BACKGROUND: De novo methylation and transcriptional silencing of p16 gene is one of the main pathways in inactivation of p16 gene in colon neoplasm. But there has been no study about that in Korea yet. The aims of this study were to determine p16 methylation status and its association with clinicopathologic parameters and stage of colon cancers and adenomas in patients of Korea. METHODS: We examined p16 methylation of sixty primary colon cancer tissues and thirty colon adenoma tissues using methylation specific PCR after bisulfite modification of the DNA samples. RESULTS: In colon cancer group, 30 patients were male and the others were female, and the average age was 59.7+/-12.5 years. Three cases were in Dukes' stage A, 24 in B, 26 in C, and 7 in D respectively. p16 gene was methylated in 20% (12 of 60) of colon cancers. There was no significant correlation between methylation status of p16 gene and clinicopathologic variables of colon cancers including patient's age, sex, tumor location, size, and differentiation. In Dukes' stage C and D, methylation was positive in 24.2% (8/33 cases) comparing 14.8% (4/27 cases) in Dukes' A and B, but there was no significant difference statistically (p=0.52). In colon adenoma group, there were 15 simple adenomas, and 15 advanced adenomas (>or=1cm, including villous component, or high grade dysplasia). The p16 gene was methylated in 16.7% (5 of 30) of colon adenomas; in 3 cases of simple adenoma and in 2 cases of advanced adenoma. There was no significant correlation between p16 methylation status and clinicopathological variables in colon adenoma. CONCLUSION: The p16 gene was methylated in 20% of colon cancers and 16.7% of colon adenomas in the present series, suggesting that the methylation of p16 tumor suppressor gene might be expressed in similar rate in colon cancer/adenoma in Korea, and play a role in colorectal tumorigenesis in its early stage.
Adenoma* ; Carcinogenesis ; Colon* ; Colonic Neoplasms* ; Colorectal Neoplasms ; DNA ; Female ; Genes, p16 ; Genes, Tumor Suppressor* ; Humans ; Korea ; Male ; Methylation* ; Polymerase Chain Reaction

BACKGROUND/AIMS: Impacted papillary stone (IPS) may lead to complete biliary obstruction and acute cholangitis. We evaluated clinical characteristics and endoscopic findings of IPS. METHODS: Data were obtained from patient recordings, radiologic and endoscopic reports in 14 patients. RESULTS: All patients had severe epigastric pain, but only 3 patients showed typical presentation of acute cholangitis. Radiologically, IPS was not found in 6 patients, but subsequently found as be a single IPS (n=5) and sandy stones filled in the bile duct and gallbladder (n=1). All patients showed a bulging and swollen papilla. Patients (n=9) without peripapillary diverticulum, or with extradiverticular papilla showed more posteriorly displaced papillary orifice and more frequent mucosal changes compared with patients (n=5) with intradiverticular papilla or juxtapapillary diverticulum. The stones were completely removed in 11 patients endoscopically, and the remainders, who had intradiverticular papilla, underwent surgical treatment. CONCLUSIONS: To predict IPS, clinical assessment is very important because the only characteristic manifestation is severe epigastric pain and radiological studies seem to be occasionally insufficient for detecting IPS. The characteristic endoscopic findings of IPS are bulging and swollen papillae with posterioriy displaced orifice and frequent mucosal changes, which may be influenced by presence or absence, and types of peripapillary diverticulum.
Bile Ducts ; Cholangitis ; Diverticulum ; Gallbladder ; Humans

A case of a patient diagnosed as the chronic spinal epidural hematoma in the lumbar region is reported. There was no history of trauma except the repeated epidural block for controlling the lower back pain at the pain clinic. The symptoms were occurred after epidural block and were exaggerated by repeated injections. Magnetic resonance imaging showed a spinal epidural mass located dorsolaterally at the level of L3-L4. After removal of the hematoma, the symptoms were completely relieved. The diagnosis of a chronic spinal epidural hematoma was confirmed with both operative and histological findings.
Hematoma ; Hematoma, Epidural, Spinal ; Humans ; Low Back Pain ; Lumbosacral Region ; Magnetic Resonance Imaging ; Pain Clinics

