Despite the availability of direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection in Korea, need remains for pangenotypic regimens that can be used in the presence of hepatic impairment, comorbidities, or prior treatment failure. We investigated the efficacy and safety of sofosbuvir–velpatasvir and sofosbuvir–velpatasvir–voxilaprevir for 12 weeks in HCV-infected Korean adults. Methods: This Phase 3b, multicenter, open-label study included 2 cohorts. In Cohort 1, participants with HCV genotype 1 or 2 and who were treatment-naive or treatment-experienced with interferon-based treatments, received sofosbuvir–velpatasvir 400/100 mg/day. In Cohort 2, HCV genotype 1 infected individuals who previously received an NS5A inhibitor-containing regimen ≥ 4 weeks received sofosbuvir–velpatasvir–voxilaprevir 400/100/100 mg/day. Decompensated cirrhosis was an exclusion criterion. The primary endpoint was SVR12, defined as HCV RNA < 15 IU/mL 12 weeks following treatment. Results: Of 53 participants receiving sofosbuvir–velpatasvir, 52 (98.1%) achieved SVR12. The single participant who did not achieve SVR12 experienced an asymptomatic Grade 3 ASL/ALT elevation on day 15 and discontinued treatment. The event resolved without intervention. All 33 participants (100%) treated with sofosbuvir–velpatasvir–voxilaprevir achieved SVR 12. Overall, sofosbuvir–velpatasvir and sofosbuvir–velpatasvir–voxilaprevir were safe and well tolerated. Three participants (5.6%) in Cohort 1 and 1 participant (3.0%) in Cohort 2 had serious adverse events, but none were considered treatment-related. No deaths or grade 4 laboratory abnormalities were reported. Conclusions: Treatment with sofosbuvir–velpatasvir or sofosbuvir–velpatasvir–voxilaprevir was safe and resulted in high SVR12 rates in Korean HCV patients.

BACKGROUND: Hepatitis B virus (HBV) infection leads to hepatic and extrahepatic manifestations including chronic kidney disease (CKD). However, the association between HBV and CKD is not clear. This study investigated the association between chronic HBV infection and CKD in a nationwide multicenter study. METHODS: A total of 265,086 subjects who underwent health-check examinations in 33 hospitals from January 2015 to December 2015 were enrolled. HBV surface antigen (HBsAg) positive cases (n = 10,048), and age- and gender-matched HBsAg negative controls (n = 40,192) were identified. CKD was defined as a glomerular filtration rate (GFR) < 60 mL/min/1.73 m² or proteinuria as at least grade 2+ of urine protein. RESULTS: HBsAg positive cases showed a significantly higher prevalence of GFR < 60 mL/min/1.73 m² (3.3%), and proteinuria (18.9%) than that of the controls (2.6%, P < 0.001, and 14.1%, P < 0.001, respectively). In the multivariate analysis, HBsAg positivity was an independent factor associated with GFR < 60 mL/min/1.73 m² along with age, blood levels of albumin, bilirubin, anemia, and hemoglobin A1c (HbA1c). Likewise, HBsAg positivity was an independent factor for proteinuria along with age, male, blood levels of bilirubin, protein, albumin, and HbA1c. A subgroup analysis showed that HBsAg positive men but not women had a significantly increased risk for GFR < 60 mL/min/1.73 m². CONCLUSION: Chronic HBV infection was significantly associated with a GFR < 60 mL/min/1.73 m² and proteinuria (≥ 2+). Therefore, clinical concern about CKD in chronic HBV infected patients, especially in male, is warranted.
Anemia ; Antigens, Surface ; Bilirubin ; Case-Control Studies* ; Female ; Glomerular Filtration Rate ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Male ; Multivariate Analysis ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic*

