PURPOSE: The purpose of this study was to identify awareness and knowledge about hepatitis B virus (HBV) infection among North Korean immigrants who had resided in South Korea. METHODS: This was a cross-sectional, community based study. Data were collected from a convenience sample of 198 North Korean immigrants aged 18 years old through 65 years old among those who had attended community centers, local churches, and gathering places in four cities. The questionnaire included 15 items about participants' knowledge on HBV infection and its consequences, mode of transmission, and preventive measures. RESULTS: The mean score of HBV knowledge was 6.3±3.8 (range 0~15). The items that over 60% of the respondents checked correct answer regarding knowledge about HBV were 'There is blood screening for hepatitis B infection', 'Hepatitis B can be transmitted through sharing needles with infected person'. Multivariate analysis showed that received education for the prevention of HBV infection and disease morbidity were significantly associated with the knowledge of HBV infection. Overall, approximately 11% of total variability in the knowledge of HBV infection could be explained by the 2 variables in this model (R²=.109, p<.001). CONCLUSION: The results showed that North Korean immigrants need more education on HBV infection and prevention to improve their knowledge about HBV.
Education ; Emigrants and Immigrants* ; Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Humans ; Korea ; Mass Screening ; Multivariate Analysis ; Needles ; Surveys and Questionnaires

The most common adverse effect of intravenous heparin is hemorrhage. Of the these, retroperitoneal hemorrhage and femoral neuropathy secondary to heparin anticoagulation has reported in 1966 for the first time by DeBolt and Jordan. We experienced a case of spontaneous retroperitoneal hemorrhage due to iliopsoas muscle hematoma in patient with myocardial infarction receiving intravenous heparin for a 3 days in therapeutic doses. The pathophysiology of iliopsoas muscle hematoma has not yet been cleared. But because of the possibility of large amount in volume, retroperitoneal hemorrhage has been known as a serious adverse effect that leads to the hypovolemic shock and death. In this article, we described the clinical manifestation, the importance of the early diagnosis and diagnostic clues and associated factors of the retroperitoneal hemorrhage in patient receiving intravenous heparin.
Early Diagnosis ; Femoral Neuropathy ; Hematoma* ; Hemorrhage* ; Heparin* ; Humans ; Jordan ; Myocardial Infarction* ; Shock

No abstract available.
Transposases*

Extramedullary hematopoiesis occurring in multiple organs such as thorax, liver and both kidneys is an unusual condition. We report the CT findings of this condition with review of literature. The lesions consisted of intrathoracic paravertebral masses, focal intrahepatic mass and masses of both pelvocalyceal systems on CT scans.
Biopsy ; Case Report ; Female ; Hematopoiesis, Extramedullary+ACo- ; Human ; Kidney/radiography ; Kidney/physiopathology ; Liver/radiography ; Liver/physiopathology ; Liver/pathology ; Mediastinum/radiography ; Mediastinum/physiopathology ; Middle Age ; Myelofibrosis/physiopathology+ACo- ; Thorax ; Tomography, X-Ray Computed

Extramedullary hematopoiesis occurring in multiple organs such as thorax, liver and both kidneys is an unusual condition. We report the CT findings of this condition with review of literature. The lesions consisted of intrathoracic paravertebral masses, focal intrahepatic mass and masses of both pelvocalyceal systems on CT scans.
Biopsy ; Case Report ; Female ; Hematopoiesis, Extramedullary+ACo- ; Human ; Kidney/radiography ; Kidney/physiopathology ; Liver/radiography ; Liver/physiopathology ; Liver/pathology ; Mediastinum/radiography ; Mediastinum/physiopathology ; Middle Age ; Myelofibrosis/physiopathology+ACo- ; Thorax ; Tomography, X-Ray Computed

