BACKGROUND/AIMS: Little is known about the treatment or outcomes of hepatocellular carcinoma (HCC) complicated with bile duct invasion. METHODS: A total of 247 consecutive HCC patients with bile duct invasion at initial diagnosis were retrospectively included. RESULTS: The majority of patients had Barcelona Clinic Liver Cancer (BCLC) stage C HCC (66.8%). Portal vein tumor thrombosis was present in 166 (67.2%) patients. Median survival was 4.1 months. Various modalities of treatment were initially employed including surgical resection (10.9%), repeated transarterial chemoembolization (TACE) (42.5%), and conservative management (42.9%). Among the patients with obstructive jaundice (n=88), successful biliary drainage was associated with better overall survival rate. Among the patients with BCLC stage C, overall survival differed depending on the initial treatment for HCC; surgical resection, TACE, systemic chemotherapy, and conservative management showed overall survival rates of 11.5, 6.0 ,2.4, and 1.6 months, respectively. After adjusting for confounders, surgical resection and repeated TACE were significant prognostic factors for HCC patients with bile duct invasion (hazard ratios 0.47 and 0.39, Ps <0.001, respectively). CONCLUSIONS: The survival of HCC patients with bile duct invasion at initial diagnosis is generally poor. However, aggressive treatments for HCC such as resection or biliary drainage may be beneficial therapeutic options for patients with preserved liver function.
Bile Ducts* ; Bile* ; Carcinoma, Hepatocellular* ; Diagnosis ; Drainage ; Drug Therapy ; Humans ; Jaundice, Obstructive ; Liver ; Liver Neoplasms ; Portal Vein ; Prognosis ; Retrospective Studies ; Survival Rate ; Thrombosis

Acute renal failure with severe loin pain and patch renal ischemia after anaerobic exercise (ALPE) is a rare cause of exercise-induced acute kidney injury. Some ALPE patients also have renal hypouricemia. Mutations in the SCL22A12 gene are among the major factors of hypouricemia. Education for the prevention of relapse and genetic counseling should be recommended to ALPE patients with renal hypouricemia. This paper reports a 25-year-old man who showed recurrent exercise-induced ARF and renal hypouricemia with R90H mutation in his SCL22A12 gene.
Acute Kidney Injury ; Genetic Counseling ; Humans ; Ischemia ; Recurrence ; Renal Tubular Transport, Inborn Errors ; Urinary Calculi

BACKGROUND/AIMS: Osteopontin (OPN) is overexpressed in hepatocellular carcinoma (HCC) with postoperative recurrence or extrahepatic metastasis. However, its prognostic value in patients treated with transarterial chemoembolization (TACE) is unclear. We investigated the utility of serum OPN levels and changes therein as prognostic markers in HCC patients who have received TACE. METHODS: Forty-six patients with HCC were enrolled. Serum OPN levels were measured before and 4 weeks after TACE. Serum biochemistry and computed tomography (CT) scans were analyzed. We evaluated baseline serum OPN levels and subsequent changes therein in relation to tumor responses and cumulative survival rates following TACE. A decreasing pattern was defined as a decrease after TACE of more than 10% relative to baseline levels. A "responder" was defined as a patient who exhibited a tumor necrosis rate of higher than 50% on the follow-up CT scan. RESULTS: Higher initial serum OPN levels were associated with a large tumor, portal vein invasion, and an advanced tumor stage. Patients who had lower initial serum OPN levels and those who exhibited decreasing patterns after TACE tended to have more favorable tumor responses (P=0.043 and 0.055, respectively) and exhibited better cumulative survival rates (P=0.036 and 0.030, respectively). However, the initial serum OPN level and subsequent changes in serum OPN levels were not independent predictors for survival on multivariate analysis. CONCLUSIONS: Serum OPN levels were significantly higher in patients with advanced HCC. In addition, HCC patients with low pretreatment serum OPN levels and those for whom serum OPN declined following TACE exhibited better tumor responses and survived for longer.
Adult ; Aged ; Area Under Curve ; Carcinoma, Hepatocellular/metabolism/secondary/*therapy ; *Chemoembolization, Therapeutic ; Female ; Humans ; Liver Neoplasms/metabolism/pathology/*therapy ; Male ; Middle Aged ; Neoplasm Staging ; Osteopontin/*blood ; Portal Vein/pathology ; Prognosis ; Severity of Illness Index ; Survival Rate ; Tomography, X-Ray Computed

