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황남철,최문석,이준혁,고광철,백승운,유병철,이종철,이광웅,조재원,박철근 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.2
목적: 간의 국소 결정성 과형성은 일반적으로 특별한 치료가 필요 없는 양성 종양이다. 그러나 드물지만 합병증이 발생한 경우와 진단이 불확실한 경우에는 수술을 시행하게 된다. 이에 저자들은 간절제술을 시행한 국소 결절성 과형성의 임상적, 영상학적 특징들을 알아보고자 하였다. 대상과 방법: 1995년부터 2003년까지 수술을 시행하여 조직을 확인한 국소 결절성 과형성 환자 10명을 대상으로 연령, 성별, 실험실 검사 및 영상 소견과 조직 소견을 분석하였다. 결과: 연령의 중앙값은 37.5세, 남녀 비는 1.5:1이었다. 5예에서는 간세포선종이나 간세포암종을 감별할 수 없어서 수술을 시행하였으며, 수술 후 우연히 진단된 예는 4예이었다. 간세포암종의 위험 인자를 가지고 있었던 예는 4예(B형 간염 바이러스 보유자 3예, 간경변 2예)이었다. CT검사가 시행되었던 6예 중 5예는 동맥기에서 조영 증강을 보였고 문맥기 및 지연기로 감에 따라 주변과 동일(4예)한 또는 감소(2예)되는 양상을 보여 간세포암종과의 감별이 어려웠다. 크기는 3.2±2.2㎝이었으며 위치는 간우엽의 후하구역(S6)에 가장 많았다(30.0%). 4예에서 수술 전 침생검을 시행하였으나 고분화 간세포암종이나 간세포선종과의 감별이 어려웠다. 결론: 임상상, 영상검사 및 간침생검으로도 간세포암종이나 간세포선종과의 감별이 어려운 경우 수술을 시행하였으며 수술 전에는 발견하지 못하였지만 다른 질환으로 인한 수술시 우연히 발견된 경우도 있어 국소 결절성 과형성의 수술 전 진단이 어려운 경우가 적지 않음을 알 수 있었다. Background/Aims: Focal nodular hyperplasia (FNH) is a benign hepatic tumor with few serious complications and no malignant transformation. However, differential diagnosis between FNH and other liver tumors, especially hepatocellular carcinoma, is often difficult. Methods: Clinical features of surgically resected FNH were reviewed. From January, 1995 to February, 2003, 10 patients with surgically resected FNH were enrolled. Their age, sex, results of laboratory examination, imaging studies and pathologic findings were evaluated. Results: Median age was 37.5 years and sex ratio (male:female) was 1.5:1. In 5 cases, resection to exclude hepatic adenoma or HCC was performed. Four cases were diagnosed incidentally after surgery. Four patients had risk factors for HCC, such as hepatitis B virus infection, liver cirrhosis or both. The size of FNH was 3.2 2.2 cm. The most common site of the tumor was segment 6 (30.0%). Differential diagnosis with HCC was difficult in 5 of six cases in whom CT was performed. Although needle biopsies were performed preoperatively in 4 cases, it was difficult to distinguish FNH from hepatic adenoma or HCC. Conclusions: FNH was resected due to uncertainty of diagnosis, or incidentally during hepatectomy in patients with other liver disease. In the former, differential diagnosis with hepatic adenoma or HCC was a major problem despite extensive work-up including dynamic CT or biopsy. (Korean J Hepatol 2004;10:135-141)
라미부딘과 HBIg 1주일 단기 병합요법은 간이식 후 B형 간염 재발 방지에 HBIg 장기 고용량 투여요법만큼 효과적인가?
김성주,장재권,이석구,도재혁,백승운,최문석,조재원,고광철,이풍렬,이종철,최규완,박상종,이준혁,김재준,임윤정,안병훈 대한소화기학회 2001 대한소화기학회지 Vol.37 No.1
Background/Aims : The aim of this study was to evaluate whether the regimen consisted of lamivudine and one-week HBIg for HBV prophylaxis after liver transplantation is as effective as long-term therapy of high dose HBIg. Methods: Sixty-one patients with HBV infection were randomly divided into two groups: HBIg group of 31 patients and combination group of 30 patients. In the HBIg group, HBIg was given according to the standard dosing schedule. In the combination group, lamivudine was given indefinitely from at least 4 weeks before transplantation, and 10,000 IU of HBIg was given during anhepatic phase and 6 consecutive days. Results: The two groups were not different in HBeAg and HBV DNA positivity. In the HBIg group, the median follow-up of 20 long-term survivors was 12.7 months (range: 4.0 - 48.2) and that of 23 survivors in the combination group was 22.3 months (4.2 - 42.2). Hepatitis B recurred in a patient of the HBIg group and 2 of the combination group. The recurrence-free survival rate of long-term survivors was 66.7% (95% C.I., 39.5% - 93.9%) in the HBIg group and 76.0% (58.6% - 93.4%) in the combination group after 40 months. Conclusions: The combined therapy of lamivudine and one-week HBIg has an effect equivalent to long-term therapy of high dose HBIg in HBV prophylaxis after liver transplantation at a much lower cost.
