BACKGROUND/AIMS: Lens culinaris agglutinin-A reactive alpha-fetoprotein (AFP L3) has been reported to be highly specific for the diagnosis of hepatocellular carcinoma (HCC). The present study was to evaluate the clinical usefulness of AFP-L3 for the diagnosis of HCC in the patients either with chronic liver disease or with HCC in complete remission who showed significant increment of serum AFP level and no mass lesion in the liver on ultrasonography. METHODS: A total numer of 34 patients (24 with chronic liver disease, 10 with HCC in complete remission) were enrolled, who showed significant increment of serum AFP level and no mass lesion in the liver on ultrasonography. Serum AFP L3 levels were analysed by AFP differentiation kit L. Abdominal spiral CT or ultrasonogram was performed at 1-3 month intervals and all of the patients were followed up for more than 6 months. RESULTS: Among 24 patients with chronic liver disease, two were positive (higher than 15%) for AFP L3; however, HCC was not detected in these patients, while HCCs were detected in two of 22 patients negative for AFP L3 during followe-up. Eight of the 10 patients with HCC in complete remission were positive for AFP L3; recurrent HCCs were detected in 7 of those 8 patients as well as in the rest 2 patients negative for AFP L3 during follow-up. The overall sensitivity and specificity of AFP L3 measurement for the detection of HCC within 6 months of follow-up were 63.6% and 87.0%, respectively. The positive and negative predictive value for HCC in patients with chronic liver disease were O% and 90.9% and for recurrent HCC in HCC patients in remission were 87.5% and ON, respectively. CONCLUSION: The measurement of AFP L3 is suggested to be useful for the diagnostic strategy in patients either with chronic liver disease or hepatocellular carcinoma in complete remission, who showed progressive increment of serum AFP level and no mass lesion in liver on ultrasonogram.
alpha-Fetoproteins* ; Carcinoma, Hepatocellular ; Diagnosis* ; Follow-Up Studies ; Humans ; Lens Plant* ; Liver Diseases* ; Liver* ; Recurrence ; Sensitivity and Specificity ; Tomography, Spiral Computed ; Ultrasonography*

BACKGROUND/AIMS: Imrnortalized human fetal liver cell lines established by transfecting simian virus 40 T gene wae found to lose differentiated liver cell functions in successive long-term culture. Butyrate, known as a differentiation-promoting agent for a variety of cancer cell lines, is produced in the colon by bacterial flora and selectively transported into the liver though the portal blood flow. Therefe, butyrate might play a role in the maintenance of differentiation in hepatocytes in vivo. In thepresent study, the effects of butyrate on cell growth and differentiation in human fetal liver cell lines was investigated. METHODS: Human fetal liver cell lines imrnortalized by SV 40 T antigen were treated with sodium butyrate (1mM), and cell growth rate after butyrate treatment were nmsured by the number of viable cells, determined by trypan blue dye exclusice method. The effects of sodium butyrate on the hepatocyte-specific differentiatian were assessed by albumin and alfa-fetoprotein (AFP) mRNA expression, analyzed using reverse-transcription polymerase chain reaction, and were also by the increment of albumin secretion into culture media, determined by a competitive inhibition ELISA. RESULTS: Treatment with sodium butyrate resulted in a cessation of cellular proliferation and alterations in cellular morphology (increased cell size and polygonal change in shape). The level of albumin mRNA after sodium butyrate treatment was elevated by about two times as compared to that of control. In contrast, AFP mRNA expression were dennstrated neither before nor after sodium butyrate treatment. The average amount of albumin released in the medium was less than 6pghnl/10'cells/2days in the absence of sodium butyrate, and increased to 17 p g/ml/10'cells/2days at day 2, 21ugfml 10'cells/2days at day 4 in the presence of sodium butyrate, and these levels thereafter were over 10 times higher than that in the absence of sodium butyrate until day 10. CONCLUSION: These mults indicate that treatment of immcetalized fetal liver cell lines with butyrate leads to inhibition of cellular proliferation and promotion of adult hepatocyte-specific differentiation.
Adult ; Antigens, Viral, Tumor ; Butyrates ; Butyric Acid* ; Cell Line* ; Cell Proliferation ; Cell Size ; Colon ; Culture Media ; Enzyme-Linked Immunosorbent Assay ; Hepatocytes ; Humans* ; Liver* ; Polymerase Chain Reaction ; RNA, Messenger ; Simian virus 40 ; Sodium* ; Trypan Blue