PURPOSE: We wanted to estimate the prevalence and risk factors of overactive bladder(OAB) in Korean children who were 5-13 years of age, according to the definition of OAB. MATERIALS AND METHODS: A randomly selected cross-sectional study was conducted on 26 kindergartens and 27 elementary schools nationwide in Korea. There were 19,240 children; a parent was asked to complete the questionnaires, which included items about OAB and the children's voiding and defecating habits. OAB was defined as urgency with or without urge incontinence, and usually with an increased daytime frequency and nocturia(ICCS 2006, group A) or an increased daytime frequency(>8 times/day) and/or urge urinary incontinence with or without urgency (group B); its prevalence and associated factors were investigated. RESULTS: The response rate for the questionnaires was 85.84%. The overall prevalence of OAB was 16.59%(group A) and 18.79%(group B). For groups A and B, the prevalence of OAB decreased with age from 22.89% to 12.16% and from 40.44% to 9.60%, respectively(p=0.0001). The overall rate of wet and dry OAB was 26.97% and 73.03%, respectively. Compared to the normal group, the children with OAB had a higher prevalence of nocturnal enuresis(NE), constipation, fecal incontinence, a history of urinary tract infection and delayed bladder control in both groups A and B(p<0.05). The rate of increased daytime frequency and urge incontinence were 3.69% and 2.31%(p=0.009), and 26.97% and 14.78%(p=0.0001) in group A and for the non-OAB children, respectively; their prevalence in group A decreased with age from 5.04% to 3.06% and from 45.74% to 18.50%, respectively(p=0.0001). CONCLUSIONS: The overall prevalence of OAB in group A for Korean children 5-13 years of age was similar to that in group B. However, the range of prevalence in group B was much more variable than that in group A. NE, constipation, fecal incontinence, a history of urinary tract infection and delayed bladder control may be risk factors for OAB in children.
Child ; Constipation ; Cross-Sectional Studies ; Fecal Incontinence ; Humans ; Korea ; Parents ; Prevalence ; Risk Factors ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence ; Urinary Incontinence, Urge ; Urinary Tract Infections

BACKGROUND AND AIMS: Hepatitis C virus (HCV)-associated cirrhosis is an increasingly frequent indication for liver transplantation (LT). However, HCV recurrence is universal and this immediately occurs following LT, which endangers both the graft and patient survival. We investigated the frequency of posttransplant recurrence of HCV infection and the patient-graft survival, and we analyzed the responses to ribavirin and interferon therapy in the patients with recurrent HCV infection after living donor liver transplantation (LDLT). METHODS: We retrospectively reviewed the clinical outcomes of 39 HCV-associated cirrhosis patients who underwent LDLT at Asan Medical Center between August 1992 and June 2006. In this study, the diagnosis of recurrent HCV was made on the basis of increased transaminases and serum HCV RNA levels greater than 10 million IU/mL because protocol liver biopsy was not performed. RESULTS: HCV recurrence was seen in 26 of the 39 LDLT patients (66.7%). 86.7% of recurrence occurred within the first postoperative year. Antiviral treatment was used for all patients with recurrence of HCV. None of the 10 patients receiving ribavirin alone and 9 of 16 patients who received combination therapy with pegylated interferon alpha-2a plus ribavirin became HCV RNA negative and they remained persistently negative during the median follow-up of 24.9 months. Our data indicates that there is no significant factor influencing HCV recurrence except for the recipient's age. The 2-year patient survival for the HCV patients with HCC and those patients without HCC were 81.2% and 81.3%, respectively (P=0.85) and the 2-year graft survival rates were 81.2% and 68.2%, respectively (P=0.29). No patient died from HCV recurrence during the follow-up period. CONCLUSIONS: Combination therapy with ribavirin and interferon appears to improve the outcome of recurrent HCV infected patients after LDLT.
Adult ; Aged ; Antiviral Agents/therapeutic use ; Combined Modality Therapy ; Female ; Graft Survival ; Hepacivirus/drug effects/isolation & purification ; Hepatitis C, Chronic/complications/diagnosis/*drug therapy ; Humans ; Interferon Alfa-2a/therapeutic use ; Liver Cirrhosis/mortality/*surgery/*virology ; Liver Neoplasms/mortality ; *Liver Transplantation ; Living Donors ; Male ; Middle Aged ; Polyethylene Glycols/therapeutic use ; Recurrence ; Retrospective Studies ; Ribavirin/therapeutic use ; Severity of Illness Index ; Treatment Outcome