Developmental venous anomalies (DVAs) are hemodynamically low flow, low resistance vascular malformations without clinical significance. Although most DVAs are asymptomatic and are found incidentally, sometimes they can be symptomatic with intracerebral hemorrhage, many of which are usually caused by associated cavernous malformations (CMs) rather than the DVAs themselves. Only a few cases have been reported in the literature where an intracerebral hemorrhage has been caused by a DVA alone. This report describes a case of an intracerebral hemorrhage due to DVA alone with review of the literature.
Caves ; Cerebral Hemorrhage ; Vascular Malformations

BACKGROUND: This study examined the clinical and radiologic mid-term results of patients treated by Oxford minimally invasive unicompartmental knee arthroplasty. METHODS: One hundred and eighty-eight knees of unicompartmental knee arthroplasties with Oxford Uni(R) in 166 patients (16 males and 150 females), which were performed between 2002 and 2005, were reviewed. The mean age was 65.3 years (range, 44 to 82 years) and the mean follow-up period was 79.8 months (range, 56 to 103 months). The preoperative diagnosis was osteoarthritis in 166 patients, osteonecrosis of the medial femoral condyle in 20 and chondrocalcinosis in 2. RESULTS: The mean Hospital for Special Surgery (HSS) knee score was 67.5 (range, 52 to 75) preoperatively and 89.9 (range, 85 to 100) at the final follow-up. The mean preoperative flexion contracture was 6.5degrees (range, 0 to 15degrees) and 0.8degrees (range, 0 to 5degrees) at the final follow-up. The mean full flexion increased from 135degrees (range, 90 to 150degrees) preoperatively to 150degrees (range, 140 to 165degrees) at the final follow-up. Active full flexion was possible within 2 postoperative months. The squatting and cross-leg postures were possible in 133 patients (80.1%) and 152 patients (91.6%) at the final follow-up. The mean tibiofemoral angle was improved from varus 1.5degrees to valgus 4.8degrees. Complications were encountered in 18 cases (9.5%). A bearing dislocation occurred in 10 cases (5.3%), tibial component loosening in 4 cases (2.1%), femoral loosening in 3 cases (1.6%) and lateral translation in 1 case (0.5%). The mean time for a bearing dislocation was 22.6 months (range, 3 to 70 months) postoperatively. Seven cases returned to the predislocation level of activity with the insertion of a thicker bearing and 3 cases converted to total knee arthroplasty. CONCLUSIONS: Minimally invasive unicompartmental knee arthroplasty with Oxford Uni(R) provided rapid recovery, good pain relief and excellent function suitable for the Korean lifestyle. In contrast, the high complication rates of Oxford Uni(R) encountered in the mid-term results suggested less reliability than total knee arthroplasty.
Adult ; Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Knee/adverse effects ; Female ; Humans ; Knee Joint/physiopathology/radiography ; *Knee Prosthesis ; Male ; Middle Aged ; Prosthesis Failure ; Range of Motion, Articular

