The authors assessed the efficacy and antiviral resistance of 48-week clevudine therapy versus lamivudine in treatment of naive patients with HBeAg positive chronic hepatitis B. In this retrospective study, a total of 116 HBeAg positive patients, who received 30 mg of clevudine once daily (n=53) or 100 mg of lamivudine once daily (n=63) for 48 weeks, were included. At week 48, clevudine therapy produced a significantly greater mean reductions in serum HBV DNA levels from baseline than lamivudine therapy (-5.2 vs. -4.2 log(10)IU/mL; P=0.005). Furthermore, a significantly higher proportion of patients on clevudine achieved negative serum HBV DNA by PCR (<13 IU/mL) at week 48 (60.4% vs. 38.1%; P=0.025). The incidence of virologic breakthrough in the clevudine group was significantly lower than in the lamivudine group (9.4% vs. 25.4%; P=0.031). However, rates of alanine aminotransferase normalization and HBeAg loss or seroconversion were similar in the two groups (83.0% vs. 81.0%, 11.3% vs. 11.1%; P=0.813, 1.000, respectively). In conclusion, clevudine is more potent for viral suppression and lower for antiviral resistance at week 48 than lamivudine in treatment of naive patients with HBeAg positive chronic hepatitis B.
Adult ; Antiviral Agents/administration & dosage ; Arabinofuranosyluracil/administration & dosage/*analogs & derivatives ; Drug Resistance, Viral ; Female ; Hepatitis B e Antigens/*blood ; Hepatitis B, Chronic/diagnosis/*drug therapy/*immunology ; Humans ; Lamivudine/*administration & dosage ; Male ; Treatment Outcome

Extrahepatic metastasis of hepatocellular carcinoma (HCC) is occasionally seen in the lung, bone, adrenal gland, and lymph nodes. It is well known that HCC sometimes invades the biliary system. Since there is no peritoneum between the gallbladder and the liver fossa, a gallbladder cancer easily invades the liver; however, HCC seldom invades the gallbladder because it rarely destroys the muscle layer or the collagen fibers of the gallbladder wall. Routes of gallbladder metastasis of HCC include direct invasion, extension to the biliary system, and invasion of the adjacent hepatic vascular system. Some cases of gallbladder metastasis of HCC without direct invasion have been reported. We report here a case of HCC that directly invaded the gallbladder, and that resembled gallbladder carcinoma invading the liver.
Adult ; Carcinoma, Hepatocellular/*diagnosis/pathology/ultrasonography ; Diagnosis, Differential ; Gallbladder Neoplasms/diagnosis/*secondary ; Humans ; Liver Neoplasms/*diagnosis/pathology/ultrasonography ; Male ; Neoplasm Invasiveness ; Tomography, X-Ray Computed

BACKGROUND: Tuberculosis (TB) remains an important cause of morbidity and mortality throughout the world. The surge of TB has been accompanied by an increase in multi-drug-resistant tuberculosis (MDR-TB). In this study, we developed a denaturing HPLC (DHPLC) method for detecting rpoB gene mutation as a rifampin resistance based on sequence. METHODS: In this study, we used 99 mycobacterial isolates grown in Ogawa media. At first, we used a PCR method that can amplify the 235 bp and 136 bp rpoB DNAs of Mycobacterium tuberculosis complex (MTB) and Non-tuberculous mycobacteria (NTM). And then, PCR-restriction fragment length polymorphism (RFLP) of rpoB DNA (342 bp), which comprises the Rif(T) region, was used for the differential identification of Mycobacteria. Finally, we detected these amplicons by DHPLC, compared to PCR-RFLP results, and performed sequencing. RESULTS: Among 99 mycobacterial isolates, 80 (81%) were MTB and 19 (19%) were NTM. NTM were identified to 7 different species by DHPLC and PCR-RFLP. rpoB mutation was detected in 9 (11%) of the MTB specimens. These results were confirmed by using sequencing. CONCLUSIONS: DHPLC provided a rapid, simple, and automatable performance for detection of rifampin resistant Mycobacterium tuberculosis complex and would be helpful as a supplemental method in high-throughput clinical laboratories.
Antibiotics, Antitubercular/*pharmacology ; Bacterial Typing Techniques ; Chromatography, High Pressure Liquid/*methods ; DNA, Bacterial ; Drug Resistance, Bacterial/genetics ; Humans ; Mutation ; Mycobacterium tuberculosis/*drug effects/genetics/*isolation & purification ; Rifampin/*pharmacology ; Tuberculosis/*microbiology

