간세포암종의 병합치료 사이버나이프 치료로 완전관해를 보인 담관의 원발성 간세포암종

정승원 ( Soung Won Jeong ),배시현 ( Si Hyun Bae ),우현영 ( Hyun Young Woo ),유찬란 ( Chan Ran You ),허원행 ( Won Hang Hur ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ),이동훈 ( Dong Hoon Lee ),이영준 ( Young Jun Lee ) 대한간암학회 2008 대한간암학회지 Vol.8 No.-

Diagnostic Approach to Viral Hepatitis

정승원 ( Soung Won Jeong ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Viral hepatitis commonly refers to the 5 well described hepatotropic viruses: hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV). Although the diagnosis of these viruses can be distinguished by their molecular and antigenic properties, all types of acute viral hepatitis produce clinically similar illnesses. HBV, HCV and HDV infections can result in a chronic infection attributed to increased risk of developing chronic liver disease and hepatocellular carcinoma. Recently, new immunoenzyme techniques can quantify hepatitis B surface and hepatitis C core antigens. The prognosis and management of patients with chronic viral hepatitis B and C depend on the amount and progression of liver fibrosis. Diagnostic approach for fibrosis can be measured noninvasively, based on a “biologica ” approach (quantifying biomarkers in serum samples) or based on a “physical” approach (measuring liver stiffness).

사례보고 : 간절제술 후 원발병소인 간내 재발 없이 간외전이를 일으킨 간상피모양혈관내피종 1예

정승원 ( Soung Won Jeong ),우현영 ( Hyun Young Woo ),유찬란 ( Chan Ran You ),허원행 ( Won Hang Huh ),배시현 ( Si Hyun Bae ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ),정찬권 ( Chan Kwon Jung ),정은선 ( Eun Sun Jung ) 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.4

간상피모양혈관내피종은 혈관에서 기원하는 종양으로 간에서 발생하는 가장 드문 육종 중의 하나로서 저등도에서 중등도의 악성도를 가지고 있다. 아직까지 원인은 알려져 있지 않으며 예후 또한 예측하기 어렵다. 발생빈도가 낮고, 불균일한 특성, 다양한 임상경과 등으로 현재까지 정해져 있는 치료지침은 없다. 저자들은 64세 여자 환자에서 우엽에 발생한 간상피모양혈관내피종을 간절제술을 시행하고 22개월 후에, 원발병소인 간내 재발은 없이 골, 흉막, 복강 등으로 간외전이를 보인 사례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Epithelioid hemangioendothelioma is a neoplasm of vascular origin with a low-to-intermediate malignant potential and is one of the rare sarcomas arising from the liver. Its etiology is unknown and its clinical outcome is unpredictable. There is no generally accepted therapeutic strategy because of its rarity and the variable natural course between hemangioma and angiosarcoma. We report a case of a 64-year old woman who underwent hepatic resection due to epithelioid hemangioendothelioma in the right lobe that progressed to extrahepatic metastases of the bone, pleura, and peritoneum 22 months later. However, after resection there was no primary hepatic recurrence. (Korean J Hepatol 2008;14:525-531)

복부초음파 검사의 실제

정승원 ( Soung Won Jeong ) 대한간학회 2018 간학회 싱글토픽 심포지움 Vol.2018 No.2

만성 C형간염에서 페그인터페론과 리바비린의 병합치료 시 지속바이러스반응에 대한 순응도의 효과

정승원 ( Soung Won Jeong ),김진동 ( Jin Dong Kim ),우현영 ( Hyun Young Woo ),유찬란 ( Chan Ran You ),이승원 ( Sung Won Lee ),송명준 ( Myeong Jun Song ),장정원 ( Jung Won Jang ),배시현 ( Si Hyun Bae ),최종영 ( Jong Young Choi ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.3

목적: 만성 C형간염에서 페그인터페론과 리바비린 병합요법 치료 시 지속바이러스반응에 영향을 미치는 다양한 예측인자들이 알려져 있지만, 치료 순응도의 효과에 대해서는 구체적으로 밝혀져 있지 않다. 본 연구에서는 지속바이러스반응에 대한 치료순응도의 효과를 조사하였다. 대상과 방법: 페그인터페론 또는 리바비린 치료를 받은 만성 C형 간염 환자 122명 중에서 페그인터페론과 리바비린 병합치료를 받은 92명의 환자를 후향적으로 분석하였다. 환자들은 유전자 1형과 비1형을 치료 프로토콜에 따라서 각각 3그룹으로 분류하였다. 그룹 1은 80% 이상의 페그인터페론 및 리바비린 용량으로 80% 이상의 치료 기간 동안 치료받은 환자들이고, 그룹 2는 60% 미만의 페그인터페론 및 리바비린의 용량으로 60%미만의 기간 동안 치료받은 환자들이며 그리고 그룹 3은 이 두 그룹에 포함되지 않은 모든 환자들로 분류하였다. 결과: 치료 순응도가 달랐던 세 그룹 사이에 초기바이러스반응(early virologic response: EVR), 치료종료반응(end of treatment response: ETR) 그리고 지속바이러스반응(sustained virologic response: SVR)이 각각 의미있는 차이를 보였다. 유전자 1형 그룹들의 SVR률은 그룹 1이 86.7%, 그룹 2가 26.7% 그리고 그룹 3이 66.7%였다(P=0.003). 유전자 비1형 그룹들의 SVR은 그룹 1이 100%, 그룹 2가 16.7% 그리고 그룹 3이 88.9%였다(P<0.001). 결론: 치료 순응도는 SVR에 도달하는 데 있어서 결정적인 역할을 하며, 치료 순응도를 높이기 위한 여러 가지 지지요법들이 전체적인 SVR률을 높일 것이다. Background/Aims: Various predictive factors for peginterferon alpha and ribavirin therapy in chronic hepatitis C have been reported, but the effect of adherence to therapy has not been established. We investigated how adherence affects the sustained virologic response (SVR). Methods: We analyzed 92 chronic hepatitis C patients receiving peginterferon alpha and ribavirin combination therapy. Patients were first identified as having either genotype 1 or genotype non-1 infection and then categorized into three groups according to their adherence to the treatment protocol: (1) patients who received ≥80% of the recommended dosage of both peginterferon alpha and ribavirin for ≥80% of the intended duration of therapy, (2) patients who received <60% of the recommended dosage of both peginterferon alpha and ribavirin for <60% of the intended duration of therapy, and (3) patients who were not included in either group 1 or 2. Results: The rates of early virologic response, end of treatment response, and SVR differed significantly with the degree of adherence to the treatment. The SVRs of genotype 1 patients were 86.7%, 26.7%, and 66.7% in groups 1, 2, and 3, respectively (P=0.003), and those of genotype non-1 were 100%, 16.7%, and 88.9%, respectively (P<0.001). Conclusions: Adherence to therapy is a key factor in achieving an SVR. Supportive strategies to improve adherence will increase overall SVR rates. (Korean J Hepatol 2009;15:338-349)

