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우현영 ( Hyun Young Woo ),김진동 ( Jin Dong Kim ),권정현 ( Jung Hyun Kwon ),배시현 ( Si Hyun Bae ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ),나성은 ( Sung Eun Rha ),변재영 ( Jae Young Byun ),천호종 ( Ho Jong Chun ),최 대한간암연구회 2009 대한간암학회지 Vol.9 No.-
Liver transplantation is curative therapy for hepatocellular carcinoma especially if ,within Milan criteria, 4 year survival and recurrence-free survival was reported to be 85% and 92%, respectively. Herein we report a patient who experience rapid recurrence following living donor liver transplantation (LDLT) for hepatocellular carcinoma within Milan criteria. A 52 year-old-men patient with known liver cirrhosis associated with hepatitis B virus was admitted for the treatment of hepatocellular carcinoma (HCC). Abdominal CT revealed two nodules less than 3 cm in right hepatic lobe. After single session of transcatheter arterial chemoembolization (TACE), the patient underwent LDLT. After seven months following transplantation, recurrent HCC was detected on transplanted liver with concurrent metastatic nodule in lung. Although TACE and metastsectomy were performed for recurrent intrahepatic mass and lung metastasis, recurrent HCC showed rapid progression and patient died of progressive tumor after 10 months following LDLT.
괴상형 간세포암 간문맥 침범을 보인 괴상형 간세포암의 치료
권정현 ( Jung Hyun Kwon ),최종영 ( Jong Young Choi ),김진동 ( Jin Dong Kim ),우현영 ( Hyun Young Woo ),배시현 ( Si Hyun Bae ),윤승규 ( Seung Kew Yoon ),이영준 ( Young Jun Lee ),천호종 ( Ho Jong Chun ) 대한간암학회 2009 대한간암학회지 Vol.9 No.-
A 52 year-old-man patient was admitted for evaluation of hepatic mass which was detected on screening ultrasonography. His abdominal CT showed a massive infiltrating mass in left hepatic lobe and another 2.4 cm nodule in S6 of Rt. Hepatic lobe with arterial enhancement and rapid wash out underlying liver cirrhosis. Also, low density tumor thrombus are filled in Lt. portal vein and extended into main portal vein. He was finally diagnosed HCC (UICC stage IVa) with liver cirrhosis (Child-Pugh class A) and hepatitis B. With the four times of trasnarterial chemo-lipiodolization and seven times of intraarterial infusion chemotherapy for huge mass and one time Radiofrequency ablation (RFA) for daughter nodule, his HCC showed no stain in hepatic angiogram at nine month from initial diagnosis. After additional eight times of intra-arterial infusion chemotherapy, new small nodule developed in S6 and was ablated with RFA. At eighteen months after initial diagnosis, he shows no viable lesion on the imaging study and tumor markers are normalized.
간 이식 후 재발한 간세포암의 Sorafenib 치료 4예 보고
홍영미 ( Young Mi Hong ),윤기태 ( Ki Tae Yoon ),조몽 ( Mong Cho ),강대환 ( Dae Hwan Kang ),김형욱 ( Hyung Wook Kim ),최철웅 ( Cheol Woong Choi ),박수범 ( Su Bum Park ),허정 ( Jeong Heo ),우현영 ( Hyun Young Woo ),임원 ( Won Lim 대한소화기학회 2015 대한소화기학회지 Vol.65 No.4
With an increasing number of patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT), tumor recurrence remains the main limiting factor for long-term survival. Although sorafenib is available for advanced HCC, there is still a lack of data on the use of sorafenib for treatment of recurrent HCC after LT. Here, we report on four cases of the use of sorafenib for treatment of recurrent HCC after LT. The median time of recurrence from LT was 4 months (range, 1-16 months). Two of the four evaluated patients showed stable disease, which was the best response and the duration of stabilization was 11 months and 5 months, respectively. One patient also experienced stable disease and remained in stable disease without sorafenib therapy for 29 months and the total duration of stabilization was 38 months. The remaining patient showed partial response but stopped treatment due to radiological tumor progression during treatment. Although all cases were high risk group for recurrence such as above Milan criteria, vascular invasion and tumor biology, clinical outcomes showed some good results. Therefore, sorafenib may be an acceptable treatment option for recurrent HCC after LT. (Korean J Gastroenterol 2015;65:246-251)
