The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 277
Poster Session
PS 1134 Gastroenterology (Liver) Association of Erectile Dysfunction with Depression in Patients with Chronic Viral Hepatitis
Gun Wung Na1, Sang Goon Shim1, Kil Jong Yu1, Dae Hyeon Cho1, Chang Uk Jeong1, Ji Eun Oh1, Hyun Chin Cho1, Kwang Min Kim1, Hyoun Soo Lee1, Man Je Park1
Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Korea1
Background: In men, erectile dysfunction (ED), which is defi ned as the inability to achieve or maintain an erection suffi cient for satisfactory sexual performance, is an important issue. There were extensive investigations in clinical and pathophysiological mechanisms with sexual dysfunction during the last decade. However, ED in patients with chronic viral hepatitis has been investigated in few and limited studies, which are often not comparable because they use different survey and patient-sampling methodologies. Moreover, few have evaluated the association of ED and depression in patients with chronic viral hepatitis. Therefore, we assessed the prevalence of ED, and their association with depression in patients with chronic viral hepatitis.
Methods: This cross-sectional study was conducted from August 2013 through Jan- uary 2014. All outpatients with chronic viral hepatitis between the age of 18 and 80 years were considered eligible. The exclusion criteria included well established causes of erectile dysfunction such as liver cirrhosis and alcohol abuse. Erectile dysfunction was assessed with the International Index of Erectile Function-5 (IIEF-5) scale. The Beck Depression Inventory (BDI) scale was used to assess depression of the patient.
Results: The prevalence of erectile dysfunction among the patients with chronic viral hepatitis was 40%. Age, employment, peg-interferon, IIEF-5 scores and BDI scores were statistically associated with erectile dysfunction. And also, IIEF-5 scores corre- lated negatively with age, employment and BDI scores. In a multiple logistic regression analysis, age and depression were independently associated with erectile dysfunction.
Conclusions : Patients with chronic viral hepatitis have a high prevalence of erectile dysfunction. Age and depression are independent factors of erectile dysfunction in male patients with chronic viral hepatitis. Evaluation of depression must be included to properly manage erectile dysfunction.
PS 1135 Gastroenterology (Liver)
Thyroid Dysfunction in Patients with Cirrhosis
Won Jang1, Dong Hyun Sinn1, Sul Hee Kim1, Jung Min Kim1 Inje University Sanggye Paik Hospital, Korea1
Background: Thyroid function in patients with cirrhosis is poorly investigated area.
Some previous studies suggested that thyroid hormone levels are altered in cirrhosis, and can be a good index of hepatic dysfunction, but data are limited.
Methods: A total of 48 cirrhotic patients [age: 56.8 ± 11.3, male = 37 (77%)] who were admitted to Sanggye Paik Hospital, Inje University between May 2013 and March 2014 were included. Thyroid function test was offered in prospective manner.
Results: Underlying cause of liver cirrhosis was alcohol, hepatitis B, hepatitis C and others in 23(48%), 15(31%), 5(10%) and 5(10%) patients, respectively. Thyroid func- tion test was normal in 23% patients. In 77% of patients, thyroid dysfunction were observed, which were subclinical hypothyroidism(15%), hypothyroidism(10%), sub- clinical hyperthyroidism(2%) and sick euthyroid syndrome(50%). In advanced cirrhosis (Child-Pugh class C), all patients had thyroid dysfunction(100%), and normal thyroid function was observed in 31% and 26% of patients in Child-Pugh class A and B (p
= 0.054). Sick euthyroid syndrome was most frequent in alcoholic cirrhosis(70%), hypothyroidism was most frequent in cirrhosis from other etiology(60%), and normal thyroid function was most frequently observed in viral hepatitis related cirrhosis(40%).
Conclusions: This data, although preliminary, suggest thyroid function are frequently altered in patients with cirrhosis, especially in advanced cirrhosis. Type of thyroid dys- function may be different according to the etiology of cirrhosis. Our fi nding warrants further larger scale study.
PS 1136 Gastroenterology (Liver) Portal and Splenic Vein Occlusion as a Complication of N-butyl-2-Cyanoacrlyate Injection Therapy in Cardiac Variceal Bleeding
Yu rim Lee1, Soo young Park1, Eun jeong Kang1, Seong jae Yeo1, Myong hi Kim1 Kyungpook National University Hospital, Korea1
Introduction: For the treatment of acute hemorrhage from gastric varices, n-bu- tyl-2-cyanoacrlyate(NBCA) injection therapy is recommended. Here we report a pa- tient with portal and splenic vein occlusion after injection therapy with NBCA.
Case: A 58-year-old man with liver cirrhosis was admitted to our hospital because of melena due to cardiac variceal bleeding. NBCA injection therapy was performed and hemostasis was achieved, so he was discharged from the hospital. After 2 weeks, the patient was readmitted because of fever, abdominal distension and poor oral intake.
There was no defi nite cause of fever, but a computed tomography scan showed scle- rotherapy agent like dense material in main and left portal vein, splenic vein. It also revealed new onset ascites, esophageal and gastric varices. Administration of antibi- otics and diuretics, and recurrent paracentesis were performed for 5 months. Finally, the patients developed renal failure, so liver transplantation was recommended, but he refused to do it and discharged. He died two months later.
Discussion: NBCA injection therapy is effective and relatively safe procedure for the treatment of active gastric variceal bleeding. However, a variety of complications have been described, including pericarditis and pulmonary embolism. In our case, the treat- ment of the cardiac varices by injection of NBCA led to portal and splenic vein embo- lization. It resulted in infection, portal hypertension, following poorly controlled tense ascites, renal failure and deconditioning. Portal vein occlusion is rare, but potentially life threatening complication of NBCA injection therapy. Clinicians should be aware of possibility of portal vein occlusion in patients following NBCA injection therapy, who develop massive ascites or fever. Careful procedure by well experienced endoscopist , early recognition and prompt management is essential.
