovery at 5 and 10 minutes after the procedure was delayed in the cirrhotic patients compared with the control group; however, at 30 minutes, the postanesthetic recovery was similar in both groups. Baseline psychomotor performance was more impaired in cirrhotic patients, but propofol was not associated with deteriorated psychomotor function even in cir-rhotic patients with a minimal hepatic encephalopathy. Conclusions: Sedation with propofol was well tolerated in cirrhotic patients. No newly developed hepatic encephalopathy was observed.

Hepatitis B Virus Reactivation Rate Is Considerably High during Sorafenib Therapy without Antiviral Treatment in Patients with Advanced Hepatocellular Carcinoma

( Sang Jun Suh ),( Hyung Joon Yim ),( Ji Hye Seo ),( Han Ah Lee ),( Tae Hyung Kim ),( Young Sun Lee ),( Jong Jin Hyun ),( Young Kul Jung ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Jong Eun Yeon ),( Kwan So 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Sorafenib is the standard treatment for advanced hepatocellular carcinoma (HCC). However, the influence of sorafenib on the replication of HBV remains unknown. Herein, we evaluated the rate of HBV reactivation during sorafenib therapy in chronic hepatitis B (CHB) patients with advanced HCC. Methods: Four hundreds thirty five advanced HCC patients who visited three hospitals affiliated with Korea University from January 2004 to December 2012 were retrospectively reviewed. Among them, 327 patients were HBsAg positive. Two hundred sixty four received antiviral therapy before initiation of sorafenib therapy, and 64 patients were treatment naive with regard to anti-HBV therapy. Patients who received sorafenib less than 4 weeks, those who had not follow-up HBV DNA value, and patients who received other treatment than sorafenib were excluded. Finally, 133 and 28 patients were analyzed, respectively in each group. HBV reactivation were defined as increase of HBV DNA >10 times of baselines or ≥ 2000 IU/mL in patients with baselines HBV DNA < 2000 IU/mL. We further investigated reactivation rates in propensity score matched liver cirrhosis patients without HCC. Results: Mean age was 54.87±9.34 and 83.2% were male. All patients were Barcelona Clinic of Liver Cancer Stage C and the sum of tumor diameter was 10.42±5.78 cm. Mean baseline HBV DNA level was 2.84±1.60 log IU/mL. Median survival was 5.97 months. At 12, 24, and 48 weeks of the sorafenib therapy, HBV reactivation occurred in 5.26%, 12.0%, 14.3% of antiviral therapy group while it developed in 28.6%, 39.3%, and 42.9% of HBV therapy naïve group, respectively. The reactivation rates was significantly higher in patient who didn’t received antiviral therapy (p = 0.001). The antiviral therapy (HR 0.250, C.I. 0.104-0.604, p = 0.002) was independent factor related to HBV reactivation by logistic regression analysis. When the 28 HBV therapy naive HCC patients who received sorafenib were compared with propensity score matched 84 HBV therapy naïve liver cirrhosis patients without HCC, the cumulative reactivation rates were also significantly higher in the former group by log-rank test (p <0.001). Conclusions: The risk of HBV reactivation is high in CHB patients receiving sorafenib due to advanced HCC. It would be necessary to administer pre-emptive antiviral therapy before sorafenib initiation.

Tenofovir-Based Combination Therapy or Monotherapy for Multi-Drug Resistant Chronic Hepatitis B; Five Year Follow-Up Data of Multicenter Prospective Cohort Study (Final Results)