NAFLD cases

정승원 ( Soung Won Jeong ) 대한간학회 2019 간학회 싱글토픽 심포지움 Vol.2019 No.1

급성 간손상: 바이러스성 간염과 독성간염을 중심으로

정승원 ( Soung Won Jeong ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.3(S)

Acute viral hepatitis is a systemic infection affecting the liver predominantly. Almost all cases of acute viral hepatitis are caused by one of five viral agents; hepatitis A, B, C, D and E viruses. Clinical courses of viral hepatitis range from asymptomatic to fulminant acute infections common to all types, on the one hand, and from subclinical persistent infections to rapidly progressive chronic liver disease with cirrhosis, common to the bloodborne types (HBV, HCV, and HDV), on the other. Toxin-induced and drug-induced hepatotoxicity, defined as any degree of liver injury caused by a drug or a toxic substance, is a frequent cause of acute liver injury and accounts for considerable portion of all cases of acute liver failure with hepatic encephalopathy.

복수

정승원 ( Soung Won Jeong ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.2

Ascites is the most common cause of decompensation in cirrhosis, and 5% to 10% of patients with compensated cirrhosis develop ascites each year. The main factor of ascites formation is renal sodium retention due to activation of the renin-angiotensin-aldosterone system and sympathetic nervous system by the reduced effective volume secondary to splanchnic arterial vasodilation. Diagnostic paracentesis is indicated in all patients with a new onset of grade 2 or 3 ascites and in those admitted to hospital for any complication of cirrhosis. A serum-ascites albumin gradient of ≥1.1 g/dL indicates portal hypertension with an accuracy of approximately 97%. Sodium restriction, diuretics, and large volume paracentesis are the mainstay of treatment in grade 1 to 3 ascites. The refractoriness of ascites is associated with a poor prognosis with a median survival of approximately six months. Repeated large volume paracentesis plus albumin is the first line treatment, and liver transplantation is recommended in patients with refractory ascites. A careful selection of patients is also important to obtain the beneficial effects of transjugular intrahepatic portosystemic shunts in refractory ascites. This review details the recent diagnosis and treatment of cirrhotic ascites. (Korean J Gastroenterol 2018;72:49-55)

도플러 초음파를 이용한 간문맥과 간정맥 혈류의 측정

정승원 ( Soung Won Jeong ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.2

Portal hypertension (PH) is a major pathophysiology in cirrhosis and the result of increased hepatic vascular resistance and portal blood flow. Hepatic venous pressure gradient (HVPG) has been the gold standard for assessing the degree of PH. However, its invasiveness and limited availability have prompted attempts to develop noninvasive alternatives. Many investigators have tried to diagnose and grade PH using non-invasive ultrasonography (US) to replace HVPG measurements. US can be used to investigate portal hemodynamics via measurements of the velocity and flow of the portal veins and the waveform and damping index (DI) of the hepatic vein (HV). However, portal blood velocity and flow can differ between patients with similar portal pressures due to significant variability in porto-systemic collateral patterns. HV wave form and DI showed an increased accuracy for diagnosing PH, and may be useful for the detection of significant PH.

자가면역간염: 진단 및 치료의 최신 지견

정승원 ( Soung Won Jeong ) 대한간학회 2017 Postgraduate Courses (PG) Vol.2017 No.1

Autoimmune hepatitis (AIH) is a generally unresolving chronic inflammatory liver disease of unknown cause, and can run a very mild subclinical course or be very acute, rarely leading to fulminant hepatic failure. AIH should be considered in any patient with acute or chronic liver disease, particularly if hypergammaglobulinemia and autoantibodies are present, and if the patient has features of other autoimmune diseases. Molecular pathogenesis of AIH has improved in the last decades, including the identification of autoantigens at the molecular level as well as the function of TH1, TH2, and TH17 cells. In addition, genome-wide association study in recent and upcoming years will help us to understand better disease susceptibility and to identify patients at particular risk. Therapies with corticosteroids alone, or in combination with azathioprine is the standard treatment for AIH. Recently, immunosuppressive drugs including cyclosporin A, tacrolimus or mycophenolate mofetil, offer an alternative for difficult to treat patients, and biological agents, like anti-TNF or anti-B cell antibodies have raised expectations within the AIH scientific community. This review summarized the recent update of pathogenesis, diagnosis, and therapeutics of AIH.