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ABSTRACT: In 18 of 547 patients who had received nucleoside analogue preparations for 1 year or more, multi-drug resistance was detected, after a median follow-up of 53 months. No patient showed liver failure related to multi-drug resistance acquisition. Multi-drug resistance was associated with entecavir (ETV) therapy in 7 lamivudine (LAM) -resistant patients, combination therapy with adefovir dipivoxil (ADV) in 8 LAM-resistant patients, LAM switching to ETV in 2 patients, and initial ETV administration in 1. For treatment, combination therapy with LAM and ADV was performed. In non-responders, combination therapy with ADV and ETV was employed. In all LAM- and ADV-resistant patients, and the HBV DNA level decreased to 3.0LC/ml or less. However, a similar decrease was noted in 7 (58.3%) of 12 LAM- and ETV-resistant patients. Of the 18 patients, 1 did not respond to combination therapy with ADV and ETV. Therapy with tenofovir disoproxil fumarate (TDF) was required.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 01/2013; 110(1):44-55.
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ABSTRACT: A 69-year-old man with liver cirrhosis was admitted to our hospital with general fatigue. Colonoscopy revealed risky red color
sign-positive enlarged tortuous rectal varices. Endoscopic injection sclerotherapy (EIS) was performed three times weekly
using 5% ethanolamine oleate with iopamidol; the total amount of sclerosant was 7 ml. Images of rectal varices and the outflowing
vessel from rectal varices were obtained via color Doppler ultrasonography before EIS, and fast Fourier transform analysis
showed a continuous flow with a frequency shift of 276.6 Hz. We successfully performed EIS for this patient, having effective
varicealography. After EIS, colonoscopy revealed shrinkage of the varices in the rectum, and color Doppler indicated an extreme
decrease of blood flow in the rectal varices. In conclusion, color Doppler is a useful noninvasive modality for detecting
rectal varices and for evaluating the therapeutic effects of EIS.
Journal of Medical Ultrasonics 04/2012; 34(1):65-68. · 0.33 Impact Factor
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ABSTRACT: We treated a 74-year-old woman who complained of tarry stool. Neither endoscopic examination of the upper gastrointestinal
tract nor colonoscopy revealed any finding indicative of bleeding, and 99mTc-HSA-D pool scintigraphic imaging showed no accumulation of blood in the digestive tract. Small tortuous collateral veins
were observed on computed tomography (CT) in the distal third portion of the duodenum. Color Doppler ultrasonography obtained
color flow images of varices in the distal third portion of the duodenum indicating turbulent flow, and color flow imaging
showed the outflow vessel from duodenal varices. Duodenoscopy revealed tortuous varices, with erosions and blue in appearance,
in the same area. Percutaneous transhepatic portography was carried out 18 days after the treatment of ascites, and hepatofugal
blood flow was confirmed in the pancreatic duodenal vein originating near the junction between the splenic and inferior mesenteric
veins with the passage of contrast medium into the duodenal varices, which drained into the left ovarian vein. We performed
selective catheterization into the afferent vein of the varices, and injected 8 ml of a 5% solution of ethanolamine oleate
containing iopamidol. Microcoil embolization using steel coils was added because the therapeutic effect resulting after the
relatively rapid washout of sclerosant was insufficient. CT and color Doppler ultrasonography showed absence of blood flow
in the varices 1 week after the therapy. This patient has had no episodes of rebleeding in the 24 months after therapy. Color
Doppler ultrasonography was useful in diagnosing this case of duodenal varices and in evaluating therapeutic effect.