BACKGROUND/AIMS: There is considerable variance in individual susceptibility to hepato-toxic effects of ethanol as evidenced by the finding that only about 10-20% of alcoholics develop alcoholic liver cirrhosis. The aims of this study were, 1) to get the data on the genetic polymorphisms of three major ethanol-metabolizing enzymes (ADH, CYP2E1, ALDH) in normal Korean adults, and to search for the specific genotypes influencing alcohol drinking behavior by the comparison of allele frequencies between healthy control group and heavy drinker group with or without liver disease, 2) to investigate the influence of the genetic polymorphisms of these enzymes on the susceptibility to alcoholic liver disease by the comparison of allele frequencies between heavy drinker group without liver disease and alcoholic liver cirrhosis group. METHODS: Healthy control group included 53 healthy males in military service without evidence of liver disease or alcoholism. Heavy drinker group without liver cirrhosis included 29 males who had been drinking 80g or more of alcohol daily for more than ten years but did not have any clinical evidence of liver disease. Alcoholic cirrhosis group included 43 male patients who had drunk 80g or more of alcohol daily for more than ten years and had clinical evidences of overt cirrhosis. Subjects with hepatitis B surface antigen or anti-hepatitis C antibody were excluded. Genotypes of the three enzymes were determined by PCR (polymerase chain reaction) and restriction fragment length polymorphism (RFLP) with genomic DNAs extracted from peripheral leukocytes. RESULTS: 1) In healthy Korean males, allele frequency of ADH22, ADH31, CYP2E1 c2 and ALDH22 was 81%, 94%, 30% and 14%, respectively. 2) The absence of ALDH22 or CYP2E1 c2 allele were significant risk factors for being a heavy drinker (odds ratio,' 0.09, 0.42, respectively). 3) Although it was not associated with the polymorphism of each ethanol-metabolizing enzymes, the susceptibility to alcoholic liver cirrhosis was significantly associated with combined genotypes of ADH2(22) & ADH3(1+1)& CYP2E1 B or C. COMCLUSION: Genetic polymorphisms of ethanol-metabolizing enzyrnes are significantly associated with the suseptability to alcoholic liver disease as well as alcohol drinking behavior.
Adult ; Alcohol Drinking ; Alcoholics* ; Alcoholism ; Alleles ; Cytochrome P-450 CYP2E1 ; DNA ; Drinking ; Ethanol ; Fibrosis ; Gene Frequency ; Genotype ; Hepatitis B Surface Antigens ; Humans ; Leukocytes ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic* ; Liver Diseases ; Liver Diseases, Alcoholic ; Male ; Military Personnel ; Polymerase Chain Reaction ; Polymorphism, Genetic* ; Polymorphism, Restriction Fragment Length ; Risk Factors

Cardiac resynchronization therapy is effective in selected patients with symptomatic left ventricular dysfunction. Coronary sinus dissection is a relatively uncommon, but much feared, complication that may occur during placement of the left ventricular pacing lead. A 68-year-old man was transferred to our hospital for treatment of severe heart failure. He developed coronary sinus dissection after balloon dilatation during the procedure for cardiac resynchronization therapy. Nevertheless, we successfully placed the left ventricular pacing lead in the coronary vein. We present the case with a review of the literature.
Aged ; Cardiac Resynchronization Therapy ; Coronary Sinus ; Coronary Vessels ; Dilatation ; Heart Failure ; Humans ; Ventricular Dysfunction, Left