( Sang Jun Suh ),( Hyung Joon Yim ),( Young Kul Jung ),( Seong Gyu Hwang ),( Hana Park ),( Yeon Seok Seo ),( Soon Ho Um ),( Sae Hwan Lee ),( Young Seok Kim ),( Jae Young Jang ),( In Hee Kim ),( Hyoung 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Background/Aims: Recommendation of management of multidrug resistant (MDR) chronic hepatitis B (CHB) is still not uniform. Although current guidelines recommend tenofovir plus entecavir (ETV) or tenofovir monotherapy for MDR CHB, real-life data comparing combinations based TDF versus (vs.) TDF monotherapy are sparse. Herein, we report a multicenter cohort study for the evaluation of TDF-based therapy for MDR CHB. Methods: The inclusion criteria were CHB patients with resistance to more than 2 nucleos(t)ide analogues and hepatitis B virus (HBV) DNA level over 200 IU/mL. Patients with decompensated cirrhosis or hepatocellular carcinoma were excluded. Primary end point was cumulative virologic response defined by undetectable HBV DNA (<20 IU/mL) until month 60. Results: A total of 256 patients were enrolled and 236 patients were included for analysis. Mean age of patients were 49 years and 77.5 % were male. Mean baseline HBV DNA level was 4.2±1.6 log IU/mL. Genotypic resistance to L-nucleoside analogues (L-NA)+adefovir (ADV) (79 patients), L-NA+ETV (106 patients), L-NA+ADV+ETV (51 patients) were confirmed at enrollment. Initial treatments for MDR CHB were TDF+ETV 1 mg (171, 72.5 %), TDF+ETV 0.5 mg (7, 3.0 %), TDF+L-NA (6, 3.0 %), and TDF monotherapy (52, 22.0%). Virologic response rates of the whole cohort at year 1, year 2, year 3, year 4, and year 5 were 77.2%, 86.9 %, 89.9 %, 90.1 %, and 92.5 %, respectively. At year 5, virologic response rate was not significantly different between the TDF monotherapy group and TDF-based combination group (87.5 % vs. 93.0 %, respectively, P=0.493 by Fisher’s exact test). The cumulative virologic response rate of TDF monotherapy was not significantly different at year 3 (92.3 % vs. 94.0%, respectively, P=0.893) and at year 5 (96.2 % vs. 97.8 %, respectively, P=0.910), and was not inferior to combination therapies considering that 95% confidence interval (-9.2% ~ 5.8% at year 3; -6.5% ~ 3.2% at year 5) did not include the 10% of non-inferiority margin. Conclusions: TDF based therapy was effective for the treatment of MDR CHB for during 5 years of follow-up. The efficacy of TDF monotherapy was not inferior to the TDF based combination therapy.

HBV : Application of Roadmap-concept on Chronic Hepatitis B Patient with Entecavir Therapy Previously Exposed to Lamivudine: A Long Term Follow-up Study

( Sang Jun Suh ),( Hyung Joon Yim ),( Yeon Seok Seo ),( Chang Wook Kim ),( Chang Don Lee ),( Sang Hoon Park ),( Myung Seok Lee ),( Choong Kee Park ),( Hee Bok Chae ),( Moon Young Kim ),( Soon Koo Baik 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background/Aim: Many patients with lamivudine-resistant (LAM-R) chronic hepatitis B (CHB) had been treated by switching to entecavir (ETV) 1.0mg. Although rate of resistance to ETV (ETV-R) is reported high, current medical insurance system doesn`t pay-back for change from ETV to other agent in patients whose resistance to ETV was not identified. This study was aimed to stratify ETV therapy in LAM-R patients. Methods: One hundred and ten CHB patients who occurred LMV-R and received ETV 1.0mg up to 5 years were evaluated prospectively. At 12 months of switching to ETV, we divided subjects into non-detection group (HBV DNA<20 IU/mL) and detection group (HBV DNA≥20 IU/mL), which was subdivided into low viral load group (20≤HBV DNA<2,000 IU/mL) and high viral load group (2,000 IU/mL≤ HBV DNA). Virologic response rate (VR; HBV DNA<20 IU/mL) and ETV-R were evaluated as end point. Results: One hundred and ten patents were enrolled. The mean age was 45±11years, the proportion of male and HBeAgpositive patient was 71% (80/110) and 77% (85/110), respectively. The mean serum HBV DNA levels were 6.89±1.03, 3.26±1.81, 3.06±1.82, 2.49±1.53, 2.43±1.35 and 1.73±0.87 log10IU/ ml at baseline, month 12, 24, 36, 48 and 60, respectively. The VR (95% vs. 29%, P<0.001) was higher and ETV-R (10% vs. 54%, P=0.001) was lower in non-detection group than in detection group. The VR (27% vs. 29%, P=0.853) and ETV-R (45% vs. 57%, P=0.367) was not significantly different between low viral load and high viral load group. Resistance to ETV occurred at 26±10.3 months (median 24 months, 12-48 months) in detection group. Conclusion: Resistance rates were high in patients with detectable HBV DNA at 12 months of ETV therapy. Therefore, switching to or adding a potent nucleotide analogue (e.g. tenofovir) is warranted in LAM-R CHB patients whose HBV DNA is detected after 12 months of ETV therapy.