Journal of Medical Ultrasonics 04/2012; 34(1):59-63. · 0.33 Impact Factor
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Itaru Ozeki,
Jun Akaike,
Yoshiyasu Karino,
Tomohiro Arakawa, Yasuaki Kuwata,
Takumi Ohmura,
Takahiro Sato,
Naohiro Kamiya,
Ichimaro Yamada,
Kazuaki Chayama,
Hiromitsu Kumada,
Joji Toyota
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ABSTRACT: Anemia is commonly observed as a side effect in a treatment with protease inhibitors combined with peginterferon alpha and ribavirin for hepatitis C virus infection. This study assessed the safety, tolerability, viral kinetics, and selection of variants in telaprevir monotherapy for 24 weeks, and outcomes of the off-study treatment with peginterferon alpha-2b and ribavirin among Japanese female patients at a median age of 54 years who were difficult to treat with the standard therapy (peginterferon alpha-2b and ribavirin) alone in Japan.
Four treatment-naïve patients with chronic hepatitis C virus subtype 1b infection received telaprevir (750 mg every 8 h) alone for 24 weeks. All patients then started the off-study treatment with peginterferon alpha-2b and ribavirin. Safety, tolerability, hepatitis C virus RNA levels, and emergence of telaprevir-resistant variants were monitored.
During the 24 weeks of telaprevir monotherapy, there was no discontinuation due to adverse events, but 2 patients stopped the intake at weeks 6 and 15 because of viral breakthrough. Emergence of telaprevir-resistant variants was observed in 3 patients who showed viral breakthrough. These variants were eliminated by the off-study treatment, and sustained virological response was achieved in all patients.
Anemia was manageable by carefully adjusting the ribavirin dosage in the standard therapy that followed telaprevir monotherapy. This sequential regimen seems to be safer and more tolerable than the triple combination of telaprevir, peginterferon alpha, and ribavirin, especially among elderly females with low baseline hemoglobin.
Journal of Gastroenterology 05/2011; 46(7):929-37. · 4.16 Impact Factor
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Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 02/2011; 108(2):202-9.
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ABSTRACT: A 52-year-old man with portal hypertension due to Hepatitis C developed anal bleeding, and endoscopic variceal ligation was performed for the internal hemorrhoids. This patient experienced anal bleeding after 1 year, and colonoscopy revealed tortuous rectal varices extending 4 cm from the dentate line. Color flow images of rectal varices and a continuous wave with fast-Fourier transform analysis were detected via endoscopic color Doppler ultrasonography, and a pulsatile wave was delineated at the anal site of the rectal varices. Endoscopic injection sclerotherapy for rectal varices was performed on this patient, and endoscopic color Doppler ultrasonography revealed the disappearance of variceal blood flow and the decrease of pulsatile wave at anal site of rectal varices.
Digestive Endoscopy 09/2008; 14(3):115 - 118. · 1.19 Impact Factor
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ABSTRACT: Background: Endoscopic injection sclerotherapy (EIS) is an effective procedure for the treatment of esophageal varices. In the present study, the pathogenesis of gastric ulcer after EIS for esophageal varices was investigated.Methods: EIS for esophageal varices was performed for 610 patients in our department, and the frequency and clinical course of gastric ulcer after EIS were investigated retrospectively. EIS was performed using 5% ethanolamine oleate with iopamidol, which was injected intermittently under fluoroscopy.Results: Gastric ulcer after EIS for esophageal varices was observed in 14 of the 610 (2.3%) patients. These were located around the cardia of the stomach from the fornix to the gastric body. Gastric ulcer extended from the stomach lining into the esophagus in 11 of the 14 cases. Severe chest pain was observed, and dark purple mucosal changes of the esophagus and stomach were detected endoscopically at the time of injection in all 14 cases. All cases received dripping therapy, and prescription of a proton pump inhibitor. Gastric ulcer after EIS was refractory, and almost 2 months was required until the healing stage was reached.Conclusion: Gastric ulcer after EIS for esophageal varices is a rare but important complication of EIS.
Digestive Endoscopy 12/2006; 19(1):13 - 17. · 1.19 Impact Factor
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ABSTRACT: Endoscopic color Doppler ultrasonography (ECDUS) is a method for detecting color flow images in blood vessels. We previously reported on the usefulness of ECDUS (convex-type scanning instruments with forward--oblique viewing) for evaluating the hemodynamics of esophageal varices. In the present study, we report the usefulness of new electronic radial ECDUS in cases of esophageal varices by comparison with convex-type ECDUS.
