Sofosbuvir–velpatasvir and sofosbuvir–velpatasvir–voxilaprevir: novel treatment options for naïve and previously treated hepatitis C infection

신현필 대한내과학회 2023 The Korean Journal of Internal Medicine Vol.38 No.4

A case of leukemoid reaction in a patient with sarcomatous hepatocellular carcinoma

신현필,전정원,박재준,차재명,주광로,이정일,강소영,김교영 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.3

A leukemoid reaction is defined as reactive leukocytosis exceeding 50,000/mm^3, with a significant increase in early neutrophil precursors, and can be a paraneoplastic manifestation of various malignant tumors. A 71-year-old male patient complained of decreased appetite, fatigue, and abdominal fullness. He had a palpable, firm liver, and laboratory investigations suggested leukemoid reaction. Liver dynamic computed tomography revealed a hypervascular mass, and an ultrasound-guided fine-needle aspiration of the mass confirmed hepatocellular carcinoma (HCC) with a sarcomatoid component. The leukocyte count of the patient had increased to 147,800/mm^3, and he died 10 days after admission. This is a rare case of leukemoid reaction in a patient with sarcomatous HCC.

Endoscopic resection of early gastric cancer

신현필,박수비,서혜란,전정원 한국운동재활학회 2023 JER Vol.19 No.5

Endoscopic resection (ER) is an effective treatment for early gastric cancer (EGC) without metastases. Existing endoscopic mucosal resection (EMR) is easy to perform, has few complications, and can be applied when the lesion size is small. However, en bloc and complete resection rates vary depending on the size and severity of the lesion. EMR using the cap-mounted panendoscopic method and EMR after circumferential preamputation of the lesion are useful in the treatment of EGC. However, completely oversized lesions (≥ 2 cm) and lesions associated with ulcers or submucosal fibrosis are more likely to fail resection. Endoscopic submucosal dissection has been widely used to resect tumors larger than 2 cm in diameter and has a higher acceptable complication rate and en bloc and complete resection rates than EMR. ER for EGC is superior to surgical resection in terms of improving patient quality of life. Additionally, compared to surgery, emergency rooms have a lower rate of treatment-related complications, shorter hospital stays, and lower costs. Accordingly, the indications for ER are expanding in the field of therapeutic endoscopy. Long-term outcomes regarding recurrence are excellent in both absolute and extended criteria for ER in EGC. Close surveillance should be performed after ER to detect early metachronous gastric cancer and precancerous lesions that can be treated with ER. Follow-up gastroscopy and abdominopelvic computed tomography scans every 6 to 12 months are recommended for patients who undergo curative ER for EGC on absolute or extended criteria.

내시경적 클립술로 치료한 직장천공 1예

신현필,동석호,김장하,한요셉,이병욱,정용희,김효종,김병호,장영운,이정일,장린 대한소화기내시경학회 2003 Clinical Endoscopy Vol.26 No.4

대장 내시경검사는 출혈, 천공 등의 합병증이 드물게 발생하고 천공이 발생하면 응급 상황으로 제한된 경우 외에는 수술적 절제술과 문합술을 시행한다. 그러나 대장 천공이 발생한 환자 중 일부는 비수술적인 치료를 시도하는데 이 중 클립을 이용한 내시경적 치료는 1997년 국외문헌에서 처음 보고되었다. 저자 등은 대장 내시경검사 중 직장천공에 의해 장내 물질이 유출되어 응급 수술을 시행해야 했던 환자에서, 기저질환으로 전신 마취 및 수술을 시행할 수 없어 내시경적 클립술을 이용한 비수술적 치료만으로 치유한 1예를 경험하였기에 문헌고찰과 더불어 보고한다. Although colonoscopy is commonly performed, it is an invasive procedure that might produce complications such as hemorrhage and perforation. Colonic perforation is an abdominal emergency with high mortality requiring surgical intervention. Sometimes non-surgical teatment can be applied when perforation is small sized, located in the retoperitoneal spaces or surgical approach is impossible. We are reporting a case of colon perforation in 64-year-old female patient. The patient visited our hospital with symptoms of dizziness and dyspnea. She was anemic and we planned to find the possible cause of anemia. Rectal perforation was developed during the diagnostic colonoscopy. However the operation was not applicable due to arrhythmia and cardiogenic shock. Therefore endoscopic clipping was done at the perforation site. Afterwards nasogastric decompression, intravenous antibiotics and total parenteral nutrition were applied. She was treated successfully without any complications. (Korean J Gastrointest Endosc 2003;26:232-235)

