Showing papers by "Do Young Kim published in 2007"

Persistent hepatitis B viral replication affects recurrence of hepatocellular carcinoma after curative resection

Abstract: Background: Elevated serum hepatitis B virus (HBV) DNA increases the development of hepatocellular carcinoma (HCC). Rather than instantaneous DNA level, the duration of persistent HBV replication is more important in carcinogenesis. Nevertheless, most investigators evaluated the DNA level at study entry. We assessed the effects of persistently detectable serum HBV DNA on HCC recurrence. Patients and methods: We included 230 consecutive patients undergoing curative resection between 2000 and 2006. Patients who had antiviral therapy (at diagnosis or during follow-up), fluctuating DNA (cut-off value: 100 000 copies/ml) or recurrence within 12 months of resection were excluded. Ultimately, 157 were enrolled: 89 (non-viraemia group) had consistently negative DNA ( 100 000copies/ml). Serum DNA level, biochemical tests, α-foetoprotein (AFP) and liver dynamic computed tomography were obtained every 3 months after surgery. Results: There were no significant differences in age, gender, liver function, histology, AFP, tumour stages or follow-up duration between the two groups. During follow-up (median: 35 months), patients in the non-viraemia group had a lower 5-year cumulative recurrence rate (54.7%) than those in the viraemia group (72.9%; P=0.043). In multivariate analysis, sustained viraemia (P=0.041) increased recurrence independently. Conclusions: Persistent viraemia increased recurrence independently after surgery. To prevent long-term recurrences, antiviral therapy should be initiated in those with detectable serum HBV DNA.

Role of 18F-fluorodeoxyglucose positron emission tomography in detecting extrahepatic metastasis in pretreatment staging of hepatocellular carcinoma.

Abstract: Objectives: 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is useful for differentiating benign from malignant lesions, evaluating tumor stage, monitoring t

PIVKA-II Is a Useful Tumor Marker for Recurrent Hepatocellular Carcinoma after Surgical Resection

Abstract: Objectives: The aim of this study is to assess the usefulness of prothrombin induced by vitamin K absence or antagonist-II (PIVKA-II) in monitoring of recurrent hepatocellular carci

Clinical significance of pre-S mutations in patients with genotype C hepatitis B virus infection

Abstract: We investigated the overall and site-specific prevalence of pre-S mutations and its clinical significance in patients with genotype C hepatitis B virus (HBV) infection. Three hundred subjects were included: 50 asymptomatic carriers (AC), 87 chronic hepatitis (CH), 91 liver cirrhosis (LC) and 72 hepatocellular carcinoma (HCC). Pre-S mutations were determined by nucleotide sequence analysis. Possible correlations between pre-S mutations and clinical/virological parameters were examined. Pre-S mutations were detected in 82 cases (27.3%); it was more frequently found in HCC (43.1%) and LC (35.2%) group than in the CH (20.7%) and AC (2.0%) group. Pre-S2 deletion was the most commonly found mutation (10.7%), followed by pre-S2 start codon mutation (9.7%), pre-S1-S2 deletion (3.0%) and both pre-S2 deletion and start codon mutation (2.7%). Pre-S2 deletion and pre-S2 start codon mutation were more frequently detected in advanced diseases (LC and HCC). Pre-S mutations were associated with older age and higher rates of positive HBV DNA (>/=0.5 pg/mL). Advanced disease and positive HBV DNA were shown to be independent predictors of pre-S mutations by logistic regression analysis. These findings suggest that pre-S mutations, especially pre-S2 deletions and pre-S2 start codon mutations, are common in patients with genotype C HBV infection and are associated with advanced liver disease and active viral replication.