Twenty-six patients with esophageal varices were identified and studied. The underlying pathologies of portal hypertension included liver cirrhosis (15 patients) and cirrhosis associated with hepatocellular carcinoma (11 patients). Endoscopic findings of esophageal varices were as follows: Cb, F3, and Ls varices in four patients; Cb, F2, and Lm varices in 21 patients; and Cb, Lm, and F1 varices in one patient. RC1 was observed in the esophagus in 14 of the 26 patients. RC2 was noted in 11 cases, and RC0 was seen in one patient. ECDUS was performed using a Pentax EG-3630UR (forward view) with a distal tip diameter of 12 mm. The instrument (electronic radial array) has a curved array scanning transducer with variable frequency (5.0, 7.5, 10.0 MHz). A Hitachi EUB 6500,8500 was used for the display, providing 270 degrees images. We monitored the color flow images of esophageal varices, paraesophageal veins, palisade veins, perforating veins, and pulsatile waves using this technique. As a control, 110 patients were examined by convex-type ECDUS.
(1) Color flow images of esophageal varices and paraesophageal veins were obtained in 26 of the 26 patients, whereas color flow images of perforating veins were obtained in 18 of the 26 patients (69.2%). Color flow images of palisade veins were obtained in 12 of the 26 patients (46.2%). (2) Color flow images of pulsatile waves were obtained in 10 of the 26 patients (38.5%). Color flow images of pulsatile waves were detected in zero (0%) of the 4 F3 varices, in nine (42.9%) of the 21 F2 varices, and in the 1 (100%) case of F1 varices. Also, color flow images of pulsatile waves were detected in seven (50.0%) of the 14 RC1 varices, in two (18.2%) of the 11 RC2 varices, and in the 1 (100%) case of RC0 varices. (3) As a control, 110 patients were examined by convex-type ECDUS. Color flow images of esophageal varices and paraesophageal veins were obtained in 110 of the 110 patients, whereas color flow images of perforating veins were obtained in 74 of 110 (67.3%) with convex-type ECDUS. The detection rate of palisade veins with electronic radial ECDUS (12 of the 26 patients, 46.2%) was significantly higher than with convex-type ECDUS (28 of the 110 patients, 25.5%) (P<0.05). The detection rate of pulsatile waves with electronic radial ECDUS (10 of the 26 cases, 38.5%) was significantly higher than with convex-type ECDUS (3 of the 110 cases, 2.7%) (P<0.0001).
Electronic radial ECDUS provides clear color flow images of blood vessels in esophageal varices with the additional advantages of forward-view optics and extended 270 degrees views. Electronic radial ECDUS was superior to convex-type ECDUS in detecting palisade veins and pulsatile waves.
Journal of Gastroenterology 02/2006; 41(1):28-33. · 4.16 Impact Factor
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ABSTRACT: There are few detailed clinical reports about extrahepatic metastases of hepatocellular carcinoma (HCC). The purpose of the present study was to elucidate the clinical features of extrahepatic metastases of HCC.
The clinical records of 482 patients who had been diagnosed as having HCC during the period from January 1995 to March 2001 were retrospectively reviewed. Extrahepatic metastases had been detected in 65 patients. Clinical features of those 65 patients were analyzed.
Patients with extrahepatic metastases had more advanced intrahepatic tumors at the first diagnosis of HCC: 73.8% of the patients with extrahepatic metastases had tumors of intrahepatic tumor stage T3 or T4 according to the TNM classification, while only 28.5% of the patients without extrahepatic metastases had tumors of T3 or T4 (P < 0.001). Vessel invasion was also detected at the first diagnosis of HCC more frequently in the patients with extrahepatic metastasis (P < 0.001). The frequent metastatic sites were lung (53.8%), bone (38.5%), and lymph node (33.8%). Other metastatic sites were the adrenal gland, peritoneum, skin, brain and muscle. The median survival time and 1-year survival rate were 7 months (range: 1-59 months) and 24.9%, respectively. Patients with Child-Pugh grade B and C (P = 0.0018) and patients with positive serum alpha-fetoprotein (P = 0.011) had significantly poor prognosis.