구연 : 신장 ; 특발성 막성신병증 환자에서의 치료 및 완전관해에 대한 영향인자 분석

신현필,임천규,이상호,김희진,이태원,김명재 대한내과학회 2002 대한내과학회 추계학술대회 Vol.63 No.-

Efficacy and safety of sofosbuvir-based regimens for treatment in chronic hepatitis C genotype 1 patients with moderately impaired renal function

신현필,박지애,Blaire Burman,Richard A. Kozarek,Asma Siddique 대한간학회 2017 Clinical and Molecular Hepatology(대한간학회지) Vol.23 No.4

Background/Aims: Treatment of chronic hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) is essential. The availability of sofosbuvir (SOF) has dramatically improved overall HCV cure rates, however there is insufficient data regarding its use in patients with CKD. We evaluated SOF in patients with hepatitis C genotype 1 (G1) and moderately impaired renal function. Methods: We retrospectively reviewed all patients treated with a SOF-based regimen from December 2013 through September 2015 at Virginia Mason Medical Center. Data was then collected for HCV G1 patients with stage 3 CKD. Results: A total of 28 patients with HCV G1 and stage 3 CKD were treated with a SOF-based regimen. Twenty-one patients had stage 3A CKD (estimated glomerular filtration rate [eGFR] 45–60 mL/min/1.73m2) and 7 patients had stage 3B CKD (eGFR 30–45 mL/min/1.73m2). The overall rate of sustained virologic response (SVR) 12 weeks after completion of therapy (SVR12) was 85.7% (24/28). SVR12 in stage 3A CKD patients was 81.0% (17/21) and in stage 3B CKD patients, SVR12 was 100% (7/7). Based on the treatment regimen used, the SVR12 was 81.8% (9/11), 92.3% (12/13), and 75.0% (3/4) for SOF/ledipasvir (LDV), SOF/simeprevir (SIM), and SOF/pegylated interferon (PEG)/ribavirin (RBV), respectively. Greater than 30% reduction eGFR was observed in 4 out of 28 patients. Conclusions: SOF-based regimens resulted in high SVR12 rates in patients with moderately impaired renal function. During therapy, HCV patients with CKD should be carefully monitored for worsening renal function.

건설안전실무 - 스카이 곤도라(Sky Gondola) 작업안전

신현필,Sin, Hyeon-Pil 대한산업안전협회 2011 안전기술 Vol.159 No.-

Sn-58Bi 솔더 페이스트와 ENIG 표면 처리된 기판 접합부의 계면 반응 및 접합강도

신현필,안병욱,안지혁,이종근,김광석,김덕현,정승부,Shin, Hyun-Pil,Ahn, Byung-Wook,Ahn, Jee-Hyuk,Lee, Jong-Gun,Kim, Kwang-Seok,Kim, Duk-Hyun,Jung, Seung-Boo 대한용접접합학회 2012 대한용접·접합학회지 Vol.30 No.5

Sn-Bi eutectic alloy has been widely used as one of the key solder materials for step soldering at low temperature. The Sn-58Bi solder paste containing chloride flux was adopted to compare with that using the chloride-free flux. The paste was applied on the electroless nickel-immersion gold (ENIG) surface finish by stencil printing, and the reflow process was then performed at $170^{\circ}C$ for 10 min. After reflow, the solder joints were aged at $125^{\circ}C$ for 100, 200, 300, 500 and 1000 h in an oven. The interfacial microstructures were obtained by using scanning electron microscopy (SEM), and the composition of intermetallic compounds (IMCs) was analyzed using energy dispersive spectrometer (EDS). Two different IMC layers, consisting of $Ni_3Sn_4$ and relatively very thin Sn-Bi-Ni-Au were formed at the solder/surface finish interface, and their thickness increased with increasing aging time. The wettability of solder joints was investigated by wetting balance test. The mechanical property of each aging solder joint was evaluated by the ball shear test in accordance with JEDEC standard (JESD22-B117A). The results show that the highest shear force was measured when the aging time was 100 h, and the fracture mode changed from ductile fracture to brittle fracture with increasing aging time. On the other hand, the chloride flux in the solder paste did not affect the shear force and fracture mode of the solder joints.

