원발성 간암환자에서 절제술후 간내재발에 미치는 요인분석

박형석(Hyung Seok Park),송시영(Si Young Song),한광협(Kwang Hyup Han),전재윤(Chae Youn Chon),문영명(Young Myong Moon),강진경(Jin Kyung Kang),박인서(In Seo Park),민진식(Jin Sik Min) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.1

N/A Background/Aims: The prognosis of hepatocellular carcinoma is very grave. The most effective method of improving survival in patients with hepatocellular carcinoma is early diagno. ' and curative hepatic resection. Recently, diagnosis of HCC at early stage has been greatly enhanced by the advent of screening techniques. However long-term survival after curative resection remains low because of high recurrence rate. To identify factors affecting intrahepatic recurrence and to analyze patterns of intrahepatic recurrence, we evaluated 72 patients who underwent curative hepatic resection. Methods: Total 72 patients were evaluated and 33 recurred cases were divided into the three patterns according to the recurrence pattern. Pattern I;recurrence near the resected margin, and pattern II;nodular recurrence, and pattern III;widespread multinodular recurrence. Results: We found 33 cases of intrahepatic recurrence. The serum AFP level of recurred group was significantly higher than that of non-recurred group, and tumor size was larger in recurred group. No difference was noted in age, sex, serum albumin, bilirubin and HBsAg between two groups. The recurrence time of pattern I was earlier than other patterns, and cirrhosis combining rate was higher in pattern 11. The portal vein and bile duct invasion rate was higher in pattern I and III than pattern Il. The survival rate of recurred group was lower than that of non-recurred group, and survival of pattern I was lower than other groups. Conclusions: It is suggested that careful follow-up is needed when tumor size is larger than 10 cm, portal vein and bile duct is infiltrated by tumor cel), and AFP is higher than 400 ng/ml. (Korean J Gastroenterol 1995;27:72-82)

초음파진단을 (超音波診斷) 이용한 한국인 정상췌장 (正常膵臟) 크기에 관한 연구

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),문영명(Young Myong Moon),이상인(Sang In Lee) 대한소화기학회 1981 대한소화기학회지 Vol.13 No.2

N/A It is difficult to examine the pancreas by routine roentgenographic methods, radioisotopic scanning and angiography. The ultrasonography has proved to be an useful tool in the evaluation of pancreatic diseases. Determination of the normal size and contour of the pancreas is important. We performed ultrasonography in 89 subjects with normal pancreas and the results were reviewed. 1 Successful ultrasonograms of normal pancreas were obtained in 84 among 89 subjects examined, being 94.4po of success rate The shapes of pancreas were dumhhell shape in 47 of 84 cases(55. 9%), sausage shape in (29.8%) tadpole shape in 11(13. 1%), and reversed tadpole shape in 1 case. 3.The pancreatic head was 1.8+-0.38cm in the mean thickness(range: l. 0-2. 9cm), the neck l. 1+- 0. 41 cm (range: 0. 4-2. 0 cm), and the body 1. 8+-0. 37 cm (range: l. 0-2. 6 cm).

간경변증에 있어서 초음파검사상 문맥의 크기와 간정맥 계압의 상관관계에 관한 연구

최흥재(Heung Jai Choi),박인서(In Suh Park),문영명(Young Myong Moon),전재윤(Chae Yoon Chon),김두식(Doo Sik Kim),정재복(Jae Bok Chung) 대한소화기학회 1985 대한소화기학회지 Vol.17 No.1

