BACKGROUND/AIMS: Computed tomography during arterial portography and computed tomography during hepatic arteriography (CTAP and CTHA), one of the most sensitive method in detection of hepatocellular carcinoma (HCC) nodules , is reported to reduce unnecessary operation of HCC. However, it is not clear whet her CT AP and CT HA can reduce early post operative recurrence rate of HCC. We performed this study to find any differences in early postoperative recurrence rate of HCC according to the imaging modalities used for preoperativest aging. METHODS: Ninety-seven patients with HCC who had underg one curative hepat icres ection from Dec.1994 to Mar. 1998 were included (median age = 52 years (26-78), M:F = 85:12). They were classified into 3 groups according to the imaging methods used for preoper ative staging: CTAP & CTHA group (n=56), Lipiodol CT group (n=24), and three phase helical CT group (n=16). No significant inter-group difference was found in preoperative status of the patients or characteristics of HCC. One-year recurrence rates were compared by log-rank test. RESULTS: HCC recurred in 17 of 97 patients (18.7%) within 12 months. A significant difference in 1- year recurrence rate was observed between the groups: helical CT , may be a superior imaging modality for preoperative staging of HCC that can reduce early postoperative recurrence rate.
Aging ; Angiography ; Carcinoma, Hepatocellular* ; Ethiodized Oil* ; Humans ; Portography ; Recurrence* ; Tomography, Spiral Computed*

BACKGROUND/AIMS: The aim of this study was to evaluate the feasibility of alpha-fetoprotein (AFP) as a diagnostic tool for hepatocellular carcinoma (HCC) in Korean patients. METHODS: We retrospectively reviewed the medical records of HCC and cirrhosis patients at three hospitals. For each HCC patient, a cirrhosis patient matched for age, sex, etiology, and Child-Pugh classification was selected by simple random sampling. The performance of AFP in the diagnosis of HCC was determined using receiver operating characteristic curve analysis. RESULTS: A total of 732 patients with HCC or cirrhosis were selected for each case and the control groups. The mean age was 54 years, and 72.4% of patients were male. The mean serum AFP levels in the HCC group and cirrhosis group were 3,315.6 and 117.2 ng/mL, respectively (p < 0.001). The area under the receiver operating characteristic curve for all HCC patients was 0.757. The sensitivity, specificity, and positive predictive value of AFP was 50.55%, 87.70%, and 80.43%, respectively, at a cut-off of 20 ng/mL; 37.70%, 95.90%, and 90.20%, respectively, at a cut-off of 100 ng/mL, and 30.05%, 97.27%, and 91.67%, respectively, at a cut-off of 200 ng/mL. A cut-off of 100 ng/mL was more sensitive than one of 200 ng/mL with equivalent specificity and positive predictive value. CONCLUSIONS: The cut-off AFP value for early-stage HCC was 17.4 ng/mL. Our study cautiously suggests that AFP has a role in the diagnosis of HCC, and that the appropriate value of AFP for the diagnosis of HCC may be 100 ng/mL rather than 200 ng/mL.
Aged ; Area Under Curve ; Carcinoma, Hepatocellular/*blood/*diagnosis/pathology ; Feasibility Studies ; Female ; Humans ; Liver Neoplasms/*blood/*diagnosis/pathology ; Male ; Middle Aged ; Neoplasm Staging ; Predictive Value of Tests ; ROC Curve ; Republic of Korea ; Retrospective Studies ; alpha-Fetoproteins/*analysis

