104 年 04 月份中部地區消化系同好會

時 間:民國 104 年 04 月 02 日下午 17:00-20:00 時
地 點:裕元花園酒店 4F 西側包廂 
住 址 :台中市台中港路三段 78-3 號
主持人:何明印主任、楊聰鎰主任
會議內容:一、病例報告           二、專題演講
 
一、病例報告                         主持人:楊聰鎰主任
討論方式:病例報告每題演講時間十五分鐘,討論時間五分鐘
1.17:00~17:20
A case of Intraductal papillary neoplasm of bile duct  
溫奕志、黃仁杰、辛政憲、何士奇、李政祺、陳季宏 1 、吳明哲 2 、英恭史 3 、林瑾 4  
1:腸胃科 2:外科 3:放射科 4:病理科
     澄清醫院  肝膽胃腸科 
One 50 years old man sufferred from epigastralgia ,fever and chilliness poor intake acid regurgitation and nausea for 3 days. So he came to our GIOPD and lab data showed elevated bilirubin. Abdominal echo showed IHD dilatation(Bil.) and CBD dilatation. Abdominal CT revealed suspected one IPMN (Intraductal Papillary Mucinous Neoplasm of the Bile duct) with cystic mass. Operation was done and pathology compared with this diagnosis of IPNB.


        
2. 17:20~17:40
 
A 76 y/o male with progressive yellowish skin, poor appetite and fever
黃泰銘 何明印 楊聰鎰 陳育佐  
衛福部豐原醫院 胃腸肝膽科    
A 76 y/o male visited ER due to progressive yellowish skin with poor  appetite for few days. He had no virus hepatitis or alcoholism history. Fever was associated and he was admitted for further survey. The abdominal echo showed mild hepatomegaly , splenomegaly, s/p cholecystectomy with mild dilated IHDs but normal CBD. Persistent fever with progressive jaundice was developed although under strong antibiotic treatment. The blood culture was
negative and no etiology of sepsis origin could be found.  
 

二、專題演講                       主持人:何明印主任
17:40~18:10
慢性肝炎的中醫輔助治療
黃進明醫師 中西整合消化系醫學會理事
18:10~19:00
Individualized Treatment of Chronic Hepatitis C in the Era of DAA in Taiwan
劉俊人教授                    國立台灣大學醫學院附設醫院  
 
Pegylated interferon α (Peg-IFN) in combination with ribavirin (RBV) is still currently recommended as the standard-of-care (SOC) treatment for chronic hepatitis C virus (HCV) infection in many Asia-Pacific countries including Taiwan, because of the relatively low cost, approved efficacy and experience. Individualized and response-guided therapy based on host-, viral- and treatment-related factors further improves the rate of sustained virologic response (SVR). However, there remain several difficult-to-treat populations, either refractory to or ineligible for IFN-based therapy. For these populations, new direct acting anti-virals (DAAs)-based therapy is a hope.

The evolution of recent HCV therapeutics, with newer potent antiviral agents allowing for a variety of combination therapy with or without the use of concomitant Peg-IFN or RBV, is expected to revolutionize the care of HCV by offering simple regimens that are better tolerated and provide high rates of SVR, with shortened treatment duration. For example, a recent clinical trial showed high SVR rates (up to 83%) when daclatasvir, an NS5A replication complex inhibitor of HCV, was used with Peg-IFN plus RBV for 48 weeks in genotype 1 treatment-naïve patients [Pol et al. 2012]. A combination of daclatasvir and asuneprevir (NS3/4A inhibitor) was effective in treating HCV subtype 1b patients [Lok et al. 2012]. A combination of ABT450/r (NS3/4A inhibitor), ABT 267 (an NS5A inhibitor) and ABT-333 (an NS5B inhibitor) with RBV resulted in high rates of SVR in treatment-naïve and treatment-experienced HCV genotype 1 patients.  

Sofosbuvir (SOF) has been well studied in clinical trials, including patients with cirrhosis and those with decompensated liver disease awaiting liver transplant. SOF is a potent first-in-class nucleoside inhibitor that has recently been approved for treatment of HCV. The drug has low toxicity, a high resistance barrier, and minimal drug interactions with other HCV direct-acting antiviral agents such as protease inhibitors or anti-NS5A agents. SOF is safe and can be used across different viral genotypes, disease stages, and special patient groups, such as those coinfected with human immunodeficiency virus. When used in combination with ribavirin or another direct-acting antiviral agent, SOF has revolutionized the HCV treatment spectrum and set the stage for nearly universal HCV antiviral therapy. More so than any other anti-HCV drug developed to date, SOF offers the widest applicability for all infected patients, and new regimens in fixed combination with ledipasvir (NS5A inhibitor) will be tailored to maximize performance.

Briefly, these IFN-contained or -free regimens have been demonstrated to be very effective in the treatment of general and even special HCV-infected populations. The updates, benefits and potential application of all approved DAAs will be reviewed in my presentation.

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