The incidence and death rate of hepathocellular carcinoma (HCC) both rank third in Korea (death rate 21.3 per 100,000 in 2000) and HCC is a major health issue in Korea. HCC causes substantial morbidity and mortality and the results of treatments for advanced HCC are still disappinting. Considering the high incidence, death rate, and poor prognosis of HCC, it is necessary to establish a national screening program by evaluating the validity. The Korean Association for the Study of the Liver (KASL) and National Cancer Center (NCC) cooperatively developed and recently released HCC screening/surveillance recommendation. The target population is patients with chronic hepatits B and C and cirrhosis of any cause, over 30 years of age in male and 40 years of age in female. The surveillance tests consist of serum alpha-fetoprotein and abdominal ultrasonography at least every 6 months. Korean national program for the early detection of cancer will start the HCC screening/surveillance program in the low economic classes from 2003, based on KASL-NCC recommendations. The efficacy of this HCC survaillance program would be worthy of attention.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Early Detection of Cancer ; Early Diagnosis* ; Female ; Fibrosis ; Health Services Needs and Demand ; Humans ; Incidence ; Korea ; Liver ; Male ; Mass Screening* ; Mortality ; Prognosis ; Ultrasonography

BACKGROUND/AIMS: The emergence of lamivudine-resistant mutant hepatitis B virus (HBV), with aminoacid substitution in the YMDD motif of DNA polymerase, has been reported in the long-term lamivudine use group. However there is no report about the emergence of mutant viruses during the short-term lamivudine therapy. The objective of this study was to investigate the emergence of YMDD mutant HBV during short-term lamivudine therapy. METHODS: We evaluated twenty-eight chronic hepatitis B patients who were HBeAg and HBV DNA positive and treated with lamivudine 100mg p.o. daily for 12 weeks. First, we investigated the emergence of YMDD mutants by nested polymerase chain reaction (PCR) method developed by Chayama et al in 19 patients who lost HBV DNA during lamivudine therapy but showed HBV DNA re-emergence 2 weeks after the end of therapy. Second, DNA subcloning and sequencing of HBV DNA polymerase including YMDD motif was undertaken in one patient's serial blood samples at 0, 8, 12 weeks to confirm the results of nested PCR. RESULTS: YMDD motif mutation was detected in 17(90%) out of 19 patients at the end of therapy and the type of mutations were YIDD only. At the end of therapy, mutant was predominant in 5 patients, both mutant and wild type were similar in proportion in 3 patients, and wild type was predominant in 9 patients. When we carried out nested PCR serially with samples of 0, 2, 4, 8, 12, 14 weeks after initiation of therapy in 5 patients who were mutant predominant at 12 weeks, YIDD mutant began to be detected from 2 weeks in 4 patients and from 4 weeks in one patient. However, rapid turnover from mutant to wild type happened after the end of therapy, so only wild type was detected in 3 patients and wild type became predominant in 2 patients at 2 weeks after the end of therapy. All the sequencing results of serial blood samples in one patient were consistent with nested PCR data. CONCLUSIONS: The presence of YMDD motif HBV polymerase mutant may be possible before administration of lamivudine in Korean chronic hepatitis B patients. Nested PCR assay would be an useful method to detect YMDD mutant.
DNA ; Hepatitis B e Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Lamivudine* ; Polymerase Chain Reaction

No abstract available.
Antiviral Agents/*administration & dosage ; Drug Therapy, Combination ; Hepatitis C, Chronic/*drug therapy ; Humans ; Interferon Alfa-2b/*administration & dosage ; Ribavirin/*administration & dosage