BACKGROUND/AIMS: Active bleeding and non-bleeding visible vessels in patients with bleeding peptic ulcer are associated with a high risk of rebleeding. The aim of our study was to define the risk factors associated with failure of endoscopic hemostasis and rebleeding in patients with active peptic ulcer bleeding. METHODS: We retrospectively reviewed 119 patients (90 men and 29 women; mean age, 60.14+/-14.67 years) with active peptic ulcer bleeding (spurting, oozing and/or non-bleeding visible vessel) and who were treated in Wonkwang Medical Center from January 2002 to January 2007. They were classified to endoscopic hemoclipping alone group (n=75) or endoscopic hemoclipping combined with epinephrine injection group (n=44), according to the therapeutic modality. RESULTS: Initial hemostasis was achieved in the two groups (100%), and permanent hemostasis was achieved 71.4% in all the patients. Operation was done in eight patients (6.7%), and six patients (5%) in the two groups, respectively, died within 1 month after initial hemostasis because of bleeding related complications. Recurrent bleeding, the duration of the hospital stay, blood transfusion requirements, complications and the operation and mortality rates were not statistically different between the hemoclip alone and combination groups. Univariate analysis showed that rebleeding was related to the presence of shock on admission (p=0.01), complication (p=0.00), the pulse rate (<100/min) on admission (p=0.04), single ulcer (p=0.032), the level of hemoglobin (<8 g/dL) (p=0.02) and the volume of transfusion (<3 units) after the procedure (p=0.005) in all the patients. On the multivariate analysis that was adjusted for age and gender, the hemoglobin level (<8 g/dL) (odds ratio = 10.5) was the only significant predictor for early rebleeding. CONCLUSIONS: This result may suggest that the combination method does not provide a substantial advantage over hemoclipping alone for the hemostatic management of active peptic ulcers bleeding. A low hemoglobin level on admission may be useful to predict rebleeding after initial endoscopic hemostasis in patients with active peptic ulcer. However, this study was designed retrospectively, so the comparison between these two groups should be re-evaluated prospectively in a large, multicenter trial.
Blood Transfusion ; Epinephrine ; Heart Rate ; Hemoglobins ; Hemorrhage ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Imidazoles ; Length of Stay ; Male ; Multivariate Analysis ; Nitro Compounds ; Peptic Ulcer ; Retrospective Studies ; Risk Factors ; Shock ; Ulcer

The purpose of this study is to evaluate the superficial bony healing after guided bony regeneration using a various bone grafts. Four types of bone grafts were performed by one oral and maxillofacial surgeon to restore the defects around endosseous implants. Group 1 included the allografts using Regenaform(R). Group 2 included the autograft. Group 3 included the combined grafts using with autogenous symphysis bone and xenograft(BioOss(R)). Group 4 included the xenograft(BioOss(R)). After some heling period, superficial bone biopsy was performed with the surgical blade(#15) during the second surgery. Histologic and histomorphmetric examination were carried out by one pathologist. There was the most new bone formation in the group 3, next group 2. However, there were no statistically significant differences. All group except for group 4 showed favorable bone formation and remodeling.
Allografts ; Autografts ; Biopsy ; Bone Regeneration* ; Heterografts ; Osteogenesis ; Regeneration ; Transplants*

We performed sinus bone graft using some amount of autogenous bone and BioOss(R) and covered the sinus window with Ossix(R) membrane in these case series. After 4 to 6 months after operation, histopathologic examinations of trephine core biopsy showed following results. 1. There were bone density of 39.2 percent to 41.2 percent four months after operation, and we could observe the favorable early new bone formation. 2. Active bony remodeling of woven and lamellar bone was observed during 4 to 6 months healing period. 3. There were no significant differences between two groups. And also there were no significant differences between 4 months and 6 months.
Biopsy ; Bone Density ; Membranes ; Osteogenesis ; Transplants*

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is heterogenous in terms of its glucose metabolism. Positron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) shows various levels of FDG uptake for patients with HCC. This study was designed to assess the usefulness of FDG-PET for predicting the outcome of the patients with HCC. METHODS: FDG-PET was performed for 27 patients with HCC. The standardized uptake value (SUV) and SUV ratio (defined as the tumor-to-nontumor ratio of SUV) was calculated for each patient. The clinical factors of the outcome were analyzed by regression analysis using Cox's multivariate proportional hazard model. The survival rate was calculated by the Kaplan-Meier method. RESULTS: Among the analyzed clinical factors including tumor size, number of tumors, AFP, involvement of major vessels, presence of systemic metastases, Child-Pugh class the SUV and SUV ratio, only the SUV was the only significant independent prognostic factor (p=0.001). On the basis of the SUV, the patients were divided into two groups of roughly equal size: group A, SUV of <7; group B, SUV >or=7. The cumulative survival rate was significantly lower for group B than for group A, and the median survival time was significantly different (4 months vs 15 months, respectively) (p=0.003). CONCLUSIONS: These results suggest that FDG-PET is useful to predict the outcome for patients with hepatocellular carcinoma.
Adult ; Aged ; Carcinoma, Hepatocellular/mortality/*radionuclide imaging ; English Abstract ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Liver Neoplasms/mortality/*radionuclide imaging ; Male ; Middle Aged ; *Positron-Emission Tomography ; Prognosis ; Radiopharmaceuticals/*diagnostic use ; Survival Rate

