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유태현,한광협,박성하,김형길,문영명,한재호,조상호 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.2
Recent advances in both the diagnosis and treatment of hepatocellular carcinoma have improved the prognosis and changed the clinical significance of the recently increasing distant metastases. Distant metastases found after successful treament of the primary lesions are of great clinical significance for the treatment of hepatocellular carcinoma. The duodenum is a rare site of hematogenous metastases or direct invasion from hepatocellular carcinoma. A 23 year old man was admitted with upper gastrointestinal bleeding. He had been diagnosed with hepatocellular carcinoma and treated by a left lobectomy and chemoembolization. The patient was admittted for 12 months after the treatment of the primary tumor. Endoscopic examination revealed a mass in the duodenal bulb that protruded into the lumen. He died due to massive hematemesis. We report on a rare case of hepatocellular carcinoma with duodenal invasion in a 23-year-old male patient.
( Hye Won Lee ),( Ha Kyung Jung ),( Beom Kyung Kim ),( Seung Up Kim ),( Do Young Kim ),( Sang Hoon Ahn ),( Kwang-hyub Han ),( Jun Yong Park ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Daclatasvir plus asunaprevir (DCV+ASV) treatment has demonstrated potent antiviral activity in patients with genotype 1b hepatitis C virus (HCV) infection. We investigated the real-life data of DCV+ASV treatment in Korea. Methods: A total of 351 patients with chronic hepatitis C started to treat with DCV+ASV from August 2015 to July 2016. We excluded patients with resistance-associated substitutions (RAS) positive and hepatocellular carcinoma at baseline. The patients received DCV (60mg once daily) plus ASV (100mg twice daily) for 24 weeks. Finally, 251 patients who finished DCV+ASV treatment and they were followed up for 12 weeks after the end of treatment were analyzed. We investigate viroglogic response and the changes of liver fibrosis with non-invasive markers and transient elastography before and after completion of the treatment. Results: The median age was 62 (range, 52-71) years and 154 (60.2%) patients were female. 77.7% were non-cirrhotic and 64.1% were treatment-naïve. The intention-to-treat analysis showed that all patients achieved end-of- treatment response and 98.0% (246/251) patients achieved sustained virological response (SVR) 12. In addition, 96.3% (103/107) of patients older than 65 years and 96.1% (49/51) with cirrhosis achieved SVR12. There was significant improvement in liver stiffness (LS) values by transient elastography (TE), FIB-4 and APRI scores at SVR12. LS values were significantly lower in SVR12 (16.69±14.97 vs. 12.69±10.14, p=0.001). Five patients discontinued this treatment due to treatment failure (n=1), gastrointestinal trouble (n=1), viral breakthrough (n=1), creatinine elevation in patients with chronic kidney disease (n=1) and elevation of liver enzyme (n=1). Conclusions: DCV+ASV dual therapy resulted in high SVR12 rates, a clinically significant improvement in parameters of liver fibrosis and was well tolerated in Korean patients with genotype 1b HCV infection. Further studies are needed to monitor the long-term results of the DCV+ASV treatment.
Case Report : Two cases of telbivudine-induced myopathy in siblings with chronic hepatitis B
( Eun Hye Kim ),( Ha Na Park ),( Kun Ho Lee ),( Sang Hoon Ahn ),( Seung Min Kim ),( Kwang Hyub Han ) 대한간학회 2013 Clinical and Molecular Hepatology(대한간학회지) Vol.19 No.1
Telbivudine is an L-nucleoside analogue with potent antiviral activity against hepatitis B virus (HBV). Clinical trials have shown that telbivudine has a more potent and sustained antiviral activity with a lower frequency of viral resistance than lamivudine. Although there are several reports concerning the safety profile of telbivudine, most adverse events are described as mild and transient in nature. Here we report two cases of telbivudine-induced myopathy in patients with chronic hepatitis B who were siblings. (Clin Mol Hepatol 2013;19:82-86)
종례 : 간 종괴로 오인된 우측 심부전에 의한 간 울혈 1예
신동호 ( Dong Ho Shin ),이명하 ( Myoung Ha Lee ),김도영 ( Do Young Kim ),이경주 ( Kyong Joo Lee ),박준용 ( Jun Yong Park ),안상훈 ( Sang Hoon Ahn ),한광협 ( Kwang Hyub Han ),전재윤 ( Chae Yoon Chon ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.4
This report describes a patient with hepatic congestion due to right heart failure mimicking liver tumor. The patient had a history of breast cancer and left total mastectomy 30 years ago, tricuspid valve regurgitation and tricuspid valve replacement 4 years ago. Three years ago, abdominal contrast-enhanced computed tomography (CT) was performed to evaluate inguinal hernia, which revealed multiple small hepatic nodules. After 1 year, the number and size of liver nodules were increased in CT scan. The patient underwent gun biopsy and histopathology revealed sinusoid enlargement. The patient recently had jaundice, abdominal distension, and peripheral edema. Liver dynamic CT scan was done to evaluate the palpable liver. The number and size of liver nodules were more increased in CT than 2 years ago. In magnetic resonance imaging (MRI), numerous variable sized ill-defined nodules replacing entire liver with progressing centripetal enhancement, which were suggestive of malignancy such as angiosarcoma, were noted. MRI finding suspects malignancy or hemangiosarcoma. Finally, the patient received repeated gun biopsy, and histopathology revealed findings compatible with hepatic congestion. (Korean J Gastroenterol 2010;56:264-267)
간동맥 화학색전술 시행 후 발생한 담도 합병증 치료 중 광범위하게 재발한 간세포암종
오현정 ( Hyun Jung Oh ),박하나 ( Ha Na Park ),이광훈 ( Kwang Hoon Lee ),김도영 ( Do Young Kim ),안상훈 ( Sang Hoon Ahn ),한광협 ( Kwang Hyub Han ),전재윤 ( Chae Yoon Chon ),박준용 ( Jun Yong Park ) 대한간암학회 2011 대한간암학회지 Vol.11 No.2
Hepatocellular carcinoma(HCC) is one of the cancers with poor prognosis. Transarterial chemoembolization(TACE) has been widely used for treating unresectable HCC. Although TACE is considered as a less invasive and relative safe procedure, severe complications such as hepatic failure, pulmonary embolism, liver abscess, biloma formationcan occur rarely after TACE. These complications sometimes may lead to fatal clinical situation, even death. We reported a case of HCC recurred extensively during treatment of biliary complication after TACE. A 44-year-old male with HCC was admitted due to fever for 3 days after undergoing TACE. Three weeks before the admission, he had been diagnosed with HCC recurrence which presented as two arterial enhancing nodules in MRI and treated with TACE. CT scan showed 7 cm sized air containing fluid collections with necrosis suggestive of liver abscess and 15 cm sized biloma formation. Because the patient was in septic shock at admission, percutaneous catheter drainage was performed with use of broad spectrum antibiotics. After treatment of 3 months, the sizes of hepatic abscess and biloma were remarkably decreased. However, 1 month later, large size tumor recurrence and perihepatic lymph node metastasis were found on a follow-up CT scan. In this case, the cause of rapid growing recurrence after TACE is uncertain, but the development of unanticipated complication seems to affect the progression to poor prognosis. Therefore, early recognization of predisposing factors with proper management would be needed to prevent these serious complications after TACE.