Determination of male and female is important in anthropology, archeology and forensic science. This study was designed to compare genotype sex of improved amelogenin PCR amplication method with morphological sex of ancient human bones. Sixty human skulls which lived from the Bronze Age to twenties centuries and excavated in Uzbekistan were used in this study. Morphological sex was determined by Uzbekistan scientist, and genotype sex was determined by improved amelogenin PCR amplication developed in this study. Among 20 morphological males, 13 samples (65%) were genotypical male. Among 40 morphological females, 20 samples (50%) were genotypical male. In conclusion, morphological method might be inadequate for sex determination of ancient bones. The improved amelogenin PCR method will be useful in sex determination of ancient bones.
Amelogenin* ; Anthropology ; Archaeology ; Female ; Forensic Sciences ; Genotype* ; Humans ; Male ; Polymerase Chain Reaction* ; Skull ; Uzbekistan*

BACKGROUND AND OBJECTIVES: The clinical association between migraine and vestibular symptoms has been indicated in many studies and it is believed that migraine-associated vertigo is one of the most common causes of spontaneous recurrent vertigo. SUBJECTS AND METHOD: We investigated the nature of vestibular and migrainous symptoms of 26 patients suffering vertigo associated with migraine and their responses to antimigrainous medications. Neurotologic tests such as oculomotor tests, calorictest, and audiometry were performed between attacks. RESULTS: A marked female predominance was found. The duration of rotational (77%) and/or to-and-fro vertigo (23%) lasted from a few seconds to several hours or, less frequently, even days. We found that patients showed vestibular abnormalities in central and peripheral types. In the symptom-free interval, 31% of the patients showed central oculomotor signs such as delayed saccadic latency and horizontal saccadic pursuit. On the other hand, 15% showed unilateral weakness in the caloric test and 15% showed positive results in the head thrust tests. Overall, 85% of patients experienced resolution or significant reduction of their attacks of vertigo with medication. CONCLUSION: Most patients with migraine-associated vertigo showed normal results on the vestibular tests and responded well to preventive medication. Migraine-associated vertigo caused various clinical manifestations and there should be relevant differential diagnosis for epiodic vertigo.
Audiometry ; Caloric Tests ; Diagnosis, Differential ; Dizziness ; Female ; Hand ; Head Impulse Test ; Humans ; Migraine Disorders ; Saccades ; Vertigo* ; Vestibular Diseases

Many data from ancient human remains became useful by molecular approach for ancient human DNA. In anthropology, genetic sex is essential to understand marriage and burial patterns, differential mortality rates between sexes, and differential patterns by sex of disease, diet, status, and material possessions. This study was designed to determine genotype sex of 52 ancient human bones with well preserved skulls, and to compare with the orphological sex. Parts of femur and other bones were used as ancient bones excavated in Mongolia aged between bronze and Mongol period. Morphological sex was determined by Mongolian scientist, and genotype sex was determined by using biallelic marker RPS4Y for Y haplogroup. Of 52 genetic males, 10 samples were morphologically female. In conclusion, biallelic marker RPS4Y. PCR amplication method will be useful in sex determination of ancient bones.
Anthropology ; Burial ; Diet ; DNA ; Female ; Femur ; Genotype ; Humans* ; Male ; Marriage ; Mongolia ; Mortality ; Polymerase Chain Reaction ; Skull ; Y Chromosome

