치료반응이 좋은 증례 현저하게 좋은 치료반응을 보인 진행성 간세포암(stage IVa)

정혜원 ( Hye Won Chung ),정재연 ( Jae Youn Cheong ),송건훈 ( Kun Hoon Song ),한광협 ( Kwang Hyub Han ),문영명 ( Young Myoung Moon ),김병로 ( Byoung Ro Kim ),성진실 ( Jin Sil Seong ),김명진 ( Myoung Jin Kim ),이도연 ( Do Yun Lee 대한간암학회 2001 대한간암학회지 Vol.1 No.-

급성 췌장염에서 CT 예후인자의 유용성

양희철(Hee Chul Yang),정재복(Jae Bock Chung),김명진(Myeong Jin Kim),송건훈(Kun Hoon Song),이종태(Jong Tae lee),유형식(Hyung Sik Yoo),정재준(Jae Joon Chung),강진경(Jin Kyung Kang) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.3

N/A Background/Aims: To evaluate the value of CT prognostic factors in acute pancreatitis. Methods: In 48 patients with acute pancreatitis, clinical course and CT findings were analyzed retrospectively. Clinical severitv was classified as severe and mild form, based on the definition of Atlanta symposiurn. CT grades were classified as A, B, C, D, E and pancreatic necrosis as 0, 30,o, 50% & more than 50%. CT severity index(CTSI) was acquired by the sum of the points of CT grade(0, 1, 2, 3, 4 for each grade) and pancreatic necrosis(0, 2, 4, 6 for each degree of necrosis). Results: Among 48 patients, thirteen patients(29%) showed severe clinical course and the remaining(717o) showed a mild course. Patients with CT grade D & E were 63% among all patients,and 40% of these patients had severe form. Among 13 with severe form, acute fluid collection was observed in 92% patients. The common sites of acute fluid collection were anterior pararenal space and lesser sac. Pancreatic necrosis was observed in 29% of patients and 85% of these patients had severe form. CT grades of patients with pancreatic necrosis were D or E. The average CTSI for all patients was 3.5 and there was significant difference(p<0.01) between mild(2.5) and severe form(6.2). The sensitivity and specificity for severe form, when CTSI was greater than 4, were 85% and 94%. Conclusions: CT prognostic factors, including CT grade, pancreatic necrosis and CTSI, were useful for predicting the clinical course of patients with acute pancreatitis. (Korean J Gastroenterol 1997;29: 362-369)

전이 증례 간좌엽절제술 및 부신절제술로 치료한 간세포암의 우측 부신 전이

윤영준 ( Young Joon Yoon ),전재윤 ( Chae Yoon Chon ),김철 ( Chul Kim ),송건훈 ( Kun Hoon Song ),정재연 ( Jae Yeon Jung ),한광협 ( Kwang Hyub Han ),문영명 ( Young Myung Moon ),이도연 ( Do Yun Lee ),이종태 ( Jong Tae Lee ) 대한간암학회 2001 대한간암학회지 Vol.1 No.-

담도침윤 증례 담관 침범을 동반한 간세포암

방승민 ( Seung Min Bang ),정혜원 ( Hye Won Chung ),정재연 ( Jae Youn Cheong ),이충렬 ( Chung Ryul Lee ),송건훈 ( Kun Hoon Song ),한광협 ( Kwang Hyub Han ),전재윤 ( Chae Yoon Cheon ),문영명 ( Young Myoung Moon ),박성일 ( Sung Il 대한간암학회 2001 대한간암학회지 Vol.1 No.-

폐와 위장의 전이성 석회화를 동반한 부갑상선 선종 1 예

송건훈,이지현,허갑범,이현철,임승길,송영득,남문석,차봉수,변영섭 대한내과학회 1996 대한내과학회지 Vol.51 No.3

Metastatic calcification of soft tissues due to hypercalcemia is a well-recognized complication of various malignancies and renal failure. It results from metabolic derangement in which calcium salts are deposited in otherwise normal tissuel. The calcific process principally affects lungs, stomach, kidneys and other soft tissues. With advance of nuclear imaging modalities, metastatic calcification can be detected earlier so that appropriate therapy may be instituted. A case of parathyroid adenoma with metastatic pulmonary and gastric calcification is presented. She showed intense concentrations of bone-seeking radionuclide( ^(99m)Technetium) in both lungs and stomach on routine bone scan. Renal function of the patient was moderately impaired, Right inferior parathyroidectomy was performed. Her serum calcium concentration decreased postoperatively and had to be maintained with orally administered calcium and aldactazide. After the operation the clinical course has been uneventful. Follow-up bone scan performed lo days following the operation revealed persistence of lung uptake despite restoration of normal blood calcium concentration, but disappearance of gastric uptake. So we report the case of parathyroid adenoma complicating metastatic pulmonary and gastric calcification with review of literature.

