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은종렬 ( Jong Ryul Eun ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.3(S)
The prognosis of patients with severe alcoholic hepatitis (AH) remains poor, with a 40% in-hospital mortality rate. Corticosteroids improve the short-term survival of the patients with severe AH. Therefore, it is important to select the subjects who should be treated with corticosteroids. Traditionally, the severity of patients with AH has been assessed using Maddrey`s discriminant function (DF). However, the model for end-stage liver disease, the Glasgow alcoholic hepatitis score and ABIC score have been reported to be superior to predict survival than Maddrey`s DF in patients with AH. More recently, the Lille model has shown to have a high sensitivity and specificity in predicting survival at 6 months in patients with AH treated with corticosteroids who do not improve after 7 days of treatment. This review will cover the characteristics of various prognostic models, and the best approach to evaluate the prognosis of patients with AH.
간동맥항암제주입요법으로 병기하향 후 근치절제를 시행한 진행 간세포암종
은종렬 ( Jong Ryul Eun ),이헌주 ( Heon Ju Lee ),김재운 ( Jae Woon Kim ),장재천 ( Jay Chun Chang ),윤성수 ( Sung Su Yun ),최준혁 ( Joon Hyuk Choi ) 대한간암학회 2011 대한간암학회지 Vol.11 No.1
Cure by single modality for advanced hepatocellular carcinoma (HCC) is difficult. Therefore, multidisciplinary approaches are needed to get a better outcome for advanced HCC. In this paper, we report a case of advanced HCC treated with curative surgical resection after downstaging by hepatic arterial infusion chemotherapy (HAIC). A 50-year-old male patient had a maximum 16.0 cm sized HCC in the right lobe. He achieved a partial response after 2 cycles of HAIC with 5-FU (750 mg/m2) and cisplatin (25 mg/m2). After completion of 6 cycles, he received a curative right hepatectomy and the histopathology revealed 95% of tumor necrosis. He is under follow-up without recurrence at 14 months of surgery. This case suggests that surgery after downstaging by HAIC may provide good clinical outcome in advanced HCC.
간내담관암종의 임상 특징과 외과 절제를 시행하지 않은 환자들의 예후인자
은종렬 ( Jong Ryul Eun ),장병익 ( Byung Ik Jang ),이준영 ( Jun Young Lee ),김경옥 ( Kyung Ok Kim ),이시형 ( Si Hyung Lee ),김태년 ( Tae Nyeun Kim ),이헌주 ( Heon Ju Lee ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.4
Background/Aims: This study was conducted to analyze the prognostic factors in patients with intrahepatic cholangiocarcinoma (ICC) who did not receive surgery. Methods: Between August 1997 and November 2007, the medical records of 175 patients (mean age; 66 years, male/female 126/49), who were diagnosed as ICC, were reviewed retrospectively. Results: Clonorchiasis and hepatolithiasis was found in 14.9%, and 6.3% of all patients, and no risk factors were identified in 77.8% of them. Surgical resection was performed in 29.1% (51 patients), chemotherapy +/- radiotherapy in 12.6% (22 patients), and palliative therapy in 58.3% (102 patients). The proportion of patients with stage I was 23.4% (41 patients). The prognostic factors in patients who did not receive surgery were alkaline phosphatase (ALP) and bilirubin levels by univariate and multivariate analysis. The median survival of patients with normal ALP and bilirubin levels was six months, whereas only one month in patients with elevated ALP and bilirubin levels (p<0.001). Tumor characteristics of patients with elevated bilirubin and ALP levels were infiltrative tumor, bile duct involvement, and very huge tumor. Conclusions: The prognostic factors of ICC in patients who did not receive surgery were ALP and bilirubin levels, but not lymph node metastasis. (Korean J Gastroenterol 2009;54:227-234)
