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문형환 고신대학교(의대) 고신대학교 의과대학 학술지 2022 고신대학교 의과대학 학술지 Vol.37 No.2
High pre-transplant isoagglutinin is a risk factor for antibody-mediated rejection in ABO-incompatible living donor liver transplantation. A 55-year-old man with alcoholic liver cirrhosis underwent ABO-incompatible living donor liver transplantation. The initial isoagglutinin immunoglobulin G titer was 1:1,024. Despite five sessions of plasmapheresis, the isoagglutinin titer was not significantly reduced (from 1:1,024 to 1:512). We decided to perform 11 plasmaphereses and proceed with liver transplantation regardless of the isoagglutinin titer (1:128 at transplantation day). Instead, we planned to administer 0.5 g/kg intravenous immunoglobulin and booster rituximab (200 mg) after transplant. On postoperative day 6, the isoagglutinin titer increased from 1:32 to 1:64, and the patient received plasmapheresis twice. The patient maintained stable liver function without evidence of further complications or rejection. The high-dose intravenous immunoglobulin, salvage plasmapheresis, and booster rituximab protocol might be able to overcome a pre-transplant high isoagglutinin titer in ABO-incompatible living donor liver transplantation without splenectomy.
문형환 고신대학교(의대) 고신대학교 의과대학 학술지 2021 고신대학교 의과대학 학술지 Vol.36 No.2
Refractory ascites is a rare complication after liver transplantation, and its incidence ranges from 5% to 7%. A 56-yearold man diagnosed with HBV-LC with massive ascites underwent living donor liver transplantation. After transplantation, more than 1000 ml/day of ascites was steadily drained until two weeks after LT. CT showed intrahepatic Rt. portal vein thrombosis and many remnant collaterals with splenomegaly. We decided to embolize the proximal splenic artery and use apixaban to reduce portal flow and resolve the intrahepatic portal thrombosis. One day after splenic artery embolization, the patient's ascites dramatically decreased. Three days later, he was discharged from the hospital. Three months later, a follow-up liver CT showed resolution of thrombosis and no ascites. Splenic artery embolization was an effective and safe procedure for portal flow modulation in portal hyertension. Apixaban was effective for partial portal vein thrombosis in a liver transplant recipient.
담낭암 절제 수술 후 종양 침범 깊이와 임파선 전이에 따른 생존율 분석
문형환(Hyung Hwan Moon),윤명희(Myunghee Yoon) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.2
Purpose: Carcinoma of the gallbladder is an aggressive, late-symptomatic disease and most patients are treated at an advanced stage, and these patients have a poor prognosis. During recent years, extended operations that combine a resection of the liver with wide lymph node dissection have improved the long-term survival. The aim of this study is to evaluate the surgical outcome for gallbladder carcinoma based on the presence of lymph node metastasis and the depth of the primary tumor invasion. Methods: A retrospective analysis was done on 68 patients who underwent a surgical resection of gallbladder carcinoma from 1997 to 2004. The factors that influenced the 5-year survival were examined. Results: The overall 5-year survival rate was 49.6%. The lymph node metastasis rate was 40.0% in T2 disease and 61.1% in T3/T4 disease. The 5-year survival rate (5-YSR) for T2 disease was 52.1% for the patients who underwent cholecystectomy with lymph node dissection and hepatic resection, and it was 51.2% for the patients who underwent only simple cholecystectomy. The 5-YSR for T3/T4 disease was 33.3% for the patients who underwent extended cholecystectomy, and it was 12.9% for the palliative cholecystectomy patients. Conclusion: The role of radical surgery seems to be limited for patients with more extensive tumor invasion or lymph node metastasis.
문형환(Hyung Hwan Moon),양송이(Song I Yang),윤기영(Ki Young Yoon),장희경(Hui Kyoung Jang),서경원(Kyoung Won Seo),이상호(Sang Ho Lee),최경현(Kyoung Hyun Choi) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.5
Mesenteric fibromatosis is a rare benign fibrous tumor that can occur from bowel mesentery of the retroperitoneum. It can infiltrate the surrounding structures and tends to recur locally even after resection but does not have metastatic capability. Mesenteric fibromatosis represents 8% of all intra-abdominal desmoid neoplasm. We experienced a case of mesenteric fibromatosis in a 50-year-old woman with a painless abdominal mass. An exploratory laparotomy was performed, and two large, small bowel mesenteric masses were found which were invading the transverse colon. The segment of the jejunum and transverse colon including the masses were resected widely and the pathologic report confirmed the diagnosis of fibromatosis. We reviewed the features of the mesenteric fibromatosis, that is, clinical, imaging, pathological, immunohistological features, and differential diagnosis and treatment of mesenteric fibromatosis.
비만을 동반한 위암 환자에서 두 병을 같이 수술 치료한 경험(증례)
최경현,윤기영,문형환,신연명,서경원,안수미,송윤미,석정희,정경연,이은하 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3
Obesity is growing problem in Korea. We had a case of bariatric surgery during gastric cancer operation. Patient was 29 year old Korean lady with early gastric cancer located in the lesser curvature side of the middle 1/3 of the stomach. Her body weight was 89 kg, height 163 cm, and thus body mass index was 33.5 kg/m2. Preoperative blood pressure was 130/90 mmHg, hemoglobin 12.9 g/dL, total lymphocyte count 3,280/mL, serum albumin 4.3 g/dL, CEA 1.1 ng/mL, CA 19-9 9.1 ng/mL, and alpha fetoprotein 2 ng/mL. Another associated disease was right thyroid follicular neoplasm. The chest X-ray was normal. After IM injection of 2,500 units of heparin 30 minutes before the induction of general anesthesia, she received curative subtotal gastrectomy and Roux en Y gastrojejunostomy when a malabsorption loop of 120 cm jejunum was incorporated between the Treitz ligament and the end to side jejuno-jejunostmy site at May 29th 2006. Her postoperative course was uneventful except a minor wound seroma and the elevations of serum amylase(up to 4 folds) and lipase(up to 2 folds). She lost her body weight 9 kg in 5th, 21 kg in 7th, and 27 kg in 10th postoperative months to became 61.5 kg. On follow up exams in July 2008, she gained 4 kg to overcome her weakness and fatigue. From the above result, the incorporation of a malabsorption loop during reconstruction phase of gastric cancer operation was a good option for obese gastric cancer patients especially in cases of early gastric cancer.