Purpose: Although protein-induced vitamin K absence or antagonist II (PIVKA-II) has been used as a diagnostic tool for hepatocellular carcinoma (HCC), its prognostic value remains unclear. Methods: This was a nationwide multicenter study using the database of the Korean Liver Cancer Association. Patients with hepatitis B-related HCC who underwent liver resection as the first treatment after initial diagnosis (2008–2014) were selected randomly. Propensity score matching (1:1) was performed for comparative analysis between those with low and high preoperative PIVKA-II. Univariable and multivariable Cox proportional-hazards regression were used to identify prognostic factors for HCC-specific survival. Results: Among 6,770 patients, 956 patients were included in this study. After propensity score matching, the 2 groups (n = 245, each) were well balanced. The HCC-specific 5-year survival rate was 80.9% in the low PIVKA-II group and 78.7% in the high PIVKA-II group (P = 0.605). In univariable analysis, high PIVKA-II (>106.0 mAU/mL) was not a significant predictor for worse HCC-specific survival (hazard ratio [HR], 1.183; 95% confidence interval [CI], 0.76–1.85; P = 0.461). In multivariable analysis, hyponatremia of <135 mEq/L (HR, 4.855; 95% CI, 1.67–14.12; P = 0.004), preoperative ascites (HR, 4.072; 95% CI, 1.59–10.43; P = 0.003), microvascular invasion (HR, 3.112; 95% CI, 1.69–5.74; P < 0.001), and largest tumor size of ≥5.0 cm (HR, 2.665; 95% CI, 1.65–4.31; P < 0.001), but not preoperative high PIVKA-II, were independent predictors for worse HCCspecific survival. Conclusion Preoperative PIVKA-II is not an independent prognostic factor for HCC-specific survival after liver resection for hepatitis B-related HCC.

Placental chorioangioma is a benign non-trophoblastic tumor of the placenta that can have various adverse effects on the mother and fetus depending on its size. Chorioamniotic membrane separation is rare condition of detachment between the amniotic membrane and chorionic membrane. Chorioamniotic membrane separation after the second trimester of pregnancy is usually occurs after invasive procedures or may occur spontaneously; it is mostly associated with fetal abnormalities. Here, we report a case of chorioamniotic membrane separation that might be occurred caused by the seromucinous secretion from a placental chorioangioma.
Amnion ; Chorion ; Female ; Fetus ; Hemangioma* ; Humans ; Membranes* ; Mothers ; Placenta ; Pregnancy ; Pregnancy Trimester, Second

Intrahepatic bile duct adenoma is a rare benign epithelial hepatic tumor derived from bile duct cells. We report the imaging findings of a patient with bile duct adenoma, which appeared as a small heterogeneously enhancing mass with focal small cystic change on CT and MRI. Follow-up images at seven months showed a slight increase in tumor size, which could be partly explained by intratumoral hemorrhage on pathologic examination. Although rare, bile duct adenoma should be considered as a differential diagnosis of a small hypervascular tumor located in the periphery of liver. Focal cystic change and intratumoral hemorrhage may occur.
Adenoma, Bile Duct/*diagnosis/surgery ; Bile Duct Neoplasms/*diagnosis/surgery ; Contrast Media/diagnostic use ; Female ; Hamartoma/*diagnosis/surgery ; Hepatectomy ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Tomography, X-Ray Computed

Adult intussusception is a rare disease and it differs from childhood intussusception in its presentation, cause and treatment. Most of the cases have an underlying lesion within the intussusception that requires surgical resection. Making the diagnosis can be delayed because of the nonspecific and chronic symptoms, and many cases are diagnosed during performance of emergency laparotomy for treating the obstructive symptoms. A computed tomography (CT) scan is most useful for making the diagnosis of adult intussusception and is helpful in revealing the underlying lesion, although a barium enema can help to diagnose colonic intussusceptions. Surgical resection remains the recommended treatment for nearly all cases, but there is controversy about whether or not the intussusception should be initially reduced before resection. Gastrointestinal lipomas are rare benign tumors that can occur anywhere along the gut, and the small bowel is the second most common site for gastrointestinal lipomas after the colon. Intussusception of the ileum by a lipoma is very rare. We report here on a case of ileo-ileal intussusception that was caused by a lipoma of the ileum in a 35-year-old man who complained of abdominal pain of one week duration. The diagnosis of an ileo-ileal intussusception caused by a lipoma of the ileum was suspected preoperatively according to the typical CT findings, so we tried to initially reduce the intussusception during laparotomy. But manual reduction was impossible due to the edema of the lesion, and an ileum of some length had to be resected.
Abdominal Pain ; Adult ; Barium ; Colon ; Edema ; Emergencies ; Enema ; Humans ; Ileum ; Intussusception ; Laparotomy ; Lipoma ; Rare Diseases