PURPOSE: There are few reports about the natural history of patients with pseudoprecocious puberty due to autonomous ovarian cyst. We reviewed the clinical course of 7 patients who had autonomous ovarian cysts and signs of precocious puberty. METHODS: We retrospectively evaluated 7 children, aged 2.8 to 7.9 years, who were diagnosed with pseudoprecocious puberty due to autonomous ovarian cysts from November 2005 to May 2011. The follow-up durations ranged from 0.5 to 6.3 years. RESULTS: Four out of 7 patients showed elevated serum estrogen levels and all revealed prepubertal response of gonadotropin to GnRH stimulation at diagnosis. The size of the cysts was from 1.7 to 4.6 cm on pelvic ultrasound examination. After 1 to 3 months, the ovarian cysts disappeared in all patients. Three of the girls developed relapsing signs of precocious puberty (vaginal bleeding and breast budding). Two of them showed an increase in growth velocity and bone age due to recurrent ovarian cysts, and one of them was converted to true precocious puberty. CONCLUSION: In our cases, all patients with autonomous ovarian cysts resolved spontaneously. However, some showed frequent recurrence of ovarian cysts, and needed a longer follow up because of the possibility of conversion to true precocious puberty and signs of McCune-Albright syndrome.
Aged ; Breast ; Child ; Estrogens ; Female ; Fibrous Dysplasia, Polyostotic ; Follow-Up Studies ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Hemorrhage ; Humans ; Natural History ; Ovarian Cysts ; Puberty ; Puberty, Precocious ; Recurrence ; Retrospective Studies

Purpose: This study investigated whether the use of ultrasound (US) guidance in transient elastography (TE) improved the technical success and reliability of liver stiffness (LS) measurements and whether 2-dimensional (2D) shear wave elastography (SWE) provided reliable LS measurements if TE measurements failed. Methods: In this prospective study, 292 participants (male:female, 189:103; median age, 60 years) with chronic liver disease (CLD) were enrolled. LS was measured via the consecutive use of conventional TE, 2D-SWE, and US-guided TE. The technical success rates and reliable LS measurement rates of the three elastography techniques were compared. The risk factors for TE failure were assessed through univariate and multivariate logistic regression models. Results: US-guided TE was associated with a higher technical success rate (281 of 292, 96.2%) and a higher reliable measurement rate (266 of 292, 91.1%) than conventional TE (technical success: 256 of 292, 87.7%; reliable measurements: 231 of 292, 79.1%; P<0.001 for both). In participants for whom conventional TE failed, 2D-SWE provided high rates of technical success (36 of 36, 100%) and reliable measurements (30 of 36, 83.3%). TE failure was associated with female sex (odds ratio [OR], 5.85; 95% confidence interval [CI], 1.30 to 26.40), severe reverberation artifacts (OR, 8.79; 95% CI, 3.93 to 19.69), and high skin-to-liver capsule depth (OR, 1.23; 95% CI, 1.09 to 1.39). Conclusion US guidance in TE improved the technical success and reliable measurement rates in the assessment of LS in patients with CLD. In participants for whom TE failed, subsequent 2D-SWE successfully delivered reliable LS measurements.

Objective: To investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) and its role as a second-line imaging modality after gadoxetate-enhanced MRI (Gd-EOB-MRI) in the diagnosis of hepatocellular carcinoma (HCC) among at risk observations. Materials and Methods: We prospectively enrolled participants at risk of HCC with treatment-naïve solid hepatic observations (≥ 1 cm) of Liver Imaging Reporting and Data System (LR)-3/4/5/M during surveillance and performed Gd-EOB-MRI. A total of one hundred and three participants with 103 hepatic observations (mean size, 28.2 ± 24.5 mm; HCCs [n = 79], non-HCC malignancies [n = 15], benign [n = 9]; diagnosed by pathology [n = 57], or noninvasive method [n = 46]) were included in this study. The participants underwent CEUS with sulfur hexafluoride. Arterial phase hyperenhancement (APHE) and washout on Gd-EOB-MRI and CEUS were evaluated. The distinctive washout in CEUS was defined as mild washout 60 seconds after contrast injection. The diagnostic ability of Gd-EOB-MRI and of CEUS as a second-line modality for HCC were determined according to the European Association for the Study of the Liver (EASL) and the Korean Liver Cancer Association and National Cancer Center (KLCA-NCC) guidelines. The diagnostic abilities of both imaging modalities were compared using the McNemar’s test. Results: The sensitivity of CEUS (60.8%) was lower than that of Gd-EOB-MRI (72.2%, p = 0.06 by EASL; 86.1%, p < 0.01 by KLCA-NCC); however, the specificity was 100%. By performing CEUS on the inconclusive observations in Gd-EOB-MRI, HCCs without APHE (n = 10) or washout (n = 12) on Gd-EOB-MRI further presented APHE (80.0%, 8/10) or distinctive washout (66.7%, 8/12) on CEUS, and more HCCs were diagnosed than with Gd-EOB-MRI alone (sensitivity: 72.2% vs. 83.5% by EASL, p < 0.01; 86.1% vs. 91.1% by KCLA-NCC, p = 0.04). There were no false-positive cases for HCC on CEUS. Conclusion The addition of CEUS to Gd-EOB-MRI as a second-line diagnostic modality increases the frequency of HCC diagnosis without changing the specificities.

