Seongnam, South Korea
Seongnam, South Korea

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Park Y.M.,Bundang Jesaeng General Hospital | Park Y.M.,General Hospital
World Journal of Hepatology | Year: 2015

The core promoter and proximal precore regions are the most complex portions of the hepatitis B virus (HBV) genome. These regions cooperatively regulate viral replication and differentially regulate the synthesis of the viral proteins E, core, and X. Multiple mutations in these regions are associated with the persistency of viral infection and the development of cirrhosis and hepatocellular carcinoma (HCC). In South Korea, nearly all HBVs are classified as HBV genotype C2; the majority of these viruses have the basal core promoter double mutation, a precore stop mutation, or both. These mutations may play a role in the alteration of viral and clinical features, and abundant and complex mutations are particularly prevalent in the core promoter and proximal precore regions. We previously demonstrated that the accumulation of ≥ 6 mutations at eight key nucleotides located in these regions (G1613A, C1653T, T1753V, A1762T, G1764A, A1846T, G1896A, and G1899A) is a useful marker to predict the development of HCC regardless of advanced liver disease. In addition, certain mutation combinations were predominant in cases with ≥ 4 mutations. In cases with ≤ 5 mutations, a low Hepatitis B e antigen titer (< 35 signal to noise ratio) was indicative of HCC risk. Viral mutation data of the single HBV genotype C2 suggest that the combined effect of the number and pattern of mutations in the core promoter and proximal precore regions is helpful in predicting HCC risk. © 2015 Baishideng Publishing Group Inc.


Lim S.-O.,Seoul National University | Park Y.M.,Bundang Jesaeng General Hospital | Kim H.S.,Seoul National University | Quan X.,Seoul National University | And 4 more authors.
Hepatology | Year: 2011

The tumor suppressor p53 is a key prognostic factor in hepatocellular carcinoma (HCC), yet only 35% of grade III tumors exhibit mutation of p53. Several other pathways have been implicated in HCC and, among these, the role of the Notch1/Snail pathway remains unclear. Therefore, we investigated the expression of p53, Notch1, and Snail proteins in HCC with regard to both clinical grade and p53 mutational status. Immunoblotting for p53 revealed that, whereas in many tumors increased p53 was a result of p53 mutation, wildtype p53 (p53WT) expression was also frequently elevated in HCCs. Coordinated evaluation of p53, Notch1, and Snail expression suggests that grade III HCC can be subdivided based on the expression of these three proteins. We found that Notch1 expression in HCC tissues and cell lines is differentially affected by p53WT and mutant p53 (p53Mut). Notch1 expression was correlated with p53 expression in cells expressing p53WT, but was not elevated in p53Mut-expressing cells. Virally mediated expression or silencing of p53WT or p53Mut confirmed that p53WT overexpression causes Notch1 up-regulation in HCC. Surprisingly, the consequence of Notch1 overexpression for the proliferative and invasive capacity of HCC cells depends on both the p53 mutational status and activation of the Snail pathway. Conclusion: In the presence of p53WT, Snail/Notch1 activation increased the invasiveness of HCC cells. In contrast, in the absence of p53WT, Notch1 decreased the invasiveness of HCC. Taken together, these findings shed new light on the complex role of the Notch1/Snail axis in HCC and provide a framework for further classifying HCC based on the expression and mutational status of p53 and the expression of Notch1 and Snail. © 2011 American Association for the Study of Liver Diseases.


Park K.Y.,University of Ulsan | Chang S.H.,Bundang Jesaeng General Hospital
Pediatric Gastroenterology, Hepatology and Nutrition | Year: 2012

Gastro-esophageal reflux disease (GERD) in otherwise healthy older children and adolescents is commonly encountered in pediatric clinics and poses a complex treatment problem involving changes of diets and lifestyle. After an initial history taking and a physical examination, typical symptoms of GERD in older children and adolescenct are initially treated with the trials of acid suppressants. With an increase of severe cases, more and more GERD children have been evaluated with endoscopy, which helps to delineate an erosive esophagitis from a non-erosive reflux disease as they are presumed to have different pathogenesis. For the pediatric patients without a significant underlying disease, a reflux esophagitis can be treated adequately with acid suppressants. Recently, the rapid increase of children who are taking anti-reflux medication has brought up a serious alarm among pediatricians. Some at risk pediatric patients with recurrent and/or chronic GERD have been linked to adulthood GERD. In this paper, pediatric GERD with and without erosive esophagitis was reviewed along with treatment options and issues specifically for the otherwise healthy older children and adolescents in the primary clinics or the secondary hospitals. © 2014 by The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition.