Leg ulcers in Behçet’s disease

Abstract: SIR, Behçet’s disease (BD) is a chronic multisystemic inflammatory disorder that originally included relapsing uveitis and ulcers of the mouth and genitalia. Cutaneous lesions in BD are important manifestations, with varying types appearing in 41–97% of patients with BD. The lesions present as erythema nodosum-like lesions, papulopustular eruptions, erythema multiforme-like lesions, thrombophlebitis, pathergy, skin ulcers, Sweet’s syndrome-like lesions, bullous necrotizing vasculitis and pyoderma gangrenosum (PG). In BD, oral and genital ulcers occur frequently, but leg ulcers are rare. Twelve patients with BD with leg ulcers were investigated clinically and histologically. Twelve patients with leg ulcers fulfilled the revised criteria of the BD research committee of Japan. The patients comprised eight men and four women whose ages at diagnosis ranged from 24 to 71 years (mean 39Æ9). All patients had oral and genital ulcers. Of these patients, four had papulopustular eruptions, nine had erythema nodosum-like lesions, four had thrombophlebitis and one had positive pathergy test. Multiple types of skin lesions were found in five of the 12 patients. Four patients had arthritis in multiple joints, and central nervous system disorder was found in one patient. Eight patients were diagnosed with deep vein thrombosis by Doppler ultrasonography. No patient had eye lesions, intestinal disorders or epididymitis. Multiple ulcers were present in seven patients, and one patient had 12 ulcers simultaneously. Leg ulcers lasted between 1 and 6 months. They were distributed across three sites (the foot, the ankle, or between the knee and ankle), with most located between the knee and ankle. The ulcers ranged in size between 1 and 60 cm, although 50% of patients had ulcers of at least 15 cm. All cases recurred, and one case recurred four times (Fig. 1). Leg ulcer biopsies were performed in seven patients to give histological confirmation of necrotizing vasculitis. Fibrinoid necrosis ranging from focal localization to extensive fibrinoid deposition was recognized in all specimens (Table 1). Except for a few reports of leg ulcers associated with vasculitis and PG, there are currently no reports on leg ulcers in BD. Leg ulcers in BD may be caused by vasculitis or deep vein thrombosis. We categorized leg ulcers into three types, according to the underlying cause. The first type (patients 1– 4) is associated with vasculitis. The ulcers presented clinically as multiple erythema nodosum-like lesions which progressed to ulcers. These ulcers had relatively well-demarcated margins and developed in any part of the leg. The second type (patients 5 and 8–11) is associated with deep vein thrombosis. In this type, a few irregular-margined ulcers developed,

Anti-hepatitis A virus seroprevalence among patients with chronic viral liver disease in Korea

Abstract: Background/objectiveIt is generally recommended that patients with chronic viral hepatitis should be vaccinated against hepatitis A virus (HAV) infection. We intended to evaluate the prevalence of IgG anti-HAV according to age in patients chronically infected with hepatitis B virus or hepatitis C vi

Clinical Features and Treatment Outcome of Advanced Hepatocellular Carcinoma with Inferior Vena Caval Invasion or Atrial Tumor Thrombus

Abstract: Background/aims Hepatocellular carcinoma (HCC) with an extension to the inferior vena cava (IVC) or right atrium is uncommon, and its prognosis remains unclear due to the few case reports. In order to elucidate the natural history and treatment outcome, this study investigated advanced HCC patients with an IVC invasion or atrial tumor thrombus. Methods Between November 1987 and June 2004, a total of 41 patients were diagnosed as having HCC with IVC or right atrial involvement using the new imaging techniques including a two-dimensional echocardiography. Those patients were stratified into the untreated 'control group' (n=17) and 'treated group' (n=24). The clinical features, treatment outcome and prognosis including patient survival were analyzed. Results The mean age of the total patients was 55 years (male:female, 33:8). The most common cause of HCC was a hepatitis B virus infection (85.4%), followed by a hepatitis C virus infection (7.4%). According to the Child-Pugh classification, 24 patients were Child-Pugh class A (58.5%), 15 were Child-Pugh class B (36.6%), and 2 were Child-Pugh class C (4.9%). Lung metastases were identified in 10 patients (24.5%). The treatment modalities of the treated group included 11 systemic chemotherapy regimens (5-FU and cisplatin), 10 transarterial chemotherapy regimens, 2 chemoradiation procedures and 1 hepatic resection. The overall survival was 3.0 months (range, 1-29 months). The 6 month survival rate was 23.5% (4/17) in the control group and 29.2% (7/24) in the treated group. The 12 months survival rate was 0% (0/17) and 25.0% (6/24), respectively. Independent prognostic factor affecting the survival was whether or not any treatment had been carried out. Conclusions Although the prognosis of advanced HCC with IVC invasion or a right atrial tumor thrombi is poor, treatment might improve the survival rate.