Ji Hyun Kim(김지현),Hae Dong Woo(우해동),Sunho Choi(최선호),Dae Sub Song(송대섭),Jung Hyun Lee(이정현),Sung Soo Kim(김성수),Hyun-Young Park(박현영) 환경독성보건학회 2021 한국독성학회 심포지움 및 학술발표회 Vol.2021 No.5
Ambient air pollution has been linked to multiple chronic diseases, and inflammatory responses and coagulation impairments were suggested as the underlying mechanism. We investigated the effects of short-, middle-, and long-term exposure to ambient air pollution on the markers of inflammation and coagulation using data from 56,643 participants in the Korean Genome and Epidemiology Study- Health Examinees Study between 2012-2017. Community Multiscale Air Quality system with surface data assimilation estimated exposures of criteria air pollutants for participants based on geo-coded residential addresses. Exposure time periods were categorized as short-term: day of visit and up to 7 days prior; middle-term: 1 and 3 months prior; and long-term: 6 months and 1 and 2 years prior for the average concentrations of PM10, PM2.5, SO2, NO2, CO, and O3. Multivariable linear regression models were applied to estimate the percent changes in high-sensitivity C-reactive protein (hs-CRP), white blood cells, fibrinogen, and platelets per interquartile-range increment for air pollutants. The strongest positive associations were observed between hs-CRP and 1-year PM10 (4.4% [95% CI: 3.2%, 5.7%]); white blood cells and 1-year NO2 (1.6% [95% CI: 1.3%, 2.0%]); and fibrinogen and 1-year PM10 (0.7% [95% CI: 0.5%, 0.9%]). The direction of associations of pollutants with markers remained similar across exposure windows, with a pattern of stronger effect estimate for longer terms. Our findings indicated that exposure to air pollution may play a role in the inflammation and coagulation process.
만성 간질환에서 혈청 retinol binding protein 4의 임상적 의의
권정현 ( Jung Hyun Kwon ),박성태 ( Seong Tae Park ),김기대 ( Gi Dae Kim ),유찬란 ( Chan Ran You ),김진동 ( Jin Dong Kim ),우현영 ( Hyun Young Woo ),장정원 ( Jeong Won Jang ),김창욱 ( Chang Wook Kim ),배시현 ( Si Hyun Bae ),최종영 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.1
사례보고 : 라미부딘 내성을 보인 HBe 항원 음성 만성 B형간염 환자에서 페그인터페론 알파 치료 1예
허원행 ( Won Haing Hur ),우현영 ( Hyun Young Woo ),정승원 ( Soung Won Jeong ),유찬란 ( Chan Ran You ),배시현 ( Si Hyun Bae ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ) 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.4
라미부딘은 부작용이 거의 없으며 비교적 저가라는 장점이 있어 만성 B형간염에 대한 항바이러스요법제로서 선호되지만, 장기간 투여할 경우 이 약물에 내성을 가진 변이종이 흔히 출현하여 이에 대한 적절한 치료법의 개발이 절실한 실정이다. 저자들은 이러한 변이종 치료의 한 방법으로 라미부딘 내성이 발생한 만성 B형간염 환자에서 PEG-IFN α-2a를 주 1회 12개월간 사용하여 특별한 부작용 없이 생화학적 간기능 호전 및 바이러스 억제효과가 관찰되고 치료 이후 24주 이상의 경과관찰에서 지속적인 치료반응을 보인 1예를 경험하였기에 보고한다. 라미부딘 내성을 가진 만성 B형간염 환자의 치료에 있어서 새로 개발된 경구용 nucleoside/nucleotide analogue와 함께 PEG-IFN도 변이종에 대한 대체치료의 한 방법으로 고려될 수 있을 것이다. The wide use of lamivudine in chronic hepatitis B has produced a monotonic increase in patients with lamivudine resistance. Therefore, treating lamivudine resistance in chronic hepatitis B is a major concern in clinical practice for the treatment of hepatitis B virus (HBV). There is conflicting evidence on the outcome of pegylated interferon alpha (PEG-IFN α) therapy against lamivudine-resistant HBV, which is due to mutations