빅 데이터 분석을 통한 적합한 골목상권 선정: 음식업

공정환(Jeong-Hwan Kong),윤병철(Byung-Chul Yun),서지수(Ji-Soo Seo),최진영(Jin-Young Choi),이효철(Hyo-Cheol Lee),테레시아(Theresia Saputri),이석원(Seok-Won Lee) 한국정보과학회 2017 한국정보과학회 학술발표논문집 Vol.2017 No.12

증례 : 소화기 ; 간 좌외하구역 형성부전을 동반한 좌측담낭 1예

이재남 ( Jae Nam Lee ),한병훈 ( Byung Hoon Han ),이지숙 ( Jee Suk Lee ),신은경 ( Eun Kyung Shin ),최평락 ( Pyoung Rak Choi ),윤병철 ( Byung Cheol Yun ),이상욱 ( Sang Uk Lee ) 대한내과학회 2010 대한내과학회지 Vol.78 No.3

좌측 담낭이 내장역위증과 무관하게 발생하는 경우는 매우 드물며, 더욱이 좌측 담낭이 간의 부분적 형성부전을 동반하는 경우는 더욱 드물 것으로 생각된다. 저자들은 오랜 기간 동안 만성 B형 간염으로 치료받는 것 이외에는 어떤 췌장담도계 질환도 나타나지 않았던 환자에서 간 3분절 형성부전을 동반한 좌측담낭 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. A left-sided gallbladder occurring in the absence of situs inversus is a rare anomaly. This anomaly was found in a 50-year-old man without any evidence of pancreatobiliary disease. Epigastric transverse ultrasonography showed a normal gallbladder with its

증례 : 소화기 ; 자가면역성 간염과 동반된 전신성 홍반성 낭창 및 원발성 쇼그렌 증후군

이규진 ( Gyu Jin Lee ),최정민 ( Jung Min Choi ),한병훈 ( Byung Hoon Han ),이상욱 ( Sang Uk Lee ),윤병철 ( Byung Cheol Yun ),김근태 ( Geun Tae Kim ),허방 ( Bang Hur ) 대한내과학회 2011 대한내과학회지 Vol.80 No.6

저자들은 황달 및 가려움증을 호소하는 52세 여자와 60세 여자에서 각각 자가면역성 간염과 동반된 전신성 홍반성 낭창과 원발성 쇼그렌 증후군을 경험하여 문헌고찰과 함께 보고하고자 한다. Autoimmune hepatitis is a generally progressive chronic hepatitis of unknown etiology. Systemic lupus erythematosus (SLE) and Sjogren`s syndrome are chronic, multifaceted inflammatory diseases that can affect every organ system, although hepatic involvement is rare. Here, we report two rare cases: autoimmune hepatitis associated with SLE and with primary Sjogren`s syndrome. A 52-year-old woman and a 60-year-old woman were admitted our hospital with jaundice and pruritus. They had no history of viral hepatitis, alcohol consumption, or drug use. The pathological findings, clinical manifestations, and laboratory findings satisfied each of the diagnostic criteria for autoimmune hepatitis as well as for SLE and Sjogren`s syndrome in the first and second cases, respectively. These patients were treated with prednisolone, and then followed regularly. (Korean J Med 2011;80:697-702)

간세포암종 환자에서 간절제술 후 간부전의 예측인자로서 알부민-빌리루빈 점수의 유용성

박현준 ( Hyun Joon Park ),서광일 ( Kwang Il Seo ),김성준 ( Sung Jun Kim ),이상욱 ( Sang Uk Lee ),윤병철 ( Byung Cheol Yun ),한병훈 ( Byung Hoon Han ),신동훈 ( Dong Hoon Shin ),최영일 ( Young Il Choi ),문형환 ( Hyung Hwan Moon ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.3

Background/Aims: Post-hepatectomy liver failure (PHLF) is a major concern for patients with hepatocellular carcinoma (HCC) who have undergone liver resection. The albumin-bilirubin (ALBI) score is a novel model for assessing liver function. We aimed to investigate the effectiveness of the ALBI score as a predictor of PHLF in HCC patients who have undergone hepatectomy in South Korea. Methods: Between January 2014 and November 2018, HCC patients who underwent hepatectomy and indocyanine retention rate at 15 min (ICG-R15) test were enrolled in this study. Results: A total of 101 patients diagnosed with HCC underwent hepatectomy. Thirty-two patients (31.7%) experienced PHLF. The ALBI score (OR 2.83; 95% CI 1.22-6.55; p=0.015), ICG-R15 (OR 1.07; 95% CI 1.02-1.12; p=0.007) and ALBI grade (OR 2,86; 95% CI 1.08-7.58; p=0.035) were identified as independent predictors of PHLF by multivariable analysis. The area under the receiver operating characteristic curve of the ALBI score and ICG-R15 were 0.676 (95% CI 0.566-0.785) and 0.632 (95% CI 0.513-0.752), respectively. The optimal cutoff value of the ALBI score in predicting PHLF was -2.62, with a sensitivity of 75.0% and a specificity of 56.5%. Conclusions: The ALBI score is an effective predictor of PHLF in patients with HCC, and its predictive ability is comparable to that of ICG-R15. (Korean J Gastroenterol 2021;77:115-122)

