A systematic and effective welfare system for people with digestive system impairments is required. In Korea, an objective and scientific rating guideline does not exist to judge the digestive system impairments. Whether the impairments exist or not and the degree of it need to be examined. Thus, with these considerations we need a scientific rating guideline for digestive system impairments to fit our cultural and social background. In 2007, a research team, for the development of rating impairment guidelines, was organized under the supervision of Korean Academy of Medical Sciences. The rating guidelines for digestive system impairments was classified into upper and lower gastrointestinal tracts impairments and liver impairment. We developed objective rating guidelines for the upper gastrointestinal tract, the impairment generated after surgery for the stomach, duodenum, esophagus, and for the lower gastrointestinal tract, the impairment generated after construction and surgery for colon, rectum, anus, and intestinal stomas. We tried to make the rating impairment guidelines to include science, objectivity, convenience, rationality, and actuality. We especially emphasized objectivity as the most important value. We worked to make it easy and convenient to use for both the subjects who received the impairment ratings and the doctors who will give the ratings.
Digestive System Diseases/classification/*diagnosis ; *Disability Evaluation ; Duodenal Diseases/classification/diagnosis ; Esophageal Diseases/classification/diagnosis ; Humans ; Inflammatory Bowel Diseases/classification/diagnosis ; Korea ; Liver Diseases/classification/diagnosis ; Postoperative Complications/classification/diagnosis ; Program Development ; Severity of Illness Index ; Stomach Diseases/classification/diagnosis

OBJECTIVETo investigate the etiology, pathology, and clinical characteristics of cryptogenic liver diseases in order to develop a pathogenic profile for clinical diagnosis and therapeutic design.

METHODSThe data of the 566 patients diagnosed with abnormal liver function and who had undergone liver biopsy at our institute between January 2006 to March 2010 were retrospectively analyzed. The Chi-squared (x²) test was used to assess disease correlation with sex and the rank sum test was used to assess disease correlation with continuous data since all data had asymmetric distribution.

RESULTSAmong the 566 patients, abnormal liver function was attributed to alcoholic liver disease (n=175; 30.92%), drug-induced or environmentally-induced liver disease (n=101; 17.84%), hereditary and metabolic disease (n=93; 16.43%), infectious hepatitis disease (n=84; 14.84%), fatty liver disease (n=53; 9.36%), and autoimmune liver disease (n=30; 53.00%). Thirty patients had unknown etiology, despite liver biopsy analysis. Among these disease subgroups, there were distinct correlations with sex, age, and levels of alanine transaminase (ALT) and gamma-glutamyltransferase (GGT). The autoimmune liver disease group was correlated with sex (q=9.14, 7.435, 5.071, 9.529, and 12.5, respectively; P less than or equal to 0.01). The alcoholic liver disease group and autoimmune liver disease group were correlated with age (vs. genetic metabolic disease group: q=17.254 and 10.302; infectious hepatitis group: q=17.523 and 10.697); drug/environmentally-induced liver damage group: q=9.170 and 5.266); fatty liver group: q=7.118 and 4.661) (P less than or equal to 0.01). In addition, the alcoholic and autoimmune liver disease groups were correlated with GGT levels (vs. genetic metabolic disease group: q=8.003; infectious hepatitis group: q=4.793; drug/environmentally-induced liver damage group: q=4.404) (P less than or equal to 0.01).

CONCLUSIONLiver pathology is important for the diagnosis of cryptogenic liver diseases. Patient age, sex, and biochemistry index may facilitate diagnosis and treatment in the absence of pathology.

