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중간 병기의 간세포암종 환자의 예후 향상을 위한 고려점
유양재 ( Yang Jae Yoo ),김지훈 ( Ji Hoon Kim ) 대한간암학회 2014 대한간암학회지 Vol.14 No.2
Hepatocellular carcinoma (HCC) is one of major malignant tumor with heterogeneity and poor prognosis. In contrast to other solid malignant tumors, the prognosis of HCC is affected by not only progression of tumor itself but also residual liver function. Therefore, diverse staging systems are developed in HCC and there was no universal consensus for best staging system. However, Barcelona Clinic Liver Cancer (BCLC) system, which was endorsed by Western expert guidelines, is most commonly used staging system. BCLC system defined intermediate stage as single tumor more than 5cm, 2-3 tumor more than 3cm or ≥ 4 tumor at any size with Child-Pugh A or B and performance status 0-1 and allocated transarterial chemoembolization (TACE) as primary treatment for this stage. Intermediate stage include heterogeneous patients population and inevitably showed diverse prognosis. Among HCC patients, about 20% belonged to intermediate stage and intermediate stage means relatively little progressed stage, fair liver function and performance status. Therefore, improvement of survival of intermediate HCC patients may be a cornerstone leading improvement of survival of overall HCC patients. Hence, the strategy for optimal classification and treatment modality for intermediate HCC patients at pre and post treatment to improve prognosis in this patients will be discussed in this review. (J Liver Cancer 2014;14:80-88)
크론병 환자에서 인플릭시맵과 메살라진 치료 후 발생한 지연발생 급성 세뇨관간질 신염 증례
유양재 ( Yang Jae Yoo ),정상윤 ( Sang Yoon Chung ),구대회 ( Dae Hoe Gu ),고강지 ( Gang Jee Ko ),표희정 ( Heui Jung Pyo ),권영주 ( Young Joo Kwon ),박영태 ( Young Tae Bak ),원남희 ( Nam Hee Won ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.5
Infliximab is a chimeric anti-tumor necrosis factor-alpha monoclonal antibody. Infusion related reactions and infection are well known side effects of infliximab; however, renal complications have not been well recognized. We report on a patient with late onset-acute tubulointerstitial nephritis (ATIN) after treatment with infliximab and mesalazine for Crohn’s disease. A 25-year-old woman was admitted with a purpuric rash on both lower extremities and arthralgia. She had been diagnosed with Crohn’s disease 5.6 years previously and had been treated with mesalazine and infliximab. Serum creatinine level, last measured one year ago, was elevated from 0.6 mg/dL to 1.9 mg/dL. Results of urinalysis, ultrasound, and serologic examinations were normal. With a tentative diagnosis of Henoch-Schonlein purpura, oral prednisolone was given, and serum creatinine decreased to 1.46 mg/dL, but was elevated to 2.6 mg/dL again at two months after discontinuation of prednisolone. Renal biopsy indicated that ATIN was probably ind ced by drug, considering significant infiltration of eosinophils. Concomitant use of infliximab with mesalazine was supposed to trigger ATIN. Oral prednisolone was administered, and serum creatinine level showed partial recovery. Thus, ATIN should be suspected as a cause of renal impairment in Crohn’s disease even after a long period of maintenance treatment with infliximab and mesalazine.
간 농양으로 오인 된 담도 확장 유발 담관내 유두 종양 1예
정상윤 ( Sang Yoon Chung ),김효정 ( Hyo Jung Kim ),김재선 ( Jae Seon Kim ),김백희 ( Baek Hui Kim ),이연호 ( Yun Ho Lee ),유양재 ( Yang Jae Yoo ),정용 ( Yong Jeong ),박영태 ( Young Tae Bak ) 대한췌담도학회 2013 대한췌담도학회지 Vol.18 No.4
담관내 유두 종양은 미세한 섬유혈관 중심을 감싸는 수많은 엽상의 유두상 주름이 발생하는 것을 특징으로, 종양자체나 혹은 종양의 잔해로 인한 폐쇄 혹은 과도하게 분비되는 점액으로 인해 담관이 막혀, 간내 담관이 확장되는 다발성의 종양으로, 췌관내 점액 유두 종양과 개념적으로 대척되어 이들 사이의 연관성을 연구 중이다. 최근 발열을 주소로 내원한 환자에서 복부초음파에서 간농양이 의심되어, 간농양의 원인을 찾고자 시행한 추가적 영상 검사에서 담관내 유두 종양이 의심되어 수술을 시행한 결과, 고도의 이형성을 동반한 점액 분비하는 간내 담관내 유두 종양으로 진단되었던 1예를 경험하였기에 문헌고찰과 함께 보고한다. Intraductal papillary neoplasm (IPN) of bile duct presents the tumor of a papillary surface comprising innumerable frondlike infolding of proliferation of columnar epithelial cells surroudings slender fibrovascular stalks. Neoplasm in the bile ducts which are dilated due to obstruction by a tumor itself, sloughed tumor debris, and excessive mucin. There are some researches of IPN of bile duct because they have same embryonic origin between IPN of bile duct and intraductal papillary mucinous neoplasm (IPMN) of pancreas. Patient with fever was suspected liver abscess in abdominal ultrasonography. Intraductal papillary neoplasm (IPN) of bile duct was suspected in additional imaging study. We experienced intraductal papillary neoplasm with high grade intraepithelial neoplasia after surgical resection. Here we report a case with the review of the reported literature.