The purpose of this study was to investigate the incidence rate of hepatitis B in the military service and to examine the effect of the asymptomatic HBsAg carriers on the incidence of hepatitis B. The subject were 223,270 men who were conscripted to the Korean Army from 1991 to 1994 year. According to the conscripted year, four conscription cohort were constructed. At the screening examination for military service no test for hepatitis B were performed in 1991 and 1992. In 1993, a screening test for hepatitis B were performed and those who were confirmed as HBsAg positive or > or = SGPT 100IU were excluded from conscription. In 1994, the criteria for conscription was changed and those who were HBsAg positive were not excluded from conscription. Only those who were > or =SGPT 100IU were excluded. The main results were as follows ; 1. The positive rate of HBsAg is 5.5% in the conscripted men. 2. The incidence rates of the hepatitis B in 1991 and 1992 conscription cohort were 9.96 and 8.10 per ten thousand per son - year, respectively. The incidence rate of the hepatitis B was 1.34 per ten thousand per son - year in 1993 conscription cohort which was confirmed as HBsAg negative at the screening test, and 7.41 per ten thousand per son - year in 1994 conscription cohort which included the HBsAg positive. 3. The incidence rate of hepatitis B was 99.98 per ten thousand per son- year in HBsAg positive group and 2.25 per ten thousand per son - year in HBsAg negative group. The incidence rate of the group with high SGPT and HBsAg positive was 255 times higher than that of normal population. 4. The incidence of hepatitis B in HBsAg negative group did not increase even though the probability of personal contact with HBsAg positive had been increased. From the above result s, the men who have high SGPT with HBsAg positive should be excluded from military service, and it can not be said that asymptomatic HBsAg carrier s influence on the hepatitis B incidence among the HBsAg negative through personal contact.
Alanine Transaminase ; Cohort Studies ; Hepatitis B Surface Antigens* ; Hepatitis B* ; Hepatitis* ; Humans ; Incidence* ; Male ; Mass Screening ; Military Personnel*

BACKGROUND/AIMS: Lamivudine, an oral nucleoside analogue, effectively inhibits hepatitis B virus replication and reduces hepatic necroinflammation in patients with chronic hepatitis B. This study investigated the effect and safety of 12 week lamivudine therapy in Korean patients with chronic hepatitis B (CHB). METHODS: In an open clinical trial, 113 patients with CHB were enrolled. They received 100 mg of lamivudine orally once daily for 12 weeks, and they were followed until 2 weeks after cessation of lamivudine. HBV DNA (by bDNA assay), liver enzymes, creatine phosphokinase, creatinine and CBC were checked at 0, 2, 4, 8, 12 and 14 weeks. Compliance and side effects were evaluated at the same time. RESULTS: After receiving lamivudine 100 mg, serum HBV DNA levels fell rapidly, remaining in 94.3% below baseline values at 2 weeks and 99.8% below baseline values at 12 weeks. Serum HBV DNA was cleared in 75.2% and alanine aminotransferase level (ALT) was normalized in 64.8% at 12 weeks. Cumulative percentage of HBeAg clearance (defined by clearance of serum HBV DNA and HBeAg) was 14.4%. Clearance of HBV DNA was more frequent in patients with lower pretreatment serum HBV DNA and higher ALT. During the treatment periods, adverse effects were negligible and transient. Two weeks after cessation of lamivudine, serum HBV DNA reappeared in 70.6% of responders. CONCLUSION: It is suggested that lamivudine is effective and safe in the treatment of CHB in Korean patients, but further study for adequate duration of treatment is needed because of high recurrence after 12 weeks therapy.
Alanine Transaminase ; Compliance ; Creatine Kinase ; Creatinine ; DNA ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Lamivudine* ; Liver ; Recurrence

Progressive liver fibrosis is a similar feature of all chronic liver diseases and eventually develops liver cirrhosis. The prognosis and treatment plans of chronic liver diseases depend strongly on the degree of liver fibrosis. These facts raise clinical interests in quantifying liver fibrosis. Although liver biopsy has been the gold standard for assessment of liver fibrosis, it has some technical limitations and risks. Accordingly, an increasing need for alternative non-invasive method to quantify liver fibrosis has been a major challenge that has stimulated search for new non-invasive methods. Such methods for diagnosing liver fibrosis have progressed significantly over the last few years notably with the appearance of several serological markers which have been reported to predict the presence of significant fibrosis or cirrhosis in patients with chronic liver disease with considerable accuracy. However, complicated calculation, cost problems, and influences of extrahepatic conditions make it less accessible to clinicians. Recently, liver stiffness measurement using FibroScan(R) is emerging as a new diagnostic method for liver fibrosis. It is totally non-invasive and reproducible and gives an immediate result without intra- and inter-observer variability. Its clinical use in comparison with liver biopsy and several available serologic markers is now intensively being investigated. Here, we review the currently available data on FibroScan(R).
Biopsy ; Fibrosis ; Humans ; Liver ; Liver Cirrhosis ; Liver Diseases ; Observer Variation ; Prognosis

