To investigate resistance to lamivudine (3TC), we examined the incidence of M184V in 20 HIV-1 patients treated with 3TC for 13.1 +/- 9 months. Fourteen of 20 patients had been exposed to zidovudine (ZDV) or didanosine (ddl) prior to 3TC therapy. Nested PCR targeting to reverse transcriptase (RT) and direct sequencing were performed for peripheral blood mononuclear cells sampled serially. There were resistance mutations to ZDV in at least 9 patients at baseline, although there was no resistance mutation to 3TC. We could detect M184V in 6 (30%) out of 20 patients. The incidence of M184V increased as the duration of therapy prolongs (13% in samples<12 months; 47% in samples gtoreq 12 months). The frequency of mutation M184V was higher in patients with previous mutation to ZDV than in patients with wild type. Resistance mutation was not detected in 7 patients. This study shows that resistance to 3TC tends to develop rapidly in patients with baseline mutations or two drugs combination therapy than in those treated simultaneously with triple drugs. This report is the first on resistance to 3TC in Korean AIDS patients.
Didanosine ; HIV-1* ; Humans ; Incidence ; Lamivudine* ; Polymerase Chain Reaction ; RNA-Directed DNA Polymerase ; Zidovudine

A retrospective analysis was made of 20 patients with pineal region tumors who were treated at the Department of Neurosurgery, Capital Armed Forces General Hospital between May of 1987 and March of 1993. We performed ventriculo-peritoneal shunt in 17 patients with obstructive hydrocephalus. Tissue diagnosis was obtained in 7 patients before irradiation and 13 patients underwent irradiation without histological diagnosis. Among 7 biopsy-proven cases, 5 were germinoma, one was mixed germ cell tumor and another one was astrocytoma. The response to irradiation and tumor marker study revealed that 13 patients who did not have tissue diagnosis seemed to be germinomatous, non-germinomatous germ cell tumors and endodermal sinus tumor. So, the following results were obtained. 1) The patients were all young males. 2) The main presenting symptoms and signs were headache, vomiting and papilledema. 3) The tumors were mainly presented as a round well-enhancing masses with calcification. 4) Based on the classification of pineal tumor, germinoma was predominant tumor type. 5) The extrapineal metastasis was found in 5 cases(25.0%). 6) The tumor marker (alpha-FP or HCG) was positive in 5 cases(25.0%). 7) Germinoma showed excellent prognosis after the irradiation.
Arm ; Astrocytoma ; Classification ; Diagnosis ; Endodermal Sinus Tumor ; Germinoma ; Headache ; Hospitals, General ; Humans ; Hydrocephalus ; Male ; Neoplasm Metastasis ; Neoplasms, Germ Cell and Embryonal ; Neurosurgery ; Papilledema ; Pinealoma ; Prognosis ; Radiotherapy ; Retrospective Studies ; Ventriculoperitoneal Shunt ; Vomiting

Myelodysplastic syndrome (MDS) is a hematologic disorder characterized by peripheral cytopenia and histologic feature of hematologic dysplasia. MDS has rarely been reported in association with Behcet's disease. We describe a patient with MDS associated Behcet's disease and a review of the literature.
Humans ; Myelodysplastic Syndromes*

We experienced a 22-year old patient with a documented history of minimal change nephrotic syndrome (MCNS), and a diagnosis of acute lymphoblastic leukemia (ALL) was then made for this patient. The patient received standard daily steroid therapy for the treatment of nephrotic syndrome. Cyclosporin A was administered because there was no clinical improvement with steroid therapy. Six years after the diagnosis of nephrotic syndrome, the patient was diagnosed with ALL. After chemotherapy for ALL, the patient was in complete remission and he showed clinical improvement of nephrotic syndrome. The hematological malignancies associated with nephrotic syndrome are mainly lymphoma and chronic lymphocytic leukemia. ALL has rarely been described in combination with nephrotic syndrome. Although the exact mechanism for development of ALL after nephrotic syndrome is unknown, at least two possibilities exist. First, the incidence of leukemia may be increased after immunosuppressive therapy, which may include cyclosporin A. Second, the underlying defect in T-lymphocyte function could account for both nephrotic syndrome and ALL. The possible mechanisms for such a relationship are discussed here along with a review of the relevant literature.
Cyclosporine ; Diagnosis ; Drug Therapy ; Hematologic Neoplasms ; Humans ; Incidence ; Leukemia ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymphoma ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; T-Lymphocytes ; Young Adult