PURPOSE: Prompt operative management of patients with peripheral artery embolism remains the treatment of choice for this malady. The clinical status of the limb, rather than the elapsed time from the onset of occlusion, was recently determined to be the best predictor of limb salvage. We investigated the clinical features, therapeutic modalities and treatment results of popliteal artery embolism compared with that of ilio-femoral artery embolism. METHODS: A retrospective review was carried out for 21 cases that were treated for lower extremity arterial embolism, from March 2000 to June 2006. The patients were classified into two groups; Group A (ilio-femoral artery embolism, n=11) and Group B (popliteal artery embolism, n=10). We analyzed the interval time from the onset of symptoms to starting treatment (the interval time), the degree of limb ischemia, the therapeutic modalities and the treatment results. RESULTS: The average interval time was 16.2+/-16.9 hours in the total 21 cases; the average interval time for Group A was 7.7+/-2.9 hours and that for Group B was 25.5+/-20.9 hours (P<0.05), and the incidence of severe limb ischemia (class IIb according to the SVS/ISCVS reporting standard) was 72.7% vs 20.0%, respectively (P<0.05). For the therapeutic modalities, surgical thromboembolectomy was performed in all cases of Group A and for 3 cases of Group B. Seven cases of Group B received radiologic intervention (3 cases percutaneous aspiration embolectomy only, and 4 cases of additional thrombolytic therapy). CONCLUSION: This study shows that the interval time for popliteal artery embolism is longer than that for ilio-femoral artery embolism. In other words, it is suggested that the symptomatic progression of popliteal artery embolism is slower than that of ilio-femoral artery embolism. Therefore, we can have more chances for variable therapeutic options such as surgical thromboembolectomy, percutaneous aspiration embolectomy and/or thrombolytic therapy in patients suffering with popliteal artery embolism.
Arteries ; Embolectomy ; Embolism ; Extremities ; Humans ; Incidence ; Ischemia ; Limb Salvage ; Lower Extremity ; Popliteal Artery ; Retrospective Studies ; Stress, Psychological ; Thrombolytic Therapy

BACKGROUND: Pitted keratolysis is a superficial bacterial infection which usually affects the pressure bearing areas of the feet. Some bacterial organisms were identified as etiologic agents, including Corynebacterium species, Micrococcus species and Dermatophilus congolensis. However, in Korea, studies to prove the causative organisms have not been performed. OBJECTIVE: We performed this study to identify causative organisms of pitted keratolysis in Korea. METHOD: Twelve normal healthy men and 27 pitted keratolysis patients were enrolled. We cultured the scraped specimens of the stratum corneum and identified the cultured organisms. We compared the cultured organisms of pitted keratolysis group with those of control group. We also compared the distribution of cultured organisms in pitted keratolysis with and without tinea pedis. RESULT: Micrococcus species and Corynebacterium species were identified in pitted keratolysis group much more frequently than in normal control group. In most cases of pitted keratolysis combined with tinea pedis, the identified organisms were Micrococcus species. CONCLUSION: Micrococcus species and Corynebacterium species are thought to be the major causative organisms of pitted keratolysis in Korea. Micrococcus species might play a certain antagonistic role, especially in patients of pitted keratolysis with tinea pedis.
Bacterial Infections ; Corynebacterium ; Foot ; Humans ; Korea ; Male ; Micrococcus ; Tinea Pedis

Green nail syndrome is characterized by greenish discoloration of the nail. It is caused by Pseudomas aeruginosa which is an aerobic gram-negative rod found in moist environment. The most common predisposing factors are frequent exposure to water and trauma history. Herein, we report two cases of green nail syndrome who developed greenish discoloration of finger nails, which were treated by systemic levofloxacin and gentian violet application.
Causality ; Fingers ; Gentian Violet ; Levofloxacin ; Pseudomonas aeruginosa ; Water