Lung is known as a vulnerable organ to metastatic tumors. Metastasis occurs mainly through lymphatics but seldom via blood vessels. Adenocarcinoma with mucin emboli is very rare. Primary foci reported in the literature were breast, lung, ovary and pancreas. A lung biopsy from a 60-year-old male patient showed floating mucin associated with metastatic adenocarcinoma to the lung in the blood vessels. The tumor cells spreaded along the vascular endothelium as if they were vascular endothelial cells. The tumor cells and mucin in the vessel were strong positive for PAS staining. Elastic and immunohistochemical staining for smooth muscle actin highlighted the vascular wall in the mucin containing structure with infarction of the lung. The primary focus was identified in the pancreatic head through the abdominal ultra-sonographic and computer-tomographic examination.
Actins ; Adenocarcinoma* ; Biopsy ; Blood Vessels ; Breast ; Endothelial Cells ; Endothelium, Vascular ; Female ; Head ; Humans ; Infarction ; Lung* ; Male ; Middle Aged ; Mucins* ; Muscle, Smooth ; Neoplasm Metastasis ; Ovary ; Pancreas

So far with the advancement in treatment modalities for malignant bone and soft tissue sarcomas the survival rate become higher. Till now there are some questions who can survive. Temporary procedure not affecting the treatment schedule would have more advantages than primary permanent one. When there is higher possibility of survival, this can be switched to permanent one. From Dec. 1986 to Jan. 1994, we had performed 40 cases of temporary arthrodesis after segmental resection of malignant bone and soft tissure tumors around the knee by using intramedullary nail andbone cement. Thirty eight cases of bone tumors[osteosarcoma(33), malignant fibrous histiocytoma(MFH)(3), chondrosarcoma(1), Ewing's sarcoma(1)] and 2 cases of soft tissue sarcomas[MFH(1), squamous cell carcinoma(1)] were analysed. Types of intramedullary nail used were rigid(Huckstep, 23 cases) or flexible(Ender, 17 cases). Six cases(15%) showed mechanical implant failure due to fracture (Huckstep;5, Ender;1) between 2 to 20 months after operation. Rearthrodesis using Ender nail and bone cement(5) or arthroplasty using Kotz prosthesis(1) were done for fractured cases. The other complicaitons were deep infection(2), peroneal nerve palsy(2), or transfixing screw fracture(2). Second reconstruction procedure was carried out in 2 cases with arthroplasty using Kotz prothesis. For IM nail, multiple Ender nailing seems to be superior to the Huckstep in mechanical strength. Contrary to the primary permanent reconsturction of the bone defect, this procedure has several advantages: 1) simple and does not hinder postoperative chemotherapy, 2) even in the extensively involved cases, can save the limb if the neurovascular structures are spared, 3) in Stage III, can save the salvagable limb, 4) economic and immediate stability can be helpful in the patient's quality of life, 5) two years later, when the survival approaches plateau, we can switch to another kinds of salvage operation, 6) Ender nail was superior to Huckstep in mechanical stability, 7) can be used for children expecting leg lengthening near puberty. It is useful for sarcoma patients around knee who require prolonged chemotherapy anbd whose life expectancy is relatively unexpectable.
Adolescent ; Appointments and Schedules ; Arthrodesis ; Arthroplasty ; Child ; Drug Therapy ; Epithelial Cells ; Extremities ; Humans ; Knee ; Leg ; Life Expectancy ; Peroneal Nerve ; Puberty ; Quality of Life ; Sarcoma ; Survival Rate

The vein of Galen malformation is a rare midline intracranial arteriovenous malformation. The majority of themalformations were seen in neonate, infancy and childhood, and the clinical symptoms and prognosis depended on ageof presentation. The authors report a case of the vein of Galen malformation in 17 month-old female withhydrocephalus, which is confirmed by CT and digital subtraction angiography.
Angiography, Digital Subtraction ; Cerebral Veins ; Female ; Humans ; Infant, Newborn ; Intracranial Arteriovenous Malformations ; Prognosis ; Veins

