Recently, the prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing in Korean population. NAFLD includes a spectrum of hepatic pathology from simple steatosis in its most benign form, to nonalcoholic steatohepatitis (NASH) and/or cirrhosis. NAFLD has a strong association with type 2 diabetes and obesity, and thus it is now recognized to represent the hepatic manifestation of metabolic syndrome. The pathogenesis of simple steatosis occurrence and its progression to NASH is not entirely elucidated and multi-factorial. Liver fat accumulation is mainly induced by insulin resistance and increased free fatty acids, and then NASH is developed by oxidative stress, lipid peroxidation, mitochondrial dysfunction, gut-derived endotoxin, and cytokine/adipokine interplay. Genetic factors and environmental factors such as exercise and high fat and high fructose diet also participate in the development of NAFLD. This review is focused to summarize the up-to-date understanding of NAFLD pathogenesis.
Diet ; Fatty Acids, Nonesterified ; Fatty Liver ; Fibrosis ; Fructose ; Insulin Resistance ; Lipid Peroxidation ; Liver ; Obesity ; Oxidative Stress ; Prevalence

No abstract available.

The presence of A-V shunting in hepatocellular carcinoma is an important factor for deciding the prognosis and in the management with transarterial chemoembolization. Twenty-four patients with hepatocellular carcinoma performed with CO2-DSA and iodinated-DSA were reviewed for the evaluation of visibility of A-V shunting. It was classified by the visibility into clearly visible, faintly visible and invisible. Also the authors evaluated neovascularity and tumor staining. And we checked side effects after the injection of CO2 gas during CO2-DSA. A-V shunting was noted in 19 cases(63%), which were clearly visible in 15 of 19 cases(79%) on CO2-DSA and in 7 of 19 cases(37%) on iodinated-DSA. In 3 cases, A-V shunting was noted only on CO2-DSA. CO2-DSA(17%)was inferior to iodinated-DSA in detection of neovasculaity and tumor staining. Side effects from CO2-DSA were abdominal pain(1 case) and chest discomfort(1 case) but improved within several minutes. In conclusion, CO2-DSA is a sensitive and effective method for the detection of A-V shunting in hepatoma.
Carcinoma, Hepatocellular* ; Humans ; Methods ; Prognosis ; Thorax

Acute-on-chronic liver failure (ACLF) is an increasingly recognized distinct disease entity encompassing an acute deterioration of liver function in patients with chronic liver disease. Although there are no widely accepted diagnostic criteria for ACLF, the Asia.Pacific Association for the Study of the Liver (APASL) and the American Association for the Study of Liver Disease and the European Association for the Study of the Liver (AASLD/EASL) consensus definitions are commonly used. It is obvious that the APASL and the AASLD/EASL definitions are based on fundamentally different features. Two different definitions in two different parts of the world hamper the comparability of studies. Recently, the EASL-Chronic Liver Failure Consortium proposed new diagnostic criteria for ACLF based on analyses of patients with organ failure. There are areas of uncertainty in defining ACLF, such as heterogeneity of ACLF, ambiguity in qualifying underlying liver disease, argument for infection or sepsis as a precipitating event, etc. Although the exact pathogenesis of ACLF remains to be elucidated, alteration of host response to injury, infection, and unregulated inflammation play important roles. The predisposition, infection/inflammation, response, organ failure (PIRO) concept used for sepsis might be useful in describing the pathophysiology and clinical categories for ACLF. Treatment strategies are limited to organ support but better understanding of the pathophysiology is likely to lead to discovery of novel biomarkers and therapeutic strategies in the future.
Chronic Disease ; Echocardiography ; Humans ; Liver Cirrhosis/complications ; Liver Failure/diagnosis/etiology/*pathology/prevention & control ; Liver Failure, Acute/diagnosis/etiology/*pathology/prevention & control ; Liver Transplantation ; Sepsis/complications

No abstract available.
Alanine Transaminase/*blood ; Antiviral Agents/*therapeutic use ; Female ; Hepatitis C, Chronic/*drug therapy ; Humans ; Interferon-alpha/*therapeutic use ; Male ; Polyethylene Glycols/*therapeutic use ; Recombinant Proteins/therapeutic use ; Ribavirin/*therapeutic use

No abstract available.