STUDY DESIGN AND OBJECTIVE: Tumor necrosis factor-alpha(TNF-alpha), a key inflammatory mediator, has been demonstrated in spinal cord injury (SCI). However, the expression of TNF receptors following SCI remains to be identified. To elucidate the expressions of TNF receptor I (TNFRI), TNFRII, XIAP, and their function in SCI, in situ hybridization and RT-PCR were performed in a SCI model. MATERIAL AND METHODS: Sprague-Dawley rats were anesthetized with halothane and laminectomized at the level of the eleventh and twelfth thoracic vertebra. Using a modified New York University Impactor, SCI was induced by dropping a 10 gm weight from a height of 20 mm. The rod of the impactor had a constant circular surface, 3 mm in diameter. After induction of the injury, rats were placed in a temperature and humidity-controlled chamber overnight. RESULTS: The TNFRI gene was not detected in the control rats, but the TNFRII gene was expressed in the neurons in the control rats. The TNFRI gene expression was maximally increased in the spinal cord 1 day after the SCI; however, that of the TNFRII gene occurred 3 days after the SCI. In the white matter, both the TNFRI and TNFRII genes were increased in the oligodendrocytes 3 days after the SCI. The XIAP gene was increased in neurons of the gray matter 1 and 3 days after the SCI, but was not detected in the white matter after the SCI. CONCLUSION: Up-regulation of the expression of TNFRII occurs later than that of TNFRI in the spinal cord after a SCI. TNFR may be related to neuronal survival considering its similar expression pattern to that of XIAP. The results from these studies may lead to alternative therapeutic targets of TNF receptors in spinal cord injury, providing the basis for developing agonist and antagonist systems for TNF receptor subtypes and also for encouraging better strategies for the treatment of spinal cord disorders related to trauma.
Animals ; Apoptosis* ; Gene Expression ; Halothane ; In Situ Hybridization ; Necrosis ; Neurons ; Oligodendroglia ; Rats* ; Rats, Sprague-Dawley ; Receptors, Tumor Necrosis Factor* ; Spinal Cord Diseases ; Spinal Cord Injuries* ; Spinal Cord* ; Spine ; Tumor Necrosis Factor-alpha* ; Up-Regulation

PURPOSE: The prognosis of patients with advanced non-small-cell lung cancer (NSCLC) is extremely poor. Many prospective randomized trials on patients with advanced NSCLC suggested systemic chemotherapy improves both the survival and quality of life. A phase II trial was conducted to evaluate the efficacy and safety profile of the combination chemotherapy of gemcitabine and cisplatin in advanced NSCLC. MATERIALS AND METHODS: Forty-four patients with locally advanced or metastatic NSCLC were enrolled. The patients received a cisplatin, 75 mg/m(2), infusion over 30 minutes on days 1, followed by a gemcitabine, 1, 250 mg/m(2), infusion over 30 minutes on days 1 and 8 every 3 weeks. RESULTS: The median age of the patients was 64 years (range: 27~75). Forty-one patients were assessable for response and toxicity analyses. The overall response rate was 53.6%, but with no complete remissions. The median time to progression was 5.6 months (range: 1~15.4). The median survival was 14.2 months (95% confidence interval (CI), 13.8~22.5). A total of 179 cycles were administered, with a median of 4 cycles of chemotherapy, ranging from 2 to 9 cycles. The most common hematological toxicities were NCI grades 3/4 neutropenia (24%) and thrombocytopenia (7.8%). The most common non-hematological toxicity was fatigue (42.4%). There were no life-threatening toxicity or treatment related mortalities. The median duration of follow up was 9.4 months, ranging from 1.6 to 30.3 months. CONCLUSION: In this trial, the combination of gemcitabine and cisplatin showed significant activity, with acceptable and manageable toxicities as a first-line regimen for patients with advanced NSCLC.
Cisplatin* ; Drug Therapy ; Drug Therapy, Combination ; Fatigue ; Follow-Up Studies ; Humans ; Lung Neoplasms* ; Lung* ; Mortality ; Neutropenia ; Prognosis ; Prospective Studies ; Quality of Life ; Thrombocytopenia

BACKGROUND: Previous data have been reported that subtype B is prevalent in South Korea, but neither the extent nor the proportion of subtypes could be evaluated. This study was designed to analyze the distribution of HIV-1 subtypes, temporal instructions and transmission dynamics between epidemiological groups. METHODS: 1,280 Koreans had been diagnosed as HIV seropositive during the period 1985 to 2000. Among them, 134 individuals were selected for this molecular epidemiological study. 134 DNAs were isolated from uncultured or cultured peripheral blood mononuclear cells. V3-V5 (0.7 kb) fragment of HIV-1 env gene was amplified by nested polymerase chain reaction and was sequenced. RESULTS: HIV-1 isolates from thirty-seven homosexuals were all subtype B (100%). On the other hand, 66 isolates from 94 heterosexuals were subtype B (70%) and 28 were non B subtypes (30%:13 A, 4 C, 2 D, 8 E, 1 G). Only subtype B strains were isolated from 73 males who were infected with HIV inside Korea while 16 B and 20 non B subtype strains were isolated from 36 males who were HIV infected outside of Korea. However, B and non B strains were isolated half and half from females who were infected inside Korea except one. CONCLUSION: The HIV-1 subtype B strains are prevalent in Korea from the early HIV infection until present in both homo and heterosexuals. Non B strains have been transmitted from men who were infected outside Korea to their spouses and casual partners. So, we need further study to monitor subtype B and non B HIV transmission in epidemiological groups of Korea.
DNA ; Female ; Genes, env ; Hand ; Heterosexuality ; HIV ; HIV Infections ; HIV-1* ; Hominidae ; Homosexuality ; Humans ; Korea* ; Male ; Molecular Epidemiology ; Polymerase Chain Reaction ; Spouses