BACKGROUND: The survival in patients with hepatocellular carcinoma (HCC) has recently been improved by the advancement in the early detection of HCC. Among the various treatment modalities, the surgical resection has been considered as the most effective for small HCC, and the clinical course of patients with small HCC who underwent curative resection is known to be dependent on the etiology of HCC. Since the differences in the etiology of HCC depend on the different geographical area, it is necessary to verify the clinical outcomes and their affecting factors in patients with small HCC after curative resection in Korea, one of the hepatitis- B-virus(HBU)-endemic areas. METHODS: A total of 89 patients with small HCC (or=50 years old), Child's classification and vascular invasion were factors affecting the rate of recurrence. CONCLUSION: These results verify that the clinical outcomes of patients with small HCC after curative resection in Korea are similar to those of patients with different etiology of HCC in other geographic areas. To improve the prognosis of patients with small HCC after curative resection, strict preoperative evaluation of the presence of vascular invasion and postoperative preservation of liver function are necessary as well as the close postoperative follow-up for the early detection of recurrence.
Carcinoma, Hepatocellular* ; Classification ; Follow-Up Studies ; Hepatitis B Surface Antigens ; Humans ; Korea ; Liver ; Liver Cirrhosis ; Mortality ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate

BACKGROUND/AIMS: Combined esophageal variceal ligation and sclerotherapy has been hypothesized to be more effective for the control of bleeding esophageal varices than ligation alone. The present study was to compare the combined therapy with ligation alone in terms of variceal eradication, rebleeding, complication and survival rates in patients with bleeding esophageal varices. METHODS: Thirty-eight patients with bleeding esophageal varices were randomly assigned to receive ligation alone in 20 patients or the combined therapy in 18 patients. The clinical and endoscopic characteristics of patients in the ligation group were similar to those of patients in the combination group. In the combination group, 1-3 mL of ethanolamine was injected proximal to each ligated site. Treatments were repeated every 2- to 3-month until varices were eradicated. RESULTS: No significant differences were found between the ligation and combination groups in variceal eradication rates (70% vs. 72%), numbers of endoscopic sessions required to achieve eradication (3.5+/-0.33 vs. 3.3+/-0.31), rebleeding rates (30% vs. 28%) or 2-yr cumulative survival rates (95% vs. 75%). There were significantly more complications in the combination group (25% vs. 89%, p=0.001). CONCLUSION: Ligation alone is recommended rather than the combined ligation and sclerotherapy because of its lower complication rates.
Esophageal and Gastric Varices* ; Ethanolamine ; Hemorrhage* ; Humans ; Ligation* ; Sclerotherapy* ; Survival Rate ; Varicose Veins

BACKGROUND/AIMS: Combined esophageal variceal ligation and sclerotherapy has been hypothesized to be more effective for the control of bleeding esophageal varices than ligation alone. The present study was to compare the combined therapy with ligation alone in terms of variceal eradication, rebleeding, complication and survival rates in patients with bleeding esophageal varices. METHODS: Thirty-eight patients with bleeding esophageal varices were randomly assigned to receive ligation alone in 20 patients or the combined therapy in 18 patients. The clinical and endoscopic characteristics of patients in the ligation group were similar to those of patients in the combination group. In the combination group, 1-3 mL of ethanolamine was injected proximal to each ligated site. Treatments were repeated every 2- to 3-month until varices were eradicated. RESULTS: No significant differences were found between the ligation and combination groups in variceal eradication rates (70% vs. 72%), numbers of endoscopic sessions required to achieve eradication (3.5+/-0.33 vs. 3.3+/-0.31), rebleeding rates (30% vs. 28%) or 2-yr cumulative survival rates (95% vs. 75%). There were significantly more complications in the combination group (25% vs. 89%, p=0.001). CONCLUSION: Ligation alone is recommended rather than the combined ligation and sclerotherapy because of its lower complication rates.
Esophageal and Gastric Varices* ; Ethanolamine ; Hemorrhage* ; Humans ; Ligation* ; Sclerotherapy* ; Survival Rate ; Varicose Veins