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Hepatic Involvement in Hereditary Hemorrhagic Telangiectasia.

The Korean Journal of Hepatology.2004;10(4):322-324.

No abstract available.
Adolescent ; Humans ; Liver Diseases/*complications/radiography ; Male ; Telangiectasia, Hereditary Hemorrhagic/*complications/radiography

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Chronic Graft Versus Host Disease.

So Young JIN

The Korean Journal of Hepatology.2004;10(4):319-321.

No abstract available.
Adult ; Chronic Disease ; Graft vs Host Disease/*pathology ; Humans ; Liver/*pathology ; Male

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A Case of Nodular Regenerative Hyperplasia of Liver that mimicked Primary Biliary Cirrhosis.

Sung Gon SHIM ; Joo Hyun SOHN ; Jae Woong LEE ; Young Woo CHUNG ; Chang Hee PAIK ; Jong Pyo KIM ; Yong Chul JEON ; Dong Soo HAN ; Joon Soo HAHM ; Dong Hoo LEE ; Choon Suhk KEE ; Young Ha OH

The Korean Journal of Hepatology.2004;10(4):313-318.

Nodular regenerative hyperplasia (NRH) of the liver is a rare disease that is characterized by multiple regenerative nodules in the hepatic parenchyma without fibrosis. The exact pathogenesis of NRH has not been established, but it's been suggested that obliteration of portal veins may initiate the nodular transformation. It is also known that this disease is associated with autoimmune disease, myeloproliferative disease, lymphoproliferative disease, primary biliary cirrhosis, and some chemotherapy agents. The patients with NRH are usually asymptomatic, yet if they have symptoms, the most common clinical manifestations are those of portal hypertension, including splenomegaly and esophageal varices with or without bleeding. We report a case of nodular regenerative hyperplasia that presented with clinical manifestations similar to those of primary biliary cirrhosis.
Aged ; Diagnosis, Differential ; English Abstract ; Female ; Focal Nodular Hyperplasia/*diagnosis/pathology ; Humans ; Hyperplasia ; Liver/*pathology ; Liver Cirrhosis, Biliary/*diagnosis

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Porphyria Cutanea Tarda Presenting as Jaundice.

Kwang Hyuk PARK ; Dong Yang PARK ; Jin Bae KIM ; Il Hyun BAEK ; Myung Seok LEE ; Gwang Ho BAIK ; Sang Hoon PARK ; Jong Hyeok KIM ; Choong Kee PARK ; Kwang Ho KIM

The Korean Journal of Hepatology.2004;10(4):308-312.

Porphyria cutanea tarda (PCT) is a disease characterized by an early appearance of severe photosensitivity with an increase in urinary uroporphyrin excretion and other porphyrins, high isocoproporphyrin fecal levels and an accumulation of protoporphyrin in erythrocyte. This disease has been known to be caused by a dramatic decrease in the activity of the uroporphyrinogen decarboxylase. Multiple infectious and environmental factors may contribute to PCT by influencing oxidative stress in the hepatocytes. We report here on a case of porphyria cutanea tarda that presented with jaundice and photosensitivity.
Adult ; English Abstract ; Humans ; Jaundice/*complications ; Male ; Photosensitivity Disorders/complications ; Porphyria Cutanea Tarda/complications/*diagnosis

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Clinical Features and Prognostic Factors of Fulminant Hepatic Failure in Koreans.

Sung Jae SHIN ; Sang Hoon AHN ; Hee Man KIM ; Ja Kyung KIM ; Byung Chang KIM ; Jae Hyun LEE ; Yong Han PAIK ; Kwan Sik LEE ; Kwang Hyub HAN ; Chae Yoon CHON ; Young Myoung MOON

The Korean Journal of Hepatology.2004;10(4):298-307.