N/A Diagnosis of portal hypertension can be made clinically by observing the esophageal varices, splenomegaly and/or ascites, but it is impossible in case without such clinical finding. For the measurement of portal pressure, wedged hepatic venous pressure, splenic pulp pressure, umblical vein pressure, mesentic vein pressure and direct punture of portal vein at laparotomy have been used, but these methods have not been frequently applied because their procedures are complicated and risky. After introduction of ultrasound in the field of clinical medicine, the portal vein size is easily visualized and the diagnosis of portal hypertension has been made by observing the portal venous system without difficulty. But the normal size of portal and splenic veins which are very important diagnostic criteria in ultrasound examination are not clearly defined and the diagnostic rate by the size of portal and splenic veins are reported by several authors with variable results. In this study we measured the diameter of splenic and portal vein with realtime ultrasonography in inspiratory and expiratory phase and checked the wedged hepatic venous pressure in 29 patients with liver cirrhosis and 14 persons without liver diease for control to see the normal range of diameter of vessels and the relationship between portal pressure and size of vessels. The results are as follows: l) The means of the diameter of splenic and portal veins of 14 control persons in inspira- tory phase were 0.49+-0.166cm and 0.79+-0.209cm and in expiratory phase 0.37% +-0.127cm and 0.67+-0.181cm respectively. The mean wedged hepatic venous pressure in control was 2. 1<1. 013 mmHg. 2) The means of the diameter of splenic and portal vein of 29 patients with liver cirrhosis in inspiration were 1.04+-0.233 cm and 1.30+-0.220 cm and expiration 0.96+-0.281 and 1.21+-0.231cm respectively. The mean wedged hepatic venous pressure in patients group was 14.0+-8.19 mmHg. 3) The upper criteria of normal diameter(mean+2SD) of splenic vein were 0.8cm in inspiration and 0.6 cm in expiration and of portal vein l. 2 cm in inspiration and 1. 0 cm in expiration. The splenic vein was within normal criteria in 13 out of 14 normaI persons in inspiration and expiration. The portal vein was in normal criteria in all in inspiration and in 13 in expiration. 4) In liver cirrhosis the wedged hepatic venous pressure was high (over 5 mmHg) in 24 cases and within normal limits in 5 cases. The size of splenic vein was larger than normal criteria in 2 cases from 5 with normal wedged hepatic venous pressure in inspiration and expiration and in 19 cases from 24 with high wedged hepatic venous pressure in inspiration and 22 cases in expiration. The size of portal vein was larger than normal criteria in 2 cases from 5 with normal wedged hepatic venous pressure in inspiration and 4 in expiration, and 17 cases from 24 with high wedged hepatic venous pressure in inspiration, and 21 cases in expiration, 5) The diagnostic efficacy of size of vessels on ultrasonography for portal hypertension was as follows. The sensitivity of splenic vein was 79.2% In inspihatory phase and 91.7% in expiratory phase and that of portal vein was 70.8% in inspiratory phase and 89.5 in expitatory phase. The specificity of splenic vein was 84.2% in inspiratory and expiratory phase and that of portal vein was 89.5% in inspiratory phase and 73.7% in expiratory phase. The positive predictability of splenic vein was 86.4% in inspiratory phase and 88.0% in expiratory phase and that of portal vein was 89.5% in inspiratory phase and 80.8% in expiratory phase. The negative predictability of splenic vein was 76.2% in inspiratory phase and 88.9% in expiratory phase and that of portal vein was 70.5% in inspiratory phase and 83.4% in expiratory phase. 6) The correlation coefficiencies between wedged hepatic venous pressure and the diameter of splenic and portal vein in control and diseased group were under 0.5, but in total the correlation coeffi

간세포암의 십이지장침윤에 의한 상부위장관 출혈 1 예

유태현,한광협,박성하,김형길,문영명,한재호,조상호 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.2

Recent advances in both the diagnosis and treatment of hepatocellular carcinoma have improved the prognosis and changed the clinical significance of the recently increasing distant metastases. Distant metastases found after successful treament of the primary lesions are of great clinical significance for the treatment of hepatocellular carcinoma. The duodenum is a rare site of hematogenous metastases or direct invasion from hepatocellular carcinoma. A 23 year old man was admitted with upper gastrointestinal bleeding. He had been diagnosed with hepatocellular carcinoma and treated by a left lobectomy and chemoembolization. The patient was admittted for 12 months after the treatment of the primary tumor. Endoscopic examination revealed a mass in the duodenal bulb that protruded into the lumen. He died due to massive hematemesis. We report on a rare case of hepatocellular carcinoma with duodenal invasion in a 23-year-old male patient.

Tsutsugamushi병 6예

박영숙,김준명,홍천수,문영명,정윤섭,최경훈,이경원,김응 대한감염학회 1987 감염 Vol.19 No.3

We experienced six cases of Tsutsugamushi disease during October-November, 1986 which were confirmed by Indirect Immunoperoxidase Antibody test and their clinical findings. In 4 Cases, They also showed positive antibody reaction to either Hantaan virus (K-Ag) or Leptospira interrogans or both. In our cases, 4 cases were recovered but 2 cases died of acute respiratory distress syndrome. We think that more concern on tsutsugamushi disease were necessary because of possible mortality in poor treated cases as well as Differential diagnosis of Acute febrile illness.