BACKGROUND/AIMS: Lamivudine therapy is effective in inhibiting HBV replications in patients with HBeAg-negative chronic liver disease. However, the sustained response rate appears to be particularly poor, because the vast majority of patients relapse soon after cessation of therapy. The aim of this study was to evaluate the efficacy of lamivudine, the breakthrough rate, and the relapse rate of discontinuing therapy after response in patients with HBeAg-negative chronic liver disease. METHODS: Fifty-nine patients with HBeAg-negative chronic liver disease who have received lamivudine for at least 6 months, were studied. The mean duration of treatment was 14 months. Complete response was defined as undetectable serum HBV DNA by bDNA and normalization of ALT levels. Once HBV DNA disappearance and ALT normalization were observed, lamivudine therapy was continued for at least two additional months. The mean follow-up after cessation of treatment was 6 (1-22) months. RESULTS: Fifty-six patients were undetectable HBV DNA. The cumulative HBV DNA loss rates at 3 months and 5 months were 90% and 95%, respectively. The ALT normalization was observed in 52 patients. The cumulative ALT normalization rates at 6 months and 10 months were 78% and 86%, respectively. The complete response was observed in 52 patients. The cumulative rates of complete response at 10 months and 18 months were 80% and 88%, respectively. A predictive factor for complete response was only the duration of lamivudine treatment. Virological breakthrough was observed in 5 (8.5%). Thirty-four patients stopped taking lamivudine after 7.7 (2-15) months of the additional therapy. Seventeen of those patients (50%) experienced relapse. The cumulative relapse rates at 3 months, 6 months and 10 months were 24%, 47%, and 66%, respectively. The only predictive factor for relapse was the duration of additional lamivudine treatment after response. CONCLUSIONS: Lamivudine was an effective treatment of HBeAg negative chronic liver disease. Relapse, however, was usually observed after cessation of lamivudine. Our results showed that long-term lamivudine therapy is required in order to decrease the high relapse rates in patients with HBeAg-negative chronic liver disease.
Antiviral Agents/*therapeutic use ; DNA, Viral/analysis ; Female ; Hepatitis B e Antigens/*blood ; Hepatitis B virus/isolation & purification ; Hepatitis B, Chronic/*drug therapy/virology ; Humans ; Lamivudine/*therapeutic use ; Male ; Middle Aged ; Recurrence

BACKGROUND/AIMS: The post-treatment relapse patterns and efficacy of lamivudine re-treatment for relapsed patients have not been clarified. The aims of this study were to evaluate the relapse patterns after discontinuing therapy and the effects of lamivudine re-treatment for relapsed patients after HBeAg seroconversion. METHODS: Therapy was discontinued after HBeAg seroconversion in 121 patients. Sixty-six patients were relapsed and included in this study. The duration of lamivudine re-treatment therapy was from 6-35 (mean: 16) months. Post-retreatment monitoring continued for 1-40 (mean: 8.9) months. RESULTS: Among the relapsed 66 patients, 50 (75.8%) had HBeAg reappearance while 16 (24.2%) remained HBeAg negative and anti-HBe positive. The cumulative relapse rates at 3, 6, 12 and 24 months were 27%, 47%, 60% and 66%, respectively. Forty-two relapsers received lamivudine re-treatment. Among them, 33 were HBeAg positive and 9 were HBeAg negative and anti-HBe positive, Response was achieved in 31 of the 42 patients (73.8%). The cumulative response rates at 6, 9 and 12 months were 62%, 69% and 72%, respectively. Six patients (14.3%) developed viral breakthrough. All patients were HBeAg positive chronic hepatitis B. The duration of lamivudine re-treatment was the only predictable factor for response of lamivudine re-treatment. Therapy was discontinued after response in 21 patients. Eleven patients were relapsed, including 6 who were HBeAg positive and 5 who were HBeAg negative. Predictive factors for post-retreatment relapse were age and the duration of additional lamivudine therapy after response. CONCLUSIONS: The response rate of lamivudine re-treatment was significantly higher than in initial lamivudine treatments. The breakthrough and relapse rates, however, were similar in both initial and retreated lamivudine therapy.
Adult ; Antiviral Agents/*therapeutic use ; Female ; Hepatitis B e Antigens/blood ; Hepatitis B, Chronic/diagnosis/*drug therapy/virology ; Humans ; Lamivudine/*therapeutic use ; Male ; Recurrence ; Retreatment

