AIM:To investigate the occurrence and severity of pruritus in chronic hepatitis C patients treated with or without interferon(IFN)therapy.METHODS:A total of 89 patients with chronic hepatitis C and 55 control(non-hepatitis)patients were asked to rate their experience of diurnal and nocturnal pruritus in the preceding week using a visual analogue scale(VAS)and a five-point scale,respectively.Blood samples were taken and serum thymus and activationregulated chemokine(TARC)levels were measured by enzyme-linked immunosorbent assay.RESULTS:A significantly greater proportion of chronic hepatitis C patients experienced nocturnal pruritus compared with control(58.4%vs 5.5%,P<0.0001).Chronic hepatitis C patients also had more severe pruritus compared with control patients,indicated by the higher mean VAS scores in both the IFN-treated and non-IFN-treated groups.In particular,patients who received combined peginterferon alfa-2b and ribavirin had significantly higher mean VAS scores than those receiving peginterferon alfa-2a or no IFN treatment.SerumTARC levels did not correlate with pruritus scores,and no significant differences in TARC levels were observed between the IFN-treated and non-IFN-treated groups.CONCLUSION:Patients with chronic hepatitis C experience pruritus more than those without.Serum TARC levels do not correlate with pruritus severity in chronic hepatitis C patients.
A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,double-felted silicone CAPD catheter was inserted,and the felt cuff was sutured to the peritoneum to avoid postoperative leakage.An adequate gradient for tube fixation to the abdominal wall was confirmed.The CAPD tube was passed through a subcutaneous tunnel.Aeroperitoneum was induced to confirm that there was no air leakage from the sites of CAPD insertion.Two trocars were placed,and we confirmed that the CAPD tube led to the rectovesical pouch.Tip position was reliably observed laparoscopically.Optimal patency of the CAPD tube was confirmed during surgery.Placement of CAPD catheters by laparoscopic-assisted surgery has clear advantages in simplicity,safety,flexibility,and certainty.Laparoscopic technique should be considered the first choice for CAPD tube insertion.
Nodular fasciitis is a benign proliferative lesion composed of fibroblast-like cells that affects various sites in the body.We describe a patient with nodular fasciitis in the mesentery,encountered during laparotomy for the treatment of ascending colon cancer.The nodular fasciitis in our patient resembled peritoneal dissemination of malignancy on macroscopic observation.Because the treatment options change with concomitant peritoneal dissemination of gastrointestinal tract malignancy,recognition of this rare condition and preparation for unexpected nodular lesions are crucial.
We describe a 77-year-old woman with chronic hepatitis B who became resistant to lamivudine.She was started on adefovir(10 mg daily)while still continuing lamivudine therapy.Four mo later her liver function improved and serum Hepatitis B virus(HBV)-DNA level became undetectable.Three years after the start of additional adefovir treatment,hepatocellular carcinoma (HCC)was detected and the patient underwent a successful hepa-tectomy.Our findings suggest tha-t the addition of adefovir to ongoing lamivudine therapy cannot completely suppress hepatocarcinogenesis,but is useful for improving liver function in patients with lamivudine-resistant HBV-related cirrhosis,allowing HCC surgery.