Adolescent ; Adult ; Biopsy ; Child ; Child, Preschool ; Female ; Humans ; Liver ; pathology ; Liver Diseases ; classification ; diagnosis ; pathology ; Male ; Middle Aged ; Young Adult

BACKGROUND: Minimal (subclinical) hepatic encephalopathy (mHE) currently diagnosed by psychometric tests or neurophysiological test adversely affects daily functioning. In view of its sociomedical relevance, simple and reproducible tests for routine diagnosis are required. The aims of this study are to evaluate cognitive function of patients with chronic liver disease by computerized neuropsychological test (STIM), and the difference of cognitive function according to Child classification. METHODS: Between June, 2002 and February, 2003 We enrolled 61 randomized consecutive patients diagnosed with chronic liver disease by biochemical tests, ultrasonographic finding or histology. This study used finger tapping, visual CPT, spatial memory test, Wisconsin card sorting test chosen from Neuscan and STIM system (Neurosoft company, U.S.A) and global-local processing test. RESULTS: In the present study, significant correlation was found between neurologic abnormalities and the degree of liver disease. The result of neuropsychological test showed that cognitive function was decreased according to the severity of chronic liver disease, especially liver cirrhosis. Cirrhotic patients, especially Child C group, exhibited selective deficits in complex attentional and fine motor skills, visuospatial perception, with preservation of memory. CONCLUSION: The STIM in this study is simple, objective and reproducible method because it can subdivide evaluation of cognitive function and computerize the measurement of response. We assume that STIM may be used early detection method of mHE if the study will be in a large scale. Because psychomotor deficits found in mHE could have a disadvanting influence on daily functioning of patients, e.g., driving abilty of a car or performance at work, we concluded early detection of mHE and aggressive treatment of mHE in clinically asymptomatic cirrhotic patients is necessary for improvement of their quality of life.
Child ; Classification ; Diagnosis ; Fingers ; Hepatic Encephalopathy ; Humans ; Liver Cirrhosis ; Liver Diseases* ; Liver* ; Memory ; Motor Skills ; Neuropsychological Tests* ; Psychometrics ; Quality of Life ; Wisconsin

BACKGROUND: Liver biopsy is the gold standard for assessing liver fibrosis; however, it has a relatively high risk of resulting in complications. Although a non-invasive method (i.e., transient elastography—fibroscan) was introduced, it is expensive and is dependent on the patient's status. Thus, the FIB-4 score, a non-invasive formula, has been used to predict the degree of liver fibrosis. The aim of this study was to evaluate the usefulness of the FIB-4 score in predicting stages of liver fibrosis. METHODS: We analysed the age, diagnosis, and liver stiffness of 282 patients by measuring the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) as well as their platelet count. Liver elasticity was evaluated by two classification criteria (Foucher et al. and Mueller et al.). The FIB-4 score was calculated using the formula: age×AST/(platelet count×ALT½). The cut-off value of the FIB-4 score was determined according to the area under the relative operating characteristic curve (AUC) based on liver elasticity. RESULTS: The FIB-4 cut-off values, as determined using two different criteria, have the highest AUC, thereby indicating a robust ability to distinguish between healthy liver tissue and the presence of any liver fibrosis. The FIB-4 score with a cut-off value of 2.07, as determined by Mueller et al., had the highest AUC (0.837) and odds ratio (2.741) with a sensitivity of 78.3% and a specificity of 76.5%. CONCLUSIONS: An FIB-4 score of 2.07 is a cut-off value that is useful in detecting fibrotic progression in chronic liver disease in our laboratory. Each laboratory should determine an appropriate FIB-4 cut-off value that is relative to the particular characteristics of their patient population.
Alanine Transaminase ; Area Under Curve ; Aspartate Aminotransferases ; Biopsy ; Classification ; Diagnosis ; Elasticity ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Mass Screening* ; Methods ; Odds Ratio ; Platelet Count ; Sensitivity and Specificity

OBJECTIVETo compare and analyze the accuracy of two diagnostic criteria of drug-induced liver injuries.

METHODS230 cases of drug-induced liver injury diagnosed clinically in the 302 hospital of PLA were retrospectively studied. The drugs which induced liver injuries were summarized and analyzed. Danan's international consensus criteria and Maria's diagnostic scale were applied to diagnose these 230 cases again and then the differences of diagnostic results were analyzed and compared.

