In patients with chronic hepatitis C, 48 weeks of therapy with interferon (IFN) plus ribavirin results in a sustained virologic response of 40%. Preliminary analysis suggests that measuring HCV RNA at week 24, rather than week 12, might provide the best prediction of treatment response. To assess the clinical utility of serum HCV RNA determinations at different times during therapy as a predictor of a sustained virologic response we evaluated 912 treatment-naïve patients. Patients were randomized to receive IFN-alpha2b, 3 million units (MU) three times weekly (tiw), for 24 or 48 weeks with either ribavirin or placebo, and then followed for 24 weeks. Serum HCV RNA was measured at weeks 4 and 12 in patients treated for 24 weeks; at 4, 12, and 24 weeks during therapy in those treated for 48 weeks, and week 24 post-therapy in all patients. Sustained response was defined as loss of serum HCV RNA at week 24 follow-up. Other patients were considered virologic nonresponders. For patients receiving 48 weeks of combination therapy, detectable serum HCV RNA at week 24 predicted nonresponse (positive predictive value) in 99% of patients compared to 89% at week 12. In patients treated for 24 weeks, testing at week 12 was more predictive of nonresponse than testing at week 4 in the combination-therapy group but not in the monotherapy group. Hence, for combination therapy, testing for serum HCV RNA as a predictor of nonresponse is most accurate at week 24 of therapy; a positive test correctly identified 99% of nonresponders.

Patients with acute esophageal coin ingestions may experience spontaneous coin passage and therefore, patients with coins located below the thoracic inlet with minor symptoms may be candidates for next-day follow-up. If repeat radiographs reveal a persistent esophageal coin, then the coin should be immediately removed. Furthermore, asymptomatic patients with coins above the thoracic inlet should undergo repeat radiographs in 2-5 h, as spontaneous coin passage may occur. Our protocol may also be more convenient and cost-effective as patients can be observed at home.

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We describe a patient with ulcerative colitis (UC) and the rare extraintestinal manifestation of fulminant tracheobronchitis. A 50-year-old man presented with respiratory compromise and bloody diarrhea. His evaluation showed large airway inflammation with fibrinopurulent debris and colonic inflammation and ulcerations consistent with UC. The etiology for the pulmonary pathology was thoroughly investigated and was thought to be an extraintestinal manifestation of the UC.