Extrahepatic metastasis of hepatocellular carcinoma (HCC) can be found in various organs, but metastasis to the female genital tract is extremely rare. A 48-year-old woman who had undergone curative left lobectomy for small HCC 4 years earlier was admitted because of sequential alpha-fetoprotein elevation. Upon abdominal MRI and hepatic angiography, no evidence of HCC recurrence was found in the remnant liver. However, a positron emission tomography CT scan showed a hypermetabolic lesion in the uterine fundus, which was revealed as metastatic HCC after total hysterectomy. This is, to our knowledge, the first documented case of metastatic uterine tumor that originated from HCC without intrahepatic recurrence.
alpha-Fetoproteins ; Angiography ; Carcinoma, Hepatocellular ; Female ; Humans ; Hysterectomy ; Liver ; Middle Aged ; Neoplasm Metastasis ; Positron-Emission Tomography ; Recurrence ; Uterine Neoplasms

BACKGROUND/AIMS: The prevalence of occult HBV infection (OBI) in patients with chronic hepatitis C (CHC) in Korea has not been reported. Additionally, it is unclear whether OBI influences treatment outcome in CHC patients. We investigated the prevalence of OBI and its impact on treatment outcome in patients with CHC. METHODS: Seventy-six patients with CHC were enrolled and treated with pegylated or conventional interferon and ribavirin. Hepatitis B virus (HBV) DNA was detected by nested polymerase chain reaction. RESULTS: Among the 68 patients who completed treatment and follow-up, HBV DNA was detected in serum from nine (13.2%) patients, liver tissue from 10 (14.7%), and serum or liver tissue from 15 (22.1%). OBI was diagnosed in nine (12.7%) control subjects. No difference in the prevalence of OBI between patients with CHC and controls was observed (13.2 vs. 12.0%; p = 0.92). No significant differences in age, sex, genotype 1 frequency, amount of hepatitis C virus RNA, anti-hepatitis B surface antigen/anti-hepatitis B core-IgG seropositivity, staging, or histology grading were observed in patients with or without HBV DNA. Sustained virological response was achieved in 73.3% of patients with OBI and 83.0% without OBI (p = 0.46). CONCLUSIONS: These results demonstrate that a significant proportion of patients with CHC have occult HBV infection and that OBI does not affect treatment outcome in patients with CHC.
DNA ; Follow-Up Studies ; Genotype ; Hepacivirus ; Hepatitis B virus ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Interferons ; Korea ; Liver ; Prevalence ; Ribavirin ; RNA ; Treatment Outcome

Extrahepatic metastasis of hepatocellular carcinoma (HCC) can be found in various organs, but metastasis to the female genital tract is extremely rare. A 48-year-old woman who had undergone curative left lobectomy for small HCC 4 years earlier was admitted because of sequential alpha-fetoprotein elevation. Upon abdominal MRI and hepatic angiography, no evidence of HCC recurrence was found in the remnant liver. However, a positron emission tomography CT scan showed a hypermetabolic lesion in the uterine fundus, which was revealed as metastatic HCC after total hysterectomy. This is, to our knowledge, the first documented case of metastatic uterine tumor that originated from HCC without intrahepatic recurrence.
alpha-Fetoproteins ; Angiography ; Carcinoma, Hepatocellular ; Female ; Humans ; Hysterectomy ; Liver ; Middle Aged ; Neoplasm Metastasis ; Positron-Emission Tomography ; Recurrence ; Uterine Neoplasms

