BACKGROUND/AIMS: Although the only therapy of proven benefit for chronic hepatitis C is interferon alpha, the rate of sustained response after treatment with interferon is less than 25%. A 6-month course of combination therapy with interferon and ribavirin was associated with higher rate of long-term response than either interferon or ribavirin alone. Pilot studies suggested that combination of interferon and ursodeoxy-cholic acid (UDCA) resulted in higher biochemical response than interferon alone. We investigated the rates of end of treatment response(ETR) and sustained response(SR) of combination therapy of interferon e2a, ribavirin and UDCA and compared it with interferon a 2a alone. METHODS: Ninty-five naive patients with chronic hepatitis C who have been positive for anti-HCV by 3rd generation EIA and HCV RNA by RT-PCR and had elevated level of ALT over 6 months were included. They were assigned to three groups. Thirty seven patients in group 1 were treated with interferon a 2a (3MU thrice weekly) in combination with ribavirin (600mg/day) and UDCA (600mg/day) for 6 months. Twenty nine patients in group 2 were treated with the same dose of interferon a 2a alone for 6 months. Changes of ALT and HCV RNA were observed over 12 months (average 3029 mos) after the end of treatment in both groups. Twenty nine patients in group 3 were observed over 12 months without antiviral treatment. HCV genotypes were tested by Innop-Lipa in 24 patients in group 1. RESULTS: In group 1, not only ETR (68%) but also 12 month SR rate (54%) was significantly higher than group 2(31%, 21% respectively). There was no difference in relapse rate between two groups. The level of ALT became normalized and HCV RNA negative within 1 month after treatment in most responders in group l. Genotype 1b was associated with lower ETR and SR than non-lb, although not significant stastistically. CONCLUSION: Both the ETR and 12 month SR rate were significantly higher after combination treatment of interferon a 2a, ribavirin and UDCA than interferon e 2a alone in chronic hepatitis C. It is suggested that this combination is preferable to interferon alone in the treatment of naive patients with chronic hepatitis C.
Genotype ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Interferon-alpha* ; Interferons* ; Recurrence ; Ribavirin* ; RNA

BACKGROUND/AIMS: Lamivudine, an oral nucleoside analogue, effectively inhibits hepatitis B virus replication and reduces hepatic necroinflammation in patients with chronic hepatitis B. This study investigated the effect and safety of 12 week lamivudine therapy in Korean patients with chronic hepatitis B (CHB). METHODS: In an open clinical trial, 113 patients with CHB were enrolled. They received 100 mg of lamivudine orally once daily for 12 weeks, and they were followed until 2 weeks after cessation of lamivudine. HBV DNA (by bDNA assay), liver enzymes, creatine phosphokinase, creatinine and CBC were checked at 0, 2, 4, 8, 12 and 14 weeks. Compliance and side effects were evaluated at the same time. RESULTS: After receiving lamivudine 100 mg, serum HBV DNA levels fell rapidly, remaining in 94.3% below baseline values at 2 weeks and 99.8% below baseline values at 12 weeks. Serum HBV DNA was cleared in 75.2% and alanine aminotransferase level (ALT) was normalized in 64.8% at 12 weeks. Cumulative percentage of HBeAg clearance (defined by clearance of serum HBV DNA and HBeAg) was 14.4%. Clearance of HBV DNA was more frequent in patients with lower pretreatment serum HBV DNA and higher ALT. During the treatment periods, adverse effects were negligible and transient. Two weeks after cessation of lamivudine, serum HBV DNA reappeared in 70.6% of responders. CONCLUSION: It is suggested that lamivudine is effective and safe in the treatment of CHB in Korean patients, but further study for adequate duration of treatment is needed because of high recurrence after 12 weeks therapy.
Alanine Transaminase ; Compliance ; Creatine Kinase ; Creatinine ; DNA ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Lamivudine* ; Liver ; Recurrence

BACKGROUND/AIMS: Chronic hepatitis C virus (HCV) infection is often associated with extrahepatic autoimmune disease, and autoantibodies such as anti-nuclear antibody (ANA) or anti-smooth muscle antibody (ASA). The presence of autoantibodies may make discrimination between chronic hepatitis C with autoimmune features and type 1 autoimmune hepatitis difficult. We studied the prevalence of autoantibodies in patients with chronic HCV infection and their clinical significance. MATERIALS AND METHODS: ANA, ASA, anti-mitochondrial antibody (AMA), anti-microsomal antibody (AmA), rheumatoid factor (RF), anti-cardiolipin antibody (aCL) and lupus anti-coagulant (LA) were tested in 116 patients (80 chronic hepatitis C, 36 liver cirrhosis). Genotypes of HCV were determined in 25 patients by INNO LiPA. RESULTS: The overall prevalence of autoantibody was 65.5%. The most common autoantibody was aCL (34.5%), followed by ANA (25%), RF (18%), LA (15.5%), ASA (6.9%), anti-microsomal antibody (6%) and AMA (1%). The positive rate of either ANA or ASA was 30.2%, but both were positive in 1.7% only. There was no difference in the demographic features, biochemistry, HCV genotypes and disease status between autoantibody-positive and autoantibody-negative patients. CONCLUSIONS: Autoantibodies were commonly found in patients with chronic HCV infection. But, the presence of autoantibodies may be a non-specific finding in chronic hepatitis C infection without clinical significance.
Autoantibodies* ; Autoimmune Diseases ; Biochemistry ; Discrimination (Psychology) ; Genotype ; Hepacivirus ; Hepatitis C, Chronic* ; Hepatitis, Autoimmune ; Hepatitis, Chronic* ; Humans ; Liver ; Prevalence* ; Rheumatoid Factor

OBJECTIVE: The result of finite element analysis depends on material properties, structural expression, density of element, and boundar or loading conditions. To represent proper elastic behavior, a finite element model was made using Hounsfield unit (HU) values in CT images. METHODS: A 13 year 6 month old male was used as the subject. A 3 dimensional visualizing program, Mimics, was used to build a 3D object from the DICOM file which was acquired from the CT images. Model 1 was established by giving 24 material properties according to HU. Model 2 was constructed by the conventional method which provides 2 material properties. Protraction force of 500g was applied at a 45 degree downward angle from Frankfort horizontal (FH) plane. RESULTS: Model 1 showed a more flexible response on the first premolar region which had more forward and downward movement of the maxillary anterior segment. Maxilla was bent on the sagittal plane and frontal plane. Model 2 revealed less movement in all directions. It moved downward on the anterior part and upward on the posterior part, which is clockwise rotation of the maxilla. CONCLUSION: These results signify that different outcomes of finite element analysis can occur according to the given material properties and it is recommended to use HU values for more accurate results.
Bicuspid ; Finite Element Analysis ; Humans ; Male ; Masks* ; Maxilla

This study was investigated the changes during treatment and retention period in the Class III malocclusion patients and explored the correlationship between factors that showed relapse tendencies and pre-treatment skeletal pattern and the changes during treatment period. Numbers of total sample were 24 and their Hellman's dental age at the start of treatment was over III B and were retained at least over 1 year 6 months. The following conclusion were obtained by comparing the differences between treatment period and retention period, and after analysing the correlationship of factors that manifested relapse tendencies. 1. The angles formed by FH plane and occlusal plane, FH plane and mandibular plane, and mandibular incisor and mandibular plane changes showed rebound effect during retention period and among them occlusal plane angle and IMPA show reverse correlationship. 2. Upward displacement of the occlusal plane at the end of treatment has returning tendency, is proportional to the displacement during treatment period, but the angle between maxillary and mandibular 1st molar to its basal bone have been constantlsy maintained during the retention period. 3. Mandibular plane decrease during retention period and downward backward rotation during treatment period show correlationship.
Dental Occlusion ; Humans ; Incisor ; Malocclusion ; Molar ; Recurrence

BACKGROUND/AIMS: The hepat it is C virus (HCV) genotypes have been shown to be differently distributed among distinct geographic areas and as sociated with different clinical present at ions. The aut hors investigated the distribution of HCV genotypes in Korean patients with chronic HCV infection and the as sociation of HCV genotypes with age, sex, severity of the liver disease, and the possible mode of transmission. METHODS: The study population consisted of 143 patients with chronic HCV infect ion: 13 with normal ALT , 78 with chronic hepatitis , 35 with cirrhosis , 17 with hepat ocellular car cinoma (HCC). HCV genotypes were determined by line probe assay. RESULTS: The principal HCV genotype was 1b ( 56%) and followed by 2a/ c ( 32%), mixed (8%), 2b ( 3%), and 1a (1%). Patients infected with type 1b and 2a/ c were older than those with ot her genotypes (p< 0.05). Genotype 1b tended to be more prevalent among patients with HCC ( 76% compared with 53% for patients with other liver diseases ; p=0.07). There was no significant relations hip bet ween genotypes and sex or mode of transmission. CONCLUSION: The most common HCV genotype in Korea was type 1b and followed by 2a/ 2c. Although patients infected with type 1b and 2a/c were older than those with other genotypes, there was no correlation between genotypes and sex, severity of liver disease, or mode of transmission.
Fibrosis ; Genotype ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Hepatitis, Chronic ; Hip ; Humans ; Ions ; Korea ; Liver Diseases

Ectopic pregnancy is a common medical problem that is difficult to diagnose and potentially may lead to significant mortality or morbidity. The incidence of ectopic pregnancy is definitely increasing due to the rise in pelvic inflammatory disease (PID), pelvic surgery, intrauterine device (IUD), and assisted reproductive technologies, such as in vitro fertilization and embryo transfer (IVF-ET). Combined ectopic gestations are much rare and their true incidence is unknown. Multiple ectopic gestations may occur in a variety of locations. The majority involve one or both fallopian tubes. We report a case of combined tubal and cervical pregnancies, and discuss their management.
Embryo Transfer ; Fallopian Tubes ; Female ; Fertilization in Vitro ; Incidence ; Intrauterine Devices ; Mortality ; Pelvic Inflammatory Disease ; Pregnancy* ; Pregnancy, Ectopic ; Reproductive Techniques, Assisted

BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) is a major problem associated with liver cirrhosis which has high mortality. Increased production of inflammatory mediators, such as tumor necrosis factor-a (TNF-a) and interleukin- (IL-) may be associated with development of renal impairment, one of the most important prognostic parameters in SBP. The aim of this study is to investigate the changes of these cytokines in ascitic fluid and plasma in patients with SBP and the relationship between these cytokines and development of renal impairment. METHODS: Forty patients with liver cirrhosis and ascites were studied 21 with SBP and 19 with sterile ascites. TNF-a and IL- levels in ascitic fluid and plasma were determined by ELISA at the time of diagnosis in both groups and 48 hours after antibiotics treatment in SBP patients. RESULTS: TNF-and IL- levels in ascitic fluid and plasma were significantly higher in patients with SBP than those without SBP (ascitic fluid TNF-a: 2.5+/-0.5 vs. 1.6+/-0.2; plasma TNF-a: 2.3+/-0.5 vs. 1.5+/-0.2; ascitic fluid IL-: 3.8+/-0.5 vs. 3.0+/-0.4; plasma IL-: 3.4+/-0.5 vs. 2.3+/-0.3, log pg/mL)(p<0.001). In patients with SBP, levels of TNF-a and IL- in ascitic fluid and plasma decreased 48 hours after antibiotics treatment. Eleven patients with SBP (11/21, 52%) developed renal impairment. Patients with renal impairment had significantly higher ascitic fluid and plasma TNF-a levels than those without renal impairment (median 2.5 vs. 2.1 for ascitic fluid, p=0.006; median 2.4 vs. 2.0, log pg/mL for plasma, p=0.04). Although four out of eleven (36%) patients who developed renal impairment died during hospitalization, all the patients without renal impairment survived (p=0.09). CONCLUSION: Our results suggest that the levels of TNF-a and IL- in ascitic fluid and plasma are increased in SBP and elevated levels of TNF-a in ascitic fluid and plasma may be associated with development of renal impairment, thus indicating poor prognosis in patients with SBP.
Anti-Bacterial Agents ; Ascites ; Ascitic Fluid* ; Cytokines ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Hospitalization ; Humans ; Liver Cirrhosis ; Mortality ; Necrosis* ; Peritonitis* ; Plasma* ; Prognosis

PURPOSE: Unlike males, inguinal hernia surgery in females is an uncommon surgical procedure. The efficacy of laparoscopic surgery for female hernia must be proven. This study compared the clinical characteristics of male and female hernia as well as the efficacy of laparoscopic surgery with that of open surgery in female hernia. METHODS: From March 2007 to February 2011, one surgeon (C.S.) at the authors' institution operated on 965 patients (male/female=884/81) who were each more than 19 years old. The female patients were divided into the laparoscopic (n=67, TEP/TAPP=66/1) and open surgery groups (n=14). RESULTS: The mean age of the female patients was lower than that of the male patients. The incidence of bilateral and direct hernia was higher in the male patients but the incidence of femoral hernia was higher in the female patients (0.6 vs. 8.6%, p<0.001). Among the 81 female patients, the mean age of the patients with femoral hernia was higher than that of the patients with other types of hernia (56.4+/-12.5/43.0+/-15.1, p<0.026). The operation times and pain scores of the two groups 7 days after surgery were comparable. CONCLUSION: The findings revealed a higher incidence of femoral hernia in the female patients than male patients. Patients with a femoral hernia were older than those with other types of hernia. Therefore, laparoscopic surgery must be considered for elderly female patients who have a high incidence of femoral hernia.
Aged ; Female ; Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Humans ; Incidence ; Laparoscopy ; Male

PURPOSE: This study was aimed to compare the results of a transanal repair with those of a transvaginal levatorplasty and to determine the long-term clinical outcomes according to the change in the depth of the rectocele after the procedure. METHODS: Of 50 women who underwent a rectocele repair from March 2005 to February 2007, 26 women (group A) received a transanal repair, and 24 (group B) received a transvaginal repair with or without levatorplasty. At 12 months after the procedures, 45 (group A/B, 22/23 women) among the 50 women completed physiologic studies, including anal manometry and defecography, and clinical-outcome measurements. The variations of the clinical outcomes with changes in the depth of the rectocele were also evaluated in 42 women (group A/B, 20/22) at the median follow-up of 50 months. RESULTS: On the defecographic findings, the postoperative depth of the rectocele decreased significantly in both groups (group A vs. B, 1.91 +/- 0.20 vs. 2.25 +/- 0.46, P = 0.040). At 12 months after surgery, 17 women in each group (group A/B, 77/75%) reported improvement of their symptoms. However, only 11 and 13 women (group A/B, 55/59%) of groups A and B, respectively, maintained their improvement at the median follow-up of 50 months. Better results were reported in patients with a greater change in the depth of their rectocele (> or =4 cm) after the procedure (P = 0.001) CONCLUSION: In both procedures, clinical outcomes might become progressively worse as the length of the follow-up is increased.
Defecography ; Female ; Follow-Up Studies ; Humans ; Manometry ; Rectocele