내시경적역행성췌관조영술(內視鏡的逆行性膵管造影術)로 확진(確診)된 췌장루(膵臟瘻)1예

강진경,최흥재,문영명 대한소화기학회 1979 대한소화기학회지 Vol.11 No.2

The traumatic pancreatic fistula was the one of the diseases to be hardly confirmed without operation. It had been usually suspected if the ascites contained the high level of amylase after abdominal trauma. After ERCP was developed and used in the diagnosis of the pancreatic diseases effectively it became possible to confirm the pacreatic fistula before operation. We have recently had the opportunity to experience one case of pancreatic fistula after trauma confirmed with ERCP. This 26 year old housewife was admitted due to severe upper abdominal pain for 4 hours, She allegedly fell 14 hours before admission, hitting her upper abdomen on a rock. On admission her abdomen was tender, especially in both upper quadrants with rebound tenderness. CBC showed leukocytosis with shift to left. Diagnostic abdominal tap was performed and gross blood was drawn. With the impression of splenic rupture exploratory laparotomy was done. At operation the spleen appeared to be normal and a pancreatic contusion over the mid-portion was noted with hematoma in the transverse mesocolon. Drainage procedure were done. On the first day after operation a severe abdominal pain was developed with running fever. The serum amylase was 705 units/L. Paracenthesis was done and 500cc. Of clear fluid was aspirated on the next day. Total protein of ascites was 2.7gm% and amylase 1980 units. After two days the pain was subsided and ascites was drained well through the rubber drain inserted at previous operation. The patients condition had been in improving state untill the post op. 14th day when a sudden abdominal pain was developed again with increased serum amylase(568 U./L). Upper G-I study done at that time revealed a extragastric mass effect on the posterior wall of the stomach suggestive of pancreatic enlargement. Abdominal ultrasonography showed some questionable mass shadow at the site of right from midline and about 4cm above the umbilicus. The rubber drain was not functioning and an exploration with a Kelley clamp and drain was changed to rubber tube. After that the asc- ites was drained well and patient became comfortable. The amylase in ascites drained through t!ibe was 15000 units. On the 22th day after operation ERCP was done using JF type B2 with 60% Hypaque as contrast media. The main pancreatic duct was visualized well from head to body. But the main pancreatic duct was abruptly cut off and a fistulous tract was seen which suggested the pancreatic internal fistula. The patient was treated with conservative methods for two weeks with some improvement. On the 39th day after operation the second operation for partial pancreatectomy was done because of recurrent pancreatitis.

간의 공간점유성 병변에 대한 초음파검사하 세침흡인세포진

이상인,김영수,강진경,박인서,전재윤,정재복,최흥재,문영명 대한내과학회 1986 대한내과학회지 Vol.30 No.6

Fine needle aspiration cytology with ultrasound guidance is widely used in the evaluation of space occupying lesions of the liver even in deep seated, small lesions because of its relative safety, simplicity, and high diagnostic accuracy. Fine needle aspiration cytology with ultrasound guidance was performed to evaluate its diagnostic value in 41 patients with space occupying lesions of the liver at Department of Internal Medicine, Severance Hospital, Yonsei University from May 1985 to September 1985. The results were as follows: 1) The final diagnoses of 41 patients were primary hepatoma in 31 patients, metastatic cancer of liver in 3 patients, and liver abacess in 7 patients. 2) The results of fine needle aspiration cytology were as follows; Of the 31 patients with primary hepatoma, fine needle aspiration cytology was positive in 27 patients(87.1%) and negative in 4 patients(12.9%). Of the 27 cytology positive patients, hepatocellula carinoma was confirmed in 20 patients and malignant cells in 7 patients. Of the 3 patients with metastatic cancer of liver. adenocarcinoma was confirmed in 2 patients. Of the 7 patients with liver abscess, fine needle aspiration cytology was negative and pus was aspirated in all patients. 3) Of the 21 patients with primary hepatoma, the ultrasound diagnosis was primary hepatoma in 8 patients, metastatic cancer of liver in 2 patients and liver abscess in one patient. Of the 3 patients with metastatic cancer of liver, the ultrasound diagnosis was metastatic cancer of liver in one patient, and primary hepatoma in 2 patients. Of the 7 patients with liver abscess, the ultrasound diagnosis was liver abscess in 6 patients, and primary hepatoma in one patient. 4) There was a tendency that the larger the lesion, the higher the diagnostic value although there was no significant correlation between the size of the lesion and the result of fine needle aspiration cytology, 5) There were no serious complications of fine needle aspiration except mild fever in one of the 41 patients(2.4%). In conclusion, fine needle aspiration cytology is a safe and useful diagnostic method in the evaluation of space occupying lesion of the liver.

