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연구논문 : 비알코올성 지방간질환에서 nonalcoholic fatty Liver diseases activity score (NAS)의 유용성 평가 및 임상적 요소와의 상관성
이경훈 ( Kyung Hun Lee ),박상훈 ( Sang Hoon Park ),김유진 ( Yu Jin Kim ),허경림 ( Kyung Rim Huh ),민광선 ( Kwang Seon Min ),전선영 ( Sun Young Jun ),김경오 ( Kyoung Oh Kim ),박철희 ( Cheol Hee Park ),한태호 ( Taeho Hahn ),유교상 ( 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.1
목적: NASH란 비만, 인슐린저항성, 2형 당뇨병, 고혈압, 고지혈증 등이 포함되는 대사증후군에서 나타나는 간질환으로 진단에 있어서 알코올 섭취 병력과 간생검 조직검사가 매우 중요하다. 그 동안 간생검 조직검사의 진단에 있어서 1999년 Brunt 등이 제시한 분류 체계를 사용해 왔는데, 2005년 NAS가 Kleiner등에 의해 제안되었다. 본 연구는 한국인 NASH환자에 대하여 NAS의 유용성 및 임상지표와의 연관성에 대하여 알아보고자 하였다. 대상 및 방법: 1999년부터 2007년까지 임상적으로 NASH로 진단 받고 초음파 유도하 간조직생검을 시행한 56예의 환자를 대상으로 분석을 시행하였다. 두 명의 병리의사가 같은 조직을 서로 다른 각각의 분류 체계를 이용하여 평가하였다. 중성지방을 포함한 혈청 지질과 CRP, 허리둘레, 체질량지수, 수축기혈압, 이완 기혈압, HOMA-IR 같은 대사증후군의 인자들과 공복 시 포도당, leptin, ferritin, 인슐린, C-peptide 비율 등의 생화학적 요소들을 측정하였다. 결과: 환자들의 평균 나이는 32.1±12.5세였으며 44명(78.6%)이 남자였다. 두 분류 체계에서 차이를 보이는 환자들은 약간의 지방 변성과 풍선양 변화와 섬유화를 동반한 환자들이었다. NAS 3, 4점의 borderline은 전체 판독 예 중 36.6%였다. 두 병리의사의 진단 일치도는 카파 값이 0.748(P<0.001)로 우수하였다. NAS가 높을수록 공복 시 혈당과 ALT, 중성지방이 증가되어 있었다. 결론: NAS는 한국인의 NASH진단에 있어서 간단하고 재연성이 좋은 분류 체계이다. Background/Aim: Nonalcoholic steatohepatitis (NASH) is commonly diagnosed using the semi-quantitative grading and staging system proposed by Brunt et al. in 1999. The Pathology Committee of the NASH established the nonalcoholic fatty liver diseases (NAFLD) activity score (NAS) in 2005. The aim of this study was to elucidate the validity and reliability of the NAS in Korean NAFLD patients. Methods: Fifty-six patients on whom sonography-guided liver biopsy for well-defined NAFLD was performed between 1999 and 2007 were identified retrospectively. Two pathologists evaluated each biopsy sample. NAFLD was evaluated using both the grading system developed by Brunt et al. and the NAS. Each pathologist was blinded to the patients` clinical data and scored independently. We evaluated the body mass index (BMI), liver enzymes, lipid profile, peripheral insulin resistance, leptin, insulin/c-peptide ratio, ferritin, and fasting blood glucose. Results: The patients were aged 32.1±12.5 years (mean±SD) and comprised 44 males (78.6%). Patients with different grades at the two grading systems had mild steatosis or ballooning changes with fibrosis, and 36.6% of them were borderline cases (NAS of 3 or 4). The interobserver agreement on diagnostic category was 0.748 (P<0.001) for the NAS (using weighted κ statistics). Elevated fasting glucose, ALT, and triglyceride were associated with the NAS. Conclusions: The simple and reproducible NAS was found to be a useful pathologic grading system in Korean NAFLD patients. However, the proportion of borderline cases based on the NAS was high. The "wait and see" strategy is necessary for evaluating the long-term prognosis. (Korean J Hepatol 2010;16:29-37)
20대 이하 간세포암종의 증례 : 20대 남자에서 발생한 자가면역간염에 의한 것으로 추정되는 간세포암 1예
김유진 ( Yu Jin Kim ),박상훈 ( Sang Hoon Park ),허경림 ( Kyung Rim Huh ),이경훈 ( Kyung Hoon Lee ),한태호 ( Tae Ho Hahn ),김동준 ( Dong Joon Kim ),이명석 ( Myung Seok Lee ),박충기 ( Choong Kee Park ),김민정 ( Min Jeong Kim ),민수 대한간암연구회 2009 대한간암학회지 Vol.9 No.-
Whether the prognosis of hepatocellular carcinoma in young patients is different from elderly patients is still controversial. Previous reports revealed that most of the young hepatocellular carcinoma patients have hepatitis B viral infection, larger tumor and more advanced stage than elderly patients, and these features not just young age are related with poor survival. We experienced a case of stage IVA hepatocellular carcinoma suspected to be related with autoimmune hepatitis in a 28-year-old man. Even though 3 times of transarterial chemoembolization and best supportive care were given, he died 7 months after diagnosis.
