Background/AimsThis study investigated the antiviral effects of tenofovir disoproxil fumarate (TDF) monotherapy in nucleos(t)ide analogue (NA)-naive and NA-experienced chronic hepatitis B (CHB) patients.MethodsCHB patients treated with TDF monotherapy (300 mg/day) for ≥12 weeks between December 2012 and July 2014 at a single center were retrospectively enrolled. Clinical, biochemical, and virological parameters were assessed every 12 weeks.ResultsIn total, 136 patients (median age 49 years, 96 males, 94 HBeAg positive, and 51 with liver cirrhosis) were included. Sixty-two patients were nucleos(t)ide (NA)-naïve, and 74 patients had prior NA therapy (NA-exp group), and 31 patients in the NA-exp group had lamivudine (LAM)-resistance (LAM-R group). The baseline serum hepatitis B virus (HBV) DNA level was 4.9±2.3 log IU/mL (mean±SD), and was higher in the NA-naïve group than in the NA-exp and LAM-R groups (5.9±2.0 log IU/mL vs 3.9±2.0 log IU/mL vs 4.2±1.7 log IU/mL, P<0.01). The complete virological response (CVR) rate at week 48 in the NA-naïve group (71.4%) did not differ significantly from those in the NA-exp (71.3%) and LAM-R (66.1%) groups. In multivariate analysis, baseline serum HBV DNA was the only predictive factor for a CVR at week 48 (hazard ratio, 0.809; 95% confidence interval, 0.729-0.898), while the CVR rate did not differ with the NA experience.ConclusionsTDF monotherapy was effective for CHB treatment irrespective of prior NA treatment or LAM resistance. Baseline serum HBV DNA was the independent predictive factor for a CVR.

Background/AimsMany prognostic models have been developed to help physicians make medical decisions on treating patients with pulmonary embolism. Among these models, the Pulmonary Embolism Severity Index (PESI) has been shown to be a successful risk stratification tool for patients with acute pulmonary embolism. The PESI, however, had not been applied to patients with pulmonary embolism in Korea.MethodsThe patients included in this study were diagnosed by computed tomography at Inje University's Ilsan Paik Hospital between December 1999 and March 2007. Risk stratification for the patients was performed using the PESI. The mortality rate was calculated according to each PESI risk class.ResultsOf the 90 patients enrolled in this study, ten were assigned to PESI class I, 29 to PESI class II, 22 to PESI class III, eight to PESI class IV, and ten to PESI class V. The mortality rate after 30 days in each class was 0, 10.3, 9.1, 0, and 50% (p=0.0016), respectively, whereas the respective hospital mortality rate was 4.8, 13.8, 13.6, 12.5, and 50% (p=0.0065). The overall mortality was 9.5, 27.6, 31.8, 50.0, and 60%, respectively (p=0.0019). The mortality rate was significantly associated with the PESI class.ConclusionsThe PESI class was found to be significantly correlated with the 30-day mortality rate, hospital mortality, and overall mortality. Our data indicate that the PESI can be used to predict the prognosis of patients with pulmonary embolism and in making medical decisions regarding the treatment of patients with pulmonary embolism.

ADRs were significantly lower when colonoscopy was performed by trainees, although withdrawal times were longer than those of staff. Our results demonstrated that the quality of colonoscopy, as measured by ADRs, may be improved by experienced examiners.

Infliximab, the monoclonal antibody to tumor necrosis factor, is indicated for refractory luminal and fistulizing Crohn's disease and rheumatoid arthritis. Infliximab treatment has adverse events including infusion reactions, opportunistic infections, and the potential for the event such as reactivation of latent tuberculosis. Cutaneous adverse reactions of TNF-α agents include skin rash, urticaria, pruritus, lupus-like eruption, and injection site reactions. Most of all, psoriasis or psoriasiform dermatitis induced by infliximab treatment for Crohn's disease is rarely reported in Korea. We report a case of psoriasis induced by infliximab treatment for Crohn's disease with a review of world literature.

