Purpose: Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC. Materials and Methods: Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR. Results: Among the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001). Conclusion High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.

BACKGROUND: Understanding the burden of disease is important to establish cost-effective treatment strategies and to allocate healthcare resources appropriately. However, little reliable information is available regarding the overall economic burden imposed by chronic obstructive pulmonary disease (COPD) in Korea. METHODS: This study is a multicenter observational research on the COPD burden in Korea. Total COPD costs were comprised of three categories: direct medical, direct non-medical, and indirect costs. For direct medical costs, institutional investigation was performed at 13 medical facilities mainly based on the claims data. For direct non-medical and indirect costs, site-based surveys were administered to the COPD patients during routine visits. Total costs were estimated using the COPD population defined in the recent report. RESULTS: The estimated total costs were approximately 1,245 million US dollar (1,408 billion Korean won). Direct medical costs comprised approximately 20% of the total estimated costs. Of these, formal medical costs held more than 80%. As direct non-medical costs, nursing costs made up the largest percentage (39%) of the total estimated costs. Costs for COPD-related loss of productivity formed four fifths of indirect costs, and accounted for up to 33% of the total costs. CONCLUSION: This study shows for the first time the direct and indirect costs of COPD in Korea. The total costs were enormous, and the costs of nursing and lost productivity comprised approximately 70% of total costs. The results provide insight for an effective allocation of healthcare resources and to inform establishment of strategies to reduce national burden of COPD.
Delivery of Health Care ; Efficiency ; Health Care Costs ; Humans ; Korea* ; Nursing ; Pulmonary Disease, Chronic Obstructive*

PURPOSE: This study was conducted in order to investigate the nutrient and food intake status, and dietary quality in Korean adults according to abdominal obesity based on waist circumference. METHODS: We analyzed data from the combined 2010~2012 KNHANES (Korean National Health and Nutrition Examination Survey). The analysis included 6,974 adults aged 40 to 64 years. In this study, according to abdominal obesity based on waist circumference (male > or = 90 cm, female > or = 85 cm), we classified the subjects into the obesity group (male, n = 775, female, n = 1,113) and control group (male, n = 2,038, female, n = 3,048). The nutrient and food group intake, ND (nutrient density), NAR (nutrient adequacy ratio), MAR (mean adequacy ratio), INQ (index of nutritional quality), DDS (dietary diversity score), and DVS (dietary variety score) were analyzed using data from the 24-recall method. RESULTS: For male, no significant difference in quality index of the diet was observed between the obesity group and the normal group. In female, in diet quality (ND, NAR, and INQ), vitamin B2 (ND, NAR, and INQ) calcium (NAR), phosphorous (ND, INQ) and potassium (ND) of the obesity group was significantly lower than those of the control group. DDS and DVS in the obesity group (3.57, 30.95) were significantly lower than those of the control group (3.68, 32.84) (p = 0.0043, 0.0002). DVS (DVS > or = 39.9) showed association with lower risk of waist obesity in a logistic regression model after adjustments for multiple confounding factors including age, education, income, alcohol intake frequency, smoking, physical activity, energy intake, and body mass index (OR: 0.616, 95% CI: 0.420-0.903). CONCLUSION: In conclusion, females with abdominal obesity had lower micronutrient intake quality, DVS than those of the control group. In Korean females, food intake variety can adversely affect waist circumference.
Adult* ; Body Mass Index ; Calcium ; Diet ; Eating* ; Education ; Energy Intake ; Female ; Humans ; Logistic Models ; Male ; Micronutrients ; Motor Activity ; Nutrition Surveys* ; Obesity ; Obesity, Abdominal* ; Potassium ; Riboflavin ; Smoke ; Smoking ; Waist Circumference*

