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

Trichogenic tumors are very rare and described as cutaneous neoplasms probably derived from hair germ which develops into hair follicles. We report a case of trichoblastic fibroma on the left parietal scalp of a 45-year-old man. The lesion was a solitary, firm, non-tender, 2×2cm subcutaneous nodule. The histopathological study showed a well circumscribed dermal tumor composed of abundant basophilic palisading basaloid lobules with some keratinous cysts, hair follicle differentiation and fibroblastic stroma.
Basophils ; Fibroblasts ; Fibroma* ; Hair ; Hair Follicle ; Humans ; Middle Aged ; Rabeprazole ; Scalp

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

Malaria is the world's most important parasitic infec tion. Although it has been eradicated from temperate zones including Korea , increasing numbers of travellers visit tropical malarious countries and imported malaria becomes important medical problem in the developed countries. In Korea with increasing travellers to malaria endemic area, the incidence of imported malaria shows rising tendency same as the developed countries. It beco mes important to provide general personal protective me asures and chemoprophylaxis to trevellers, when employed in appropriate manner, that can be highly effective in preventing malaria . We recently experienced a case of imported Plasmodium vivax malaria with delayed mani festations due to inadequate chemoprophylaxis. A 53- year-old woman with history of trevel to East Africa 4 months ago and chief complaint of fever was diagnosed as tertian malaria. She had irregularly taken prophylatic antimalarial during travel and had not taken it after return but should have taken it at least 4 weeks after return.
Africa, Eastern ; Chemoprevention* ; Developed Countries ; Female ; Fever ; Humans ; Incidence ; Korea ; Malaria ; Malaria, Vivax* ; Plasmodium vivax* ; Plasmodium*

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

PURPOSE: To evaluate the CT appearance of renal cell carcinoma and to correlate it with nuclear grading andcell type. MATERIALS AND METHODS: The size, outer margin and heterogeneity of inner texture of renal cell carcinomas in 86 patients were evaluated on CT scan and were correlated with nuclear grade and cell type. RESULTS: Tumors less than 5cm were of low grade in 28 of 31 patients, while those larger than 5cm were of low grade in 28 of 55 patients. The lesions which showed no or round protrusion with a sharp margin were of low grade in 26 of 28 patients, while those which showed an undulated or indistinct margin were of low grade in 30 of 58 patients. Lesions which showed a homogeneous solid appearance, focal low densities, or mostly cystic changes were of low grade in 23 of 26 patients, while those which showed multiple or confluent low densites were low grade in 33 of 60 patients. There was a significant difference in the distribution of nuclear grading between the groups. Differences in CT apperance according to cell type were not found. CONCLUSION: Differences in less than 5cm showing no or round protrusion with a sharp margin, homogeneous inner texture with solid appearance, and heterogeneous inner texture with cystic appearance or focal low densities on CT scan were thought to be the findings suggesting low nuclear grading.
Carcinoma, Renal Cell* ; Humans ; Population Characteristics ; Tomography, X-Ray Computed

PURPOSE: The purpose of the study was to evaluate the accuracy of two different fluid intake measurement methods (fluid only vs. all dietary intake) in measuring fluid balance compared to body weight change among patients with cancers. METHODS: A total of 60 cancer patients in an urban cancer center in South Korea participated in the study. Adult patients who were over 18 years old; having 24-hr I&O order; and taking either normal regular diet or soft blend diet were included. Demographic information and disease related information were also gathered. The data were analyzed using SPSS 18.0 program. RESULTS: Measuring 'fluid only' for oral intake was a more accurate measure than measuring 'all dietary intake' (p=.026 vs. p=.094). Both methods had positive correlations with the amount of weight change (r=.329, p=.010; r=.303, p=.019). Measuring body weight was a more accurate and efficient way of evaluating the fluid balance than 24 hr cumulative I&O. CONCLUSION: Developing clinical manual for selecting proper patients who needs fluid balance monitoring is imperative. Administering weight check and/or 24 hr cumulative I&O should be considered thoroughly based on solid nursing evidence in future.
Adult ; Body Fluids ; Body Weight ; Body Weight Changes ; Diet ; Humans ; Nutrition Assessment ; Republic of Korea ; Water-Electrolyte Balance

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

BACKGROUND/AIMS: The distribut ion of HCV genotypes varies with geographical area, and genot ypes can affect t he nat ur al course of HCV infection, but adequate genot yping data were not accumulat ed in Korea. This study was des igned to det ermine the pattern of distribution of HCV genotypes in Korea and it's clinical implications. METHODS: 100 cons ecut ive anti- HCV( +), RT-PCR(+) cases were recruited. Genotype specific oligonucleotide primers were made according to the sequence variation of NS5 region of HCV genome. Heminested PCR with mixed primersets was per formed, and genotype specific PCR products of different size were verified. Sequencing of cloned PCR products was done in cases with representative genotypes. Clinical profiles of genotype 1b and 2a were compared. RESULTS: Genotyping was done in 78 among 100 cases. Genotype 1b (48/ 78, 57.7%) and 2a (25/ 78, 32.1%) were most prevalent , and 1a (1/ 78, 1.3%) and mixed form (7/ 78, 9.0%) were also found. Milder cases with persistent normal ALT levels were more frequently seen in genotype 2a ( 9/ 25, 36.0%) than in genot ype 1b (3/ 45, 6.7%) (p< 0.01). CONCLUSIONS: Genotype 1b and 2a were major ones in anti- HCV( +) Korean adults, and the tendency of milder clinical course of genotype 2a was suggested.
Adult ; Clone Cells ; DEET ; DNA Primers ; Genome ; Genotype ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Korea ; Polymerase Chain Reaction*