Hafnia alvei is a gram-negative bacillus that is rarely isolated from human clinical specimens and is rarely pathogenic. This organism is an extremely uncommon cause of spontaneous bacterial peritonitis (SBP). We report a case of an 83-year-old male with hepatitis C-associated liver cirrhosis and hepatocellular carcinoma who was diagnosed with SBP caused by H. alvei. He was admitted to an university-affiliated hospital with fever and abdominal pain. There were 2 episodes of SBP during 2 months. Although isolates of H. alvei from ascitic fluid were shown to be susceptible to cefotaxime, responses for cefotaxime treatment were inadequate in both episodes. Therefore, cefotaxime was switched to imipenem in the first episode and to ciprofloxacin in the second, according to the results of antimicrobial susceptibility.After the antibiotics was changed, SBP was resolved.

Propofol (2,6-diisopropylphenol) is a rapid and short-acting anesthetic agent that is used for general anesthesia and endoscopic sedation. It is available as an aqueous lipid emulsion and this preparation could serve as a bacterial culture medium.We report a case of a 46-year-old female who developed septic shock caused by Escherichia coli after being sedated by propofol to undergo gastrointestinal endoscopy. The contaminated propofol was identified as the cause of septic shock by pulsed-gel electrophoresis. 구 수치도 6,590/mm 3 으로 감소하였다. 혈액과 약물 배양 검사에서 분 리된 E. coli 의 연관성을 조사하기 위하여 2개의 E. coli 균주의 배양 액에서 chromonosomal DNA를 추출하여 제한효소 Xba1으로 절단 한 후 CHEF DR III system (Bio-Rad, hercules, CA, USA)을 이용하 여 pulsed-field gel electrophoresis (PFGE)를 시행하였다(Fig. 1). PFGE결과 2개의 E.coli 가 동일한 균주로 확인되어 오염된 propofol이 패혈성 쇼크의 원인이었음을 증명할 수 있었다. 환자는 혈압이 안정되 고 발열은 호전되어 meropenem으로 14일간 치료한 후 퇴원하였다. 고찰 Propofol은 1% propofol과 주요 부형제인 10% soy bean oil, 2.25% glycerol, 1.2% purified egg phosphatide로 구성되어 있는데, 지질 을 함유한 용매 때문에 다른 마취제보다 세균증식의 위험이 높아서 propofol 사용 후의 감염사례가 드물지 않게 보고되고 있다[3-6]. Bennett 등은 3년 간 7개 병원에서 62건의 수술 후 감염사례를 연구하 였는데, 수술 전에 propofol을 사용한 것이 수술 후 감염과 연관이 있 는 것으로 보고하였다[3]. Propofol 앰플은 오염이 되어 있지 않았으 나 propofol을 담은 주사기가 오염되어 있었고, 의사들과의 면담을 통 하여 무균 조작 수행의 문제점을 발견하였다. 이에 지질이 함유된 약물 을 사용할 때는 무균 조작이 무엇보다 중요하다고 하였다[3]. Verber 등은 프랑스에서 발생한 4건의 Klebsiella pneumoniae 패혈증을 보 고하였는데 이 경우 중에는 propofol 바이알 하나로 환자 2명에게 2일 이상의 기간에 걸쳐 투여한 것으로 나타났고, 이로써 propofol을 장기 간 사용하거나 바이알을 여러 환자에게 사용할 경우 감염 확률이 높 아진다고 보고하였다[7]. 따라서 Propofol을 사용할 때에는 약물 용기 를 무균적으로 조작해야 하고, 개봉 후 즉시 무균 주사기를 이용하여 야 한다. 일단 개봉한 약품은 6시간 이내에 사용하는 것을 권장하고 있 고(prefilled syringe의 경우에는 12시간), 하나의 앰플 및 바이알은 한 환자에게만 사용하여야 한다[8-11]. 본 증례의 경우 내시경시 사용된 propofol 바이알은 지속적인 마취 유도에서 사용되는 용량인 50 mL (500 mg)이었고, 입원 당일 수거한 약물의 남아있는 양은 약 30 mL (300 mg)이었다. 흔히 성인 수면 내시 경에서 사용되는 일반적인 용량이 10-40 mg (25-75 µ g/kg/min)이라 는 점을 고려할 때 한 환자에게 투여하였다고 보기에는 남아 있는 약물 의 양이 적어, 한 바이알의 약물을 여러 환자에게 사용되었을 가능성과 24시간 이상 개봉된 상태로 사용하였을 가능성을 배제할 수 없다[1]. 수면내시경을 시행한 1차 의료기관의 propofol 약물 취급 실태에 대 해 조사할 수는 없었으나, 사용 후 남아 있는 약물과 환자의 혈액에서