PURPOSE: The aim of this study was to define the capsules of synchronous multicentric small hepatocellular carcinomas (HCCs) with use of high-frequency intraoperative ultrasonography (IOUS). METHODS: Among the 131 consecutive patients undergoing hepatic resection and high-frequency IOUS for HCC, 16 synchronous multicentric small HCCs in 13 patients were histologically diagnosed in the resected specimens. High-frequency IOUS and pathologic findings of these lesions were compared, with particular focus on the presence and appearance of the capsule in or around each lesion. RESULTS: Synchronous multicentric small HCCs were pathologically classified into distinctly nodular (n=12) or vaguely nodular (n=4) types. All 12 distinctly nodular HCCs including six subcentimeter lesions showed detectable capsules on high-frequency IOUS and pathology. The capsules appeared as a hypoechoic rim containing hyperechoic foci (n=6), hypoechoic rim (n=5), or hyperechoic rim (n=1) with varying degrees of coverage around each lesion. Histologically, the capsules were composed of a combination of one to four layers consisting of a fibrous capsule, peritumoral fibrosis, prominent small vessels, and entrapped hepatic parenchyma. CONCLUSION: Synchronous multicentric small HCCs with distinctly nodular type, even at subcentimeter size, can show capsules with varying coverage and diverse echogenicity on high-frequency IOUS.
Capsules ; Carcinoma, Hepatocellular* ; Fibrosis ; Humans ; Liver Neoplasms ; Pathology ; Ultrasonography*

BACKGROUND/AIMS: The distribution of hepatitis C virus (HCV) genotypes varies geographically. In Korea, genotypes 1 and 2 comprise more than 90% of HCV infections, while genotype 6 is very rare. This study compared the clinical and epidemiological characteristics of patients with genotype 6 HCV infection with those infected with HCV genotypes 1 and 2. METHODS: This was a prospective, multicenter HCV cohort study that enrolled 1,173 adult patients, of which 930 underwent HCV genotype analysis, and only 9 (1.0%) were found to be infected with genotype 6 HCV. The clinical and epidemiological parameters of the genotypes were compared. RESULTS: The patients with genotype 6 HCV had a mean age of 41.5 years, 77.8% were male, and they had no distinct laboratory features. A sustained virologic response (SVR) was observed in four (67%) of six patients who received antiviral therapy. Risk factors such as the presence of a tattoo (n=6, 66.7%), more than three sexual partners (n=3, 33.3%), and injection drug use (n=3, 33.3%) were more common among genotype 6 patients than among genotypes 1 or 2. CONCLUSIONS: The epidemiology and treatment response of patients infected with genotype 6 HCV differed significantly from those with genotypes 1 or 2, warranting continuous monitoring.
Adult ; Antiviral Agents/therapeutic use ; Asian Continental Ancestry Group ; Cohort Studies ; Female ; Genotype ; Hepacivirus/*genetics ; Hepatitis C, Chronic/*diagnosis/drug therapy/epidemiology ; Humans ; Liver/pathology ; Male ; Middle Aged ; Prospective Studies ; RNA, Viral/blood ; Republic of Korea ; Risk Factors ; Sexual Behavior ; Substance-Related Disorders/complications ; Tattooing