발병연령에 따른 두개인두종의 합병증 및 예후

송건훈,이지현,허갑범,이현철,임승길,이은직,김경래,송영득,남문석,차봉수 대한내분비학회 1995 Endocrinology and metabolism Vol.10 No.3

Craniopharyngioma is the most common tumor involving the hypothalamo-pituitary area in childhood and adolescence. Recently, we carried out collective review of 70 patients with craniopharyngioma treated from January 1980 to December 1994 in order to inverstigate the endocrine outcome and survival according to the age of onset. The following results were obtained: 1) The male to female ratio was 1:1. Age at diagnosis ranged from 2 to 64 years(mean age: 23) with the greatest frequency in the 2nd decade of life(28.6%). Of the 70 cases, the first group, 27 cases were under the age of 15, and the other group, 43 cases were over 15 year-old. 2) The most common symptom at diagnosis in both groups was headache. In the adult group, symptoms related to hypogonadism(amenorrhea, decreased libido, galactorrhea etc.) were not uncommon. The lag of time between onset of symptom and hospital visit ranged from 3 days to 156 months(mean: 20 months). 3) The main site of tumor was suprasellar region in both groups. The most common CT finding in both groups was calcification in sella turcica. 4) In pre-operative combined pituitary function test, the most common, abnormal responses were shown in growth hormone and thyroid stimulating hormone in both groups. In addition, prolactin frequently showed abnormal response in the adult group.In post-operative combined pituitary function test, more hormones tended to reveal abnormal response in the group treated with surgery plus radiation therapy. 5) The operation by subtotal removal followed by radiation therapy was the most commonly used method in treatment of both groups. After treatment, panhypopituitarism was occurred more frequently in the group treated with RT after surgery than those treated with surgery alone, but the difference was not statistically significant(p=0.136 in childhood, 0.436 in adults). Except the cases with panhypopituitarism, the most commonly encountered endocrine abnormalities were growth retardation in the children group, and hypogonadism in adult. The recurrence was clinically observed in 11 cases. The recurrence rate were 11.1% in children, and 18.6% in adult respectively. The mean time from the initial treatment to recurrence was 23 months. There was no significant difference in recurrence rate between the group treated with RT after subtotal removal and the group treated with total removal(p=0.475). The overall five-year survival rate after treatment was 82.8%. According to the treatment modalities, the patients undergone RT after subtotal removal survived much longer than those treated with other modalities such as subtotal removal only or total removal, but the differences in survival were not statistically significant(Log rank test, p=0.0539)(J Kor Soc Endocrinol 10: 262-272, 1995).

TNM Stage IVa의 진행성 간암에서 간동맥내 항암제 주입약제에 따른 치료성적과 예후인자

안상훈,한광협,윤영훈,김명환,송건훈,이관식,전재윤,문영명,이도연,이종태 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.4

Background/Aims: The study proposed to evaluate the efficacy of anticancer drugs of intraarterial chemoinfusion and investigate prognostic factors influencing survival. Methods: A total of 127 patients diagnosed as having advanced hepatocellular carcinoma(HCC) of same stage (TNM stage IVa) from 1996 to 1998 were examined. Two intraarterial infusion chemotherapeutic regimens were employed: Adriamycin(Group I) and Cisplatin(Group II). Results: Overall survival was significantly diffrent(10.0 vs 5.7months) and favored Group I. By the univariate analysis, significant prognostic factors included: age, portal vein thrombosis(PVT), size($gt;5cm) and type of tumor, response rate (size & -fetoprotein) at 3 months after therapy, level of albumin, alkaline phosphatase, and total bilirubin. After repeated therapy, Group I showed better survival (14.0 vs 7.9 months), but there was no statistical difference in survival rate between two groups in the case of large size, PVT, and diffuse type. Conclusion: Group I showed better survival than Group II in advanced HCC of TNM stage IVa. But, considering prognostic factors, there was no significant difference in survival rate between two groups except small size or nodular type of HCC. TNM classification of stage IVa should be reconsidered to include prognostic factors influencing survival rate such as PVT, size and type of HCC.(Korean J hepatol 2000;6;456-467)

혈전용해치료와 혈관 내 스텐트삽입술로 치료한 상장간막동맥 혈전폐쇄 1예

김경식,김명환,송건훈,전재윤,한광협,문영명,이도연,조덕규 대한소화기학회 2001 대한소화기학회지 Vol.37 No.2

Superior mesenteric artery thrombosis usually occurs in an area of severe atherosclerotic narrowing, most often at the origin of the superior mesenteric artery. On angiography, the absence of collateral vessels or the presence of collaterals with inadequate filling of the superior mesenteric artery indicates an acute occlusion and demands prompt intervention. A 44-year-old man presented with epigastric and right upper quadrant pain after eating. Computed tomography and angiography showed superior mesenteric artery thrombosis. After treating with intra-arterial infusion of urokinase and intraluminal stent insertion, the patient showed clinical improvement and near complete resolution of superior mesenteric artery thrombosis. Thus, direct infusion of urokinase into the superior mesenteric artery and angioplasty with stenting for treatment of superior mesenteric artery thrombosis can be the alternative to surgery in selected patients with superior mesenteric artery thrombosis.