RESULTSThe drugs which induced liver injuries in the 230 patients were arranged in order of their usage frequencies: traditional Chinese herbs and the like, antibiotics, antipyretic analgesics, antituberculosis medicines, cardiovascular drugs, over-the-counter health stuff, psychopharmaceuticals, dermatological agents, drug for diabetes, tapazol, and others. Based on the 230 adult inpatients with drug-induced liver injury, according to Danan's international consensus criteria, 149 cases (64.8%), 71 (30.9%) and 10 (4.3%) were classified as drug-related, indeterminate and drug-unrelated respectively; according to Maria's diagnostic scale, not one was a definite drug-induced liver injury, 55 cases (23.9%) were probable, while 126 (54.8%), 33 (14.3%) and 16 (7.0%) were possible, unlikely and excluded respectively.

CONCLUSIONThe accordance rate of Danan's international consensus criteria and clinical diagnosis was higher than that of Maria's diagnostic scale. Neverthelessìthe current diagnostic methods for drug-induced liver injury need to be revised for clinical practice.

Adolescent ; Adult ; Aged ; Chemical and Drug Induced Liver Injury ; classification ; diagnosis ; Female ; Humans ; Liver Diseases ; diagnosis ; Male ; Middle Aged ; Reference Standards ; Retrospective Studies ; Young Adult

PURPOSE:The International Labor Organization (ILO) has established an international standard for chest X-ray diagnosis of pneumoconiosis since 1980. However, there is a need for improved diagnosis and staging in occupational disease. We evaluated Ga-67 citrate scintigraphy quantitatively and correlated the scintigraphic findings with pulmonary function tests and chest X-ray result. MATERIALS AND METHODS: Twenty-five patients underwent whole body scintigraphy with additional chest and abdomen images 48 hrs after intravenous injection of 185 MBq of Ga-67 citrate. Ten normal controls were also studied. Regions of interest (ROI) were drawn on the posterior image to measure counts from the liver and lungs (Lung/Liver Ratio). RESULTS: L/L ratio according to the stages of chest X-ray classification were as follows; stage 0 (normal, n=10): 0.3948+/-0.0692, stage 1 (n=10): 0.5763+/-0.1837, stage 2 (n=11): 0.6849+/-0.1459, stage 3 (n=4): 0.9913+/-0.0712. There was a significant correlation between the scintigraphic L/L ratio and the X-ray stage (r=0.618, p<0.05). However, no significant correlation between L/L ratio and pulmonary function tests were observed (p>0.05). CONCLUSION: Quantitative Ga-67 scintigraphy can be a useful method for staging of silicosis. However, it is not a method to assess pulmonary functional impairment.
Abdomen ; Citric Acid ; Classification ; Diagnosis ; Humans ; Injections, Intravenous ; Liver ; Lung ; Occupational Diseases ; Pneumoconiosis ; Radionuclide Imaging* ; Respiratory Function Tests ; Silicosis* ; Thorax*

Objective: To investigate the correlation between the syndrome types of traditional Chinese medicine (TCM) and clinical symptoms of benign prostatic hyperplasia (BPH) with chronic prostatitis (BPH-CP). METHODS: We selected 150 cases of BPH-CP in this study and divided them into 7 TCM syndrome types. Using univariate and multivariate logistic regression analyses, we studied the correlation of each TCM syndrome type with the age, disease course, prostate volume, postvoid residual urine volume (PVR), prostate-specific antigen (PSA) level, maximum urinary flow rate (Qmax), and International Prostate Symptoms Score (IPSS). RESULTS: Kidney-yin deficiency was correlated positively with the prostate volume but negatively with Qmax and IPSS; kidney-yang deficiency positively with the age and prostate volume but negatively with IPSS; the damp heat syndrome positively with the PSA level but negatively with the disease course, prostate volume and Qmax; the spleen-qi deficiency syndrome positively with the prostate volume but negatively with the disease course; liver-qi stagnation positively with the disease course but negatively with the age, prostate volume and PVR; the syndrome of qi stagnation and blood stasis positively with the disease course and IPSS but negatively with PVR; the syndrome of lung-heat and qi blockage positively with the age, Qmax and IPSS but negatively with the disease course. CONCLUSIONS The TCM syndrome types of BPH-CP are closely correlated to their clinical symptoms. The analysis of the clinical objective indexes of BPH-CP can provide some reliable evidence for accurate identification of the TCM syndrome type of the disease.
Age Factors ; Chronic Disease ; Disease Progression ; Humans ; Kidney Diseases ; diagnosis ; Liver Diseases ; diagnosis ; Male ; Medicine, Chinese Traditional ; Organ Size ; Prostate-Specific Antigen ; blood ; Prostatic Hyperplasia ; classification ; diagnosis ; Prostatitis ; classification ; diagnosis ; Qi ; Regression Analysis ; Splenic Diseases ; diagnosis ; Symptom Assessment ; classification ; methods ; Urination ; Yang Deficiency ; diagnosis ; Yin Deficiency ; diagnosis

