TACE와 Sorafenib 치료 후 수술을 시행한 간세포암종

노금엽 ( Geum Youb Noh ),한철주 ( Chul Ju Han ),김연주 ( Youn Joo Kim ),양기영 ( Ki Young Yang ),박수철 ( Su Cheol Park ),김진 ( Jin Kim ),김유철 ( Yu Cheol Kim ),최윤희 ( Yoon Hee Choi ),이효락 ( Hyo Rak Lee ) 대한간암학회 2011 대한간암학회지 Vol.11 No.1

Surgical resection for hepatocellular carcinoma (HCC) is one of the managements, showing improved long term survival. Nowadays, it is being accepted as the main curative treatment. However, the biggest problem we used to face is that surgery cannot be applied at the point of presentation in many patients due to advanced stage. Here we present a case of 54 years old female, who had transarterial chemoembolization (TACE) and sorafenib due to advanced stage of HCC, and later underwent curative surgery due to remarkable response. She had a CT scan of abdomen, which showed multiple huge masses. HCC was confirmed by ultrasonography-guided liver biopsy. TACE was performed once. After TACE, the size of masses increased. Therefore, sorafenib was administered and then continued for 9 months. As partial response was obtained at that time, surgical resection was successfully done. In the pathological report of removed tumor, we could confirm total necrosis of tumor. Now, it`s been 6 months and she is followed up without any recurrence.

간외 전이로 처음 발견된 간세포암종 간외 전이가 있는 간세포암종에 대한 systemic doxorubicin-cisplatin (AP) 감량요법 후 완전 관해에 도달한 2예

남승범 ( Seung Bum Nam ),한철주 ( Chul Ju Han ),이호진 ( Ho Jin Lee ),김연주 ( Youn Joo Kim ),양기영 ( Ki Young Yang ),박수철 ( Su Cheol Park ),김진 ( Jin Kim ),김유철 ( Yu Cheol Kim ) 대한간암학회 2010 대한간암학회지 Vol.10 No.-

The effect of systemic chemotherapy in patients with advanced HCC is very limited, not only in regard to poor response to cytotoxic chemotherapeutic agents but also poor tolerance to therapy and related adverse effects. Herein, we report two cases of hepatocellular carcinoma (HCC) with extrahepatic metastasis who achieved complete remission following administration of doxorubicin and cisplatin in reduced dosage. The first case was a 41-year-old male who had HCC with multiple lung and intraabdominal lymph nodes metastasis. After 9 cycles of chemotherapy with 50% reduced dosage, he achieved a complete remission of both primary and metastatic lesions. He showed no evidence of disease for 11 more months during follow-up and still lives without recurrence. The second case was a 61-year-old female who had HCC with inferior vena cava thrombosis and multiple lung metastasis. After one cycle of treatment with 25% reduced dosage, she underwent life-threatening toxicities and poor tolerance to chemotherapy and further treatment was discontinued. However, she achieved a complete remission of both primary and metastatic lesions. Following 26 months of recurrence free period, she suffered from a recurrent tumor near previously treated lesion, which was successfully treated by TACE and radiation therapy. This modified doxorubicin and cisplatin regimen in reduced dosage could be used as means of evading life threatening toxicity and selecting out responders to systemic chemotherapy with reduced risk.

간세포암종에 대한 Cyberknife 치료 후 완전관해가 왔던 환자에서 하반신 마비가 발생한

노금엽 ( Geum Youb Noh ),한철주 ( Chul Ju Han ),김연주 ( Youn Joo Kim ),양기영 ( Ki Young Yang ),박수철 ( Su Cheol Park ),김진 ( Jin Kim ),김유철 ( Yu Cheol Kim ),김미숙 ( Mi Sook Kim ) 대한간암학회 2011 대한간암학회지 Vol.11 No.2