BACKGROUND/AIMS: There have been scant reports on the prognostic factors of fulminant hepatic failure for selecting the patients who need liver transplantation. We investigated the clinical features and prognostic factors throughout the clinical course of the disease in Korean patients with fulminant hepatic failure. METHODS: Between 1992 and 2003, a total of 60 patients with fulminant hepatic failure were divided into the survival group and the non-survival group, and these groups were compared according to gender, age, etiology, values of the laboratory tests, grade of the encephalopathy that was obtained at the time of admission and the worst clinical status (hepatic encephalopathy). RESULTS: The mean age of the total patients was 40.9 years (M:F=31:29) and the survival rate was 28.3% (n=17). Drugs (n=25, 12 herbal medicines) and viral infection (n=24, 18 HBV infection) were most common causes. On univariate analysis, the WBC, AST, ALT, total bilirubin and HE IV stage at the time of admission were the significant factors for a poor prognosis. Total bilirubin, albumin and HE IV stage also remained as significant factors at the time of the worst clinical status. On multivariate analysis, total bilirubin (P=0.033) and ALT (P=0.042) at admission were the prognostic factors, and the progression to HE IV stage (P=0.019) or hypoalbuminemia (P=0.028) during hospitalization represented the significant factors for a poor prognosis. CONCLUSIONS: In contrast to Western countries, HBV infection and herbal medicines were major causes of fulminant hepatic failure in Korea. The total serum bilirubin level and progressive hyperbilirubinemia with HE (stage IV) during hospitalization seemed to be the most important prognostic factors, and liver transplantation should be considered before the patient reaches this status.
Adult ; English Abstract ; Female ; Humans ; Liver Failure, Acute/*diagnosis/etiology/surgery ; Liver Transplantation ; Male ; Middle Aged ; Prognosis

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The Clinical Report of 1,078 Cases of Hepatocellular Carcinomas: National Cancer Center Experience.

Jae Hee CHEON ; Joong Won PARK ; Kyung Woo PARK ; Young Il KIM ; Sung Hoon KIM ; Woo Jin LEE ; Hong Suk PARK ; Sang Jae PARK ; Eun Kyoung HONG ; Chang Min KIM

The Korean Journal of Hepatology.2004;10(4):288-297.

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is the third leading cause of cancer and the 5 year survival rate is 9.6% in Korea. To develop a strategy for surveillance and treatments, we studied the recent clinical characteristics of HCC diagnosed at single institution in Korea, where is in an endemic area of chronic hepatitis B. METHODS: One thousand and seventy eight patients with HCC who visited the National Cancer Center between June 2001 and December 2003 were retrospectively studied. RESULTS: The male/female ratio was 4.5:1. The mean age of the patients was 56.3 years. 74.2% of patient had hepatitis B virus (HBV) infections, 8.6% had hepatitis C virus (HCV) infections, 6.9% of the patients abused alcohol and 10.3% of the patients had non-B non-C considered as the etiologic factors of their HCC. Only 10.0% of patients had a tumor sized 2 cm or less and 53.3% of patients had a large tumor over 5 cm in diameter. 33.2% of patients had a single tumor. At the time of diagnosis, the modified UICC staging was as follows: 6.5%, 20.1%, 30.9%, 25.2% and 17.3% in stages I, II, III, IVa and IVb, respectively. The initial treatment performed was transcatheter arterial chemoembolization (48.2%), radiofrequency ablation (1.5%), hepatic resection (11.2%), systemic chemotherapy (7.5%), radiotherapy (2.1%), and conservative medical treatments (29.5%). The mean number of treatments was 1.65. The response rates to the initial treatments were 27.9% (complete response), 23.6% (partial response), 7.5% (minimal response), 14.2% (stable disease), and 30.4% (progressive disease). CONCLUSIONS: HBV infection is a major etiologic factor for Korean HCC patients. Most cases are still in advanced stages and these cases responded poorly to any treatments. The national surveillance program and its guideline for HCC are expected to improve the survival of HCC patients.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/*diagnosis/etiology/therapy ; English Abstract ; Female ; Humans ; Korea ; Liver Neoplasms/*diagnosis/etiology/therapy ; Male ; Middle Aged

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Positron Emission Tomography with Fluorine-18-Fluorodeoxyglucose is Useful for Predicting the Prognosis of Patients with Hepatocellular Carcinoma.

Yun Ho KONG ; Chul Ju HAN ; Sang Dae LEE ; Wee Sik SOHN ; Min Jae KIM ; Seung Seog KI ; Jin KIM ; Sook Hyang JEONG ; You Cheoul KIM ; Jhin Oh LEE ; Gi Jeong CHEON ; Chang Woon CHOI ; Sang Moo LIM

The Korean Journal of Hepatology.2004;10(4):279-287.