Jang S.Y.,Bundang Jesaeng General Hospital
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi | Year: 2012

Castleman's disease is a rare disease characterized by lymph node hyperplasia. Although Castleman's disease can occur wherever lymphoid tissue is found, it rarely appears in the abdominal cavity, and is especially rare adjacent to the liver. Here, we report a rare case of Castleman's disease in the portal area that mimicked a hepatocellular carcinoma (HCC) in a chronic hepatitis B patient. A 40 year-old woman with chronic hepatitis B presented with right upper quadrant discomfort. Computed tomography and magnetic resonance imaging results showed a 2.2 cm-sized, exophytic hypervascular mass in the portal area. HCC was suspected. However, histologic examination revealed Castleman's disease. We suggest that Castleman's disease should be included as a rare differential diagnosis of a hypervascular mass in the portal area, even in patients with chronic hepatitis B.


Yeo J.-S.,Bundang Jesaeng General Hospital | Choi J.-W.,Bundang Jesaeng General Hospital
Korean Circulation Journal | Year: 2010

Background and Objectives: High-dose intravenous immunoglobulin (IVIG) (2 g/kg) is usually given in the treatment of Kawasaki disease (KD). According to the authors' experience, however, medium-dose immunoglobulin (1 g/kg) was also effective in the majority of patients. We performed a retrospective clinical study to validate effectiveness of the medium-dose regimen in treatment of KD. Subjects and Methods: A total of 274 patients with KD who were treated with medium-dose immunoglobulin at Bundang Jesaeng General Hospital from July 1998 to October 2007 were enrolled. Results: Medium-dose immunoglobulin was given once in 220 patients (group A; 80.3%) and twice or more in 54 patients (group B; 19.7%). Age and gender distributions, duration of fever before treatment, hemoglobin concentrations, and white blood cell and platelet counts did not differ significantly between the two groups (p>0.05). Concentrations of C-reactive protein, aspartate aminotransferase, alanine aminotransferase, and bilirubin were significantly higher in group B (p<0.005). Coronary arterial lesions (CAL) were found in 51 patients (23.2%) in group A and in 26 patients (48.1%) in group B during the acute stage, and in 14 patients (6.4%) in group A and in 11 patients (20.4%) in group B during the convalescent stage (p<0.005, respectively). A giant aneurysm was found in one patient in each group (0.5% in group A and 1.9% in group B; p<0.005) during the follow-up period. Conclusion: A single infusion of medium-dose immunoglobulin was effective in 80% of patients with KD. About 20% of patients required two or more infusions of medium-dose immunoglobulin, who had higher concentrations of C-reactive protein, aspartate aminotransferase, alanine aminotransferase and bilirubin. The authors think that the medium-dose regimen proffers an advantage over the high-dose regimen in view of cost-effectiveness. Copyright © 2010 The Korean Society of Cardiology.


Combination treatment consisting of hepatic arterial infusion chemotherapy with epirubicin and cisplatin (HAIC-EC) and systemic infusion of low-dose 5-fluorouracil (5-FU) are sometimes effective against advanced hepatocellular carcinoma (HCC). However, there is no effective treatment for advanced HCCs with arterioportal shunts (APS) or arteriovenous shunts (AVS). We investigated a response and adverse events of a new combination protocol of repeated HAIC-EC and percutaneous intratumoral injection chemotherapy with a mixture of recombinant interferon-gamma (IFN-γ) and 5-FU (PIC-IF) in patients with far-advanced HCCs with large APSs or AVSs. There was a complete response (CR) for the large vascular shunts in all three patients and for all tumor burdens in two patients. Significant side effects were flu-like symptoms (grade 2) and bone marrow suppression (grade 2 or 3) after each cycle, but these were well-tolerated. These results suggest that the combination of HAIC-EC and PIC-IF is a new and promising approach for advanced HCC accompanied by a large APS or AVS.