No abstract available.
Internal Medicine

Recently the use of hydrochloric acid as a toilet disinfectant has become more common, and the risk of its ingestion is though to be increasing. We experienced a case of 67 year-old man who accidentally ingested hydrochloric acid and as a result developed a postprandial epigastric fullness end pain 3 weeks thereafter, The patient underwent an UGI series, fiberoptic gastroscope and abdominal ultrasonography and was found to have a gastric midbody stricture. A total gastreetomy and Roux-en- Y esophagojejunostomy was performed. We report this case with brief review of the literature.
Aged ; Constriction, Pathologic ; Eating ; Gastritis* ; Gastroscopes ; Humans ; Hydrochloric Acid* ; Ultrasonography

The combination of pegylated interferon (PEG-IFN) and ribavirin (RBV), the current therapy for hepatitis C virus (HCV) infection, has saved the lives of many HCV-infected patients. Direct-acting antivirals (DAAs) target several sites of HCV nonstructural proteins, resulting in the cessation of viral replication. The first NS3/4A protease inhibitors consisted of boceprevir and telaprevir, which have shown superior efficacy against genotype 1 HCV infection when combined with PEG-IFN/RBV compared with the standard therapy in both treatment-naive and -experienced patients. Simeprevir, faldaprevir, and asunaprevir are second-wave, first-generation NS3/4A inhibitors that have already been or will soon be approved. Second-generation protease inhibitors are in clinical trials. Daclatasvir is the first approved DAA belonging to the class of NS5A replication complex inhibitors. The potency of daclatasvir is very high, and this drug is an important and essential component of combination regimens for all genotypes. Sofosbuvir, the first approved NS5B polymerase inhibitor, is characterized by high potency and genetic barriers to resistance. Sofosbuvir combined with RBV achieved an interferon-free regimen in genotype 2 or 3 patients with a reduced treatment duration. It can also be used in combination with PEG-IFN/RBV in genotype 1 patients for 12 weeks. DAAs have provided new hope for curing HCV infections with a short treatment duration and acceptable adverse events.
Antiviral Agents/*therapeutic use ; Drug Therapy, Combination ; Hepacivirus/drug effects/genetics ; Hepatitis C/*drug therapy ; Humans ; Protease Inhibitors/therapeutic use ; Viral Nonstructural Proteins/antagonists & inhibitors ; Virus Replication/drug effects

BACKGROUND: The quantification of hepatitis C virus (HCV) is useful in diagnosis and monitoring of HCV infection. We evaluated clinical usefulness of HCV quantification and two quantification methods using different assay principles. METHODS: HCV RNA quantities and liver function were measured in patients with different disease severity using bDNA assay (QuantiplexTM, Chiron, USA). HCV RNA loads were quantified at the time of pre/post-interferon treatment in some of them using RT-PCR hybridization assay (AMPLICORTM, Roche, USA). These two quantification methods were also compared. RESULTS: HCV RNA loads showed no significant difference according to disease severity (group I, 3.8 5.3 MEq/mL; group II, 3.8 7.4 MEq/mL; group III, 5.9 13.0 MEq/mL; P=0.181) or interferon response (complete responders, 1.5 105/mL; partial or non responders, 2.2 105/mL; P=0.670). But HCV viral loads decreased at 6th month after interferon treatment (P=0.063) and correlated poorly with liver function tests. The bDNA assay correlated well with the RT-PCR hybridization method (r2=0.854). CONCLUSIONS: The quantificaion of HCV RNA is useful in following up treatment effect but not in predicting therapeutic failure or assessment of disease severity. HCV RNA quantities are independent of liver function. The bDNA assay showed good correlation with the RT-PCR hybridization method.
Branched DNA Signal Amplification Assay ; Diagnosis ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Interferons ; Liver Diseases* ; Liver Function Tests ; Liver* ; RNA ; Viral Load