만성 B 형 간염환자에서 HBV DNA-polymerase 의 활성도 및 Ara-AMP 의 효과

김경희,오상환,박효진,강진경,전재윤,김용범,최흥재,문영명 대한내과학회 1986 대한내과학회지 Vol.31 No.5

Since the presence of DNA-polymerase has been reported by Hirschman et al, In concentrated preparations containing Au antigen, the activity of DNA-polymerase has been used as the index of degree of the viral replication and as the ost sensitive marker for the effects of antiviral therapy. The activity of DNA-polymerase was measured through radiological assay in 80 patients with HBsAg positive chroriic HBV infection(57 patients with chronicactive hepatitis, 12 with chronic persistent hepatitis and 11 with liver cirrhosis) and serially checked for aboutone year in 37 patients with HAsAg positive chronic active hepatitis, whoreceived 4 weeks Ara-AMP therapy. The following results were obtained; 1) The mean DNA-polymerase activity of the HBeAg positive chronic hepatitis patients was significantly higher than that of the HBeAg negative patients(p$lt;0. 05), but differences of the SGOT and SGPT levels between the both groups were not significant(p$gt;0.05). 2) The differences of mean DNA-polymerase activity among the chronic active hepatitis, chronic persistent hepatitis and liver cirrhosis were not significant(p$gt;0.05). 3) During the 4 weeks of Ara-AMP therapy, the mean levels of DNA-polymeraee activity, SGOT fell dramatically. 10 of 16 patients who could follow up for over 24 weeks maintained DNA-polymerase activity normal. However, remaining g relapsed. From 1 to g months after therapy, 7 of 16 patients became HBeAg negative, while only one of 6 controls became HBeAg negative, 4) Side effects of Ara-AMP such as anorexia (21.6%), nausea(16.2%), general weakness(16.2%), paresthesia(2.7%), granulocytopenia(2.7%), and thrombocytopenia(2.7%) were observed. In conclusion, the measurement of DNA-polymerase activity will be helpful in evaluation of infectivity of chronic viral hepatitis and effect of antiviral therapy. More work is needed to determine whether the use of Ara-AMP in more pro- longed or repeated courses or both, and application earlier in the course of the illness might be more effect in the eradication of virus and in stopping progression of chronic liver disease. Alternatively, Ara-AMP may be more effective when combined with antiviral agents, and controlled studies to evaluate various combination regimens are required.

복수내 Carcinoembryonic Antigen(CEA)의 진단적 가치

이상인,박인서,전재윤,정재복,조철호,최흥재,임대순,문영명 대한내과학회 1986 대한내과학회지 Vol.31 No.5

Ascites may be caused by various benign and malignant diseases but it is sometimes difficult to determine whether the ascites is caused by benign diseases or malignant diseases. Various diagnostic methods such as ascites level and ascites/serum ratio of protein and LDH, cytology and peritoneoscopy have been used in differentiating between benign and malignant ascites. Carcinoembryonic antigen(CEA) level in pleural effusion is known to be useful to make the diagnosis of the malignant diseases in thoracic cavity. Loewenstein et al(1978j reported that CEA level in ascites was manyfold higher than in serum in patients with malignant diseases and ascites. In order to determine whether ascites CEA is of help to make the diagnosis of malignant diseases in abdominal cavity and their peritoneal metastasis, both ascites CEA and serum CEA were measured and analyzed in 75 patients with ascites who were admitted to Yonsei University Severance Hospital from March 1985 to October 1985. The results were as follows: 1) The mean value of CEA level in ascites and serum in benign ascites group was 2.46 ng/ml, and 3.83 ng/ml respectively. The upper limit(mean+2 S.D,) of ascites and serum CEA in benign ascites group was 8.72 ng/ml, and 9.95 ng/ml respectively. 2) Ascites CEA level was higher than 8.72ng/ml in 6 of g patients with malignant ascites(66.7%), 14 of 36 patients with malignant diseases (38.9%), and one of 30 patients with benign ascites(3.3%). In 16 patients ascites CEA level was higher than 50 ng/ml(6 patients with malignant ascites, and 10 patients with malignant diseases). All of them had malignant diseases in abdominal cavity. 3) Serum CEA level was higher than 9.95 ng/ ml in 5 of 9 patients with malignant ascites(55.5%), 12 of 36 patients with malignant diseases (33.3%), and 2 of 30 patients with benign ascites (6. 7o). In 8 patients serum CEA level was higher than 50 ng/ml(3 patients with malignant ascites and 5 patientes with malignant diseases). All of them had malignant diseases in abdominal cavity. 4) In 5 patients ascites CEA level v as higher than 8.72ng/ml but serum CEA level was lower than 9.95ng/ml. Four had malignant diseases in abdominal cavity(one patient with malignant ascites and 3 patients with malignant diseases). 5) The specificity of ascites CEA(8.72 ng/ml) for malignant diseases in abdominal cavity was 96.7%, the positive predictability 95.2%, the sensitivity 44.4%, and the negative predictability 53.7%. 6) The specificity of serum CEA(9.95ng/ml) for malignant diseases in abdominal cavity was 93.3%, the positive predictability 89.5%, the sensitivity 37.8%, and the negative predictability 50.0%, which were slightly lower than those of ascites CEA. In summary, the measurement of ascites CEA level is useful in determining the existence of malignant diseases in abdominal cavity and higher than that of serum CEA in the diagnostic accuracy. Also it is useful in predicting the peritoneal metastasis in cases with ascites CEA level higher than 50 ng/ml.