다수의 정맥용 도관의 피하삽입과 지속흡인을 이용한 다량의 자발성 피하공기증 치료
김선영 ( Sun Young Kim ),엄광석 ( Kwang Seok Uom ),이영석 ( Young Seok Lee ),허경림 ( Kyung Rim Huh ),권진우 ( Chin Woo Kwon ),장승훈 ( Seung Hun Jang ),김동규 ( Dong Gyu Kim ),정기석 ( Ki Suck Jung ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.2
A-61-year-old COPD patient was hospitalized due to dyspnea and was diagnosed with acute exacerbation of COPD. During the hospital stay, the patient`s dyspnea was aggravated by massive spontaneous subcutaneous emphysema. Multiple 16 gauge intravenous catheters were inserted at the midclavicular line for drainage. Although subcutaneous catheter drainage was carried out, respiratory failure developed with an increased in massive subcutaneous emphysema. Continuous suction drainage with wall suction was applied resulting in the rapid resolution of the subcutaneous emphysema. We report a case of the that effective management of massive subcutaneous emphysema using multiple 16 gauge intravenous catheters with continuous suction. (Tuberc Respir Dis 2006; 61: 178-183)
성인에서 국소 장괴사를 동반한 Henoch-Schonlein Purpura 1예
김수진 ( Su Jin Kim ),박철희 ( Cheol Hee Park ),김소연 ( So Yeon Kim ),이인정 ( In Joung Lee ),박철민 ( Chul Min Park ),조창범 ( Chang Beom Cho ),권진우 ( Jin Woo Kwon ),박지원 ( Ji Won Park ),허경림 ( Kyung Rim Huh ),김경오 ( Kyo 대한장연구학회 2011 Intestinal Research Vol.9 No.2
Henoch-Schonlein purpura (HSP) is a vasculitis of the small vessels of the skin, joints, gastrointestinal tract, and kidneys characterized by immunoglobulin A deposits in the involved organs. HSP is typified by the classic tetrad of purpura, arthralgia, abdominal pain, and renal involvement. It is common in childhood, but may also occur in adults and can be accompanied by severe complications. Gastrointestinal symptoms occur in up to 85% of patients,and gastrointestinal involvement can manifest as severe problems including intussusception, obstruction, and perforation. The disease course is often self-limited, but severe manifestations occasionally require surgical intervention. We report the case of a 24-year-old man with HSP who presented with abdominal pain and vomiting. Computerized tomography revealed thickening of the ileal wall and multifocal disrupted prominent mucosal enhancement. These findings suggested hemorrhagic enteritis and mucosal necrosis. After treatment with high dose corticosteroids, the lesion improved and surgical intervention was avoided. Our experience suggests that corticosteroid therapy may help in controlling HSP with suspicious small bowel necrosis. (Intest Res 2011;9:148-152)
김제열,조상호,김건일,허경림,김현숙,조구영,최영진,이원용,임종윤 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.2
Cardiac tumors, especially the primary tumors involving any part of the heart are extremely rare and its relative incidence has been reported to be approximately 0.02%. We report a patient with huge cardiac hemangioma who complained of shortness of breath, general weakness, and dizziness, Imaging study by echocardiography and computed tomography of thorax revealed a huge lobulating mass like a bunch of grapes in the right chamber of heart. The surgical exploration of thorax was performed and a histological diagnosis of spindle cell hemangioma was obtained by microscopy. The patient was treated by surgical resection of the tumor and doing well after surgery. Our experience indicated that prompt diagnosis and treatment of cardiac hemangioma is imperative for patients' prognosis.