Background/Aims: The ursodeoxycholic acid (UDCA) response score (URS) was developed to identify poor responders to UDCA before treatment, in order to offer timely and proactive intervention. However, validation of the URS in Asian population is warranted. Methods: A total of 173 Asian patients diagnosed with primary biliary cholangitis (PBC) between 2007 and 2016 at seven academic institutions in Korea who started UDCA treatment were analyzed to validate the performance of URS. UDCA response was defined as an alkaline phosphatase level less than 1.67 times the upper limit of normal after 1-year of UDCA treatment. In addition, prognostic performance of URS for liver-related events, defined as newly developed hepatic decompensation or hepatocellular carcinoma was evaluated. Results: After 1 year of UDCA treatment, 133 patients (76.9%) achieved UDCA response. UDCAresponse rate was 98.7% for those with URS ≥1.41 (n=76) and 58.8% for those with URS <1.41(n=97). The area under the receiver operating characteristic curve of URS in predicting UDCAresponse was 0.84 (95% confidence interval, 0.78 to 0.88). During a median follow-up of 6.5years, liver-related events developed in 18 patients (10.4%). Among 117 patients with PBC stage I-III by histological evaluation, the 5-year liver-related event-free survival rate differed accordingto the URS; 100% for URS ≥1.41 and 86.5% for URS <1.41 (p=0.005). Conclusions URS demonstrated good performance in predicting a UDCA treatment response in Asian PBC patients. In addition, the risk of liver-related events differed according to the URS for the PBC stage. Thus, URS can be used to predict the response and clinical outcome in patients with PBC.

The association between vitamin D levels and nonalcoholic fatty liver disease (NAFLD) has been recognized. However, few studies showed independent associations between vitamin D deficiency and NAFLD after a sex-related adjustment for metabolic factors. We aimed to study whether vitamin D deficiency is an independent risk factor of NAFLD even after controlling for metabolic syndrome and visceral fat in both sexes. In this cross-sectional study, 7,514 Korean adults (5,278 men, 2,236 women) participated in a health check-up program. They underwent blood tests, abdominal computed tomography (CT) of the visceral fat area, and ultrasonography for NAFLD screening. Multiple logistic regression analysis was used to investigate the association of vitamin D deficiency with NAFLD according to the sex differences. Vitamin D deficiency is associated with NAFLD. The adjusted odds ratio (aOR) for NAFLD increased sequentially with decreasing vitamin D level, even after adjusting for metabolic syndrome and visceral fat. The subjects in the vitamin D sufficiency group (20–30 ng/mL) had an aOR for NAFLD of 1.18 (95% CI, 1.00–1.39), whereas the deficiency group (< 20 ng/mL) had an aOR of 1.29 (95% CI, 1.10–1.52). However, we have detected a significant sex-related interaction when analyzing the results. A significant relationship between vitamin D deficiency and NAFLD was found in men (aOR, 1.33; 95% CI, 1.11–1.60) but not in women.
Adult ; Cross-Sectional Studies ; Female ; Hematologic Tests ; Humans ; Intra-Abdominal Fat ; Logistic Models ; Male ; Mass Screening ; Metabolic Syndrome X ; Non-alcoholic Fatty Liver Disease* ; Odds Ratio ; Risk Factors* ; Sex Characteristics ; Ultrasonography ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*

PURPOSE: Terpene combination (Rowatinex) is known to help with the expulsion of urinary stones. The aim of this study was to determine how Rowatinex affects the expulsion of remnant stones after shock wave lithotripsy (SWL). MATERIALS AND METHODS: Clinical data were collected retrospectively from 499 patients with a diagnosis of ureteral stones who underwent SWL from January 2009 to August 2012. Ureteral stones were diagnosed in all patients by kidney, ureter, and bladder x-ray and abdominal computed tomography (CT). The progress of patients was documented every 2 weeks to confirm remnant stones after SWL. The patients with remnant stones underwent SWL again. Group 1 consisted of patients who were prescribed an analgesic, Tamsulosin 0.2 mg, and Rowatinex. Group 2 consisted of patients who were prescribed only an analgesic and Tamsulosin 0.2 mg. The expulsion rate of urinary stones was compared between groups. RESULTS: The expulsion rate of urinary stones was not significantly different between the two groups after 2 weeks. However, after 4 weeks, group 1 had a significantly higher expulsion rate (72.2% compared with 61.1%, p=0.022). Fifteen patients (10.2%) in group 1 and 40 (11.4%) in group 2 had to undergo ureteroscopic removal of the stone (p=0.756). Acute pyelonephritis occurred in one patient (0.7%) in group 1 and in one patient (0.3%) in group 2 (p=0.503). CONCLUSIONS: The long-term administration of Rowatinex for 4 weeks increased the expulsion rate of urinary stones after SWL.
Calculi* ; Diagnosis ; Humans ; Kidney ; Lithotripsy* ; Pyelonephritis ; Retrospective Studies ; Shock* ; Ureter* ; Urinary Bladder ; Urinary Calculi ; Urolithiasis

