BACKGROUND: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. We conducted real-world analysis of HBV prophylaxis after LT in the Korean population. METHODS: Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis. RESULTS: The study cohort comprised 267 cases of living-donor LT and 59 cases of deceased-donor LT. Hepatocellular carcinoma (HCC) was diagnosed in 232 (71.2%) of these subjects. Antiviral agents were used in 255 patients (78.2%) prior to LT. HBV DNA was undetectable in 69 cases (21.2%) and detectable over wide concentrations in the other 257 patients (78.8%) prior to LT. Polymerase chain reaction analysis of the store blood samples detected HBV DNA in all patients, with 159 patients (48.9%) showing concentrations > 100 IU/mL. Post-transplant HBV regimens during the first year included combination therapy in 196 (60.1%), hepatitis B immunoglobulin (HBIG) monotherapy in 121 (37.1%), and antiviral monotherapy in 9 (2.8%). In the second post-transplant year, these regimens had changed to combination therapy in 187 (57.4%), HBIG monotherapy in 112 (34.4%), and antiviral monotherapy in 27 (8.3%). Trough antibody to hepatitis B surface antigen titers > 500 IU/mL and >1,000 IU/mL were observed in 61.7% and 25.2%, respectively. The mean simulative half-life of HBIG was 21.6 ± 4.3 days with a median 17.7 days. Up to 2-year follow-up period, HCC recurrence and HBV recurrence developed in 18 (5.5%) and 6 (1.8%), respectively. HCC recurrence developed in 3 of 6 patients with HBV recurrence. CONCLUSION Combination therapy is the mainstay of HBV prophylaxis protocols in a majority of Korean LT centers, but HBIG was often administered excessively. Individualized optimization of HBIG treatments using SHL is necessary to adjust the HBIG infusion interval.

Background/Aims: Distinguishing gastric ectopic pancreas (GEP) from malignant tumors is relatively difficult. This study evaluated the endosonography findings of pathologically proven GEP. Methods: Thirty-one patients diagnosed with GEP based on a histopathological analysis from January 2004 to July 2018 were enrolled in this study. All patients underwent EUS and an endoscopic resection. Results: Seventeen patients were female, and the median age was 41.1 years (range, 14-74). The lesions were localized most commonly in the antrum. The mean size of the GEP was 10.6 mm (range, 7-15). Superficial type lesions, lesions with heterogeneous echogenicity, mixed pattern lesions, and lesions with indistinct borders were commonly observed on EUS. Calcification, anechoic duct-like structures, and thickening of the muscularis propria were observed in some patients. Endoscopic mucosal resection (41.9%) and endoscopic submucosal dissection (58.1%) were performed. The mean procedure time was 22.5 minutes. Complete resection was achieved for 71% of patients. No statistically significant results between the endosonography findings and complete resection rates were obtained. The mean follow-up esophagogastroduodenoscopy duration was 4.5 months. None of the patients presented with residual lesions on subsequent endoscopy. Conclusions EUS can help identify the features of GEP. Careful observations of the EUS findings can avoid unnecessary removal of GEP.

BACKGROUND: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. We conducted real-world analysis of HBV prophylaxis after LT in the Korean population.METHODS: Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis.RESULTS: The study cohort comprised 267 cases of living-donor LT and 59 cases of deceased-donor LT. Hepatocellular carcinoma (HCC) was diagnosed in 232 (71.2%) of these subjects. Antiviral agents were used in 255 patients (78.2%) prior to LT. HBV DNA was undetectable in 69 cases (21.2%) and detectable over wide concentrations in the other 257 patients (78.8%) prior to LT. Polymerase chain reaction analysis of the store blood samples detected HBV DNA in all patients, with 159 patients (48.9%) showing concentrations > 100 IU/mL. Post-transplant HBV regimens during the first year included combination therapy in 196 (60.1%), hepatitis B immunoglobulin (HBIG) monotherapy in 121 (37.1%), and antiviral monotherapy in 9 (2.8%). In the second post-transplant year, these regimens had changed to combination therapy in 187 (57.4%), HBIG monotherapy in 112 (34.4%), and antiviral monotherapy in 27 (8.3%). Trough antibody to hepatitis B surface antigen titers > 500 IU/mL and >1,000 IU/mL were observed in 61.7% and 25.2%, respectively. The mean simulative half-life of HBIG was 21.6 ± 4.3 days with a median 17.7 days. Up to 2-year follow-up period, HCC recurrence and HBV recurrence developed in 18 (5.5%) and 6 (1.8%), respectively. HCC recurrence developed in 3 of 6 patients with HBV recurrence.CONCLUSION: Combination therapy is the mainstay of HBV prophylaxis protocols in a majority of Korean LT centers, but HBIG was often administered excessively. Individualized optimization of HBIG treatments using SHL is necessary to adjust the HBIG infusion interval.
Antiviral Agents ; Carcinoma, Hepatocellular ; Cohort Studies ; DNA ; Follow-Up Studies ; Half-Life ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B ; Hepatitis ; Humans ; Immunoglobulins ; Korea ; Liver Transplantation ; Liver ; Organ Transplantation ; Polymerase Chain Reaction ; Recurrence ; Transplants

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

OBJECTIVES: Masked hypertension is associated with metabolic risks and increased risk of cardiovascular disease. The purpose of this study was to identify the frequency of and risk factors of masked hypertension in Korean workers. METHODS: The study was conducted among 121 employees at a hotel in Gyeongju, Korea, from December 2008 to February 2009. We measured blood pressure (BP) both in the clinic and using 24-hour ambulatory BP monitors for all subjects. Hypertension was defined independently by both methods, and subjects were classified into four groups: true normotension, masked hypertension, white coat hypertension, and sustained hypertension. RESULTS: The frequency of masked hypertension in our study group was 25.6%. Compared with true normotension, the factors related to masked hypertension were male gender (odds ratio [OR], 10.7; 95% confidence interval [CI], 1.41 to 81.09), aging one year (OR, 0.88; 95% CI, 0.78 to 0.99), clinic BP 120-129/80-84 mmHg (OR, 8.42; 95% CI, 1.51 to 46.82), clinic BP 130-139 / 85-89 mmHg (OR, 12.14; 95% CI, 1.80 to 81.85), smoking (OR, 5.51; 95% CI, 1.15 to 26.54), and increase of total cholesterol 1 mg / dL (OR, 1.05; 95% CI, 1.02 to 1.08). In males only, these factors were clinic BP 120-129 / 80-84 mmHg (OR, 15.07; 95% CI, 1.55 to 146.19), clinic BP 130-139 / 85-89 mmHg (OR, 17.16; 95% CI, 1.56 to 189.45), smoking (OR, 11.61; 95% CI, 1.52 to 88.62), and increase of total cholesterol 1 mg/dL (OR, 1.05; 95% CI, 1.01 to 1.09). CONCLUSIONS: The frequency of masked hypertension was high in our study sample. Detection and management of masked hypertension, a known strong predictor of cardiovascular risk, could improve prognosis for at-risk populations.
Adult ; Age Factors ; Blood Pressure ; Female ; Health Behavior ; Humans ; Hypertension/*ethnology ; Lipids/blood ; Male ; Middle Aged ; Occupational Diseases/ethnology ; Occupational Health/statistics & numerical data ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Sex Factors ; Smoking/adverse effects/ethnology ; Socioeconomic Factors ; Stress, Psychological/complications/ethnology ; Workplace/psychology/statistics & numerical data

BACKGROUND/AIMS: In Korea, few studies have examined primary cardiac tumors, which have a reported incidence of 0.0017~0.19% in autopsy series. This study surveyed the status of primary cardiac tumors over the past 7 years in one region. METHODS: A retrospective review examined all patients with primary cardiac tumors, except for confirmed thrombus, using hospital medical records from 2000 to 2006 at six community hospitals. Identified cases undergoing biopsy and surgery were selected for the study. RESULTS: The operative mortality was 7.7%. Of the 71 patients (26 males) with identified primary cardiac tumors, 65 (91.5%) tumors were benign and 6 (8.5%) were malignant. The benign tumors were myxoma (78.9%), rhabdomyoma (4.2%), fibroelastoma (2.8%), fibroma (1.4%), and leiomyoma (1.4%). Two of the myxomas were present at multiple locations. The malignant tumors included sarcomas (67%) and lymphomas (33%). Most of the tumors were located in the left atrium (76%). The majority of patients presented with chest pain and dyspnea. During follow-up for an average of 26.8+/-21.3 months, all but one patient with benign tumors was alive; one myxoma patient died perioperatively (1.5%). Four of the patients with malignant tumors (67%) died. CONCLUSIONS: Cardiac myxomas and sarcomas were the most common primary benign and malignant tumors, respectively. Benign tumors had excellent postoperative survival rates, while malignant tumors had high mortality.
Autopsy ; Biopsy ; Chest Pain ; Dyspnea ; Fibroma ; Follow-Up Studies ; Heart Atria ; Heart Neoplasms ; Hospitals, Community ; Humans ; Incidence ; Korea ; Leiomyoma ; Lymphoma ; Medical Records ; Myxoma ; Retrospective Studies ; Rhabdomyoma ; Sarcoma ; Survival Rate ; Thrombosis

Recent global warming trends may have a significant impact on vector-borne viral diseases, possibly affecting vector population dynamics and disease transmission. This study measured levels of hemagglutination-inhibition (HI) antibodies against Japanese encephalitis virus (JEV) and neutralizing antibodies against Akabane virus (AKAV) and Aino virus (AINV) for Thoroughbred horses in Korea. Blood samples were collected from 989 racehorses in several provinces, between October 2005 and March 2007. Sera were tested using either an HI assay or a virus neutralization test. Approximately half (49.7%; 492/989) of the horses tested were antibody-positive for JEV. The HI titer against JEV was significantly correlated with racehorse age (p < 0.05). Horses with an HI antibody titer of 1: 160 or higher accounted for 3.9% of the animals tested, indicating that vectors transmitting arthropod- borne viruses bit relatively few horses. In contrast, 3.8% (19/497) and 19.5% (97/497) of horse sera collected in March 2007 were positive against AKAV and AINV, respectively. The presence of antibodies against AKAV and AINV may indicate the multiplication of AKAV and AINV in these horses.
Aging ; Animals ; Encephalitis Virus, Japanese/*isolation & purification ; Hemagglutination Inhibition Tests/veterinary ; Horse Diseases/blood/*epidemiology ; Horses ; Korea/epidemiology ; Orthobunyavirus/*isolation & purification ; Seroepidemiologic Studies

We experienced a case of primary middle ear tuberculosis extended to skull base and cervical spines. There were many reports of middle ear tuberculosis in korea, but no case of tuberculosis extended to the skull base has been reported. The patient underwent mastoidectomy for the diagnosis and the pathologic report was compatible with tuberculosis. We checked serially computed tomography and magnetic resonance image during 18 months of anti-tuberculosis chemotherapy and could find the gradual improvements of the infiltrating destructive skull base lesion.
Cervical Vertebrae* ; Diagnosis ; Drug Therapy ; Ear, Middle ; Female ; Humans ; Korea ; Skull Base* ; Skull* ; Spine ; Tuberculosis*