BACKGROUND: Hemophagocytic syndrome (HS) is a distinct clinical entity characterized by high fever and hemophagocytosis with histiocytosis in tissue biopsy. We seldom encounter patients who suffer from unexplained, persistent fevers. Although there have been many studies about childhood HS, studies about adult HS are relatively rare. The causes and prognoses of HS in adults were evaluated in this study. We focused on infection-related HS. MATERIALS AND METHODS: We enrolled 41 adult patients with HS retrospectively from four hospitals in Kyungbuk province and Daegu city. The patients were diagnosed by bone marrow or liver biopsy, either of which showed hemophagocytosis with histiocytosis and had clinical findings consistent with HS. We explored the etiologies, clinical symptoms, laboratory findings, treatments, and outcomes of each case. RESULTS: The most common cause of HS was infection, such as the Epstein-Barr virus (EBV) or Mycobacterium tuberculosis. Old age and malignancy-associated HS had a poor prognosis. The overall mortality rate was 17.1%. Most patients survived after conservative therapy and the control of underlying diseases, in contrast to previous studies that showed a poor prognosis of infection-associated HS. CONCLUSIONS: A proper investigation is crucial to determine the cause of HS in patients who have unexplained persistent fever and hemophagocytosis with histiocytosis in their tissue. Cases of infection-related HS are common, but physicians should consider undiagnosed malignancy that may be related to a poor prognosis. Treatments appropriate to the causes are important for better outcomes in adult HS.
Adult ; Biopsy ; Bone Marrow ; Fever ; Herpesvirus 4, Human ; Histiocytosis ; Humans ; Liver ; Lymphohistiocytosis, Hemophagocytic ; Mycobacterium tuberculosis ; Prognosis ; Retrospective Studies ; Risk Factors

BACKGROUND: This study examined the clinical and radiologic mid-term results of patients treated by Oxford minimally invasive unicompartmental knee arthroplasty. METHODS: One hundred and eighty-eight knees of unicompartmental knee arthroplasties with Oxford Uni(R) in 166 patients (16 males and 150 females), which were performed between 2002 and 2005, were reviewed. The mean age was 65.3 years (range, 44 to 82 years) and the mean follow-up period was 79.8 months (range, 56 to 103 months). The preoperative diagnosis was osteoarthritis in 166 patients, osteonecrosis of the medial femoral condyle in 20 and chondrocalcinosis in 2. RESULTS: The mean Hospital for Special Surgery (HSS) knee score was 67.5 (range, 52 to 75) preoperatively and 89.9 (range, 85 to 100) at the final follow-up. The mean preoperative flexion contracture was 6.5degrees (range, 0 to 15degrees) and 0.8degrees (range, 0 to 5degrees) at the final follow-up. The mean full flexion increased from 135degrees (range, 90 to 150degrees) preoperatively to 150degrees (range, 140 to 165degrees) at the final follow-up. Active full flexion was possible within 2 postoperative months. The squatting and cross-leg postures were possible in 133 patients (80.1%) and 152 patients (91.6%) at the final follow-up. The mean tibiofemoral angle was improved from varus 1.5degrees to valgus 4.8degrees. Complications were encountered in 18 cases (9.5%). A bearing dislocation occurred in 10 cases (5.3%), tibial component loosening in 4 cases (2.1%), femoral loosening in 3 cases (1.6%) and lateral translation in 1 case (0.5%). The mean time for a bearing dislocation was 22.6 months (range, 3 to 70 months) postoperatively. Seven cases returned to the predislocation level of activity with the insertion of a thicker bearing and 3 cases converted to total knee arthroplasty. CONCLUSIONS: Minimally invasive unicompartmental knee arthroplasty with Oxford Uni(R) provided rapid recovery, good pain relief and excellent function suitable for the Korean lifestyle. In contrast, the high complication rates of Oxford Uni(R) encountered in the mid-term results suggested less reliability than total knee arthroplasty.
Adult ; Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Knee/adverse effects ; Female ; Humans ; Knee Joint/physiopathology/radiography ; *Knee Prosthesis ; Male ; Middle Aged ; Prosthesis Failure ; Range of Motion, Articular