Extrahepatic metastases of HCC are not rare. The possibility of extrahepatic metastases and the clinical features of extrahepatic metastases should be considered when examining patients with HCC, particularly those with advanced intrahepatic tumors, to enable precise evaluation of the spread of HCC and determination of the appropriate treatment method.
Journal of Gastroenterology and Hepatology 12/2005; 20(11):1781-7. · 2.87 Impact Factor
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ABSTRACT: Gastric antral vascular ectasia (GAVE) is a rare cause of chronic gastrointestinal bleeding. The aim of this study was to evaluate the relationship between GAVE with cirrhotic patients and liver dysfunction, portal hypertension and the safety and efficacy of argon plasma coagulation (APC) in treating GAVE with cirrhotic patients. Eight cirrhotic patients with the characteristic endoscopic findings of GAVE were registered. In this study, APC was performed for GAVE in all eight patients. The patients-liver function was classified by Child-Pugh classification and classifications were: two class A, five class B and one class C (mean score: 7.8). Five patients had previously received prophylactic endoscopic injection sclerotherapy for esophageal varices and one had esophageal varices. Balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices had been performed in other one patient. Portal hypertensive gastropathy (PHG) was recognized in only one case. APC was performed in all eight patients and one to three treatment sessions were needed (mean: 1.8 sessions). No complications were observed in the initial treatment. During follow-up, endoscopies revealed the recurrence of GAVE in two patients requiring further treatment by APC (recurrence rate: 25%). After APC treatment, the recurrence of GAVE was not observed with endoscopy in the other six patients. The results suggest that GAVE is related to severe liver damage and portal hypertension in cirrhotic patients. APC is a safe and effective treatment against GAVE.
Hepatology Research 07/2005; 32(2):121-6. · 2.20 Impact Factor
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ABSTRACT: We examined the usefulness of endoscopic color Doppler ultrasonography, using Levovist in evaluating the arterial blood flow, in patients with esophageal varices.
The study involved 110 patients with esophageal varices who were examined using endoscopic color Doppler ultrasonography (ECDUS). We compared vessel images detected by pre-contrast ECDUS with those detected by enhanced ECDUS. We evaluated the detection rate of the pulsatile wave, and measured systolic velocity and end-diastolic velocity. We calculated the resistance index (RI), which demonstrates the resistance of peripheral vessels in arterial flow.
Color flow images of the pulsatile wave were obtained by pre-contrast ECDUS in 3 (2.7%) of the 110 patients. Color flow images of the pulsatile waves were obtained in 40 (36.4%) of the 110 patients by enhanced ECDUS using Levovist. That is, by using Levovist, a pulsatile wave could be delineated in 37 patients in whom pulsatile waves were previously undiagnosed via pre-contrast ECDUS. Color flow images of the pulsatile waves were detected in 37 (37.7%) of the 98 F2 varices and in 3 (25.0%) of the 12 F3 varices. Color flow images of the pulsatile wave were detected in 35 (40.2%) of the 87 red color (RC)(+) varices, and in 5 (21.7%) of the 23 RC(++) or RC (+++) varices. Next, we calculated the RI of the pulsatile wave, obtained by enhanced ECDUS using Levovist, in 40 patients. The RI ranged from 0.49 to 0.83 (mean, 0.67 +/- 0.09); there were nine patients with RIs of less than 0.60, and all 9 of these patients had both F2 and RC(+) type varices (100%).
Levovist contrast in ECDUS examinations suggests that arterial flow is involved in the formation of esophageal varices.