BACKGROUND: Although abnormal serum alanine aminotranferase(ALT) and aspartate aminotransferase (AST) clearly indicates certain disease in the liver, normal reversion of serum ALT and AST during the disease process, after the histologic diagnosis of chronic hepatitis, does not ensure that the patients liver would be normal. We considered a partial remission of chronic hepatitis as the levels of serum ALT and AST were persistently normal over 6 months or more, and studied how the histologic findings in the partial-remitted patients of chronic hepatitis would change. MATERIALS: Twenty-three agreed to rebiopsy in the patients of chronic hepatitis with normal level of serum ALT and AST over 6 months. The histologic findings between the first and second liver-biopsied specimens were compared, and the classification of their morpholgy was translated with Batts and Ludwigs new scoring system of chronic hepatitis divided into grade and stage. RESULTS: The grading scores of the first and second biopsy were 2.70 +/- 0.16 and 1.48 +/- 0.14, respectively, and the grading scores of the second biopsy decreased significantly than of the first biopsy (p=0.000); 18 cases(78.1%) were improved, but none was aggravated. The staging scores of the first and second biopsy were 1.870.19 and 1.430.22, respectively, and the staging scores of the secand biapsy also decreased significantly than of the first biopsy (p=0,020); 14 cases (61.2%) were unchanged, 8 cases (34.5%) were improved, but 1 case (4.3%) was aggravated. The stage-improved cases were 7 in the patients of chronic viral hepatitis B, and 1 in the patient of chronic viral hepatitis C, and viral loads of them disappeared. Three cases (13.0%) of them changed into no fibrosis, and 2 cases of them (8.7%) with severe fibrosis improved to mild fibrosis. But, although the levels of serum ALT and AST were persistently normal over average 16 months, grading and staging scores decreased over 2 points in 21.0% and 13.0%, respectively, and the case of which both grading and staging scores improved to normal was only 4.3%. CONCLUSION: Serum ALT and AST level were well correlated with grading. However, the correlation between serum ALT and AST level and staging was poor, even though the triggering factors of chronic hepatitis had been disappeared. Then, we recommand close follow-up and treatment to lessen the fibrogenic reaction of the liver in them.
Alanine* ; Aspartate Aminotransferases ; Aspartic Acid* ; Biopsy ; Classification ; Diagnosis ; Fibrosis ; Follow-Up Studies ; Hepatitis B ; Hepatitis C ; Hepatitis, Chronic ; Humans ; Liver Diseases* ; Liver* ; Viral Load

