Cerebrovascular lesions during pregnancy, although uncommon, account for a significant number of maternal deaths. Maternal mortality related to stroke is usually associated with eclampsia complicated by cerebral edema or intracerebral hemorrhage. At times, hypertensive intracerebral hemorrhage, cerebral arteriovenous malformation, and moyamoya disease may also be related. Nine patients with cerebrovascular disease during pregnancy were reviewed. The mean age of pregnancy related hypertensive intracerebral hemorrhage was 32.1+/-6.6years and the time of attack was intrauterine pregnancy(IUP) 27.2+/-13.8 weeks. The basal ganglia hemorrhage was noted in 55.5%(5 ca-ses), followed by intraventricular hemorrhage(IVH)(4 cases) and subcortical hemorrhage(3 cases). The pregnancy related hypertensive intracerebral hemorrhage was developed more often in multigravida(6 out of 9) than in priemiparous woman. Good outcome was expected in patients with subcortical location(p=0.058), primigravida(p=0.058), and high initial GCS score(p=0.056).
Basal Ganglia Hemorrhage ; Brain Edema ; Cerebral Hemorrhage ; Eclampsia ; Female ; Humans ; Intracranial Arteriovenous Malformations ; Intracranial Hemorrhage, Hypertensive ; Maternal Death ; Maternal Mortality ; Moyamoya Disease ; Pregnancy* ; Stroke

Acase of 14-year-old student is presented with the complaint of recurrent attack of transient quadriparesis during hyperextension of the neck. On 3-dimensional spinal CT and MRI, the authors confirmed intrusion of posterior tubercle of the atlas with increased signal on T1- and T2- weighted image was found. The clinical manifestations were improved without having cervical instability after a posterior laminectomy of the atlas.
Adolescent ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Neck ; Quadriplegia*

BACKGROUND/AIMS: This study assessed the antiviral efficacy and safety of tenofovir disoproxil fumarate (TDF) for up to 12 months in Korean treatment-naive chronic hepatitis B (CHB) patients. METHODS: A total of 411 treatment-naive CHB patients who had been treated with TDF for at least 3 months (median 5.6) were consecutively enrolled. Clinical, biochemical, virological parameters and treatment adherence were routinely assessed every 3 months. RESULTS: The median age was 51.3 years, 63.0% of the patients were male, 49.6% were HBeAg (+), and 210 patients had liver cirrhosis. The median baseline HBV DNA was 5.98 (SD 1.68) log10 IU/mL. Among the patients completing week 48, 83.3% had a complete virologic response (CVR, <12 IU/mL by HBV PCR assay), and 88.2% had normalized levels of alanine aminotransferase (ALT). The cumulative probabilities of CVR at 3, 6, 9 and 12 months were 22.8%, 53.1%, 69.3% and 85.0%. During the follow-up period, 9.8% patients achieved HBeAg loss and 7.8% patients achieved HBeAg seroconversion. There was no virological breakthrough after initiating TDF. The most common TDF-related adverse event was gastrointestinal upset, and three patients discontinued TDF therapy. However, no serious life-threatening side effect was noted. CONCLUSIONS: In a clinical practice setting, TDF was safe and highly effective when administered for 12 months to Korean treatment-naive CHB patients.
Adenine/adverse effects/*analogs & derivatives/therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; Antiviral Agents/adverse effects/*therapeutic use ; Cohort Studies ; DNA, Viral/blood ; Female ; Gastrointestinal Diseases/epidemiology/etiology ; Hepatitis B e Antigens/blood ; Hepatitis B virus/genetics ; Hepatitis B, Chronic/complications/*drug therapy/virology ; Humans ; Liver Cirrhosis/etiology ; Male ; Middle Aged ; Organophosphonates/adverse effects/*therapeutic use ; Republic of Korea ; Retrospective Studies ; Treatment Outcome ; Young Adult

PURPOSE: Refractory ascites (RA) is closely related to a high morbidity and mortality. In this study, we investigated predictors of RA development in patients with hepatitis B virus (HBV)-related cirrhosis who were hospitalized to control ascitic decompensation, and determined predictors for survival in patients who experienced RA. MATERIALS AND METHODS: We analyzed 199 consecutive patients with HBV-related cirrhosis who were hospitalized to control ascitic decompensation between January 1996 and December 2008. RESULTS: Multivariate analyses showed that only serum potassium at admission predicted RA development independently [p=0.013; hazard ratio (HR), 2.800; 95% confidence interval (CI), 1.166-6.722]. During the follow-up period, 16 (8.0%) patients experienced RA within 4.2 (range, 1.0-39.2) months after admission for controlling ascitic decompensation, and they survived a median of 8.7 (range, 3.9-51.3) months. Child-Pugh class and RA type were identified as independent prognostic factors affecting the survival in patients with RA (p=0.045; HR, 8.079; 95% CI, 1.231-67.984 and p=0.013; HR, 14.510; 95% CI, 1.771-118.874, respectively). CONCLUSION: Serum potassium was an independent predictor of RA development in patients with HBV-related cirrhosis who were hospitalized to control ascitic decompensation. After RA development, Child-Pugh class and RA type were independent predictors for survival.
Adult ; Aged ; Ascites/complications/*diagnosis/mortality ; Female ; Hepatitis B, Chronic/complications/mortality/*therapy ; Hospitalization ; Humans ; Liver Cirrhosis/complications/mortality/*therapy ; Liver Transplantation ; Male ; Middle Aged ; Multivariate Analysis ; Potassium/blood ; Prognosis ; Retrospective Studies ; Treatment Outcome