Journal of Gastroenterology 02/2005; 40(1):64-9. · 4.16 Impact Factor
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ABSTRACT: Background: Endoscopic color Doppler ultrasonography (ECDUS) is a method for obtaining color flow images in blood vessels. In the present study, we evaluated the usefulness of three-dimensional endoscopic color Doppler ultrasonography (3D-ECDUS) using electronic radial ECDUS.Methods: Five patients with esophageal varices were studied. The technique of ECDUS was performed using a Pentax EG3630-UR (forward-view) with a distal tip diameter of 12 mm. The instrument (electronic radial array) has a curved array scanning transducer with variable frequency (5.0, 7.5, 10.0 MHz) and B mode/color Doppler/power Doppler capability. A Hitachi EUB 8500 was used for the display, which provided a 270° image. We monitored the color flow images of esophageal varices, paraesophageal veins and perforating veins. Scanning was performed from the cardiac part of the stomach to the distal esophagus by moving the instrument. After completing the examination, 3D-ECDUS images were reconstructed.Results: Color flow images of esophageal varices and paraesophageal veins were obtained in five of the five patients. Color flow images of perforating veins were obtained in five of the five patients with 3D-ECDUS. 3D-ECDUS clearly delineated the continuity of vessels from the cardiac varices to the esophageal varices, and between the perforating veins and esophageal varices. Furthermore, 3D-ECDUS clearly showed the continuity of vessels from the anterior branch of the left gastric vein to the esophageal varices and from the posterior branch of the left gastric vein to the paraesophageal veins.Conclusion: 3D-ECDUS more clearly provides visualization of vessel continuity in esophageal varices, which allows for better understanding of the hemodynamics of esophageal variceal cases.
Digestive Endoscopy 12/2004; 17(1):81 - 84. · 1.19 Impact Factor
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ABSTRACT: Case 1: A 75-year-old woman was admitted to our department in February 1996 with tarry stool. At 71 years of age, she had been diagnosed with idiopathic myelofibrosis (IMF) based upon laboratory data and a biopsy of iliac bone marrow. Fibergastroscopic examination on admission revealed esophageal varices graded as Ls, F2, Cb, and red color (RC)(+ +). Esophageal varices were considered the most likely cause of the bleeding. Computed tomography (CT) showed a markedly enlarged spleen and large collateral veins (left gastric vein, spleno-renal shunt). We performed endoscopic injection sclerotherapy (EIS) twice weekly using 5% ethanolamine oleate with iopamidol (5% EOI), the total amount of sclerosant was 13 mL. No further variceal bleeding occurred until she died in June 1996. Case 2: A 67-year-old man was admitted to our hospital in February 1992 with anemia and leukocytosis after a health check. He was diagnosed with IMF based upon laboratory data and a biopsy of iliac bone marrow. Screening upper gastrointestinal endoscopy demonstrated esophageal varices graded as Ls, F3, Cb, and red color (RC)(+) and gastric varices graded as Lg–cf, F2, and RC(–). CT showed a markedly enlarged spleen and large collateral veins (left gastric vein, short gastric vein). We performed EIS four times weekly using 5% EOI, the total amount of sclerosant was 32 mL. Two weeks after EIS the varices were graded as F1, RC(–). This patient experienced esophageal varix recurrence up to 1 year later, and EIS was performed twice using 5% EOI.