BACKGROUND: As of 30 September 2001, a total of 1,515 human immunodeficiency virus(HIV) infected persons has been reported in Korea. The number of newly infected persons tends to increase year by year, with the result that the contacts between HIV infected persons and health care workers (HCW) become more frequent. This survey was to investigate the current state of occupational HIV exposure and postexposure management among HCW in Korea. METHODS: We surveyed retrospectively the cases of occupational HIV exposure reported until the first half of 2001, in total 14 tertiary teaching hospitals. We reviewed these cases for the details about ; i) exposure type. medium and depth of injuty, ii) postexposure prophylaxis(PEP) and follow up serologic test and iii) source patients. RESULTS: Forty-eight cases(65% female, no pregnant woman) of occupational HIV exposure were identified. The number of cases tends to increase rapidly in recent two years. The majority of the exposure occurred in nurses and doctors, after percutaneous needle stick injury. The mean time from exposure to administration of PEP drugs was 20 hours. Of 39 cases receiving the PEP drug, 62% completed all of the drugs as initially prescribed and 31% discontinued all PEP drugs. The reasons for discontinuation included adverse events(9 cases), health care provider judgment(1case), and source patient HIV negative(1case). There was at least one adverse event in 59% of cases receiving the PEP drugs. The most frequent adverse events were gastrointestinal symptoms such as nausea. vomiting, anorexia, and indigestion. So far. there has been no HCW infected with HIV via occupational exposure. Conelusion: Although primary prevention remains the best strategy for protecting HCW from occupational HIV transmission, exposures are nevertheless likely to occur. Systematized PEP programs that include written protocols for prompt reporting, evaluation, counseling, treatment. and follow-up of occupational exposures will be needed for the secondary prevention.
Anorexia ; Counseling ; Delivery of Health Care* ; Dyspepsia ; Female ; Follow-Up Studies ; Health Personnel ; HIV* ; Hospitals, Teaching ; Humans ; Korea* ; Nausea ; Needles ; Occupational Exposure ; Primary Prevention ; Retrospective Studies ; Secondary Prevention ; Serologic Tests ; Vomiting

Gastric tuberculosis is quite rare and usually combined with pulmonary tuberculosis. Its diagnosis is so difficult as it is often unsuspected. We report a patient with gastric tuberculosis who presented with hematemesis in Korea. Upper endoscopy showed large, deep penetrating ulcer containing an exposed vessel and adherent clot in the body. Gastric biopsies revealed only chronic inflammation and no evidence of granuloma or malignancy. Diffuse mural thickening was noted on abdominal CT. The diagnosis was made postoperatively following gastrectomy for bleeding gastric ulcer. Microscopic examination of resected stomach showed peptic detritus and noncaseating granulomas. However, multiple caseating granulomas with Lagerhan's giant cells were found on the examination of lymph nodes. The patient was treated with antituberculous therapy for 12 months without any complications.
Biopsy ; Diagnosis ; Endoscopy ; Gastrectomy ; Giant Cells ; Granuloma ; Hematemesis* ; Hemorrhage ; Humans ; Inflammation ; Korea ; Lymph Nodes ; Stomach ; Stomach Ulcer ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

BACKGROUND: Ascitic fluid infection is frequently associated with gastrointestinal bleeding and heralds poar prognosis in patients with liver cirrhosis. The aims of this study were to assess the incidence of ascitic fluid infection and to determine the risk factors associated with ascitic fluid infection in cirrhotic patients with variceal bleeding. METHODS: Total 148 bleeding cirrhotic patients receiving endoscopic variceal ligation were evaluated. Characteristics of patients and bleeding were compared between the infected group (with ascitic fluid infection) and non-infected group (without ascitic fluid infection). RESULTS: Ascitic fluid infection was detected in 22 (14.9%) of 148 patients. Child-Pugh class B or C (90.9% vs 61.9%, p<0.001), diabetes melitus (36.4% vs 12.7%, p=0.01), systolic blood pressure lower than 90 mmHg (40.9% vs 17.5%, p=0.02), active bleeding (68.1% vs 31.9%, p=0.02), transfusion of 4 pints or more (54.5% vs 20.6%, p=0.002) were more frequently found in infected group compared to non-infected group (n=126). Multivariate analysis showed that Child-Pugh class (p=0.03, R=0.21) and transfusion amount (p=0.02, R=0.34) were independent risk factors of ascitic fluid infection. CONCLUSION: In bleeding cirrhotics with Child-Pugh class B or C or transfusion of 4 pints or more, risk for ascitic fluid infection was high and antibiotic prophylaxis should be considered.
Antibiotic Prophylaxis ; Ascitic Fluid* ; Blood Pressure ; Esophageal and Gastric Varices* ; Fibrosis ; Hemorrhage ; Humans ; Incidence ; Ligation ; Liver Cirrhosis ; Multivariate Analysis ; Prognosis ; Risk Factors*