Hepatocellular carcinoma (HCC) is one of the cancers with poor prognosis. However, surgical resection is the treatment of choice as curative aim for early HCC with preserved liver function. A 5 year survival rate after curative resection is over 50%. We experienced a case of rapidly recurred HCC with bone metastasis after surgical resection. In our case, microscopically microvessel invasion was present after resection. Microvascular invasion (MVI) is an important factor to influence survival and/or HCC recurrence. So we suggested the patients with MVI need to follow up intensively and adjuvant therapy may be considered.
Carcinoma, Hepatocellular* ; Follow-Up Studies ; Humans ; Liver ; Microvessels ; Neoplasm Metastasis* ; Prognosis ; Recurrence ; Survival Rate

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) with Barcelona Clinic Liver Cancer (BCLC) intermediate stage includes a highly heterogeneous population. Here, we aimed to sub-classify hepatocellular carcinoma with BCLC intermediate stage for better prognostification. METHODS: Between 2003 and 2008, 325 patients who were newly diagnosed as HCC with BCLC intermediate stage were considered eligible. Tumor factor and liver function were used for sub-classification. Overall survival (OS) was analyzed using Kaplan-Meier method with a comparison by log-rank test. RESULTS: A total of 325 patients with intermediate stage HCC were analyzed. Patients with tumor size ≥7 cm, tumor number ≥4 and Child-Pugh class B had the worse OS compared to those with tumor size <7 cm, tumor number <4 and Child-pugh class A, respectively (all P<0.05). These three variables affected the OS independently from multivariate Cox regression analysis (all P<0.05). So, using these three variables, patients were finally sub-classified as those with fulfilling none of three factors (B-a), one of three factors (B-b), two of three factors (B-c) and all of three factors (B-d) with the median OS of 39.2, 20.6, 12.0 and 8.3 months with statistical significances (all P<0.05 between B-a and B-b, between B-b and B-c, and between B-c and B-d), respectively. CONCLUSIONS: Sub-classification of HCC with BCLC intermediate stage may be useful in not only prognostification but also guidance of treatment strategies.
Carcinoma, Hepatocellular* ; Humans ; Liver Neoplasms* ; Liver* ; Prognosis

BACKGROUND/AIMS: The renal effects of nucleos(t)ide analogs in patients with chronic hepatitis B are controversial. We aimed to compare the impact of entecavir (ETV) and tenofovir (TDF) on renal function in patients with hepatitis B virus (HBV)-related cirrhosis. METHODS: We performed a retrospective cohort study of 235 consecutive treatment-naïve patients with HBV-related cirrhosis who were treated with ETV or TDF between December 2012 and November 2013 at Severance Hospital, Seoul, Korea. RESULTS: Compensated cirrhosis was noted in 183 patients (ETV 130, TDF 53), and decompensated cirrhosis was noted in 52 patients (ETV 32, TDF 20). There were no significant changes in estimated glomerular filtration rates (eGFR) from baseline in either the ETV- or TDF-treated groups at week 96 (Chronic Kidney Disease Epidemiology Collaboration, ETV −1.68% and TDF −5.03%, p=0.358). Using a multivariate analysis, the significant factors associated with a decrease in eGFR >20% were baseline eGFR, diabetes mellitus (DM), and the use of diuretics. The use of antiviral agents and baseline decompensation were not determined to be significant factors. CONCLUSIONS: In patients with HBV-related cirrhosis, TDF has shown similar renal safety to that of ETV over a 2-year period. Renal function should be closely monitored, especially in patients who exhibit decreasing eGFR, DM, and the use of diuretics.
Antiviral Agents ; Cohort Studies ; Cooperative Behavior ; Diabetes Mellitus ; Diuretics ; Epidemiology ; Fibrosis* ; Glomerular Filtration Rate ; Hepatitis B virus ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Kidney Diseases ; Korea ; Multivariate Analysis ; Retrospective Studies ; Seoul ; Tenofovir*

