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신승각 ( Seung Kak Shin ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.2
Abdominal ultrasonography is an easy to use and relatively safe method for screening of focal liver diseases. Sonographic features such as size, location, echogenicity, and mass effect of lesions are helpful for the differentiation of focal liver diseases. In this article, sonographic characteristics for the differentiation of liver masses and focal lesions including benign and malignant lesions are discussed.
유전자 6형 만성C형간염 환자의 유병률과 위험인자 그리고 임상적 특징: 단일기관 경험
신승각 ( Seung Kak Shin ),박수용 ( Soo Yong Park ),정영걸 ( Young Kul Jung ),김의주 ( Eui Joo Kim ),이헌남 ( Heon Nam Lee ),이종준 ( Jong Joon Lee ),권오상 ( Oh Sang Kwon ),최덕주 ( Duck Joo Choi ),김연수 ( Yun Soo Kim ),김주현 ( 대한소화기학회 2015 대한소화기학회지 Vol.65 No.2
Background/Aims: Hepatitis C genotypes 1 and 2 are widely distributed globally. In contrast, genotype 6 is found mainly in Southeast Asia, while genotype 6 is rare in Korea. This study aims to investigate the prevalence, risk factors and clinical characteristics of patients with genotype 6 chronic hepatitis C. Methods: We retrospectively identified 133 HCV-infected patients who underwent HCV genotype analysis between January 2012 and December 2012, and analyzed the prevalence, risk factors and clinical characteristics of patients diagnosed with genotype 6 chronic hepatitis C. Results: Among 133 patients, 53 patients (39.8%) were infected with genotype 1, 62 patients (46.6%) with genotype 2, 2 patients (1.5%) with genotype 3, 14 patients (10.5%) with genotype 6, and 2 patients (1.5%) with mixed genotypes (genotype 1 and 6). The risk factors associated with genotype 6 were acupuncture (n=4, 28.6%), intravenous drug use (n=3, 21.4%), tattoo (n=2, 14.3%), and transfusion (n=2, 14.3%). Of the 14 patients with genotype 6, 6 patients were treated with pegylated interferon and ribavirin. Five patients had reached the end of treatment. All patients reaching end of treatment for genotype 6 showed early virological response and sustained virological response. Conclusions: The prevalence of genotype 6 is 10.5% and mixed infections of genotype 1 and 6 are 1.5% in patients with chronic hepatitis C. A major potential risk factor is intravenous drug use and the treatment response rate to pegylated interferon plus ribavirin is high in patients with genotype 6 chronic hepatitis C. Large scale multicenter studies are needed.
진행 간세포암종 환자에서 소라페닙 치료 후 발생한 간농양증
신승각 ( Seung Kak Shin ),정영걸 ( Young Kul Jung ),윤현화 ( Hyun Hwa Yoon ),권오상 ( Oh Sang Kwon ),김연수 ( Yun Soo Kim ),최덕주 ( Duck Joo Choi ),김주현 ( Ju Hyun Kim ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.1
Hepatocellular carcinoma (HCC) is a critical global health issue and the third most common cause of cancer-related deaths worldwide. The majority of patients who present HCC are already at an advanced stage and their tumors are unresectable. Sorafenib is a multi-kinase inhibitor of the vascular endothelial growth factor pathway and was recently introduced as a therapy for advanced HCC. Furthermore, studies have shown that oral sorafenib has beneficial effects on survival. However, many patients experience diverse side effects, and some of these are severe. Liver abscess development has not been previously documented to be associated with sorafenib administration in HCC. Here, we report the case of a HCC patient that developed a liver abscess while being treated with sorafenib. (Korean J Gastroenterol 2014;63:47-50)
소화기; 악성 림프종 환자에서 항암화학요법 후 발생하는 B형 간염의 재활성화
장승준 ( Seung Jun Jang ),정영걸 ( Young Kul Jung ),백혜림 ( Hae Lim Baek ),윤현화 ( Hyun Hwa Yoon ),신승각 ( Seung Kak Shin ),홍준식 ( Jun Shik Hong ),박진희 ( Jin Ny Park ),권오상 ( Oh Sang Kwon ),김연수 ( Yun Soo Kim ),최덕주 ( 대한내과학회 2013 대한내과학회지 Vol.85 No.6