BACKGROUND: It is well known that plasma paraquat concentration is one of the most important prognostic indicators for paraquat poisoning. Quantitative analyses of paraquat, however, are not generally used in clinical laboratories. In this work, we evaluated the second-derivative spectroscop-ic method for quantitation of paraquat in plasma and urine, and investigated the clinical significance in patients with paraquat poisoning. METHODS: Linearity, precision, interferences, and comparison with high-performance liquid chro-matography (HPLC) were evaluated in 20 paraquat-poisoning cases using the UV-160 A recording spectrophotometer. The relationship of plasma and urine paraquat concentrations with the clinical outcomes was also studied. RESULTS: The within-run and between-day coefficients of variation (CV) for groups of low and high levels were less than 5%. The derivative amplitude was linearly related to paraquat concentra-tion through the range from 0.5 to 10 ng/mL. The correlation coefficient (r) between spectrophotom-etry and HPLC was 0.992. The accuracy for predicting the outcome for patients based on plasma paraquat concentration was 84.6%. The urine paraquat levels on admission were more than 10 ng/ mL in all of the 9 non-survivors group and in 5 out of 11 of the survivors group. The eliminating rates for plasma and urine paraquat concentrations by extracorporeal procedures were not statistically different between the two groups. CONCLUSIONS: Second-derivative spectroscopic methods for quantitation of paraquat showed an acceptable performance and suitable procedure for clinical laboratory use and it was thought to be seful in assessing the severity and in predicting the prognosis for paraquat poisoning.
Chromatography, High Pressure Liquid ; Humans ; Paraquat* ; Plasma* ; Poisoning ; Prognosis ; Spectrophotometry ; Survivors

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is a drug-resistant tumor. The expression of a multidrug resistant gene, P-glycoprotein (P-gp) is a major mechanism of drug resistance. The aims of our study were, firstly, to observe the expression rate of P-gp in HCC tissue obtained by percutaneous fine needle aspiration (PCNA) from stage IV HCC patients; secondly to examine the association between P-gp and chemotherapeutic response; and finally to investigate the correlation between p53 protein expression and P-gp expression. Subjects and METHODS: We studied 29 cases of stage IV HCC treated by systemic chemotherapy. Expression of P-gp and p53 were evaluated by immunohistochemical staining of HCC tissue with human monoclonal antibody, JSB-1 (Anti P-gp) and DO-7 (Anti p53), respectively. We analyzed the results of immunohistochemical staining of HCC tissues of the patients in relation to chemotherapeutic response and other clinical characteristics. RESULTS: The expression rate of P-gp was 27.6%. Partial response to anti-cancer chemotherapy was observed in 16.7% of the patients. Although we could not see a statistically significant association between P-gp expression and chemotherapeutic response, none of the responsive patients showed P-gp expression. p53 protein expression was found in 45% of the patients. There was no significant correlation between p53 protein expression and P-gp expression. CONCLUSIONS: Although the number of our study subjects was small, chemotherapy- responsive patients didn't show P-gp expression. P-gp expression might be used as a predictor of response to potentially toxic anti-cancer chemotherapy in HCC patients. Further study is warranted to confirm our results.
Biopsy, Fine-Needle ; Carcinoma, Hepatocellular* ; Drug Resistance ; Drug Therapy* ; Humans ; P-Glycoprotein*

BACKGROUNDS/AIMS: The fine-needle aspiration (FNA) is a useful method for diagnosis of hepatocellular carcinoma (HCC). The aims of our study are to assess diagnostic accuracy of FNA, to define proper indications of FNA for diagnosis of HCC, and to evaluate the complications of FNA. SUBJECTS AND METHODS: To assess diagnostic accuracy we compared the results of preoperative FNA with postoperative pathology in 38 resected cases with primary liver cancer. To define proper indications and complications of FNA, we prospectively followed 138 patients received FNA for their liver tumors which were suspicious of primary liver tumor. RESULTS: The sensitivity, specificity, positive and negative predictive values of FNA were 100%, 97%, 100% and 66% respectively. All patients with serum alpha-fetoprotein (AFP) level over 1000 ng/ml were having HCC on FNA result. Among 36 patients with AFP level ranged 15-1000 ng/ml and hypervascular mass on angiography, 96% were having HCC. Among 50 patients with normal AFP level and hypervascular mass on angiography, 92% were having HCC. The major complications after FNA such as hemoperitoneum, pneumothorax, and iatrogenic arterioportal shunt developed in 2%, 2%, and 7% of subjects, respectively. We did not find any case of needle-tract seeding of cancer during a mean 4.7 months of follow-up. CONCLUSIONS: Although the FNA is an accurate method for diagnosis of HCC, FNA was usually not indicated for patients with serum AFP level over 1000 ng/ml or patients with hypervascular mass on angiography when they were suspected of having primary liver cancer. Major complications were hemoperitoneum, pneumothorax and iatrogenic arterioportal shunt. Iatrogenic arterioportal shunt may influence the efficacy of subsequent transcatheter arterial embolization.
alpha-Fetoproteins ; Angiography ; Biopsy, Fine-Needle* ; Carcinoma, Hepatocellular* ; Diagnosis* ; Follow-Up Studies ; Hemoperitoneum ; Humans ; Liver ; Liver Neoplasms ; Pathology ; Pneumothorax ; Prospective Studies ; Sensitivity and Specificity