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is heterogenous in terms of its glucose metabolism. Positron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) shows various levels of FDG uptake for patients with HCC. This study was designed to assess the usefulness of FDG-PET for predicting the outcome of the patients with HCC. METHODS: FDG-PET was performed for 27 patients with HCC. The standardized uptake value (SUV) and SUV ratio (defined as the tumor-to-nontumor ratio of SUV) was calculated for each patient. The clinical factors of the outcome were analyzed by regression analysis using Cox's multivariate proportional hazard model. The survival rate was calculated by the Kaplan-Meier method. RESULTS: Among the analyzed clinical factors including tumor size, number of tumors, AFP, involvement of major vessels, presence of systemic metastases, Child-Pugh class the SUV and SUV ratio, only the SUV was the only significant independent prognostic factor (p=0.001). On the basis of the SUV, the patients were divided into two groups of roughly equal size: group A, SUV of <7; group B, SUV >or=7. The cumulative survival rate was significantly lower for group B than for group A, and the median survival time was significantly different (4 months vs 15 months, respectively) (p=0.003). CONCLUSIONS: These results suggest that FDG-PET is useful to predict the outcome for patients with hepatocellular carcinoma.
Adult ; Aged ; Carcinoma, Hepatocellular/mortality/*radionuclide imaging ; English Abstract ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Liver Neoplasms/mortality/*radionuclide imaging ; Male ; Middle Aged ; *Positron-Emission Tomography ; Prognosis ; Radiopharmaceuticals/*diagnostic use ; Survival Rate

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Efficacy of Hepatic Arterial Infusion Therapy for Advanced Hepatocellular Carcinoma Using 5-fluorouracil and Cisplatin.

Byoung Kuk JANG ; Ki Min KWON ; Woo Jin CHUNG ; Kyung Sik PARK ; Kwang Bum CHO ; Jae Seok HWANG ; Sung Hoon AHN ; Gab Chul KIM ; Young Hwan KIM ; Jin Soo CHOI ; Jung Hyeok KWON

The Korean Journal of Hepatology.2004;10(4):271-278.

BACKGROUND/AIMS: There has been no standard treatment for advanced hepatocellular carcinoma (HCC) until now. The aim of this study was to evaluate the efficacy of hepatic arterial infusion therapy (HAIT) using 5-fluorouracil (5-FU) and cisplatin (CDDP) for advanced HCC. METHODS: Twenty patients received repeated HAIT using an implanted drug delivery system. Of the 20 patients, eight patients had HCC with portal vein tumor thrombosis (PVTT), eleven patients had residual tumor despite transcatheter arterial chemoembolization (TACE) or percutaneous ethanol injection therapy (PEIT), and one patient had multiple recurrent HCC nodules after surgical resection. The patients were repeatedly treated with an arterial infusion of 5-FU (250 mg/5 hours on day 1-5) and CDDP (10 mg/1 hour on day 1-5) via the drug delivery system at three weekly intervals. RESULTS: Of the 20 patients, three patients were excluded from the study due to death within the first 1 week of treatment or during follow-up before evaluation. The response rate according to tumor size on abdominal CT was 29.4% (5 patients). One of the five patients showed a complete response (CR, 5.9%), three patients showed partial responses (PR, 17.6%), and one patient showed a minor response (MR, 5.9%). Chemotherapy- related side effect, such as grade I-II nausea (n=2), grade II vomiting (n=1), fever (n=1), drug eruption (n=1) and catheter-related complication such as dislodgement of the catheter (n=2), occurred in six patients. CONCLUSIONS: HAIT using the FP regimen is another option for patients having advanced HCC with PVTT or for patients showing an ineffective response to other therapies.
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Carcinoma, Hepatocellular/*drug therapy/radiography ; Cisplatin/administration & dosage ; English Abstract ; Fluorouracil/administration & dosage ; *Hepatic Artery ; Humans ; Infusion Pumps, Implantable ; *Infusions, Intra-Arterial ; Liver Neoplasms/*drug therapy/radiography ; Male ; Middle Aged

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Reappraisal of HBV Genotypes and Clinical Significance in Koreans Using MALDI-TOF Mass Spectrometry.

