High Risk of Depressive Disorders in Patients With Gout: A Nationwide Population-Based Cohort Study

Metabolic abnormalities are common in patients with depressive disorders. However, the relationship between gout and depression is unclear. We explored the causal relationship among gout, antigout medication, and the associated risk of incidental depressive disorders.In this nationwide cohort study, we sampled data from the National Health Insurance Research Database to recruit 34,050 patients with gout as the gout cohort and 68,100 controls (without gout) as the nongout cohort. Our primary endpoint was the diagnosis of depressive disorders during follow-up. The overall study population was followed up until depression diagnosis, withdrawal from the NHI program, or the end of the study. The differences in demographic and clinical characteristics between both cohorts were determined using the Chi-square test for categorical variables and the t-test for continuous variables. Cox proportional hazard regression models were used to examine the effect of gout on the risk of depression, represented using the hazard ratio with the 95% confidence interval.Patients with gout exhibited a higher risk of depressive disorders than controls did. The risk of depressive disorders increased with age and was higher in female patients and those with hypertension, stroke, and coronary artery disease. Nonsteroidal antiinflammatory drug and prednisolone use was associated with a reduced risk of depression. Patients with gout who had received antigout medication exhibited a reduced risk of depressive disorders compared with nongout patients.Our findings support that gout increases the risk of depressive disorders, and that antigout medication use reduces the risk.     

Virological response and incidence of adefovir resistance in lamivudine-resistant patients treated with adefovir dipivoxil

BACKGROUND AND AIMS: The incidence of adefovir dipivoxil (ADV) resistance in patients with lamivudine (3TC)-resistant mutants who received ADV therapy remains unclear. The aims of this study were to determine the virological response to ADV, the incidence and the risk factors of ADV resistance, and the associated factors of initial virological response (IVR) in lamivudine-resistant patients. PATIENTS AND METHODS: Forty-six consecutive lamivudine-resistant chronic hepatitis B patients treated with ADV for more than 12 months with or without 3TC overlapping were prospectively examined for virological response and adefovir resistance. RESULTS: IVR was documented in 24 (52.2%) of patients. Of the 46 patients, 11 had ADV resistance (5 rtN236T, 5 rtA181T, 1 rtA181T and rtN236T). The cumulative incidence of ADV resistance at month 6, 12, 18 and 24 was 0%, 6.5%, 24.6% and 38.3% respectively. Compared with those without ADV resistance, patients with ADV resistance had a significantly higher rate of liver cirrhosis. Based on Cox regression analysis, the significant risk factor of ADV resistance was younger age (OR=0.92, 95% CI=0.86-0.99, P=0.023) and liver cirrhosis (OR=5.3, 95% CI=1.12-25.09, P=0.036). In addition, patients with ADV resistance were associated with higher HBV DNA levels and lower HBV DNA reduction in first 6 months of ADV treatment than those without ADV resistance. CONCLUSION: Only half of our patients achieved IVR on ADV treatment. The incidence of ADV resistance was high in 3TC-resistant patients treated with ADV.     

Capillary‐Venous Malformation in the Upper Limb

We present a group of patients with regional capillary malformations of the upper limbs and few additional findings other than prominent veins. We believe that this entity is the upper extremity equivalent of capillary‐venous malformation of the lower limb and, likewise, belongs at the minor end of the spectrum of vascular disorders with overgrowth.     

Chronic hepatitis C virus infection associated with dermatomyositis and hepatocellular carcinoma

Dermatomyositis is a rare and idiopathic inflammatory myopathy with characteristic cutaneous manifestations. In recent years, some researchers have showed the cause of dermatomyositis might be due to an autoimmune response induced by viral infections. However, chronic hepatitis C virus (HCV) infection associated with dermatomyositis is very rare. In this report, we present a patient with dematomyositis with abnormal liver function test results and elevated alfa-fetoprotein level. After excluding multiple viral infections known to cause myositis, the case was proven to be chronic hepatitis C by positive HCV-RNA in the serum. Abdominal computed tomography showed a liver tumor on the right lobe and needle biopsy proved it to be hepatocellular carcinoma. Chronic hepatitis C or hepatocellular carcinoma might cause dermatomyositis by inducing the formation of autoantibodies. Chronic hepatitis C or hepatocellular carcinoma should be considered in patients of dermatomyositis if no other cause is found.     

Eosinophilic gastroenteritis involving the distal small intestine and proximal colon

Eosinophilic gastroenteritis (EG) is an unusual disorder. It is characterized by eosinophil infiltration of the gut wall histologically and is manifested by gastrointestinal (GI) symptoms clinically. This disease entity preferentially affects the stomach and proximal small intestine. Mucosal layer disease is the most common form of this uncommon disease. We present a case of EG with transmural distal small intestinal and proximal colonic involvement whose clinical symptoms included watery diarrhea, abdominal pain, and body weight loss. Colonoscopy showed non-specific colitis in the proximal colon. Small bowel series showed diffuse jejunal dilatation with wall thickening and rigidity. Abdominal computed tomography also showed a thickened bowel wall with partial ileus and ascites. Diagnosis was established through endoscopic biopsy and ascites paracentesis, while at the same time excluding the possibility of parasite infection. Treatment with prednisolone produced a dramatic response. A high index of suspicion in cases of peripheral eosinophilia with concomitant GI symptoms is needed for the early diagnosis of this uncommon disease.     

Use of sonography in the evaluation of the gastroesophageal junction

To demonstrate the gastroesophageal junction with a real-time, transabdominal sonography through the window of left lobe of liver, the normal sonographic pattern and the thickness of the wall of abdominal esophagus were determined. The detection rate of the normal pattern in 30 control subjects was 93%, the normal thickness of the wall being 3.8 ± 1.2 mm (range 2 mm to 5 mm). In 7 patients with severe acute esophageal inflammation, the thickness was 7.6 ± 2.1 mm (range 5 mm to 10 mm). In 6 patients with an invading lesion in the gastroesophageal junction due to malignancy, the thickness of the wall was more than 10 mm in each case. This preliminary study indicates that the sonographic detection of gastroesophageal junction through the liver window can be included in routine abdominal sonography. An increased thickness of the wall needs further study to find the cause of the thickening. © 1996 John Wiley & Sons, Inc.     

Extraordinary muscular structure leads to urethral injury after vaginal delivery in animal study

Introduction and hypothesis  

The aim of this study is to explore causality of birth trauma after vaginal delivery and anatomical findings.     

Salmonellosis with liver abscess mimicking hepatocellular carcinoma in a diabetic and cirrhotic patient: a case report and review of the literature.

Salmonellosis with liver abscess in a cirrhotic liver is extremely rare. We report the first case of Salmonellosis with septic shock and liver abscess in a diabetic and cirrhotic patient. The image studies of liver initially favored hepatocellular carcinoma. But no definite focus of sepsis was found. After close follow-up of the liver space-occupied lesion, ultrasound examination revealed the features of liver abscesses at space-occupied lesion later. Ultrasound-guided liver aspiration proved abscess. The clinical and radiological responses were good after antibiotics treatment.