만성 C 형 간염 환자에서 인터페론치료에 의한 갑상선질환의 발생

김민대(Min Dae Kim),전익수(Ik Soo jeon),강승수(Seung Su Kang),엄재섭(Jae Sup Eum),손호성(Ho Seung Son),박현용(Hyung Lyong Park),윤병철(Byung Cheol Yun),이상욱(Sang Uk Lee),한병훈(Byung Hoon Han) 대한소화기학회 2001 대한소화기학회지 Vol.37 No.6

Background/Aims: It has been suggested that hepatitis C virus is associated with the autoimmune disease and interferon also induces hepatic and non-hepatic autoimmune reaction. We conducted this study to assess the effect of interferon-alpha (INF-α) on the induction of thyroid autoantibodies and clinical thyroid disease and to know whether the thyroid autoantibodies affect the IFN-α efficacy in patients with chronic hepatitis C. Methods: Twenty-nine patients with chronic hepatitis C were enrolled. Anti-thyroglobulin antibody (ATA), anti-microsomal antibody (AMsA), thyroid stimulating hormone and free thyroxine were measured before, during, and after IFN-α therapy. Results: Two of the 29 patients (6.5%) were positive for ATA and AMsA before IFN-α therapy. Of these two patients, one patient was a woman, who showed hyperthyroidism druing IFN-α therapy. Of the 27 patients who had been negative for ATA and AMsA, one female patient became ATA positive with the development of hyperthyroidism, and 3 male patients became AMsA positive during IFN-α therapy. There was no difference in the efficacy of INF-α therapy between the thyroid autoantibody positive and negative groups. Conclusions: IFN-α therapy induced thyroid disease with high prevalence in the patients with chronic hepatis C. Thus, thyroid status should be checked even in patients without thyroid autoantibodies, especially in woman. Antithyroid autoantibodies seem unlikely to affect the efficacy of IFN-α therapy. (Korean J Gastroenterol 2001;37:436-442)

간세포암에서 Cyclooxygenase-2와 p53의 발현의 연관성과 수술 후 재발에 미치는 영향

윤병철,한병훈,이상욱,허방 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.1

Background : Overexpression of COX-2 has been well documented in different malignancies has been develop in the gastrointestinal tract, breast, cervix, lung, prostate, and hepatocellular carcinoma(HCC). The p53 tumor suppressor gene has a critical role for regulation of cell cycle, cellular growth, and maintenance of genomic integrity. However, the exact correlation of COX-2 and p53 expression in HCC is still unclear. To evaluates the expression of COX-2 and p53, and their relationships to clinicopathological variables in patients with HCC and feasiblity of chemoprevention of hepatocellular carcinoma by COX-2 inhibitors was investigated. Materials and Method : Formalin-fixed, paraffin-embedded, archival surgical specimens that had been obtained from 50 patients who had received a diagnosis of primary HCC were studied. The expression of COX-2 and p53 in tissue were assessed immunohistochemically. This study analyze the correlation between COX-2 or p53 expression and various clinicopathological variables. Results : The COX-2 overexpression was not significantly associated with p53 positivity. High COX-2 expression was associated with well differentiated HCC(p=0.049). Disease free survival rate of high COX-2 expressor in nonneoplastic liver tissue are significantly lower than that of patients with low COX-2 expressor. Conclusions : This study suggest that the COX-2 may play a role in the early stage of hepatocarcinogenesis and it provide a rationale for testing whether COX-2 inhibitors can prevent development of HCC.

만성 간질환 환자에서 혈청학적 표지자에 따른 B형 간염바이러스와 C형 간염바이러스 중복감염

윤병철,한병훈,이상욱 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

Background: Hepatitis B virus(HBV) and hepatitis C virus(HCV) are two major etiologic of chronic hepatitis. The epidemiological similarities between HBV and HCV infections were noted, The interaction between HBV and HCV has so far been poorly investigated in Korea. In this study, we evaluate to the virologic and clinical characteristics of the coinfection in Korea. Methods: We enrolled 103 patients of chronic liver disease and classified as group A of HBsAg/anti-HCV positive patients. Group B of HBsAg positive/anti-HCV negative and group C of HBsAg negative/anti-HCV positive patients. The clinical characteristics of each groups were assessed and compared. Results: Serum HBV DNA was found more frequently in group B (68.4%) than in group A(17.9%). The prevalence of patients with serum HBV DNA was signigicant lower in group A than group B in anti-HBe positive patients. The prevalence of patients with serum HCV RNA was significant lower in group A(64.3%) than in group C(86.5%). The comparison of baseline LFT and liver histology between each groups is not significant. Conclusion: These results suggest that HBV and HCV coinfection shows a reciprocal inhibitory effect on HBV and HCV replications, the inhibitory effect of HBV on HCV might be limited in the anti-HBe positive groups. The coinfection is not associated with the severity of liver disease and clinical course.