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.
Surveys and Questionnaires ; Delivery of Health Care ; Dizziness ; Electronic Mail ; Korea ; Otolaryngology ; Otolithic Membrane ; Public Opinion ; Vertigo

Barrett's esophagus is defined as the replacement of normal squamous epithelium of distal esophagus with specialized columnar epithelium. This condition is considered to be a premalignant lesion of esophageal adenocarcinoma. Barrett's esophagus is classified into long-segment (> or = 3 cm in length) and short-segment ( <3 cm in length). Detection of the former is more difficult. Adenocarcinomas arising from short-segment Barrett's esophagus are uncommon in Korea. Barrett's adenocarcinoma restricted to the mucosa can be treated by endoscopic mucosectomy. In recent years, endoscopic submucosal dissection for early esophageal cancer has been extensively applied because it is a reliable method to achieve en bloc resection. In this paper, we report a case of esophageal adenocarcinoma arising from ultrashort-segment Barrett's esophagus, which was successfully resected by endoscopic submucosal dissection.
Adenocarcinoma ; Barrett Esophagus ; Epithelium ; Esophageal Neoplasms ; Esophagus ; Korea ; Mucous Membrane

OBJECTIVE Clomiphene citrate is one of the most commonly used drugs in the treatment of infertility, but the pregnancy rate achieved with clomiphene citrate is significantly lower than the ovulation rate due to its antiestrogenic effect on the endometrium. Endometrial prolactin is considered to be a marker and an inducer of predecidualization that is characteristic of secretory endometrium. The purpose of this study was to evaluate the association of clomiphene citrate and unsatisfactory endometrial differentiation to secretory endometrium by examining the endometrial expression of prolactin in clomiphene citrate-treated infertile women with luteal phase defect. METHODS: The endometrial samples from infertIle women wIth luteal phase defect (n=27) were examined. Five cases during secretory phase and six cases during proliferative phase were obtained by biopsy. Sixteen cases were obtained by biopsy during secretory phase after clomiphene citrate treatment. By immunohistochemical staining for prolactin, all obtained endometrial tissues were examined. The differences in the endometrial expression of prolactin were evaluated between proliferative phase and secretory phase, and between clomiphene citrate treated group and no treatment group during secretory phase. RESULTS: The staining of endometrial prolactin was significantly more intense in the glandular epithelial cells and stromal cells in the secretory endometrium than in the proliferative endometrium. The glandular expression of prolactin in the secretory endometrium was not significantly different between the clomiphene citrate-treated group and no treatment group (p=0.719), but the staining of prolactin in the stromal cells was significantly less intense in the clomiphene citrate-treated group than no treatment group (p=0.019). CONCLUSION: in this investigation, we demonstrated that the endometrial stromal expression of prolactin in the secretory phase was significantly lower in the clomiphene citrate-treated group campared with no treatment group in infertile women with luteal phase defect. And our finding suggests that clomiphene citrate may have an adverse effect on the endometrial predecidualization in infertile women.
Biopsy ; Clomiphene* ; Endometrium ; Epithelial Cells ; Estrogen Receptor Modulators ; Female ; Humans ; Infertility ; Luteal Phase* ; Ovulation ; Pregnancy Rate ; Prolactin* ; Stromal Cells