BACKGROUND/AIMS: The aim of this study was to describe the types and causes of liver disease in patients from a single community hospital in Korea between April 2005 and May 2010. METHODS: A cohort of patients who visited the liver clinic of the hospital during the aforementioned time period were consecutively enrolled (n=6,307). Consistent diagnostic criteria for each liver disease were set by a single, experienced hepatologist, and the diagnosis of all of the enrolled patients was confirmed by retrospective review of their medical records. RESULTS: Among the 6,307 patients, 528 (8.4%) were classified as acute hepatitis, 3,957 (62.7%) as chronic hepatitis, 767 (12.2%) as liver cirrhosis, 509 (8.1%) as primary liver cancer, and 546 (8.7%) as a benign liver mass or other diseases. The etiologies in the acute hepatitis group in decreasing order of prevalence were hepatitis A (44.3%), toxic hepatitis (32.4%), other hepatitis viruses (13.8%), and cryptogenic hepatitis (9.1%). In the chronic hepatitis group, 51.2% of cases were attributed to viral hepatitis, 33.3% to nonalcoholic fatty liver disease, and 13.0% to alcoholic liver disease (ALD). Of the cirrhoses, 73.4% were attributable to viral causes and 18.1% to alcohol. Of the hepatocellular carcinoma cases, 86.6% were attributed to viral hepatitis and 11.6% to ALD. Among the benign tumors, hemangioma comprised 52.2% and cystic liver disease comprised 33.7%. CONCLUSIONS: Knowledge of the current status of the type and cause of liver disease in Korea may be valuable as a basis for evaluating changing trends in liver disease in that country.
Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking/adverse effects ; Carcinoma, Hepatocellular/epidemiology/etiology/pathology ; Chronic Disease ; Cohort Studies ; Fatty Liver/epidemiology ; Female ; Hepatitis/epidemiology ; Hepatitis, Viral, Human/complications/epidemiology ; Humans ; Liver Cirrhosis/epidemiology/etiology ; Liver Diseases/*diagnosis/epidemiology ; Liver Diseases, Alcoholic/complications/epidemiology ; Liver Neoplasms/epidemiology/etiology/pathology ; Male ; Middle Aged ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Young Adult

Thioredoxin-1 (Trx-1) is one of important anti-oxidative molecules to overcome the oxidative stress. The aim of the present study is to investigate the clinical relationship between serum concentration of Trx-1 on the pre-percutaneous coronary intervention (prePCI) and myocardial damage amount in the patients with acute myocardial infarction with the culprit lesion in only the left anterior descending artery on coronary angiography (n = 100). Initial value of creatine kinase (CK) was 368.3 +/- 531.4 U/L, and MB isoenzyme of CK (CK-MB) level was 22.92 +/- 33.8 ng/mL, and cardiac specific troponin T (cTnT) level was 0.61 +/- 1.6 ng/mL. Positive correlations were observed between prePCI Trx-1 level and initial CK (P = 0.005, r = 0.281), and cTnT (P < 0.001, r = 0.453), peak CK (P = 0.001, r = 0.316) in all patients, but the statistical relation was observed only in ST segment elevation myocardial infarction (STEMI) patients (P = 0.008, r = 0.329 for initial CK, P = 0.001, r = 0.498 for initial cTnT, P = 0.005, r = 0.349 for peak CK), not in Non-STEMI patients. Conclusively, we consider prePCI serum Trx-1 as a predictor for myocardial damage amount in patients with STEMI.
Acute Disease ; Adult ; Aged ; Biological Markers/blood ; Coronary Angiography ; Creatine Kinase/blood ; Creatine Kinase, MB Form/blood ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*blood/pathology ; Myocardium/*pathology ; Percutaneous Coronary Intervention ; Thioredoxins/*blood ; Troponin T/blood