PURPOSE: The authors evaluated the clinical and radiological results of ceramic on ceramic articulation cementless total hip arthroplasty using a large diameter head. MATERIALS AND METHODS: Seventy-two hips were followed for more than 2 years after ceramic on ceramic articulation cementless total hip arthroplasty using a 36 mm diameter head. The mean patient age was 62 years (range: 50-85), and the mean follow-up period was 35.3 months (range: 25-53). The Harris hip score, the postoperative inguinal pain and the thigh pain were analyzed clinically. The radiological results were assessed using various radiological indices. RESULTS: The mean Harris hip score improved from preoperative 57.5 points to postoperative 94.8 points. The postoperative mean flexion of hip was 109degrees (range: 100degrees-125degrees), external rotation was 42degrees (range: 35degrees-49degrees) and abduction was 35degrees (range: 30degrees-45degrees). There was one case of inguinal pain. Radiologically, all the stems demonstrated stable fixation without progressive subsidence of the stem or significant change in the cup obliquity. A radiolucent line was observed around the stem in 4 cases (5.6%) and around the cup in 2 cases (2.8%). Endosteal new bone formation was observed around the stem in 28 cases (38.9%) and around the cup in 26 cases (36.1%). There was no osteolysis around the stem or the cup. CONCLUSION: The short-term results of ceramic on ceramic cementless total hip arthroplasty using a large diameter head demonstrated satisfactory results.
Arthroplasty ; Ceramics ; Follow-Up Studies ; Head ; Hip ; Humans ; Osteogenesis ; Osteolysis ; Thigh

BACKGROUND: Bile examination is believed to be the most precise method for detecting Clonorchis sinensis (CS) eggs. We carried out bile examination to evaluate infestation state of CS in patients with pancreatobiliary diseases in Ulsan, known as an endemic area of CS infestation. METHODS: We examined CS eggs in bile in three hundreds and nine patients with pancreatobiliary diseases. The bile was obtained from endoscopic nasobiliary or percutaneous transhepatic biliary drainage tubes. RESULTS: The overall egg positive rate was 27.5% (35.3% in male, 17.6% in female). The egg positive rate was not significantly different according to the age group: 20.0% in thirties, 26.7% in forties, 24.2% in fifties, 29.9% in sixties, 36.2% in seventies and 16.7% in eighties or more. The egg positive rate according to the disease, except CS cholangitis, was not also statistically different: 32.6% in bile duct cancer, 38.5% in gallbladder cancer, 11.1% in ampulla of Vater cancer, 24.0% in pancreatic cancer, 26.4% in gallstone diseases and 12.5% in the reminder. The location of gallstone and whether CS related diseases or CS unrelated diseases did not affect the egg positive rates. The egg positive rate in patients with normal radiological findings including cholangiography was 17.0%. CONCLUSION: This result shows that regardless of age, sex, and sorts of diseases, the infestation rate of CS was very high. On the basis of our results, it is therefore presumes that clonorchiasis is still endemic disease in Korea.
Ampulla of Vater ; Bile Duct Neoplasms ; Bile* ; Biliary Tract Diseases ; Cholangiography ; Cholangitis ; Clonorchiasis ; Clonorchis sinensis* ; Drainage ; Eggs ; Endemic Diseases ; Gallbladder Neoplasms ; Gallstones ; Humans ; Korea ; Male ; Ovum ; Pancreatic Diseases ; Pancreatic Neoplasms ; Ulsan*

Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder. Not only does XGC occasionally present as a mass formation with adjacent organ invasion like a malignant neoplasm, it can also infrequently be associated with gallbladder cancer. In the situation, it is difficult to make a differential diagnosis between the diseases. Here, we describe a case of a simultaneous XGC and a carcinoma of the gallbladder in a 61-year-old woman. To the best of our knowledge, there are only a small number of reports on this combination of diseases.
Adenocarcinoma/complications/diagnosis/*pathology/surgery ; Biopsy, Needle ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystitis/complications/diagnosis/*pathology/surgery ; Endosonography ; Female ; Gallbladder Neoplasms/complications/diagnosis/*pathology/surgery ; Granuloma/complications/diagnosis/*pathology ; Humans ; Immunohistochemistry ; Middle Aged ; Neoplasm Staging ; Prognosis ; Risk Assessment ; Tomography, X-Ray Computed ; Xanthomatosis/complications/diagnosis/*pathology