Hepatitis E virus is an enterically transmitted virus that causes endemic cases of acute hepatitis in many countries in Africa, and Southeast and Central Asia. Sporadic cases of acute hepatitis E also have been reported in developed countries. In non-endemic areas, most of the sporadic cases of hepatitis E are introduced from the endemic areas. Until now, only three cases of acute hepatitis E have been reported in Korea. Recently, we experienced nine cases of acute hepatitis, in which serologic studies showed positive of IgM anti-HEV. We report these as cases of acute hepatitis E. These cases suggest that HEV infection occurs sporadically in Korea and should be considered as a cause of cryptogenic acute hepatitis.
Middle Aged ; Male ; Korea/epidemiology ; Humans ; Hepatitis E/diagnosis/*epidemiology ; Female ; Adult ; Acute Disease

PURPOSE:In Korea, the school urine screening program is a useful tool for screening urine abnormalities. It is particularly useful in early detection of membranoproliferative glomerulonephritis(MPGN) I, which frequently progresses to chronic renal failure. In this study, we studied the medical history, laboratory findings, and histologic findings of MPGN I to gain helpful information on early detection and treatment. METHODS:The subjects were 19 children, who were diagnosed with MPGN I from kidney biopsies that were performed in ten nationwide university hospitals because of abnormal urine findings from school urine screening programs conducted from July 1999 to April 2004. We divided the patients into 2 groups, a nephrotic range proteinuria group(n=8) and a non- nephrotic proteinuria group(n=11), and retrospectively analyzed the clinical features, laboratory findings, histologic findings, treatment, and clinical course. RESULTS:The mean age at the first abnormal urinalysis was 10.6+/-2.2 years in the nephrotic proteinuria group and 9.6+/-3.2 years in the non-nephrotic proteinuria group. The mean age at the time of kidney biopsy was 11.3+/-2.3 years in the nephrotic range proteinuria group and 10.4+/-3.2 years in the non-nephrotic proteinuria group respectively. There was no significant difference in the mean age and sex between the two groups. In the nephrotic proteinuria group, 6 children had a low plasma C3 level and in the non-nephrotic proteinuria group, 8 children had a low plasma C3 level, but there was no significant difference between the 2 groups. There was no significant difference in the laboratory test results(including WBC count, RBC count, platelet count and other serologic tests) between the 2 groups except for 24 hour urine protein secretion. There was no difference between the 2 groups with regard to the acute and chronic changes in the glomerulus on light microscopic findings, IgG, IgA, Ig M, C1q, C3, C4, fibrogen deposition on immunofluoroscence findings, and mesangial deposits, subendothelial deposits, and subepithelial deposits on electron microscopic findings. The children were treated with corticosteroids, ACE(angiotensin-converting enzyme) inhibitors, dipyridamole and other immunosuppressive agents. During the course of treatment, there were no children whose clinical condition worsened. Among 19 children, 3 children went into remission (2 in the nephrotic proteinuria group, 1 in the non-nephrotic proteinuria group) and 9 children went into a partial remission(4 in the nephrotic proteinuria group, 5 in the non-nephrotic proteinuria group) on urinalysis. There was no significant difference in the treatment results between the two groups. CONCLUSION:The 73.7% of children who were incidentally diagnosed with MPGN I by the school urine screening program had reduced C3. 42.1% of the children had nephrotic range proteinuria. There were no significant differences in clinical features, laboratory test results, light microscopic, immunofluorescence microscopic, and electron microscopic findings between the nephrotic proteinuria group and the non-nephrotic proteinuria group except for the 24 hour urine protein secretion. Therefore, for early detection of MPGN I during the school urine screening program, we strongly recommend a kidney biopsy if children have abnormal urine findings such as persistent proteinuria and persistent hematuria, or if the serum C3 is reduced.
Adrenal Cortex Hormones ; Biopsy ; Child ; Dipyridamole ; Fluorescent Antibody Technique ; Glomerulonephritis, Membranoproliferative* ; Hematuria ; Hospitals, University ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Immunosuppressive Agents ; Kidney ; Kidney Failure, Chronic ; Korea ; Mass Screening* ; Plasma ; Platelet Count ; Prognosis ; Proteinuria ; Retrospective Studies ; Urinalysis