Abdominal computed tomography of a 71-year-old man revealed a 3-cm mass in gastric cardia. Although the mass was widely attached to the gastric wall, no clear contrast enhancement was observed. Abdominal magnetic resonance imaging revealed the mass to have homogenous high intensity on T2W1 images and isointensity on T1W1 images. On diffusion-weighted imaging, no high intensity was observed. However, the mass had a smooth surface and was widely attached to the gastric wall, consistent with computed tomography findings. A gastric submucosal tumor was suspected. Laparoscopic tumor resection was performed. Histopathologic diagnosis of the mass was a bronchogenic cyst derived from the respiratory primordium originating in the foregut of the primitive intestine. Such cysts are mostly found in the mediastinum or thoracic cavity; their occurrence on the gastric wall is extremely rare. Despite this, we think that bronchogenic cysts should be considered in the differential diagnosis of abdominal unilocular cystic diseases.
Objectives: A high virological response rate can often be shown to be obtained with PEG-IFN α-2b and ribavirin combination therapy in chronic hepatitis C patients. Viral dynamics have been utilized for the evaluation of antiviral effects, especially the exponential second decay slope, which represents the elimination of infected cells. Methods: Forty-nine patients were randomly assigned to the IFN α-2b group (n = 26) or the PEG-IFN α-2b group (n = 23). Ribavirin was administered equally to both groups. Measuring the serum concentration of HCVRNA, the exponential viral decay during phase 1 and 2 was calculated. Results: The exponential decay slope in phase 2 during the first 2 weeks was greater in the IFN α-2b group than in the PEG-IFN α-2b group; however, from weeks 3 to 4, it was greater in the PEG-IFN α-2b group than in the IFN α-2b group. Interestingly, in the PEG-IFN α-2b group, the exponential decay slope was greater from weeks 3 to 4 after initiating combination therapy than during the weeks 1–2 (p < 0.01), despite administration of the same PEG-IFN α-2b dose (1.5 µg/kg once weekly). Conclusions: In PEG-IFN α-2b and ribavirin combination therapy, elimination of infected cells may be pronounced following an increase in serum ribavirin concentration in chronic hepatitis C patients with genotype 1b infection and a high viral load.
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