Current therapeutic approaches in childhood chronic hepatitis B infection: a multicenter study

BACKGROUND AND AIM: The aim of the present study was to compare the therapeutic efficacy of three different regimens in childhood chronic hepatitis B (CHB) infection. METHODS: A total of 182 children with CHB infection were prospectively allocated to three random groups. Sixty-two patients in the first group received high-dose interferon (IFN)-alpha 2b (10 MU/m2) thrice/weekly alone for 6 months. In the second (n = 60) and third groups (n = 60), IFN-alpha was used for 6 months (5 MU/m2) thrice/weekly in combination with lamivudine (LAM) (4 mg/kg, maximum 100 mg/day) for 12 months. Lamivudine was started simultaneously with IFN in the second group, while it was started 2 months prior to IFN injections in the third group. RESULTS: The initial mean alanine aminotransferase (ALT) values for the first, second and third groups were 109 +/- 93 IU/L, 101 +/- 64 IU/L and 92 +/- 42 IU/L, respectively (P > 0.05). At the end of the therapy, ALT values decreased to 82 +/- 111 IU/L, 38 +/- 41 IU/L and 29 +/- 16 IU/L in groups 1, 2 and 3, respectively. The mean ALT value of the first group was significantly different to the second and third groups (P = 0.046 and P = 0.002, respectively) at the end of the therapy and these differences were found to be sustained after 18 months. However, results in the second and third groups were similar (P > 0.05). There were no significant differences in HBeAg clearance and anti-HBe seroconversion at the initial stage, 12 months and 18 months between the three groups (P > 0.05). Hepatitis B virus (HBV) DNA clearance in the first group was different from the second and third groups, while the second and third groups had similar HBV DNA clearance ratios at 12 and 18 months. No significant difference was found in the complete response (normalization of ALT, clearance of HBV DNA and seroconversion of anti HBe) ratios of all groups (at 12 months: 28.8, 45.5, 35.8% and at 18 months 33.3, 49 and 34% in groups 1, 2 and 3, respectively, P > 0.05). CONCLUSIONS: Although the ALT normalization and HBV DNA clearance ratios of IFN plus LAM combination groups were better than the high-dose IFN-alpha monotherapy group, no significant difference was found in the complete response ratios of all three groups.     

The evaluation of immune responses that occur after HBV infection and HBV vaccination in hemodialysis patients

The hepatitis B virus (HBV) vaccination never lose its importance; however, we did not get immune response with vaccination in some cases at the hemodialysis (HD) units. In this research, our aim was to evaluate antibody responses that constitute with natural ways and vaccination against HBV infection in chronic HD patients. In this retrospective cohort study (between 1999 February and 2001 December), 34 patients, 19 males and 15 females that were at the HD program, were enrolled. Patients were divided into two groups: group A, vaccination group (n = 15); and group B, anti-HBc IgG (+) cases (n = 19). We injected 40 microg of recombinant HBV vaccine into the deltoid muscle at 0, 1, 2, and 6 months. The anti-HBs levels, over 10 mIU/mL, were accepted for enough immunization. In group A, after vaccination 12 of 15 (80%) patients had seroconversion but later, in five of 12 (33.3%) patients, HBs-antibody became negative and in seven of 12 (46.7%) patients the positivity of HBs-antibody continued. However, in group B, 16 of 19 (66.7%) immune patients who faced HBV infection, it was established that antibody response continued (P > 0.05). The patients in group A who had anti-HCV negativity and serum albumin levels >/=3.5g/dL (7/0; P < 0.05) had too much antibody response against the vaccine. The difference of our research was that patients under 49 years old, patients who did not respond to HBV vaccine, were proportionally higher as compared to those from other researches. In conclusion, it was realized that the immune response of the HBV vaccine was low in the HD patients and it was affected by several factors such as gender, anti-HCV positivity and nutritional status. But, in spite of getting all universal precautions, still to face with new cases emphasizes the importance of the vaccination.     