BACKGROUND/AIMS: The heavy metals like cadmium (Cd) are neither destroyed nor produced in human body and may infiltrated into air, water, soil, food, human body and redistributed by biological and geographical circulation. With advent of recent industrialization detrimental heavy metal poisoning in human body is increased by industrial pollution. We aimed to establish the relative abilities of chelators to mobilized liver cadmium contents in chronic cadmium intoxication rats. METHODS: Sprague-Dawley albino male rats weighing 200 to 250 mg were used. All animals were loaded with 3 intraperitoneal injections of cadmium chloride (1.5 mg/kg) given at % hourly interval. Intraperitoneal injection of chelators commenced 1 week after the last loading injection and continued every 72 hour for a total of 10 injections. Chelators were given at a level of 1 mmole/kg (except 0.01 mmol/kg of BAL). The chelators used in present experiment are 1,2-diaminocyclohexane tetra acetate (CDTA), disodium calcium ethylene diamine tetra acetate (EDTA), sodium 2.3-dimer capto propane sulfonate (DMPS), sodium di ethyl dithio carbamate (DDTC), dimercapto succinate (DMSA), 2,3-dimer capto propanol (BAL), diethylene triamine penta acetate (DTPA), triethylene tetr amine hexa acetate (TTHA), D-penicillamine(DPA), Nacetyl penicillamine (NAPA). RESULTS: 1) The residual liver cadmium content was reduced in rats administered DPA, EDTA, NAPA, CDTA, DDTC and DMSA (32%, 23%, 19%, 17%, 16% and 15% respectively) compared with control group. 2) The residual kidney cadmium content was reduced in rats administered DPA, DDTC, CDTA and EDTA (33%, 21%, 18% and 17% respectively) 3) The summation of residual cadmium content in liver and kidney was reduced in rats administered DPA, EDTA, DDTC and CDTA (33%, 20%, 18% and 17% respectively) compared with control group. CONCULUSIONS: We suggested that DPA, EDTA, CDTA and DDTC might have protective role against the toxic effects of cadmium.
1-Propanol ; Animals ; Cadmium Chloride ; Cadmium* ; Calcium ; Characidae ; Chelating Agents* ; Edetic Acid ; Human Body ; Humans ; Injections, Intraperitoneal ; Kidney ; Liver* ; Male ; Metals, Heavy ; Penicillamine ; Poisoning ; Propane ; Rats* ; Rats, Sprague-Dawley ; Sodium ; Soil ; Succimer ; Succinic Acid

BACKGROUND/AIMS: Combined computed tomography during arterial portography(CfAP) and computed tomography during hepatic arteriography(CBiA) are more sensitive methods compared to conventional spiral CT in detecting small hepatocellular carcinoma. However, there are few data available on the influence of combined CTAP and CTHA on decision making for treatment of hepatocellular carcinoma. We aimed to evaluate the usefulness of CTAP and CfHA as a preoperative study of hepatocellular carcinoma for surgical treatment. METHODS: Eighty-two patients with histologically proven hepatocellular carcinoma who were considered to be surgical candidates on spiral CT and angiography were included. CfAP and CTHA were performed as the routine protocol. The findings of CTAP and CTHA were analyzed and compared to conventianal spiral Cl and angiography. ReESULTS: 1) 105 nodules were found on spiral Cf plus angiography, whereas, 138 nodules found on combined CIAP and CTHA: 33 additional nodules were found in 23 cases(28%). 2) The treatment plan changed from surgery to nonsurgical treatment in 10(12%) cases: 9 cases(10%) with bilobar involvement, and 1 case (1%) with more than three nodules. 3) The larger the tumor nodules on the spiral CT, the more additional tumor nodules were found on CTAP and CTHA: combined CTAP and CTHA were able to find more nodules in 21% of tumor < 3cm, 27% of tumor with 3 - 10cm, and 71% of tumor >10cm on spiral CI' (p=0.03). CONCLUSION: Compared to spiral CT plus angiography, CI'AP and CfHA may be useful in avoiding unnecessary operation of hepatocellular carcinoma, especially in large tumors.
Angiography ; Carcinoma, Hepatocellular* ; Decision Making ; Humans ; Tomography, Spiral Computed

In Korea, careinoma of the cervix is the most common malignancy in women annually affecting 25 per every 100,000 female. The widespread use of the Papanicolaou smear has resulted in earlier detection of the tumor and a reduction in the number of patients with advanced disease, but the incidence of cervix. carcinoma is still the fifth most common malignancy in the world. Cervical carcinoma spreads to the small bowel primarily by direct extension from involved lymph nodes, most commonly from peraaortic or mesenteric nodes to the serosa of the bowel. But, the involvement of small bowel by cervical carcinoma is so rare, and shows a maximum incidence of small bowel involvement of less than 1.5%. We report a patient with squamous cell carcinoma of the cervix metastases to the second portion of the duodenum in whom the diagnosis was made by endoscopic biopsy of the lesion.
Biopsy ; Carcinoma, Squamous Cell ; Cervix Uteri ; Diagnosis ; Duodenum* ; Esophagus* ; Female ; Humans ; Incidence ; Intestines* ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Papanicolaou Test ; Serous Membrane ; Stomach*

