BACKGROUND/AIMS: The purpose of this study was to evaluate the effectiveness of lamivudine treatment in patients with chronic liver disease caused by chronic infection of hepatitis B virus (HBV). METHODS: Thirty-ive patients with chronic infection of HBV were included in this study who were diagnosed at Hanyang University Hospital from January 1998 to January 1999. They received 150mg of lamivudine per oral once daily for 6 months with follow-p of liver function test, serum HBV DNA and serologic markers for hepatitis B virus every two months. Lamivudine was well tolerated. Eight patients underwent liver biopsies before entering the study and follow-p biopsies were done at 5 patients. RESULTS: Out of all 35 patients, chronic hepatitis patients histologically confirmed were 8, chronic hepatitis patients clinically diagnosed were 25 and liver cirrhosis patients clinically diagnosed were 2. The mean age was 35.7 years. Male-female ratio was 2.2:1. There was no hepatitis B surface antigen (HBsAg) negative seroconversion. The HBeAg loss rate was 26.9%(7/26) and HBeAg seroconversion rate was 10.7%(3/28) at the end of follow-p. Ten patients were anti-Be positive prior to treatment, 3 of them became anti-Be negative at the end of follow-p. Five patients underwent follow-p liver biopsies, in which histologic improvements were shown in 4 cases. Serum replicative HBV DNA by bDNA assay was decreased in all patients and HBV DNA was undetectable in 52.9%(9/17) at the end of treatment. Out of the 15 patients with abnormal alanine aminotransferase (ALT) levels at baseline, ALT level in 7 patients(46.7%) was normalized at treatment completion. Pretherapy ALT level was the only predictive factor for loss of HBeAg by stepwise logistic regression analysis(odds ratio : 1.0208) (95% Confidence Interval : 1.0023 ~ 1.0396) (p value=0.0271). CONCLUSIONS: Lamivudine induced sustained suppression of HBV replication during treatment in all patients. In treating patients with lamivudine, who had chronic liver disease due to chronic infection of HBV, the improvement of liver function test and suppression of viral replication appeared early and was sustained during the 6months treatment. This, in turn, may induce histological improvement as well. Pretherapy ALT level was the only predictive determinant for HBeAg loss during lamivudine therapy, and that should be kept in mind in selecting patients for treatment.
Alanine Transaminase ; Biopsy ; Branched DNA Signal Amplification Assay ; DNA ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Lamivudine* ; Liver ; Liver Cirrhosis ; Liver Diseases ; Liver Function Tests ; Logistic Models ; Prospective Studies*

On July 23rd, 2010 a revised medical law (Article 58) was passed to change existing evaluation system of medical institutions to an accreditation system. The new healthcare accreditation system was introduced to encourage medical institutions to work voluntarily and continuously to improve patient safety and medical service quality. Changes regarding the healthcare accreditation system included the establishment of an accreditation agency, the voluntary participation of medical institutions, accreditation standards centering on the treatment process and patient safety, tracing methodology, and the announcement of comprehensive results concerning accreditation. Despite varying views on the healthcare accreditation system, including some that are critical, it is meaningful that the voluntary nature of the system acknowledges that the medical institutions must be active agents in improving medical service quality. Healthcare quality is not improved instantaneously, but instead gradually through continuous communication within the clinical field. For this accreditation system to be successful, followings are essential: the accreditation agency becomes financially independent and is managed efficiently, the autonomy and regulation surrounding the system are balanced, the professionalism of the system is ensured, and the medical field plays an active role in the operation of the system.
Accreditation/*legislation & jurisprudence ; Delivery of Health Care/*legislation & jurisprudence ; Health Policy/legislation & jurisprudence ; Humans ; Quality Improvement ; Quality of Health Care ; Republic of Korea