악성담도폐쇄 환자에서 경피경간 담도배액술과 금속담도배액술 치료의 장기 합병증 비교 연구

윤병철 고신대학교 의과대학 2011 고신대학교 의과대학 학술지 Vol.26 No.1

OBJECTIVES: Several advances in the diagnosis, therapy and palliation of patients affected by malignant biliary obstruction have occurred during the last decades. Unresectable malignant biliary obstruction has usually been treated by percutaneous transhepatic biliary drainage (PTBD) versus metallic biliary drainage (MBD). The optimal management of complications after biliary drainage is still an unresolved problem. To compare the complications of malignant biliary obstruction after PTBD and MBD. METHODS: We enrolled 51 patients of malignant biliary obstruction after biliary drainage. The clinical characteristics and complications of each groups were assessed and compared. RESULTS: The complications after biliary drainage of MBD are lower than those of PTBD (59.1% vs 82.8%, P = 0.06, respectively). Patients with PTBD tended to have a shorter event of complication time compared to MBD patients (2.9 months vs 7.1 months, P < 0.01). Patients with older age in PTBD tended to have a longer event of complication time compared to younger patients (4.6 months vs 2.3 months, P < 0.01). CONCLUSIONS: The method of biliary drainage in malignant biliary obstruction have statistically significant impact on the complication time. The clinical efficacy of metallic stent in patients with malignant biliary obstruction is better than that of PTBD.

B형 간염에 의한 간경변증에서 항바이러스제의 효과

심인경,윤병철,한병훈,이상욱,임성경,이혜원,조은주,김봉준,박세진,이신준 고신대학교 의과대학 2011 고신대학교 의과대학 학술지 Vol.26 No.1

OBJECTIVES: Improvement of liver synthetic function and the incidence of complication in the patients with hepatitis B-related liver cirrhosis is important. In this study, we study whether antiviral therapy was effective in patients with hepatitis B-related liver cirrhosis. METHODS: 103 patients with hepatitis B-related liver cirrhosis treated with lamivudine 100mg daily over 6 months and followed up over 30 months. 71 patients were positive for serum HBeAg. HBeAg, HBV DNA , CBC, prothrombin time, biochemistry, ultrasonography and endoscopy were tested every 6 months. RESULTS: The medians of ALT, albumin improved after 6 months and then aggravated after 18 months, but they didn't aggravated at 30 months compared with initial test. The median of Child-turcotte-pugh (CTP) score imporved after 6 months and then aggravated after 12 months, but they didn't aggravated at 30 months compared with initial test. The CTP score improved (2 point reduction) in 29 patients. The finding of ultrasonography didn't aggravaed (improved or didn't changed) in 58 patients. The 5 year incidence rate of hepatocelluar carcinoma was 8.3%. CONCLUSIONS: The antiviral therapy in patients with hepatitis B-related liver cirrhosis is improved CTP score and biochmical data. The improvement is more useful in decompensated cirrhosis the compensated cirrhosis. The incidence of hepatocellular carcinoma decreases than other studies. Therefore, the antiviral medication in patients with hepatitis B-related liver cirrhosis is helpful to consider more aggressively.

