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소간세포암에 대한 근치적 절제 후의 생존율 및 예후 결정인자
우광훈(Gwang Hoon Woo),윤정환(Jung Hwan Yoon),한철주(Chul Ju Han),이효석(Hyo Suk Lee),이건욱(Kun Wook Lee),김정룡(Chung Yong Kim) 대한내과학회 1997 대한내과학회지 Vol.53 No.5
N/A Background: The survival in patients with hepatocellular carcinoma (HCC) has recently been improved by the advancement in the early detection of HCC. Among the various treatment modalities, the surgical resection has been considered as the most effective for small HCC, and the clinical course of patients with small HCC who underwent curative resection is known to be dependent on the etiology of HCC. Since the differences in the etiology of HCC depend on the different geographical area, it is necessary to verify the clinical outcomes and their affecting factors in patients with small HCC after curative resection in Korea, one of the hepatitis- B-virus(HBU)-endemic areas. Methods: A total of 89 patients with small HCC (≤3cm in diameter) and adequate hepatic functional reserve(Child's A or B). who had undergone curative resection at Seoul National University Hospital between January 1985 and December 1994 were enrolled and retrospectively analyzed to evaluate clinical course and to assess the prognostic factors. Results: Serum HBsAg and anti-HCV were positive in 70% and 25% of patients, respectively, and pre-existing liver cirrhosis was found in 73% of patients. Postoperative mortality and morbidity occurred in 2.2% and 21% of patients, respectively. Cumulative recurrence rates at the end of 0.5, 1st, 2nd and 3rd year were 6.3Ya, 15.7%, 35.l% and 52.9%, respectively; cumulative probabilities of progression to hepatic decompensation at the end of 1st, 2nd and 3rd year were 4.2%, 19.4% and 22.6%, respectively; cumulative survival rates at the end of 0.5, 1st, 2nd and 3rd year were 91.1%, 89.9%, 77.9% and 74.5%, respectively. Six patients died as a result of tumor recurrence and eleven patients died of causes not related to tumor recurrence. The most important predictive factor of shorter survival time and higher rate of hepatic decompensation was vascular invasion. Age(≥50 years old), Child's classification and vascular invasion were factors affecting the rate of recurrence. Conclusion: These results verify that the clinical outcomes of patients with small HCC after curative resection in Korea are similar to those of patients with different etiology of HCC in other geographic areas. To improve the prognosis of patients with small HCC after curative resection, strict preoperative evaluation of the presence of vascular invasion and postoperative preservation of liver function are necessary as well as the close postoperative follow-up for the early detection of recurrence.
포스터 전시 : 위장관 ; 공장에 발생한 gastrointestinal autonomic nerve tumor 1예
이우진 ( Woo Jin Lee ),이준성 ( June Sung Lee ),백현욱 ( Hyun Wook Baik ),전영빈 ( Young Bin Jeon ),이정환 ( Jung Whan Lee ),김유선 ( You Sun Kim ),우광훈 ( Gwang Hoon Woo ),문정섭 ( Jeong Seop Moon ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-
gastrointestinal automomic nerve tumor (GANT)는 1984년 Herrera 등에 의해 plexosarcoma로 처음 기술된 신경총에서 유래한 종양이다. Gastrointestinal stromal tumor(GIST) 등의 다른 간엽계세포에서 유래한 종양과 감별이 어려우며, 전자현미경상 dense core granule 등의 소견이 진단에 필수적이다. GANT는 소화관의 근간신경총을 발생모지로 하는 의견이 유력한데, 최
이광혁(Kwang Hyuk Lee),김태헌(Tae Hyun Kim),우광훈(Gwang Hoon Woo),윤정환(Jung Hwan Yun),이효석(Hyo Suk Lee),김정룡(Chung Yong Kim) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3
Ticlopidine, an antiplatelet agent, is widely used for the prevention of coronary artery stent thrombosis or for secondary prevention of stroke and transient ischemic attack. Although asymptomatic elevation of liver enzymes has been reported in 5% of patients taking ticlopidine, jaundice due to ticlopidine was rare. We have recently experienced three cases presented with jaundice due to ticlopidine. All three patients developed first symptoms less than 30 days after ticlopidine medication. Their liver function test showed elevation of serum alkaline phosphatase level and hyperbilirubinemia. Histopathologic examination which was performed in two of them showed cholestatic hepatitis. In two patients who have been followed up, jaundice was disappeared 22 and 28 weeks after cessation of the drug, respectively. Thus, in diagnosis of a patient who shows abnormal liver function test of cholestatic pattern while taking ticlopidine for less than one month, we should consider the possibility of ticlopidine induced hepatitis and forbid the patient to take the drug at appropriate time. (Kor J Gastroenterol 2000;36:419 - 423)