Jae Keun Park,Ju-Il Yang,Jong Kyun Lee,Joo Kyung Park,Kwang Hyuck Lee,Kyu Taek Lee,Jae-Won Joh,Choon Hyuck David Kwon,Jong Man Kim 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.1
Background/Aims: Biliary strictures remain one of the most challenging aspects after living donor liver transplantation (LDLT). The aim of this study was to assess long-term outcome of endoscopic treatment of biliary strictures occurring after LDLT and to identify risk factors of recurrent biliary strictures following endoscopic retrograde biliary drainage (ERBD) in LDLT. Methods: A total of 1,106 patients underwent LDLT from May 1995 to May 2014. We compared the risk factors between patients with and without recurrent biliary strictures. Results: Biliary strictures developed in 24.0% of patients. Technical success rate of ERBD for biliary stricture after LDLT was 66.2% (145/219). Among 145 patients managed by endoscopic drainage, stricture resolution occurred in 69 with median duration of stent indwelling of 13.6 months (range, 0.5 to 67.3 months), and stricture recurrence was seen in 20 (21.3%) out of 94. The median recurrence-free duration after final endoscopic success was 13.1 months (range, 0.5 to 67.3 months). Older donor age (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.03 to 1.17; p=0.004) and non-B, non-C liver cirrhosis (HR, 5.10; 95% CI, 1.10 to 25.00; p=0.043) were associated with higher recurrence of biliary stricture. Conclusions: Long-term stricture resolution rate after ERBD insertion for biliary stricture occurring after LDLT was 73.4%. Clinicians should pay careful attention during following-up to decide when to remove ERBD in patients who have factors associated with recurrent biliary strictures.
Lim, Jae Hoon,Kim, Min Ju,Chiang, Liu Wei,Lim, Hyo Keun,Park, Cheol Keun,Paik, Seung Woon,Joh, Jae Won,Koh, Kwang Cheol 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.2
Objective: The objective of this study was evaluate the diagnostic efficacy of three-phase helical dynamic CT in the detection of hepatocellular carcinomas in patients with advanced liver cirrhosis. Materials and Methods: Three-phase helical dynamic CT in 77 patients with advanced liver cirrhosis was evaluated prospectively before orthotopic liver transplantation. The histopathologically confirmed hepatocellular carcinomas in the explanted livers were compared with pretransplantation CT results by one-to-one correlation. Results: Histopathologic examination of the explanted livers revealed 72 hepatocellular carcinomas in 41 patients. The size of the hepatocellular carcinomas was 0.5-14.0 cm (mean, 1.6 cm). The use of helical dynamic CT enabled the detection of 38 of 72 hepatocellular carcinomas (sensitivity, 53%). Fifteen of 35 (43%) hepatocellular carcinomas smaller than 2 cm and 23 of 37 (62%), hepatocellular carcinomas ranging from 2.0 cm to 14.0 cm were detected. Patient sensitivity and specificity in the detection of hepatocellular carcinoma were 81% (33/41) and 94% (34/36), respectively. Conclusions: Three-phase helical dynamic CT is insensitive for detection of hepatocellular carcinomas in patients with advanced liver cirrhosis, especially for hepatocellular carcinomas smaller than 2 cm.(Korean J Hepatol 2002;8:201-208)
( Mll Jae Shin ),( Sang Hyun Song ),( Hyung Hwan Moon ),( Sang Hoon Lee ),( Tae Seok Kim ),( Jong Man Kim ),( Choon Hyuck ),( David Kwon ),( Sung Joo Kim ),( Jae Won Joh ),( Suk Koo Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Purpose: At the time of transplantation, the recipient serum is tested with the prospective donor lymphocytes to identify specific reactivity in the donor-specific crossmatch. A positive crossmatch is a contraindication for kidney transplantation because of the higher incidence of antibody mediated rejection. However, numerous studies has found that the liver is resistant to it. We investigated the relationship between the pretransplant lymphocytotoxic crossmatch results and the long-term outcome after liver transplantation in a single center. Methods: From January 1996 to December 2010, 1021 living or deceased donor liver transplant recipients were included. Their medical records and pretransplant crossmatch results were collected. Results: 69 of 1021 (6.8%) liver transplants were performed with a positive crossmatch and their outcome was compared with the remaining 952 performed with a negative crossmatch. No significant differences in rejection, biliary complication, vascular complication, primary disease recurrence and de novo malignancy were found in negative and positive T- or B-lymphocytotoxic crossmatch recipients. Graft loss and patient survival were not inferior in the recipient group testing positive crossmatch. Besides, T and B cell crossmatch against donor showed positive results initially. But recipient``s autocontrol (recipient``s cell + recipient``s serum) also showed similar positive results. After dithiothreitol (DTT) treatment, all previous positive result was converted to negative. So, IgM class autoantibody against recipient``s own antigen was strongly suggested. We defined these subpopulation as false positive crossmatch group, accounting for 41 (4.0%) recipients. Significantly high incidences of de novo malignancies, especially lymphoid malignancy including posttransplant lymphoproliferative disorder, were observed in false positive crossmatch recipients compared to those of negative controls. (p=0.018 in overall de novo malignancy, p=0.029 in lymphoid malignancy) Conclusion: This study demonstrated that the presence of circulating IgM autoantibody in the recipient may be a risk factor for de novo malignancy, specially lymphoid malignancy. Although the precise mechanism remains unclear, immunologic factors is considered to involve in the pathogenesis of de novo malignancy.