BACKGROUND/AIMS: Long-term treatment with lamivudine causes breakthrough, but the clinical course after lamivudine breakthrough is not well known. The aims of this study were to evaluate the clinical course in lamivudine after breakthrough, and to identify predictive factors of breakthrough. METHODS: 124 patients with chronic hepatitis B infection, who represented viral breakthrough during lamivudine therapy, were included. The mean duration of lamivudine therapy and additional lamivudine therapy after breakthrough was 30.5 months and 12.5 months, respectively. RESULTS: The cumulative breakthrough rates at 12, 18, 24 and 36 months were 8, 24, 36 and 52%, respectively. After viral breakthrough, only 4 patients maintained normal ALT levels. 120 patients showed ALT elevation. The number of patients with ALT levels greater than 5 times, and greater than 10 times, the upper normal limit were 67 (56%) and 29 (24%), respectively. While still on lamivudine therapy after breakthrough, 98 patients presented ALT elevation. Only 22 had normalized ALT levels. Hepatic decompensation developed in 2 patients. HBeAg seroconversion after breakthrough occurred in 10 patients. The changing pattern of quantitative HBeAg levels during lamivudine therapy was the only predictive factor associated with viral breakthrough. The mean time of turning points in decrescendo-crescendo patterns of HBeAg levels during lamivudine therapy was earlier than viral breakthrough (9 months vs. 17 months). CONCLUSIONS: These results suggested that deterioration of hepatic function can usually be observed after breakthrough. The serial monitoring of serum quantitative HBeAg levels may allow an early recognition of viral breakthrough.
Adolescent ; Adult ; Aged ; DNA, Viral/blood ; English Abstract ; Female ; Hepatitis B e Antigens/blood ; Hepatitis B virus/*isolation & purification ; Hepatitis B, Chronic/drug therapy/*virology ; Humans ; Lamivudine/*therapeutic use ; Male ; Middle Aged ; Prognosis ; Reverse Transcriptase Inhibitors/*therapeutic use

BACKGROUND/AIMS: Lamivudine, an oral nucleoside analogue, effectively suppresses hepatitis B virus (HBV) replications and improves liver enzymes as well as liver histology. The aim of this study was to evaluate the effectiveness of lamivudine and the patient-dependent or laboratory variables that predict HBeAg seroconversion. METHODS: We retrospectively analyzed 519 consecutive patients with HBeAg-positive chronic hepatitis B who were treated with lamivudine. The duration of lamivudine therapy was from 6 to 64 months (mean 20 months). RESULTS: The HBeAg seroconversion was achieved in 192 patients (37%). The cumulative HBeAg seroconversion rates were 28% at 12 months, 39% at 24 months, 49% at 36 months, and 53% at 48 months. The predictive factors of lamivudine-induced HBeAg seroconvresion were the changing patterns of quantitative HBeAg level during lamivudine therapy, pretreatment quantitative HBeAg levels, ALT levels, and the duration of lamivudine therapy. One hundred eighty-three patients who had achieved HBeAg seroconversion showed patterns that HBeAg levels were continuously decreased. Therapy was discontinued after HBeAg seroconversion in 121 patients. Sixty-six patients experienced a relapse during the follow-up period (mean 8.9 months). CONCLUSIONS: The continuously decreasing patterns of quantitative HBeAg levels during lamivudine therapy can predict HBeAg seroconversion in clinical settings.
Adolescent ; Adult ; Aged ; Antiviral Agents/*therapeutic use ; Female ; Hepatitis B e Antigens/blood ; Hepatitis B, Chronic/*drug therapy/virology ; Humans ; Lamivudine/*therapeutic use ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Duplications of the gastrointestinal tract are rare congenital malformations that are usually present during the first decade of life. However, a smaller number of cases may remain occult until adulthood. Overall, the colon is the least common site of congenital gastrointestinal duplications. Colonic duplications can present with symptoms of diverticulitis and can be confused with acquired giant cysts or masses. We present a rare case of a duplication cyst of the colon in a female adult. Although the preoperative evaluations, including an abdominal CT scan and colonoscopy, were suggestive of a gastrointestinal tumor of the colon, the final diagnosis was a colonic duplication cyst based on the histopathologic examination of the resected specimen. Even if intestinal duplication cysts are uncommon, they should be considered in the differential diagnosis of intestinal masses.
Adult ; Colon ; Colonoscopy ; Diagnosis, Differential ; Digestive System Abnormalities ; Diverticulitis ; Female ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans