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1.
Article in English | WPRIM | ID: wpr-875263

ABSTRACT

Objective@#Clinical outcomes of patients who undergo transarterial chemoembolization (TACE) for single small hepatocellular carcinoma (HCC) are not consistent, and may differ based on certain imaging findings. This retrospective study was aimed at determining the efficacy of pre-TACE CT or MR imaging findings in predicting survival outcomes in patients with small HCC upon being treated with TACE. Besides, the study proposed to build a risk prediction model for these patients. @*Materials and Methods@#Altogether, 750 patients with functionally good hepatic reserve who received TACE as the first-line treatment for single small HCC between 2004 and 2014 were included in the study. These patients were randomly assigned into training (n = 525) and validation (n = 225) sets. @*Results@#According to the results of a multivariable Cox analysis, three pre-TACE imaging findings (tumor margin, tumor location, enhancement pattern) and two clinical factors (age, serum albumin level) were selected and scored to create predictive models for overall, local tumor progression (LTP)-free, and progression-free survival in the training set. The median overall survival time in the validation set were 137.5 months, 76.1 months, and 44.0 months for low-, intermediate-, and high-risk groups, respectively (p < 0.001). Time-dependent receiver operating characteristic curves of the predictive models for overall, LTP-free, and progression-free survival applied to the validation cohort showed acceptable areas under the curve values (0.734, 0.802, and 0.775 for overall survival; 0.738, 0.789, and 0.791 for LTP-free survival; and 0.671, 0.733, and 0.694 for progression-free survival at 3, 5, and 10 years, respectively). @*Conclusion@#Pre-TACE CT or MR imaging findings could predict survival outcomes in patients with small HCC upon treatment with TACE. Our predictive models including three imaging predictors could be helpful in prognostication, identification, and selection of suitable candidates for TACE in patients with single small HCC.

2.
Journal of Stroke ; : 64-75, 2020.
Article | WPRIM | ID: wpr-834643

ABSTRACT

Recent advances in endovascular thrombectomy have enabled the histopathologic analysis of fresh thrombi in patients with acute stroke. Histologic analysis has shown that the thrombus composition is very heterogeneous between patients. However, the distribution pattern of each thrombus component often differs between patients with cardiac thrombi and those with arterial thrombi, and the efficacy of endovascular thrombectomy is different according to the thrombus composition. Furthermore, the thrombus age is related to the efficacy of reperfusion therapy. Recent studies have shown that neutrophils and neutrophil extracellular traps contribute to thrombus formation and resistance to reperfusion therapy. Histologic features of thrombi in patients with stroke may provide some clues to stroke etiology, which is helpful for determining the strategy of stroke prevention. Research on thrombus may also be helpful for improving reperfusion therapy, including the development of new thrombolytic agents.

3.
Article | WPRIM | ID: wpr-833514

ABSTRACT

Objective@#Endovascular thrombectomy (EVT) fails in approximately 20% of anterior circulation large vessel occlusion (ACLVO).Nonetheless, the factors that affect clinical outcomes of non-recanalized AC-LVO despite EVT are less studied. Thepurpose of this study was to identify the factors affecting clinical outcomes in non-recanalized AC-LVO patients despite EVT. @*Materials and Methods@#This was a retrospective analysis of clinical and imaging data from 136 consecutive patients whodemonstrated recanalization failure (modified thrombolysis in cerebral ischemia [mTICI], 0–2a) despite EVT for AC-LVO. Datawere collected in prospectively maintained registries at 16 stroke centers. Collateral status was categorized into good or poorbased on the CT angiogram, and the mTICI was categorized as 0–1 or 2a on the final angiogram. Patients with good (modifiedRankin Scale [mRS], 0–2) and poor outcomes (mRS, 3–6) were compared in multivariate analysis to evaluate the factorsassociated with a good outcome. @*Results@#Thirty-five patients (25.7%) had good outcomes. The good outcome group was younger (odds ratio [OR], 0.962;95% confidence interval [CI], 0.932–0.992; p = 0.015), had a lower incidence of hypertension (OR, 0.380; 95% CI, 0.173–0.839; p = 0.017) and distal internal carotid artery involvement (OR, 0.149; 95% CI, 0.043–0.520; p = 0.003), lower initialNational Institute of Health Stroke Scale (NIHSS) (OR, 0.789; 95% CI, 0.713–0.873; p < 0.001) and good collateral status(OR, 13.818; 95% CI, 3.971–48.090; p < 0.001). In multivariate analysis, the initial NIHSS (OR, 0.760; 95% CI, 0.638–0.905; p = 0.002), good collateral status (OR, 14.130; 95% CI, 2.264–88.212; p = 0.005) and mTICI 2a recanalization (OR,5.636; 95% CI, 1.216–26.119; p = 0.027) remained as independent factors with good outcome in non-recanalized patients. @*Conclusion@#Baseline NIHSS score, good collateral status, and mTICI 2a recanalization remained independently associatedwith clinical outcome in non-recanalized patients. mTICI 2a recanalization would benefit patients with good collaterals innon-recanalized AC-LVO patients despite EVT.

4.
Article | WPRIM | ID: wpr-832284

ABSTRACT

Background/Aims@#This study examined the risk factors associated with mortality in cirrhotic patients hospitalized with variceal bleeding, and evaluated the effects of acute-on-chronic liver failure (ACLF) on the prognosis of these patients. @*Methods@#This study was retrospectively conducted on patients registered in the Korean acute-on-chronic liver failure study cohort, and on 474 consecutive cirrhotic patients hospitalized with variceal bleeding from January 2013 to December 2013 at 21 university hospitals. ACLF was defined as described by the European Association for the Study of Liver-Chronic Liver Failure Consortium. @*Results@#Among a total of 474 patients, 61 patients were diagnosed with ACLF. The cumulative overall survival (OS) rate was lower in the patients with ACLF than in those without (P<0.001), and patients with higher ACLF grades had a lower OS rate (P<0.001). The chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score was identified as a significant prognostic factor in patients hospitalized with variceal bleeding (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.30–1.50; P<0.001), even in ACLF patients with variceal bleeding (HR, 1.32; 95% CI, 1.19–1.46, P<0.001). Concerning the prediction of the mortality risk at 28- and 90-day using CLIF-SOFA scores, c-statistics were 0.895 (95% CI, 0.829–0.962) and 0.897 (95% CI, 0.842–0.951), respectively, and the optimal cut-off values were 6.5 and 6.5, respectively. @*Conclusions@#In cirrhotic patients hospitalized with variceal bleeding, the prognosis was poor when accompanied by ACLF, especially depending upon CLIF-SOFA score. CLIF-SOFA model well predicted the 28-day or 90-day mortality for cirrhotic patients who experienced variceal bleeding.

5.
Article | WPRIM | ID: wpr-832263

ABSTRACT

Alcohol is a well-known risk factor for premature morbidity and mortality. The per capita alcohol consumption of the world’s population rose from 5.5 L in 2005 to 6.4 L in 2010 and was still at the level of 6.4 L in 2016. Alcohol-attributable deaths and disability-adjusted life years (DALYs) declined from 2000 to 2016 by 17.9% and 14.5%, respectively. However, these gains observed in the alcohol-attributable burden have proportionally not kept pace with the total health gains during the same period. In 2016, 3.0 million deaths worldwide and 132 million DALYs were attributable to alcohol, responsible for 5.3% of all deaths and 5.0% of all DALYs. These burdens are the highest in the regions of Eastern Europe and sub-Saharan Africa. The alcohol-attributable burden is particularly heavy among young adults, accounting for 7.2% of all premature mortalities. Among the disease categories to which alcohol is related, injuries, digestive diseases, and cardiovascular diseases are the leading causes of the alcohol-attributable burden. To reduce the harmful use of alcohol in a country, the ‘whole of government’ and ‘whole of society’ approaches are required with the implementation of evidence-based alcohol control policies, the pursuit of public health priorities, and the adoption of appropriate policies over a long period of time. In this review, we summarize previous efforts to investigate the alcohol-attributable disease burden and the best ways to protect against harmful use of alcohol and promote health.

6.
Article | WPRIM | ID: wpr-832253

ABSTRACT

Background/Aims@#Suboptimal responses to lamivudine or telbivudine plus adefovir (LAM/LdT+ADV) rescue therapy are common in patients with LAM-resistant hepatitis B virus (HBV) infections. We compared patients switched to entecavir plus tenofovir (ETV+TDF) to those maintained on LAM/LdT+ADV. @*Methods@#This prospective randomized controlled trial examined 91 patients whose serum HBV DNA levels were greater than 60 IU/mL after at least 24 weeks of treatment with LAM/LdT+ADV for LAM-resistant HBV. Patients were randomized to receive a new treatment (ETV+TDF, n=45) or maintained on the same treatment (LAM/LdT+ADV, n=46) for 48 weeks. Patients with baseline ADV resistance were excluded. @*Results@#Compared to LAM/LdT+ADV group, ETV+TDF group had more patients with a virologic response (42/45 [93.33%] vs. 3/46 [6.52%], P<0.001) and had a greater mean reduction in serum HBV DNA level from baseline (-4.16 vs. -0.37 log10 IU/mL, P<0.001). Multivariate analysis indicated that high baseline HBV DNA level (P=0.005) and LAM/LdT+ADV maintenance therapy (P=0.001) were negatively associated with virologic response. At week 48, additional ADV- or ETV-associated mutations were cleared in ETV+TDF group, but such mutations were present in 4.3% of patients in LAM/LdT+ADV group (P=0.106). The two groups had similar rates of adverse events. @*Conclusions@#ETV+TDF combination treatment led to a significantly higher rate of virologic response compared to LAM/LdT+ADV combination treatment in patients with LAM-resistant HBV who had suboptimal responses to LAM/LdT+ADV regardless of HBV genotypic resistance profile (NCT01597934).

7.
Article | WPRIM | ID: wpr-832218

ABSTRACT

Background/Aims@#Data on the trends in the prevalence of chronic liver disease (CLD) in Korea are scarce. This study aimed to evaluate whether the CLD prevalence changed between 1998–2001 and 2016–2017. @*Methods@#Data were extracted from the Korea National Health and Nutrition Examination Survey (1998–2001 to 2016– 2017; n=25,893). Non-alcoholic fatty liver disease (NAFLD) was defined as a hepatic steatosis index >36 in the absence of any other evidence of CLD. The definition of alcohol-related liver disease (ALD) was excessive alcohol consumption (≥210 g/week for men and ≥140 g/week for women) and an ALD/NAFLD index >0. @*Results@#The prevalence of NAFLD increased from 18.6% (95% confidence interval [CI], 17.8–19.5%) in 1998–2001 to 21.5% (95% CI, 20.6–22.6%) in 2016–2017. During the same time period, increases were observed in the prevalence of obesity (27.0 vs. 35.1%), central obesity (29.4 vs. 36.0%), diabetes (7.5 vs. 10.6%), and excessive drinking (7.3 vs. 10.5%). ALD prevalence also increased from 3.8% (95% CI, 3.4–4.2%) to 7.0% (95% CI, 6.4–7.6%). In contrast, chronic hepatitis B decreased from 5.1% (95% CI, 4.6–5.5%) to 3.4% (95% CI, 3.0–3.8%). The prevalence of chronic hepatitis C was approximately 0.3% in 2016–2017. @*Conclusions@#The prevalence of NAFLD and ALD increase among Korean adults. Our results suggest potential targets for interventions to reduce the future burden of CLD.

8.
Article | WPRIM | ID: wpr-831837

ABSTRACT

Background/Aims@#Enzymatic analysis of aspartate/alanine aminotransferase (AST/ALT) does not exactly represent the progression of liver fibrosis or inflammation. Immunoassay for AST (cytoplasmic [c] AST/mitochondrial [m] AST) and ALT (ALT1/ALT2) has been suggested as one alternatives for enzymatic analysis. The objective of this study was to evaluate the efficacy of immunoassay in predicting liver fibrosis and inflammation. @*Methods@#A total of 219 patients with chronic hepatitis B (CHB) who underwent hepatic venous pressure gradient (HVPG) and liver biopsy before antiviral therapy were recruited. Serum samples were prepared from blood during HVPG. Results of biochemical parameters including enzymatic AST/ALT and immunological assays of cAST, mAST, ALT1, and ALT2 through sandwich enzyme-linked immunosorbent assay (ELISA) immunoassay with fluorescence labeled monoclonal antibodies were compared with the results of METAVIR stage of live fibrosis and the Knodell grade of inflammation. @*Results@#METAVIR fibrosis stages were as follows: F0, six (3%); F1, 52 (24%); F2, 88 (40%); F3, 45 (20%); and F4, 28 patients (13%). Mean levels of AST and ALT were 121 ± 157 and 210 ± 279 IU/L, respectively. Mean HVPG score of all patients was 4.7 ± 2.5 mmHg. According to the stage of liver fibrosis, HVPG score (p < 0.001, r = 0.439) and ALT1 level (p < 0.001, r = 0.283) were significantly increased in all samples from patients with CHB. ALT (p < 0.001, r = 0.310), ALT1 (p < 0.001, r = 0.369), and AST (p < 0.001, r = 0.374) levels were positively correlated with Knodell grade of inflammation. @*Conclusions@#ALT1 measurement by utilizing sandwich ELISA immunoassay can be useful method for predicting inf lammation grade and fibrosis stage in patients with CHB.

9.
Article in English | WPRIM | ID: wpr-830336

ABSTRACT

Background@#Recently, there have been some trials to use dexmedetomidine in the obstetric field but concerns regarding the drug include changes in uterine contractions after labor. We aimed to evaluate the effects of dexmedetomidine on the myometrial contractions of pregnant rats. @*Methods@#In a pilot study, the contraction of the myometrial strips of pregnant Sprague-Dawley rats in an organ bath with oxytocin at 1 mU/ml was assessed by adding dexmedetomidine from 10-6 to 10-2 M accumulatively every 20 min, and active tension and the number of contractions were evaluated. Then, changes in myometrial contractions were evaluated from high doses of dexmedetomidine (1.0 × 10−4 to 1.2 × 10−3 M). The effective concentrations (EC) for changes in uterine contractions were calculated using a probit model. @*Results@#Active tension and the number of contractions were significantly decreased at 10-3 M and 10-4 M dexmedetomidine, respectively (P < 0.05). A complete loss of contractions was seen at 10-2 M. Dexmedetomidine (1.0 × 10−4 to 1.2 × 10−3 M) decreased active tension and the number of contractions in a concentration-dependent manner. The EC95 of dexmedetomidine for inhibiting active tension and the number of contractions was 5.16 × 10-2 M and 2.55 × 10-5 M, respectively. @*Conclusions@#Active tension of the myometrium showed a significant decrease at concentrations of dexmedetomidine higher than 10-3 M. Thus, clinical concentrations of dexmedetomidine may inhibit uterine contractions. Further research is needed for the safe use of dexmedetomidine in the obstetrics field.

10.
Article | WPRIM | ID: wpr-830300

ABSTRACT

Background@#Postoperative vomiting (POV) is one of the most serious complications in pediatric patients undergoing strabismus surgery. This study was conducted to test the hypothesis that gastric decompression (GD) could prevent POV caused by gastric distension after mask ventilation. @*Methods@#A total of 60 pediatric patients (ASA PS I–II, aged one to 10 years) were randomly allocated to two groups; Group D (n = 30) and Group C (n = 30). Induction of anesthesia was performed with careful face mask ventilation with 100% O2 (3 L/min) and sevoflurane 3 vol% to limit airway pressure below 20 cmH2O. Endotracheal intubation was done after confirming adequate neuromuscular blockade. Then, the patients in Group D received GD, while patients in Group C did not. After the surgery, POV was assessed during the emergence from anesthesia in the operating room and postanesthetic care unit (30 min and 60 min). @*Results@#During the emergence, POV was significantly decreased in Group D compared to Group C (Group D 3.3% vs. Group C 30.0%, P = 0.006). The odds ratio analysis showed a lower incidence of POV in Group D (odds ratio = 0.080; 95% confidence limit: 0.009–0.685) during the emergence period. There was no significant difference in the incidence of POV in the postanesthetic care unit (Group D 6.7% vs. Group C 4.3% at 30 min, P = 1.000; 0% in both groups at 60 min). @*Conclusions@#GD reduced the incidence of POV in pediatric patients undergoing strabismus surgery during emergence.

11.
Article in English | WPRIM | ID: wpr-785365

ABSTRACT

BACKGROUND: Nicardipine, a calcium channel blocker, is used to treat hypertension in pregnancy or preterm labor. The current study was conducted to investigate the relaxant effects of nicardipine on the isolated uterine smooth muscle of the pregnant rat.METHODS: We obtained uterine smooth muscle strips from pregnant female SD rats. After uterine contraction with oxytocin 10 mU/ml, we added nicardipine (10⁻¹² to 10⁻⁸ M) accumulatively every 20 min. We recorded active tension and frequency of contraction, and calculated EC₅ (effective concentration of 5% reduction), EC₂₅, EC₅₀, EC₇₅, and EC₉₅ of active tension and frequency of contraction using a probit model.RESULTS: Nicardipine (10⁻¹² to 10⁻⁸ M) decreased active tension and frequency of contraction in a concentration-dependent manner. The EC₅₀ and EC₉₅ of nicardipine in the inhibition of active tension of the uterine smooth muscle were 2.41 × 10⁻¹⁰ M and 3.06 × 10⁻⁷ M, respectively. The EC₅₀ and EC₉₅ of nicardipine in the inhibition of frequency of contraction of the uterine smooth muscle were 9.04 × 10⁻¹¹ and 4.18 × 10⁻⁷ M, respectively.CONCLUSIONS: Nicardipine relaxed and decreased the frequency of contraction of the uterine smooth muscle in a concentration-dependent pattern. It might be possible to adjust the clinical dosage of nicardipine in the obstetric field based on our results, but further clinical studies are needed to confirm them.


Subject(s)
Animals , Calcium Channels , Female , Humans , Hypertension , Muscle, Smooth , Nicardipine , Obstetric Labor, Premature , Oxytocin , Pregnancy , Rats , Relaxation , Uterine Contraction , Uterus
12.
Article in English | WPRIM | ID: wpr-741413

ABSTRACT

OBJECTIVE: We report the results of a pilot clinical study that evaluated the safety and efficacy of a newly-developed, retrievable flow diverter (FloWise; Taewoong Medical) for the treatment of internal carotid artery (ICA) aneurysm. MATERIALS AND METHODS: A total of 10 patients were enrolled. Inclusion criteria were 1) unruptured aneurysm with a dome size of ≥ 8 mm and a neck size of ≥ 4 mm at the ICA, or 2) two or more unruptured aneurysms of any size able to be spanned by a single FloWise at the ICA. Co-primary effectiveness end points were technical success of FloWise placement, and a 50% or greater decrease in aneurysm volume at the 6-month follow-up angiogram. The primary safety end point was the new development of neurological deficits persisting for more than 1-month post-treatment. RESULTS: Ten patients harboring 14 ICA aneurysms (median diameter, 9.4 mm; range, 2.3–31.0 mm) were enrolled between January 2016 and July 2017. FloWise placement was successful in all patients. There were no newly-developed neurological deficits during the 6-month clinical follow-up period. One patient did not receive follow-up imaging due to pregnancy. Nine patients with 12 aneurysms received a 6-month angiographic follow-up. Ten aneurysms (83.3%) showed decreases in volume greater than 50% (mean volume decrease, 82.8 ± 32.9%), of which 8 (66.7%, 95% confidence interval, 35.4–98.0%) showed complete occlusion. One patient was retreated due to mass symptom aggravation. CONCLUSIONS: In this pilot study, FloWise appeared to be safe and effective for ICA aneurysm treatment. A prospective multicenter study to validate the effectiveness and safety of FloWise would be worthwhile.


Subject(s)
Aneurysm , Carotid Artery, Internal , Clinical Study , Follow-Up Studies , Humans , Intracranial Aneurysm , Neck , Pilot Projects , Pregnancy , Prospective Studies
13.
Neurointervention ; : 91-98, 2019.
Article in English | WPRIM | ID: wpr-760598

ABSTRACT

PURPOSE: Hereditary hemorrhagic telangiectasia (HHT), a rare genetic vascular disorder, has been rarely reported in South Korea. We investigated the current prevalence and presenting patterns of genetically confirmed HHT in South Korea. MATERIALS AND METHODS: We defined HHT patients as those with proven mutations on known HHT-related genes (ENG, ACVRL1, SMAD4, and GDF2) or those fulfilling 3 or 4 of the Curaçao criteria. A computerized systematic search was performed in PubMed and KoreaMed using the following search term: (“hereditary hemorrhagic telangiectasia” AND “Korea”) OR (“Osler-Weber-Rendu” AND “Korea”). We also collected government health insurance data. HHT genetic testing results were collected from three tertiary hospitals in which the genetic tests were performed. We integrated patient data by analyzing each case to obtain the prevalence and presenting pattern of HHT in South Korea. RESULTS: We extracted 90 cases from 52 relevant articles from PubMed and KoreaMed. An additional 22 cases were identified from the three Korean tertiary hospitals after excluding seven cases that overlapped with those in the published articles. Finally, 112 HHT patients were identified (41 males and 71 females, aged 4–82 years [mean±standard deviation, 45.3±20.6 years]). The prevalence of HHT in South Korea is about 1 in 500,000, with an almost equal prevalence among men and women. Forty-nine patients underwent genetic testing, of whom 28 had HHT1 (ENG mutation) and 19 had HHT2 (ACVRL1 mutation); the other two patients were negative for ENG, ACVRL1, and SMAD4 mutations. CONCLUSION: The prevalence of HHT is underestimated in Korea. The rate of phenotypic presentation seems to be similar to that found worldwide. Korean health insurance coverage is limited to representative genetic analysis to detect ENG and ACVRL1 mutations. Further genetic analyses to detect HHT3, HHT4, and other forms of HHT should be implemented.


Subject(s)
Arteriovenous Fistula , Arteriovenous Malformations , Diagnosis , Epistaxis , Female , Genetic Testing , Hemorrhage , Humans , Insurance, Health , Korea , Male , Prevalence , Telangiectasia, Hereditary Hemorrhagic , Tertiary Care Centers
14.
Korean Journal of Radiology ; : 1285-1292, 2019.
Article in English | WPRIM | ID: wpr-760295

ABSTRACT

OBJECTIVE: To evaluate the safety and efficacy of the coil-protected technique for liquid embolization in neurovascular malformations. MATERIALS AND METHODS: Twenty-two patients who underwent coil-protected liquid embolization for symptomatic cranial (n = 13) and spinal (n = 9) arteriovenous fistula (AVF) or arteriovenous malformations (AVMs) were identified. A total of 36 target feeder vessels were embolized with N-butyl cyanoacrylate and/or Onyx (Medtronic). This technique was used to promote delivery of a sufficient amount of liquid embolic agent into the target shunt or nidus in cases where tortuous feeding arteries preclude a microcatheter wedging techniqu and/or to prevent reflux of the liquid embolic agent in cases with a short safety margin. The procedure was considered technically successful if the target lesion was sufficiently filled with liquid embolic agent without unintentional reflux. Angiographic and clinical outcomes were retrospectively evaluated. RESULTS: Technical success was achieved for all 36 target feeders. Post-embolization angiographies revealed complete occlusion in 16 patients and near-complete and partial occlusion in three patients each. There were no treatment-related complications. Of the six patients who showed near-complete or partial occlusion, five received additional treatments: two received stereotactic radiosurgery for cerebral AVM, two underwent surgical removal of cerebral AVM, and one underwent additional embolization by direct puncture for a mandibular AVM. Finally, all patients showed complete (n = 19) or near-complete (n = 3) occlusion of the target AVF or AVM on follow-up angiographies. The presenting neurological symptoms improved completely in 15 patients (68.2%) and partially in seven patients (31.8%). CONCLUSION: The coil-protected technique is a safe and effective method for liquid embolization, especially in patients with various neurovascular shunts or malformations who could not be successfully treated with conventional techniques.


Subject(s)
Angiography , Arteries , Arteriovenous Fistula , Arteriovenous Malformations , Cyanoacrylates , Follow-Up Studies , Humans , Methods , Punctures , Radiosurgery , Retrospective Studies
15.
Article in English | WPRIM | ID: wpr-765053

ABSTRACT

BACKGROUND: This study aimed to determine the prognostic role of the categorized hemodynamic stage (HS) based on the hepatic venous pressure gradient (HVPG) in patients with portal hypertension. METHODS: Of 1,025 cirrhotic patients who underwent HVPG measurement, data on 572 non-critically-ill patients were collected retrospectively between 2008 and 2013. The following two HS categorizations were used: HS-1 (6–9, 10–12, 13–16, 17–20, and > 20 mmHg; designated as groups 1–5, respectively) and HS-2 (6–12, 13–20, and > 20 mmHg). Clinical characteristics, mortality rates, and prognostic predictors were analyzed according to the categorized HS. RESULTS: During the mean follow-up period of 25 months, 86 (15.0%) patients died. The numbers of deaths in HS-1 groups were 7 (6.3%), 7 (6.9%), 30 (18.0%), 20 (15.6%), and 22 (34.4%), respectively (P 20 mmHg; HR, 5.45) and intermediate model for end-stage liver disease (MELD) score (HVPG, 13–20 mmHg; HR, 3.86 and HVPG > 20 mmHg; HR, 8.77; P < 0.05). CONCLUSION: Categorizing HVPG values according to HS-2 is a useful prognostic modality in patients with portal hypertension and can play an independent role in predicting the prognosis in patients with hypoalbuminemia and an intermediate MELD score.


Subject(s)
Discrimination, Psychological , Fibrosis , Follow-Up Studies , Hemodynamics , Humans , Hypertension, Portal , Hypoalbuminemia , Liver Diseases , Mortality , Multivariate Analysis , Prognosis , Retrospective Studies , Venous Pressure
16.
Chinese Medical Journal ; (24): 1645-1651, 2018.
Article in English | WPRIM | ID: wpr-688064

ABSTRACT

<p><b>Background</b>Until now, various types of combined therapy with nucleotide analogs and pegylated interferon (Peg-INF) in patients with hepatitis B patients have been tried. However, studies regarding the benefits of de novo combination, late-add on, and sequential treatment are very limited. The objective of the current study was to identify the efficacy of sequential treatment of Peg-INF after short-term antiviral treatment.</p><p><b>Methods</b>Between June 2010 and June 2015, hepatitis B e antigen (HBeAg)-positive patients (n = 162) received Peg-IFN for 48 weeks (mono-treatment group, n = 81) and entecavir (ETV) for 12 weeks with a 48-week course of Peg-IFN starting at week 5 of ETV therapy (sequential treatment group, n = 81). The primary endpoint was HBeAg seroconversion at the end of follow-up period after the 24-week treatment. The primary endpoint was analyzed using Chi-square test, Fisher's exact test, and regression analysis.</p><p><b>Results</b>HBeAg seroconversion rate (18.2% vs. 18.2%, t = 0.03, P = 1.000) and seroclearance rate (19.7% vs. 19.7%, t = 0.03, P = 1.000) were same in both mono-treatment and sequential treatment groups. The rate of alanine aminotransferase (ALT) normalization (45.5% vs. 54.5%, t = 1.12, P = 0.296) and serum hepatitis B virus (HBV)-DNA <2000 U/L (28.8% vs. 28.8%, t = 0.10, P = 1.000) was not different in sequential and mono-treatment groups at 24 weeks of Peg-INF. Viral response rate (HBeAg seroconversion and serum HBV-DNA <2000 U/L) was not different in the two groups (12.1% vs. 16.7%, t = 1.83, P = 0.457). Baseline HBV-DNA level (7 logU/ml vs. 7.5 logU/ml, t = 1.70, P = 0.019) and hepatitis B surface antigen titer (3.6 logU/ml vs. 4.0 logU/ml, t = 2.19, P = 0.020) were lower and predictors of responder in mono-treatment and sequential treatment groups, respectively.</p><p><b>Conclusions</b>The current study shows no differences in HBeAg seroconversion rate, ALT normalization, and HBV-DNA levels between mono-therapy and sequential therapy regimens.</p><p><b>Trial Registration</b>ClinicalTrials.gov, NCT01220596; https://clinicaltrials.gov/ct2/show/NCT01220596?term=NCT01220596&rank=1.</p>

17.
Article in English | WPRIM | ID: wpr-715320

ABSTRACT

Alcohol consumption has increased over the past 40 years in Korea concomitantly with the country's rapid socioeconomic development. As a result, alcohol-related deaths and mortality continue to increase in Korea. This review will summarize the recent epidemiology of alcoholic liver disease in Korea.


Subject(s)
Alcohol Drinking , Alcoholics , Epidemiology , Health Policy , Humans , Korea , Liver Diseases, Alcoholic , Mortality
19.
Neurointervention ; : 41-47, 2018.
Article in English | WPRIM | ID: wpr-730268

ABSTRACT

PURPOSE: Adjuvant coils may offer advantages in flow control during glue embolization of high flow vein of Galen aneurysmal malformation (VGAM) patients but involves specific issues such as feasibility, durability and coil mass effect. The purpose of this study is to assess the outcome of adjuvant coils in addition to transarterial glue embolization for treatment of these patients. MATERIALS AND METHODS: Five pediatric VGAM patients (age range; 11 weeks to 2 yrs 2 mos) with high flow fistulous angioarchitecture were treated with adjuvant coils 1) in the distal feeding artery and/or 2) in the vein of Galen followed by glue embolization of the shunt. The angiographic / clinical outcomes were assessed. RESULTS: Adjuvant coils were deployed in the distal feeding artery (n=3), vein of Galen pouch plus distal feeding artery (n=2). Additional transarterial glue embolization of the fistulae was successfully performed (n=4). Complete occlusion was achieved with coils in one case. Complete occlusion was achieved for all mural type cases (n=4). Residual feeders remained in a case of choroidal type of VGAM. No complications were noted related to the treatment. All patients showed normal development on follow up (range: 7.6 to 88.8 mo, mean 49.3 mo). Initial hydrocephalus improved on follow up despite coil mass effect in dilated vein of Galen. CONCLUSION: Adjuvant coils for flow control with glue embolization may be a safe and effective treatment method for VGAM patients with high flow fistulous feeders.


Subject(s)
Adhesives , Aneurysm , Arteries , Cerebral Veins , Choroid , Fistula , Follow-Up Studies , Humans , Hydrocephalus , Methods , Veins
20.
Journal of Liver Cancer ; : 51-54, 2018.
Article in Korean | WPRIM | ID: wpr-765680

ABSTRACT

Non-alcoholic fatty liver disease (NAFLD) has been one of the causes of cryptogenic hepatocellular carcinoma (HCC). NAFLD-associated HCC (NAFLD-HCC) have clinical features such as high body mass index, deranged lipid profiles, or diabetes mellitus. We experienced a 72-year–old woman with NAFLD associated HCC which was recurred after surgical resection.


Subject(s)
Body Mass Index , Carcinoma, Hepatocellular , Diabetes Mellitus , Female , Humans , Non-alcoholic Fatty Liver Disease
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