Transarterial chemoembolization (TACE) is recommended as one of the first line therapy for unresectable hepatocellular carcinoma (HCC). Rupture of HCC following TACE is a rare and potentially fatal complication. We report a case of hepaticoduodenal fistula with ruptured HCC and liver abscess complicated by TACE. A 52-year-old male was treated by TACE three times, followed by radiation therapy and systemic chemotherapy. 30 days after the last TACE, right upper quadrant pain of abdomen was developed. About 1 month later, computed tomography of abdomen showed ruptured HCC with debris containing liver abscess and hepaticoduodenal fistula. Esophagogastroduodenoscopy revealed hepaticoduodenal fistula and hepatic parenchyme covered with exudate. The patient was managed with supportive care, but the hepaticoduodenal fistula persisted.
Carcinoma, Hepatocellular/radiotherapy/*therapy ; Chemoembolization, Therapeutic/*adverse effects ; Endoscopy, Digestive System ; Gastric Fistula/*etiology ; Humans ; Liver Abscess/etiology ; Liver Diseases/*etiology ; Liver Neoplasms/radiotherapy/*therapy ; Male ; Middle Aged ; Rupture, Spontaneous/etiology ; Tomography, X-Ray Computed

BACKGROUND/AIMS: The aim of this study was to evaluate the estimated glomerular filtration rate (eGFR) during telbivudine (LdT) versus entecavir (ETV) treatment in chronic hepatitis B (CHB) patients with underlying comorbidities such as diabetes mellitus (DM), hypertension, and cirrhosis. METHODS: From 2010 to 2012, 116 CHB patients treated with LdT and 578 treated with ETV were compared in this real-practice cohort. The mean changes in eGFR (Modification of Diet in Renal Disease [MDRD] formula) from baseline to months 6, 12, and 18 were analyzed using a linear mixed model. RESULTS: In LdT-treated patients, the mean eGFR increased by 7.6% at month 18 compared with the eGFR at baseline (MDRD formula in mL/min/1.73 m2). However, in ETV-treated patients, the mean eGFR decreased by 4.1% at month 18 compared with the eGFR at baseline. In the LdT-treated patients with DM, hypertension, cirrhosis or low eGFR <90 mL/min/1.73 m2, the mean eGFR showed a steady improvement, whereas the mean eGFR was reduced in the same subgroups of ETV-treated patients. CONCLUSIONS: The eGFR gradually increased over time during LdT treatment, especially in patients with mild abnormal eGFR at baseline, and in those with DM, hypertension, and cirrhosis, whereas a reduction in eGFR was seen with ETV treatment.
Adult ; Antiviral Agents/*administration & dosage ; Diabetes Complications ; Diabetes Mellitus ; Drug Administration Schedule ; Female ; Fibrosis/complications ; Glomerular Filtration Rate/*drug effects ; Guanine/administration & dosage/*analogs & derivatives ; Hepatitis B, Chronic/complications/*drug therapy/physiopathology ; Humans ; Hypertension/complications ; Linear Models ; Male ; Middle Aged ; Thymidine/administration & dosage/*analogs & derivatives ; Time Factors ; Treatment Outcome

PURPOSE: The diagnosis of acute cholecystitis is usually made by performing ultrasonography or biliary scintigraphy. We have introduced the (99m)Tc-ciprofloxacin (infecton) scan for diagnosing of acute cholecystitis. The main aim of this study was to evaluate the efficacy of (99m)Tc-ciprofloxacin imaging in comparison with ultrasonographic findings for the diagnosis of acute cholecystitis. METHODS: Sixteen patients who were thought to have acute or chronic cholecystitis, based on the clinical and sonographic findings, were included in this study. We gave intravenous (99m)Tc-ciprofloxacin to sixteen patients and we obtained the SPECT images after one hour. The final diagnosis of acute cholecystitis was made according to the pathologic reports. RESULTS: According to pathologic reports, out of the sixteen patients, twelve patients had acute cholecystitis and four patients had chronic cholecystitis. On the (99m)Tc-ciprofloxacin scans, twelve patients had positive images showing acute cholecystitis on account of the hot uptake in the gallbladder and four patents had negative images showing chronic cholecystitis due to the negative uptake in the gallbladder. Among them, one false positive case and one false negative case were observed. With performing ultrasonography, twelve and four patients were diagnosed as having acute and chronic cholecystitis respectively. Out of them one false positive case and three false negative cases were observed. Based on the pathologic reports, (99m)Tc-ciprofloxacin imaging has a sensitivity of 91.7% and a specificity of 75%. The ultrasonography had a sensitivity of 91.7% and a specificity of 25%. CONCLUSION: As a result of comparing the sensitivity and specificity of the (99m)Tc-ciprofloxacin scan with those of the ultrasonography, the (99m)Tc-ciprofloxacin scan is considered to be useful test method to diagnose acute cholecystitis.
Cholecystitis ; Cholecystitis, Acute* ; Diagnosis* ; Gallbladder ; Humans ; Radionuclide Imaging ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon ; Ultrasonography