Kim N.Y.,Bundang Jesaeng General Hospital
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi | Year: 2011

Acute phlegmonous gastritis is an uncommon disease, often fatal condition characterized by suppurative bacterial infection of the gastric wall. It has a high mortality rate mainly because the diagnosis is usually made late. Until recently, gastrectomy in combination with antibiotics was recommended. We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia. At upper gastrointestinal endoscopy, the gastric lumen was narrow, and the mucosa was severely inflamed, which was erythematous, swelled, and showed necrotic areas covered with purulent exudate. Klebsiella oxytoca and Acinetobacter lwoffii were isolated in the gastric tissue culture. Contrast-enhanced computerized tomography scan of abdomen demonstrated diffuse gastric wall thickening and an intramural abscess in the gastric antral wall. Although delayed gastric emptying by gastroparesis prolonged the in-hospital period, the only medical treatment with antibiotics alone successfully cured the patient without gastrectomy.


We aimed to determine the association between the co-expression patterns of Notch1, Snail, and p53 proteins (NSP) and the postoperative prognosis of hepatocellular carcinoma (HCC). The immunoblot data for molecular expression (147 HCC/corresponding non-HCC tissues and 15 dysplastic nodules) and the sequencing data for p53 mutations (110 HCCs) were obtained from our previous study. Data analyses were restricted to cases with HCC differentiation grade III (n=47), due to its high p53 mutation rate. Nineteen of the 47 patients (40.4%) -comprising 12 in the liver and 7 in distant organs-had relapsed at 1-2 years after surgery. There was no relationship between p53 mutation and postoperative recurrence in the grade III HCCs. Seven (87.5%) of the eight relapsed cases with Notch1, Snail, and p53 (wild) co-expression experienced recurrence only within the liver, and all tumors were smaller than 5 cm in diameter. Extrahepatic relapse occurred mostly in HCC patients with tumors larger than 5 cm in diameter, without any deviation in the NSP pattern. The results of this preliminary study suggest that the co-expression of Notch1, Snail, and p53 (wild) is not inferior to the patterns with p53 mutation as an indicator of postoperative recurrence of grade III HCC.


Young Park M.I.N.,Bundang Jesaeng General Hospital | Sung Hong Y.O.O.,Bundang Jesaeng General Hospital | Sung-Hyun K.I.M.,Bundang Jesaeng General Hospital
Anticancer Research | Year: 2013

Despite the potential utility of adipose-derived mesenchymal stem cells (ADSCs) in regenerative medicine, not much is known about their interaction with residual cancer cells. Here, we studied the direct co-culture effects of ADSCs on H358 lung cancer cells. The paracrine effects of ADSCs were compared to those of the cancer-associated fibroblasts. Extracellular matrix and conditioned media were used to determine the underlying molecules. Time-lapse photography, fluorescence-activated cell sorting (FACS), scratch assays, immunocytochemistry, and reverse-transcription polymerase chain reaction were used to analyze the effects. ADSCs differentiated into myofibroblasts expressing αSMA, and H358 cells strongly attached to them. EMT-like changes were observed in H358 cells which were inhibited by γ-secretase inhibitor, a-NOTCH inhibitor. Surprisingly, both mesenchymal and epithelial genes were expressed, and the effects were readily reversed when cells were sorted by FACS. These data suggest that ADSCs may differentiate into tumor stroma that plays supportive roles during cancer progression.


Jeon D.O.,Bundang Jesaeng General Hospital
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi | Year: 2013

Inferior mesenteric arteriovenous fistula is rare and may be congenital or acquired. Affected patients present with abdominal pain, mass, or manifestations of portal hypertension and bowel ischemia. Until now, inferior mesenteric arteriovenous fistula due to trauma has not been reported. Herein, we report a case of a 53-year-old woman who had inferior mesenteric arteriovenous fistula considered to have originated from remote blunt trauma that was successfully treated by surgical resection of only the arteriovenous fistula without colectomy. To our knowledge, this is the first case of traumatic inferior mesenteric arteriovenous fistula.

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