만성 C 형 간질환에서 혈청 히아루론산 및 PIIINP 농도와 간조직 소견의 비교
이준성 ( Jun Sung Lee ),김태헌 ( Tae Hun Kim ),임영석 ( Young Suk Lim ),이효석 ( Hyo Suk Lee ),김정룡 ( Chung Yong Kim ),윤정환 ( Jung Hwan Yoon ),우광훈 ( Gwang Hoon Woo ),김경아 ( Kyung Ah Kim ),장자준 ( Ja Jun Jang ) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4
Background/Aims: In chronic liver disease type C, there have been no clinically useful serum markers to reflect histological findings such as hepatic necroinflammation and fibrosis except for an invasive liver biopsy. In an attempt to find out serum markers predicting these histological degree of progression in patients with chronic liver disease type C, we compared the histological findings with the levels of serum hyaluronate and N-terminal peptide of procollagen III (PIIINP) which are produced during the metabolism of extracellular matrices. Methods: Thirty-seven patients with antibody to HCV were enrolled in this study. Histological findings were scored for degree of piecemeal necrosis, lobular inflammation and fibrosis according to Ludwig's score. Then, serum concentrations of hyaluronate and PIIINP were measured by enzyme immunoassay and radioimmunoassay, respectively. Results: Hyaluronate at the concentration of 100 ng/mL had a positive predictive value of 80% and a negative predictive value of 100% for diagnosis of stage 3, 4 fibrosis. The positive and negative predictive values of PIIINP at the level above 1.5 U/mL were 100% and 89.3% for the diagnosis of grade 3, 4 piecemeal necrosis, and 100%, 85.7% for the diagnosis of grade 3, 4 lobular inflammation, respectively. Conclusions: Serum hyaluronate may be a useful serum marker of liver fibrosis compared with PIIINP. However, PIIINP may be a useful marker for detecting grade 3, 4 necroinflammation in patients with chronic liver disease type C. (Korean J Gastroenterol 2001;38:254-261)
송인성(In Sung Song),김정룡(Chung Yong Kim),정현채(Hyun Chae Jung),김윤준(Yoon Jun Kim),김병관(Byeong Gwan Kim),장동경(Dong Kyung Chang),우광훈(Gwang Hoon Woo),한철주(Chul Ju Han),김진(Jin Kim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.3
N/A Background/Aims: Reports of the change of intestinal pemeability(IP) in various diseases have recently been made. We performed this study to investigate the change of IP in chronic inflammatory bowel diseases including Crohn's disease, Behcet's disease, intestinal tuberculosis and ulcerative colitis. Methods: We evaluated the change of IP in chronic inflammatory bowel diseases including Crohns disease(18 patients), Behcets disease(7), intestinal tuberculosis(2) and ulcerative colitis(15) by the use of lactulose and mannitol. Lactulose, which permeates via paracellular pathway, and mannitol, via transcellular pathway, are known so far as good probe molecules for measuring intestinal permeability. Results: The disease groups showed increased IP hut the increase never reached statistical significance. There was no difference in IP between Crohn's, Behcets and intestinal tuberculosis mainly involving small intestine and ulcerative colitis involving only colon. In the point of severity, the urinary lactulose recovery rate(Folac) in control, mild, moderate and severe groups was 0.51%, 0.747c, 1.22% and 1.82% respectively, the urinary mannitol recovery rate(%man) was 15.24%, 16.21%, 8.117o and 9.94% respectively and the lactulose mannitol recovery ratio was 0.033, 0.050, 0.187 and 0.302 respectively. The moderate to severe disease groups showed increased urinary lactulose recovery rate(p<0.05), decreased urinary mannitol recovery rate(p<0.05) and increased lactulose mannitol recovery ratio(p<0.05) as compared to mild to control groups. Conclusions: IP is increased in severe inflammatory bowel disease irrespective of dit'ferent regional involvement or disease entities. (Korean J Gastroenterol 1995;27:317 - 322)
