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( Dong Hoo Joh ),( Jin Dong Kim ),( Young Nam Kim ),( Ha Hun Song ),( Hyun Kim ),( Kyung Ho Song ),( Sang Jin Lee ),( Jeong Rok Lee ),( Won Joong Jeon ),( Byung Hyo Cha ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.4
Hepatocellular carcinoma (HCC) in the caudate lobe remains one of the most intricate locations where various treatments tend to pose problems with regard to the optimal approach. Surgical resection has been regarded as the most effective treatment; however, isolated resection of the caudate lobe is strenuous and associated with a high rate of early recurrence. Percutaneous ablation might be technically difficult or impossible to perform due to the deep location of tumors and adjacent large vessels. Treatment with drug-eluting beads (DEB) can potentially enhance the therapeutic efficacy for patients with unresectable HCC by drawing on the slower, more consistent drug delivery process. We described a case of a 62-year-old man with HCC in the caudate lobe who was successfully treated by DEB. (Korean J Hepatol 2010;16:405-409)
( Dong Hoo Joh ),( Sang Hoon Ahn ),( Seung Up Kim ),( Do Yong Kim ),( Kwang Hyub Han ),( Chae Yon Chon ),( Jun Yong Park ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background/Aim: Entecavir (ETV) is a potent and safe treatment for Lamivudine (LAM)-refractory chronic hepatitis B (CHB), but risk of ETV resistance is known to be high in LAM resistant patients. Although many current hepatitis B virus (HBV) treatment guidelines do not recommend ETV as a rescue therapy for LAM refractory HBV, many patients with LAM resistance have been treated with ETV. This study analyzed long term (median 30month) treatment response of ETV rescue therapy for LAM resistant HBV in a single center. Methods: We retrospectively reviewed 92 CHB patients with LAM resistance who underwent rescue therapy with ETV from January 2007 to December 2011 at Severance Hospital. All patients were treated with ETV 1mg, with treatment duration of at least 1 year. Results: Cumulative virologic response was 38%, 48.2%, 49.7%, 52.6% and cumulative virologic breakthrough was 1.1%, 15.0%, 29.0%, 31.9% at 12month, 24month, 36month, 48month respectively. HBeAg negativity (p-value 0.021) and lower titer of initial HBV DNA level (p-value 0.003) were related to virologic response. The receiver operating characteristic curve analysis showed that the DNA levels at 12month had the greatest power (AUROC 0.907; 95% CI 0.836, 0.977; p<0.001) to predict the HBV DNA negativity at median 36month. The best cutoff value for the DNA level at 12month was 2.25 log10IU/ml, with a sensitivity and specificity of 90% and 83.3%. Conclusions: This study provides long term real-life data of ETV monotherapy for patients with LAM resistant HBV for maximum 48month. The cumulative virologic response did not increase consistently during maximum follow up period, but virologic breakthrough did. HBeAg negativity and low initial HBV DNA level were predictive factors for virologic response. Patients who achieved HBV DNA level of <2.25 log10 IU/ml at 12month are expected to have long term antiviral efficacy, and should therefore maintain ETV therapy.
( Dong Hoo Joh ),( Sang Hoon Ahn ),( Seung Up Kim ),( Do Yong Kim ),( Kwang Hyub Han ),( Chae Yon Chon ),( Jun Yong Park ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Background/Aim: Entecavir (ETV) is a potent and safe treatment for Lamivudine (LAM)-refractory chronic hepatitis B (CHB), but risk of ETV resistance is known to be high in LAM resistant patients. Although many current hepatitis B virus (HBV) treatment guidelines do not recommend ETV as a rescue therapy for LAM refractory HBV, many patients with LAM resistance have been treated with ETV. This study analyzed long term (median 30month) treatment response of ETV rescue therapy for LAM resistant HBV in a single center. Methods: We retrospectively reviewed 92 CHB patients with LAM resistance who underwent rescue therapy with ETV from January 2007 to December 2011 at Severance Hospital. All patients were treated with ETV 1mg, with treatment duration of at least 1 year. Results: Cumulative virologic response was 38%, 48.2%, 49.7%, 52.6% and cumulative virologic breakthrough was 1.1%, 15.0%, 29.0%, 31.9% at 12month, 24month, 36month, 48month respectively. HBeAg negativity (p-value 0.021) and lower titer of initial HBV DNA level (p-value 0.003) were related to virologic response. The receiver operating characteristic curve analysis showed that the DNA levels at 12month had the greatest power (AUROC 0.907; 95% CI 0.836, 0.977; p<0.001) to predict the HBV DNA negativity at median 36month. The best cutoff value for the DNA level at 12month was 2.25 log10IU/ml, with a sensitivity and specificity of 90% and 83.3%. Conclusions: This study provides long term real-life data of ETV monotherapy for patients with LAM resistant HBV for maximum 48month. The cumulative virologic response did not increase consistently during maximum follow up period, but virologic breakthrough did. HBeAg negativity and low initial HBV DNA level were predictive factors for virologic response. Patients who achieved HBV DNA level of <2.25 log10 IU/ml at 12month are expected to have long term antiviral efficacy, and should therefore maintain ETV therapy.