목적: 악성 림프종 환자에서 항암 치료 후 발생하는 B형간염의 재활성화는 중요한 합병증 중 하나이다. 이러한 B형간염의 재활성화는 항암 치료의 연기 혹은 심각한 간부전을 초래함으로써 결국 악성 림프종 환자의 생존율에 악영향을 준다. B형 간염의 재활성화는 항암 치료 전 검사에서 HBsAg양성인 환자뿐만 아니라 HBsAg 음성인 환자에서도 발생할 수 있다. 실제로 HBsAg이 음성일지라도 과거 B형 간염을 앓았거나 잠재감염 상태인 환자는 anti-HBc 양성 소견을 보인다. 본 연구는 단일 의료센터에서 6년간 항암 치료를 받은196명의 환자를 후향적으로 분석하여 B형 간염의 재활성화 율과 이를 예방하기 위한 방법에 대해 알고자 한다. 방법: 2005년 1월부터 2010년 12월까지 가천대 길병원에서 악성 림프종을 진단받고 항암 치료를 시행받은 196명이 환자들의 검사 결과 및 임상경과 자료를 후향적 분석하였다. 결과: 악성 림프종을 진단받은 총 196명의 환자에 대해항암 치료 전 HBsAg 검사율은 88% (172/196)였으며 11명이 양성이었다. Anti-HBc 검사율은 13% (26/196)에 그쳤으며 HBsAg 음성이면서 Anti-HBc 양성인 환자는 15명이었다. 재활성화는 HBsAg 양성군에서 27.3% (3/11), HBsAg 음성군에서 6.7% (1/15) 발생하였으며 이들은 entecavir 혹은 lamivudine복용 후에 모두 후유증 없이 간기능을 회복하였으며 항암치료를 종료하였다. 결론: HBsAg 양성인 환자뿐만 아니라 과거감염이나 회복된 감염을 의미하는 Anti-HBc 양성인 환자에서도 재활성화는 발생하였다. 따라서 항암 치료 시작 전에 B형 간염 바이러스에 대한 상태를 평가하고 재활성화를 예방하기 위한 적절한 검사와 선제 치료가 필요하다. Background/Aims: Reactivation of hepatitis B virus (HBV) has been reported in HBV surface antigen (HBsAg)-positive patients undergoing chemotherapy, as well as HBsAg-negative patients with antibodies against HBV core antigen (HBcAg) and/or HBsAg (HBsAb). Chemotherapy-including rituximab-has recently been identified as a predictive factor for HBV reactivation in HBsAg- negative patients with malignant lymphoma. The aim of our study was to identify the factors predictive of HBV reactivation after chemotherapy in patients with malignant lymphoma. Methods: We conducted a retrospective analysis of medical records from patients diagnosed with malignant lymphoma at Gachon University Gil Medical Center in City, County from January 2005 to December 2010. We subsequently determined HBsAg, HBsAb and anti-HBc status in the 196 patients treated with chemotherapy. Results: The mean age of the patients was 57.3 ± 14.5 years; 56.3% were male. A total of 172 of 196 (88%) patients in the study population were HBsAg (+) prior to chemotherapy. Three patients (3/11, 27.3%) in the HBsAg (+) group had confirmed HBV reactivation after chemotherapy. In addition, 26 of 196 (13%) patients in the study population tested HBcAg (+) positive prior to chemotherapy. One patient (1/15, 6.7%) in the HBsAg (-)/HBcAb (+) group had confirmed HBV reactivation. In the four patients with HBV reactivation, infection was resolved after treatment with 0.5 mg entecavir or 100 mg lamivudine. Conclusions: Reactivation of HBV after systemic chemotherapy can occur in HBsAg (-) patients. We recommend that malignant lymphoma patients undergoing chemotherapy be screened for HBV infection status, including HBcAg, and followed closely to prevent HBV reactivation. (Korean J Med 2013;85:598-603)
HBsAg 소실 후 경구 핵산유사체를 중단한 만성 B형간염의 혈청 재양전 및 급성 악화
조혜정 ( Hye Jeong Cho ),신승각 ( Seung Kak Shin ),권오상 ( Oh Sang Kwon ),김주현 ( Ju Hyun Kim ),김연수 ( Yun Soo Kim ) 대한소화기학회 2020 대한소화기학회지 Vol.76 No.5
Although rare patients with chronic hepatitis B can achieve HBsAg loss on oral nucleos(t)ide analog (NA), the optimal timing of stopping oral NAs safely has been considered when HBsAg and HBV DNA are negative in the serum because HBsAg loss induced by nucleos(t)ide analogs (NAs) appears to be durable if immunosuppressive therapy or chemotherapy are not done. On the other hand, the author experienced a case of HBsAg seroreversion and acute decompensation after the discontinuation of NA in a patient with HBsAg loss. This rare case highlights the need for the close monitoring of patients who achieved HBsAg loss and stopped NA. (Korean J Gastroenterol 2020;76:256-260)
이동민 ( Dong Min Lee ),권오상 ( Oh Sang Kwon ),최윤이 ( Youn-i Choi ),신승각 ( Seung Kak Shin ),장승준 ( Seung Jun Jang ),서현정 ( Hyunjung Seo ),이종준 ( Jong Joon Lee ),최덕주 ( Duck Joo Choi ),김연수 ( Yun Soo Kim ),김주현 ( J 대한소화기학회 2018 대한소화기학회지 Vol.72 No.2
Simple hepatic cysts are common benign liver lesions that usually have no malignant capability. They are generally asymptomatic and are often found incidentally by abdominal imaging procedures. Treatment becomes necessary, however, when huge hepatic cysts cause symptoms and develop complications, such as hemorrhage, adjacent organ damage, and infection. Several therapeutic options have been performed for symptomatic and huge cysts, including the aspiration of cystic fluid, infusion of various sclerosing agents, and surgical intervention. The optimal management of huge hepatic cysts is controversial and each option has its complications and limitations. This paper reports a case of a 66-year-old woman diagnosed with a simple hepatic cyst 2 years earlier, who was referred to hospital due to abdominal pain. The diagnosis was a huge hepatic cyst with symptoms by abdominal imaging studies. During the follow-up period, the huge cysts resolved spontaneously without treatment. (Korean J Gastroenterol 2018;72:86-89)