Ulnar artery aneurysm in a patient with Behçet’s disease

Behçet’s disease is a systemic disease characterized by oral aphthosis, genital ulcers, ocular lesions, gastrointestinal, musculoskeletal, neurological and major vessel involvement. Arterial involvement, aneurysms and arterial thrombosis have been reported in 1.5–3% of patients. In this case report, we present a patient with ulnar arterial aneurysm associated with Behçet’s disease.     

Intra-Left Atrial Mechanical Delay Detected by Tissue Doppler Echocardiography Can Be a Useful Marker for Paroxysmal Atrial Fibrillation

Objectives: There are some clinical and echocardiographic parameters to predict paroxysmal atrial fibrillation (PAF), but more sensitive predictors are needed. Tissue Doppler imaging may be a sensitive method for this purpose. Methods: Thirty-four patients with PAF and 31 control subjects were studied. Time intervals from the beginning of P-wave to beginning of A-wave from lateral and septal mitral and right ventricular tricuspid annuli in tissue Doppler imaging were recorded. The differences between these intervals gave the mechanical delays between/within the corresponding atria. Results: There were no differences between groups with regard to age. PAF patients were found to have increased left atrial dimension and intra-left atrial mechanical delay. Twenty-five milliseconds was calculated as cutoff value to predict PAF. P-wave dispersion was found to be increased in PAF. Conclusions: This study shows an increase in intra-left atrial mechanical delay in PAF patients. This method can be used as an early marker to detect PAF.     

Recurrent syncope in a case of metastatic malignant melanoma--an unusual presentation of an uncommon disease.

Cardiac tumours may be rare causes of syncope. Here we report a malignant melanoma that metastasized to the right atrium as an intracavitary mass that intermittently obstructed the tricuspid valve producing syncope episodes.     

Magnesium sulfate infusion prevents shivering during transurethral prostatectomy with spinal anesthesia: a randomized,double-blinded,controlled study

Study ObjectiveTo determine whether magnesium sulfate (MgSO₄) infusion during surgery reduces shivering during spinal anesthesia.DesignDouble-blinded placebo-controlled, randomized trial.SettingOperation room of a university hospital.Patients60 patients, aged 40 to 70 years, scheduled for elective transurethral resection of the prostate (TURP) during spinal anesthesia.InterventionsSubarachnoid anesthesia consisting of hyperbaric bupivacaine three mL 0.5% was injected using a 25-G Quincke spinal needle. Patients received either saline (Group C, n = 30) or MgSO₄ (Group Mg, n = 30). Group Mg received an intravenous (IV) bolus of MgSO₄ 80 mg/kg via syringe pump over a 30-minute period, followed by a two g/hr infusion during the intraoperative period. Group C received an equal volume of saline.MeasurementsMotor blockade was evaluated by Bromage motor scale. Sensory block level was assessed by pinprick test. Shivering was assessed after the completion of subarachnoid drug injection. Side effects were recorded.Main ResultsHypothermia was observed in all patients (100%) in Group Mg and in 24 patients (80%) in Group C (P = 0.024). The decrease in core temperature in Group Mg was significantly greater (P < 0.005). Shivering was observed in two patients (6.7%) in Group Mg and 20 patients (66.7%) in Group C (P = 0.0001).ConclusionsMgSO₄ infusion in the perioperative period significantly reduced shivering during TURP with spinal anesthesia. MgSO₄ infusion prevents shivering in patients receiving spinal anesthesia but increases the risk of hypothermia.     

Unilateral brachial artery antegrade selective cerebral perfusion following carotid endarterectomy for carotid, coronary, and aortic aneurysmal surgery

Abstract   In the presence of multiple concomitant occlusive and aneurysmal diseases, selection of the brain protection method is a primary concern. A case with a disease triad of stenotic lesions in internal carotid arteries, coronary artery atherosclerosis, and an ascending-arcus aorta aneurysm is presented. We simultaneously performed right carotid endarterectomy, coronary artery bypass grafting, and graft replacement of the ascending-arcus aorta. Brain protection was achieved with continuous right brachial artery antegrade selective cerebral perfusion under moderate hypothermia, following carotid endarterectomy. The operative technique is detailed and antegrade selective cerebral perfusion following the carotid endarterectomy for aneurysmal surgery is discussed.