BACKGROUND/AIMS: Hepatitis A is increasing during the recent years in Korea, and sporadic cases of hepatitis E are not rare. We investigated the etiology of acute viral hepatitis, including 27 cases of coinfection with hepatitis A and E, during the last 3 years. METHODS: Retrospective analysis of one hundred eleven patients with acute viral hepatitis at Chung-Ang University Hospital was done from January 2005 to July 2007. The patients were positive for any one of the following tests: IgM anti-HAV, IgM anti-HBc, HCV RNA and IgM anti-HEV. RESULTS: The proportions of acute viral hepatitis A, B and C were 94.6% (105/111), 4.5% (5/111) and 0.9% (1/111), respectively. Among the patients with hepatitis A, 27 patients (24.3%) were positive for IgM anti-HEV. We analyzed 105 patients with either hepatitis A only or they had coinfection of hepatitis A and E. The mean age, the duration of the hospital stay, the mean levels of serum transaminase, bilirubin and albumin and the protrombin time were similar between the patients with hepatitis A only and those with coinfection of hepatitis A and E. All the patients were discharged without serious complication such as fulminant hepatic failure. The biochemical liver function tests were normalized in all patients within 8 weeks. CONCLUSIONS: The most common etiology of acute viral hepatitis in Koreans was the hepatitis A virus. Patients coinfected with hepatitis A and E were observed. The patients with coinfection of hepatitis A and E showed no significant difference in their clinical features and laboratory parameters, as compared to the patients with hepatitis A only.
Bilirubin ; Coinfection ; Hepatitis ; Hepatitis A ; Hepatitis A Antibodies ; Hepatitis A virus ; Hepatitis E ; Humans ; Immunoglobulin M ; Korea ; Length of Stay ; Liver Failure, Acute ; Liver Function Tests ; Retrospective Studies ; RNA

Burkitt's lymphoma is a rare disease that belongs to the aggressive non-Hodgkin's lymphoma. Herein, we report a case of primary hepatic Burkitt's lymphoma. A 19-year-old man visited the hospital for right upper quadrant pain. He felt fatigue for two months. Physical examination revealed hepatomegaly and no palpable lymph node. He had no fever, weight loss, or night sweating. Laboratory finding showed mild anemia (hemoglobin, 12.4 g/dL), mild elevated transaminase (ALT, 52 IU/L), elevated lactate dehydrogenase (LDH, 437 IU/L), and alkaline phosphatase (ALP, 129 IU/L). The viral marker was positive for HBsAg, HBeAg, anti-HBs, and anti-HBc (IgG), and negative for anti-HBe, anti-HCV, and anti-HIV. CEA, AFP, and CA19-9 levels were within normal ranges. The HBV DNA quantitation was 1.3x10(9) copies/ml. Abdominal-Pelvis CT scan and abdominal MRI finding were compatable with malignant lymphoma. Liver biopsy examination confirmed Burkitt's lymphoma. No metastasis was detected in the thoracic cavity, bone marrow, and spinal fluid. The patient was treated with the combination regimen of cyclophosphamide, doxorubicin, vincristine, prednisone and high dose methotrexate. Cytosine arabinoside and methotrexate were added for CNS prophylaxis by intrathecal installation. Chemotherapy was administered every 3 weeks for fifteen cycles. Serial follow-up CT scan showed a marked decrease in the size of hepatic lesions. Follow-up CT scan and PET-CT scan were perfomed 4 weeks after the final cycle disclosed no definite residual or active lesion confirming the state of complete remission.
Antimetabolites, Antineoplastic/therapeutic use ; Burkitt Lymphoma/*diagnosis/drug therapy/pathology ; Combined Modality Therapy ; Cytarabine/therapeutic use ; Diagnosis, Differential ; Humans ; Liver Neoplasms/*diagnosis/drug therapy/pathology ; Male ; Methotrexate/therapeutic use ; Tomography, X-Ray Computed ; Young Adult

BACKGROUND/AIMS: Diabetes mellitus (DM) is associated with an increased incidence of colon cancer. However, the relationship between DM and colorectal adenoma is not definite. In this study, we sought to determine the association between DM and the prevalence of colorectal adenoma. METHODS: We enrolled 606 patients with DM and 606 asymptomatic adults who underwent colonoscopy for routine health evaluations from June 2003 to June 2007. The frequency and characteristics of the colorectal adenomas were analyzed and compared between the two groups. RESULTS: The sex ratio and mean age were 1.67:1 (M:F) and 58.1+/-10.6 years, respectively, in patients with DM, and 1.68:1 and 57.6+/-8.9 years, respectively, in patients without DM, and these values were similar. The frequency of colorectal adenoma was 33.2% for the patients with DM and 32.3% for the patients without DM. The frequency, location, number, size and histopathologic findings of the colorectal adenomas were not different between the two groups. Among the patients with DM, the frequency of colorectal adenoma was 35.7% in the patients treated with oral hypoglycemic agents and 31.4% in the patients treated with insulin. Also, the other characteristics of the colorectal adenomas were not different according to the treatment method. CONCLUSIONS: The frequency and characteristics of colorectal adenomas were not different between the patients with and without DM.
Adenoma ; Adult ; Colonic Neoplasms ; Colonoscopy ; Diabetes Mellitus ; Humans ; Hypoglycemic Agents ; Incidence ; Insulin ; Prevalence ; Sex Ratio