십전대보탕(十全大補湯)을 투여한 흰쥐의 혈액중 금속농도변화에 관한 연구
조후리,이선동,Joh Hoo-Li,Lee Sun-Dong 대한예방한의학회 1999 대한예방한의학회지 Vol.3 No.2
This study was to investigate the metal accumulation from SipJeonDaeBo-Decoction to rat blood of Sprague Dawley. 1. There were no significance in body weight, water dose feed ingestion quantity, liver, kidney, brain, bone weights between the control and the experimental groups. Under the experiment with drinking waters was no metal ${\sim}\;0.65mg/L$ detected. Metal level within feed found 0.0001-376.983mg/kg. 2. In the pack of SipJeonDaeBo-decoction, there detected no metal ${\sim}2.086mg/L$ 3. After P.O(per os) SipJeonDaeBo-decoction, As is detected $2.390{\pm}0.812mg/kg$ in blood; Cd $0.001{\pm}0.001mg/kg$, Co $0.003{\pm}0.001mg/kg$, Cr $0.432{\pm}0.234mg/kg$, Cu $1.013{\pm}0.373mg/kg$, Fe $426.293{\pm}114.842mg/kg$, no Hg, Mn $0.109{\pm}0.082mg/kg$, Ni $0.122{\pm}0.068mg/kg$, Zn $3.584{\pm}1.270mg/kg$. 4. The concentration of Hazardous heavy metal (As, Cd, Co, Cr, Hg, Ni, Pb) within blood control group is searched $0.488{\pm}0.138\;mg/l$; experiment I group $0.432{\pm}0.080mg/l$, experiment II group $0.588{\pm}0.213mg/l$. In the concentration of non hazardous heavy metal(Cu, Fe, Mn, Zn) control group $101.409{\pm}6.832mg/l$; experiment I group $96.062{\pm}5.732\;mg/l$, experiment II group $125.139{\pm}044.820mg/l$. 5. Correlation among every metal in blood Zn and Cr was 0.87956 ; Cd and As -0.02316, Pb and As -0.08738, Ni and As 0.07824, Mn and As 0.07824, Mn and Cd 0.04999. Briefly under the injection of SipJeonDaeBo-decoction, this study was defined within safety in blood level by P.O. during 10 days.
The Rebleeding Risk and Prognostic Factors of Acute Hemorrhagic Rectal Ulcer
( Bun Kim ),( Min Seok Han ),( Dong Hoo Joh ),( Dong Jun Lee ),( Hye Sun Shin ),( Soo Jung Park ),( Sung Pil Hong ),( Jae Hee Cheon ),( Tae Il Kim ),( Won Ho Kim ) 대한장연구학회 2012 Intestinal Research Vol.10 No.4
Background/Aims: Acute hemorrhagic rectal ulcer (AHRU) is an important etiology of lower gastrointestinal bleeding in intensive care unit patients and hospital inpatients. Moreover, with increasing elderly populations, and improved survival in critically ill patients, the incidence of AHRU has increased. The aim of this study is to determine rebleeding risk and prognostic factors of AHRU patients. Methods: We retrospectively reviewed 32 patients with AHRU in Severance Hospital from February 2006 to October 2010, collected clinical data, and analyzed their association with the recurrence of bleeding and mortality of patients. Results: The mean age of patients was 65.5 years, and 27 patients (84.4%) showed Eastern Cooperative Oncology Group performance status 3-4. Nineteen patients (59.4%) had recurrent bleeding. Hypoalbuminemia (≤2.5 g/dL) was a risk factor of rebleeding in univariate and multivariate analysis. For patients with chronic liver disease, hypoalbuminemia (≤2.5 g/dL), renal dysfunction (>2 mg/dL) and thrombocytopenia (<150,000/μL) showed relatively earlier rebleeding than those without (P=0.007, P=0.009, P=0.027 and P=0.043, respectively). The endoscopic hemostasis at the first bleeding event was associated with lower early rebleeding rate (P=0.048). In univariate analysis, chronic liver disease, hypoalbuminemia (≤2.5 g/dL) and the prolongation of activated partial thromboplastin time (>40 seconds) increased mortality (P=0.028, P=0.008 and P=0.027, respectively) and the patients with rebleeding showed a tendency toward higher mortality, compared to those without (57.9% vs. 23.1%, P=0.051). Conclusions: In AHRU patients, hypoalbuminemia was a risk factor of rebleeding, and chronic liver disease, hypoalbuminemia, renal dysfunction, thrombocytopenia and no endoscopic treatment at the first bleeding event was correlated with relatively earlier rebleeding. (Intest Res 2012;10:343-349)