Jung Min LEE ; Sang Hoon AHN ; Hye Young CHANG ; Ji Eun SHIN ; Do Young KIM ; Myoung Ki SIM ; Sun Pyo HONG ; Hyun Jae CHUNG ; Soo Ok KIM ; Kwang Hyub HAN ; Chae Yoon CHON ; Young Myoung MOON

The Korean Journal of Hepatology.2004;10(4):260-270.

BACKGROUND/AIMS: Recent studies have shown that the genotype of hepatitis B virus (HBV) may correlate with the disease natural history and treatment outcome. However, several of these studies used low sensitivity assays in a small number of patients, and this has precluded an accurate evaluation of Korean HBV genotypes. We analyzed Korean HBV genotypes in a large population by employing a new technology, restriction fragment mass polymorphism (RFMP) using MALDI-TOF mass spectrometry, in a sensitive and specific manner. METHODS: Between February 1995 and December 2003, a total of 475 patients with chronic HBV infection were enrolled. The assay is based on the mass measurement of oligonucleotides having genotypic variations of the S gene. Clinical features including the virologic status and disease progression were also evaluated. RESULTS: The median age of the total patients was 35.5 years. Out of 475 patients, there were 162 (34.1%) inactive carriers, 172 (36.2%) had chronic hepatitis, 77 (16.2%) had liver cirrhosis and 64 (13.5%) had hepatocellular carcinoma (HCC). There were 454 patients (95.6%) with genotype C, 4 patients (0.8%) with genotype A, 16 patients (3.4%) with the mixed A and C genotype [7 patients (1.4%) with AA], and 1 patient (0.2%) with B genotype. Comparing genotype A and C, genotype A patients were all inactive carriers without HCC, whereas genotype C patients included those with chronic hepatitis, liver cirrhosis and HCC. CONCLUSIONS: HBV genotype C is highly prevalent in Korea. Although it is a small percentage, genotype A also exists and it seems to take a more benign clinical course than genotype C. Further studies are necessitated to assess the relationship between HBV genotypes and the various aspects of the diseases' clinical course.
Adolescent ; Adult ; Aged ; English Abstract ; Female ; Genotype ; Hepatitis B virus/classification/*genetics ; Hepatitis B, Chronic/virology ; Humans ; Korea ; Male ; Middle Aged ; Polymorphism, Restriction Fragment Length ; *Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

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Hepatitis B Virus Surface Antigen: A Multifaceted Protein.

Jung Hyun PARK

The Korean Journal of Hepatology.2004;10(4):248-259.

Despite the small size of its genome (3.2 kb) and having only four genes that are encoded within it, the hepatitis B virus (HBV) is one of the most successful viral pathogens in human history. It is estimated that there are about 350-400 million people worldwide who are chronically infected with HBV, and even with the extensive efforts that are being done with preventive vaccination, this malady still remains a clear and present danger to the public health. How is it possible that this small double-stranded DNA virus can escape and outfox the surveillance of the complex human immune system? One explanation is that HBV gene products play multiple roles in infections and throughout the viral life cycle so that the virus can effectively survive under various hostile circumstances. Indeed, the HBV DNA polymerase, for example, exerts several functions such as reverse transcription and RNA degradation, and the HBV X protein not only acts as a transcriptional activator, but it also interferes with the host cells' DNA repair mechanism as well as inducing apoptosis and controlling signal transduction. The HBV surface protein, which is encoded in the env gene, is another intriguing example of such multifunctionality. Thus, our present article overviews and summarizes the multifaceted role of this membrane protein as shown in 1) its role as a structural protein of the virus envelope; 2) its function as the viral ligand for interacting with the viral receptors on host cells; 3) its characteristics as an energy-independent transporter molecule that can mediate the nuclear accumulation of itself and other tagged molecules; 4) its role as a viral transactivator protein that can cause hepatocellular carcinoma; 5) its hypothetical function in viral apoptotic mimicry that results in host anti-inflammatory responses; and last 6) its immunostimulatory property by providing for strong and well-defined B- and T-cell epitopes. Understanding these various functions and the versatility of this single protein will help us decipher and understand the viral- and immuno-pathogenesis of HBV itself.
Animals ; English Abstract ; Hepatitis B Surface Antigens/*physiology ; Humans

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