BACKGROUND/AIMS: Internet has become an important source of medical information not only for medical personnels but also for patients. The aim of this study was to evaluate the quality of internet based medical information about 'gastroesophageal reflux' or 'reflux esophagitis' in Korea. METHODS: The first 15 internet sites using the key words 'gastroesophageal reflux' or 'reflux esophagitis' were retrieved from the 7 most frequently used internet search engines. The quality of information from a total of 108 websites was evaluated using a checklist. RESULTS: Among total 108 sites related to 'gastroesophageal reflux' or 'reflux esophagitis', fifty-six sites (51.8%) were made by hospitals or clinics and 94 sites (87.0%) were made for patients. Of the 108 sites, eleven web sites (10.1%) had more than three JAMA benchmarks (authorship, references, currency, and disclosure). Higher quality sites (at least three JAMA benchmarks) were less likely to contain inaccurate information than lower quality sites (fewer than three JAMA benchmarks)-3/11 (27.2%) vs. 60/97 (61.9%) (p<0.01). Despite the fact that articles in the literature emphasized an insufficient evidence to support an association between the lifestyle, dietary behaviors, and GERD, such guidelines continue to be recommended as first-line therapy in most websites. CONCLUSIONS: Informations about gastroesophageal reflux disease were incomplete in the majority of medical web sites. These would bring about confusion to patients seeking for an information about GERD through the internet. There is a need for better sources in evidence based informations about gastroesophaeal reflux diseases on the web.
Gastroesophageal Reflux/diagnosis/drug therapy/*etiology ; Health Education/*standards ; Humans ; Information Services/standards ; *Internet ; Korea ; Quality of Health Care ; User-Computer Interface

BACKGROUND/AIMS: The rapid urease test (RUT) is an invasive method to diagnose Helicobacter pylori infection, which relies on the acquisition and examination of gastric antrum and body tissues. We determined and compared the efficacy of RUT when the tissues were examined separately or after being combined. METHODS: Two hundred and fourteen patients were included and underwent esophagogastroduodenoscopy from July 2008 to June 2010. The separate test was defined as evaluating the status of infectivity of H. pylori from the antrum and body separately; whereas the united test was carried out putting both tissues from the antrum and body in the same RUT kit. All RUTs were read by a single observer 1, 3, 6, 12, and up to 24 hours later. We also got two biopsy specimens stained with hematoxylin and eosin and quantified H. pylori density was calculated on a scale of 0 to 3. RESULTS: Overall positivity for H. pylori was 137 (64%) for the separate test and 148 (69.2%) for the united test (p<0.01). The mean time to a positive test was 3.58 hours for the separate test and 1.69 hours for the united test (p<0.01). The correlation between the time to positive RUT and the severity of histology showed r=+0.556 for the antrum (p<0.01) and r=+0.622 for the body (p<0.01). CONCLUSIONS: Combining tissues prior to RUT enhances the detection of H. pylori, as compared with the examination of separate tissues, and shortens the time to develop a positive reaction by approximately 50%. These diagnostic advantages are also accompanied by increased cost-savings.
Biopsy ; Endoscopy, Digestive System ; Eosine Yellowish-(YS) ; Helicobacter ; Helicobacter pylori ; Hematoxylin ; Humans ; Pyloric Antrum ; Urease

BACKGROUND/AIMS: Toxoplasmic encephalitis (TE) is one of the most common causes of focal brain lesions, which complicate the course of acquired immunodeficiency syndrome (AIDS). There is wide geographic variation in the prevalence of toxoplasma infection. This study was performed to characterize toxoplasma infection in human immunodeficiency virus (HIV)-infected patients in South Korea. METHODS: We retrospectively examined the incidence and clinical characteristics of TE in 683 HIV-infected patients who were enrolled between 1990 and 2008 at four university hospitals in Busan, Korea. We also assessed the seroprevalence of IgG antibodies to Toxoplasma gondii, risk factors for toxoplasma seropositivity, and seroconversion rates during the course of HIV infection. RESULTS: Among 683 HIV-infected patients, six (0.9%) patients were diagnosed with TE. The incidence of TE was 0.34 per 100 person-years (py) during the study period. Of the 414 patients who had undergone serological examinations for Toxoplasma gondii, 35 (8.5%) patients were seropositive. Univariate analysis showed that the risk factors associated with toxoplasma seropositivity included increased age, heterosexual transmission, marriage, and a history of overseas residence (p<0.05). Of these factors, a history of overseas residence was a significant risk factor in a multivariate analysis (p<0.05). A total of 95 patients who were seronegative on their initial screen showed serial toxoplasma IgG antibodies (mean duration of follow-up, 2.1 years). Among these patients, only two (2.1%) acquired IgG antibodies to Toxoplasma gondii during the follow-up period. CONCLUSIONS: The seroprevalence of anti-toxoplasma IgG antibodies in HIV-infected patients in Korea was 8.5%. A history of overseas residence was a significant risk factor for toxoplasma seropositivity. The incidence of TE was 0.34/100 py, which is lower than that reported in other countries. Toxoplasma seroconversion was also uncommon (2.1%).
Acquired Immunodeficiency Syndrome ; Antibodies ; Brain ; Encephalitis ; Follow-Up Studies ; Heterosexuality ; HIV ; HIV Infections ; Hospitals, University ; Humans ; Immunoglobulin G ; Incidence ; Korea ; Marriage ; Multivariate Analysis ; Prevalence ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Seroepidemiologic Studies ; Toxoplasma