간경변 환자의 영양상태에 있어서 경구용 분지형 아미노산제제의 효과에 대한 전향적 연구

이종호,안수현,송건훈,전재윤,한광협,문영명,이관식,김명수 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.4

Background / Aims : A prospective comparative study was conducted to investigate the efficacy of orally administered branched-chain amino acids(BCAA) in cirrhotic patients. Methods : Forty-seven patients with liver cirrhosis of viral etiologies, whose hypoalbunemia could not be corrected with adequate protein intake, were randomly assigned to either the BCAA group(n=31) or the control group(n=16). The selection criteria were ages between 16 and 70 years, patients whose Child-Pugh scores were less than 13 points and who were willing to participate in the study. Most patients(87.1%) belonged to Child -Pugh class B. Patients in the BCAA group received oral supplementation with branced-chain amino acid granules(12g/day, each packet containing total 4g of BCAA , i.e.leucine, 1904 mg ; valine, 1144mg; isoleucine, 952mg) for 12 weeks. Patients had complete blood counts and chemistry at entry and once every month. Serum ferritin and amino acid concentrations in plasma were determined. Anthropometric parameters including body weight, body fat contents and body mass index were assessed at the beginning and at the end of the 3-month period. Results : In the BCAA group, there was a significant increment in plasma levels of isoleucine, valine(p<0.001) whereas levels of aromatic amino acids did not show substantial change. Total BCAA concentration and BCAA/AAA(aromatic amino acid) molar ratio(Fischer's ratio) also increased significantly after administration of oral BCAA (p<0.02). In contrast, patients in the control group showed no significant change in assessed parameters. Conclusion : Oral supplementation of BCAA to or other serious adverse effects.

급성 췌장염에서 내시경적 역행성 담췌관 조영술의 임상적 의의

강진경,박인서,송건훈,정재복,송시영,한기준 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.3

The safety of endoscopic retrograde cholangiopancreatography(ERCP) in patients with acute pancreatitis(AP) was confirmed in the past decade. Especially in ease of acute gallstone panereatitis, early ERCP/EST(endoscopic sphincterotomy) may reduce the incidence of complications by removing gallstone which causes acute attack of pancreatitis. To assess clinical usefulness of ERCP/EST in the setting of AP, we reviewed clinical records of 58 patients with AP who had undergone ERCP /EST during the same period of admission. 1) There were thirty-four men and twenty-four women with a mean age of 51.4 (range 14-82). According to the Atlanta classification, forty-two patients were determined to have 'mild' pancreatitis, while the remaining sixteen were determined to have `severe' pancreatitis. 2) The most common indication which urged to perform ERCP was common bile duct(CBD) stones suspected by other imaging reodalities(23 cases). The next common was dilatation of CBD detected on ultrasonography in nine cases. 3) Seven patients received ERCP within 24 hours and seventeen underwent ERCP between the period of 24-72 hours after admission. Therefore 24 patients(41.4%) underuvent ERCP within 72 hours after admission. 4) The rate of visualization of either bile duct(BD) or pancreatic duct(PD) was 93.1 %. There was no significant complication attributable to the procedure itself. 5) In 8 patients(21.1%), pancreatogram revealed chronic pancreatitis. This finding was more commonly encountered in patients who were determined to have 'severe' pancreatitis. Eighteen patients(39.1%) had stones of common bile duct and this was the most common cholangiographic finding. But the incidence of CBD stone was not different between `mild' and 'severe' pancretitis groups. 6) Among various predictors of gallstone panreatitis such as elevated total blirubin, alcalin pbosphatase, gamma-glutamyl transpeptidase and suspected stones on sonography the stones found orb sonography was proceed to be the most sgnificant factor in prediction of gallstaMe pancreatitis(p=0.032). 7) EST was successfully performed in 13 patents without significant procedurerelated complication. 8) In patients who were treated for acute gallstone pancreatitis, there was no significant difference in various clinical paramlters including severity, in-hospital stay, incidence of complication and laboratory indings between the surgery group and the EST group. 9) ERCP was useful in 35 patients(60.3%) by providing diagnostic information or therapeutic modalities. The confirmation and endoscopic removal of CBD stones represented the most part of advantages. In conclusion, we have found ERCP/EST to be a safe and useful modality in both diagnostic and therapeutic aspects for patients with AP. Especially in patients with gallstone pancreatitis, ERCPIEST lave evolved into an important role by early identification and safe removal of gallstone.