은종렬 ( Jong Ryul Eun ),김태년 ( Tae Nyeun Kim ),최선택 ( Sun Taek Choi ),이정훈 ( Jung Hoon Lee ),장병익 ( Byung Ik Jang ),이헌주 ( Heon Ju Lee ),배영경 ( Young Kyung Bae ) 대한내과학회 2007 대한내과학회지 Vol.72 No.5
담관의 막성구조는 국내에서 10예 미만이 보고되어 있을 정도로 매우 드문 질환이며 특징적인 내시경적 역행성 담관조영술 소견으로 진단할 수 있는데 원인은 다양하나 일부는 선천적인 것으로 다른 일부는 염증에 의한 후천성 원인이 제시되고 있다. 특징적인 우상복부 통증으로 내원한 31세 여자 환자에서 내시경적 역행성 담관조영술로 담관결석이 동반된 총간관 막성구조로 인한 협착이 진단되어 Roux-en-Y 간공장문합술로 치료한 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Biliary web is a very rare disease and it can be diagnosed by its characteristic findings on endoscopic retrograde cholangiogram. The etiology of biliary web is variable. We were able to diagnose a common hepatic duct web in association with choledocholithiasis by performing endoscopic retrograde cholangiogram and operation. A 31-year-old woman visited our emergency room because of colicky right upper abdominal pain she had experienced for several hours. The endoscopic retrograde cholangiogram showed web-like stricture and stone at the common hepatic duct. She was treated by cholecystectomy with Roux-en-Y hepaticojejunostomy. We report here on this rare case along with a review of the literature. (Korean J Med 72:536-539, 2007)
난소의 악성 혼합 뮬러리안 종양의 소장 및 대장 재발 1예
이지은 ( Ji Eun Lee ),손장원 ( Jang Won Sohn ),문희정 ( Hee Jung Moon ),이상훈 ( Sang Hoon Lee ),박윤선 ( Youn Sun Park ),최재원 ( Jae Won Choi ),김국현 ( Kook Hyun Kim ),은종렬 ( Jong Ryul Eun ),장병익 ( Byung Ik Jang ),김태년 ( 대한장연구학회 2006 Intestinal Research Vol.4 No.1
Malignant mixed mullerian tumor (MMMT) is rare tumor of the ovary, representing less than 1% of all ovarian malignancies. MMMT is an uncommon tumor containing epithelial and mesenchymal components. Most of all were heterologous type and 80% occur in postmenopausal women. It is a aggressive and rapidly progressive tumor. MMMT is highly malignant and the prognosis is poor because of frequent metastasis and recurrance. The survival rate is very low in spite of surgery, chemotherapy and radiotherapy. The optimal treatment is still controversial. We experienced one recur case of malignant mixed mullerian tumor of the ovary in intestine and report with brief review of literature. (Intestinal Research 2006;4:53-56)
파열된 후 복강으로 파종된 간세포암종이 위벽으로 침윤되어 일으킨 상부 위장관 출혈
김동희 ( Dong Hee Kim ),은종렬 ( Jong Ryul Eun ),문희정 ( Hee Jung Moon ),오희주 ( Hee Ju Oh ),김용길 ( Yong Kil Kim ),장병익 ( Byung Ik Jang ),김태년 ( Tae Nyeun Kim ),이헌주 ( Heun Ju Lee ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.3
Hepatocellular carcinoma (HCC) rarely invades the gastrointestinal (GI) tract. It occurs in 0.7% to 2% of clinical HCC cases. Moreover, gastric invasion with GI hemorrhage via peritoneal seeding is very rare. We report the case of 67-year-old woman who had a history of HCC rupture and was admitted due to left upper quadrant abdominal pain. The patient was diagnosed with three omental metastatic masses and underwent hepatic segmentectomy and omental tumorectomy. Two months later, the patient had massive melena, and an esophagogas-troduodenoscopy showed very large ulcerated friable mass on the gastric body. The histology was consistent with the diagnosis of metastatic HCC. The patient died from persistent GI hemorrhage 93 days after the admission. This case illustrates the very rare event of peritoneal seeding of a ruptured HCC causing direct invasion of the stomach, followed by GI hemorrhage. (Korean J Gastroenterol 2009;53:194-197)