BACKGROUND/AIMS: Perioperative endoscopic retrograde cholangiopancreatography (ERCP) and en copic sphincterotomy (EST) offer the ability to remove common bile duct (CBD) stones and it ean make laparoscopic cholecystectcqny possible instead of open cholecystectomy. Although ERCP accurately detects CBD stones, the associated financial costs and potential morbidity argue against its indiscriminate use. Thus, we undertook the current retrospective study to analyze our own experience in the identification of preoperative indicators of CBD stones in patients managed by laparoscopic cholecystectomy. METHODS: Between October 1994 and October 1996, 503 laparoscopic cholecystectomy were performed at Samsung Medical Center. We analyzed the value of serum biochemical tests and findings of ultrasonography in patients ted by laparoscopic cholecystectomy. RESULTS: A total of 117 patients underwent perigperative ERCP; 113 patients underwent preoperative ERCP with 2/113 (1.8%) failing to cannulate the ampulla; 21 patients (18.0%) had choledocholithiasis; and all patients with CBD stones were cleared by EST without major complications. The indication of ERCP for prediction of CBD stones were categorized as 4 groups; abnormal liver function tests (LFT) and duct dilatation in ultrasonography 61.9% (13/22), only abnormal liver function tests 13.6% (6/44), only duct dilatation in ultrasonography 5,9% (1/17), and normal liver function tests with normal findings in ultrasonopaphy 2.9% (1/35) in this study. In patients with CBD stones, there was no significant difference to predict CBD stones in total bilirubin, alkaline phosphatase, and alanine aminotransferase. Gallstone pancreatitis patients who had hyperamylasemia and abnornal LFT that were resolved or resolving before ERCP revealed no CBD stones (0/10, 0%). CONCLUSIONS: ERCP before laparoscopic cholecystectomy is needed in selected patients who have abnormal liver function and/or CBD dilatation on ultrasonography. Gallstone pancreatitis that is resalving or resolved clinically may not require preoperative ERCP. ERCP with EST and laparoscopic cholecystectomy is a safe and effective method for the management of symptomatic eholelithiasis and choledocholithiasis.
Alanine Transaminase ; Alkaline Phosphatase ; Biliary Tract* ; Bilirubin ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Choledocholithiasis ; Common Bile Duct ; Dilatation ; Gallstones ; Humans ; Hyperamylasemia ; Liver ; Liver Function Tests ; Pancreas* ; Pancreatitis ; Retrospective Studies ; Ultrasonography

Disappearance of hepatitis B surface antigens (HBsAg) in chronic hepatitis B usually indicates clearance of hepatitis B virus (HBV) infection. However, false HBsAg negativity with mutations in pre-S2 and 'a' determinant has been reported. It is also known that YMDD mutations decrease the production of HBV and escape detection of serum HBsAg. Here, we report overlapping gene mutations in a patient with HBsAg loss during the lamivudine therapy. After 36 months of lamivudine therapy in a 44-yrold Korean chronic hepatitis B patient, serum HBsAg turned negative while HBV DNA remained positive by a DNA probe method. Nucleotide sequence of serum HBV DNA was compared with the HBV genotype C subtype adr registered in NCBI AF 286594. Deletion of nucleotides 23 to 55 (amino acids 12 to 22) was identified in the pre-S2 region. Sequencing of the 'a' determinant revealed amino acid substitutions as I126S, T131N, M133T, and S136Y. Methionine of rtM204 in the P gene was substituted for isoleucine indicating YIDD mutation (rtM204I). We identified a HBV mutant composed of pre-S2 deletions and 'a' determinant substitutions with YMDD mutation. Our result suggests that false HBsAg negativity can be induced by combination of overlapping gene mutations during the lamivudine therapy.
Adult ; Amino Acid Sequence ; Anti-HIV Agents/therapeutic use ; Base Sequence ; Comparative Study ; DNA Mutational Analysis ; DNA, Viral/blood/chemistry/genetics ; DNA-Directed DNA Polymerase/genetics ; Gene Deletion ; Genes, Overlapping/*genetics ; Hepatitis B Surface Antigens/blood/*genetics ; Hepatitis B virus/*genetics ; Hepatitis B, Chronic/blood/*drug therapy/virology ; Humans ; Lamivudine/*therapeutic use ; Male ; Molecular Sequence Data ; *Mutation ; Protein Precursors/genetics ; Sequence Alignment ; Sequence Homology, Amino Acid ; Sequence Homology, Nucleic Acid ; Viral Proteins/genetics