Hereditary ovarian cancer accounts for about 5% to 10% of the total ovarian cancer bnurden, The discase has been observed in context with three types of hereditary ovarian cancer prone syndrome : (1) site-specific ovarian cancer, (2) hereditary breast/ivarian cancer syndrome, (3) hereditary nonpolyposis colorectal cancer(Lynch syndrome II). Each of these syndmmcs is chracterized by autosomal dominant transmission of cancer, sigrdficant early age of onset, and exeess of multiple Iprimary cancers. Auuthor expxeriencecl six families with hereditaty ovarian cancer, two families with a site-spxific. ovarian cancer and four with a breast/ovarian cancer syndrome, and report these families.
Age of Onset ; Chymopapain ; Humans ; Ovarian Neoplasms*

Hereditary ovarian cancer accounts for about 5% to 10% of the total ovarian cancer bnurden, The discase has been observed in context with three types of hereditary ovarian cancer prone syndrome : (1) site-specific ovarian cancer, (2) hereditary breast/ivarian cancer syndrome, (3) hereditary nonpolyposis colorectal cancer(Lynch syndrome II). Each of these syndmmcs is chracterized by autosomal dominant transmission of cancer, sigrdficant early age of onset, and exeess of multiple Iprimary cancers. Auuthor expxeriencecl six families with hereditaty ovarian cancer, two families with a site-spxific. ovarian cancer and four with a breast/ovarian cancer syndrome, and report these families.
Age of Onset ; Chymopapain ; Humans ; Ovarian Neoplasms*

Exercise is one of the most ubiquitous triggers of acute bouts of asthma. Late asthmatic responses(LARs) have been described following strenuous exercise, as in allergen-induced asthma. However, most studies have reported that airway responsiveness is not increased after exercise, even in subjects with LAR to exercise. This suggests that LAR after exercise may not be associated with inflammatory changes in the airways. We have frequently seen asthmatic children whose complaint is that symptoms are exacerbated at night after strenuous daytime exercise. Furthermore, airway responsiveness to allergen was reported to increase after LAR to exercise. Therefore, it is crucial to know whether exercise can induce airway inflammation, as in allergen-induced asthma. As an indirect measure to investigate it, we measured the activation status of eosinophil granulocyte in the peripheral blood during the early and late phase of exercise- or allergen-induced asthma. Eight subjects who showed early asthmatic response(EAR) and LAR(group 1), or EAR only (group 2) to allergen (Dermatophagoides pteronyssinus) challenge were selected. Similarly eight subjects who showed EAR and LAR(group 3), or EAR only (group 4) to exercise were selected. Blood samples were drawn at baseline, the early phase, the late phase, and 24 hours after each stimuli. Eosinofphil cationic protein (ECP) was measured in the serum. Eosinophil granulocytes were separated and the production of leukotriene C4 (LTC4) from purified eosinophfis was measured after stimulation with the calciumionophore. Serum levels of ECP were unchanged at EAR after allergen or exercise challenge. In the dual responder to allergen (group 1), serum ECP level was elevated at LAR and 24 hours after allergen challenge, as compared with the baseline level. On the other hand, in the dual responder to exercise (group 3), it remained unaltered up to 24 hours after exercise challenge. Eosinophils at EAR after allergen or exercise challenge in each group generated the similar amounts of LTC4 as baseline values. In group 1, the production of LTC4 was slightly increased though not significantly at LAR, and significantly increased 24 hours after allergen challenge. In group 3, it was increased significantly at LAR, but restored to the baseline values at 24 hours after exercise challenge. These results indicate that not only allergen but also exercise can activate eosinophils in accordance with LAR. The present findings suggest that LAR to exercise may also have the potential to induce airway eosinophilic inflammation although its duration may be shorter than that of LAR to allergen. Therefore exercise should be understood not only as a triggering factor of bronchoconstriction but also as one that incites or deteriorates airway inflammation.
Asthma* ; Bronchoconstriction ; Child ; Ear ; Eosinophils* ; Granulocytes ; Hand ; Humans ; Inflammation ; Leukotriene C4

