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1.
Gut and Liver ; : 410-419, 2021.
Article in English | WPRIM | ID: wpr-898455

ABSTRACT

Background/Aims@#This study was performed to evaluate the efficacy of direct-acting antivirals (DAAs) in Korean patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) and to investigate the risk factors associated with HCC recurrence. @*Methods@#A total of 100 patients with HCV-related HCC, who were treated with DAAs between May 2015 and December 2016, were recruited from seven university hospitals in Korea. Claim data of 526 patients with HCC obtained from the Health Insurance Review and Assessment Service in South Korea were used for external validation of the results. @*Results@#Among the 100 patients, 88% achieved a sustained virological response (SVR) 12weeks after the end of DAA therapy (SVR12), and 37% experienced HCC recurrence after DAA therapy. Short last HCC treatment durability (<12 months) before DAA commencement was independently associated with HCC recurrence (hazard ratio [HR], 2.89; p=0.011). In the nationwide validation cohort, 20.3% of the patients experienced HCC recurrence. The last HCC treatment with a noncurative method, a short last HCC treatment durability (<12 months), and a longer total duration of HCC treatment (≥18 months) were independently related with HCC recurrence (HR3.73, p<0.001; HR 3.34, p<0.001; and HR 1.74, p=0.006; respectively). @*Conclusions@#DAA therapy showed an acceptable SVR12 rate in patients with HCV-related HCC. Short last HCC treatment durability (<12 months) was associated with HCC recurrence after DAA therapy. This finding suggests that the last HCC treatment durability is an important predictor of HCC recurrence after DAA therapy.

2.
Gut and Liver ; : 606-615, 2021.
Article in English | WPRIM | ID: wpr-898434

ABSTRACT

Background/Aims@#Recent data indicate the presence of liver enzyme abnormalities in patients with coronavirus disease 2019 (COVID-19). We aimed to evaluate the clinical features and treatment outcomes of COVID-19 patients with abnormal liver enzymes. @*Methods@#We performed a retrospective, multicenter study of 874 COVID-19 patients admitted to five tertiary hospitals from February 20 to April 14, 2020. Data on clinical features, laboratory parameters, medications, and treatment outcomes were collected until April 30, 2020, and compared between patients with normal and abnormal aminotransferases. @*Results@#Abnormal aminotransferase levels were observed in 362 patients (41.1%), of which 94 out of 130 (72.3%) and 268 out of 744 (36.0%) belonged to the severe and non-severe COVID-19 categories, respectively. The odds ratios (95% confidence interval) for male patients, patients with a higher body mass index, patients with severe COVID-19 status, and patients with lower platelet counts were 1.500 (1.029 to 2.184, p=0.035), 1.097 (1.012 to 1.189, p=0.024), 2.377 (1.458 to 3.875, p=0.001), and 0.995 (0.993 to 0.998, p>0.001), respectively, indicating an independent association of these variables with elevated aminotransferase levels. Lopinavir/ ritonavir and antibiotic use increased the odds ratio of abnormal aminotransferase levels after admission (1.832 and 2.646, respectively, both p<0.05). The median time to release from quarantine was longer (22 days vs 26 days, p=0.001) and the mortality rate was higher (13.0% vs 2.9%, p<0.001) in patients with abnormal aminotransferase levels. @*Conclusions@#Abnormal aminotransferase levels are common in COVID-19 patients and are associated with poor clinical outcomes. Multivariate analysis of patients with normal aminotransferase levels on admission showed that the use of lopinavir/ritonavir and antibiotics was associated with abnormal aminotransferase levels; thus, careful monitoring is needed.

3.
Article in English | WPRIM | ID: wpr-898117

ABSTRACT

Background@#This study aimed to investigate the association between hepatic steatosis burden and albuminuria in Korean patients with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD). @*Methods@#We recruited 100 patients with both T2DM and NAFLD, but without chronic kidney disease. Albuminuria was defined as a spot urinary albumin-to-creatinine ratio (ACR) ≥30 mg/g. Transient elastography was performed, and the steatosis burden was quantified by controlled attenuation parameter (CAP) with significant steatosis defined as CAP >302 dB/m. @*Results@#The prevalence of significant steatosis and albuminuria was 56.0% and 21.0%, respectively. Subjects with significant steatosis were significantly younger and had a significantly shorter duration of T2DM, greater waist circumference, and higher body mass index, total cholesterol, triglyceride, and low density lipoprotein cholesterol levels, than subjects without severe NAFLD (all P<0.05). Albuminuria was higher in patients with significant steatosis than in patients without significant steatosis (32.1% vs. 6.8%, P=0.002). Urinary ACR showed a correlation with CAP (r=0.331, P=0.001), and multiple linear regression analysis revealed a significant association between a high degree of albuminuria and high CAP value (r=0.321, P=0.001). Additionally, multivariate logistic regression analysis demonstrated the independent association between urinary ACR and significant steatosis after adjustment for confounding factors including age, body mass index, duration of T2DM, low density lipoprotein level, and renin-angiotensin system blocker use (odds ratio, 1.88; 95% confidence interval, 1.31 to 2.71; P=0.001). @*Conclusion@#T2DM patients with NAFLD had a higher prevalence of albuminuria, which correlated with their steatosis burden.

4.
Gut and Liver ; : 410-419, 2021.
Article in English | WPRIM | ID: wpr-890751

ABSTRACT

Background/Aims@#This study was performed to evaluate the efficacy of direct-acting antivirals (DAAs) in Korean patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) and to investigate the risk factors associated with HCC recurrence. @*Methods@#A total of 100 patients with HCV-related HCC, who were treated with DAAs between May 2015 and December 2016, were recruited from seven university hospitals in Korea. Claim data of 526 patients with HCC obtained from the Health Insurance Review and Assessment Service in South Korea were used for external validation of the results. @*Results@#Among the 100 patients, 88% achieved a sustained virological response (SVR) 12weeks after the end of DAA therapy (SVR12), and 37% experienced HCC recurrence after DAA therapy. Short last HCC treatment durability (<12 months) before DAA commencement was independently associated with HCC recurrence (hazard ratio [HR], 2.89; p=0.011). In the nationwide validation cohort, 20.3% of the patients experienced HCC recurrence. The last HCC treatment with a noncurative method, a short last HCC treatment durability (<12 months), and a longer total duration of HCC treatment (≥18 months) were independently related with HCC recurrence (HR3.73, p<0.001; HR 3.34, p<0.001; and HR 1.74, p=0.006; respectively). @*Conclusions@#DAA therapy showed an acceptable SVR12 rate in patients with HCV-related HCC. Short last HCC treatment durability (<12 months) was associated with HCC recurrence after DAA therapy. This finding suggests that the last HCC treatment durability is an important predictor of HCC recurrence after DAA therapy.

5.
Gut and Liver ; : 606-615, 2021.
Article in English | WPRIM | ID: wpr-890730

ABSTRACT

Background/Aims@#Recent data indicate the presence of liver enzyme abnormalities in patients with coronavirus disease 2019 (COVID-19). We aimed to evaluate the clinical features and treatment outcomes of COVID-19 patients with abnormal liver enzymes. @*Methods@#We performed a retrospective, multicenter study of 874 COVID-19 patients admitted to five tertiary hospitals from February 20 to April 14, 2020. Data on clinical features, laboratory parameters, medications, and treatment outcomes were collected until April 30, 2020, and compared between patients with normal and abnormal aminotransferases. @*Results@#Abnormal aminotransferase levels were observed in 362 patients (41.1%), of which 94 out of 130 (72.3%) and 268 out of 744 (36.0%) belonged to the severe and non-severe COVID-19 categories, respectively. The odds ratios (95% confidence interval) for male patients, patients with a higher body mass index, patients with severe COVID-19 status, and patients with lower platelet counts were 1.500 (1.029 to 2.184, p=0.035), 1.097 (1.012 to 1.189, p=0.024), 2.377 (1.458 to 3.875, p=0.001), and 0.995 (0.993 to 0.998, p>0.001), respectively, indicating an independent association of these variables with elevated aminotransferase levels. Lopinavir/ ritonavir and antibiotic use increased the odds ratio of abnormal aminotransferase levels after admission (1.832 and 2.646, respectively, both p<0.05). The median time to release from quarantine was longer (22 days vs 26 days, p=0.001) and the mortality rate was higher (13.0% vs 2.9%, p<0.001) in patients with abnormal aminotransferase levels. @*Conclusions@#Abnormal aminotransferase levels are common in COVID-19 patients and are associated with poor clinical outcomes. Multivariate analysis of patients with normal aminotransferase levels on admission showed that the use of lopinavir/ritonavir and antibiotics was associated with abnormal aminotransferase levels; thus, careful monitoring is needed.

6.
Article in English | WPRIM | ID: wpr-890413

ABSTRACT

Background@#This study aimed to investigate the association between hepatic steatosis burden and albuminuria in Korean patients with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD). @*Methods@#We recruited 100 patients with both T2DM and NAFLD, but without chronic kidney disease. Albuminuria was defined as a spot urinary albumin-to-creatinine ratio (ACR) ≥30 mg/g. Transient elastography was performed, and the steatosis burden was quantified by controlled attenuation parameter (CAP) with significant steatosis defined as CAP >302 dB/m. @*Results@#The prevalence of significant steatosis and albuminuria was 56.0% and 21.0%, respectively. Subjects with significant steatosis were significantly younger and had a significantly shorter duration of T2DM, greater waist circumference, and higher body mass index, total cholesterol, triglyceride, and low density lipoprotein cholesterol levels, than subjects without severe NAFLD (all P<0.05). Albuminuria was higher in patients with significant steatosis than in patients without significant steatosis (32.1% vs. 6.8%, P=0.002). Urinary ACR showed a correlation with CAP (r=0.331, P=0.001), and multiple linear regression analysis revealed a significant association between a high degree of albuminuria and high CAP value (r=0.321, P=0.001). Additionally, multivariate logistic regression analysis demonstrated the independent association between urinary ACR and significant steatosis after adjustment for confounding factors including age, body mass index, duration of T2DM, low density lipoprotein level, and renin-angiotensin system blocker use (odds ratio, 1.88; 95% confidence interval, 1.31 to 2.71; P=0.001). @*Conclusion@#T2DM patients with NAFLD had a higher prevalence of albuminuria, which correlated with their steatosis burden.

7.
Article in English | WPRIM | ID: wpr-875458

ABSTRACT

Background/Aims@#Many patients uses the internet to obtain information about their diseases. However, there is increasing concern regarding the quality of internet information. Thus, we aimed to systematically evaluate the quality of websites containing educational information about non-alcoholic fatty liver disease (NAFLD) in Korea. @*Methods@#Naver, Daum, and Google search engines were searched using the term “non-alcoholic fatty liver disease” in Korean. Two reviewers independently evaluated website quality using the quality evaluation instrument (QEI), which awarded websites scores for specific information on various aspects of NAFLD, as well as a five-point Likert scale (1–5), the DISCERN instrument, and a global quality scale (GQS). @*Results@#Forty-seven websites met the inclusion criteria. We found that the quality of the internet information about NAFLD is generally poor. The mean QEI score with standard deviation was 10.31 ± 5.09 (range, 4 to 22), with only 17% of websites scoring higher than 10 points. The median GQS of the websites was 2.0, with no website achieving a score of 4 or 5. The QEI score was highly associated with the GQS score (r = 0.74, p < 0.01). For each DISCERN question from question 1 to question 15, the mean score was less than 3. @*Conclusions@#Overall, the internet health information for patients regarding NAFLD is poor and in need of much improvement. There is a need for institutional support, qualitative regulation of internet information, and development of an accreditation system to provide patients with internet health information of appropriate quality.

8.
Journal of Liver Cancer ; : 167-172, 2020.
Article | WPRIM | ID: wpr-836100

ABSTRACT

To date, there are limited data and little consensus on treatment strategies for huge hepatocellular carcinoma (HCC). Surgical resection provides significantly better survival than other modalities for single large HCC regardless of tumor stage. Recently, with technological advances in radiation therapy, stereotactic body radiation therapy (SBRT) is considered an alternative treatment option for HCC. Herein, we present a case of huge HCC that was successfully managed by SBRT. Transarterial embolization, previously performed in Russia, was incomplete. It was also not suitable for resection and transarterial chemoembolization. Although the rationale for radiotherapy in huge HCC was insufficient, SBRT was performed because no other treatment options were available. Additional radiofrequency ablation was performed for small HCC in a different segment, and radiological complete response (CR) was achieved. The CR was maintained over 4 years. Therefore, SBRT may be an alternative treatment option for large HCC that is not suitable for curative treatment.

9.
Article | WPRIM | ID: wpr-832268

ABSTRACT

Background/Aims@#Although coronavirus disease 2019 (COVID-19) has spread rapidly worldwide, the implication of pre-existing liver disease on the outcome of COVID-19 remains unresolved. @*Methods@#A total of 1,005 patients who were admitted to five tertiary hospitals in South Korea with laboratory-confirmed COVID-19 were included in this study. Clinical outcomes in COVID-19 patients with coexisting liver disease as well as the predictors of disease severity and mortality of COVID-19 were assessed. @*Results@#Of the 47 patients (4.7%) who had liver-related comorbidities, 14 patients (1.4%) had liver cirrhosis. Liver cirrhosis was more common in COVID-19 patients with severe pneumonia than in those with non-severe pneumonia (4.5% vs. 0.9%, P=0.006). Compared to patients without liver cirrhosis, a higher proportion of patients with liver cirrhosis required oxygen therapy; were admitted to the intensive care unit; had septic shock, acute respiratory distress syndrome, or acute kidney injury; and died (P @*Conclusions@#This study suggests liver cirrhosis is a significant risk factor for COVID-19. Stronger personal protection and more intensive treatment for COVID-19 are recommended in these patients.

10.
Article | WPRIM | ID: wpr-831608

ABSTRACT

Background@#Liver cirrhosis has become a heavy burden not only for patients, but also for our society. However, little is known about the recent changes in clinical outcomes and characteristics of patients with cirrhosis-related complications in Korea. Therefore, we aimed to evaluate changes in characteristics of patients with liver cirrhosis in Daegu-Gyeongbuk province in Korea over the past 15 years. @*Methods@#We retrospectively reviewed the medical records of 15,716 liver cirrhotic patients from 5 university hospitals in Daegu-Gyeongbuk province from 2000 to 2014. The Korean Standard Classification of Diseases-6 code associated with cirrhosis was investigated through medical records and classified according to the year of first visit. @*Results@#A total of 15,716 patients was diagnosed with cirrhosis. A number of patients newly diagnosed with cirrhosis has decreased each year. In 2000, patients were most likely to be diagnosed with hepatitis B virus (HBV) cirrhosis, followed by alcoholic cirrhosis. There was a significant decrease in HBV (P < 0.001), but alcohol, hepatitis C virus (HCV), and non-alcoholic fatty liver disease (NAFLD) showed a significant increase during the study period (alcohol, P = 0.036; HCV, P = 0.001; NAFLD, P = 0.001). At the time of initial diagnosis, the ratio of Child-Turcotte-Pugh (CTP) class A gradually increased from 23.1% to 32.9% (P < 0.001). The most common cause of liver-related hospitalization in 2000 was hepatocellular carcinoma (HCC) (25.5%); in 2014, gastrointestinal bleeding with esophageal and gastric varices (21.4%) was the most common cause. Cases of hospitalization with liver-related complication represented 76.4% of all cases in 2000 but 70.9% in 2014. Incidence rate of HCC has recently increased. In addition, HCC-free survival was significantly lower in CTP class A than in classes B and C. Finally, there was significant difference in HCC occurrence according to causes (P < 0.001). HBV and HCV cirrhosis had lower HCC-free survival than alcoholic and NAFLD cirrhosis. @*Conclusion@#In recent years, the overall number of cirrhosis patients has decreased. This study confirmed the recent trend in decrease of cirrhosis, especially of cirrhosis due to HBV, and the increase of HCV, alcoholic and NAFLD cirrhosis. Targeted screening for at-risk patients will facilitate early detection of liver diseases allowing effective intervention and may have decreased the development of cirrhosis and its complications.

11.
Article in English | WPRIM | ID: wpr-919038

ABSTRACT

BACKGROUND/AIMS@#Previous studies have reported a high rate of sustained virologic response (SVR) and a low rate of serious adverse events with the use of daclatasvir (DCV) and asunaprevir (ASV) combination therapy. We evaluated the efficacy and safety of DCV and ASV combination therapy for patients with chronic hepatitis C virus (HCV) genotype 1b infection in real world.@*METHODS@#We enrolled 278 patients (184 treatment-naïve patients) from five hospitals in Daegu and Gyeongsangbuk-do. We evaluated the rates of rapid virologic response (RVR), end-of-treatment response (ETR), and SVR at 12 weeks after completion of treatment (SVR12). Furthermore, we investigated the rate of adverse events and predictive factors of SVR12 failure.@*RESULTS@#The mean age of patients was 59.5 ± 10.6 years, and 140 patients (50.2%) were men. Seventy-seven patients had cirrhosis. Baseline information regarding nonstructural protein 5A (NS5A) sequences was available in 268 patients. Six patients presented with pretreatment NS5A resistance-associated variants. The RVR and the ETR rates were 96.6% (258/267) and 95.2% (223/232), respectively. The overall SVR12 rate was 91.6% (197/215). Adverse events occurred in 17 patients (7.9%). Six patients discontinued treatment because of liver enzyme elevation (n = 4) and severe nausea (n = 2). Among these, four achieved SVR12. Other adverse events observed were fatigue, headache, diarrhea, dizziness, loss of appetite, skin rash, and dyspnea. Univariate analysis did not show significant predictive factors of SVR12 failure.@*CONCLUSIONS@#DCV and ASV combination therapy showed high rates of RVR, ETR, and SVR12 in chronic HCV genotype 1b-infected patients in real world and was well tolerated without serious adverse events.

12.
Clinical Endoscopy ; : 266-273, 2018.
Article in English | WPRIM | ID: wpr-714595

ABSTRACT

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has been widely accepted as a method of treatment of early gastric tumor. This study aimed to identify the incidence and characteristics of multiple gastric tumors after ESD. METHODS: Patients with early gastric tumors who were treated by ESD from January 2004 to June 2012 and followed up with endoscopic examination periodically for at least 1 year were enrolled. All multiple gastric lesions were subsequently treated with ESD and the medical records of the patients were retrospectively reviewed. RESULTS: In total, 643 patients were included. The mean duration of endoscopic follow-up was 45.27±27.59 (range, 12–148) months. Overall, 144 patients (22.4%) showed multiple gastric tumors during the follow-up period (44 synchronous [6.8%] and 100 metachronous [15.5%]). The cumulative incidence rate steadily increased during the follow-up period. More than 50% of the tumors that developed at the same longitudinal location of the stomach were of the same macroscopic and histological type as the primary lesions. CONCLUSIONS: Because synchronous and/or metachronous gastric tumors are common, considerable attention should be paid to detect multiple gastric lesions after ESD of early gastric neoplasm.


Subject(s)
Follow-Up Studies , Humans , Incidence , Medical Records , Methods , Neoplasms, Second Primary , Retrospective Studies , Stomach , Stomach Neoplasms
13.
Journal of Liver Cancer ; : 158-162, 2017.
Article in Korean | WPRIM | ID: wpr-120516

ABSTRACT

External beam radiotherapy, transarterial chemoembolization and sorafenib are currently standard treatments for advanced hepatocellular carcinoma (HCC) with portal vein thrombosis. However, hepatic arterial infusion chemotherapy has been applied to advanced stage HCC with a view to improving the therapeutic effect. We experienced a case of advanced HCC with clinical complete response after hepatic artery infusion chemotherapy and radiation therapy and report that.


Subject(s)
Carcinoma, Hepatocellular , Chemoradiotherapy , Drug Therapy , Hepatic Artery , Portal Vein , Radiotherapy , Thrombosis , Venous Thrombosis
14.
Journal of Liver Cancer ; : 15-18, 2017.
Article in Korean | WPRIM | ID: wpr-164275

ABSTRACT

Recently, various combination therapies have been applied to the treatment of hepatocellular carcinoma (HCC). Among various treatment modalities, transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) were combined to improve the therapeutic effect of RFA. The decrease of blood flow by TACE can increase the size of the ablation area by reducing heat loss during RFA. Based on these theoretical advantages, TACE and RFA combination therapy have been tried for the treatment of patients with HCC which is not feasible to be removed by surgery. However, TACE and RFA combination therapy has not been standardized by various protocols for each study. This review discusses the implications and role of this treatment, although there are several limitations to clearly demonstrate the indications and efficacy of TACE and RFA combination therapies.


Subject(s)
Body Temperature Regulation , Carcinoma, Hepatocellular , Catheter Ablation , Humans
15.
16.
Article in English | WPRIM | ID: wpr-46328

ABSTRACT

BACKGROUND/AIMS: Treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains controversial. We compared the outcomes of hepatic resection (HR), transarterial chemoembolization (TACE), and sorafenib therapy as treatments for HCC with PVTT. METHODS: Patients diagnosed as HCC with PVTT between January 2000 and December 2011 who received treatment with sorafenib, HR, or TACE were included. Patients with main PVTT, superior mesenteric vein tumor thrombosis, or Child-Turcotte-Pugh (CTP) class C were excluded. The records of 172 patients were analyzed retrospectively. HR, TACE, and sorafenib treatment were performed is 40, 80, and 52 patients respectively. PVTT was classified as either involving the segmental branch (type I) or extending to involve the right or left portal vein (type II). RESULTS: The median survival time was significantly longer in the HR group (19.9 months) than in the TACE and sorafenib groups (6.6 and 6.2 months, respectively; both p<0.001), and did not differ significantly between the latter two groups (p=0.698). Among patients with CTP class A, type I PVTT or unilobar-involved HCC, the median survival time was longer in the HR group than in the TACE and sorafenib groups (p=0.006). In univariate analyses, the initial treatment method, tumor size, PVTT type, involved lobe, CTP class, and presence of cirrhosis or ascites were correlated with overall survival. The significant prognostic factors for overall survival in Cox proportional-hazards regression analysis were initial treatment method (HR vs. TACE: hazard ratio=1.750, p=0.036; HR vs. sorafenib: hazard ratio=2.262, p=0.006), involved lobe (hazard ratio=1.705, p=0.008), PVTT type (hazard ratio=1.617, p=0.013), and CTP class (hazard ratio=1.712, p=0.012). CONCLUSIONS: Compared with TACE or sorafenib, HR may prolong the survival of patients with HCC in cases of CTP class A, type I PVTT or unilobar-involved HCC.


Subject(s)
Adult , Aged , Antineoplastic Agents/therapeutic use , Carcinoma, Hepatocellular/complications , Chemoembolization, Therapeutic , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Liver Neoplasms/complications , Male , Middle Aged , Niacinamide/analogs & derivatives , Phenylurea Compounds/therapeutic use , Portal Vein , Proportional Hazards Models , Retrospective Studies , Severity of Illness Index , Survival Rate , Treatment Outcome , Venous Thrombosis/complications
17.
Gut and Liver ; : 95-100, 2016.
Article in English | WPRIM | ID: wpr-111612

ABSTRACT

BACKGROUND/AIMS: Data on the epidemiology of alcoholic cirrhosis, especially in Asian countries, are limited. We compared the temporal evolution of patterns of alcoholic and nonalcoholic cirrhosis over the last decade. METHODS: We retrospectively examined the inpatient datasets of five referral centers during 2002 and 2011. The study included patients who were admitted due to specific complications of liver cirrhosis. We compared the causes of hospital admissions and in-hospital deaths between patients with alcoholic and nonalcoholic cirrhosis. RESULTS: Among the included 2,799 hospitalizations (2,165 patients), 1,496 (1,143 patients) were from 2002, and 1,303 (1,022 patients) were from 2011. Over time, there was a reduction in the rate of hepatic encephalopathy (HE) as a cause of hospitalization and an increase in the rate of hepatocellular carcinoma. Deaths that were attributable to HE or spontaneous bacterial peritonitis (SBP) significantly decreased, whereas those due to hepatorenal syndrome (HRS) significantly increased over time in patients with alcoholic cirrhosis. However, in patients with nonalcoholic cirrhosis, hepatic failure and HRS remained the principal causes of in-hospital death during both time periods. CONCLUSIONS: The major causes of in-hospital deaths have evolved from acute cirrhotic complications, including HE or SBP to HRS in alcoholic cirrhosis, whereas those have remained unchanged in nonalcoholic cirrhosis during the last decade.


Subject(s)
Aged , Asia/epidemiology , Bacterial Infections/etiology , Carcinoma, Hepatocellular/etiology , Cause of Death , Female , Hepatic Encephalopathy/etiology , Hepatorenal Syndrome/etiology , Hospital Mortality/trends , Hospitalization/trends , Humans , Liver Cirrhosis/complications , Liver Cirrhosis, Alcoholic/complications , Liver Neoplasms/etiology , Male , Middle Aged , Peritonitis/microbiology , Retrospective Studies , Risk Factors , Time Factors
18.
Article in Korean | WPRIM | ID: wpr-121466

ABSTRACT

Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is rare less than 1% of all cases of TB. Because hepatic TB lacks typical clinical manifestations as well as typical imaging findings, it is difficult to differentiate TB from the malignancies such as hepatic metastasis, intrahepatic cholangiocarcinoma and hepatocellular carcinoma. A 76-year-old woman was presented with single liver mass detected on routine examination. She was clinically diagnosed with hepatocellular carcinoma and underwent surgical excision of the lesion. However, histologic examination revealed caseous necrotizing granuloma and the PCR test for Myco-bacterium tuberculosis was positive. The final diagnosis was primary hepatic TB. Here we report the case with primary hepatic TB who was initially misdiagnosed with hepatocellular carcinoma and underwent surgical excision.


Subject(s)
Aged , Carcinoma, Hepatocellular , Cholangiocarcinoma , Diagnosis , Female , Granuloma , Hepatitis B , Hepatitis , Humans , Liver , Neoplasm Metastasis , Polymerase Chain Reaction , Tuberculosis , Tuberculosis, Hepatic
19.
Article in English | WPRIM | ID: wpr-121099

ABSTRACT

Orphan nuclear receptor estrogen-related receptor γ (ERRγ) regulates cell growth and tumorigenesis in various cancers. However, the clinical relevance of ERRγ to hepatocellular carcinoma (HCC) remains unclear. Here we examined the clinical significance of ERRγ in HCC and its potential as a therapeutic target. ERRγ levels in tissues from completely resected specimens from 190 HCC patients were examined immunohistochemically and their association with clinical stage and pathological grade was analyzed. Small interfering RNA (siRNA)-mediated knockdown of ERRγ (siRNA-ERRγ) or an ERRγ inverse agonist, GSK5182, were also used to examine the effects of ERRγ inhibition on the proliferation and growth of a human hepatoma cell line, PLC/PRF/5. Immunohistochemical analysis revealed that tumor tissues showed higher levels of ERRγ-positivity than adjacent non-tumor lesions. Tumors showing high levels of ERRγ immunoreactivity also had advanced tumor node metastasis (TNM) and Barcelona Clinic Liver Cancer stages and a higher Edmondson–Steiner grade. In addition, high-level expression of ERRγ in tumors of advanced TNM stage correlated with poorer overall survival. Treatment of PLC/PRF/5 cells with siRNA-ERRγ or GSK5182 inhibited proliferation through G1 arrest, increased expression of p21 and p27 and decreased expression of phosphorylated retinoblastoma protein. GSK5182-induced reactive oxygen species also suppressed the proliferation of PLC/PRF/5 cells. The present study showed that ERRγ expression is clinically significant in HCC; therefore, it can be considered a biomarker for HCC diagnosis. Moreover, the results provide a rationale for the use of ERRγ inhibitors such as GSK5182 as potential therapeutic agents.


Subject(s)
Carcinogenesis , Carcinoma, Hepatocellular , Cell Line , Cell Proliferation , Child , Child, Orphaned , Diagnosis , Humans , Liver Neoplasms , Liver , Neoplasm Metastasis , Reactive Oxygen Species , Retinoblastoma Protein , RNA, Small Interfering
20.
Article in English | WPRIM | ID: wpr-149374

ABSTRACT

BACKGROUND/AIMS: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency that can be life threatening. This study evaluated predictive factors of 30-day mortality in patients with this condition. METHODS: A prospective observational study was conducted at a single hospital between April 2010 and November 2012, and 336 patients with symptoms and signs of gastrointestinal bleeding were consecutively enrolled. Clinical characteristics and endoscopic findings were reviewed to identify potential factors associated with 30-day mortality. RESULTS: Overall, 184 patients were included in the study (men, 79.3%; mean age, 59.81 years), and 16 patients died within 30 days (8.7%). Multivariate analyses revealed that comorbidity of diabetes mellitus (DM) or metastatic malignancy, age > or = 65 years, and hypotension (systolic pressure or = 65 years, and hemodynamic instability during hospitalization were predictors of 30-day mortality in patients with NVUGIB. These results will help guide the management of patients with this condition.


Subject(s)
Adult , Age Factors , Aged , Chi-Square Distribution , Comorbidity , Diabetes Mellitus/mortality , Endoscopy, Gastrointestinal , Female , Gastrointestinal Hemorrhage/diagnosis , Hemodynamics , Hospital Mortality , Hospitalization , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Neoplasm Metastasis , Odds Ratio , Predictive Value of Tests , Prospective Studies , Republic of Korea , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
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