OBJECTIVE: Although the regulation of implantation is not clearly understood, recent studies have revealed that many cytokines and growth factors play an essential role in preimplantation endometrial development. Among the cytokines, the expression of leukemia inhibitory factor (LIF) is absolutely essential for implantation, although its precise role is not fully understood. Clomiphene citrate is most commonly used drug in the treatment of infertility, but pregnancy rate achieved with clomiphene citrate is significantly lower than the ovulation rate due to the antiestrogenic effect of it on the cervical mucus and endometrium. The our purpose was to evaluate the endometrial expression of LIF in clomiphene citrate treated infertile women with luteal phase defect and association of clomiphene citrate and unsatisfactory endometrial development. METHODS: The endometrial samples from women with luteal phase defect (n=27) were examined. The endometrial tissue was obtained during secretory phase in 5 cases, and during proliferative phase in 6 cases without clomiphene citrate treatment. In 16 cases, the endometrial tissue was obtained by biopsy during secretory phase after clomiphene citrate treatment. Immunohistochemical staining was performed for LIF in the endometrial tissues. And then the expression of LIF was compared between clomiphene citrate treatment group and no treatment group during secretory phase, and secretory and proliferative phase were compared in the no treatment group. RESULTS: The endometrial expression of LIF was not significantly different between clomiphene citrate treated group and no treated group (p. value=0.123) and between proliferative phase and secretory phase without clomiphene citrate (p. value=0.306). The expressions of LIF were detected mostly in glandular epithelial cells and not in the stromal cells. CONCLUSION: We demonstrated that LIF was expressed in glandular epithelial cells rather than stromal cells and there was not menstrual cycle dependent difference of endometrial expression of LIF in infertile women with luteal phase defect. And our finding suggested that clomiphene citrate did not affect the secretory phase endometrial expression of LIF in infertile women with luteal phase defect.
Biopsy ; Cervix Mucus ; Clomiphene* ; Cytokines ; Endometrium ; Epithelial Cells ; Estrogen Receptor Modulators ; Female ; Humans ; Infertility ; Intercellular Signaling Peptides and Proteins ; Leukemia Inhibitory Factor* ; Leukemia* ; Luteal Phase* ; Menstrual Cycle ; Ovulation ; Pregnancy Rate ; Stromal Cells

Primary carcinoma of the fallopian tube is very rare and accounts for less than 1% of all gynecologic malignancies. Nonspecific symptoms are presented, so primary carcinoma of the fallopian tube was confirmed postoperatively on the basis of the pathologic examination. The evaluation and treatment are similar to that of the ovarian cancer. We have experienced a case of primary carcinoma of the fallopian tube, especially fimbrial portion and report with a brief review of the literature
Fallopian Tubes* ; Female ; Ovarian Neoplasms

OBJECTIVE: The resistance mechanisms of tumor cells to chemotherapeutic drugs are known as the followings; the alterations in the drug transport and activation, the enhanced expression of the DNA repair and replication and the decreased apoptosis. The aim of this study is to examine a relative difference on the level of the mRNA expression of the multidrug resistance (MDR)-related and the apoptosis-associated genes between cisplastin-sensitive and cisplatin-resistant human ovarian cancer cell line. METHODS: MDR-associated genes (lrp, mdr1/p-glycoprotein, mrp) and PKC isozymes (alpha, beta1, beta2, epsilon, eta, theta), DNA mismatch repair (MMR) genes (hMLH1, hMSH2, hMSH3, hMSH6), DNA topology-related genes (topoisomerase IIalpha and beta) and apoptosis-related genes (p53, p21, mdm2, fas (Apo-1), trail (Apo-2L) were analyzed in cisplatin-sensitive ovarian cancer cell line A2780 and -resistant cell line A2780cp by complementary DNA polymerase chain reaction. RESULTS: The mdr1 and PKC eta in mRNA level were expressed in A2780cp, but not in A2780. The mRNA expressions of lrp, p21 and mdm2 were more increased in A2780cp than drug sensitive variant A2780, but not significantly correlated. In contrast mRNA expression of hMLH1, a kind of DNA MMR gene, was remarkably decreased and mRNA expression of hMSH2 was slightly decrease in A2780cp. However, the levels of mrp, topo II alpha and beta, hMSH3, hMSH6, p53, fas and trail were not affected. CONCLUSION: These results showed that mdr1/p-gp expression may be an important determinant of MDR phenotype in resistant cell line to chemotherapeutic agents, and PKC isozymes and DNA MMR genes may be responsible for cisplatin resistant in ovarian cancer.
Apoptosis* ; Cell Line* ; Cisplatin* ; DNA ; DNA Mismatch Repair ; DNA Repair ; DNA, Complementary ; Drug Resistance, Multiple* ; Humans* ; Isoenzymes ; Ovarian Neoplasms* ; Phenotype ; Polymerase Chain Reaction ; RNA, Messenger

In adult women, hypothyroidism has significant effect on reproduction. Hypothyroidism is associated with oligomenorrhea, amenorrhea, anovulation, hypermenorrhea, menorrhagia, infertility, spontaneous abortion, stillbirth or preterm delivery. It can cause ovarian tumor, which clinically resembles ovarian hyperstimulation syndrome or multicystic ovarian tumor. We have experienced a case of spontaneously regressed huge ovarian tumor which was found in patient. With hypothyroidism. So we report this case with a brief review of literature.
Abortion, Spontaneous ; Adult ; Amenorrhea ; Anovulation ; Female ; Humans ; Hypothyroidism* ; Infertility ; Menorrhagia ; Oligomenorrhea ; Ovarian Hyperstimulation Syndrome ; Pregnancy ; Reproduction ; Stillbirth