What is the role of diagnostic laparoscopy in a gastroenterology unit

Abstract: Diagnostic laparoscopy is known to be a relatively safe invasive procedure. However, its use has decreased owing to the development of imaging techniques, and fewer gastroenterologists now practice diagnostic laparoscopy. Our aim was to examine the role of diagnostic laparoscopy in a gastroenterology unit in the era of advanced imaging techniques. We retrospectively reviewed 855 diagnostic laparoscopy cases. Its safety and efficacy were evaluated for various indications. No mortality was observed, and complications were noted in ten patients (1.2%). Among the indications were evaluation of chronic liver disease (n = 673), liver tumor (n = 15), ascites of unknown origin and peritoneal disease (n = 142), and staging of intra-abdominal malignancy (n = 25). In patients with chronic liver disease, 461 were diagnosed as having chronic viral hepatitis, based on clinical data including imaging studies, but the diagnosis was changed to cirrhosis after a laparoscopic exam in 69 patients (15.0%). In patients with ascites of unknown origin and peritoneal disease, the diagnostic yield was 87.2% (123/141). In 24 (19.5%) of the 123 patients, the diagnosis changed or the less probable diagnosis was confirmed after laparoscopic examination. The confirmed diagnoses were mainly primary peritoneal disease, including peritoneal tuberculosis, in 17 patients, peritoneal metastatic carcinoma in five, and mesothelioma in two. Diagnostic laparoscopy in a gastroenterology unit is safe and useful, especially for confirmation of liver cirrhosis and primary peritoneal disease evaluation.

Efficacy of adefovir dipivoxil in the treatment of lamivudine‐resistant hepatitis B virus genotype C infection

Abstract: Background and Aims: Adefovir dipivoxil (ADV) is a nucleotide analogue that is known to be effective for lamivudine-resistant hepatitis B virus (HBV) mutants as well as wild-type HBV. The aim of this study is to assess the efficacy of ADV against lamivudine-resistant genotype C HBV mutants. Methods: Thirty-five patients with breakthrough hepatitis due to lamivudine-resistant HBV received ADV 10 mg daily with discontinuation of lamivudine. Quantitative HBV DNA, HBeAg, liver function test including alanine aminotransferase (ALT) was checked every 4–12 weeks to evaluate the efficacy of ADV. Results: ADV was administered for a median of 48 weeks (range: 24–120 weeks). The rate of serum HBV DNA loss was 68.6%, 80.0%, 84.0%, and 88.2% at weeks 12, 24, 36, and 48, respectively. The rate of serum HBeAg seroconversion was 8.3% and 14.3% at weeks 24 and 48, respectively. The rate of serum ALT normalization at week 48 was 70.6%. Within 32 weeks after stopping ADV therapy, serum HBV DNA levels increased to a median of 378.9 pg/ml in 88.9% of patients, who were treated for a median of 40 weeks. Moreover, in some patients, the ALT level increased to more than five times the upper limit of normal. Conclusions: Administration of ADV is an effective option for the treatment of patients with lamivudine-resistant genotype C HBV infection.

Use of the 308-nm excimer laser for nevus depigmentosus: a promising treatment for either nevus depigmentosus or vitiligo.