Digestive Endoscopy 09/2004; 16(4):356 - 360. · 1.19 Impact Factor
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ABSTRACT: Background: Endoscopic color Doppler ultrasonography (ECDUS) is a useful modality for obtaining color flow images of esophageal varices. The direction of blood flow in passageways is fundamentally hepatofugal flow according to ECDUS. The present study is designed to evaluate the alternate direction of color flow image of passageways via ECDUS in esophageal variceal patients.Methods: The study involved 125 patients with esophageal varices using ECDUS. The grades of red color (RC) were as follows: RC(+) in 79 cases, RC(+ +) in 35 cases, and RC(+ + +) in 11 cases. We investigated the alternate direction on color flow images of the left gastric vein, the palisade vein, and the perforating veins via ECDUS.Results: Color flow images of the esophageal varices and the left gastric vein were obtained in all 125 (100%) patients by ECDUS. Color flow images of the perforating veins were obtained in 90 (72.0%) of the 125 patients. Vessel images of the palisade veins were detected in 33 (26.4%) of the 125 patients. The alternate direction on color flow images was detected in seven (5.6%) of the 125 patients with ECDUS: in three patients, left gastric vein; in three patients, perforating veins; and in one patients, left gastric vein and palisade veins. This phenomenon was observed periodically at regular intervals. The endoscopic findings were RC(+) in all seven patients.Conclusion: The alternate direction of blood flow in the passageways was observed in a few cases of RC(+) esophageal varices. We can observe the hemodynamics of esophageal varices non-invasively and in real time with ECDUS, and clarify the frequencies of the alternate direction of blood flow in RC-positive esophageal variceal patients.
Digestive Endoscopy 06/2004; 16(3):208 - 212. · 1.19 Impact Factor
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ABSTRACT: We evaluated the usefulness of endoscopic color Doppler ultrasonography (ECDUS) with Levovist, a galactose-based contrast agents, for detecting veins in the esophageal wall in patients with recurrent esophageal varices after endoscopic therapies.
We compared vessel images detected prior to the use of contrast with those detected by enhanced ECDUS in 29 patients with recurrent esophageal varices. After the pre-contrast ECDUS examination, all 29 patients received Levovist intravenously, at a concentration of 300 mg/ml. A 7.5-ml dose of the contrast agent was injected at a slow infusion rate, of 1 ml/min. The perforating veins detected by ECDUS were classified, according to flow direction, into three different types. Type 1 showed inflow from the paraesophageal veins to the esophageal varices. Type 2 showed outflow from the esophageal varices to the paraesophageal veins, while type 3 was a mixed type with both inflow and outflow. For comparison, 26 patients without recurrent esophageal varices were studied.
Color flow images of perforating veins were obtained in 9 (31.0%) of the 29 patients with recurrent esophageal varices with pre-contrast ECDUS. The detection rate of perforating veins in the patients with recurrent esophageal varices (31.0%) was significantly higher than that in patients without recurrent esophageal varices (0 of 26; 0%) with pre-contrast ECDUS. Color flow images of perforating veins were detected in 22 (75.9%) of the 29 patients with recurrent esophageal varices after Levovist contrast. On the other hand, color flow images of perforating veins were not detected in any of the 26 patients without recurrent esophageal varices after Levovist contrast. Type 1 perforating veins were recognized in 6 (20.7%) of the 29 patients, type 2 in 2 (6.9%) of the 29, and type 3 in 1 (3.4%) of the 29 prior to the use of contrast. After the enhanced ECDUS, type 1 perforating veins were recognized in 13 (44.8%) of the 29 patients, type 2 in 6 (20.7%) of the 29, and type 3 in 3 (10.3%) of the 29. All color-flow images detected with pre-contrast ECDUS were enhanced after Levovist contrast.
Perforating veins can be detected at a high rate by ECDUS with Levovist in patients with recurrent esophageal varices after endoscopic therapy.
Journal of Gastroenterology 02/2004; 39(5):422-8. · 4.16 Impact Factor
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ABSTRACT: Background: Endoscopic color Doppler ultrasonography (ECDUS) is a method for detecting color flow images in blood vessels. In the present study, electronic radial ECDUS in cases of esophageal varices is described.Methods: Thirteen patients with esophageal varices were studied. The technique of ECDUS was performed using a Pentax EG3630-UR (forward-view) with a distal tip diameter of 12 mm. The instrument (electronic radial array) has a curved array scanning transducer with variable frequency (5.0, 7.5, 10.0 MHz) and B mode/color Doppler/power Doppler capability. A Hitachi EUB 6500 was used for the display, providing a 270° image. We monitored the color flow images of esophageal varices, paraesophageal veins and perforating veins using this technique.Results: Color flow images of esophageal varices and paraesophageal veins were obtained in 13 of the 13 patients, whereas color flow images of perforating veins were obtained in four of the 13 patients (30.8%). The 13 esophageal varices exhibited velocities ranging between 3.0 and 11.7 cm/s (mean = 6.3 cm/ s). The forward-viewing optics facilitated insertion, but the stiffness of the distal tip limited the flexibility of the scope, especially when attempting J- or U-turn views.Conclusion: Electronic radial ECDUS provides color flow images similar in quality to those of convex-type ECDUS with the additional advantages of forward-view optics and extended 270° views.