We have recently experienced a case of intramedullary ependymoma in the upper thoracic spinal cord. A 46 years old man was admitted to our Department of Neurosurgery because of spastic paraplegia and disturbance of urination since 6 years ago when the disability developed rather abruptly. Myelogram showed a subtotal block of the dye column at the level of T-3 intervertebral space about where a fusiform enlargement of the cord was shadowed. Opening the duramater after total laminectomy performd through C7 to T3, a markedly swallen and enlarged spinal cord was under a great pressure. Spinal cord was paper thin and fully filled with a massive tumor inside of it. The intrameduallary tumor was mushroomed out on dorsal myelotomy. Histological study was verified to be ependymoma. The patient has not shown any improvement of neurological deficits in postoperative period.
Agaricales ; Ependymoma* ; Humans ; Laminectomy ; Middle Aged ; Neurosurgery ; Paraplegia ; Postoperative Period ; Spinal Cord* ; Urination

PURPOSE: We report two cases of retinal folds developing after pars plana vitrectomy in patients exhibiting rhegmatogenous retinal detachment. CASE SUMMARY: (Case 1) A healthy 52-year-old male visited our clinic complaining of blurred vision in his right eye. His visual acuity was 0.8 in that eye. Fundal examinations revealed upper retinal detachment and retinal tears at the 12 and 1 o'clock positions. He underwent pars plana vitrectomy with gas injection, and 1 week later, the retina was reattached. A retinal fold was detected at the 4 o'clock position; the fold extended for two disc diameters from the optic disc to the equator. The fold resolved spontaneously after 3 months. (Case 2) A 59-year-old male visited our clinic complaining of blurred vision in his right eye. His visual acuity was “counting fingers” in that eye. Fundal examination revealed a retinal tear at the 11 o'clock position and upper retinal detachment involving the macula. He underwent pars plana vitrectomy with gas injection. A retinal fold was detected in the temporal region of the disc running from the 7 o'clock position to the equator. Over 11 months of observation without treatment, optical coherence tomography (OCT) revealed that the retinal fold resolved. CONCLUSIONS: We report the first two Korean cases of spontaneous relief of retinal folds developing after vitrectomy, and the OCT patterns of the folds.
Humans ; Male ; Middle Aged ; Retina ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde ; Running ; Temporal Lobe ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy

BACKGROUNR/AIMS: Heterogeneity of liver cell populations within the hepatic lobules can affect xenobiotic reaction. In this study, we attempt to clarify the stereological distribution of the y-GTP positive foci in hepatic lobule initiated by diethylnitrosamine and promoted by phenobarbital. METHODS/METERIALS: To the five Sprague-Dawley rats, one day after birth, diethylnitrosamine (0.15 pmole/pn) was intraperitoneally injected and by the weaning at four weeks of life, 0.035% phenobarbital in drinking water was fed for four weeks, at which time the rats were sacrified to obtain the livers. Livers were fixed in fresh cold ethanol acetic acid. Ihe 200 cotmecutive tissue sections were stained by histochemistry for y-GIP and countastained with toluidine blue ar HkE. Employing Zeiss microprojector, y-GTP foci wae traced. And then the largest cross-sectian (size class: 65-165 pm in diameter) of 52 y-GTP foci were selected. Using microscopic grid, distances fiom center of y-GlP foci to nearest centtal vein and bile ductule was measured. As a control group, out of 52 random points determined by rareken digit table, the distances were measured by the same romr. RESULT: the diameter Aom the central points of y-GIP positive foci to the neatest bile ductules was measured as 0.234620+0.14899mm (mean+SD) and the diameter from random points to the neatest bile ductules was measured as 0.303080+0.19582mm (mean+SD). Y-GTP positive foci located within 0.3mm diameter fram bile ductules were counted as 73.1% of 52 foci, whereas that of random points were only 55.8%. Accoring to Aequency table analysis by Shapiro-Wilk W test, there was significant difference by W-value (0.812065) and p-value (0.0144866). CONCLUSION: Stereologically, y -GTP positive foci initiated by diethylnitros;unine, promoted by phaxkarbital in neonatal Spague-Dawley rats were non-rarxlanly distributed in peripcetal atea (Rappaport zone I) in hepatic lobule during hepatocarcinogenesis.
Acetic Acid ; Animals ; Bile ; Diethylnitrosamine ; Drinking Water ; Ethanol ; Liver* ; Parturition ; Phenobarbital ; Population Characteristics ; Rats* ; Rats, Sprague-Dawley* ; Tolonium Chloride ; Veins ; Weaning