Abstract: Dear Editor, Nevus depigmentosus (ND) is a congenital, nonprogressive, hypopigmented lesion that is usually stable throughout life. ND can be frequently misdiagnosed as other dermatoses because it clinically resembles vitiligo and other leukodermas. Because definite therapeutic modalities to treat ND are not yet established, improper diagnosis can lead to considerable unnecessary costs and lost time during therapy. We present a case of a 5-year-old boy with an irregularly-shaped, unilateral, achromic patch involving his trunk that appeared 3 years earlier (Fig. 1). There was no alteration in its distribution or relative size during the preceding 3 years, nor any hyperpigmented border around the achromic area. According to clinical diagnostic criteria proposed by Coupe, we diagnosed it as ND. Treatment with a 308-nm excimer laser was started twice weekly at 200 mJ/cm with weekly increments of 50 mJ/cm depending on the duration of the persistent erythema after each treatment. Subtle improvement of the lesion was observed after only four treatments, and the skin lesion was almost cleared by 14 exposures with the total cumulative dose of 4950 mJ/cm. Hyperpigmentation on surrounding normal skin remained, but no complications related to the treatment were noticed (Fig. 2). To our knowledge, only a few therapeutic attempts have been made to achieve repigmentation of ND by surgical means, such as an autologous graft with melanocytes or a conventional epidermal graft. However, unlike in vitiligo, the epidermal graft has a limited role because the extension of repigmentation from graft foci with the migration of melanocytes is hard to expect in cases of ND. Moreover, there has been no reported attempt to induce repigmentation of ND using phototherapeutic modalities. The hypothesis that ND is caused by functional defects of melanocytes and morphological abnormalities of melanosomes is generally suggested. Ultraviolet irradiation (UVR) has profound effects on skin pigmentation through a variety of mechanisms. UVR results in increased transport of melanosomes

Older donor allografts are associated with poor patient survival after living donor liver transplantation for hepatitis B virus-related liver diseases.

Abstract: Background and Aims: The significance of donor age in living donor liver transplantation (LDLT) for hepatitis B virus (HBV) infection has not been fully evaluated. Methods: We analyzed the data of 136 patients who underwent LDLT for HBV-related liver diseases from January 1999 to April 2004. The recipients were divided into an older donor group (donor age ≥40) and a younger donor group (donor age <40). Posttransplant clinical outcomes and survival were compared between two groups, and predictors of survival after LDLT were evaluated. Results: Baseline characteristics were not different between the two groups, except for more number of female donors and higher positive donor anti-HBc rate in the older group. The frequencies of acute rejection and early mortality after transplantation were similar in the two groups. The long-term survival rates for the older donor group were significantly lower than those of the younger donor group (1-, 3-, 5-year survival rate=84%, 75%, 46% vs. 92%, 86%, and 83%, P=0.03). Multivariate analysis showed that older donor age was the only independent risk factor associated with survival after LDLT (HR=2.3; 95% CI=1.1–5.6, P=0.04). Conclusions: Our study suggests that older donor allografts would be associated with poor patient survival after LDLT for HBV-related liver diseases.

An Experimental Study on Laminar Heat Transfer in Flat Aluminum Extruded Tubes Having Small Hydraulic Diameter

Abstract: Laminar heat transfer experiments were conducted in flat extruded aluminum tubes. Three different flat tubes-two with smooth inner channel, one with micro-finned inner channel-were tested. Smooth tube data were in reasonable agreement with the predictions by simplified theoretical models. The heat transfer coefficients of the micro-fin tube were significantly smaller than those of the smooth tube. The reason was attributed to the decelerating flow in the inter-fin region. Heat transfer correlations were developed from the data.

Flow Efficiency in Multi-Louvered Fins Having Large Louver-to-Fin Pitch Ratio

Abstract: Flow visualization experiments were conducted for two louver arrays having large louver pitch ratio (LpIFp = 1.0 and 1.4). Flow efficiencies and critical Reynolds numbers were obtained from the data, and were compared with existing correlations. The correlations failed to predict the present flow efficiency data adequately; some correlation overpredieted the data, while others underpredicted the data. Large louver pitch ratio of the present model, which is outside of the applicable range of the correlations may partly be responsible. The critical Reynolds numbers obtained from the present flow visualization data were in close agreement with those obtained from the heat transfer tests on actual flat tube heat exchangers. Existing correlations on the critical Reynolds number generally overpredicted the present data.

Iterative decision feedback equalisation with no feedback filter

Abstract: An iterative modified decision feedback equaliser (I-MDFE) with no feedback filter over broadband channels is proposed. Generally, in the structure of an I-DFE, a soft residual postcursor intersymbol interference (ISI) is removed by a feedback filter (FBF). However, the ISI in the I-MDFE is precancelled prior to the equalisation, which results in no requirement of the FBF. It is demonstrated in the simulation evaluation that the I-MDFE can offer excellent performance under the broadband channel, with shorter filter taps than those of an iterative linear equaliser (I-LE) and the I-DFE.