B형 간염 바이러스에 의한 만성 간질환 환자에서 라미부딘 치료 도중 나타난 Viral Breakthrough의 임상적 의미

박찬복,임현정,윤병철,이상욱,한병훈 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.2

목적: HBV에 의한 만성 간질환 환자들에서 라미부딘 투여 도중에 발생한 viral breakthrough가 만성 간질환의 경과에 어떤 영향을 주는지 알아보고자 이 연구를 시행했다. 대상과 방법: HBV에 의한 만성 간질환으로 라미부딘에 반응을 나타냈던 환자들 중 viral breakthrough가 있었던 환자들을 대상으로 했다. 이러한 환자들은 라미부딘 치료 시작 전 기준으로 만성 간염군과 대상성 간경변증군을 합한 비대상성 간기능 저하가 없던 군 32예와 비대상성 간기능 저하가 있던 군 32예로 나누었다. 결과: 라미부딘 치료 시작 후 경과 관찰 기간은 31.5±10.5(범위: 10-48)개월이었고, viral breakthrough가 나타난 시기는 라미부딘 치료 시작 후 16.5±6.6(범위: 8-31)개월이었다. viral breakthrough 후 전체적으로는 혈청 ALT치가 정상 상한치의 1.2배 이상으로 증가는 64예 중 40예(62.5%)에서 나타났다. ALT치가 정상 상한치의 5배 이상 증가는 11예(17.2%)에서, 그리고 황달(혈청 빌리루빈>3.0 ㎎/dL)은 비대상성 간기능 저하가 없던 군에서는 나타나지 않았고 비대상성 간기능 저하가 비대상성 간기능 저하가 있던 군 32예 중 6예(18.8%)에서 나타나, 전체적으로 급성 악화는 15예(23.4%)에서 발생했다. 이 15예 중 비대상성 간기능 저하 군에 속한 경우가 10예로 비대상성 간기능 저하가 비대상성 간기능 저하가 있던 군에서 급성 악화를 보인 빈도는 31.3%였다. 혈청 ALT치가 정상 상한치의 1.2배 미만이고, 황달이 나타나지 않았던 예는 전체 64예 중 24예(37.5%)였다. Viral breakthrough 후 라미부딘 투여 기간은 전체적으로 15.0±9.7(범위: 0-31)개월이었다. 이 기간 동안 혈청 HBV DNA 소실과 ALT치의 정상화는 전체 64예 중 15예(23.4%)에서 볼 수 있었고 비대상성 간기능 저하가 없던 군과 있던 군에서는 각각 10예(31.3%)와 5예(15.6%)로 비대상성 간기능 저하가 없던 군이 있던 군에 비해 높았으나 통계적 유의성은 없었다. 이 기간 동안 HBeAg 혈청전환은 전체적으로 HBeAg 양성 환자 51예 중 7예(13.7%)에서 관찰되었고, 비대상성 간기능 저하가 없던 군과 있던 군에서 각각 4예(15.4%)와 3예(12.0%)였다. 급성 악화가 나타났던 15예 중 5예는 비대상성 간기능 저하가 없던 군에 속했는데 이들 중 3 예(60.0%)가 혈청 ALT치가 정상으로 변했고 혈청 HBV DNA치가 측정치 이하로 떨어졌으며, 2예(40.0%)는 HBeAg 혈청전환이 있었다. 또 나머지 10예는 비대상성 간기능 저하가 있던 군에 속했으며, 이들은 1예를 제외한 9예(90.0%)가 심한 비대상성 간기능 저하에 빠지거나 사망했다. 특히 viral breakthrough시 황달이 나타났던 6예 중 3예는 황달이 나타나고 나서 바로, 다른 1예는 5개월 후에 각각 사망했다. 결론: Viral breakthrough가 나타날 경우 라미부딘 치료 전 비대상성 간기능 저하 소견만 없으면 비교적 안전하고 그 치료 효과도 계속해서 나타나며, 특히 급성 악화가 있으면 라미부딘의 치료 효과는 더 증가하는 것처럼 보였다. 그러나 라미부딘 치료 시작 전 비대상성 간기능 저하가 있던 환자들에게 급성 악화는 비교적 높은 빈도에서 나타날 뿐만 아니라 치명적일 것이라 생각되었다. Background/Aims: Viral breakthrough has been considered a major limitation of lamivudine in the treatment of hepatitis B virus related chronic liver disease. Its clinical meaning has not been thoroughly assessed. Methods: 64 patients who showed viral breakthrough during lamivudine treatment were retrospectively reviewed. We evaluated the rate of HBeAg seroconversion and hepatic decompensation after viral breakthrough. Results: After viral breakthrough, serum alanine transaminase (ALT) elevation more than 1.2×upper limit of normal (ULN) was noticed in 40 patients (62.5%). Acute flare (serum ALT elevation >×5 ULN, or serum bilirubin >3 ㎎/dL) occured in 15 patients (23.4%). During the period of follow up (15.0 9.7 months; range, 0-31 months) since viral breakthrough, decreased serum HBV-DNA level to below the detection limit and serum ALT normalization was seen in 15 patients (23.4%). HBeAg seroconversion was noticed in 7 (13.7%) of a total of 51 HBeAg positive patients at base line; in 4 (15.4%) of 26 patients with non-hepatic failure (chronic hepatitis or Child-Pugh class A liver cirrhosis) at base line; and in 2 (40.0%) of 5 patients with non-hepatic failure at base line and acute flare after viral breakthrough. During this period, terminal hepatic decompensation (Child-Pugh class C) or death was noticed in 9 (90.0%) of 10 patients who had hepatic decompensation (Child-Pugh class B or C) at baseline and acute flare after viral breakthrough. Conclusions: Acute flare after viral breakthrough seemed to continue during HBeAg seroconversion and rarely developed into terminal hepatic decompensation or death in patients with non-hepatic decompensation at baseline. Its incidence is not only high but lethal to most patients with hepatic decompensation at baseline. (Korean J Hepatol 2004;10:108-116)