We report here on an unusual case of mucinous cystic tumor that was associated with endometriosis in the cecum. A 45-year-old woman was admitted to the hospital due to her 5 day history of right lower quadrant abdominal pain with a mild fever. A laparotomy was performed under the clinical impression of the tubo-ovarian abscess. A relatively well defined a multi-locular cystic mass (8.0x8.0x7.0 cm) filled with white-to-yellow thick mucoid material was found in the wall of the cecum. The right ovary and fallopian tube showed marked fibrous adhesion to the external surface of the cecal mass. A right hemicolectomy and salpingo-oophorectomy were performed. Histologically, the tumor was similar to those of ovarian borderline mucinous tumor, the intestinal type, and the mucinous epithelium of the tumor was merged with the endometriotic epithelium and stroma. On immunostaining, the CK20 positive mucinous epithelium was well demarcated from the CK7 endometriotic epithelium. This is the first case of low-grade mucinous cystic tumor intimately associated with intestinal endometriosis in the cecum.
Abdominal Pain ; Abscess ; Cecum* ; Endometriosis ; Epithelium ; Fallopian Tubes ; Female ; Fever ; Humans ; Laparotomy ; Middle Aged ; Mucins* ; Ovary

A 67-year-old man presented with a 3-month history for intermittent epigastric pain and postprandial discomfort. Upper gastrointestinal endoscopy and contrast-enhanced axial computed tomographic scan demonstrated two separate tumors of the gastric antrum and the duodenal second portion, suggestive of the preoperative diagnosis of a double primary cancer. Pancreaticoduodenectomy with lymph node dissection was performed, and the microscopic features and immunohistochemical profiles of the resected specimen confirmed the diagnosis of the composite neuroendocrine carcinoma with adenocarcinoma of the stomach (mixed exocrine-endocrine carcinoma).
Adenocarcinoma* ; Aged ; Carcinoma, Neuroendocrine* ; Diagnosis ; Endoscopy, Gastrointestinal ; Humans ; Lymph Node Excision ; Neuroendocrine Tumors ; Pancreaticoduodenectomy ; Pyloric Antrum ; Stomach*

Isolated injury of the gallbladder rarely occurs after blunt abdominal trauma and, if so, is usually associated with damage to other intra-abdominal organs clearly necessitating surgical intervention. Blunt abdominal trauma is often overlooked because there may be no visible signs on the abdominal wall. It is important to closely follow patients and look for early signs of organ damage, as isolated injury of the gallbladder often follows a vague and insidious clinical course. A combination of special investigations may be required to confirm the diagnosis of this relatively rare but serious injury. Our case was a 38-year-old female, admitted to the hospital with a history of blunt abdominal trauma secondary to a fall. Initial computed tomographic scan demonstrated an edematous gallbladder; a follow-up computed tomographic scan showed a 5-cm collection of fluid around the gallbladder, suspicious for gallbladder perforation. Diagnostic laparoscopy followed by laparoscopic cholecystectomy was performed without complications. The postoperative course was uneventful and the patient was discharged on postoperative day three.
Abdominal Wall ; Adult ; Cholecystectomy, Laparoscopic ; Diagnosis ; Female ; Follow-Up Studies ; Gallbladder* ; Humans ; Laparoscopy