Radiation therapy (RT) is one of the managements for unresectable hepatocellular carcinoma (HCC). Traditionally, RT has played only a limited role in HCC treatment because of its low efficacy and the low tolerance of the liver for this modality. However, as the technology of RT grows rapidly in recent years, indication of RT for HCC has been extended remarkably. Stereotactic body radiation therapy (SBRT) is a technique that allows precise delivery of a large ablative radiation dose to the tumor while sparing normal surrounding tissue in 1 to 5 fractions. As RT becomes useful therapeutic strategy, the important problem is that there could be serious complication after RT. Here we present a case of 54 years old male with advanced stage of HCC, who underwent a serious neurologic complication of paraplegia following Cyberknife (CK) treatment. He had a huge HCC in right lobe of the liver, and initially transarterial chemoembolization (TACE) was performed with an unsatisfactory response. Therefore, CK was performed, and another TACE was done for a new lesion, which was followed by remarkable complete remission of the tumor. However, paraplegia developed in both of his lower extremities a year after CK. Investigation has shown radiation myelitis as the cause of paralysis. Three and a half years have passed since CK treatment, and HCC is still in complete remission state, however, paraplegia is persistent now. Radiation myelitis should be considered as a complication, when CK is applied to treatment of HCC.

악성 식도 협착에서의 식도 확장술 및 내시경적 내인공관 삽입술

박중원(Jung Won Park),김진욱(Jin Wook Kim),류지곤(Ji Kon Ryu),고광철(Kwang Cheol Koh),한철주(Cheol Joo Han),김용태(Yong Tae Kim),유권(Kwon Yoo),정현채(Hyun Chae Jung),윤용범(Yong Bum Yoon),송인성(In Sung Song),최규완(Kyu Wan Choi),김 대한내과학회 1992 대한내과학회지 Vol.43 No.5

N/A Background: The prognosis of esophageal malignancy is poor and symptomatic palliation is important for those patients with malignant dysphagia and tracheoesophageal fistula. Endoscopic endoprosthesis insertion has been widely u for the palliative purpose, and authors analyzed the effects and complications of endoscopic esophageal dilation and endoprosthesis insertion. Methods: Thirty patients with dysphagia or frequent aspiraton due to esophagogastric malignancy were managed with esphageal dilation and/or endoscopic endoprosthetic tube insertion for the purpose of symptomatic palliation. Twenty-one patients had esophageal cancer, six had gastric cancer, and three had lung cancer. Results: Dysphagia was relieved in 72% of the patients and aspiration due to fistula was improved in 40% of the patients. Complications were as follows; Perforation (17%), tube obstruction (21%), dislocation (14%), bleeding (3.3%). Perforations were managed with conservative medical measures. There was no immediate procedure-related mortality. Conclusion: Esophgeal dilation and/or endoscopic endoprosthetic tube insertion were effective measure for the palliation of esophageal symptoms due to esophagogastric malignancies.

위장관 ( 胃腸管 ) : 식도 확장술에 합병된 식도 천공의 치료

윤용범(Yong Bum Yoon),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim),정현채(Hyun Chae Jung),김용태(Yong Tae Kim),한철주(Cheol Joo Han),이준혁(Joon Hyeok Lee),김진욱(Jin Wook Kim),김태호(Tae Ho Kim),최상운(Sang Oun 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3

N/A We reviewed the total 291 procedures in 134 patients in whom esophageal dilatation or esophageal endoprosthesis insertion had been performed in Seoul National University Hospital from March 1987 to September 1990. Twelve cases(4.1%) of esophageal perforation developed. Eight cases of them were managed successfully only with medical treatment. Two cases were not followed up after self-discharge during medical treatement. One case was treated successfully with immediate surgical intervention and one case underwent delayed surgical repair two times because of the failure of initial medical treatment. There were 7 cases of esophageal perforation with pleural or peritoneal involvement. Five of them were managed successfully with medical treatment. Thus we recommended the medical management as the first choice of treatment in iatrogenic esophageal perforation even in the cases with pleural or peritoneal involvement except in some selected cases.