PURPOSE: This study estimated the economic burden of cancer in Korea during 2000-2010 by cancer site, gender, age group, and cost component. MATERIALS AND METHODS: Data came from national health insurance claims data and information from Statistics Korea. Based on the cost of illness method, this study calculated direct, morbidity and mortality cost of cancer in the nation during 2000-2010 by cancer site, gender, and age group. RESULTS: With an average annual growth rate of 8.9%, the economic burden of cancer in Korea increased from 11,424 to 20,858 million US$ (current US dollars) during 2000-2010. Colorectal, thyroid, and breast cancers became more significant during the period, i.e., the 5th/837, the 11th/257, and the 7th/529 in 2000 to the 3rd/2,210, the 5th/1,724, and the 6th/1,659 in 2010, respectively (rank/amount in million US$ for the total population). In addition, liver and stomach cancers were prominent during the period in terms of the same measures, i.e., the 1st/2,065 and the 2nd/2,036 in 2000 to the 1st/3,114 and the 2nd/3,046 in 2010, respectively. Finally, the share of mortality cost in the total burden dropped from 71% to 51% in Korea during 2000-2010, led by colorectal, thyroid, breast, and prostate cancers during the period. These results show that the economic burden of cancer in Korea is characterized by an increasing importance of chronic components. CONCLUSION: Incorporation of distinctive epidemiological, sociocultural contexts into Korea's cancer control program, with greater emphasis on primary prevention such as sodium-controlled diet and hepatitis B vaccination, may be needed.
Aging ; Breast ; Cost of Illness ; Diet ; Hepatitis B ; Humans ; Incidence ; Korea ; Liver ; Mortality ; National Health Programs ; Primary Prevention ; Prostatic Neoplasms ; Stomach Neoplasms ; Thyroid Gland ; Vaccination

BACKGROUND: Jehovah's Witnesses are well known for their refusal of blood transfusions which, challenges the safety of performing cardiac surgeries. Their stand regarding blood transfusions has garnered criticism from some medical and legal sources, but has also added incentive for the development of many bloodless surgery techniques. To assess the impact on the continuing progress of blood saving protocols and increasing operative risk; herein our results in this specific population are reported. METHODS: The medical records of Jehovah's Witnesses, who underwent cardiac surgeries without blood transfusions, between Feb 1996 and Sep 2005, were retrospectively reviewed. RESULTS: 103 surgical procedures were performed on 102 patients. The age of patients varied from 2 months to 78 years, with a sex ratio of 60:42 (Male:Female). Cardiopulmonary bypass (CPB) was used in 81 cases. The mean hemoglobin (Hb) and hematocrit (Hct) levels were 13.2 g/dl (8.1-17.3), and 39.2% (24.3-52.5) before surgery, and 11.8 g/dl (8.0-16.5), and 35.3% (24-49) after surgery, respectively. Recombinant human erythropoietin (rHuEPO) and iron were used in 95 and 69 cases before and after surgery, respectively. High dose aprotinin (2 million KIU IV loading dose, 2 million KIU into the pump prime volume and 500,000 KIU per hour of surgery as a continuous intravenous infusion) was used in 67 cases. Acute normovolemic hemodilutions were performed in 7 cases. Cell saver was used in all procedures. Re-operations were needed in two cases due to wound infections and one patient died-of arrhythmias on the 2nd post-operative day. CONCLUSIONS: Bloodless cardiac surgery can be performed on Jehovah's Witnesses, but effective care of such patients requires close collaborative team efforts and advance planning to ensure favorable outcomes. At our hospital, preoperative iron and rHuEPO, as well as high dose aprotinin and cell saver are routinely used where indicated.
Aprotinin ; Arrhythmias, Cardiac ; Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Cardiopulmonary Bypass ; Disulfiram ; Erythropoietin ; Hematocrit ; Hemodilution ; Humans ; Iron ; Jehovah's Witnesses ; Medical Records ; Motivation ; Retrospective Studies ; Sex Ratio ; Thoracic Surgery ; Wound Infection