송인성(In Sung Song),김정룡(Chung Yong Kim),김용일(Yong Il Kim),정현채(Hyun Chae Jung),정준기(June Key Chung),김윤준(Yoon Jun Kim),임영석(Young Seok Lim),이대희(Dae Hee Lee),우광훈(Gwang Hoon Woo),이국래(Kook Lae Lee),한준구(Joon Koo 대한소화기학회 1997 대한소화기학회지 Vol.29 No.3
Protein-losing enteropathy is a mamfestation of various disorders associated with an excess loss of serum proteins into the gastrointestinal tract, thereby leading to hypoproteinemia and other sequelae. We present here a case of protein-losing enteropathy with unknown etiology. In spite of explorative laparotomy for multiple stricture of the small bowel, we were unable to uncover the etiology of protein-losmg entetopathy. After the resection of most severe stricture site, serum protein level was normalized, (Korean J Gsstroenterol 1997; 29: 416-421)
SV40 Large T 유전자를 이입해 불멸화시킨 사람 간근섬유아양 세포주의 확립
이효석,김정룡,윤정환,이준성,우광훈,전형식 대한소화기학회 1999 대한소화기학회지 Vol.34 No.3
Background/Aims: Myofibroblast like cell (MFLC) plays an important role in hepatic fibrogenesis. A continuously proliferating human MFLC line would be valuable in studying human hepatic fibrogenesis. The present study was attempted to establish immortalized human liver MFLC line. Methods: Fetal liver cells were transfected with SV40 large T gene. The transfected cells were selected and those colonies with morphologic characteristics of MFLCs were further cloned by limiting dilution method. Growth characteristics of subcultured cells were investigated. Indirect immuno-fluorescece studies were carried out to confirm the expression of SV40 large T antigen, to analyze the expression pattern of intermediate filaments, and to detect smooth muscle alpha-actin. Moreover, the activity to store vitamin A was analyzed. Results: Subcultured cells were spindle in shape and aggregated to form a typical hills-and-valleys structure in an overconfluent culture condition. They were stained positively for SV40 large T antigen. Doubling time of the cells was approximately 36 hours. Their growth rates were accelerated by increasing serum concentration in the media and they did not form colonies in soft agar assay. They were stained to vimentin and smooth muscle alpha-actin but not to cytokeratin and factor-VIII related antigen. These cells were also able to take up and store vitamin A. Conclusions: We established an immortalized human MFLC line derived from the hepatic stellate cells.
이효석,김정룡,윤정환,우광훈,김경아 대한소화기학회 2000 대한소화기학회지 Vol.35 No.6
Background/Aims: Recognition of diurnal variation in clinical disorders helps uncover a pathophysiological mechanism and establish treatment strategies. The aim of this study was to investigate the features of upper gastrointestinal bleeding in patients with liver cirrhosis and assess diurnal variation of variceal bleeding. Methods: Medical records of patients with liver cirrhosis who had visited Seoul National University Hospital for hematemesis or melena from January 1990 to December 1997 were reviewed. Results: There were 345 episodes of upper gastrointestinal bleeding in 249 patients. Among them, 252 episodes (73%) presented with hematemesis and 93 episodes (27%) presented with melena. Causes of bleeding were variceal rupture in 258 episodes (74.8%), portal hypertensive gastropathy in 19 episodes (5.6%) and peptic ulcer in 28 episodes (8.3%). Occurrence rate of hematemesis due to variceal rupture varied with the lapse of time. Namely, 14.2% of them occurred between 2 and 6 o'clock, 11.0% between 6 and 10 o'clock, 11.0% between 10 and 14 o'clock, 16.1% between 14 and 18 o'clock, 27.1% between 18 and 22 o'clock, and 20.6% between 22 and 2 o'clock. These differences showed statistical significance (p$lt;0.05). Conclusions: Variceal bleeding presenting with hematemesis occurred frequently from 18 to 2 o'clock and thus, showed significant diurnal variation.