위장관 ( 胃腸管 ) : 소화기암과 연관되어 발생한 다발적 원발성 악성종양

윤용범(Yong Bum Yoon),송인성(In Sung Song),김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),최상운(Sang Woon Choi),최규완(Kyu Wan Choi),김용태(Yong Tae Kim),한철주(Cheol Joo Han),이준혁(Joon Hyeok Lee),류지곤(Ji Kon Ryu),정현채(Hyun Chae C 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3

N/A Owing to the development of diagnostic techniques and treatment modalities, more and more cases of multiple primary cancers are being discovered and active researches concerning maltiple primary cancers are being done. The mortrality due to cancers of gastrointestinal tract occupies more than two thirds (68.4%) of total number of deathes due to cancers in Korea, but researches on multiple primary cancers concerning gastrointestinal tract are lacking. We reviwed 70 cases of multiple primary cancers concerning gastrointestinal tract, we experienced in the past decade. The ratio of male to female was 3.7:1, the mean age was 52.8 years. From 70 patients with multiple primary cancers, sixty patients had synchronous multiple primary cancers and ten patients had metachronous ones. The frequent sites involved were stomach (51.9%) and liver (21.2%). The most frequent combination of primary and secondary cancer was stomach cancer and primary liver cancer (27%). These results may be contributed to the actual incidence of each cancer, and routine staging work-up of liver for stomach cancer and routine gastroopy for primary liver cancer. In synchronous cancers, majority of the second cancers were found incidentally during routine staging work-up (58.3%) or during operation (8.4%), whereas only 33.3% of second cancers were found due to concomittent symtoms. Thus the incidence of each multiple primary cancer in our study may reflect the relative frequency of each cancer in Korea. In order to determine the true risk of occurrence of multiple primary cancers in Korea, prospective studies based on the large population of community should be conducted.

간세포암의 간동맥 화학색전술후 Lipiodol에 의한 폐 장애

이종균,정훈용,한철주,이준혁,이한주,이효석,김정룡 대한내과학회 1992 대한내과학회지 Vol.42 No.1

간세포암의 간동맥 화학색전술후 분명한 동-정맥 단락의 증거없이 발생한 Lipiodol에 의한 폐 장애 2예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Symptomatic pulmonary embolism by Lipiodol (iodized ethyl esters of the fatty acids of poppy-seed oil) after transarterial chemoembolization for hepatocellular carcinoma has not been reported in the literature. We experienced 2 cases of symptomatic pulmonary complication after transarterial chemoembolization using Lipiodol, adriamycin, gelfoam, and mitomycin-C for the treatment of a huge hepatocellular carcinoma which did not show any angiographic evidence of arteriovenous shut. The first patient suffered from cough, hemoptysis, and fever on the 5th day after transarterial chemoembolization. The presence of retained Lipiodol in the lung was proven by CT scan. The second patient suffered from dyspnea, cough, hemoptysis, and fever on the 4th day after transarterial chemoembolization. The delayed onset of respiratory symptoms was probably due to pulmonary edema compliating pulmonary embolism by Lipiodol.

인체 원발성 간암 세포에서 ras 암유전자들의 활성화와 B형 간염 바이러스 유전자 발현과의 관계

이효석,김정룡,한철주 대한소화기학회 1992 대한소화기학회지 Vol.24 No.3

Substantial epidemiological and molecular biological evidence shows that hepatitis B virus is the most common etiologic agent of human hepatocellular carcinoma. Several studies have revealed increased expression of ras oncogene in hepatocellular carcinoma tissues both in experimental animal and in human. This study was performed to determine the direct relationship of the activation of ras oncogene in human HCC to the expression of HBV genome at the cellular level, using immunocyto-chemical analysis to detect HBsAg and ras p21 on the subsequent different tissue sections and immunocytochemical assay for the detection of ras p21 in combination with in situ hybridization for the detection of HBV DNA/RNA on the same tissue section. Of the twenty-two cases of HCC tissue sections studied, enhanced expression of ras p21 was observed in one HCC case (4.5%); the distribution of ras p21-expressing HCC cells was focal. HBsAg arid HBV DNA/RNA were mostly found in nontumorous hepatocytes but not in ras p21-expressing HCC cells. These findings suggested that continued expression of HBsAg or the presence of HBV DNA/RNA is not necessary for the activation of ras proteins in a given human HCC cell. We conclude that ras oncogene is not directly activated by HBV gene expression.