소화기내과 전임의 수련에 대한 COVID-19의 영향

신현필 ( Hyun Phil Shin ),차재명 ( Jae Myung Cha ),김범경 ( Beom Kyung Kim ),명대성 ( Dae-seong Myung ),문성훈 ( Sung-hoon Moon ),송명준 ( Myeong Jun Song ),윤승배 ( Seung Bae Yoon ),유인경 ( In Kyung Yoo ),이정훈 ( Jeong Hoon 대한소화기학회 2021 대한소화기학회지 Vol.77 No.5

목적: COVID-19 유행은 다양한 사회 문화적 변화를 야기하였지만, 소화기내과 전임의 교육에 대한 영향에 대한 연구는 거의 없었다. 이번 연구에서는 소화기내과 전임의 수련에 대한 COVID-19의 영향에 대해 조사하였다. 대상 및 방법: 2021년 2월 15일부터 3월 15일까지 국내 소화기내과 전임의들에게 온라인 기반 설문조사를 발송하였다. 설문은 소화기내과 전임의의 특성, COVID-19의 유행에 대한 인식도, COVID-19과 비대면 진료의 소화기내과 전임의 교육에 대한 영향에 대한 내용으로 구성되었다. 결과: 111건의 설문 결과들 중 94건의 설문 응답을 분석하였다. 소화기내과 전임의들은 COVID-19 유행에 대해 충분한 정보를 제공받고 있었으며(74.7%), 개인보호장구 착용에 대해 잘 교육받고 있었고, 충분히 제공받고 있었다(각각 74.7% 및 83.9%). 하지만, 외래 진료 스케줄과 환자 수는 각각 25.5%와 37.8%의 응답자들이 감소하였다고 응답하였고, 소화기 내시경 검사 세션과 환자 수도 각각 51.1%와 65.6%의 응답자들이 감소하였다고 응답하였다. 그 결과, 응답자들의 78.9%는 COVID-19의 유행으로 교육에 부정적인 영향을 받았다고 답변하였다. COVID-19 유행 동안에 도입된 비대면 진료가 각각 환자와 의사 측면에서 긍정적인 면이 있다고 답변한 응답자들은 불과 20.0%와 10.6%에 불과하였다. 게다가, 응답자들의 25.9%만이 수가가 적절하게 보상되더라도 비대면 진료를 이용하겠다고 응답하였으며, 68.2%의 응답자들은 비대면 진료가 교육에 부정적인 영향이 있다고 응답하였다. 결론: COVID-19 유행은 외래 진료 감소, 소화기 내시경 검사 감소, 온라인 컨퍼런스, 비대면 진료 도입을 통해 국내 소화기내과 전임의들의 교육에 부정적인 영향이 있었다. COVID-19와 같은 감염병 유행 시에 소화기내과 전임의 교육에 대한 대책 마련이 필요하다. Background/Aims: The coronavirus disease 2019 (COVID-19) outbreak caused numerous social and cultural changes, but few studies focused on their effects on gastroenterology (GI) fellowship training. This study evaluated the impact of COVID-19 on GI fellowship training. Methods: A web-based questionnaire was sent out to GI fellows in Korea between 15 February and 15 March 2021. The questionnaire included questions regarding the characteristics of GI fellows, perception of COVID-19 outbreak, impact of COVID-19 outbreak, and telemedicine on the education of a GI fellowship. Results: Among 111 answers, 94 respondents were analyzed. The GI fellows were provided with sufficient information about the COVID-19 outbreak (74.7%), well educated, and provided with personal protective equipment use (74.7% and 83.9%, respectively). On the other hand, outpatient schedule and volume decreased in 25.5% and 37.8% of respondents, respectively. Moreover, endoscopy sessions and volume decreased in 51.1% and 65.6% of respondents, respectively. As a result, 78.9% of respondents were concerned that the COVID-19 outbreak adversely affected their education. Telemedicine utilization was introduced during the COVID-19 outbreak, but only 20.0% and 10.6% of respondents agreed that telemedicine has benefits from the patient’s and doctor’s perspectives, respectively. In addition, only 25.9% of respondents were willing to continue telemedicine if adequately reimbursed, and 68.2% of respondents were concerned that it adversely affected their education. Conclusions: The COVID-19 outbreak has adversely affected GI fellowship training in Korea for outpatient clinics, gastrointestinal endoscopy, educational conferences, and telemedicine. This study highlights that GI fellowship training needs more attention in the COVID-19 outbreak. (Korean J Gastroenterol 2021;77:205-213)

Current and Future Tests of Hemostasis in Liver Disease

신현필 ( Hyun Phil Shin ) 대한간학회 2021 간학회 싱글토픽 심포지움 Vol.2021 No.2