Kyo Won Lee,Chan Woo Cho,Nuri Lee,Gyu-Seong Choi,Yang Hyun Cho,Jong Man Kim,Choon Hyuck David Kwon,Jae-Won Joh 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.93 No.3
Purpose: This study was designed to assess the outcome of the extracorporeal membrane oxygenation (ECMO) in liver transplantation (LT) recipients with refractory septic shock and predict the prognosis of those cases. Methods: From February 2005 to October 2012, ECMO was used in 8 cases of refractory septic shock. Laboratory values including lactate and total bilirubin level just before starting ECMO were obtained and sepsis-related organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACH) II score and simplified acute physiology score (SAPS) 3 were calculated. Subsequent peak serum lactate and total bilirubin level, and SOFA score after 24 hours of starting ECMO were measured. Results: Comparisons were made between survivors and nonsurvivors. ECMO was weaned off successfully in 3 patients (37.5%) and 2 patients (25%) survived to hospital discharge. Clinical scores including SOFA, APACH II, and SAPS3 and laboratory results including lactate, total bilirubin and CRP were not significantly different between survivor and nonsurvivor groups. Lactate level and SOFA score tended to decrease after ECMO support in survivor group and total bilirubin and CRP level tended to increase in nonsurvivor group. Conclusion: Our findings suggest that the implantation of ECMO might be considered in highly selected LT recipients with refractory septic shock.
( Mill Jae Shin ),( Sang Hyun Song ),( Hyung Hwan Moon ),( Sang Hoon Lee ),( Tae Seok Kim ),( Jong Man Kim ),( Choon Hyuck David Kwon ),( Sung Joo Kim ),( Jae Won Joh ),( Suk Koo Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Purpose: At the time of transplantation, the recipient serum is tested with the prospective donor lymphocytes to identify specific reactivity in the donor-specific crossmatch. A positive crossmatch is a contraindication for kidney transplantation because of the higher incidence of antibody mediated rejection. However, numerous studies has found that the liver is resistant to it. We investigated the relationship between the pretransplant lymphocytotoxic crossmatch results and the long-term outcome after liver transplantation in a single center. Methods: From January 1996 to December 2010, 1021 living or deceased donor liver transplant recipients were included. Their medical records and pretransplant crossmatch results were collected. Results: 69 of 1021 (6.8%) liver transplants were performed with a positive crossmatch and their outcome was compared with the remaining 952 performed with a negative crossmatch. No significant differences in rejection, biliary complication, vascular complication, primary disease recurrence and de novo malignancy were found in negative and positive T- or B-lymphocytotoxic crossmatch recipients. Graft loss and patient survival were not inferior in the recipient group testing positive crossmatch. Besides, T and B cell crossmatch against donor showed positive results initially. But recipient`s autocontrol (recipient`s cell + recipient`s serum) also showed similar positive results. After dithiothreitol (DTT) treatment, all previous positive result was converted to negative. So, IgM class autoantibody against recipient`s own antigen was strongly suggested. We defined these subpopulation as false positive crossmatch group, accounting for 41 (4.0%) recipients. Significantly high incidences of de novo malignancies, especially lymphoid malignancy including posttransplant lymphoproliferative disorder, were observed in false positive crossmatch recipients compared to those of negative controls. (p=0.018 in overall de novo malignancy, p=0.029 in lymphoid malignancy) Conclusion: This study demonstrated that the presence of circulating IgM autoantibody in the recipient may be a risk factor for de novo malignancy, specially lymphoid malignancy. Although the precise mechanism remains unclear, immunologic factors is considered to involve in the pathogenesis of de novo malignancy.