OBJECTIVE: To evaluate the effect of a gonadotropin-releasing hormone (GnRH) antagonist protocol using corifollitropin alfa in women undergoing assisted reproduction. METHODS: Six hundred and eighty-six in vitro fertilization-embryo transfer (IVF)/intracytoplasmic sperm injection (ICSI) cycles were analyzed. In 113 cycles, folliculogenesis was induced with corifollitropin alfa and recombinant follicle stimulating hormone (rFSH), and premature luteinizing hormone (LH) surges were prevented with a GnRH antagonist. In the control group (573 cycles), premature LH surges were prevented with GnRH agonist injection from the midluteal phase of the preceding cycle, and ovarian stimulation was started with rFSH. The treatment duration, quality of oocytes and embryos, number of embryo transfer (ET) cancelled cycles, risk of ovarian hyperstimulation syndrome (OHSS), and the chemical pregnancy rate were evaluated in the two ovarian stimulation protocols. RESULTS: There were no significant differences in age and infertility factors between treatment groups. The treatment duration was shorter in the corifollitropin alfa group than in the control group. Although not statistically significant, the mean numbers of matured (86.8% vs. 85.1%) and fertilized oocytes (84.2% vs. 83.1%), good embryos (62.4% vs. 60.3%), and chemical pregnancy rates (47.2% vs. 46.8%) were slightly higher in the corifollitropin alfa group than in the control group. In contrast, rates of ET cancelled cycles and the OHSS risk were slightly lower in the corifollitropin alfa group (6.2% and 2.7%) than in the control group (8.2% and 3.5%), although these differences were also not statistically significant. CONCLUSION: Although no significant differences were observed, the use of corifollitropin alfa seems to offer some advantages to patients because of its short treatment duration, safety, lower ET cancellation rate and reduced risk of OHSS.
Embryo Transfer ; Embryonic Structures ; Female ; Follicle Stimulating Hormone* ; Gonadotropin-Releasing Hormone* ; Humans ; Infertility ; Luteinizing Hormone ; Oocytes ; Ovarian Hyperstimulation Syndrome ; Ovulation Induction ; Pregnancy Rate ; Reproduction* ; Spermatozoa

Hepatoid thymic carcinoma is an extremely rare subtype of primary thymus tumor resembling “pure” hepatoid adenocarcinomas with hepatocyte paraffin 1 (Hep-Par-1) expression. A 53-year-old man presented with voice change and a neck mass. Multiple masses involving the thyroid, cervical and mediastinal lymph nodes, and lung were detected on computed tomography. Papillary thyroid carcinoma was confirmed by biopsy, and the patient underwent neoadjuvant chemoradiation therapy. However, the anterior mediastinal mass was enlarged after the treatment whereas the multiple masses in the thyroid and neck decreased in size. Microscopically, polygonal tumor cells formed solid sheets or trabeculae resembling hepatocytes and infiltrated remnant thymus. The tumor cells showed immunopositivity for cytokeratin 7, cytokeratin 19, and Hep-Par-1 and negativity for α-fetoprotein. Possibilities of germ cell tumor, squamous cell carcinoma, and metastasis of thyroid papillary carcinoma were excluded by immunohistochemistry. This report on the new subtype of thymic carcinoma is the third in English literature thus far.