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( Ji Ho Seo ),( Sunmin Kim ),( Eunae Cho ),( Chung Hwan Jun ),( Sun Young Park ),( Sung Bum Cho ),( Chang Hwan Park ),( Hyun Soo Kim ),( Sung Kyu Choi ),( Jong Sun Rew ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) has been increasing because the increase in the longevity of the general population. But there is no proper management based on age stratification in elderly patients. We compared clinical characteristics, outcomes and treatment efficacy, safety between oldest-old (aged more than 85 years), middle-old (aged between 80 and 85 years) and young-old (aged between 75 and 80 years) patients with HCC. Methods: We conducted a retrospective cohort study, from January 2010 to December 2016, at Chonnam National University Hospital. A total of 550 elderly patients whose data included demographics, co-morbidity, etiology of liver disease, presence of cirrhosis, staging of HCC, treatment modality and treatment related adverse event were evaluated retrospectively. Also overall survival was assessed in enrolled patient. Results: Fifty one patients (oldest-old; median 87 years old), 153 patients (middle-old; median 82 years old) and 346 patients (young-old; median 77 years old) were diagnosed with HCC. Both oldest- and middle-old patients, compared to young-old patients had significantly lower rate of alcohol-related disease (13.7% vs 20.9% vs 34.1%, P = 0.001). There were no significant difference in underlying sex, body mass index, presence of co-morbidity, hepatitis C-related disease and stage of HCC. The Child-Pugh class (CPT class A 88.9% vs 84.1% vs 83.6%, CPT class B 11.1% vs 15.9% vs 15.0% and CPT class C 0.0% vs 0.0% vs 1.3%, respectively, P = 0.912) and Model for End Stage Liver Disease score (mean MELD score 7.22±3.34 vs 5.88±3.01 vs 5.77±3.14, P = 0.166) were no significant difference between the patients with active treatment. The modified UICC staging (stage I 5.6% vs 17.1% vs 18.6%, stage II 55.6% vs 46.3% vs 47.3%, Stage III 22.2% vs 24.4% vs 24.8%, Stage IV-A 11.1% vs 6.1% vs 4.9% and Stage IV-B 5.6% vs 6.1% vs 4.4%, respectively, P = 0.826) and Barcelona Clinic Liver Cancer staging (stage 0 5.6% vs 9.8% vs 9.3%, stage A 16.7% vs 17.1% vs 22.1%, stage B 27.8% vs 29.3% vs 24.8%, stage C 50.0% vs 43.9% vs 41.2% and stage D 0.0% vs 0.0% vs 2.7%, respectively, P = 0.878) were no significant difference between the patients with active treatment. Furthermore, there were no difference between the age groups in treatment modality (Surgical resection 0.0% vs 3.3% vs 5.2%, P = 0.166; Radiofrequency ablation 2.0% vs 8.5% vs 11.0%, P=0.113; Transcatheter arterial chemoembolization 21.6% vs 34.6% vs 41.6%, P=0.014; Best supportive care 62.7% vs 40.5% vs 29.2%, P < 0.001), adverse event related treatment (P = 0.731) and disease-free survival days (329 .3±309.1 days vs 271.7 ± 414.2 days vs 357.2 ± 511.6 days, P = 0.336). Multivariate analysis showed that age, performance status, CTP class, MELD score, modified UICC staging, presence of portal vein thrombosis and ruptured HCC are risk factors for mortality. Conclusions: Clinician should make an active treatment in elderly patients with HCC not a age but performance status, liver function and disease status of cancer.
( Mi Young Kim ),( Chung Hwan Jun ),( Seon Young Park ),( Chang Hwan Park ),( Hyun Soo Kim ),( Young Eun Joo ),( Jong Sun Rew ),( Sung Kyu Choi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Because the incidence of gastric neuroendocrine tumors (NETs) has recently increased due to advanced diagnostic methods and awareness of gastric NETs, we investigated clinicopathological characteristics and treatment results in patients with gastric NETs. Methods: We retrospectively reviewed the medical records of 27 patients (17 males, mean age: 56 years) with gastric NETs who were diagnosed and treated at Chonnam national university hospital from January 2004 to July 2014. Results: The study included 27 patients with gastric NETs who had a total of 54 lesions. The tumors were located in the body (48/52 lesions, 92.3%), fundus (3/52 lesions, 5.7%), and antrum (1/52 lesions, 2.0%). Most of the tumors were solitary (24/27 patients, 88.8%). The median size was 6.6mm (range 2-20). Most of the tumors (94.2%) were classifi ed into WHO grade 1. Methods of treatment were endoscopic mucosal resection, endoscopic submucosal dissection, cold and hot biopsy, argon plasma coagulation, wedge resection (56.5%, 10.9%, 21.7%, 2.2%, 8.7% respectively). No procedure- related complications occurred. Median follow-up time was 14 months (range 2-78). Recurrence rate was 25%. Gastric adenoma including low and high gradedysplasia was identifi ed in 25.9% (7/27 patients) during initial diagnosis and follow-up period. Conclusions: Endoscopic resection of gastric NETs is a safe and effective treatment option with a relatively low recurrence rate. The close observation about coincidence of gastric adenoma should be considered during endoscopy surveillance in patient with gastric NETs.
Refl ux Episode Reaching the Proximal Esophagus Are Associated with Chronic Cough
( Jeong Hyun Lee ),( Seon Young Park ),( Sung Bum Cho ),( Wan Sik Lee ),( Chang Hwan Park ),( Young Il Koh ),( Young Eun Joo ),( Hyun Soo Kim ),( Sung Kyu Choi ),( Jong Sun Rew ) 대한소화기학회 2012 Gut and Liver Vol.6 No.2
Background/Aims: Gastroesophageal reflux (GER) has been implicated in the pathogenesis of chronic cough. The aims of this study were to evaluate the diagnostic usefulness of multichannel intraluminal impedance combined with pH monitoring (MII/pH monitoring) in patients with suspected symptoms of gastroesophageal reflux disease (GERD) and to assess the correlation between GER symptoms and refl ux nature. Methods: Seventy patients with suspected symptoms of GERD (such as heartburn, acid regurgitation, noncardiac chest pain, globus and chronic cough) were enrolled. All patients were asked to discontinue medications that would infl uence esophageal motor function and gastric acid secretion at least one week ago. All subjects underwent MII/pH monitoring. Results: Forty-five patients (64.3%) were diagnosed with GERD. Among these patients, eleven patients (15.7%) had pathologic acid refl ux by pH data and thirty-four patients (48.6%) had pathologic bolus exposure by impedance. Subjects with chronic cough had a higher De- Meester score (p=0.009), percentage of acid exposure time (p=0.007), acid bolus exposure % time (p=0.027), distal acid refl ux episodes (p=0.015) and proximal acid refl ux episodes (p=0.030) than subjects without chronic cough. Conclusions: The results of this study showed that the impedance monitoring enhanced diagnostic sensitivity than pH-monitoring alone by 48.6%. In addition, refl ux episodes at the distal and proximal esophagus were noted to be important factors associated with chronic cough. (Gut Liver 2012;6:197-202)