증례 : 소화기 ; 재발성 췌장암으로 항암화학요법을 시행한 환자에서 발생한 복부 방선균증
조인래 ( In Rae Cho ),이승우 ( Seung Woo Yi ),조중현 ( Jung Hyun Jo ),조동후 ( Dong Hoo Joh ),한민석 ( Min Seok Han ),박정엽 ( Jeong Youp Park ),송시영 ( Si Young Song ) 대한내과학회 2013 대한내과학회지 Vol.85 No.4
저자들은 재발성 췌장암으로 인해 고식적 항암화학치료를 받고 있던 46세 남자 환자에서 복부 전산화 단층 촬영상 암종의 재발로 의심되는 종괴 형태로 발생한 복부의 방선균증의 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. A 46-year-old male patient with recurrent pancreatic cancer was admitted with a newly developed abdominal mass. The patient had a history of diabetes and underwent total pancreatectomy with partial gastrectomy followed by adjuvant concurrent chemoradiation therapy and palliative chemotherapy. Abdominal CT scan during palliative chemotherapy showed an abdominal wall mass. We performed excisional biopsy for diagnosis. Histological examination revealed actinomycosis of the abdominal wall. The patient was treated with penicillin G. This case showed that actinomycosis can occur in a patient receiving chemotherapy and may mimic cancer recurrence. Therefore, when evaluating a newly developed abdominal mass in patients who are receiving chemotherapy or radiotherapy, the probability of actinomycotic infection must also be considered, especially in patients with a history of surgery and diabetes mellitus. (Korean J Med 2013;85:401-405)
( Beom Kyung Kim ),( Seung Up Kim ),( Hyon Suk Kim ),( Jun Yong Park ),( Sang Hoon Ahn ),( Chae Yoon Chon ),( In Rae Cho ),( Dong Hoo Joh ),( Young Nyun Park ),( Kwang Hyub Han ),( Do Young Kim ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background/Aims: Diagnostic values of FibroTest (FT) for hepatic fibrosis have rarely been assessed in Asian chronic hepatitis B (CHB) patients. We aimed to validate its diagnostic performances in comparison with liver stiffness (LS). Methods: From 2008 to 2010, 194 CHB patients who underwent liver biopsies along with FT and transient elastography were prospectively enrolled. Fibrosis stage was assessed according to the Batts and Ludwig system. Results: To predict significant fibrosis (F≥2), advanced fibrosis (F≥3), and cirrhosis (F=4), areas under receiver operating characteristic curves (AUROCs) of FT were 0.903, 0.907, and 0.866, comparable to those of LS (0.873, 0.897, and 0.910, respectively). Optimized cutoffs of FT to maximize sum of sensitivity and specificity were 0.32, 0.52, and 0.68 for F≥2, F≥ 3, and F=4, while those of LS were 8.8, 10.2, and 14.1 kPa, respectively. According to FT and LS cutoffs, 123 (63.4%) and 124 (63.9%) patients were correctly classified consistent with histological fibrosis (F1, F2, F3, and F4), respectively. Overall concordance between each fibrosis stage estimated by FT and LS was observed in 111 patients, where 88 were correctly classified with histological results. A combination formula adding LS to FT (LS+FT) showed similar AUROC levels (0.885, 0.905, and 0.915), while another multiplying LS by FT (LS×FT) showed the best AUROCs (0.941, 0.931, and 0.929 for F≥2, F≥3, and F4, respectively). Conclusions: FT provides good fibrosis prediction, with comparable outcomes to LS in Asian CHB patients. FT substantially reduces need for liver biopsy, especially when used in combination with LS.