Digestive Endoscopy 09/2003; 15(4):275 - 279. · 1.19 Impact Factor
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ABSTRACT: Recently, hepatitis C virus (HCV) dynamics during interferon (IFN) therapy have been studied in detail. We examined factors that regulate the viral kinetics and the relationship between the viral kinetics and clinical effect of IFN therapy.
Eighty-eight patients with chronic hepatitis C entered this study. All patients had been treated with 3 MU of IFN-beta twice a day for the first 2-4 weeks, then IFN-alpha for the next 20-22 weeks (three injections per week). The levels of serum HCV RNA were determined by Amplicor HCV Monitor version 1.0, before and 24 h after the first injection of IFN; then the decline of HCV was calculated. Liver inflammation and fibrosis were scored as 0 (none), 1 (mild), 2 (moderate) or 3 (severe) using biopsy specimens.
The decline of serum HCV RNA was 1.42 +/- 0.65 log copies/mL in genotype 1b and 1.83 +/- 0.72 in genotype 2a or 2b (P < 0.01). By a logistic regression model, genotype (1b, 2a or 2b) and hepatic fibrosis (0 or 1, 2 or 3) associated with 24-h decline of serum HCV RNA, independently. As the predictor of IFN therapy, the decline of serum HCV RNA and serum HCV RNA levels before IFN therapy were the independent significant factors (P < 0.001).
The decline of serum HCV RNA during the first 24 h of IFN therapy was regulated by genotypes and hepatic fibrosis. The decline of serum HCV RNA and initial HCV load were independent factors that can be the predictor of the subsequent sustained viral response to IFN therapy.
Journal of Gastroenterology and Hepatology 04/2003; 18(4):404-10. · 2.87 Impact Factor
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ABSTRACT: Background: Endoscopic color Doppler ultrasonography (ECDUS) is a useful modality for obtaining color flow images of esophageal varices. Levovist is a microbubble echo-enhancing agent that improves Doppler ultrasound examination. This study is designed to evaluate the usefulness of ECDUS using Levovist in diagnosing palisade veins of esophageal varices.Methods: The study involved 67 patients with esophageal varices using ECDUS. All 67 patients received Levovist intravenously at a concentration of 300 mg/mL. A 7.5-mL dose of the contrast agent was injected at a slow infusion rate of 1 mL/min. We compared vessel images detected with precontrast with those detected by enhanced ECDUS.Results: Color flow images of palisade veins were obtained in 16 (23.9%) of the 67 patients with precontrast ECDUS. Vessel images of palisade veins were detected in 15 of 61 F2 type varices (24.6%) and in one of six F3 varices (16.7%). The color flows of these vessels showed a continuous wave on fast-Fourier transform analysis. Sixteen palisade veins had velocities in the 3.3 cm/s−11.6 cm/s range. Color flow images of palisade veins were obtained in 27 (40.3%) of the 67 cases by enhanced ECDUS using Levovist. Palisade veins could be delineated after Levovist contrast in 11 patients who could not be detected on precontrast ECDUS. After Levovist contrast, color flow images detected with precontrast ECDUS were enhanced in all patients.Conclusion: Endoscopic color Doppler ultrasonography with Levovist contrast can improve the diagnostic quality of the palisade veins in esophageal varices.
Digestive Endoscopy 03/2003; 15(2):87 - 92. · 1.19 Impact Factor