Clinical management of chronic hepatitis B is rapidly evolving after the recent development of new antiviral drugs. These agents have been shown to be effective in improving virological, biochemical, and histological features in high proportion of the patients with chronic hepatitis B. However, these drugs can not eliminate hepatitis B virus (HBV) directly. It can only suppress HBV replication. Furthermore, the emergence of drug resistant HBV has become problematic according to the long-term use of oral antiviral drugs. Therefore, physicians should be careful in selecting whom to treat, when to start treatment, how long to treat, how to monitor patients before, during and after the treatment, which drug to choose, and how to manage patients with drug resistance. This review will focus on the monitoring and treatment strategy for chronic hepatitis B and drug resistant hepatitis B, quoting some clinical data of recently introduced or promising future drugs.
Alanine Transaminase/blood ; Antiviral Agents/*therapeutic use ; *Drug Resistance, Viral ; Hepatitis B e Antigens/blood ; Hepatitis B virus/*drug effects ; Hepatitis B, Chronic/*drug therapy/virology ; Humans ; Reverse Transcriptase Inhibitors/therapeutic use

BACKGROUND AND OBJECTIVES: The aims of this study were to evaluate the anatomical features of patients with obstructive sleep apnea syndrome (OSAS) using upper airway computed tomography (CT) in the awake state, and to analyze the correlation between anatomical features and severity of polysomnography (PSG) findings. MATERIALS AND METHODS: Sixty-eight patients presenting with snoring and sleep apnea were included, and upper airway CT in the awake state and PSG were performed in all patients. The average apnea-hypopnea index (AHI) and minimal arterial oxygen saturation (minSaO2) values were calculated. The axial and sagittal images from the level of the nasopharynx to that of the hypopharynx were obtained and measured. The correlations of the anatomical parameters with AHI and minSaO2 were statistically analyzed. RESULTS: The significant parameters correlated with AHI were nasopharynx anterior-posterior (A-P) diameter and transverse diameter, soft palate transverse diameter, uvula length, tongue length, lingual transverse diameter, and hypopharynx A-P diameter & transverse di-ameter. The parameters correlated with minSaO2 were nasopharynx transverse diameter and lingual transverse diameter. Conclusions: Upper airway analysis using CT in awake OSAS patients provides anatomical parameters which correlate with the severity of OSAS. Therefore, upper airway CT in the awake state may be helpful in diagnosing OSAS.
Airway Obstruction ; Humans ; Hypopharynx ; Nasopharynx ; Oxygen ; Palate, Soft ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring ; Tongue ; Uvula ; Wakefulness

Mastocytosis is characterized by an accumulation of mast cells in various organs, most frequently in the skin. A solitary mastocytoma is a clinical variant of cutaneous mastocytosis. It is defined as a localized collection of mast cells in the skin without evidence of extracutaneous organ involvement. Here we report on a 2-year-old female patient presenting with Solitary erythematous bulla on her lower back. The patient had a history of spinal tap on the lower back for evaluation of meningitis at 5 months of age, which resulted in trauma at the site. Histopathology showed mast cells infiltrating the papillary and reticular dermis and metachromatic purple cytoplasmic granules seen with Giemsa staining. As a result, the patient was diagnosed with a solitary bullous mastocytoma and administered antihistamine. The patient showed complete remission at 3 months. Herein, we report a rare case of solitary bullous mastocytoma occurring at a trauma site.
Azure Stains ; Child, Preschool ; Cytoplasmic Granules ; Dermis ; Female ; Humans ; Mast Cells ; Mastocytoma* ; Mastocytosis ; Mastocytosis, Cutaneous ; Meningitis ; Skin ; Spinal Puncture*

BACKGROUND: There are highly-polymorphic DNA markers in the human genomic DNA, known as the variable number of tandem repeats (VNTR). The VNTR markers can be used to evaluate the engraftment of stem cells. We evaluated the discrimination power of 3 types of long-tandem repeat (LTR) and tried to predict underlying disease relapses by DNA chimerism. METHODS: Twenty-nine patients were transplanted with allogeneic peripheral blood stem cells (PBSCs) and their related donors were tested. We used the three long-tandem repeats (LTR) D1S80, D1S111, and YNZ22 for VNTR-PCR. The informative test was performed before transplantation. The chimerism analysis was performed on days +30, +60, +90, and +180 after transplantation. RESULTS: The most informative marker was D1S80 with 55.2% discrimination potential. The power of discrimination was 79.3% in the combination of 3 LTRs. Twenty-two cases were tested for DNA chimerism analysis. When the complete chimerism was represented, the engraftment was more successful and when the mixed chimerism was represented, the underlying disease relapse rate increased. CONCLUSTIONS: DNA chimerism analysis was useful to evaluate the marrow status of patients. It also served as an indication for donor lymphocyte infusion. However, compared to unrelated allogenic PBSCT, the discrimination potential for the combination of 3 LTR loci was lower in the related allogenic PBSCT. Therefore, it is thought that additional short-tandem repeats and DNA sequencing are required for more discrimination power especially in related transplantation cases.
Bone Marrow ; Chimerism ; Discrimination (Psychology)* ; DNA ; Genetic Markers ; Humans ; Lymphocytes ; Minisatellite Repeats ; Recurrence ; Sequence Analysis, DNA ; Stem Cells* ; Tissue Donors