OBJECTIVES: The pathogenesis of nonalcoholic fatty liver in non-obese persons is poorly understood. We aimed to elucidate whether hyperinsulinemia and glucose intolerance are associated with development of fatty liver in patients with normal body weight. METHODS: Forty-seven patients with fatty liver were divided into non-obese (n = 25) and obese groups (n = 22) according to age adjusted body mass index. Inclusion criteria were as follows: (1) elevated transaminase levels during more than 3 months of follow up period, (2) no detectable HBsAg or anti-HCV in the serum, (3) alcohol consumption less than 40 gm/week, (4) no use of potential hepatotoxic drugs within 3 months and (4) sonographic evidence of fatty liver(moderate to severe degree). Baseline insulin levels and oral glucose tolerance test using 75gm of glucose were performed and the results were compared in each group of patients. RESULTS: Mean baseline insulin levels were elevated in both groups above the reference value, 9.3 +/- 3.5 microU/L in non-obese group and 9.9 +/- 3.5 microU/L in obese group (p = 0.26). Seventeen of non-obese patients (68%) had elevated basal insulin level and 16 of obese patients (73%) had elevated basal insulin level (p = 0.39). In oral glucose tolerance test, there was no difference in glucose level between non-obese and obese groups from O minute to 180 minutes (p > 0.05). Eleven patients from the non-obese group (44%) and 8 patients from the obese group (36%) had either impaired glucose tolerance or diabetes (p = 0.29). CONCLUSION: Our data suggest that hyperinsulinemia and glucose intolerance may play a role in the pathogenesis of fatty liver in patients with normal body weight as well as in patients with obesity.
Adult ; Body Weight ; Fatty Liver/pathology ; Fatty Liver/etiology* ; Fatty Liver/blood ; Female ; Glucose Intolerance/complications* ; Human ; Insulin/blood* ; Insulin Resistance ; Male ; Middle Age ; Obesity/complications

BACKGROUND/AIMS: We assessed the clinical features and prognosis of acute viral hepatitis A (AHA) complicated with acute kidney injury (AKI) and elucidated predictive factors for AKI in patients with AHA. METHODS: We reviewed medical record of 391 patients with AHA admitted at our institution since 2000. RESULTS: AKI was present in 45 patients (11.5%). The proportion of the AKI group increased since 2008 (5.4% before 2008 vs. 15.9% since 2008, p=0.001). The AKI group was older than the non-AKI group (35.7+/-8.7 years vs. 31.3+/-7.8 years, p=0.002). Other baseline clinical characteristics were similar between two groups. Initial hemoglobin, platelet, and serum albumin were significantly low and prothrombin time, serum bilirubin, creatinine, AST, and ALT were significantly high in the AKI group. Hepatic encephalopathy, ascites, gastrointestinal bleeding, and sepsis were more frequently observed in the AKI group. While six patients (13%) in the AKI group received liver transplantation (LT) but three patients died within one month, one patient in the non-AKI group receiving LT is alive. Multivariate analysis showed that older age (OR 1.07, 95% CI 1.02-1.12), initial thrombocytopenia <150,000/mm2 (OR 2.85, 95% CI 1.24-6.57), prothrombin time (PT) prolongation (OR 5.34, 95% CI 2.55-11.19), and hypoalbuminemia (OR 8.24, 95% CI 2.53-26.86) were independently associated with the occurrence of AKI. CONCLUSIONS: AHA with AKI is an increasing problem showing significant morbidity and mortality in Korea. AKI is highly associated with older age, initial thrombocytopenia, PT prolongation, or low serum albumin, and has bad prognostic effect.
Acute Disease ; Acute Kidney Injury/complications/*diagnosis/therapy ; Adult ; Age Factors ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Bilirubin/blood ; Creatine/blood ; Female ; Hemoglobins/analysis ; Hepatitis A/complications/*diagnosis ; Humans ; Hypoalbuminemia/complications ; Liver Transplantation ; Male ; Middle Aged ; Odds Ratio ; Platelet Count ; Predictive Value of Tests ; Prognosis ; Prothrombin Time ; Serum Albumin/analysis ; Thrombocytopenia/complications

Hepatocellular carcinoma (HCC) is one of the most common malignancies. Many factors are considered to be etiology associated with HCC; the important factors are hepatitis B and C viruses and alcohol. Cirrhosis is present in the majority of patients with HCC. It is assumed that all diseases, which lead to liver cirrhosis, may be complicated by the development of HCC. We report a 36-year-old man with HCC which developed from cardiac cirrhosis caused by constrictive pericarditis in whom both hepatitis B virus and hepatitis C viral marker tests were all negative. CT scan of his heart showed pericardial calcification with diastolic dysfunction of right ventricle. Abdominal CT scan revealed mottled mosaic pattern of contrast enhancement of liver parenchyme and two hepatic lesions that were considered to be HCCs. Left lateral segmentectomy of liver was performed. There were two well-circumscribed masses which were confirmed to be HCC and the remaining hepatic parenchyma showed bridging fibrosis between central zonal regions. To our knowledge, this is the first case of HCC complicating cardiac cirrhosis in Korea.
Adult ; Bromhexine ; Carcinoma, Hepatocellular/*complications/radiography ; Humans ; Liver Cirrhosis/*complications/radiography ; Liver Neoplasms/*complications/radiography ; Male ; Pericarditis, Constrictive/*complications/radiography