위궤양에 대한 Cetraxate 2분복법과 3분복법의 치료효과 비교

이동호,윤용범,한철주 대한소화기학회 1992 대한소화기학회지 Vol.24 No.3

To evaluate the effect of 400 mg of cetraxate twice daily on healing of benign gastric ulcer in comparison with that of 200 mg of cetraxate three times daily, 55 patients with benign gastric ulcer were randomly assigned to either group and given each medication for 8 weeks. After 8 weeks of medication the effect of each medication was compared between the two groups with respect to subjective symptoms, degree of ulcer healing by endoscopy, general improvement, adverse reactions and overall effectiveness. In the group of patients given 400 mg of cetraxate twice daily (27 patients), general improvement rate above a moderate degree was 81% and no serious adverse drug reactions were observed. In the group of patients given 200 mg of cetraxate three times daily (28 patients), general improvement rate above a moderate degree was 75% and no adverse drug reactions were not observed either. Comparison of general improvement rate between the two groups showed no difference statistically. Patient compliance to medication did not differ between the two groups, so it seemed that the effects of each medication on ulcer healing were equally effective. Considering that the regimen of 400 mg of cetraxate twice daily is superior to that of 200 mg of cetraxate three times daily in terms of convenience, we conclude that the former. is superior to the latter.

Behcet 장염에서 궤양병변의 내시경적 분류에 따른 임상경과의 예측에 관한 연구

김선미,이동호,김병관,송인성,정현채,박동영,김정룡,최규완,임선희,한철주,정운태 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.1

The intestinal lesion of Behcet's colitis shows aphthoid or punched-out ulceration. But these morphological characteristics are variable and the clinical course of Behcet's colitis is also diverse. There have been many case reports since 1962, but there is few study for clinical course or for morphological characteristics of intestinal lesion of Behcet's colitis. So we retrospectively investigated the clinical course of Behcet's colitis according to colonoscopic findings. Thirty-two patients with Behcet's colitis were investigated retrospectively from January 1984 to July 1994. The patients who had at least two mayor stigmata of Behcet's syndrome with intestinal lesions were included, and whose colonoscopic films were available and whose follow-up studies were done. The studies used at their follow-up were colonoscopy and/or barium enema. In our study the patients ranged in age from 15 to 64 years old, with mean age of 37 years old; 28% were in 3rd decade. The mean follow-up period was 33 months. The macroscopic finding could be classified into 3 types; volcano-shape ulcer, geographic ulcer, and aphthous ulcer. The volcano shaped ulcers that were deep ulcers with nodular margins, converging folds or pseudopolyps were 17 cases, the geographic ulcers that were irregular and rather shallow ulcers with clear edges were 8 cases, and the aphthous ulcers that were ovoid or round, shallow and discrete ulcers were 7 cases. In clinical course, 9(53%) out of 17 cases with volcanoshaped ulcer received operation, 1(6%) out of 17 responded to medical treatment, and 7 cases(41%) didn't respond to medical treatment. While in group of geographic ulcer or aphthous ulcer, 1 case, respectively, (13% of geographic ucer, 14% of aphthous ulcer) received operation and 5 eases in each group (63%, 71% respectively) responded to medical treatment. from these results, we could conclude that the ulcerative lesions of Behcet's colitis classified as volcano shape tend to respond to medical treatment less favorably than those classified as non-volcano shaped ulcer. Moreover, this type has much higher chance of receiving operation than the other two types.