in the YMDD motif. We experienced a patient with chronic hepatitis B who was successfully treated with PEG-IFN α-2a after the development of virologic and biochemical breakthrough during lamivudine therapy. Virologic breakthrough was associated with the emergence of YMDD mutants 48 months after starting lamivudine therapy. Treatment with PEG-IFN α-2a for 12 months resulted in an undetectable serum level of HBV DNA and the resolution of hepatitis, and the virologic response was maintained over 16 months after cessation of PEG-IFN α-2a. (Korean J Hepatol 2008;14:513-518)
연구논문 : 간경변증을 동반한 만성 C형간염 환자에서 페그인터페론과 리바비린 병합요법의 치료 효과와 안전성
정홍렬 ( Hong Ryeol Cheong ),우현영 ( Hyun Young Woo ),허정 ( Jeong Heo ),윤기태 ( Ki Tae Yoon ),김동욱 ( Dong Uk Kim ),김광하 ( Gwang Ha Kim ),강대환 ( Dae Hwan Kang ),송근암 ( Geun Am Song ),조몽 ( Mong Cho ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.1
목적: 페그인터페론과 리바비린의 병합요법은 만성 C형간염의 효과적 치료이지만 간경변증을 동반한 환자에서는 치료 효과가 떨어지는 것으로 알려져 있다. 이에 저자들은 간경변증을 동반한 만성 C형간염 환자를 대상으로 페그인터페론과 리바비린 병합요법의 효과 및 부작용을 후향적으로 조사하였다. 대상 및 방법: 2004년 1월부터 2007년 1월까지 간경변증을 동반한 만성 C형간염 환자 중 페그인터페론과 리바비린의 병합요법을 받은 65명을 대상으로 바이러스 반응과 부작용을 조사하였다. 페그인터페론 알파-2a는 체중에 관계없이 180μg을(n=32), 페그인터페론 알파-2b는 1.5μg/kg을 주1회 피하주사하였다. 리바비린은 1형 유전자의 경우 75kg 미만에서는 1,000mg, 75kg 이상에서는 1,200mg을 사용하였고 비1형 유전자의 경우 체중에 관계없이 800mg을 투여하였다. 유전자형에 따라 1형 유전자형 만성 C형간염인 경우는 48주간 치료하였으며 비1형 유전자형은 24주간 치료하였다. 치료 효과는 지속바이러스반응률(SVR)로 평가 하였다. 결과: 본 연구에 포함된 65명 환자 중 HCV유전자 1형 환자(50명)에서 EVR은 70.0%(35/50), ETR은 52.0%(26/50)였고 SVR은 24.0%(12/50)였다. HCV 유전자 비1형 환자(15명)에서 ETR은 53.3%(8/15)였으며 SVR은 33.3%(5/15)였다. 비대상 간경변증 환자(10명)에서 SVR은 대상 간경변증 환자(55명)와 비교하여 큰 차이를 보이지 않았다(20.0% vs. 27.3%, P=0.630). 치료 과정에서 간경변증으로 인한 합병증이 10명에서 발생하였고 11명이 치료 와 관련된 부작용으로 치료를 중단하였다. 결론: 간경변증 환자에게서 페그인터페론과 리바비린의 병합요법은 기존의 간염 환자를 대상으로 한 보고와 비교하여 치료 효과가 낮고 심한 부작용으로 중단하는 경우가 흔하였다. 그러나 진행된 간경변증 환자에서 간이식 외에는 다른 효과적인 치료법이없으므로 만일 부작용이 대해 충분히 주의한다면 일부 환자에서는 병합치료를 고려해 볼 수 있을 것이다. Background/Aims: The combination therapy of peginterferon (PEG-IFN) and ribavirin is the standard treatment for hepatitis C virus (HCV) infection. However, few trials have involved patients with cirrhosis. The purpose of this study was to elucidate the efficacy and safety of treatment with PEG-IFN and ribavirin in patients with cirrhosis associated with HCV infection. Method: A total of 65 patients were treated with PEG-IFN alpha-2a/ribavirin (n=32) or PEG-IFN alpha-2b/ribavirin (n=33). PEG-IFN alpha-2a and PEG-IFN alpha-2b were administered at doses of 180 μg/week and 1.5 μg/kg/week, respectively, and ribavirin was administered orally at doses of 800-1200 mg. Patients with HCV genotype 1 and genotype non-1 were treated for 48 and 24 weeks, respectively. The treatment response was assessed based on the sustained virologic response (SVR). Results: The early virologic response (EVR), end-of-treatment response (ETR), and SVR were 70.0%, 52.0%, and 24.0%, respectively, in genotype 1 (n=50). In genotype non-1 (n=15), the ETR was 53.3% and the SVR was 33.3%. The overall SVR did not differ with genotype (1vs non-1, 24.0%vs.33.3%; P=0.471) or between decompensated cirrhosis and compensated cirrhosis (20.0%vs.27.3%, P=0.630). Ten patients developed cirrhotic complications during the treatment, and 11 stopped treatment due to treatment -related adverse events. Conclusion: The combination therapy of PEG-IFN and ribavirin exhibited a low efficacy in cirrhotic patients with HCV infection and was associated with frequent serious complications. However, with careful management of complications, the therapy may have a considerable efficacy in some patients with cirrhosis and HCV infection. (Korean J Hepatol 2010;16:38-48