Authors studied the workers' knowledge about the health problems detected through the previous workers' periodic health examination, content of follow-up management and actions taken for their health problem detected on previous health examination. From June to September 1992, workers' periodic health examination was performed on workers employed in 10 companies located in 2 middle-sized Korean cities. A questionnaire survey was done for 150 workers who reported to have D2 result of either hypertension or liver disorder at the previous workers' periodic health examination done in 1991. The results are as follows; 1. Of 160 workers who had D2 result of either hypertension or liver disorder in previous examination one year before, only 85 workers(51.3%, 43 workers with hypertension, 38 workers with live disorder) responded that they have such disorders. The other 65 workers responded to questionnaire were all those with C results. Respondents' knowledge about their diagnoses was relatively precise (95.2% in hypertension group, 94.6% in liver disorder group) but knowledge about classification of diseases was poor. 2. The main efforts to solve the health problem was self management (26 spells, 55.3%), visiting clinic or hospital (6 spells, 12.8%), use of herb medicine (2 spells, 4.3%) and use of drug store (2 spells, 4.3%) in hypertension group. In liver disorder group, 30 spells (71.4%) relied on self management, 6 spells (14.3%) on hospital or clinic and 9 spells (21.4%) had no effort to improve the health problem. Content of self management was low salt diet, quit smoking, regular exercise and quit alcohol drinking in order. Avoidance of salt in diet was high in hypertension group and quitting alcohol drinking was high in liver disorder group. In those with self management, 80.7% of hypertension group and 83.3% of liver disorder group continued previous effort. Those, however, who utilized clinic or hospital, only 16.7% and 50.0% were still visiting hospital or clinic. 3. Fifty seven percent of hypertension group and 64.3% of liver disorder group was presently smoking, 8.5% and 11.9% reduced smoking and 21.3% and 14.3% stopped smoking. Forty nine percent of hypertension group and 28.6% of liver disorder group was presently drinking. Reduced alcohol intake was reported in 29.8% and 40.5%, 12.8% and 23.8% stopped alcohol drinking. Sixty six percent of hypertension group and 73.8% of liver disorder group did no regular exercise, but 12.8% and 11.9% of each group increased their physical exercise for last one year. Forty three percent of hypertension group and 38.1% of liver disorder group was overweight (defined by bodymass index greater or equal than 25). Reduced body weight was reported in 17.2% and 16.7% of each group. Reduced dietary salt intake was high in hypertension group (51.5%). The study results suggest that follow-up management after workers' periodic health examination is not satisfactory. In order to improve this situation, adequate information on the result of the workers' periodic health examination should be distributed to each worker group with health education and counselling.
Alcohol Drinking ; Body Weight ; Classification ; Diagnosis ; Diet ; Drinking ; Exercise ; Follow-Up Studies ; Health Behavior ; Health Education ; Hypertension ; Liver ; Liver Diseases ; Overweight ; Surveys and Questionnaires ; Self Care ; Smoke ; Smoking

Smooth muscle antibodies (SMAs) are diagnostic markers for the serological diagnosis of type 1 autoimmune hepatitis. SMA that is restricted to staining of the stomach muscle and blood vessel walls was referred to as "SMA-V". In addition, SMAs are classified into the peritubular (SMA-T) and glomerular (SMA-G) patterns. SMAs are occasionally present in patients with malignancies, but have not yet been reported in thyroid cancer. We came across the first case of SMA positivity in a patient with papillary thyroid carcinoma (PTC). A 31-yr-old male was admitted to our hospital for evaluation of incidentally detected thyroid cancer. He had been diagnosed with PTC based on pathological results following fine-needle aspiration biopsy. The patient underwent total thyroidectomy followed by radio-iodine treatment. The serum levels of AST and ALT were increased before radiotherapy. Tests were conducted for the evaluation of liver disease. SMA was positive at a titer of 1:320, showing positive results for the vessel walls but negative results for the glomerulus and tubules in the kidney (SMA-V pattern). The association of SMA with malignancies and the classification of SMA immunofluorescent subtypes have been previously reported. However, these studies have not clearly established the ability of SMA subtype to predict a specific disease. Therefore, evaluation of an association of SMA pattern with specific diseases in SMA-positive patients may provide additional and useful information for the rapid diagnosis and accurate treatment of patients with autoimmune diseases or malignancies. This case report could serve as a great resource for further studies on SMA.
Antibodies ; Autoimmune Diseases ; Biopsy, Fine-Needle ; Blood Vessels ; Classification ; Diagnosis ; Hepatitis, Autoimmune ; Humans ; Kidney ; Liver Diseases ; Male ; Muscle, Smooth* ; Radiotherapy ; Stomach ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy