PURPOSE: This study aimed to evaluate the value of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels to detect gastric cancer recurrence. MATERIALS AND METHODS: We retrospectively reviewed 154 patients who developed recurrence within 2 years after curative gastric cancer surgery and analyzed the relationship between postoperative CEA and CA19-9 levels and recurrence. We readjusted the cut-off values to improve the detection of recurrence. Subgroup analysis according to clinicopathologic variables was performed to further investigate the relationship between recurrence and CEA and CA19-9 levels. RESULTS: The sensitivity and specificity for elevated CEA levels to detect recurrence were 40.6% and 89.5%, respectively, and those for CA19-9 were 34.2% and 93.6%, respectively. The sensitivity and specificity for elevation of either tumor marker were 54.3% and 84.0%, respectively; those for elevation of both tumor markers were 19.2% and 98.4%, respectively. By readjusting the cut-off values from 5.0 ng/ml to 5.2 ng/ml for CEA and from 37.00 U/ml to 30.0 U/ml for CA19-9, the sensitivity was increased from 34.2% to 40.2% for CA19-9, while there was no increase in sensitivity for CEA. In subgroup analysis, the sensitivity of CEA was higher in patients with elevated preoperative CEA levels than in patients with normal preoperative CEA levels (86.7% versus 33.7%; P<0.001). Furthermore, the sensitivity of CA19-9 was higher in patients with elevated preoperative CA19-9 levels than in patients with normal preoperative CA19-9 levels (82.61% versus 26.83%; P<0.001). CONCLUSIONS: CEA and/or CA19-9 measurement with the readjusted cut-off values allows for more effective detection of gastric cancer recurrence.
Carcinoembryonic Antigen* ; Humans ; Recurrence* ; Retrospective Studies ; Sensitivity and Specificity ; Stomach Neoplasms* ; Biomarkers, Tumor

Tinea incognito (TI) is a dermatophytic infection which has lost its typical clinical appearance because of improper use of steroids or calcineurin inhibitors. The incidence of TI is increasing nowadays. We conducted retrospective review on 283 patients with TI from 25 dermatology training hospitals in Korea from 2002-2010 to investigate the demographical, clinical, and mycological characteristics of TI, and to determine the associated risk factors. More than half (59.3%) patients were previously treated by non-dermatologists or self-treated. The mean duration of TI was 15.0 +/- 25.3 months. The most common clinical manifestations were eczema-like lesion, psoriasis-like, and lupus erythematosus-like lesion. The trunk and face were frequently involved, and 91 patients (32.2%) also had coexisting fungal infections. Among 67 isolated strains, Trichophyton rubrum was the most frequently detected (73.1%). This is the largest study of TI reported to date and the first investigational report concerning TI in Korea. We suggest that doctors should consider TI when a patient has intractable eczema-like lesions accompanied by tinea pedis/unguium. Furthermore, there should be a policy change, which would make over-the-counter high-potency topical steroids less accessible in some countries, including Korea.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Demography ; Eczema/pathology ; Face/pathology ; Female ; Humans ; Lupus Erythematosus, Cutaneous/pathology ; Male ; Middle Aged ; Psoriasis/pathology ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Tinea/*diagnosis/microbiology ; Trichophyton/isolation & purification ; Young Adult

PURPOSE: Graft-Versus-Host Disease (GVHD) is a rare (0.1~2%) but severe complication after liver transplantation (LT). It is the most lethal complication after LT and there are currently no effective preventive or therapeutic measures available. Approximately 90 such cases have been reported in the literature, but only one case has been reported in Korea. METHODS: We performed a retrospective analysis of 767 patients who underwent LT (living donor:deceased donor=554:213) at Seoul National University Hospital, Korea from 1998 to 2009. Four patients (4/767, 0.52%) with histologically proven GVHD were found. The diagnosis of GVHD was made according to observing macrochimerism in the peripheral blood and the affected tissue biopsy. RESULTS: Four patients underwent LT due to Hepatitis B virus-related liver cirrhosis and two of these patients had coexisting hepatocellular carcinoma. Three patients received livers from deceased donors and one received a liver from a live donor. All their blood matching were identical. The first diagnosed case underwent human leukocyte antigen (HLA) typing only after LT and it showed complete one-way donor-recipient HLA matching. The onset of GVHD occurred between 10 days and 55 days after LT. All the patients developed high-grade fever, skin rash, neutropenia, diarrhea and the main signs and symptoms related to GVHD. All the patients died because of sepsis despite intensive treatment. CONCLUSION: GVHD after LT is an extremely rare and fatal complication and it is difficult to diagnose. Therefore, we should perform pre-transplant HLA matching and try to establish an early diagnosis for patients who are clinical suspicious of having GVHD. Further study in this area is needed and physicians need to be alert to detect this malady.
Carcinoma, Hepatocellular ; Chimerism ; Diarrhea ; Early Diagnosis ; Exanthema ; Fever ; Graft vs Host Disease ; Hepatitis B ; Humans ; Korea ; Leukocytes ; Liver ; Liver Cirrhosis ; Liver Transplantation ; Neutropenia ; Retrospective Studies ; Sepsis ; Tissue Donors

PURPOSE: Primary malignant lymphomas of the salivary glands are uncommon, representing only 1.7% to 3.1% of all salivary neoplasms and 0.6% to 5% of all tumors and tumor-like lesions of the parotid gland. Lymphomas of the parotid glands are usually manifestations of a systemic disease process but primary lymphomas of the parotid glands are rare. Most of these lesions are classified as extranodal non-Hodgkin's lymphoma. We report the clinicopathological features of primary malignant lymphoma of the parotid gland based on an analysis of our cases. METHODS: The subject was a 48-year-old male patient with a malignant lymphoma originating in the parotid gland, which had been slowly increasing in size over previous 6 months. The diagnosis was established by MRI and a superficial lobectomy. After diagnosis, the patient was referred to an oncologist for staging and medical treatment. RESULTS: The stage was IIIA. The patient was treated with chemotherapy following surgery with rituximab and CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone). The tumor was controlled successfully by chemotherapy. The patient was followed up for 1 year with no relapse. CONCLUSION: A case of primary non-Hodgkin's lymphoma of the parotid gland was treated with a superficial parotidectomy and chemotherapy. The disease was well controlled after a 1 year follow-up.
Antibodies, Monoclonal, Murine-Derived ; Doxorubicin ; Follow-Up Studies ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin ; Male ; Middle Aged ; Parotid Gland ; Recurrence ; Salivary Glands ; Vincristine

PURPOSE: To investigate the differentiation of rat bone marrow-derived mesenchymal stem cells (MSCs) into hepatocytes by cell transplantation using fibrin gels in a 70% hepatectomized rat model. METHODS: MSCs were isolated from Sprague-Dawley rats. MSCs (1.5x10(7) cells) were mixed with fibrin gels and injected immediately into the abdominal cavity of 70% hepatectomized rats. Fibrin-gels consisted of 500 IU/ml of thrombin and 90 mg/ml of fibrinogen. Transplanted MSCs in the fibrin scaffold were retrieved from surgically opened peritoneal cavities of rats on days 5, 10, 15, and 21 after the operation. The specimens were analyzed histologically and immunohistochemically. RESULTS: On H&E staining, MSCs from hepatectomized rats had changed to a round shape, while MSCs of the control group kept their spindle shape. When the fibrin matrix was biodegraded at day 15, the morphology of the MSCs had changed to hepatocyte-like cells without sinusoids and the hepatocyte-like cells had formed a three-dimensional tissue permitting cell-to-cell contacts within the matrix. On immunohistochemistry, MSCs expressed the hepatocyte markers cytokeratin 18, albumin, and alpha-fetoprotein, after 15 days of transplantation. CONCLUSION: When bone marrow-derived MSCs are transplanted using fibrin gels in the 70% hepatectomized rat, MSCs differentiate into hepatocyte-like cells and are conglomerated so that they form three-dimensional tissue-like hepatocytes without sinusoids.
Abdominal Cavity ; alpha-Fetoproteins ; Animals ; Bone Marrow ; Cell Differentiation ; Cell Transplantation ; Fibrin ; Fibrinogen ; Gels ; Hepatocytes ; Immunohistochemistry ; Keratin-18 ; Mesenchymal Stromal Cells ; Rats ; Rats, Sprague-Dawley ; Thrombin ; Transplants

OBJECTIVES: The objective of this study was to compare the long-term auditory performance and language skill depending on the age of cochlear implantation in the Korean population. We especially tried to separate the effect of maturation/development from that of the age at implantation. METHODS: Eighty-six pre-lingual children with profound hearing loss who underwent a cochlear implantation before the age of six and had been followed for more than 3 yr were included in this study prospectively. Categories of Auditory Performance (CAP) and Korean Picture Vocabulary Test (K-PVT) were serially followed up. In order to separate the age at implantation effect, K-PVT results were readjusted to the child's chronological age in the normal hearing population. RESULTS: When the CAP and K-PVT scores were directly compared without chronological readjustment, we failed to show a significant difference for improvements according to the age at implantation. Early cochlear implantation was associated with better language development, only when the K-PVT scores were readjusted to percentile scores of their chronological age. CONCLUSION: Early cochlear implantation was associated with better language development even within the critical period. This advantage may be recognized only when the effect of the age at implantation is separated from the effect of maturation/development.
Child ; Cochlear Implantation ; Cochlear Implants ; Critical Period (Psychology) ; Hearing ; Hearing Loss ; Humans ; Imidazoles ; Korea ; Language Development ; Language Tests ; Nitro Compounds ; Prospective Studies

PURPOSE: Split liver transplantation (SLT) offers an effective way of increasing the donor pool. However, it is often difficult to perform SLT under current allocation system. We retrospectively analyzed the outcome of the patients who had undergone SLT in Seoul National University Hospital. METHODS: From the first case of SLT in Korea on November 4, 1998, 8 patients underwent SLT in our center. Three adult patients received extended right liver graft and five child patients received left lateral section graft. All liver were split by in-situ method. RESULTS: All adult patients were alive. One adult patient developed hepatic artery thrombosis one month after SLT and underwent retransplantation due to graft failure. Another patient developed biliary leakage and had to undergo operative bile duct revision. Two of child patients were died of pneumonia and hepatic failure due to HBV hepatitis, respectively. One child patient suffered from hepatic venous stricture and persistent ascites and received interventional therapy. Overall 3-year patient survival rate was 87.5% and graft survival rate was 75.0%. No primary nonfunction developed and three patients (37.5%) suffered form vascular or biliary complications. CONCLUSION: The results of SLT were similar to that of conventional deceased donor liver transplantation. Although SLT is technically difficult and increase the risk of vascular or biliary complications just like living donor liver transplantation (LDLT), its result might be acceptable and it could be a successful method to expand the donor pool if it would be performed in the center experienced in LDLT.
Adult ; Ascites ; Bile Ducts ; Child ; Constriction, Pathologic ; Graft Survival ; Hepatic Artery ; Hepatitis ; Humans ; Korea ; Liver Failure ; Liver Transplantation* ; Liver* ; Living Donors ; Pneumonia ; Retrospective Studies ; Seoul ; Shiga Toxin 1 ; Survival Rate ; Thrombosis ; Tissue Donors ; Transplantation ; Transplants

PURPOSE: In our experience, post-LT persistent isolated unconjugated hyperbilirubinemia (IUH) has been frequently observed even after liver transplantation (LT) from normal donors. The present study was performed to evaluate the incidence and clinical significance of post-LT IUH. METHODS: Eighty-five patients were enrolled, and they had undergone adult-to-adult living donor LT between Jan 1999 and Jun 2003 and they had been followed-up for more than 2 years. Persistent post-LT IUH was defined as the case that showed repeated IUH 3 times or more per year. We excluded those cases that had other liver function abnormality, biliary complication, active infection or hemolysis. The donor's condition and the long-term prognosis of the post-LT IUH patients were investigated. RESULTS: Sixteen patients (18.8%) showed post-LT IUH. Seven of them underwent LT from donors who had IUH preoperatively. Nine (10.6%) of them, however, underwent LT from normal donors, that is, there was newly developed IUH postoperatively. There was no clinical factor associated with post-LT IUH for those nine patients, yet they developed no graft failure and major complications. A gradual increasing tendency of the bilirubin level during follow-up duration was observed for 3 of these 9 patients. CONCLUSION: Although about 10% patients developed post-LT IUH from normal donors, they all showed a good prognosis. Therefore, post-LT IUH was likely to be benign. However, close observation may be required because a gradual increasing tendency of bilirubin level was observed in some patients.
Bilirubin ; Follow-Up Studies ; Gilbert Disease ; Hemolysis ; Humans ; Hyperbilirubinemia* ; Incidence ; Liver Transplantation* ; Liver* ; Living Donors ; Prognosis ; Tissue Donors ; Transplants

PURPOSE: The mass cultivation of functional hepatocytes is a key factor of a bioartificial liver. Combining spheroid and microcarrier cultures has been applied for enhancing the cell viability and metabolic activities. Hence, the optimal number of hepatocytes per microcarrier was investigated. METHODS: Firstly, spheroid cultures were carried out with 1 g Cytodex 3 microcarrier plus 2 x 10(9), 4 x 10(8) and 8 x 10(7) viable hepatocytes per flask. The numbers of hepatocytes per microcarrier were approximately 666.7, 133.3 and 26.7, respectively. The control group consisted of a spheroid culture of 4 x 10(8) hepatocytes without any microcarrier. According to the primary experimental results, spheroid cultures with 1 x 10(8) of hepatocytes plus 1 g, 2 g and 3 g of the Cytodex 3 microcarrier were performed. The numbers of hepatocytes per microcarrier were approximately 33.3, 16.7 and 11.1, respectively. The control group consisted of a spheroid culture of 1 x 10(8) hepatocytes. The cell viabilities were assayed using a Cell Counting Kit-8; with the albumin production assayed using ELISA. RESULTS: According to the primary experiment, the group consisting of 26.7 hepatocytes per microcarrier showed the highest viability (P<0.01). However, there was no statistical difference in the albumin production between the groups (P=0.744). The second Experiment showed the groups consisting of 11.1 and 16.7 hepatocytes per microcarrier had higher viabilities than the other hepatocyte and control groups (P<0.01). The albumin production was similar for each group (P=0.187). CONCLUSION: With respect to their application to a bioartificial liver, about 130 hepatocytes per microcarrier was appeared to be good for the mass cultivation of a hepatocytes spheroid culture using the Cytodex 3 microcarrier.
Cell Count ; Cell Survival ; Enzyme-Linked Immunosorbent Assay ; Hepatocytes* ; Liver, Artificial

Purpose: Recently the incidence of vancomycin resistant enterococcus (VRE) infection and colonization has increased in the hospitalized patients. The purpose of present study is to examine the clinical significance of VRE infection and colonization in liver transplantation (LT) patients and to investigate the outcome. Methods: Among 194 patients who underwent LT from January 2001 to July 2004, 15 patients had at least one report of culture positive of VRE (VRE(+)). We compared the clinical outcome of 15 VRE(+) patients with those of VRE(-) patients. Results: One year mortality was higher in VRE(+) patients than VRE(-) patients (27% vs 4%; P=0.0001). Causes of death were primary graft non-function, infective endocarditis, MRSA sepsis and CMV pneumonitis. Mean duration of hospital stay was 102+/-63 days in VRE(+) patients, which shows significant difference with 51+/-30 days in VRE(-) patients (P=0.008). Cases who underwent gastroscopy (1.00+/-1.51 vs. 0.12+/-0.47; P=0.04) and percutaneous catheter drainage (1.33+/-1.49 vs. 0.40+/-1.05; P=0.03) were significantly more frequent in VRE(+) patients. The findings of gastroscopy were upper gastrointestinal bleeding (n=4), and bile duct obstruction (n=1). The contents of percutaneous catheter drainage were hematoma (n=3), bile juice (n=3) and ascites (n=1). Conclusion: VRE infected patients experienced more frequently gastrointestinal tract complications including bleeding or biliary complication and they showed higher 1-year mortality rate, although these patients died of causes other than VRE infection.
Ascites ; Bile ; Catheters ; Cause of Death ; Cholestasis ; Colon ; Drainage ; Endocarditis ; Enterococcus* ; Gastrointestinal Tract ; Gastroscopy ; Hematoma ; Hemorrhage ; Humans ; Incidence ; Length of Stay ; Liver Transplantation* ; Liver* ; Methicillin-Resistant Staphylococcus aureus ; Mortality ; Pneumonia ; Sepsis ; Transplants ; Vancomycin*