Obviously, the administration of the prescribed amount of activity to the patient requires proper operation of the dose calibrator, which shall be verified by implementing the required quality control on the instrument. This investigation examined the accuracy and precision of dose calibrator activity measurement of the radiopharmaceutical F-18 FDG. To investigate the status of the nuclear medicine centers in Korea for the performance of dose calibrators, 10 centers providing PET/CT system services in Korea were inspected in 2008. We measured accuracy and precision in 10 equipments in consideration of PET/CT model, installation area, and installation time. According to the results of comparative analysis of 10 dose calibrators used to measure radioactivity of F-18 FDG, accuracy was -5.00~4.50% and precision was 0.05~0.45%, satisfying the international standards, which are accuracy +/-10% and precision +/-5%. This study demonstrated that, for accurate measurements, no adjustment is necessary for a dose calibrator setting when measuring different dose calibrators of F-18 FDG activity prescriptions.
Humans ; Korea ; Nuclear Medicine ; Quality Control ; Radioactivity

Obviously, the administration of the prescribed amount of activity to the patient requires proper operation of the dose calibrator, which shall be verified by implementing the required quality control on the instrument. This investigation examined the accuracy and precision of dose calibrator activity measurement of the radiopharmaceutical F-18 FDG. To investigate the status of the nuclear medicine centers in Korea for the performance of dose calibrators, 10 centers providing PET/CT system services in Korea were inspected in 2008. We measured accuracy and precision in 10 equipments in consideration of PET/CT model, installation area, and installation time. According to the results of comparative analysis of 10 dose calibrators used to measure radioactivity of F-18 FDG, accuracy was -5.00~4.50% and precision was 0.05~0.45%, satisfying the international standards, which are accuracy +/-10% and precision +/-5%. This study demonstrated that, for accurate measurements, no adjustment is necessary for a dose calibrator setting when measuring different dose calibrators of F-18 FDG activity prescriptions.
Humans ; Korea ; Nuclear Medicine ; Quality Control ; Radioactivity

Biliary hamartoma is a benign neoplasm that normally measures < 1 cm in diameter and can occur throughout the liver. It is composed of dilated bile ducts embedded in a fibrous stroma and is a congenital fibrocystic disease derived from incomplete remodeling of the ductal plates in the embryonic development of intrahepatic bile ducts. Incidentally found in imaging studies without clinical symptoms, it is known to be infrequently accompanied by cholangiocarcinoma. However, biliary hamartoma must be differentiated from other cystic lesions that are similar to metastatic tumors or abscesses. We describe four cases of biliary hamartoma.
Abscess ; Bile Duct Neoplasms ; Bile Ducts ; Bile Ducts, Intrahepatic ; Biopsy ; Cholangiocarcinoma ; Embryonic Development ; Female ; Hamartoma ; Liver ; Liver Neoplasms ; Pregnancy

PURPOSE: To compare the variable inflammatory parameters of acute pyelonephritis patients treated with inpatient therapy at 13 hospitals, according to the age and gender distributions. MATERIALS AND MATHODS: A total of 3,544 medical records of patients with confirmed acute pyelonephritis, and admitted to hospital between January 2000 and December 2005, were retrospectively analyzed. RESULTS: The mean age of the patients was 43.2+/-16.2 years old, with a male:female ratio of 1 : 5.1. The average duration of hospital admission was 7.9+/-5.3 days. Underlying diseases were found in 23.0% (749/3,252 patient), largely due to diabetes (35.1%). Radiological abnormal findings were found in 13.7%. The leukocyte count, ratio of segmented form, erythrocyte sedimentation rate (ESR), c-reactive protein, pyuria, positive blood culture, positive urine culture were 11,014+/-5,778/mm(3), 74.8+/-14.5%, 44.0+/-32.0 mm/hr, 12.4+/-9.3mg/dl, 83.9%, 10.5% and 46.7%, respectively. E. coli grow in 79% of the urine culture positive patients. In a comparison of 3 age groups (<40 years, 40-60 years, >61 years), the elderly patients had a greater number of underlying diseases and more pathogens in cultured blood. When divided into males and females, the elderly male patients had more pathogen in cultured urine, but contrary to the male patients, the elderly female patients had elevated leukocyte count and erythrocyte sedimentation rate. Also, the old patient group had more resistance to ampicillin when they had E. coli as the uropathogen (p=0.021). Patients with higher ESR required longer hospital admission periods. CONCLUSIONS: It was found that variable clinical parameters of acute pyelonephritis patients treated with inpatient therapy differed according to both gender and age group in Korea. Therefore, these factors should be taken into account in the treatment plan.
Aged ; Ampicillin ; Blood Sedimentation ; C-Reactive Protein ; Female ; Humans ; Inpatients ; Korea ; Leukocyte Count ; Male ; Medical Records ; Pyelonephritis* ; Pyuria ; Retrospective Studies

Endoscopic retrograde cholangiopancreatography (ERCP) has played an important role in diagnosis and management of biliary disease. Traditionally, duodenal perforations, rare complication of ERCP, have been managed surgically. However, in the past decade, there were arguments for surgical and nonsurgical management of ERCP-related duodenal perforations and reports of successful conservative treatment were increasing especially in patients with old age and poor medical conditions. We experienced a case of type I duodenal perforation following ERCP treated with covered metal stent in 74 years old female with duodenal invasion by Klatskin tumor.
Aged ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Female ; Humans ; Klatskin's Tumor ; Stents*

BACKGROUND AND OBJECTIVES: The objective of this article is to evaluate the effectiveness and the compliance rates of immunotherapy, and to identify the factors affecting the compliance of immunotherapy. SUBJECTS AND METHOD: We evaluated the charts of 120 patients with allergic rhinitis and/or asthma, for which allergen immunotherapy was carried out from 1998 and 2000. Information was obtained via chart reviews and telephone surveys. RESULTS: Among the 120 patients with allergic rhinitis, 41 patients also had asthma. The common allergens identified by the skin prick test prior to immunotherapy were D. farinae, D. pteronyssinus, dog fur, cat fur, and cockroaches, et al. The skin prick test reactivity to common allergens is significantly lower after three years of immunotherapy than it is prior to immunotherapy. The satisfaction of patients after immunotherapy between the allergic rhinitis group and allergic rhinitis with asthma group are as follows: much satisfied (25.4%/27.3%), fairy satisfied (31.6%/33.7%), a little satisfied (15.2%/17.2%), not satisfied (17.1%/13.3%), and unsure (10.7%/8.5%). In our study, the compliance rates of immunotherapy were 65.7%. The reasons cited for discontinuance of allergen immunotherapy were inconvenience (45%), lack of improvement in symptoms (23%), improvement in symptoms (15%), greater improvement in symptoms through medication (11%), and other reason (7%). CONCLUSION: If we increase the compliance of immunotherapy through various researches on the compliance of immunotherapy and educating patients about it, allergen immunotherapy may become more effective in treating allergic disorders.
Allergens ; Animals ; Asthma ; Cats ; Cockroaches ; Compliance* ; Desensitization, Immunologic ; Dogs ; Humans ; Immunotherapy* ; Rhinitis* ; Skin ; Telephone

Combined hepatocellular-cholangiocarcinoma is a rare form of primary liver cancer, featuring both hepatocellular and biliary epithelial differentiations. An intrahepatic tumor may be considered as a metastatic lesion. It has been suggested in the literature that the likelihood of metastasis in the cirrhotic liver is lower than that in the non-cirrhotic liver. A rare case of combined hepatocellular-cholangiocarcinoma and second primary colon adenocarcinoma in a 67-year-old male patient with liver cirrhosis is presented. Histologically, the intrahepatic mass was composed of a spindle cell sarcomatous component; a hepatocellular carcinoma component; and a cholangiocarcinoma component. There were focal transitional regions among the different components. Immunohistochemically, the cholangiocarcinoma component of the intrahepatic mass showed positive reactions for CK-7 but negative reactions for CK-20. The adenocarcinoma of the colon showed positive reactions for CK-20 but negative reactions for CK-7.
Adenocarcinoma/*pathology ; Aged ; Bile Duct Neoplasms/*pathology ; *Bile Ducts, Intrahepatic ; Carcinoma, Hepatocellular/*pathology ; Cholangiocarcinoma/*pathology ; Colonic Neoplasms/*pathology ; English Abstract ; Humans ; Liver Neoplasms/*pathology ; Male ; Neoplasms, Second Primary/*pathology